Allan Cronin

Pain, Death and LSD:

A Retrospective of the Work of Dr. Eric Kast

 

By

Allan J. Cronin, RN, BSN, BA

 

This paper was first published in Psychedelic Monographs and Essays Volume 5 (1990) edited by the late Thomas Lyttle.  It was published under a pseudonym.  The author hopes that it’s reprinting will bring the work of Dr. Kast to a larger audience.

 

 

 

LSD is perhaps best known for its role in the psychedelic subcultures of the 1960’s.  There exists, however, a lesser known but extensive literature reporting investigations of the drug’s medical therapeutic potentials.  This, the first in a series of articles retrospectively examining the work of some all-but-forgotten researcher, will focus on the work of Eric C. Kast, M.D.

 

Born in Vienna, Austria in 1916, he and his family converted to Catholicism in 1935.  They fled to the United States after the Nazi invasion of Austria in 1938.  He completed his M.D. at Loyola University Medical School in Chicago in 1944 having interned at Michael Reese Hospital and completed residencies in both medicine and psychiatry at the University of Chicago Clinics, Permanente Foundation Hospital in Oakland, California and Manteno Hospital in Illinois.  Dr. Kast was a teaching fellow at Tufts Medical College and is a member of Sigma Xi.

 

With staff appointments at Cook County Hospital, Mt.Sinai Hospital Department of Medicine, Michael Reese Hospital, Hektoen Institute for Medical Research as well as Clinical Assistant Professorships in both medicine and psychiatry at Chicago Medical School, Dr. Kast also maintained an outpatient practice at his downtown Chicago office.

 

The earliest publication I was able to find (Kast, 1962) is an attempt to define a method for measuring the elusive concept of pain and responses to analgesics.  He differentiates between “pathologic pain” related to a disease process and “experimental pain” induced by a mechanical apparatus.  The patients in the study controlled the pain inducing apparatus and were instructed to increase the experimental pain to a level that they felt equaled their pathologic pain.  The level of pneumatic pressure required of the device to induce experimental pain was used as an objective indicator of the pathological pain.

 

Various analgesic drugs and a placebo were assessed for the degree to which they produced pain relief.  Objective data are presented on the efficacy of the drugs versus placebo.

 

In this study, which precedes his experiments with LSD, Dr. Kast advances an interesting theoretical idea about pain.  He notes that the subjects’ experience of experimental pain was not affected by analgesics while pathologic pain was relieved.  The explanation he offers is that pathologic pain has both a sensory (physical) aspect and an affective (emotional) aspect while experimental pain (controlled by the subject) has only a sensory aspect.

 

To explain the action of the analgesic drugs he suggests that they induce a “feeling of removal of the self from emotional problems,” allowing the subject to distance themselves from the painful part of the body while maintaining a sense of bodily integrity.  He cites a psychoanalytic article (Ramzy and Wallerstein, 1958) which states that narcotics produce “a feeling of grandeur and spiritual expansion at the expense of bodily feelings and concerns.”  Dr. Kast suggests that this may also apply to other intoxicating agents and non-narcotic analgesics.  Foundational methodology for this work is detailed in two previous articles (Kast and Loesch, 1959 and Kast and Loesch, 1961).

 

The medical model approach to research is evident in Kast’s first report on the use of LSD (Kast and Collins, 1964a) is a comparison of the duration of analgesia produced by  meperidine (Demerol), dihydromorphinone (Dilaudid), and LSD-25 in gravely ill and terminal patients.  Their  conclusion was that LSD-25, while slower in onset, produced greater and longer lasting pain relief than either of the narcotics.  Also noted was the fact that 8 of the 50 patients refused further administration of LSD, 30 patients were indifferent and only 12 patients wished to experience the drug again even though all experienced significant pain relief.

 

Two mechanisms are proposed to explain LSD’s analgesic effect: “…certain obliterations of the ego boundaries (permitting) sequestration of the diseased part…alleviating pain affect” and “…LSD-25 produces an inability to maintain selective attention on a sensation of importance (which) should alleviate both components of the pain experience.”

 

In an article which first appeared in David Solomon’s well-known anthology “LSD: The Consciousness Expanding Drug” (Kast, 1964b) and subsequently revised (Kast, 1967a), a study of single dose administration of LSD 100mcg to 128 “preterminal” cancer patients at Chicago’s Cook County Hospital is described.

 

Four factors are proposed as mechanisms to explain the analgesic potential of LSD:

1.     “(LSD) seems to deprive the patient of his ability to concentrate on one specific sensory input, even if the input is of urgent survival value.”;

2.    “…’minor’ sensations, namely those of less importance for survival, make a claim on the patient’s attention sometimes in preference to those of major survival significance.”;

3.    “(LSD) diminishes cortical control of thought, concepts, or ideas and reduces their significance in control of vegetative function and behavior in general.  The meaning of pain…and its frightful resonance…is greatly alleviated.”; and

4.    “…LSD obliterates the individual ego’s boundaries (and) a geographic separation can more easily be made between the self and the ailing part.”

These same factors are used to support a further elaboration, the theory of “attenuation of anticipation” in which the author suggests that LSD allows the patient to escape the anticipation of pain by making immediate sensory input relatively more important.

 

The results of the study showed a precipitous drop in pain about two to three hours after administration of the 100mcg dose of LSD.  Pain relief lasted an average of 12 hours despite the fact that no other analgesics were given during this period.  And total pain intensity was reported to be less for up to three weeks thereafter.

 

Patients’ general mood was reported to be elevated, “almost euphoric” , for 11 to 12 hours after which their moods returned to baseline.  Curiously, some patients seemed unconcerned about their impending death and they experienced more restful sleep for up to ten days.  But the concerns about their condition and inability to sleep did eventually return.

 

Only 10% of the patients reported hallucinations but 50% reported visual distortions.  Panic reactions were seen in 7 patients (5.5%) and 42 (33%) suffered mild anxiety reactions.  All reactions responded to follow up psychotherapy and, most notably, no medical complications occurred.

 

Another paper which was published in the Chicago Medical School Quarterly (Kast, 1966a) is apparently a discussion of the same clinical trial.  It does not specifically refer to the location of the trial and the fact that the chapter in Solomon’s 1964 book is not cited in the bibliography suggests that this paper is offered specifically to the academic community.

 

In view of Dr. Kast’s principal role as a clinician and the impending constraints resulting in the termination of most LSD research in humans, it is not surprising that he conducted no further work with LSD.  Two papers which appeared in 1966 (Kast and Collins, 1966b; Kast, 1966c) are only slightly different versions of the authors’ research on a new analgesic agent, methotrimeprazine (Levoprome), a non-narcotic analgesic which can still be found in clinical use.  The basic theoretical framework for pain assessment remains intact but there is clearly a shift to more concrete clinical research with substances whose pharmacology is better understood and whose actions are thought to be desirable in these terms. (1)

 

Interest in social and political issues is the dominant theme in the remainder of Kast’s published output, (Kast, 1966d, 1967b, 1972,1973, 1974, 1976).  He published on the subject of LSD again only once (Kast, 1970) integrating social/political concerns in describing the impact of LSD on the concept of death.  While he cites more radical, non-academicians such as Che Guevara and Aldous Huxley, the article remains a sound discussion of the possible benefits of LSD in terminal patients.

 

Dr. Kast’s obituary (Heise, 1988) describes him as, “…deeply Catholic, proudly Jewish and militantly Marxist.”  Until his death from cancer on November 26, 1988 he was active in establishing three free health clinics in Chicago’s poverty stricken neighborhoods.  At one point in 1969 he worked with the radical Black Panthers to establish one of these clinics.

 

In a 1985 article (Kurland, 1985) Kast’s research is prominently cited and describes four cases histories not unlike those described by Kast in which 100mcg of LSD was administered to cancer patients with variable but, at times, positive results.

 

At the time Dr. Kurland, a psychiatrist with the National Institute of Mental Health, was the only person licensed to administer LSD to human subjects in the United States.  His conclusion is that good reasons remain to pursue research with LSD in the terminally ill.

 

 

 

Notes

1.     The pharmacology of LSD and the mechanism(s) of action remain poorly understood. 

 

 

Bibliography

 

Heise, Kenan. (1988, December).  Dr. Eric C. Kast, 72; Ran Free Health Clinic, Chicago Tribune.

 

Kast, E.C. and Loesch, John. (1959). “A Contribution to the Methodology of Clinical Appraisal of Drug Action” Psychosomatic Medicine 21 (3): 228-234

 

Kast, E.C. and Loesch, John (1961). “Influence of the Doctor-Patient Relationship on Drug Action. “Illinois Medical Journal (119): 390-393.

 

Kast, E.C. (1962). “The Measurement of Pain: A New Approach to an Old Problem.” Journal of New Drugs 2: 344-351.

 

Kast, E.C. (1963). “The Analgesic Action of Lysergic Acid Compared with Dihydromorphinone and Meperidine.” Bulletin on Drug Addiction and Narcotics. Vol 27 (Appendix): 3517-3529.

 

Kast, E.C. and Collins, V.J. (1964). “A Study of Lysergic Acid Diethylamide as an Analgesic Agent.” Anesthesia and Analgesia. 43: 285-291

 

Kast, E.C. (1964). “Pain and LSD-25: A Theory of Attenuation of Anticipation.” In D.Solomon (Ed.), LSD: The Consciousness Expanding Drug. (pp. 241-256) New York: G.P. Putnam and Sons.

 

Kast, E.C. (1966a). “LSD and the dying Patient.” Chicago Medical School Quarterly. 26:80-87.

 

Kast, E.C. and Collins, V.J. (1966b). “A Theory of Human Pathologic Pain and Its Measurement: The Analgesic Activity of Methotrimeprazine.” Journal of New Drugs. 6: 142-148.

 

Kast, E.C. (1966c). “An Understanding of Pain and Its Measurement.” Medical Times. 95 (12): 1501-1513.

 

Kast, E.C. (1966d). “The Predicament of the Aged.” Illinois Medical Journal. 129 (2): 132-136.

 

Kast, E.C. (1967a). “Attenuation of Anticipation: A Therapeutic Use of Lysergic Acid Diethylamide.” Psychiatric Quarterly. 41 (4): 646-657.

 

Kast, E.C. (1967b). “A Limited Discussion of the Treatment of Parkinson’s Disease.” Diseases of the Nervous System. 28 (10): 684-685.

 

Kast, E.C. (1970). “A Concept of Death.” In B. Aaronson and H. Osmond (Eds.), Psychedelics: The Uses and Implications of Hallucinogenic Drugs. New York: Anchor Books, Doubleday and Co., Inc.

 

Kast, E.C. (1972). “On Being Old and Dying.” Journal of the American Geriatrics Society. 20 (11): 524-530.

 

Kast, E.C. (1973). Letter: A Sense of Direction. Lancet 2 (820): 105.

 

Kast, E.C. (1974). Letter: Health Care in South Africa. Lancet 1 (847): 95-96.

 

Kast, E.C. (1976). Letter: Treatment of Alcoholism. Journal of the American Medical Association. 236 (12): 1352-1353.

 

Kurland, A. (1985). “LSD in the Supportive Care of the Terminally Ill Patient.” Journal of Psychoactive Drugs. 17 (4): 279-290.

 

Ramzy, I. and Wallerstein, S. (1958). “Pain, Fear and Anxiety: A Study in Their Interrelationships.” Psychoanalytic Study of the Child. 13:147.

 

The author wishes to thank the staff and research facilities of Rush University, the University of Illinois at Chicago, the Chicago Medical School and the Chicago Public Library acknowledging their kind assistance in the preparation of this paper.