Carbon Dioxide Therapy (First Edition)
Reviewed by Lux

Carbon Dioxide Therapy is a seminal monograph documenting the use of carbogen in psychiatry as a treatment for neurosis. Carbogen is a psychoactive mixture of carbon dioxide and oxygen that exerts anesthetic and visionary effects. The book’s author administered a blend called “Meduna’s Mixture”, consisting of 30% carbon dioxide and 70% oxygen, to hundreds of patients, and the results of his research are copiously document in this engaging monograph. Exposure to increased levels of carbon dioxide can be dangerous or even be fatal, but Meduna encountered no serious problems in administering his 70/30 blend in sessions of up to 50 breaths in length.

Carbogen had an enthusiastic but short-lived following as a psychedelic tool in the 50s and 60s. Al Hubbard and Myron Stolaroff both commonly administered carbogen as a prelude to LSD sessions. But Carbon Dioxide Therapy was written before Wasson’s infamous Life Magazine article, and Meduna probably would have been amazed to hear that a later generation would explore carbogen purely out of interest in its mind-altering effects. (For more information on carbogen’s use by the psychedelic community, see “Carbogen” and “Carbogen Redux” by B. James and Earth Erowid in Erowid Extracts #12.)

Born in 1896, Ladislas Meduna was a Hungarian psychiatrist who emigrated to Chicago in 1938, where he lived and taught until his death in 1964. He had a career-long interest in psychiatric therapies involving sleep, coma, and related states of consciousness. Meduna was an early pioneer in convulsive therapy, and in 1934 he achieved promising results in the treatment of catatonia with camphor-induced convulsions. This research eventually led to research in electroconvulsive therapy, which is regarded as a descendant of Meduna’s camphor therapy.

Meduna’s therapeutic philosophy as presented in this book is an interesting synthesis of ideas taken from cybernetics and sleep therapy. He believed that psychoneurosis is caused by self-perpetuating patterns of maladaptive neural activity in the brain. If those patterns are temporarily interrupted, new patterns are free to emerge, allowing patients to shift out of neurotic behavior patterns in which they had previously been trapped.

In 1943 Meduna’s attention shifted from camphor to carbogen and he began experimenting with different gas mixtures and administration techniques. He eventually settled on applying his 70/30 mixture from a pressurized tank using a breathing mask in sessions lasting up to 50 breaths. Many of his patients reported dramatic visionary effects under the influence of carbogen, often describing colorful, geometric visions and a feeling of movement. Carbogen experiences were sometimes pervaded by a sense of spiritual importance. One subject reports:

After the second breath came an onrush of color, first a predominant sheet of beautiful rosy-red, following which came successive sheets of brilliant color and design, some geometric, some fanciful and graceful …. Then the colors separated; my soul drawing apart from the physical being, was drawn upward seemingly to leave the earth and to go upward where it reached a greater Spirit with Whom there was a communion, producing a remarkable, new relaxation and deep security. (pg. 28)

Meduna describes these experiences with interest and offers a thought-provoking commentary on the character of these visions. I found this to be the most interesting part of the book.

Many of his subjects responded with anxiety or panic to carbogen therapy, usually because of the feeling of suffocation that sometimes accompanied the sessions. True to his theoretical single-mindedness, Meduna sometimes recommended electroconvulsive therapy or the induction of a “light insulin coma” to treat his patients’ fear of carbogen therapy.

The student of psychology may find Meduna’s book interesting as an early example of hardline cognitivism. Other psychiatrists talked about carbogen’s therapeutic benefits in Freudian terms, pointing to the release of pent-up emotions through catharsis and abreaction that occurred in many carbogen sessions. Meduna, however, rigorously held to a biomedical model of carbogen’s effects, arguing that the gas itself induces change through its pharmacological action. He used this as evidence to support his broader theory that neurotic behavior is ultimately a biological problem, rooted in the functioning of the brain rather than in repressed feelings and emotions. To support his theory, he administered carbon dioxide to his patients without any accompanying psychotherapy, so that any observed improvement could only be described in terms of the direct effects of the gas.

Meduna concludes that carbogen was effective in generating improvement in 68% of the subjects he evaluated in this book. Their diagnosed conditions included frigidity, anxiety disorders, stress-related ulcers, and homosexuality. His methods for measuring improvement seem arbitrary by today’s standards; one patient was judged to be much improved due to “the clear, merry look of his eyes”. He also relied heavily on self-reports by patients, and used tests that are currently regarded as unacceptably imprecise, like the Thematic Apperception Test. He employed no control group in his study, raising unanswerable questions of placebo effect.

Given the archaic quality of Meduna’s diagnostic criteria, assessment tools, and experimental design, the study itself is of limited value to contemporary research. Nonetheless, the book presents interesting ideas. Meduna argues for the inherent value in what amounts to pressing the reset button on human consciousness. I was persuaded that periodic interruptions to habitual patterns by which people operate may have intrinsic value, and in some cases may help people to realign themselves. This insight has echoes in the recent work of psychedelic researchers Franz Vollenweider and Giorgio Samorini.

Nearly 60 years after it was published, Carbon Dioxide Therapy remains the definitive statement on carbogen as a psychiatric tool for treatment of neurosis. The book was re-released in a greatly-expanded second edition in 1958. The second edition is nearly twice as long and contains papers written by a number of other researchers in the gas.