In the novel, lead character and narrator Dylan Steffan (now 34), while attending psychiatry school at Johns Hopkins in 1973, has a series of conversations with JHU Fellow and professor Dr. Stanislav Grof. Grof describes things that go wrong with psychedelics before outlining the psychodynamic dimension of psychedelic experiences. These overlap with some of Dr. Arthur Janov’s Primal Therapy (depth psychology) and with some talk therapy, although they tend to be more experiential than talk therapy.
Baltimore
Fall 1973
I felt bewildered, frustrated, and sad through much of my first year here at Johns Hopkins University. I’ve progressed well enough toward my psychiatry degree but almost none of what I’m learning has anything to do with my mission.
As I start my second year, I find one major exception. I’m about to meet a JHU Fellow and psychiatry professor I’ve been hearing a lot about: Stanislav Grof.
Grof moved to Baltimore from Czechoslovakia about six years ago. I hear he’s got a very interesting new approach to the realms of the mind and psyche, that he accepts the spectrum of human spiritual and transpersonal experiences, that he deals with trauma, and that he’s gotten some amazing results with patients with a wide range of disorders.
Word has made it to Dr. Grof that I engaged in Primal Therapy this summer. When he runs into me in the cafeteria one day Grof skips the small talk.
“Some people are more eager than others to explore the hidden recesses of their mind. The appeal of psychedelic experiences is that they provide unique learning opportunities.”
Is this an invitation? “I tried psilocybin this summer. It went well but I’m not intending to do it again.”
“There is no better way to explore the forces of our personality,” Grof continues. “And there’s no better way to explore the deep dynamic structures underlying clinical symptoms.”
“Well, Doctor Grof, I’m not just interested in the clinical side of psychiatry. I’m interested in helping my clients maximize their spiritual development.”
“Psychedelics are ideal for people who pursue self-exploration with great interest and involvement,” Grof tells me. “People of superior intelligence and strong intellectual interests in art, culture, psychology, philosophy, and religion.”
“That would be me,” I affirm.
“Psychedelics provide opportunities to confront mysteries and riddles – of the universe, of human existence. While transcending the framework of traditional psychology, you can enhance your serious philosophical and spiritual quest.”
I raise my eyebrows. “I’d like to hear more about your view of human personality and of psychodynamic experiences and breakthroughs. I hear great things.”
“Gratifying to know,” Grof concludes. “Feel free to come by my office at your earliest convenience.”
“Now, psychedelics are not a panacea,” Grof starts out when we’re seated across his desk from each other a week later. “People who want to maintain perfect control over their emotions, instincts, and behavior usually approach psychedelics with anxiety and apprehension.”
“Makes sense,” I reply.
As expected, he speaks with a Czech accent. His voice is a lyrical, even musical, baritone.
“But the much more common problem is that psychedelics can intensify personality traits and behavior patterns – including the bad ones – and accentuate current clinical symptoms. Even subtle problems in the personality can become amplified and obvious.”
“Geesh. Like what?”
Grof thinks for a moment. “Feelings and attitudes – positive and negative feelings and attitudes, ambivalent and conflicting feelings and attitudes – toward people and situations. More fear, anxiety, depression, despair, irritability, aggressive tension, impulsivity. People deprived of love when young have an intense need for love during the session. Neurotics feel more useless, cannot see the meaning of their lives, and have even more need to be needed and sought after.”
“What else?”
“Self-image and self-esteem. More feelings of inferiority as they compare themselves unfavorably to other people. Some feel more dread about their physical defects – real or imagined. Some feel more primitive, uneducated, unimaginative, stupid, incapable, or dull – usually without basis in reality. Some feel more worthless, immoral, perverted, or evil – even feel guilt over things that are trivial or that are common to most human beings.”
“Not good,” I say. “That it?”
“More compensatory moves to cover up their feelings of inferiority,” Grof adds. “Some people turn even more boastful or more authoritative or more critical, cynical, or caustic in their comments toward other people. Other people start to chatter, clown, joke, entertain, turn theatrical – looking for attention and affection. Some withdraw from other people. Some become more dominant and manipulative, and others become more submissive and deferential.”
“Not exactly a strong case you’re making here for psychedelics, Doctor Grof.”
“Bear with me, Dylan. These are all superficial elements of personality structure. Soon more powerful elements emerge.”
“Psychodynamic elements.”
“Yes.”
“Which are?”
“Psychodynamic experiences involve biographical material,” Grof explains. “Psychodynamic experiences are memories, problems, unresolved conflicts, and repressed material from one’s life. Especially events, situations, and circumstances from various periods of one’s life that are highly relevant and emotionally charged.”
“People relive these in their psychedelic sessions?”
“Yes. Now, they may have fantasies, dramatized daydreams, and complex mixtures of fantasy and reality. And they may have important unconscious material appear in symbolic disguise, defensive distortion, or metaphorical allusion. But most often they relive – they vividly re-enact – memories from infancy, childhood, or later periods of life. Some of these life events, these memories, are traumatic. Some are pleasant. All are unusually emotional and highly relevant.”
“What if they are emotionally stable individuals with a largely uneventful childhood?” I inquire.
“Not much will come up,” Grof replies.
“And all the rest of us must resolve and integrate this underlying unconscious material?”
“Yes.”
“How many psychedelic sessions does it take?”
“Several. In tougher cases, about twenty sessions.” He stands up. “I’ve got to attend to a matter, Dylan. Let’s meet again soon, at your convenience.”
“Let’s start with the positive,” I suggest in his office a week later.
“Certainly,” he says. “A good womb experience, a good breast and bonding experience, the experience of feeling loved and accepted and appreciated, enjoyable play with one’s peers, security and satisfaction, days with plenty of excitement and adventure – people get in touch with all these kinds of experiences during psychedelic sessions.”
“So how do positive and negative experiences reside in our personality?”
“I call all of them condensed experience systems,” Grof tells me. “COEX systems.”
“Every person’s personality contains COEX systems?”
“Correct. Memory constellations.”
“Okay. How do they work?”
“COEX systems are all the memories and emotions of a particular kind,” Grof says. “Their number, extent, and intensity vary from one person to the next.”
“And COEX systems can be positive or negative?”
“That’s right. Negative COEX systems are unpleasant emotions and memories from unpleasant experiences. Positive COEX systems are pleasant emotions and memories from pleasant experiences.”
“And COEX systems are important,” I surmis
“COEX systems influence one’s perception of oneself, other people, situations, and the world. A person structures one’s attitudes, feelings, thinking, expectations of people, relationships, life experiences, and behaviors around one’s COEX systems – and they even affect one’s bodily processes and health.”
“I’d call that important,” I reply, smiling.
“See you next time, Dylan,” Grof says, as we stand up and head out his office door.
My exams and papers and Dr. Grof’s medical work hold us up a bit, but a couple weeks later I’m sitting across his desk from him again.
I start things off. “So psychedelics can activate a strong negative COEX system?”
“That’s most of the work at the psychodynamic level, yes,” says Grof.
He’s got my curiosity. “How does it start?”
“There’s a disturbance in the flow of images, emotions, ideas, and body sensations. Their consistency and congruence are disrupted. The visual imagery turns chaotic. Something unpleasant is emerging into the patient’s experiential field.”
“Sounds simple,” I reply.
“Not usually,” Grof answers. “There can be anxiety, panic, an aggressive outburst, a wave of depression or tension or nausea. The patient may suddenly feel isolated, alone, intensely disgusted, morally depraved, inferior, self-hating, helpless as a child. The person may shake or twist or go into a stupor.”
“Oh. The therapist is not in control.”
“Not at all. While reliving a memory, the patient’s body often reacts. This is a logical and integral part of the COEX system. But it may not be obvious to the therapist while it’s happening.”
I’m getting even more curious. “What traumas are they reliving?”
“Post-puberty, there are only a few,” Grof replies. “Shocking and repressed sexual trauma. Rape. Seduction by a stepparent or parent. Observation of violent or disgusting sexual scenes.”
“Right.”
“In the later years of childhood, emotional rejection is the most common. Parental preference for other children. Parents, teachers, siblings, and peers comparing the child unfavorably to others, derision, devaluation, humiliation, evoking guilt, excessive criticism. Parents and other adults being unreliable or neglectful, lying, betraying, breaking promises. Scenes that shatter parental authority and produce insecurity. Shocking and frightening events. Cruel treatment resulting in psychological and physical suffering. And even normal sibling rivalry.”
“All those makes sense,” I say.
“In early childhood,” Grof continues, “toilet training or any issues around urinating and defecating. Observing adults engaged in sexual activity. Sexual seduction by adults. Observing the delivery of a human or animal baby. And discovering the anatomical differences between the two genders.”
“Sure.”
“And then there’s the infant. Lack of love from the mother. Lack of warmth, peace, and protection. Emotional deprivation. A bad suckling experience. Bad weaning. Bad teething. Times they fell or were dropped. Times they nearly drowned in the tub or seemed to. Times they felt smothered or threatened by the body of their sleeping mother. Times their respiration was restricted by liquid or an object. Times they were exposed to the cold. Painful medical interventions. Diseases like diphtheria, whooping cough, and pneumonia.”
I’m surprised. “People relive all this stuff on psychedelics?”
“Yes,” Grof answers. “And reliving these events dramatically improves their clinical condition.”
“They regress to the age of the trauma?”
“Yes.”
“Good heavens,” I say. “Very impressive.”
“Let’s continue soon,” Grof says.
A week later I start our conversation with a question. “How do the reliving of traumatic memories relate to the COEX systems?”
“Memories and feelings of all the humiliating situations that damaged one’s self-esteem seem to go into one COEX system,” Grof explains. “Emotional deprivation and rejection memories and feelings go into another COEX system. Guilt and moral failure into another. Claustrophobic and suffocating memories and feelings into another – from oppressive and restricting situations when you can’t fight back or defend yourself or escape. Anxiety from shocking and frightening events go into another. Memories and feelings of the dangerous or disgusting aspects of sex go into another. Aggression and violence seem to go into yet another. And situations endangering the survival, health, and integrity of one’s body go into yet another.”
“That’s seven. There are seven COEX systems?”
“It’s still early in my research,” Grof says. “I’m not sure how many COEX systems there are.”
“So what’s the mechanism for a COEX system to move from unconscious to conscious?”
“At the time that they happen, traumas are recorded in the memory with associated feelings. As the patient relives each negative psychodynamic episode, he or she understands the psychopathological symptom even as it disappears. There is a logical structure to the unconscious material and thus to one’s irrational thoughts and behavior – one’s symptoms. This is all clarified as the patient reexperiences events during the psychedelic session.”
“How do you know when you’re done?”
“The patient almost always works his or her way back to the oldest experience, the original experience – the primary trauma that forged the pattern,” Grof says. “This is the nucleus of the COEX constellation – the core around which the COEX formed and built. Negative life experiences, especially traumatic events, related to that core experience keep going into the COEX system, until we intervene in the process.”
“So the core COEX experience is followed by many situations of a similar kind?”
“Usually. Including accidental situations and self-inflicted situations.”
“And this negative COEX system just keeps getting activated and reinforced?”
“Pretty much. And unconscious, unresolved negative COEX systems harm relationships.”
“Seems solid,” I say, “seems true.”
“Let’s meet one more time, Dylan,” he says as we head out into the hall.
“Where were we?” Grof asks when we sit down together a week later.
“So positive COEX systems help relationships?” I ask.
“Absolutely,” says Grof.
“Before we talk more about a positive outcome, what else can go wrong?”
“If the negative COEX system – and all that unconscious material – is not fully relived and resolved, a person can stay under its influence for an indefinite period of time.”
“Good grief.”
“Frankly,” Grof warns, “clinical symptoms can be intensified. Also, there can emerge a new negative COEX system. With new symptoms.”
“How?”
“The COEX system was lying there, latent, in the dynamic structure of the personality. Once one negative COEX system is moved out, another one is activated and emerges to the forefront.”
“Well, this is no cakewalk,” I say. “When it works how does it work?”
“The patient relives the negative experiences – including the original trauma – and reliving them resolves them,” Grof tells me. “The COEX system loses its governing function permanently. The problems never reappear.”
“It works often, then.”
“Yes. Psychodynamic sessions are a process of unfolding, reliving, and integrating negative COEX systems and opening the pathways to living your life influenced by positive COEX systems. There is striking clinical improvement as the positive COEX system comes to dominate the patient’s experiential field.”
I look him in the eye. “You have had many positive outcomes.”
“Hundreds,” Grof replies. “I’ve seen people’s perception of themselves and their world transformed. More positive views. Trusting people, seeing them as predominantly good and friendly. Feeling safe, comfortable, peaceful. Appreciating paintings and nature. More open, more sincere. Able to engage in reciprocally open and sincere interactions with other people. Transformed relationships. Even their bodies are tension-free.”
I smile. We both know I’m going to have another psilocybin experience.