L’émergence des psychothérapies assistées au LSD (1950-1970)
Résumé
In the early 1950s, a new psychotropic substance appeared in the field of psychiatry, LSD-25. As one of the most studied drugs of the 1950-1970 period, LSD was used in a wide variety of indications. In particular, its effects were quickly considered therapeutic when taken in conjunction with psychotherapy. It was also used to train health care personnel: therapists were recommended to self-experiment with the substance in order to develop empathy towards subjects under the influence of psychedelics, but also towards their psychotic patients in general. LSD was indeed classified as a “psychotomimetic”, i.e. a drug that mimics psychosis. Thus, temporarily experiencing an artificial psychosis was intended to allow caregivers to better manage their patients. These practices led to the development of new concepts to improve LSD-assisted psychotherapy, known as set and setting. From then on, the relationship between therapists and patients was more horizontal: the former had to make sure to create a therapeutic alliance, a secure and reassuring environment for the latter. Two models of psychotherapy were also developed: psycholytic therapy and psychedelic therapy. The first was based on a large number of sessions with increasing, but still medium, doses. The idea was that the patient would gradually discover the effects of the substance, releasing the defense mechanisms in order to accelerate the psychotherapeutic process. This therapeutic model was particularly used in Europe, where many therapists developed it. Psychedelic therapy, on the other hand, involved giving high doses of LSD in order to create a deep and transformative experience in one to three sessions, generating new behaviors. These new kinds of psychotherapies were carried out both in hospitals, in services specially built to implement them and in private psychiatry. This article will present the emergence of this therapeutic model with its different currents, the actors involved in this research at the international level and the problems raised by these new methods which break with traditional practices. It will also indicate the methodological differences between the French practices and the proposals related to set and setting which were elaborated by English, German, Canadian or American therapists.
Au début des années 1950, une nouvelle substance psychotrope apparaît dans le champ de la psychiatrie, le LSD-25. Faisant partie des médicaments les plus étudiés de la période 1950-1970, le LSD est employé dans une grande variété d’indications. Ses effets sont notamment rapidement considérés comme thérapeutiques lorsque sa prise est associée à une psychothérapie. Des thérapeutes élaborent alors de nouveaux concepts visant à améliorer la prise en charge des sujets sous l’influence de LSD, rassemblés sous l’expression de set and setting. Désormais, la relation entre les thérapeutes et les patients se fait plus horizontale : les premiers doivent s’assurer de créer une alliance thérapeutique, un environnement sécurisant et rassurant pour les seconds. Deux modèles de psychothérapie sont également développés : la thérapie psycholytique et la thérapie psychédélique. Ces psychothérapies d’un nouveau genre sont réalisées à la fois à l’hôpital, dans des services spécialement construits pour les mettre en place et en psychiatrie libérale. Cet article vise à présenter l’émergence de ce modèle thérapeutique avec ses différents courants, les acteurs investis dans cette recherche au niveau international et les problématiques soulevées par ces nouvelles méthodes en rupture avec les pratiques traditionnelles.
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