Ketamine as a Catalyst for Paradigm Change in Mental Health
Scott Shannon, MD FAACAP
Psychedelic Research and Training Institute
Fort Collins, CO
Scott Shannon, MD FAACAP
Psychedelic Research and Training Institute
Fort Collins, CO
Introduction
This essay will explore the potential for ketamine to shift our view and practice of mental health
care in this country. We currently have two competing models for mental health care:
psychotherapy and psychopharmacology. Ketamine effectively treats depression, but it can also
catalyze transformative insight when combined with therapy. Ketamine catalyzes therapy and
demonstrates the application of medication for gains in awareness and insight. This paradigm
shift will begin to heal the split between therapists and prescribers in the mental health field.
The use of ketamine as a medication to enhance therapy and build insight offers a glimpse of an
emerging paradigm. The growing use of this application will shift how we think about both
therapy and medication in mental health. Some call this perspective psychedelic medicine. In
some ways it is not new or novel. Rather, this is the path of the shaman. This paradigm values
deep exploration of the psyche and affirms our innate ability to heal. Ketamine will help
practitioners re-embrace an ancient paradigm using a new tool that offers many benefits over
the current model.
We are now in the twilight of the chemical imbalance model founded on the relationship
between specific neurotransmitters and mental illness. The promise of this model peaked in the
decade after the introduction of Prozac in 1988 and it now erodes with each passing year. As the
evidence for the grave limitations of this model grow, so do the number of dissatisfied
psychiatrists, psychotherapists and suffering individuals in search of a new path. Our current
psychopharmacology model tends to suppress the psyche with daily symptomatic control.
Ketamine offers a path for deeper healing that is evocative and honors the primacy of the
psyche. Consciousness and awareness become our guides. This chapter explores how a single
chemical compound called ketamine helps us heal both individuals and professions.
care in this country. We currently have two competing models for mental health care:
psychotherapy and psychopharmacology. Ketamine effectively treats depression, but it can also
catalyze transformative insight when combined with therapy. Ketamine catalyzes therapy and
demonstrates the application of medication for gains in awareness and insight. This paradigm
shift will begin to heal the split between therapists and prescribers in the mental health field.
The use of ketamine as a medication to enhance therapy and build insight offers a glimpse of an
emerging paradigm. The growing use of this application will shift how we think about both
therapy and medication in mental health. Some call this perspective psychedelic medicine. In
some ways it is not new or novel. Rather, this is the path of the shaman. This paradigm values
deep exploration of the psyche and affirms our innate ability to heal. Ketamine will help
practitioners re-embrace an ancient paradigm using a new tool that offers many benefits over
the current model.
We are now in the twilight of the chemical imbalance model founded on the relationship
between specific neurotransmitters and mental illness. The promise of this model peaked in the
decade after the introduction of Prozac in 1988 and it now erodes with each passing year. As the
evidence for the grave limitations of this model grow, so do the number of dissatisfied
psychiatrists, psychotherapists and suffering individuals in search of a new path. Our current
psychopharmacology model tends to suppress the psyche with daily symptomatic control.
Ketamine offers a path for deeper healing that is evocative and honors the primacy of the
psyche. Consciousness and awareness become our guides. This chapter explores how a single
chemical compound called ketamine helps us heal both individuals and professions.
Old and new models of care
To understand the value of ketamine we must understand where psychiatry and mental health
has been for the last 70 years. Prior to 1950 psychiatry was predominated by various forms of
talk therapy, such as psychoanalysis or forms of somatic (body oriented) therapies such as
prefrontal lobotomies or various shock therapies. While we shudder today at the concept of
psychosurgery so horrifically presented in One Flew Over the Cuckoo’s Nest, consider how
recently these tools were mainstream: In 1949, the Portuguese neurologist António Egas Moniz
received the Nobel Prize in physiology or medicine for his development of the
has been for the last 70 years. Prior to 1950 psychiatry was predominated by various forms of
talk therapy, such as psychoanalysis or forms of somatic (body oriented) therapies such as
prefrontal lobotomies or various shock therapies. While we shudder today at the concept of
psychosurgery so horrifically presented in One Flew Over the Cuckoo’s Nest, consider how
recently these tools were mainstream: In 1949, the Portuguese neurologist António Egas Moniz
received the Nobel Prize in physiology or medicine for his development of the
prefrontal lobotomy. This treatment is widely considered today to be wildly harmful to both our
functional capacity and our basic humanity.
The discovery of chlorpromazine in 1950 and its widespread use a few years later initiated a
new era in mental health: the era of psychopharmacology. Anti-depressant drugs (1951) and
benzodiazepines (1955) followed soon after chlorpromazine. The essence of this approach
involved quieting the expression of the psyche. People were not cured by these agents. We
merely dulled the inner turmoil and make individuals care less about their misery. The deeper
reaches of the psyche were seen as frightening, calling for medical management and ultimately
hidden away.
This ran in stark contrast to the goals and process of psychotherapy. The central posit of
psychotherapy is that exploration of the psyche and the resultant insight carries relief and
healing. For much of the last 70 years psychotherapists and psychiatrists often labored in
conflict as one group worked to explore and understand the psyche, while the other group tried
to sedate and chemically obscure the deeper reaches of the psyche. These two arms of the
mental health field have been on a collision course for generations.
We now understand that the current models of talk therapy and daily medication management
both have grave limitations for the treatment of serious mental illness. Many professionals
appreciate that neither model represents the future of mental health care. Practitioners on
both sides of this divide recognize this and now look beyond their frustrations to explore other
paradigms of care.
Psychedelic medicine (PM) stands as the epitome of one emerging approach. Employing classic
psychedelics to explore the psyche has become fascinating for many mental health care
professionals. The powerful neurological effects of psychedelics have been increasingly
documented by researchers with neuroimaging and connectivity studies over the last decade.
These medicines dramatically alter the neuro-chemical and thus the neuro-electrical functions
of the human brain. It may be a bit simplistic, but one shared theme is that the classic
psychedelics (and ketamine) quiet the default mode network (DMN), which represents our best
expression of the ego, personal narrative and self-referential dialogue without dimming our
self-awareness. Thus, these chemicals allow us to experience our world and our self without the
self-created filters that separate us from those realities. This close encounter with our real self
carries us on a deep dive into the psyche and a new unfiltered world. We often leave this
experience enlightened, humbled, inspired and much more deeply connected to the natural
ecology that embraces us.
Psychedelic medicine (PM) improves both arms of mental health. Medication can enhance
access to the psyche through enhanced self-awareness and a reduction of ego defenses. These
medicines can help individuals break free of self-created barriers or access repressed traumas.
In so doing our profession moves from a dose dependent daily suppression of the psyche
(conventional psychiatric medications) to an episodic catalyst that tries to peel back the psyche
and allow it to be seen and more fully experienced (the psychedelic session). The medication
opens the psyche to exploration by removing barriers. The use of evocative tools like ketamine
The discovery of chlorpromazine in 1950 and its widespread use a few years later initiated a
new era in mental health: the era of psychopharmacology. Anti-depressant drugs (1951) and
benzodiazepines (1955) followed soon after chlorpromazine. The essence of this approach
involved quieting the expression of the psyche. People were not cured by these agents. We
merely dulled the inner turmoil and make individuals care less about their misery. The deeper
reaches of the psyche were seen as frightening, calling for medical management and ultimately
hidden away.
This ran in stark contrast to the goals and process of psychotherapy. The central posit of
psychotherapy is that exploration of the psyche and the resultant insight carries relief and
healing. For much of the last 70 years psychotherapists and psychiatrists often labored in
conflict as one group worked to explore and understand the psyche, while the other group tried
to sedate and chemically obscure the deeper reaches of the psyche. These two arms of the
mental health field have been on a collision course for generations.
We now understand that the current models of talk therapy and daily medication management
both have grave limitations for the treatment of serious mental illness. Many professionals
appreciate that neither model represents the future of mental health care. Practitioners on
both sides of this divide recognize this and now look beyond their frustrations to explore other
paradigms of care.
Psychedelic medicine (PM) stands as the epitome of one emerging approach. Employing classic
psychedelics to explore the psyche has become fascinating for many mental health care
professionals. The powerful neurological effects of psychedelics have been increasingly
documented by researchers with neuroimaging and connectivity studies over the last decade.
These medicines dramatically alter the neuro-chemical and thus the neuro-electrical functions
of the human brain. It may be a bit simplistic, but one shared theme is that the classic
psychedelics (and ketamine) quiet the default mode network (DMN), which represents our best
expression of the ego, personal narrative and self-referential dialogue without dimming our
self-awareness. Thus, these chemicals allow us to experience our world and our self without the
self-created filters that separate us from those realities. This close encounter with our real self
carries us on a deep dive into the psyche and a new unfiltered world. We often leave this
experience enlightened, humbled, inspired and much more deeply connected to the natural
ecology that embraces us.
Psychedelic medicine (PM) improves both arms of mental health. Medication can enhance
access to the psyche through enhanced self-awareness and a reduction of ego defenses. These
medicines can help individuals break free of self-created barriers or access repressed traumas.
In so doing our profession moves from a dose dependent daily suppression of the psyche
(conventional psychiatric medications) to an episodic catalyst that tries to peel back the psyche
and allow it to be seen and more fully experienced (the psychedelic session). The medication
opens the psyche to exploration by removing barriers. The use of evocative tools like ketamine
and classic psychedelics run counter to all that conventional psychiatrists have been taught for
decades. Medication can enhance access to the psyche instead of merely suppressing
symptoms.
Psychotherapy represents the other half of psychedelic medicine. Psychotherapy is crucial to
growth in psychedelic medicine as most people need some guidance to process after the
restrictive containment of the DMN is peeled away. However, the role of expert is shifted.
The therapist takes on the role of sitter, container and guide while the individual immersed in
the close encounter with the depths of the psyche plays the role of expert. Thus, the classic
polarity of wise expert and suffering patient/client so central to the psychotherapeutic
paradigm becomes scrambled and reorganized to reflect this new perspective about the
primacy of the psyche and its innate wisdom. The psychedelic medicine peels back the barrier
we ourselves create and allows the psyche to reconfigure using the tool of full awareness. With
the support of psychedelics (and an appropriate set and setting) each individual has an
enhanced ability to learn more about the greater self to expand awareness and build insight.
Psychotherapy becomes a tool in service of the self instead of a targeted expansion of the
therapist’s expertise that may not always reflect the individual’s inner truth or have unrestricted
access to the deeper layers of the psyche.
PM is built upon the same roots as holistic/integrative medicine in that both posit that all
healing (and health itself) is built upon the innate ability of our being to move towards
wholeness when barriers (such as the DMN) are removed. PM validates this perspective by
moving the seat of expertise and power from the therapist to the person immersed in the
psychedelic experience. The psychotherapist, while critical, becomes more of a midwife to help
support the growth process.
symptoms.
Psychotherapy represents the other half of psychedelic medicine. Psychotherapy is crucial to
growth in psychedelic medicine as most people need some guidance to process after the
restrictive containment of the DMN is peeled away. However, the role of expert is shifted.
The therapist takes on the role of sitter, container and guide while the individual immersed in
the close encounter with the depths of the psyche plays the role of expert. Thus, the classic
polarity of wise expert and suffering patient/client so central to the psychotherapeutic
paradigm becomes scrambled and reorganized to reflect this new perspective about the
primacy of the psyche and its innate wisdom. The psychedelic medicine peels back the barrier
we ourselves create and allows the psyche to reconfigure using the tool of full awareness. With
the support of psychedelics (and an appropriate set and setting) each individual has an
enhanced ability to learn more about the greater self to expand awareness and build insight.
Psychotherapy becomes a tool in service of the self instead of a targeted expansion of the
therapist’s expertise that may not always reflect the individual’s inner truth or have unrestricted
access to the deeper layers of the psyche.
PM is built upon the same roots as holistic/integrative medicine in that both posit that all
healing (and health itself) is built upon the innate ability of our being to move towards
wholeness when barriers (such as the DMN) are removed. PM validates this perspective by
moving the seat of expertise and power from the therapist to the person immersed in the
psychedelic experience. The psychotherapist, while critical, becomes more of a midwife to help
support the growth process.
Ketamine as catalyst for professional change
Ketamine is playing a pivotal role in the transition from the old models of mental health (daily
medicated suppression of the psyche and the therapist as external expert) in a range of other
ways as well. First, ketamine typically works better for severe depression than any of our
conventional medications. This has gathered the attention of modern conventional psychiatry
and even Big Pharma (witness the release of Sprovato by Janssen in 2019). Second, ketamine
works when given in an episodic manner, not daily suppression. Third, ketamine is an agent
that decreases the activity of the DMN like psychedelics do. So, it has the ability to trigger
profound psychedelic like insights that can alter someone’s life trajectory with a single dose.
Fourth, we now have evidence that the dissociation found with ketamine may be central to its
efficacy. Fifth, many are finding that ketamine, like MDMA or the classic psychedelics, can
enhance psychotherapy to speed and deepen the process. All of these facets become quite
apparent when you work with ketamine in a clinical setting that fosters exploration and not
merely an impersonal infusion routine. As more and more psychiatrists are drawn to ketamine
by one of these angles, more and more begin to embrace the paradigm of PM. It is a slippery
ride on an effective slope. Psychiatrists and psychotherapists find ketamine to be an intriguing
medicated suppression of the psyche and the therapist as external expert) in a range of other
ways as well. First, ketamine typically works better for severe depression than any of our
conventional medications. This has gathered the attention of modern conventional psychiatry
and even Big Pharma (witness the release of Sprovato by Janssen in 2019). Second, ketamine
works when given in an episodic manner, not daily suppression. Third, ketamine is an agent
that decreases the activity of the DMN like psychedelics do. So, it has the ability to trigger
profound psychedelic like insights that can alter someone’s life trajectory with a single dose.
Fourth, we now have evidence that the dissociation found with ketamine may be central to its
efficacy. Fifth, many are finding that ketamine, like MDMA or the classic psychedelics, can
enhance psychotherapy to speed and deepen the process. All of these facets become quite
apparent when you work with ketamine in a clinical setting that fosters exploration and not
merely an impersonal infusion routine. As more and more psychiatrists are drawn to ketamine
by one of these angles, more and more begin to embrace the paradigm of PM. It is a slippery
ride on an effective slope. Psychiatrists and psychotherapists find ketamine to be an intriguing
and flexible tool to explore this emerging paradigm of PM. Ketamine offers one major
characteristic that will trigger the emergence of this new paradigm.
Access. One major roadblock slows the emergence of psychedelic medicine. Currently, these
medicines are illegal and out of reach for many individuals and practitioners. While some
explorers feel comfortable breaking the law to gain these valued experiences, many find that
illegality and access issues represent a formidable barrier. For most practitioners, this legal
barrier stands even more foreboding given the career and financial cornerstone their licensure
represents. Granted the barrier on psychedelics appears does appear to be softening in some
places (in 2019 Denver and Oakland decriminalized possession of psilocybin mushrooms), but
for most people around the world the emerging paradigm may take a decade or more to reach
them. So, the central dilemma emerges: PM has escalating research validation, strong
professional interest and an almost frenzied lay demand, yet it is unavailable and criminalized.
Ketamine is legal right now. Ketamine may be a gateway medicine in other ways too.
Access. One major roadblock slows the emergence of psychedelic medicine. Currently, these
medicines are illegal and out of reach for many individuals and practitioners. While some
explorers feel comfortable breaking the law to gain these valued experiences, many find that
illegality and access issues represent a formidable barrier. For most practitioners, this legal
barrier stands even more foreboding given the career and financial cornerstone their licensure
represents. Granted the barrier on psychedelics appears does appear to be softening in some
places (in 2019 Denver and Oakland decriminalized possession of psilocybin mushrooms), but
for most people around the world the emerging paradigm may take a decade or more to reach
them. So, the central dilemma emerges: PM has escalating research validation, strong
professional interest and an almost frenzied lay demand, yet it is unavailable and criminalized.
Ketamine is legal right now. Ketamine may be a gateway medicine in other ways too.
Ketamine is easier
Given the unique effects of ketamine, it is well poised to play a few other roles in the
transformation of mental health care. The essence of this role is that ketamine acts somewhat
like a psychedelic without being one. The result of this bridging role is that ketamine can help
introduce practitioner and traveler to the PM. The role of traveler is the more critical as this is
central to all of PM. Ketamine is a gentle, safe and more accessible entry point for explorations
of the psyche. I first want to highlight some of the ways in which ketamine may help the novice
psychonaut (explorer of the psyche) become comfortable in this realm prior to full legalization.
The first few items reflects it ease, comfort and safety:
Ketamine reduces anxiety. It quiets that part of our central nervous system that worries and
frets. Many of the major psychedelic medicines (especially LSD) can have a significant element
of anxiety as part of the journey. If you are new to psychedelics this can be intimidating and
overwhelming. Research indicates that ketamine is euphoric and mood boosting for most
people. Unpleasant or frightening trips are possible, but they are much less likely than with
psilocybin or LSD.
Ketamine opens the floodgates slowly. Both ketamine and the major psychedelics decrease
activity of the default mode network, which is our closest brain equivalent to the ego. With
these filters that we create ourselves dramatically reduced, the major psychedelics can and will
release a tsunami of unconscious material that can be very powerful (and overwhelming).
Ketamine does decrease the filter of the self, but it simultaneously decreases the power of
cortical awareness and this reduces the unpredictable wave of the unconscious material that is
brought to experience. Traumatic experiences may be accessed, but the weight of the new
insights are typically more limited. Ketamine can work as gentler introduction to these
experiences.
transformation of mental health care. The essence of this role is that ketamine acts somewhat
like a psychedelic without being one. The result of this bridging role is that ketamine can help
introduce practitioner and traveler to the PM. The role of traveler is the more critical as this is
central to all of PM. Ketamine is a gentle, safe and more accessible entry point for explorations
of the psyche. I first want to highlight some of the ways in which ketamine may help the novice
psychonaut (explorer of the psyche) become comfortable in this realm prior to full legalization.
The first few items reflects it ease, comfort and safety:
Ketamine reduces anxiety. It quiets that part of our central nervous system that worries and
frets. Many of the major psychedelic medicines (especially LSD) can have a significant element
of anxiety as part of the journey. If you are new to psychedelics this can be intimidating and
overwhelming. Research indicates that ketamine is euphoric and mood boosting for most
people. Unpleasant or frightening trips are possible, but they are much less likely than with
psilocybin or LSD.
Ketamine opens the floodgates slowly. Both ketamine and the major psychedelics decrease
activity of the default mode network, which is our closest brain equivalent to the ego. With
these filters that we create ourselves dramatically reduced, the major psychedelics can and will
release a tsunami of unconscious material that can be very powerful (and overwhelming).
Ketamine does decrease the filter of the self, but it simultaneously decreases the power of
cortical awareness and this reduces the unpredictable wave of the unconscious material that is
brought to experience. Traumatic experiences may be accessed, but the weight of the new
insights are typically more limited. Ketamine can work as gentler introduction to these
experiences.
It is short. The short half-life of ketamine is under 30 minutes. This means that the entire
experience lasts less than one hour. Good or bad, the journey is short and manageable. The
total time from check in at the office to walking out the front door is typically about two hours.
People clear from the effects of ketamine fully in a few hours and typically experience no
lingering adverse effects.
It is safe. Over the last 50 years or so ketamine has become a well known and well utilized
medication on operating rooms, emergency departments and pain centers. The track record is
one of safety and predictability at the doses being employed in psychiatry (0.5 to 1.5 mg/kg).
The Ketamine Treatment Centers noted that they delivered over 20,000 psychiatric doses
without one serious adverse event. It is widely used around the world as a dissociative
anesthetic and listed by the World Health Organization as an Essential Medicine for these
reasons.
total time from check in at the office to walking out the front door is typically about two hours.
People clear from the effects of ketamine fully in a few hours and typically experience no
lingering adverse effects.
It is safe. Over the last 50 years or so ketamine has become a well known and well utilized
medication on operating rooms, emergency departments and pain centers. The track record is
one of safety and predictability at the doses being employed in psychiatry (0.5 to 1.5 mg/kg).
The Ketamine Treatment Centers noted that they delivered over 20,000 psychiatric doses
without one serious adverse event. It is widely used around the world as a dissociative
anesthetic and listed by the World Health Organization as an Essential Medicine for these
reasons.
Ketamine offers a range of non-ordinary states
Ketamine can also create powerful and psychedelic like effects. Like the classic psychedelics, it
diminishes the effects of the default mode network. But it also has a number of other effects
that make it attractive to providers laboring in this space:
Ketamine is powerful. Never mind that ketamine is not a true psychedelic, this experience may
be one of the most profound alterations of consciousness that anyone will ever experience with
any agent. As a dissociative agent, ketamine disconnects most of our cortical awareness and
creates an experience that will astound. Do not underestimate the power of this experience. For
therapists in training for work in PM it is very important to have a personal experience of a
powerful state of non-ordinary consciousness. Ketamine provides this and more.
Ketamine alters our thinking. Ketamine modifies the default mode network, disrupts
thalamocortical relays and it significantly enhances neuroplasticity. In plain English: it offers a
new way of thinking, particularly about one’s own life and the big picture of our existence. A
different vantage point offers new perspective. People come away with a refreshed look at their
life journey and their options for change. After a ketamine experience our brain is more open to
change. This plasticity lasts acutely for 36 hours or so, but with proper integration it can last a
lifetime.
Dissociation is different. While many will say that ketamine is not a classic psychedelic medicine
and thus should play no role in the training for professionals, the opposite is actually true: a
fully dissociated experience is unique and not approximated by classic psychedelics. Ketamine
provides a very unique experience that teaches us about the underlying nature of
consciousness. Psychedelics provide deep disruption of our cortical functions while ketamine
disconnects us from these limitations. Both are useful. There is no priority in these two different
road maps. It is merely terrain to be explored.
diminishes the effects of the default mode network. But it also has a number of other effects
that make it attractive to providers laboring in this space:
Ketamine is powerful. Never mind that ketamine is not a true psychedelic, this experience may
be one of the most profound alterations of consciousness that anyone will ever experience with
any agent. As a dissociative agent, ketamine disconnects most of our cortical awareness and
creates an experience that will astound. Do not underestimate the power of this experience. For
therapists in training for work in PM it is very important to have a personal experience of a
powerful state of non-ordinary consciousness. Ketamine provides this and more.
Ketamine alters our thinking. Ketamine modifies the default mode network, disrupts
thalamocortical relays and it significantly enhances neuroplasticity. In plain English: it offers a
new way of thinking, particularly about one’s own life and the big picture of our existence. A
different vantage point offers new perspective. People come away with a refreshed look at their
life journey and their options for change. After a ketamine experience our brain is more open to
change. This plasticity lasts acutely for 36 hours or so, but with proper integration it can last a
lifetime.
Dissociation is different. While many will say that ketamine is not a classic psychedelic medicine
and thus should play no role in the training for professionals, the opposite is actually true: a
fully dissociated experience is unique and not approximated by classic psychedelics. Ketamine
provides a very unique experience that teaches us about the underlying nature of
consciousness. Psychedelics provide deep disruption of our cortical functions while ketamine
disconnects us from these limitations. Both are useful. There is no priority in these two different
road maps. It is merely terrain to be explored.
A tool for enhancing consciousness study
For those deeply interested in the power of psychedelics to alter and improve our mental health
ketamine offers some very advanced capabilities that deserve consideration. The dissociative
mechanisms of ketamine bring some unique characteristics not shared by classic psychedelics.
Much of our cortical self-referential loops are taken offline by the interruptions of
cortico-thalamic relays. This in turn, creates a much different type of consciousness. These
relays are also progressively altered by the dose of ketamine involved. Classic psychedelics leave
these relays less impacted, but rather they create massive shifts in the default mode network.
While this can unleash major change in ego functioning, it is less likely to bring the same level of
shift to the essence of consciousness that is experienced with ketamine. It drives a less specific
and more generic separation of awareness from cortex (and thus body). This dose dependent
effect provides psychedelic explorers with useful options for experience and training.
Ketamine offers a sense of pure consciousness. This introduces folks to a non-cognitive open
field of awareness that is unique and awe inspiring. In other words, ketamine decreases our
thinking brain enough for us to realize that our awareness exists even without thought. This
experience often take years of meditation practice to encounter. This can assist a client to find
hope, let go of outmoded perspectives and open up to greater change and flexibility.
Ketamine has a clear dose response curve. Folks can dial in the intensity of experience they
would like to have: low dose: verbal, yet quite altered (somewhat like peyote); moderate dose:
some verbal capacity, but left with most of personal narrative gone (more like psilocybin); high
dose: non-verbal and totally disconnected from this earthly plane (quite similar to DMT).
Ketamine can mimic the near-death experience. Near-death experiences (NDE) have been
studied for decades. We now know that these close encounters with death provide some
individuals with an amazing refresh of their world view and spiritual perspective that is durable
and shift the survivor’s spiritual perspective significantly. This shift results in a movement
towards more openness, enhanced love for others and greater personal optimism among other
positives. While a small percentage (10 to 20%) of people who are revived share this specific
experience, the essence of it is remarkably consistent and powerful. Recently published
research compared the central themes of 15,000 psychedelic journey narratives with 625 NDE
reports. The researchers found that that the ketamine experience most consistently aligned
with the NDE journey. Unfortunately, a significant percentage of those facing an NDE do indeed
perish, the same is not true of ketamine. As mentioned, ketamine is quite safe and the death of
the physical body is unheard of from psychiatric doses. However, death of the ego and self can
be quite common. This may be part of the huge transformation that is possible with a ketamine
experience. Ironically, death of the ego may be life giving.
ketamine offers some very advanced capabilities that deserve consideration. The dissociative
mechanisms of ketamine bring some unique characteristics not shared by classic psychedelics.
Much of our cortical self-referential loops are taken offline by the interruptions of
cortico-thalamic relays. This in turn, creates a much different type of consciousness. These
relays are also progressively altered by the dose of ketamine involved. Classic psychedelics leave
these relays less impacted, but rather they create massive shifts in the default mode network.
While this can unleash major change in ego functioning, it is less likely to bring the same level of
shift to the essence of consciousness that is experienced with ketamine. It drives a less specific
and more generic separation of awareness from cortex (and thus body). This dose dependent
effect provides psychedelic explorers with useful options for experience and training.
Ketamine offers a sense of pure consciousness. This introduces folks to a non-cognitive open
field of awareness that is unique and awe inspiring. In other words, ketamine decreases our
thinking brain enough for us to realize that our awareness exists even without thought. This
experience often take years of meditation practice to encounter. This can assist a client to find
hope, let go of outmoded perspectives and open up to greater change and flexibility.
Ketamine has a clear dose response curve. Folks can dial in the intensity of experience they
would like to have: low dose: verbal, yet quite altered (somewhat like peyote); moderate dose:
some verbal capacity, but left with most of personal narrative gone (more like psilocybin); high
dose: non-verbal and totally disconnected from this earthly plane (quite similar to DMT).
Ketamine can mimic the near-death experience. Near-death experiences (NDE) have been
studied for decades. We now know that these close encounters with death provide some
individuals with an amazing refresh of their world view and spiritual perspective that is durable
and shift the survivor’s spiritual perspective significantly. This shift results in a movement
towards more openness, enhanced love for others and greater personal optimism among other
positives. While a small percentage (10 to 20%) of people who are revived share this specific
experience, the essence of it is remarkably consistent and powerful. Recently published
research compared the central themes of 15,000 psychedelic journey narratives with 625 NDE
reports. The researchers found that that the ketamine experience most consistently aligned
with the NDE journey. Unfortunately, a significant percentage of those facing an NDE do indeed
perish, the same is not true of ketamine. As mentioned, ketamine is quite safe and the death of
the physical body is unheard of from psychiatric doses. However, death of the ego and self can
be quite common. This may be part of the huge transformation that is possible with a ketamine
experience. Ironically, death of the ego may be life giving.
Tool for Psychotherapy and psychotherapeutic training
Ketamine alters the experience of personal recall. The dissociative mechanism inherent with
ketamine reduces the intensity of all emotions including fear, anxiety and trauma. This also
ketamine reduces the intensity of all emotions including fear, anxiety and trauma. This also
makes it a useful tool for controlling pain. Once partially dissociated, someone with a trauma
history can access distressing emotions without disorganizing terror or panic. MDMA does this
as well, but it maintains full cognitive clarity. Given this, MDMA is a superior tool for processing
trauma, but it is not yet available for therapists legally. Ketamine offers therapists a pathway to
process trauma. It also can be applied to the therapeutic encounter in a number of methods.
Ketamine enhances immediate psychotherapy. Low dose lozenges provide a twilight type of
experience that enhances access to painful material and speeds psychotherapy. We tolerate the
difficult insights better and can process our wounding at a much deeper level. Ego controls are
reduced, but not gone. This catalyzes psychotherapeutic change. Ketamine is an anesthetic
agent, but when used in this manner it opens our access to trauma. The options for ketamine
assisted psychotherapy are twofold: immediate and delayed: The immediate benefits are part of
the low dose lozenge method in which the practitioner sits with someone under the influence
of low dose sublingual lozenges (most common) or a slowed IV drip (less common). Some direct
processing is possible after the traveler emerges from an IV or IM session. The challenge here is
that, especially with the IM injection, this time frame between first alertness and full sobriety
can be quite brief. It does however allow for some existential processing and anchoring of the
major experiential qualities.
Ketamine enhances delayed psychotherapy. The alterations found with dissociation these brain
regions and in these specific brain locations (default mode network and hippocampus), while
maximal for the hour’s journey, do linger for up to 48 hours or so. This offers a practical window
for enhancing conventional psychotherapy. In our experience if conventional psychotherapy
occurs within 36 hours of the infusion the results are enhanced and synergistic.
Psychotherapists, not familiar with KAP, will comment that the gains made in one of these
penumbra sessions will often surpass all of the work done in the prior year in terms of insight,
cognitive flexibility and insight gained.
Ketamine enhances psychotherapeutic training. Ketamine provides psychotherapists with an
invaluable tool for learning the basics of psychedelic assisted psychotherapy. Given these dosing
and delivery options, a huge range of journey experiences can be arranged for the apprenticing
therapist to witness and support. The short time frame of a ketamine journey makes it more
practical for psychotherapeutic training. Ketamine is more predictable than the major
psychedelics, this actually makes it a superior tool to deliver a safe and effective training
experiences that do not overwhelm the student seeking to learn from another’s powerful inner
experience. The fact that these powerful inner and outer experiences can be linked in time also
build empathy and therapeutic wisdom.
Can ketamine support self-care? Another issue is raised by this discussion: Can ketamine
support the average person to explore and better their own self-care through enhanced
self-awareness. Bob Jesse calls this application the betterment of well people. Should ketamine
sessions and ketamine assisted psychotherapy be readily available to non-symptomatic
individuals? Is this form of self-care and personal training any less important?
as well, but it maintains full cognitive clarity. Given this, MDMA is a superior tool for processing
trauma, but it is not yet available for therapists legally. Ketamine offers therapists a pathway to
process trauma. It also can be applied to the therapeutic encounter in a number of methods.
Ketamine enhances immediate psychotherapy. Low dose lozenges provide a twilight type of
experience that enhances access to painful material and speeds psychotherapy. We tolerate the
difficult insights better and can process our wounding at a much deeper level. Ego controls are
reduced, but not gone. This catalyzes psychotherapeutic change. Ketamine is an anesthetic
agent, but when used in this manner it opens our access to trauma. The options for ketamine
assisted psychotherapy are twofold: immediate and delayed: The immediate benefits are part of
the low dose lozenge method in which the practitioner sits with someone under the influence
of low dose sublingual lozenges (most common) or a slowed IV drip (less common). Some direct
processing is possible after the traveler emerges from an IV or IM session. The challenge here is
that, especially with the IM injection, this time frame between first alertness and full sobriety
can be quite brief. It does however allow for some existential processing and anchoring of the
major experiential qualities.
Ketamine enhances delayed psychotherapy. The alterations found with dissociation these brain
regions and in these specific brain locations (default mode network and hippocampus), while
maximal for the hour’s journey, do linger for up to 48 hours or so. This offers a practical window
for enhancing conventional psychotherapy. In our experience if conventional psychotherapy
occurs within 36 hours of the infusion the results are enhanced and synergistic.
Psychotherapists, not familiar with KAP, will comment that the gains made in one of these
penumbra sessions will often surpass all of the work done in the prior year in terms of insight,
cognitive flexibility and insight gained.
Ketamine enhances psychotherapeutic training. Ketamine provides psychotherapists with an
invaluable tool for learning the basics of psychedelic assisted psychotherapy. Given these dosing
and delivery options, a huge range of journey experiences can be arranged for the apprenticing
therapist to witness and support. The short time frame of a ketamine journey makes it more
practical for psychotherapeutic training. Ketamine is more predictable than the major
psychedelics, this actually makes it a superior tool to deliver a safe and effective training
experiences that do not overwhelm the student seeking to learn from another’s powerful inner
experience. The fact that these powerful inner and outer experiences can be linked in time also
build empathy and therapeutic wisdom.
Can ketamine support self-care? Another issue is raised by this discussion: Can ketamine
support the average person to explore and better their own self-care through enhanced
self-awareness. Bob Jesse calls this application the betterment of well people. Should ketamine
sessions and ketamine assisted psychotherapy be readily available to non-symptomatic
individuals? Is this form of self-care and personal training any less important?
Conclusion
Ketamine is a non-specific agent that can deliver many different functions. It can be a
chameleon that looks dissociative or psychedelic, verbal or non-verbal, like near death or
merely cognitively loosening, a powerful personal experience or a training opportunity.
Dissociation is a powerful tool that can be applied in a vast number of ways. Ketamine offers a
wide and unique range of possible interventions.
Ketamine can treat severe treatment resistant depression, provide deep access to
consciousness, facilitate psychotherapy and train psychedelic psychotherapists. Given the
exploding research findings, surging professional interest and massive lay demand, the access
issues for the classic psychedelics stand as a stark reminder that this remains an emerging
paradigm. Professionals and explorers have few options. The only other reasonable options to
reach these goals involve travel to another country or breaking the law. It is difficult to
rationalize an effective training track for therapists that involves a criminal act or mandates
international travel. We can train psychedelic therapists with ketamine legally and in this
country.
Years from now we will likely have MDMA, psilocybin and perhaps other legal options to provide
needed care. Ketamine is a tool for shifting the paradigm in mental health. We must speed the
transition to psychedelic medicine and medication assisted psychotherapy. We have ketamine
right now to help us achieve that goal.
chameleon that looks dissociative or psychedelic, verbal or non-verbal, like near death or
merely cognitively loosening, a powerful personal experience or a training opportunity.
Dissociation is a powerful tool that can be applied in a vast number of ways. Ketamine offers a
wide and unique range of possible interventions.
Ketamine can treat severe treatment resistant depression, provide deep access to
consciousness, facilitate psychotherapy and train psychedelic psychotherapists. Given the
exploding research findings, surging professional interest and massive lay demand, the access
issues for the classic psychedelics stand as a stark reminder that this remains an emerging
paradigm. Professionals and explorers have few options. The only other reasonable options to
reach these goals involve travel to another country or breaking the law. It is difficult to
rationalize an effective training track for therapists that involves a criminal act or mandates
international travel. We can train psychedelic therapists with ketamine legally and in this
country.
Years from now we will likely have MDMA, psilocybin and perhaps other legal options to provide
needed care. Ketamine is a tool for shifting the paradigm in mental health. We must speed the
transition to psychedelic medicine and medication assisted psychotherapy. We have ketamine
right now to help us achieve that goal.
