THE EFFECT OF LSD ON THE ASSOCIATIVE PROCESSES

JV-lI,TER FVEISTRAUB, N D , ARTHUR B SILVERSTEIN, PII D ' 1 I ~ D 'ER-lI,D D I<I,EE, h1 D L

Altliougl~ lysergic acid clietliylaillicle (LSD! llas been ~vitlely hailed a s a n iinportant esperinlcntal tool in the investigation of tlie so-cailed functional psychoses, tlie psychological nature of the L S D "nloclel ~ ~ s y c h o s i s remains shrouded in mystery. " Different workers hold sharply conflicting \-iem-s concerning its possible relation to endogenous psychotic disorders, and even such crucial problems as the relationship of close to L S D response ancl the influence of the subject's pcrsonality on his reaction to thc dl.ilg ]lax-e received littlc systenlatic attention. An interdisciplinary research teaill a t the Psychiatric Institute of t h e University of hlarylancl has bccn studying sollie of these .important issues. I n il, recent papcr, t ~ v oof tlie authors have atteiilptecl to show to ~x-llat extent the developnient of l ~ a r a n o i dreactions in LSD subjects m a y depend upon certain very specific personality traits, ancl how this knom-ledge can help in predicting which subjects a r e most likely to dcvelop suck1 reactions ( I ) . I t is clear t h a t the typical L S D subject suffers impairment of a number of ego functions. Perceptual distortions are frequent, the ability t o concentrate is affected, there are strange feelings of depersonalization, there liavc been etc. U p t o now, llo~vcvel.~ relatively few a t t e i i ~ p t s to compare systelnatically t h e responses of LSD subjects Lvitli those of normal controls and psychiatric paticnts on psychological tests specifically designed to assess ego functioning. This paper describes a n attempt t o attack
' T h e Psychiatric Institutc, Universitj~of hIaryland School of i\.lecticlne, Baltimore. The aut11oi.s wish t o express their gratitude to Dr. David RapsPort, who, after rcading a prtliminary version of this paper, discussed with us some of the theoretiimplications of our findings.

this probleni by acliliinistering the ~vorclassociation test [?VAT) used by Rapaport, Gill, ancl Scllafer ( 2 ) to 25 L S D subjects and an equal n u i ~ i b e rof controls. I n acldition to coiilparing the responses of these two groups wit11 each other, we shall a t teml.>t to coiilpare tlie results of t h e L S D suhjects tvitli the scliizopllrenic, del~ressive, ancl neurotic patients and the control subjects studied by Rapaport et al., keeping in inind, of course, t h a t the groups were not cquatcd for such critical factors a s age, ses, iind intelligence. Eventually, we hope to collect d a t a on a sufficient nunlber of schizophrenics to make a more rigorous comparison. Before presenting t h e results of t h e esl?criment, a brief description of tlie FVAT is in order. The test consists of two parts: in tlie first part, the subject is instructed t o respond quickly with the first word t h a t coines to his mind after hearing eilc1-1 of 60 stimulus-words. T h e examiner records and tiines the responses. I n tlie second p a r t of t h e tcst, the words are read again and t h e subjcct is asked to give t h e same responses t h a t he gave the first time; all reproduction failures as well a s delayed reaction tiines a r e noted. I n scoring t,he reactions, a n adequate response is consitlered t o hc one n:lTliich is related to the stimulus in a conventional may and n-hich tends to be a t the same conceptual level, e.cJ., table-chair, dog-cut, etc. Pathological responses v a r y from serious ones such as blocking, repetition of t h e stimulus, and clang associations to relatively ininor deviations s u c l ~as the use of proper noLlns, self-references, e.g., doctor-my father, and phrase completions, e.g., Lampshade. I n treating the d a t a , IT-e have followed,

110

7T-EI3-TRhl-B, GILJ-ERSTEIS A S D ICLEE

for purposes of compariso~i, tllc c s a i n l ~ l c of tui~bancesoil t h c second testing, a n d , in orR a p a p o r t et n l . in iii:~kiilg t h e follon-ing der t o invcstigalc tliis effect., :r, separate study was undertaken, i l ~ c i.esults of wliicll distinctions : 1 i Res1)onses t o trauiiiatic vs. tliosc t o Kill dooil be ready for publication. I11 tlie l)i.cscnt stuily, 50 youiig illale adult iiontr~tuillaticstiiiiuli. Of t,lie 60 stimuli, 20 rr arc considered to be "trauinat'ic". Tlicy in- v o l ~ ~ i i t e cn-ere scrccncti, I)y iilcalls of 1)sy1)sycliological tests, , clude sucli n-orde ns b ~ m s t 7irnstlr~bccteant1 cliiatl~jcintervie\\-s i ~ i ~ d ,~,~otlze,-, n-llei.cas Ilic noiltraunliltic stiillnli in order to 1 . ~ out~ s ~ r i o u 1 ) > ~ ~ 1 1 0 1 1 i ~ t I l 1 s consist of 111oi.c~ncuti.:il n-orcls, a s chair, Tile sul)jects wcl.c di~.itlcd a t i~:lndom into tn-o gl,oul>s of ec111a1 size, onc of \vl~iclirescreeil. ant1 f n n t l . 2 I Serious ~ s iiiinol. d e ~ i a t i o i l s ics- cci~.cti2 ganinit- kilo LSD orally. One and . auil~les 1)otli 1i:ive 11eci1g i ~ - e n of a1,ox-(3). u Iialf Iluul,s a f t e r thy drug \\.its given, the 31 Close vs. distant i~caciions.111 older \\'AT I Y ~ L Saclniinistci~ctl. Tllc sr11)jccts in the t o u i ~ t l c ~ ~ s t a n t l disti~lctioil t is necessary sccoilil groui, actctl as c o ~ ~ t r o l s .a c h test tllis i E to o u t l i ~ ~ c coi1cc~l)tion tlie i~ssociativc rcco~,tln.as scoi.etl by t ~ v ojudges ;ind tlie tlie of 1)c.i.ccntwgc~ scol.ing a g r e e l i ~ c ~ ifor of ts process oil'eiwl 114' 1iapal)ort e t ill. T h e y re- ovc~,nll gard tliis lxoccss as Ilaving t\\-o 1)llases: al? t l i c ~3,000 rcsponsch \\.as 91.0 per cant 181.8 aiialytic l~llasc,in wl~icll tile stiiilulus is 1)ci. eelit c~xclutling 1)ol)ul:lr i.e:~ctions, for "l)rokcii t1on.n" illto its sul,jccti\-e co111l)o- \vliicIi tl~c,scoi~iiigib o l ~ j e c t i ~ c ~ ! . nents, ;uid a. s y n t l ~ c t i cphase. in ~\.hiclian accc1)table response is "built ul)" fro111 tlie Poplrlar Keacfiotcs. Tllc "l)ol)ula~ rcactliouglits or iniagcs aroueetl 1,)- tlic stiillution-n-ords" liaicd 11y 1iupal)ort e t (11. are lus. Close reactions ;arc 11clic~-cilo occur I)(.t tliosc gil-en by a t lcilst 10 of tlleir 151 clii~ici~uscof difficulties ill tlle :in:~lytic 1)liiisc. cnl nn(1 control cnscs. Altlio~igliour rccol~cls Tlle associations clo not see111 t o clc.l)n~,t f - inclicatc tlif~ci.ciiccs tlle co~ill)ni.ativc w in ireficicntly fi.oiil t l ~ c stiiiluli ant1 toiitl c>itliei.to cjl~t~ncice ccrtnin nilcc~untc:~ , ~ > l ) o i ~ s e h . of TI-e coinplcte or t o define tlicl btilliullii n.ol.tls. lin~.ca,ncvcrtIlcl(~ss. follon-cci tllc,ir list for T l ~ 11iorc~~:rtllological c i.c:~ctio~is tliie cat('- ~ ) u ~ ' l ~ o s cco1111)arison. iii of s A4rcoi~tliilg 1:apaio gory iiiclililc dcfinitioils, c l a ~ associ:~tions 1)ol.t et (11.. tlic ]ii.ol)o~.tionof ])oln~l;irrei~ and rrpctitioi~s. sl~oilscsd~crc:~sccl ~vitliiiici.(';~si~ig I)P>-CIIO I l i s t a n t rt'i~ctioi?h:[re I ) ~ l i t ~ \ . (to ( l ) (111~' l)atl~ology. Tllcir figllrcs for tllc 1ilca11 ~ 1 ~ to difficulties in tlic syiitlictic pli:isc. Tlic1.c 1)crccnt:rgc of popular rc:~ctionsin tlic varial)l>earst o 1)e lit'tle 01, on connection, con- ous gi,oul)s tcstctl \\-ere: scliizol)lii~c~licsiic d ai cel,tu:illp or ot'licrn-is?, 1)ctn-ccn tlle stimu- d c l v c s , s i ~ - ~43.2 l ~ c rc c ~ l;t nclu.otics, 52.9 s, lus ant1 tlic rcsl~onsc~, tirr~rgi~fer,-zlilln~/e. ctilt and coiiti~ols, e.y.. l)ci GO.0 l)(>r cc.111. I 1 the 1 ]>rcsc.nt study t h C ilit3alls a r c 56.8 ]'el, ccnt and 47.4 l)er ccnt for for tlic control g~,oul) 13c.cnuse int1i.i-icllials 1-ar>- so g w a t l y in tlic L S D eubjccts. Tliie diffc~rcnceis sisnifit h c i ~i~cnctions t o L S D , it is h i g l ~ l y de- cant a t tlic 0.01 lox-el i f = 3.35). Tlie LSD sirable t h a t n , l i e n c ~ c r possible subjects gl,oul~ falls about inicl~vayI~ctn-ecn ]leytlic s l ~ o u l da c t a s their on-11 controle. Tlie cs- cliotic allti nc~urotic groups s t l ~ d i e d Rapsby pcriiiieilt was originally clesigiled in t,liis pori et n l . , hut n-e do ~ i o t t t a c h ~lluclisiga n-a>-, I ~ u tpilot studies iilncle i t clear t h a t l l i f i c a ~ ~ c c this quantitizlive difference. I 1 to 1 there is a mai.l<ed "l~raciice"effect when tlic coilll~aring reactions of the LSD subjccts the TYAT is adilli~listereclt o t h e s a i ~ l csubjcct t o ille c l i ~ ~ i c cases of Ra1,aport et nl., lye al morc t l l a i ~ oace. Subjects tend t o h a ~ inore shall bc particularly conccr~ied~ v i t lqualic ~ popular respoiises a n d fewer association dis- t a t i ~ e diff'erences, since the degree of cl~alige

LSD h 3 D

4bSOCIArIVE

PROCESSEb

T \BLE 1 is ~ ) r o l ) a l ~closelv nbsoc~ated~'i-ltli h e dose lv t ilssocicciion Distn~.banc.es I L Ti~aun/cc.lic d ,vanO a of LSD ndliiinistercd. t ~ . a ~ o ~ n S it c r ~ ~ l ~7 ~ a t / o .Conirol ur~tl Drug t i [ li Trazirilntic ctnd A\'orrt~.nir~untic ,?7tii~~z~li. (lonc1ilion.s (For each gro~ip,1 = 25) V Tlic clntil for total association clisturi~aiices P slion n lligllly significant diffcrcncc bet~vceii Type of Stimulus tlic control nntl LSD gi,oul~s(see Table l j . Tliis overall tliffcrcncc, of course, n-~ls be Traumatic (20 3.3 to \vorcls) (16.4%) (20.8%) esl)cctcci. N o n t r a r ~ m ~ ~ t i1 c4.4 S .1 3 . 7 9 <.001 I t is iiotc~vorthythat altliough the LSD (40 vvorda) (11.1%) ( 2 0 . 2 % ) ~ 3.45 0.86 gl,oul) has a, somen-ixat lligller nuixber of 1 1 ' errors on the trauiiiatic worcls t h a n tlle coil- All S t i m u l i trol group, this cliffercmce is not significant, vr-liclrc>:~::tlic, iiiilfcrcncc I)ct~\-ecn the tn-o TABLE 2 grolips in tlic nulii1)cr of ai~iionnal rcspoiis-.es Reuc,tion 2'i~tle.son 7',.cclc1,lutic,and l\-onli.nrcrrlatic to tlic nontrnuniatic 11-ords is lliglily signifiS t i ~ n f t l iCTnrlcr Control cc.ncl Uriig Condilions (For ercrh yl-olip, IV = 25) cant. Tllc rlatii were cllcclietl to see n-hctlier this rvsult illigllt I>(' due to tlic f : ~ tthat sonic of tlic, nonti,:lu~llatic I - O ~ C ~ S J ) C C O ~ I ~ C T 1i:1(1 "t,r;~r~lli:itic." 1111(10r t l i ~ coiirlitions 01 t l l ~ 'CS- Tralinit~tic( 2 0 3.0" 3.2" 0.70 I nY periilicnt, thus rccbci\-iiig ii rlihlirol)o~tionatc \\-or.ds) 2.93 ' <.01 2.7" 2.3" share ol ~)atllological response?. Tlic statis- Sontl.;l.um:ltir (40 tliat tical annIy,sis slio~.i-t~l tliis WLLSnot tlic words) 1 3.6 2.54 Cast'. < .01 < .05 Ral)al)ort c t n l . folmtl tllnt in both tlieir 1' - 1 1 Stimuli i 2.4" 2.8" 2.50 <0 5 control :mtl c1inic:rl groups tlic perccnt~xge of tlistu1~1)ancc:: wna significantly grclater on TABLI!: 3 thc tr;\~liilatic tllrali on t,lic ~~ontriili~niatic stii~iulusTI-orcls.Our results s1io11- a, ashnrply Seriolts and J I i r ~ o rDerialion.~Vncler Control and Drill, Conditions (For each grotlp, = 286) cont,rasting picture. Thc colitrol group cloes P folio\\- tlic general 1)attern tlcscril~ecl 1)y Type o f Deviation ' ~ 2 : ~ g:: i l ~Ra1):lport ct nl., Ilut tlic diffcrcncc i)ct\\-ccn <.01 3.21 6.2 2.4 t,he 1)erccantagc of tlistul,hanccs on trauii~ntic Serious ns 0.77 6.0 53 anti nontrnu~nntics t i n ~ u l i thc LSD sub- Minor for jects is not significant. Recrction 'rime Dist~trbcinces. Tlic d a t a sllonsc to trnulllatic and nontraulili-ltic stimfor rc~actiont i l i ~ c reveal a significant tliffer- uli whicli is cllaracteristic of the control ence bctwccn the LSD and control groups group. Rapaport et al. iouncl t h a t hot11 their !see Table 2 ) . It is interesting to note tllat clinical and control groups did react differoncc again tile difference between tlie two elltially to trauinatic and nontraumatic groups is clue primarily to t'lieir reactions to stimuli. Serious arid Minor Deviations. It m a y be the nontraumatic, stimuli. T h e difference in the mean reaction tirile on the traumatic of interest to note tliat the tendency t o inake words is not significant; for tlie nontrau- serious deviations is significantly greater in lnatic words, thc difference is significant. the LSL) group t h a n among t h e controls Looking a t the d a t a in another way, the (sec Table 3 ) . On t h e other hand, t h e difLSD subjects show in tlieir reaction times, ference betmeen the two groups in t h e mean as they do in their association disturbances, number of lninor deviations is not signifiWnie tendency t o abolish the differential re- cant. This parallels t h e finding of R a p a p o r t

y<c:zl

A V

412

T\-CISTRAUB,

SILT-ERSTEIX AND KLEE

t o reproduce and lo11g delays of correct reproductions; and minor deviations, which include related false reproductions, corrected false reproductions and partially correct reType of Reaction I g" 1 1 - productions. Tliey found t h a t tlle number 2.1 1 . 7 I 2.95 <.01 of reproduction distu~.bances ivas proporClose 1.2 1.11 2.4 Distant tionate to tlic dcgrce of l ~ s y c l i o p a t l ~ o l o g I =IS and tliat this was especially true for serious tleviatione. TA4l3LE5 Our results fully heal tliis out. Table 5 S e r i o i ~ sa n d N i n o ~ Reprocli~c.lionD i s l u r b a n c e s . I ' n d e r Coiilrol and U ~ . L C(oIn d i l i o ? ~ ~ I (For. s l i o ~ r s t h a t i11 total reproduction disturbeuch g r o u p , :V = 9 5 ) - anccs, tlie LSD group significantly exceeds Type of Control Drug tile control group. However, this difference P hiean Disturbance Mean i is almost entirely in the category of serious 1 <.01 dcviat,ions. I n tlie case of ~ilinordeviations, 9.4 2.97 5.5 Serious ns 1.63 1.5 Minor tlic diff'el,ence ljetwcen the two groups is not 10.0 1 . 3.44 <0 1 A11 Disturbsignificant. ances
~

TABLE 4 Close a n d D i s t a n t Reaclzons 17racler Control a n d D7 ~ r qC u l ~ d z t z o n s ( F o r each g ~ o z c p ,X = 2 5 )

DISCUSSION

and liis associates, t h a t a relativc increase in serious deviations accompaniecl a n i n crease in psychopat,hology. Close (mcl D i s t a n t Reactions. According t o Ral?apol,t et al., tlic incidence of both close and distant reactions was greater in tlieir neurotic and psycliotic groups t h a n in their control group. Ilon-c\-cr, t11c~reportctl a significant difference in tllc relative increase of tlic tn-o types of re:lctions in t h e vai,ious diagnostic categories. T11usa nlarkecl increase in close reactions was characteristic of dcl3ressi1-e patients whereas ecliizoplil~enics tcndcti t o accuiilulatc distant reactions. Seurotics, too, characteristically had a greater incrcasc in distant reactions: altliougli to a lcsser extent tlian t l ~ escliizopllrcnics. Tlie results of t h e present study a r e recorded in T a h l e 4, n;liicli slion-s tliat t h e LSD sulsjects gave a considerably greater number of close rcac,tiolls t h a n t h c controls. Tliis is n o t true of t h e distant react,ions, nrhere tlie nuinber of errors, altllougli greater in tlic LSD group, is not sigllificantlp so. K e p r o d ~ r c t i o nDistztrbnnces. R a p a l ~ o r te t al.. divide reproductioll disturbances into inti\-o groups: serious deviations, ~~-1licl1 clude unrelated false reproductions, failures

T o suiiiinarizc tlie princi1)al findings of tlie s t u d y : As coi~ii~ared n-it11 nonnals, LSD subjects nlalie lllorc errors: liave fewer popular responses aild react niore slo~vly.I n addition, closc reactions predominate, as do serious del-iations and tlie differential reaction to traumatic and i ~ o ~ i t r a u i l ~ a t i ~ stimuli is abolislied. I n comparing tllcsc results with those for t h e clinical groups studicd by Rapaport et al., n-c see tliat thc LSD responses form a patt,ern quite distinct froin t h a t of a n y of tlle endogellous disorders. I n t,n-o nlajor respects: t h e ~,rcpondcranceof closc reactions and tlie abolition of the differential response to trauinatic ancl nontrxuniatic stimuli, tlie LSD suhjccts diffclr Iroiii all the clinical groups. It is true t h a t t h e depressive group of R a l ~ a p o r t and his co-workers also slloived a great increase in close reactions, but tliis was accoii~paniedby a substantial increase in distant reactions. I 1 tliis coi~ncction~ is 1 it iiltcresting to note tallat T%Toodrow and Lon-ell (3) adininistered a word association test to 1,000 children, aged 9-12, a n d found t h a t there was a tendelicy for tlieir subjects to coinpletc or enlarge upon tile idea conw y e d by tlic stimuliie rather than t o give a related, parallel rceponse.

LSD AND ASSOCIATIVE

PROCESSES

413

How can we explain the puzzling tendency of the L S D subjects t o react nondifferentially t o traumatic and nontraumatic stimuli? Tlie crux of the iilatter is t h a t tliey iilake no more errors on traumatic words than do the controls, despite t h e fact t h a t tlie overall responses prove t h a t their associative processes are significantly disturbed. We know froin tlieir reactions t h a t t h e x o r d s a r e heard and understood hy the subjects ancl yet they have no more effect t h a n tlic more neutral stiniuli. We liavc numerous e s a i ~ i ~ ) l c a liow suhjccts untler L S D actuof ally responded more adequately to certain cliargccl wo~cls than. tliey did under nonclrug conditions. One subject, for csainple, gave as a response to the stiniulus word penis tlie association peter under the influence of LSD and a 7nnn's organ under control conditions. as Another volunteer offered se.?-7ic~l a response to intercourse under drug conditions and gave affairs w t (1 zcoman in the control ih part of the esperiment. I n both these illustrations, the control responses are clearly inadequate by t,hc standards of Rapaport e t al., since they a r e multi~vord definitions rather t h a n conceptually equivalent, oneword associations. Under drug conditions the responses are hettcr but in t h e first case, a vulgar word is used, and in the second case, w h a t is probably a inore einotionally charged word is used. There has been a certain amount of speculation concerning the iiiipact of L S D on the "repressive barrier," and certainly one ~ o u l c l c x p e c t h a t any sucli effect would influence the w a y L S D subjects ~voulclreact to charged and noncharged stimuli. Froin t h e ego-psychological point of view, the conventional responses, which are given quiclily a n d automatically, can be viewed as representatives of what EIartman calls t h e conflict-free area of t h e ego. I n normal individuals, the great majority of nontraulnatic stimuli can be lianclled in this autolnatic w a y without serious interference from unconscious influences. Traumatic stimuli are much more likely t o inipinge on con-

flictual areas ancl, therefore, t o elicit slower, more deviant responses. I n tlie case of neurotics and especially psychotic patients, t h e conflict-free area of tlie ego is narrowed, but, nevertlleless, is still coinparable to what we find in norulal subjects. I t is likely t h a t L S D in llallucinogcnic closes succeeds somehow in clissolviiig tile boundaries between tlie a~ltonoinousancl conflictual areas of the we ego. Ok~viously, liave only placed a n observed phenomenon in a convenient frame of reference, without attenipting t o answer tlie question of how this c l ~ a n g ein t h e ego conies about. One final cluestion which merits brief coiiliiient is the prohleii~of dosage in L S D esperiments. As was nientioned above, t h e degree of abnoriliality on a n y test using L S D subjccts will tend to increase with close. I t has even been suggested t h a t t h e LSD reaction changes cjualitatively with increasing dose, and, if this should prove t o be so, the conclusions drawn froin t h e d a t a of this st,ucly nlay have t o he qualified. Up to now, however, no convincing evidence lias been put forward to indicate t h a t altering the dose of L S D will actually change t h e nature of t h e reaction in a n y significant way. Lowering t h e close will bring t h e subject closer t o normality, not t o schizophrenia.
SUMMARY

1. T h e responses of 25 L S D subjects t o tlic word association t'est eillploycd b y Rapaport, Gill a n d Schafer have been compared t o those of a control group a n d t o t h e responses given by groups of schizophrenic, depressive, ancl neurotic patients tested by Rapaport et al. 2. Our analysis s h o ~ v st h a t in t h e associative processes, a t least, t h e L S D reaction does not closely approximate a n y of t h e principal "functional" psychiatric clisorders. 3. Probably tlie most striking w a y in which t h e L S D reaction differs from all other conditions is the abolition of t h e differential response t o traumatic a n d nontrau-

414

WEIKTRAUB, SILVERSTEIN AND KLEE

matic stimuli. We haye attellzl?ted t o place this phenomenoi~n~itliinthe fraiiieworli of ilioderi~ego-psychology theory.
REFERENCES
1. I ~ L E E , D. A N D TVEISTR.IUB, Paranoid reG. mT. actions following lysergic acid diethylamide

(LSD-25). Read at illc Collegiulll Internationale Neuropsycl1opharl11acologir:111n, Rome, Italy, Septenlher 13, 1958. 2. Rapii~owr,D., GILL, M. AXD SCI~AFEII, DiugR. nostic P.vychologicnl Testing, Vol. 2. Year Book Publishers, Chicago, 1946. H. I?. 3. V\:OODRO\\-, . ~ N DI,OTVELL, Children's associatioll frequency tables. Psychol. Monogr. KO. 97, 1916.