THIS case illustrates how psychotomimetics such as mescaline and LSD can initiate and facilitate a breakdown of personality integration that may outlast the drugged state, and how the psychotomimetic state may permit an individual who might not have otherwise done so to take his own life. There is no direct report in the literature of successful suicide during the psychotomimetic syndrome. There are a number of cases in which the previous use of LSD may have been involved in successful and unsuccessful attempts at suicide( 1).
Case Report
Mr. A., a 20-year-old college undergraduate, completely disrobed and jumped from a window to his death while under the influence of self-administered LSD.
He had been interviewed and tested psychologically in a psychiatric clinic six months prior to his death. He complained of symptoms of anxiety and of difficulty in studying and was adjudged to be mildly or moderately disturbed, but there was no evidences of several psychopathology in the interview records or in the test protocols. He declined further psychiatric contact; the remainder of the story comes from his acquaintances and from academic records.
Mr. A. had been going with a girl some months prior to his death but the relation had been discontinued. He was on friendly terms with a number of women but did not have a "girl friend" in the usual sense; he was not overtly homosexual. He became increasingly involved in a student, once-student, and nonstudent group that used marijuana, amphetamine, peyote, and LSD freely and he used the latter two drugs regularly. The group of which he was a member engaged at times in a combination of self and mutual analysis while under the influence of LSD or mescaline during which, carried along by each other and the drugs, they became conscious or over-conscious of homosexual tendencies, and/or inhibition of sexuality. For most, the latter took the form of a conviction that they were asexual or that their sexuality was spurious.
Members of the group eventually could enter into this type of thought without the drugs and tended to do so with each other. This process was interesting to all and disturbing to most; Mr. A. was more fascinated than most by this activity and pursued it even when it made others uncomfortable. These recognitions, or pseudorecognitions, of usually unconscious feelings were accompanied by ideas, often recognized as just ideas, that many cues in the environment meant that others had similar feelings, etc. This ideation was present in many in the nondrugged state; the degree of reality-testing fluctuated and there are evidences that at least one member of the group other than Mr. A. eventually had periods in which reality testing was impaired.
Mr. A. continued as an integral member of the group but was not particularly close to any member. His class attendance became more irregular and his academic performance deteriorated, but his work continued to be of passing quality. An examination paper he wrote a few days prior to death was mediocre in content and execution but not disorganized. A few days prior to his death he discussed plans for the immediate and distant future with friends.
He took LSD in the company of others, was observed to pace in and out of the room in which the others were, and, without explanation, while by himself, disrobed and took his life.
Comment
Personal as well as drug factors are involved when an individual takes his life while in a state of drug intoxication: not many people kill themselves while under the influence of LSD. Mr. A.'s history gives evidences of the development of withdrawal, a subtle type of social isolation, preoccupation with usually unconscious processes, and paranoid tendencies, all of which are consistent with serious psychopathology. These evidences, however, are suggestive rather than definitive. Mr. A. remained in school and acknowledged a future.
Mescaline and LSD may be involved in Mr. A.'s death in two ways. The first involvement is in terms of whether the breakdown in repression and changes in personality integration were induced or facilitated by LSD. Such breakdown does occur without pharmacological assistance, but in Mr. A.'s case the process definitely was initiated during a drug session and facilitated by the use of these drugs.
The second involvement of LSD is in terms of Mr. A.'s mental state immediately prior to taking his life. Although there may have been strong tendencies to self-destruction, these were held in check in the nondrugged state; he stayed in school and spoke of the future. His disrobing prior to taking his life indicates that major disintegration of psychological controls was present and that bizarre constellations could determine behavior. The circumstances strongly suggest that he would not have died at the time he did if he were not in a state of LSD intoxication.
REFERENCE
Case Report
Mr. A., a 20-year-old college undergraduate, completely disrobed and jumped from a window to his death while under the influence of self-administered LSD.
He had been interviewed and tested psychologically in a psychiatric clinic six months prior to his death. He complained of symptoms of anxiety and of difficulty in studying and was adjudged to be mildly or moderately disturbed, but there was no evidences of several psychopathology in the interview records or in the test protocols. He declined further psychiatric contact; the remainder of the story comes from his acquaintances and from academic records.
Mr. A. had been going with a girl some months prior to his death but the relation had been discontinued. He was on friendly terms with a number of women but did not have a "girl friend" in the usual sense; he was not overtly homosexual. He became increasingly involved in a student, once-student, and nonstudent group that used marijuana, amphetamine, peyote, and LSD freely and he used the latter two drugs regularly. The group of which he was a member engaged at times in a combination of self and mutual analysis while under the influence of LSD or mescaline during which, carried along by each other and the drugs, they became conscious or over-conscious of homosexual tendencies, and/or inhibition of sexuality. For most, the latter took the form of a conviction that they were asexual or that their sexuality was spurious.
Members of the group eventually could enter into this type of thought without the drugs and tended to do so with each other. This process was interesting to all and disturbing to most; Mr. A. was more fascinated than most by this activity and pursued it even when it made others uncomfortable. These recognitions, or pseudorecognitions, of usually unconscious feelings were accompanied by ideas, often recognized as just ideas, that many cues in the environment meant that others had similar feelings, etc. This ideation was present in many in the nondrugged state; the degree of reality-testing fluctuated and there are evidences that at least one member of the group other than Mr. A. eventually had periods in which reality testing was impaired.
Mr. A. continued as an integral member of the group but was not particularly close to any member. His class attendance became more irregular and his academic performance deteriorated, but his work continued to be of passing quality. An examination paper he wrote a few days prior to death was mediocre in content and execution but not disorganized. A few days prior to his death he discussed plans for the immediate and distant future with friends.
He took LSD in the company of others, was observed to pace in and out of the room in which the others were, and, without explanation, while by himself, disrobed and took his life.
Comment
Personal as well as drug factors are involved when an individual takes his life while in a state of drug intoxication: not many people kill themselves while under the influence of LSD. Mr. A.'s history gives evidences of the development of withdrawal, a subtle type of social isolation, preoccupation with usually unconscious processes, and paranoid tendencies, all of which are consistent with serious psychopathology. These evidences, however, are suggestive rather than definitive. Mr. A. remained in school and acknowledged a future.
Mescaline and LSD may be involved in Mr. A.'s death in two ways. The first involvement is in terms of whether the breakdown in repression and changes in personality integration were induced or facilitated by LSD. Such breakdown does occur without pharmacological assistance, but in Mr. A.'s case the process definitely was initiated during a drug session and facilitated by the use of these drugs.
The second involvement of LSD is in terms of Mr. A.'s mental state immediately prior to taking his life. Although there may have been strong tendencies to self-destruction, these were held in check in the nondrugged state; he stayed in school and spoke of the future. His disrobing prior to taking his life indicates that major disintegration of psychological controls was present and that bizarre constellations could determine behavior. The circumstances strongly suggest that he would not have died at the time he did if he were not in a state of LSD intoxication.
REFERENCE
- Cohen, S.: Lysergic Acid: Side Effects and Complications, J. Nerv. Ment. Dis. 130:30-39, 1960