Why Ketamine Therapy? A Psychiatrist’s Perspective
Does psychedelic medicine have a legitimate place in the fields of psychiatry and medicine?
In my evolving and empirically-informed clinical work, I have come to believe that ketamine-assisted psychotherapy (KAP) does play a potentially indispensable and unique clinical role.
Here is what I have learned…
Ketamine might not be unique, except that among medicines with psychedelic properties, only ketamine is legal. Given its safety profile as an anesthetic -- ketamine is on the WHO list of 100 essential medicines because of its rare profile of being especially safe and effective. Psychedelic medicine undoubtedly has made a comeback. Why? Especially as almost all psychedelic agents are, from a clinical and legal perspective, deemed to have no legitimate medical uses and federally outlawed on “Schedule I.” Shouldn’t we be skeptical of any claim that ketamine so far as it is psychedelic does have unique medical and psychotherapeutic applications? We have negative associations with mind-altering drugs including criminality, dyscontrol, poverty, and brain damage. From the perspective of the layperson, a doctor who administers a mind-altering drug may seem the opposite of doctorly. Given the stigma and pre-conceptions, a “ketamine doctor” may seem harmful and dishonest, a "Dr. Feelgood” or a “quack." From the perspective of the medical professional or psychotherapist, its mind-altering effects still may seem like a mere mental fireworks display or, to any extent they do help, like an ethically questionable and unnecessary shortcut.
The law must be respected, however, not all laws are created equal. As a board-certified psychiatric physician with depth-psychological leanings, I concord with the many cultures and traditions that have found therapeutic and social value in psychedelics. Whether natural, plant-based, or completely synthetic, psychedelic medicines are particularly useful in psychotherapy. They may have a unique capacity to heal trauma at its root and origin.
The human animal is emotionally characterized by its relational origins. There is a layer of the mind that forever refuses to give up the idea or satisfaction of total all-encompassing love. This can also be understood as total acceptance ergo total safety. Despite the best potential conditions of early life (love, supportive caring family support, security) social reality is overwhelming and devastating and a “primal trauma” occurs. The primal trauma can be translated thusly: The frustration of my need for total all-encompassing love has annihilated me. My own desire (my own self) has caused pain and suffering. Defense mechanisms like splitting, denial, and internalization are defenses of the traumatized infantile psyche. The internalized and split-off unconditionally “bad” haunts and torments the self-experienced as a void or absence, leading to mental distress whenever these parts arise. The parts that seek love, acceptance, and security are denied and when we feel this we experience emotional pain. The goal of healing is ultimately to integrate these denied parts of the self and allow and accept them, so as to not experience internal rejection in the form of defense mechanisms.
In our modern era, our evolutionary goal will no longer be simply survival but would best be to achieve human goals like integration or self-actualization, or global goals like social peace and harmony. Traditional psychotherapy holds remarkable promise to become in touch with the “bad parts” or rejected self to reduce mental health symptomatology but is slow and arduous. Is it unreasonable to wish for a technology that could both hasten healing and improve upon traditional methods, for ourselves and the collective?
In my experience and judgment, safe ketamine-assisted psychotherapy is such a technology. Ketamine is a portal into the deepest, most insightful psychic depths. With ketamine, we feel experience, and “know” deep truths about ourselves that are otherwise very difficult to access. This is likely because ketamine quiets the egoic functioning (those defensive mechanisms within the brain which create splitting and other defensive denials) allowing us to reach a part of the consciousness beyond the defensiveness which causes us distress.
How much of our conscious life and development is spent adapting to a fabricated social world including those of our family and culture? How much genius was suppressed, in many cases lost forever, in that process? We forget how to authentically love, and we forget how to be, for being is relational, requiring conditions of safety and trust.
When we are attentive to those needs, we are fully alive and thrive. We are fully present and live creatively and meaningfully including societally. We become creative-destructive agents of society, and society itself gets better.