One of the most important questions about cannabis is the consequences, if any, of prolonged use. Since conclusive experiments in humans have not yet been performed, we must rely on clinical evidence or on objective examination of subjective experiences recorded in the literature. One of the best reports extant, because of its scope and keen observation and because it relates the subjective effects of cannabis to chronic use and psychological dependence, was given 114 years ago by the young American Fitz Hugh Ludlow (1857) in the autobiography The Hasheesh Eater. The present paper examines Ludlow's experiences and their relevance to current knowledge and interests about cannabis.
Ludlow was an intelligent, sensitive and imaginative youth of 16 when he discovered cannabis in the local drug store where he had already experimented with ether, chloroform. opium and "....the whole gamut of queer agents within my reach" (p.17). But cannabis exerted a special fascination and so he used it intensely for the next three or four years. He wrote The Hasheesh Eater as part of a withdrawal program and published It anonymously when he was 21 years old.
Ludlow made several trials with Cannabis indica extract, ingesting increasing doses of it, but experienced no effects. Finally he took 30 grains, and three hours later suddenly realized he was under the influence of hashish:
"My first emotion was one of uncontrollable terror - a sense of getting something which I had not bargained for" (p.20).
The reaction lasted several hours and consisted of a sequence of well structured hallucinations, mostly visual and auditory. This was perceived as a strange awesome subjective state which, however, he was able to conceal from others. He became acutely aware of his heart beat and of every detail of his circulation. This caused increasing anxiety, until he thought death was imminent:
"I gave myself up for lost, since judgment, which still sat unimpaired above my perverted senses, argued that congestion must take place in a few moments, and close the drama with my death" (p.27).
Episodes of panic are common complications of the use of hallucinogens, especially by novices. Becker (1967) has suggested they may be related to uncertainty and anxiety about the drug effects when the setting does not provide reassurance and guidance.
After being reassured by a physician, Ludlow went to bed and then experienced the ecstatic part of the reaction:
"I am borne aloft upon the glory of sound. I neat in a trance among the burning choir of the seraphim" (p.36).
When he awoke he was glad to realize this was not another hallucination:
"it was like returning from an eternity spent in loneliness among the palaces of strangers" (p.43).
He also noted distortion of perception, a sense of splitting of the self. repeated interruption of the abnormal state by periods of lucidity, and a lack of hangover. With respect to time and space he says:
"Now...l experienced that vast change which hasheesh makes in all measurements of time. The first word of the reply [to a question he had been asked] occupied a period sufficient for the action of a drama.... And now, with time, space expanded also... the whole atmosphere seemed ductile, and spun endlessly out into great spaces surrounding me on every side" (p.22).
These feelings, which were interpreted mystically as the achievement of eternity and immortality, became an important factor in his strong fascination with the drug. The sense of duality of the self, and the emergence of periods of lucidity, are eloquently expressed:
"One portion of me was whirled unresistingly along the track of this tremendous experience, the other sat looking down from a height upon its double, observing, reasoning, and serenely weighing all the phenomena"(p.23).
"Ever and anon I returned from my dreams into consciousness." (p.24).
In addition to over a dozen subjective experiences, Ludlow gives an objective description of four selected cannabis reactions in friends upon whom he experimented. From them a composite picture of the effects of cannabis emerges. The only physical features noted consistently are thirst and freedom from hangover symptoms. He considered the intense thirst and other physical sensations to be due at least partly to enhanced perception:
"Hasheesh... magnifies the smallest sensation till it occupies immense boundaries. The hasheesh-eater who drinks during his highest state of exaltation almost invariably supposes that he is swallowing interminable floods, and imagines his throat an abyss which is becoming gorged by the sea" (p.73).
He referred to the related phenomenon of synesthesia as "the interchange of senses."
"Thus the hasheesh eater knows what it is to be burned by salt fire, to smell colors, to see sounds, and, much more frequently, to see feelings" (p.149).
The quantitative and qualitative alterations of perception are undoubtedly linked to the other psychological phenomena of the reaction and to the influence of emotional set and setting on them. Ludlow was aware of the significance of the latter. "Light," he says, "is a necessity to him, even when sleeping; it must tinge his visions, or they assume a hue as sombre as the banks of Styx" (p.67). He also found that the presence of a sympathetic: friend "prevented any undercurrent of horror from breaking up through my delightful tides of vision" (p.203).
Enhanced suggestion, auto-suggestion and empathy all influenced the quality of the experience:
"it is possible for a man of imaginative mind, by mere suggestions of rich veins of thought, to lead a companion in the hasheesh state through visions of incomparable delight" (p.55).
Through autosuggestion he could direct his visions almost at will by concentrating on a particular subject before ingesting cannabis. He describes an instance of empathy in which he shared the experiences of an intoxicated friend when he himself was undrugged, and vice versa. He notes, however, that at the height of the reaction the subject becomes refractory to suggestion.
These phenomena relate to the manner in which the personality integrates the experience. Ludlow also described depersonalization, manifested as grotesque body distortions, dissociation of body and mind, and assumption of a multiple personality. In one instance, forgotten childhood memories were recalled. Ludlow realized the relation between some of these phenomena and those seen in psychotic states:
"The hasheesh state, in its intensest forms, is generally one of the wildest insanity. By this I do not mean to say that the hasheesh-eater... necessarily loses his self control, or wanders among the incoherent dreams of a lawless fancy, for neither of these propositions is true" (p.164).
The beginner, he noted, finds it almost impossible to control his behavior under the influence of the drug, but this becomes gradually feasible and eventually a habit.
At the cognitive level he observed speeding-up of thought processes and the subjective sense of great intellectual ability, "be its result true or false" (p.167).
He also gives an interesting example of the apparent influence of cannabis on objective musical performance. A friend, while intoxicated, mimicked the sound of a bugle and "played in my hearing a strain of his own impromptu composition so beautiful that it would have done credit to any player upon wind instruments that ever obtained celebrity" (p.117).
The affect attached to Ludlow's fantasies ranged from marked euphoria to intense anxiety. Occasionally the euphoria was related simply to humorous situations, and it is evident that he understood the discrepancy between his subjective state and objective reality:
"Every gesture of the figures that passed before me told me more of raillery than tongue could utter... not the faintest stroke of humor in look or manner escaped me, and I no doubt often committed that most gross error in any man, laughing when my neighbors saw fit not to be moved" (p.169).
More frequently the euphoria was related to intensely pleasurable esthetic experiences and to feelings of omnipotence and omniscience:
"My powers became superhuman; my knowledge covered the universe; my scope of sight was infinite" (p.96). "All strange things in mind, which had before been my perplexity, were explained - all vexed questions solved. The springs of suffering and of joy, the action of the human will, memory, every complex fact of being, stood forth before me in a clarity of revealing which would have been the sublimity of happiness" (p. 138).
Omnipotence was consistently expressed as a state of mystical identification with God which gradually gave rise to conflict. In one instance he both destroyed and rcsuscitated Him. This was accompanied by strong feelings of guilt and by punishnlent, retlected in the increasing frequency and intensity of terrifying episodes and progressive loss of pleasure:
"At length the reasons of my punirhment were shown me... I was told, `Thou hast lifted thyself above humanity to peer into the speechless secrets before thy time; and thou shalt be smitten - smitten - smitten'" (p.189).
The anxiety is often expressed as self-annihilation or death fantasies:
"I felt myself weeping, and ran to a looking-glass to observe the appearance of my eyes. They were pouring forth streams of blood! And now a sudden hemorrhage took place within me; my heart had dissolved, and from my lips the blood was breaking also" (p.134).
Ludlow interpreted the hashish reaction in terms similar to those employed by contemporary advocates of the use of psychedelic drugs. The drug, he felt, revealed unknown areas of the mind which were often disclosed in symbolic fashion, and allowed for otherwise inaccessible insights:
"in the hasheesh-eater a virtual change of worlds has taken place.... Truth has no become expanded, but his vision has grown telescopic.... To his neighbor in the natural state he turns to give expression to his visions, but finds that to him the symbols which convey the apocalypse to his own mind are meaningless, because, in our ordinary life, the thoughts which they convey have no existence; their two planes are utterly different" (p. 148).
Ludlow, however, eventually reached the conclusion that the use of drugs was the wrong pathway to these discoveries:
"...the soul at last pays a most bitter price for all its ecstasies; moreover, the use of (cannabis) is not the proper means of gaining any insight" (p.91).
He believed that involvement in social causes, and esthetic appreciation of nature and art, satisfied the same needs in a healthier way, and felt that destruction of the natural environment increased man's need for drugs.
A very significant factor contributing to Ludlow's ultimate attitude was his eventual loss of control over the use of hashish. This question will be considered after a brief description of some relevant pharmacological points.
Ludlow consistently talked of "hasheesh," but in fact he took the solid extract of Cannabis indica which was roughly twice as potent as the crude resin and ten times as potent as marijuana. A rough calculation shows that his intake was equivalent to about 6 or 7 marijuana cigarettes per dose, i.e., at the hallucinatory rather than at the euphoriant level prevalent ino contemporary North Amencan use. Medical literature of the 19th century contains many case reports of hallucinatory reactions after much smaller doses. A few representative cases are' those described by Beckler (1886), Gardner (1852), Kelly (1883), Kuykendall (1875), Minter (1896), and Ruelle (1897). Moreover, smoking cannabis may differ from ingestion of the whole extract with respect to both the quality and quantity of the active principles absorbed (Joachimoglu, 1965). Effects begin almost immediately after smoking but are delayed one hour or more following ingestion. Lastly, oral intake does not allow for the fine graduation of intake possible by smoking, so that the chances of overdosage are far greater. All these factors, but particularly the habitual intake of high doses of a very potent preparation, must be kept in mind in assessing Ludlow's acute reactions and the strength of his eventual dependence.
Ludlow observed that the intensity of effect depended on the dose. He stated, however, that there was no need to increase the dose on continued use. Indeed, initially the reverse was true:
"Unlike all other stimuli with which I am acquainted, hasheesh, instead of requiring to be increased in quantity as existence in its use proceeds, demands rather a diminution, seeming to leave, at the return of the natural state... an unconsumed capital of exaltation for the next indulgence to set up business upon" (p.104).
The nature of this well recognized phenomenon, recently referred to as "reverse tolerance" (Well et al., 1968), is unclear. There are several possible interpretations. Repeated use of cannabis might lead to a reduction of emotional inhibitions and facilitation of conscious recognition of the subjective effects (Becker, 1958). Alternatively, there might be "pharmacological sensitization" to the drug (Weil et al., 1968). This term might include an unexplained enhancement of sensitivity of the receptors as a result of the first dose, saturation of inactive binding sites in plasma and elsewhere, or induced increase in metabolic conversion of tetrahydrocannabinol to more active substances (Mechoulam, 1970). Finally, in smoking cannabis, the inexperienced user might not inhale deeply enough and therefore absorb only part of the dose. The fact that Ludlow observed the same phenomenon after ingestion makes this explanation less likely.
He also emphasized a related but not generally recognized phenomenon, i.e., if a second dose of the extract, no matter how small, was taken before the effects of the first had completely subsided, the reaction was extremely intense and unpleasurable.
Persistence and recurrence of effects in the undrugged state were also described:
"Returning to consciousness, he did not, however, recover from the more moderate hasheesh effects for months. The nervous thrills... reappeared to him at intervals, and his dreams constantly wore a hasheesh tint" (p.122).
This resembles recent descriptions of spontaneous recurrence of acute effects of cannabis (Keeler et al., 1968) and LSD (Smart and Bateman, 1967). Ludlow provided some evidence for a psychological rather than a pharmacological explanation in his statement that, after months of complete withdrawal:
"...Even in perfect consciousness, I believed I was still dreaming, and to this day I have so little lost the memory of that one demoniac toll, that, while writing these lines. I have put my hand to my forehead, hearing and feeling something, through the mere imagination, which was an echo of the original pang" (p.201).
A potentially significant observation was that normal dreaming disappeared during chronic use of the drug:
"...although, previously to acquiring the habit, I never slept without some dream more or less vivid, during the whole progress of the hasheesh life my rest was absolutely dreamless. The visions of the drug entirely supplanted those of nature" (p.242).
Edes (1893) and Stockings (1947) have reported similar effects. Klüver (1966) has described the same phenomenon with mescaline, but it has received very little attention in the cannabis literature.
Ludlow was also well aware of the intra- and inter-individual variability of effects. About the former he said:
"At two different times, when body and mind are apparently in precisely analogous states, when all circumstances, exterior and interior, do not differ tangibly in the smallest respect, the same dose of the same preparations of hasheesh will frequently produce diametrically opposite effects. Still further, I have taken at one time a pill of thirty grains, which hardly gave a perceptible phenomenon, and at another, when my dose had been but half that quantity, I have suffered the agonies of a martyr, or rejoiced in a perfect phrensy" (p.66).
Many writers who have commented on the marked variability of cannabis effects have failed to distinguish between the highly variable specific content and affective character of the experience, and the relatively constant basic processes of perceptual modification. In the quotation above, Ludlow was differentiating clearly between intensity and affective character of the effect. He also recognized that subjects with different temperaments tended to react differently:
"...upon persons of the highest nervous and sanguine temperanlents hasheesh has tile strongest effect; on those of the bilious occasionally almost as powerful a one; while lymphatic constitutions are scarcely influenced at all except in some physical manner, such as vertigo, nausea, coma, or muscular rigidity" (p.123).
Ludlow's account contains most of the elements that characterize the contemporary notion of cannabis dependence (Eddy et al., 1965). His initial motive was a general curiosity about psychoactive drugs very similar to the attitude of some contemporary users. It is significant, however, that he found the cannabis "high" far more attractive than those of ether, chloroform, or opium. It was the very quality of his reaction - not sensual but "of the most exalted ideal nature" that led him to subsequent experiments. At the same time it satisfied his passive tendencies:
"I had now a way of gratifying it [his passion tor travelling] I which comported both with indolence and economy.... For the humble sum of six cents I might purchase an excursion ticket over all the earth" (p.64).
This vicarious satisfaction was gradually reinforced to the point that it eventually replaced "...all other excitement" (p.101).
His major rationalization for repeating the experience many times was the idea that he was conducting research:
"Moreover, through many ecstasies and many pains, I still supposed that I was only making experiments" (P. 101).
Nevertheless, he realized that the habit was becoming increasingly difficult to control:
"At what precise time in my experience I began to doubt the drug being, with me, so much a mere experiment as a fascinating indulgence, I do not now recollect. It may be that the fact of its ascendancy gradually dawned upon me; but at any rate, whenever the suspicion became definite, I dismissed it by so varying the manner of the enjoyment as to persuade myself that it was experimental still" (p.153).
He went on "experimenting" until he was in a state of almost continuous intoxication, noting that on continued use "the effect of every successive indulgence grows more perduring until the hitherto isolated experiences become tangent to each other" (p98).
The compulsive need for cannabis and the increasingly terrifying experiences made Ludlow decide to give the drug up altogether. Various attempts at gradual or complete withdrawal were unsuccessful. For several weeks he mangaged on about half his usual dose, and experienced milder effects:
"I sat in solitude, with closed eyes, enjoying the tranquil procession of images, especially those of scenery, which I could dispel at will, since they did not reach the reality of hallucination" (p.220).
But maintaining this regimen was difficult:
"The utmost that could be done was to keep the bolus from exceeding fifteen grains. From ten and five, which at times I tried, there was an insensible sliding back to the larger allowance, and even there my mind rebelled at the restriction" (p.227).
In these circumstances Ludlow got help and encouragement from the author of an article in Putnam's Magazine who claimed to have successfully broken the cannabis habit. To make the definitive break, he accepted a position as school teacher in a town where cannabis was not available. Complete withdrawal was characterized by intense craving for cannabis, spontaneous recurrence of the nightmarish features of the drug reaction "with a vividness only less than amounting to hallucination" (p.213) and profound depression but no physical symptoms. The depression was expressed as withdrawal into the self - "an abhorrence of speech or action except toward the fewest possible persons, possessed me" (p.240) - and by suicidal ideas. Ludlow describes his despondency thus:
"My troubles were not merely negative, simply regrets for something which was lost, but a loathing, a fear, a hate of something which was. The very existence of the outer world seemed a base mockery, a cruel sham" (p.240).
He began to dream again during sleep, but the content was not normal. The dreams "mirrored the sights and echoed the voices of the former hasheesh life" (p.243). They, as well as the cannabis-like episodes during the day, were heavily loaded with anxiety.
The intensity of the craving subsided gradually over the next few months, but there were occasions of "absolute struggle" brought about by various stimuli, including tobacco deprivation:
"To defer for an hour the nicotine indulgence was to bring on a longing for the cannabine which was actual pain" (p.261).
The need for visions was satisfied by such ingenious procedures as blowing soap bubbles where he "found some faint actualization of [his] remembered hasheesh sky" (p.262), building exotic structures with his books and, most effectively, by reenacting his cannabis experience in writing:
"From this reproduction of the past... I gained a double benefit, the pleasure of appeasing the fascination without increasing it, and the salutary review of abominable horrors without any more than the echo of a pang" (p.264).
He tried substituting opium but gave it up for fear of developing a strong dependence, of being unable to conceal its effects, and of being ridiculed as a "Coleridge le petit" or a "De Quincey in the second edition" (p.282). He was indeed subsequently called "a minor De Quincey" (Bragman, 1925). But most importantly, he found the effect of opium "invariably bad."
Finally, Ludlow resorted to a sympathetic and understanding physician whom he saw almost daily for several months. Ludlow considered this crucial, since it significantly contributed to lifting his depression and thus enabled him to mobilize his own resources towards his rehabilitation:
"...when my own life had become to me a vague and meaningless abstraction, by participation with his thought and sympathy I somehow gradually drew into it an injected energy which made its juiceless pulses throb again, and awoke me out of the lethargy into which I was sinking deeper every day" (p.252).
THE SIGNIFICANCE OF LUDLOW'S REPORT
From this examination of The Hasheesh Eater it is evident that Ludlow recognized, with remarkable insight, most of the characteristic subjective effects of cannabis. He also noted, and interpreted essentially correctly, such pharmacological points as the relation of dose to effect, inter- and intra-individual variations in response, and the influence of set and setting. Most importantly, perhaps, he recorded the development of his dependence on cannabis more comprehensively and astutely than anyone to date. The initial motives - including features of his own personality and temperament - the constant rationalization, compulsive use despite obvious untoward effects, the progression to a state of almost continuous intoxication, the inability to reduce his dose gradually, and the intense craving and depression after abrupt withdrawal, are all clearly described. Ludlow recognized also the lack of physical symptoms during withdrawal, and the difference from opium withdrawal in this respect.
With the benefit of hindsight, we can also identify in Ludlow's account a number of other features consistent with present knowledge, but which even scientists of his day could not possibly have known. For example, the initial change in tolerance, the continuum between euphoria and hallucinations (Isbell et al., 1967), the differentiation between the hallucinatory process and the affective reactions to it, the relation between spontaneous and drug-induced perceptual changes, the similarity between the effects of cannabis and those of other hallucinogens, the attempts at drug substitution therapy (opium, tobacco), and the role of psychotherapy and of abreactive writing, are all in keeping with contemporary thought. These points permit the modern reader to feel even greater confidence in the extraordinary accuracy and perceptiveness of Ludlow's record.
This analysis, however, is not intended merely to arouse the reader's admiration for Ludlow. Its purpose is to emphasize two important benefits which contemporary investigators may gain from careful reading of older literature, including some nonscientific writings such as Ludlow's. The first consists of ideas for new research arising from seemingly minor observations recorded in them. An example is Ludlow's observation that dream activity ceased completely during the period of cannabis use and returned after withdrawal. In view of the importance of dreaming in the normal mental economy, this point deserves objective study by recording of paradoxical sleep (Oswald, 1966). Another example is the inference from Ludlow's account, that the strength of dependence is related both to the intensity and quality of subjective effects, and the potency of the preparation used. This is relevant to the comparisons between marijuana, hashish and pure tetrahydrocannabinols. If the more potent substances become readily available, the question of dependence may assume greater importance, and careful investigation of experience in India (Chopra and Chopra, 1957), North Africa (Bouquet, 1950, 1951), and elsewhere would be desirable.
The second benefit offered by this literature is the wealth of observations which it provides as raw material for objective analysis. Ludlow's book, for example, contains over 35,000 words of vived description of the imagery, phantasy, and transcendental nature of his drug experiences, which has barely been touched on here. This material, together with that of other authors, lends itself for a systematic exanlination such as that of Kl¨ver (1966) on the perceptual effects of mescaline. Some workers in this field have taken the extreme view that none of the older literature is now relevant because it originated in other societies, or was not based on modern prilrciples of experimental design. Really striking findings, such as Claude Bernard's discovery of glycogen. do not require statistical evaluation. Moreover, evidence can be of different types. Modern experimental and statistical methods are of unquestionable value, but it must not be forgotten that they have limitations. Because of the influence of set and setting on subjective effects of cannabis and other drugs, "neutral laboratory conditions" may be quite inappropriate for the study of emotional reactions which occur in the more usual circumstances of drug use. Much more valuable information on this aspect is likely to be provided by clinical and allied approaches, such as the examination of verbal reports of thoughts and emotions as they were experienced. An excellent resumé of much of this literature can be found in Chapter 6 of Walton's monograph (1938), which is also a most useful source of references. It is the perceptive, introspective and articulate creative writers - such as Ludlow, Baudelaire, and Huxley - who can best communicate such experiences. To dismiss their writings as excessively imaginative and atypical, is to waste valuable material which deserves interpretation in the light of contemporary neurophysiology, psychology and psychiatry.
This paper is an attempt to show the merits of a re-examination of the older literature in the course of contemporary research. A knowledge of past achievements and thought can help to avoid useless repetition, and provide valuable clues for future work. It is worth recalling thatMoreau (1845) used cannabis in elaborating the concept of the model psychosis, over a century before modern investigators rediscovered the idea. As Santayana (1954) has remarked, "Those who do not remember the past are condemned to repeat it."
The author thanks Dr. H. Kalant for his detailed discussions and major assistance in the preparation of the manuscript, and Dr. H. Brill and Mr. R.E. Popham for their valuable suggestions.