I REPORTED to the Instituto at 10:00 P. M. on a February evening, along with a number of other patients. We were given a psychological test called the "Hartman Values Questionnaire. " After this, more patients arrived and we assembled in an adjacent room to get acquainted. Since I cannot speak Spanish I felt somewhat isolated until one of the participants asked me in English to say something about myself. As he translated my remarks for the others I felt more at ease and more a member of the group. Eventually there were about 25 of us.
Between midnight and one o'clock we were led into a room not larger than 30 by 40 feet. About 1,000 square feet had been set aside as a treatment area for the patients. During the next 20 hours no patient was allowed to leave the treatment area except to go to the adjoining bathroom. A space of about 10 by 30 feet allotted to the medical corps and electronic equipment was divided from the treatment area by a table at which Dr. Roquet, his staff and a few observers sat. Their white coats distinguished them from the patients. The walls were covered with bizarre pictures painted by former patients and likenesses of Freud, Gandhi and former Chilean President Salvador Allende. A crucifix hung on one wall.
After a brief period of yoga-type exercises each of us was allowed to select a pallet as a kind of home base for the period of the treatment. The patients lay down and restful music was turned on. Shortly thereafter, the lights were turned down and a series of sound movies were shown. These were scenes of violence, death and crude pornography, apparently designed to shock and disturb the sensibilities of the average patient, although other scenes reflected natural beauty, love, tenderness and the like so that the whole sweep of human passion and experience was represented. In other parts of the room still pictures with similar themes were projected against the walls. As this variety show continued the music gradually rose in volume and cacophony. Patients could watch the scenes or not as they pleased but it was difficult to ignore the assault upon our ears. However, the staff prevented us from falling asleep.
During this time one patient after another was called to the table, weighed and examined by a physician. The doctor checked me over and remarked that my heart was strong enough for the treatment but should not be abused. The altitude of Mexico City had brought back an irregularity which had been under control before I left the United States. This news, accentuated by some of the scenes of the video show, helped turn my thoughts to death and associated problems. The other patients seemed similarly disturbed.
At about four or five o'clock the staff began administering psychedelic drugs or plants, the drug and dosage tailored for each patient. (My watch had been taken from me so my sense of time was disoriented.) My own turn came at what I judged was about six o'clock. I received 250 micrograms of LSD-25. Shortly after all the dosages had been administered the sensory overload reached its peak. The cacophonous music and an alternation of bright lights and total darkness punctuated with strange neon effects created an extremely weird atmosphere.
By this time the room began to resemble a l9th-Century snake pit or even an 18th-Century bedlam. Many of us were weeping, others rolled on the floor and shouted in anguish, others vomited, some stared into space and still others made hostile movements toward the electronic equipment. At times I was afraid some patients might attack Dr. Roquet as he sat impassively directing the stage effects responsible for this violence and disturbance.
I myself became possessed by a confused notion that the persons in white coats were tormentors appointed by the Inquisition to drive me out of my mind. They all seemed so undisturbed by the confusion they were creating that I strode up to the table and violently denounced them for their smugness, an act hardly characteristic in my normal state of mind. With my rapid alternation between concerns about approaching death, the remorse that assails me whenever I experience psychedelics, and distress over many things I had intended to do but had left undone, the whole experience can best be described as a descent into hell. I hardly could distinguish what was outer from what was inner.
Toward the end of this phase of the treatment the music and other sensory stimuli were moderated or turned off and the lights were turned up. Referring to individual records when necessary, Dr. Roquet summoned a number of the patients to the table in succession and questioned them about their problems and experiences while the rest of us listened. Translators interpreted the various languages for the other patients. Some patients were asked to read short passages appropriate to their problems, perhaps something personal of their own or perhaps something chosen by the doctors, often with expressions of poignant anguish. One young woman read a passage from Flaubert's novel Madame Bovary, which drew out a painful identification with the personality of the novel's Emma.
During this phase of the treatment certain subjects received an injection of ketamine hydrochloride, a powerful new psychedelic drug as used by Dr. Roquet. Its effects vary with different persons but often it produces a violent abreaction. One young man who had received an injection was carrying on a conversation when suddenly he dropped to the floor in a violent display of anguish and terror, vomiting and writhing in torment.
At this point two staff members with vomit bags and towels came to his assistance showing infinite gentleness and compassion. This scene struck me as forcefully as had my previous conviction that the staff were persecutors. I realized that the whole ordeal had been manufactured for the patients' benefit and that what had seemed like hell had really been a heaven. This perception called my attention to the positive aspects of the treatment and helped bring me back to normality.
After an hour or so, this phase of the treatment ended, the lights were turned down again, soft music was played and we were invited to rest for several hours. At the end of this time the windows were thrown open, letting in the sunlight. We were not permitted to leave the room but were invited to exercise and express ourselves, by dancing if we wished. By this time I felt intensely tender toward my fellow subjects and grateful toward the staff. Since I could not communicate in their language I found myself expressing my feelings in improvised dance.
After the rest period, the few unprocessed patients received attention. The staff distributed to each patient significant pictures from his fileusually family photographs, pictures of the patient himself at various ages or photos of friends and lovers. These sometimes touched off further emotional scenes. But by late afternoon, some 20 hours after I had reported to the Instituto, everyone had returned to a normal state of consciousness. About this time relatives began to call for the patients and I found great comfort in seeing my wife. At about nine o'clock we had the final ceremony; a rose was presented to each subject. In my three weeks' stay in Mexico City every patient I encountered either as an observer or as a participant had returned to normal consciousness by the close of the treatment.
A FEW days afterwards members of my group reassembled for five-hour-group therapy sessions or for some individuals, private sessions of shorter duration. Each patient composed a written account of his session for his file. These follow-up sessions continued until the staff decided the patient would benefit from another long session, sometimes as soon as a month later, although the time was longer as the patient improved. Improvement was measured by the Hartman test and also by the clinical impressions of the psychiatrists.
Since I was not strictly speaking a patient and since my stay in Mexico was brief, I did not participate in all this follow-up but I did get to participate in a second long session about two weeks after my first one.
I had hoped to take ketamine hydrochloride during my second session but my heart irregularity persisted and the doctors judged that inadvisable. This decision again turned my mind to the theme of death. At my second session there were only 10 patients, a more manageable number and yet sufficient for valuable interaction between patients. Otherwise the procedure was similar to the first time except that now I ingested fresh Psilocybe mushrooms sent for my benefit by Maria Sabina, a curandera from Huautla.
This time I re-experienced the death phenomena but instead of a descent into hell the experience took on almost the character of a festival although against a background of solemnity nurtured by the strains of Brahms' Requiem. I not only attained delightful and moving insights into my own subjective life but I could see humorous aspects associated with my death which brought refreshing laughter. I also realized how the cacophony and sensory overload which was designed to "frighten me out of my wits" has a parallel in society where the perfectly natural occurrence of death is transformed into a fearful event in the average person's mind.
On the whole, this second session was the richest of my 10 to 15 experiences with psychedelic materials. It was the first such experience in which guilt played no conscious part. I don't credit the happy outcome of this "trip" to the mushrooms but rather to the important conditioning of my previous "descent into hell."
The effectiveness of Dr. Roquet's technique is evident in my state of mind since my experiences with him. For nearly two years now my zest for life has been more positive than ever before. My appreciation of music has grown almost to an addiction and other aspects of my life have-been 'similarly enriched. Naturally this has given me subjective insight into what the treatment might accomplish for persons whose mental health is not as well established as my own.
WHAT ARE the implications of Dr. Roquet's exciting technique for the field of mental health? Based on my three weeks of intensive involvement with his program I feel that what the average psychoanalyst accomplishes in five or six years Dr. Roquet often achieves in as many monthsand betterat from a 10th to a 20th the cost! Dr. Roquet has brought psychiatry into the 20th Century. Doubtless someday his methods will be improved but I do not doubt that they will be hailed as a crucial breakthrough in the progress of psychiatry.
In my research with psychedelic drugs I often have found that the "bad trips" are the best trips, especially when handled properly. Dr. Roquet deliberately sets up a bad trip to bring the patient's worst fears and problems to the surface although this may mean, and usually does, a visit to his own private underworld where madness lurks. For this reason Dr. Roquet refers to his technique as "psychodisleptic," meaning "temporarily disruptive of the mind's functions." The specific aim of this technique is to overwhelm the carefully built defenses that often make the patient's neurosis or psychosis invulnerable to a physician. Many conventional psychiatrists might argue that such violent methods may damage the psyche. The successful outcome for nearly 3,000 patients treated at the Instituto obviously best answers such objections.
How important are the drugs in the treatment? Dr. Roquet says the drugs constitute no more than 10 percent of the total treatment. I would agree but also would argue they are a very important 10 percent. The drugs appear to multiply the cogency of the experience and enable it to penetrate the levels of the unconscious seldom uncovered in ordinary psychotherapy.
Among the other important factors in the technique are the interpersonal relationships. The staff's matter-of-factness and lack of alarm assure the patient that Dr. Roquet and his colleagues are completely in control of the situation. More important, their actively compassionate attitude during the final phases of the therapy acts as a vital healing influence. Almost as important is the interaction between the patients themselvesincluding the supportive touching and the awareness that one's own anguish is matched by another's across the room.
Dr. Roquet has developed a thoughtful and perceptive theory that underlies his therapy but this is too complex for presentation here. Doubtless Dr. Roquet eventually will speak for himself in English translation. I believe that in time Dr. Roquet's contribution to psychotherapy will seem equal to that of Sigmund Freud.
ON NOVEMBER 21, 1974, Dr. Salvador Roquet, his assistants and 25 patients were arrested during a group therapy session by Mexican police, who burst into the Institute brandishing pistols and machine guns The raid was instigated by Guido Belasso, director of-the Mexican Center of Drug Independence, according to the Mexican newsmagazine "Tiempo".
The patients were jailed only briefly but Dr Roquet and his assistant Dr Pierre Favreau were imprisoned for several wee s due to the seriousness of the drug charges Dr Roquet had operated his clinic in complete openness for more than six years and had earned the gratitude of government officials for his help in stemming unrest at the Universidad de Mexico by successfully treating a radical student leader.
An organization of Roquet's former patients, led by influential Mexicans, came to Roquet's defense and a number of distinguished American psychiatrists testified to the validity and effectiveness of his methods. Ultimately Drs Roquet and Favreau were cleared of the charges and allowed to reopen the Instituto.