August 3rd, 1956Venice
Thanks for your letter. I enclose that article on the effects of various drugs I have used. I do not know if it is suitable for your publication. I have no objection to my name being used.
No difficulty with drinking. no desire to use any drug. General health excellent. Please give my regards to Mr.----. I use his system of exercises daily with excellent results.
I have been thinking of writing a book on narcotic drugs if I could find a suitable collaborator to handle the technical end.
The use of opium and opium derivatives leads to a state that defines limits and describes "addiction"--(The term is loosely used to indicate anything one is used to or wants. We speak of addiction to candy, coffee, tobacco, warm weather, television, detective stories, crossword puzzles). So misapplied the term loses any useful precision of meaning. The use of morphine leads to a metabolic dependence on morphine. Morphine becomes a biologic need just as water and the user may die if he is suddenly deprived of it. The diabetic will die without insulin, but he is not addicted to insulin. His need for insulin was not brought about by the use of insulin. He needs insulin to maintain a normal metabolism, and so avoid the excruciatingly painful return to a normal metabolism.
I have used a number of "narcotic" drugs over a period of twenty years. Some of these drugs are addicting in the above sense. Most are not:
Opiates.--Over a period of twelve years I have used opium, smoked and taken orally (injection in the skin causes abscesses. Injection in the vein is unpleasant and perhaps dangerous), heroin injected in skin, vein, muscle, sniffed (when no needle was available), morphine, dilaudid, pantopon, eukodol, paracodine, dionine, codeine, demerol, methodone. They are all habit forming in varying degree. Nor does it make much difference how the drug is administered, smoked, sniffed, injected, taken orally, inserted in rectal suppositories, the end result will be the same: addiction. And a smoking habit is as difficult to break as an intravenous injection habit. The concept that injection habits are particularly injurious derives from an irrational fear of needles--("Injections poison the blood stream"-- as though the blood stream were any less poisoned by substances absorbed from the stomach, the lungs or the mucous membrane). Demerol is probably less addicting than morphine. It is also less satisfying to the addict, and less effective as a pain killer. While a demerol habit is easier to break than a morphine habit, demerol is certainly more injurious to the health and specifically to the nervous system. I once used demerol for three months and developed a number of distressing symptoms: trembling hands (with morphine my hands are always steady), progressive loss of coordination, muscular contractions, paranoid obsessions, fear of insanity. Finally I contracted and opportune intolerance for demerol--no doubt a measure of self preservation--and switched to methodone. Immediately all my symptoms disappeared. I may add that demerol is quite as constipating as morphine, that it exerts an even more depressing effect on the appetite and the sexual functions, does not, however, contract the pupils. I have given myself thousands of injections over a period of years with unsterilized, in fact dirty, needles and never sustained an infection until I used demerol. Then I came down with a series of abscesses one of which had to be lanced and drained. In short demerol seems to me a more dangerous drug than morphine. Methodone is completely satisfying to the addict, an excellent pain killer, at least as addicting as morphine.
I have taken morphine for acute pain. Any opiate that effectively relieves pain to an equal degree relieves withdrawal symptoms. The conclusion is obvious: Any opiate that relieves pain is habit forming, and the more effectively it relieves pain the more habit forming it is. The habit forming molecule, and the pain killing molecule of morphine are probably identical, and the process by which morphine relieves pain is the same process that leads to tolerance and addiction. Non habit forming morphine appears to be a latter day Philosopher's Stone. On the other hand variations of apomorphine may prove extremely effective in controlling the withdrawal syndrome. But we should not expect this drug to be a pain killer as well.
The phenomena of morphine addiction are well known and there is no reason to go over them here. A few points, it seems to me, have received insufficient attention: The metabolic incompatibility between morphine and alcohol has been observed, but no one, so far as I know, has advanced an explanation. If a morphine addict drinks alcohol he experiences no agreeable or euphoric sensations. There is a feeling of slowly mounting discomfort, and the need for another injection. The alcohol seems to be short-circuited perhaps by the liver. I once attempted to drink in a state of incomplete recovery from an attack of jaundice (I was not using morphine at this time). The metabolic sensation was identical. In one case the liver was partly out of action from jaundice, in the other preoccupied, literally, by a morphine metabolism. In neither case could it metabolize alcohol. If an alcoholic becomes addicted to morphine, morphine invariably and completely displaces alcohol. I have known several alcoholics who began using morphine. They were able to tolerate large doses of morphine immediately (1 grain to a shot) without ill effects, and in a matter of days stopped taking alcohol. The reverse never occurs. The morphine addict can not tolerate alcohol when he is using morphine or suffering from morphine withdrawal. The ability to tolerate alcohol is a sure sign of disintoxication. In consequence alcohol can never be substituted for morphine directly. Of course a disintoxicated addict may start drinking and become an alcoholic.
During withdrawal the addict is acutely aware of his surroundings. Sense impressions are sharpened to the point of hallucination. Familiar objects seem to stir with a writhing furtive life. The addict is subject to a barrage of sensations external and visceral. He may experience flashes of beauty and nostalgia, but the overall impression is extremely painful--(Possibly his sensations are painful because of their intensity. A pleasurable sensation may become intolerable after a certain intensity is reached.)
I have noticed two special reactions of early withdrawal: (1) Everything looks threatening; (2) mild paranoia. The doctors and nurses appear as monsters of evil. In the course of several cures, I have felt myself surrounded by dangerous lunatics. I talked with one of Dr. Dent's patients who had just undergone disintoxication for a pithidine habit. He reported an identical experience, told me that for 24 hours the nurses and the doctor "seemed brutal and repugnant." And everything looked blue. And I have talked with other addicts who experienced the same reactions. Now the psychological basis for paranoid notions during withdrawal is obvious. The specific similarity of these reactions indicates a common metabolic origin. The similarity between withdrawal phenomena and certain states of drug intoxication, is striking. Hashish, Bannisteria Caapi (Hamaline), Peyote (Mescaline) produce states of acute sensitivity, with hallucinatory viewpoint. Everything looks alive. Paranoid ideas are frequent. Bannisteria Caapi intoxication specifically reproduces the state of withdrawal. Everything looks threatening. Paranoid ideas are marked, especially with overdose. After taking Bannisteria Caapi, I was convinced that the Medicine Man and his apprentice were conspiring to murder me. It seems that metabolic states of the body can reproduce the effects of various drugs.
In the U.S.A. heroin addicts are receiving an involuntary reduction cure from the pushers who progressively dilute their wares with milk sugar and barbiturates. As a result many of the addicts who seek treatment are lightly addicted so they can be completely disintoxicated in a short time (7 to 8 days). They recover rapidly without medication. Meanwhile any tranquilizing, anti-allergic, or sedative drug, will afford some relief, especially if injected. The addict feels better if he knows that some alien substance is coursing through his blood stream. Tolserol, Thorazine and related "tranquillizers," every variety of barbiturate, Chloral and Paraldehyde, anti-histamines, cortisone, reserpine, even shock (can lobotomy be far behind?) have all been used with results usually described as "encouraging." My own experience suggests that these results be accepted with some reserve. Of course, symptomatic treatment is indicated, and all these drugs (with possible exception of the drug most commonly used: barbiturates) have a place in the treatment of the withdrawal syndrome. But none of these drugs is in itself the answer to withdrawal. Withdrawal symptoms vary with individual metabolism and physical type. Pigeon chested, hay fever and asthma liable individuals suffer greatly from allergic symptoms during withdrawal: running nose, sneezing, smarting, watering eyes, difficulty in breathing. In such cases cortisone, and anti-histamine drugs may afford definite relief. Vomiting could probably be controlled with anti-nausea drugs like thorazine.
I have undergone ten "cures" in the course of which all these drugs were used. I have taken quick reductions, slow reductions, prolonged sleep, apomorphine, antihistamines, a French system involving a worthless product known as "amorphine," everything but shock. (I would be interested to hear results of further experiments with shock treatment on somebody else.) The success of any treatment depends on the degree and duration of addiction, the stage of withdrawal (drugs which are effective in late or light withdrawal can be disastrous in the acute phase) individual symptoms, health, age, etc. A method of treatment might be completely ineffective at one time, but give excellent results at another. Or a treatment that does me no good may help someone else. I do not presume to pass any final judgements, only to report my own reactions to various drugs and methods of treatment.
Reductions Cures.--This is the commonest form of treatment, and no method yet discovered can entirely replace it in cases of severe addiction. The patient must have some morphine. If there is one rule that applies to all cases of addiction this is it. But the morphine should be withdrawn as quickly as possible. I have taken slow reduction cures and in every case the result was discouragement and eventual relapse. Imperceptible reduction is likely to be endless reduction. When the addict seeks cure, he has, in most cases, already experienced withdrawal symptoms many times. He expects an unpleasant ordeal and he is prepared to endure it. But if the pain of withdrawal is spread over two months instead of ten days he may not be able to endure it. It is not the intensity but the duration of pain that breaks the will to resist. If the addict habitually takes any quantity, however small, of any opiate to alleviate the weakness, insomnia, boredom, restlessness, of late withdrawal, the withdrawal symptoms will be prolonged indefinitely and complete relapse is almost certain.
Prolonged Sleep.--The theory sounds good. You go to sleep and wake up cured. Industrial doses of chloral hydrate, barbiturates, thorazine, only produced a nightmare state of semi-consciousness. Withdrawal of sedation, after 5 days, occasioned a severe shock. Symptoms of acute morphine deprivation supervened. The end result was a combined syndrome of unparalleled horror. No cure I ever took was as painful as this allegedly painless method. The cycle of sleep and wakefulness is always deeply disturbed during withdrawal. To further disturb it with massive sedation seems contraindicated to say the least. Withdrawal of morphine is sufficiently traumatic without adding to it withdrawal of barbiturates. After two weeks in the hospital (five days sedation, ten days "rest") I was still so weak that I fainted when I tried to walk up a slight incline. I consider prolonged sleep the worst possible method of treating withdrawal.
Anti-histamines.--The use of anti-histamines is based on the allergic theory of withdrawal. Sudden withdrawal of morphine precipitates and overproduction of histamine with consequent allergic symptoms. (In shock resulting from traumatic injury with acute pain large quantities of histamine are released in the blood. In acute pain as in addiction toxic doses of morphine are readily tolerated. Rabbits, who have a high histamine content in the blood, are extremely resistant to morphine.) My own experience with anti-histamines has not been conclusive. I once took a cure in which anti-histamines were used, and the results were good. But I was lightly addicted at that time, and had been without morphine for 72 hours when the cure started. I have frequently used anti-histamines since then for withdrawal symptoms with disappointing results. In fact they seem to increase my depression and irritability (I do not suffer from typical allergic symptoms).
Apomorphine.--Apomorphine is certainly the best method of treating withdrawal that I have experienced. It does not completely eliminate the withdrawal symptoms, but reduces them to an endurable level. The acute symptoms such as stomach and leg cramps, convulsive or manic states are completely controlled. In fact apomorphine treatment involves less discomfort than a reduction cure. Recovery is more rapid and more complete. I feel that I was never completely cured of the craving for morphine until I took apomorphine treatment. Perhaps the "psychological" craving for morphine that persists after a cure is not psychological at all, but metabolic. More potent variations of the apomorphine formula might prove qualitatively more effective in treating all forms of addiction.
Cortisone.--Cortisone seems to give some relief especially when injected intravenously.
Thorazine.--Provides some relief from withdrawal symptoms, but not much. Side effects of depression, disturbances of vision, indigestion offset dubious benefits.
Reserpine.--I never noticed an effect whatever from this drug except a slight depression.
Barbiturates.--It is common practice to prescribe barbiturates for the insomnia of withdrawal. Actually the use of barbiturates delays the return of normal sleep, prolongs the whole period of withdrawal, and may lead to relapse. (The addict is tempted to take a little codeine or paregoric with his nembutal. Very small quantities of opiates, that would be quite innocuous for a normal person, immediately re-establish addiction in a cured addict.) My experience certainly confirms Dr. Dent's statement that barbiturates are contraindicated.
Chloral and paraldehyde.--Probably preferable to barbiturates if a sedative is necessary, but most addicts will vomit up paraldehyde at once. I have also tried on my own initiative, the following drugs during withdrawal:
Alcohol.--Absolutely contraindicated at any stage of withdrawal. The use of alcohol invariably exacerbates the withdrawal symptoms and leads to relapse. Alcohol can only be tolerated after metabolism returns to normal. This usually takes one month in cases of severe addiction.
Benzedrine.--May relieve temporarily the depression of late withdrawal, disastrous during acute withdrawal, contraindicated at any stage because it produces a state of nervousness for which morphine is the physiological answer.
Cocaine.--The above goes double for cocaine.
Cannabis indica (marijuana).--In late or light withdrawal relieves depression and increases the appetite, in acute withdrawal an unmitigated disaster. (I once smoked marijuana during early withdrawal with nightmarish results.) Cannabis is a sensitizer. If you feel bad already it will make you feel worse. Contraindicated.
Peyote, Bannisteria caapi.-- I have not ventured to experiment. The thought of Bannisteria intoxication superimposed on acute withdrawal makes the brain reel. I know of a man who substituted peyote during late withdrawal, claimed to lose all desire for morphine, ultimately died of peyote poisoning.
In cases of severe addictions, definite, physical, withdrawal symptoms persist for one month at least.
I have never seen or heard of a psychotic morphine addict, I mean anyone who showed psychotic symptoms while addicted to an opiate. In fact addicts are drearily sane. Perhaps there is a metabolic incompatibility between schizophrenia and opiate addiction. On the other hand the withdrawal of morphine often precipitates psychotic reactions--usually mild paranoia. Interesting that drugs and methods of treatment that give results in schizophrenia, are also of some use in withdrawal: anti-histamines, tranquillizers, apomorphine, shock.
Sir Charles Sherington defines pain as "the psychic adjunct of an imperative protective reflex."
The vegetative nervous system expands and contracts in response to visceral rhythms and external stimuli, expanding to stimuli which are experienced as pleasurable--sex, food, agreeable social contacts, etc.--contracting from pain, anxiety, fear, discomfort, boredom. Morphine alters the whole cycle of expansion and contraction, release and tension. The sexual function is deactivated, peristalsis inhibited, the pupils cease to react in response to light and darkness. The organism neither contracts from pain nor expands to normal sources of pleasure. It adjusts to a morphine cycle. The addict is immune to boredom. He can look at his shoe for hours or simply stay in bed. He needs no sexual outlet, no social contacts, now work, no diversion, no exercise, nothing but morphine. Morphine may relieve pain by imparting to the organism some of the qualities of a plant. (Pain could have no function for plants which are, for the most part, stationary, incapable of protective reflexes.)
Scientists look for a non-habit forming morphine that will kill pain without giving pleasure, addicts want--or think they want--euphoria without addiction. I do not see how the functions of morphine can be separated, I think that any effective pain killer will depress the sexual function, induce euphoria and cause addiction. The perfect pain killer would probably be immediately habit forming. (If anyone is interested to develop such a drug, dehydro-oxyheroin might be a good place to start.)
The addict exists in a painless, sexless, timeless state. Transition back to the rhythms of animal life involves the withdrawal syndrome. I doubt if this transition can ever be made in comfort. Painless withdrawal can only be approached.
Cocaine.--Cocaine is the most exhilarating drug I have ever used. The euphoria centres in the head. Perhaps the drug activates pleasure connections directly in the brain. I suspect that an electric current in the right place would produce the same effect. The full exhilaration of cocaine can only be realised by an intravenous injection. The pleasurable effects do not last more than five or ten minutes. If the drug is injected in the skin, rapid elimination vitiates the effects. This goes double for sniffing.
It is standard practice for cocaine users to sit up all night shooting cocaine at one minute intervals, alternating with shots of heroin, or cocaine and heroin mixed in the same injection to form a "speed ball." (I have never known an habitual cocaine user who was not a morphine addict.)
The desire for cocaine can be intense. I have spent whole days walking from one drug store to another to fill a cocaine prescription. You may want cocaine intensely , but you don't have any metabolic need for it. If you can't get cocaine you eat, you go to sleep and forget it. I have talked with people who used cocaine for years, then were suddenly cut off from their supply. None of them experienced any withdrawal symptoms. Indeed it is difficult to see how a front brain stimulant could be addicting. Addiction seems to be a monopoly of sedatives.
Continued use of cocaine leads to nervousness, depression, sometimes drug psychosis with paranoid hallucinations. The nervousness and depression resulting from cocaine use are not alleviated by more cocaine. They are effectively relieved by morphine. The use of cocaine by a morphine addict, always leads to larger and more frequent injections of morphine.
Cannabis Indica (hashish, marijuana).--The effects of this drug have been frequently and luridly described: disturbance of space-time perception, acute sensitivity to impressions, flight of ideas, laughing jags, silliness. Marijuana is a sensitizer, and the results are not always pleasant. It makes a bad situation worse. Depression becomes despair, anxiety panic. I have already mentioned my horrible experience with marijuana during acute morphine withdrawal. I once gave marijuana to a guest who was mildly anxious about something ("On bum kicks" as he put it). After smoking half a cigarette he suddenly leapt to his feet screaming "I got the fear!" and rushed out of the house.
An especially unnerving feature of marijuana intoxication is a disturbance of the affective orientation. You do not know whether you like something or not, whether a sensation is pleasant or unpleasant.
The use of marijuana varies greatly with the individual. Some smoke it constantly, some occasionally, not a few dislike it intensely. It seems to be especially unpopular with confirmed morphine addicts, many of whom take a puritanical view of marijuana smoking.
The ill effects of marijuana have been grossly exaggerated in the U.S. Our national drug is alcohol. We tend to regard the use of any other drug with special horror. Anyone given to these alien vices deserves the complete ruin of his mind and body. People believe what they want to believe without regard for the facts. Marijuana is not habit forming. I have never seen evidence of any ill effects from moderate use. Drug psychosis may result from prolonged and excessive use.
Barbiturates.--The barbiturates are definitely addicting if taken in large quantities over any period of time (about a gramme a day will cause addiction). Withdrawal syndrome is more dangerous than morphine withdrawal, consisting of hallucinations with epilepsy type convulsions. Addicts often injure themselves flopping about on concrete floors (concrete floors being a usual corollary of abrupt withdrawal). Morphine addicts often take barbiturates to potentiate inadequate morphine rations. Some of them become barbiturate addicts as well.
I once took two nembutal capsules (one an a half grain each) every night for four months and suffered no withdrawal symptoms. Barbiturate addiction is a question of quantity. It is probably not a metabolic addiction like morphine, but a mechanical reaction from excessive front brain sedation.
The barbiturate addict presents a shocking spectacle. He can not coordinate, he staggers, falls off bar stools, goes to sleep in the middle of a sentence, drops food out of his mouth. He is confused, quarrelsome and stupid. And he almost always uses other drugs, anything he can lay hands on: alcohol, benzedrene, opiates, marijuana. Barbiturate users are looked down on in addict society: "Goof ball bums. They got no class to them." The next step down is coal gas and milk, or sniffing ammonia in a bucket--"The scrub woman's kick."
It seems to me that barbiturates cause the worst possible form of addiction, unsightly, deteriorating, difficult to treat.
Benzedrene.--This is a cerebral stimulant like cocaine. Large doses cause prolonged sleeplessness with feelings of exhilaration. The period of euphoria is followed by a horrible depression. The drug tends to increase anxiety. It causes indigestion and loss of appetite.
I know of only one case where definite symptoms followed the withdrawal of benzedrene. This was a woman of my acquaintance who used incredible quantities of benzedrene for six months. During this period she developed a drug psychosis and was hospitalized for ten days. She continued the use of benzedrene, but was suddenly cut off. She suffered an asthma type seizure. She could not get her breath and turned blue. I gave her a dose of anti-histamine (thepherene) which afforded immediate relief. The symptoms did not return.
Peyote (mescaline).--This is undoubtedly a stimulant. It dilates the pupils, keeps one awake. Peyote is extremely nauseating. Users experience difficulty keeping it down long enough to realize the effect, which is similar, in some respects, to marijuana. There is increased sensitivity to impression, especially to colours. Peyote intoxication causes a peculiar vegetable consciousness or identification with the plant. Everything looks like a peyote plant. It is easy to understand why the Indians believe there is a resident spirit in the peyote cactus.
Overdose of peyote may lead to respiratory paralysis and death. I know of one case. There is no reason to believe that peyote is addicting.
Bannisteria caapi (Harmaline, Banisterine, Telepathine). -- Bannisteria caapi is a fast growing vine. The active principle is apparently found throughout the wood of the fresh cut vine. The inner bark is considered most active, and the leaves are never used. It takes a considerable quantity of the vine to feel the full effects of the drug. About five pieces of vine each eight inches long are needed for one person. The vine is crushed and boiled for two or more hours with the leaves of a bush identified as Palicourea sp. rubiaceae.
Yage or Ayuahuaska (the most commonly used Indian names for Bannisteria caapi) is a hallucinating narcotic that produces a profound derangement of the senses. In overdose it is a strong convulsant poison. The antidote is a barbiturate or other strong, anti-convulsant sedative. Anyone taking Yage for the first time should have a sedative ready in the even of an overdose.
The hallucinating properties of Yage have led to its use by Medicine Men to potentiate their powers. They also use it as a cure-all in the treatment of various illnesses. Yage lowers the body temperature and consequently is of some use in the treatment of fever. It is a powerful antihelminthic, indicated for treatment of stomach or intestinal worms. Yage induces a state of conscious anaesthesia, and is used in rites where the initiates must undergo a painful ordeal like whipping with knotted vines, or exposure to the sting of ants.
So far as I could discover only the fresh cut vine is active. I found no way to dry, extract or preserve the active principal. No tinctures proved active. The dried vine is completely inert. The pharmacology of Yage requires laboratory research. Since the crude extract is such a powerful, hallucinating narcotic, perhaps even more spectacular results could be obtained with synthetic variations. Certainly the matter warrants further research.
I did not observe any ill effects that could be attributed to the use of Yage. The Medicine Men who use it continuously in the line of duty seem to enjoy normal health. Tolerance is soon acquired so that one can drink the extract without nausea or other ill effect.
Yage is a unique narcotic. Yage intoxication is in some respects similar to intoxication with hashish. In both instances there is a shift of viewpoint, an extension of consciousness beyond ordinary experience. But Yage produces a deeper derangement of the senses with actual hallucinations. Blue flashes in front of the eyes is peculiar to Yage intoxication.
There is a wide range of attitude in regard to Yage. Many Indians and most White users seem to regard it simply as another intoxicant like liquor. In other groups it has ritual use and significance. Among the Jivaro young men take Yage to contact the spirits of their ancestors and get a briefing for their future life. It is used during initiations to anaesthetize the initiates for painful ordeals. All Medicine Men use it in their practice to foretell the future, locate lost or stolen objects, name the perpetrator of a crime, to diagnose and treat illness.
The alkaloid of Bannisteria caapi was isolated in 1923 by Fisher Cardenas. He called the alkaloid Telepathine alternately Banisterine. Rumf showed that Telepathine was identical with Harmine, the alkaloid of Perganum Harmala.
Bannisteria caapi is evidently not habit forming.
Nutmeg.--Convicts and sailors sometimes have recourse to nutmeg. About a teaspoon is swallowed with water. Results are vaguely similar to marijuana with side effects of headache and nausea. Death would probably supervene before addiction if such addiction is possible. I have only taken nutmeg once.
There are a number of narcotics of the nutmeg family in use among the Indians of South America. They are usually administered by sniffing a dried powder of the plant. The Medicine Men take these noxious substances, and go into convulsive states. Their twitching and mutterings are thought to have prophetic significance. A friend of mine was violently sick for three days after experimenting with a drug of the nutmeg family in South America.
Datura-scopolamine.--Morphine addicts are frequently poisoned by taking morphine in combination with scopolamine.
I once obtained some ampoules each of which contained one-sixth grain of morphine and one-hundredth grain of scopolamine. Thinking that one-hundredth grain was a negligible quantity, I took six ampoules in one injection. The result was a psychotic state lasting some hours during which I was opportunely restrained by my long suffering landlord. I remembered nothing the following day.
Drugs of the datura group are used by the Indians of South America and Mexico. Fatalities are said to be frequent.
Scopolamine has been used by the Russians as a confession drug with dubious results. The subject may be willing to reveal his secrets, but quite unable to remember them. Often cover story and secret information are inextricably garbled. I understand that mescaline has been very successful in extracting information from suspects.
Morphine addiction is a metabolic illness brought about by the use of morphine. In my opinion psychological treatment is not only useless it is contraindicated. Statistically the people who become addicted to morphine are those who have access to it: doctors, nurses, anyone in contact with black market sources. In Persia where opium is sold without control, 70 per cent of the adult population is addicted. So we should psycho-analyser several million Persians to find out what deep conflicts and anxieties have driven them to the use of opium? I think not. According to my experience most addicts are not neurotic and do not need psychotherapy. Apomorphine treatment and access to apomorphine in the event of relapse would certainly give a higher percentage of permanent cures than any programme of "psychological rehabilitation."