Note: Although ketamine is the main character here, the same idea can be broadly applied to all psychedelics, natural and synthetic, as they begin usage in the assisted psychotherapy space.
“Yesterday was a Blue Supermoon, and today is the last day of a month of dedicated routine, self-care, and commitment to myself. I can tell it’s finally working.”
That was my journal entry the morning of the last day of a hot August. I had been nearly a recluse for an entire month. My traumatic response coping mechanism is to self-isolate, like a wounded animal separating from the pack. For the first time in my life, I was alone by choice. I had three friends I was in regular communication with, but outside of the “must dos” and “need to-s”, I had all but withdrawn from everyone. I stopped participating in group texts, I turned down invitations to go out. Six months of major depression, a toxic business partnership I tried unsuccessfully to escape from quickly, being punted off a board due to performance issues surrounding my depressive capabilities, and getting dumped by a lover for not being “enjoyable” anymore with all that crying I was doing had me acting like a ghost. I almost became one.
Out of curiosity, I flipped back to my August 1st entry.
“My shrink put me back on suicide watch again and I have to pick up the phone now when she calls. I understand why but I don’t know how to help it.”
It had been my third time being placed on suicide watch over the summer. The police pounded down my door at 5:00 that morning for a welfare check. (I was terrified and it did nothing for my feelings of safety and protection.)
I flipped back to my last entry of August. Thirty-one days later, I didn’t find my way back to who I was… instead, I was discovering who I am.
I started psychedelic therapy with a home-based ketamine service in February, which at first glance doesn’t say much about its effectiveness. As a newly relentless advocate of the controversial treatment, how could I say it works to the extent that it saved my life in the same essay that makes it clear I had been suicidal while using? Ah. And therein lies ketamine’s biggest PR problem.
To understand why ketamine saved my life in August when it had done no such thing in the months prior, one has to understand two really important points; Firstly, ketamine is its most effective when done as a course of 6 treatments in close proximity (a week or less) of each other. Secondly, the primary benefit of any psychedelic therapy comes in the weeks following treatment, long after the high is gone, during the conscious practice of integration.
During my first two cycles, I kept having interruptions in my treatment. First, I got a sinus infection mid-cycle and had to stop while on another medication. Then I had work travel, which isn’t exactly the kind of trip you want to trip on. That was followed by a concussion, then COVID.
Setting aside the seemingly impossible task of six weeks healthy and home, I was completely lacking an understanding of what integration meant. To be fair to the program and my guide, everyone did their job to set me up to win. This wasn’t about my inability to comprehend something that seems esoteric (it’s not). I was simply operating on the generally accepted premise that the drug was going to do the work for me. It took me coming to the brink of ending my life in order for me to fully commit to doing whatever it takes to pull myself out of it. I became a living, breathing version of the phrase “do it or die trying”.
It doesn’t need to be that extreme and should never come to that. But, it’s going to be an uphill battle to change the narrative that fits with the politically comfortable stigmas.
Conventional SSRIs are ongoing daily medications that smooth things over and either dull or mask emotional disorders. Ketamine, and other psychedelic therapies, create optimal conditions for real change to take place. If post-psychedelic therapy integration is not applied, thoughts, behaviors, lifestyles, and habits will continue to perpetuate mood disorders, which in turn will make it seem like ketamine therapy is ineffective. Whereas psychedelics give people a chance to do the work themselves, SSRIs do the work for you (not really, but they smother things enough to make it seem like it). Ketamine’s branding problem isn’t going to be that it gets people high - it’s going to be that it requires people to be active participants in their own emotional well-being to be effective. Psychedelics require us to be radically responsible for our own lives - those who fail to do so will lay blame on the drugs and not themselves.
That’s gonna piss a lot of people off. Accepting personal responsibility for how we experience our lives requires spine and humility, and is not for the faint of heart.
If all anyone gets out of their ketamine-based therapy is forty-five minutes of feeling “high”, without taking meaningful action with the neuroplasticity available to them in the days following treatment, the likelihood of them reverting back to depressive states is significant. Traditional psychiatric antidepressants don’t have the same problem; that pill gets popped every day, with or without positive behavior changes. Sure, there’s usually some adjustment in the beginning what with finding the cocktail and dosage and of course the inevitable six-weeks waiting for the meds to kick in, but all of these problems we’ve collectively decided to accept.
Conventional antidepressants help us not to lose. Ketamine sets us up to win, but requires we play the game.
Ketamine sits on the opposite side of the SSRI co-dependency. We get six doses per cycle to start making changes. It provides opportunity, not solutions. And, while the safety of the drug is such that the cycles can be revisited as needed (it’s not a fix-all and never claimed to be), without an intentional integration practice (psychotherapy, mediation, journaling, or other), the drug falls flat a few days after the antidepressant effects have worn off.
The need for Integration Coaches, Psychedelic Guides, Ketamine-Assited Psychotherapy, and all other emerging forms of informed practitioners will continue to rise, and, fingers crossed, be gainfully employed. We’ll need to figure out a way to convince the general public and those positioned to make law that these are legal and necessary providers and that to isolate them from the treatment itself like we’ve been doing for decades is useless. Psychologists and psychiatrists have been separate professionals for years, a mind-boggling fact when you consider that one provides the diagnosis and the other provides the treatment. In my own mental health journey, I’ve struggled to get both providers on the same page so that my treatment plan is accurate and effective.
Ketamine, or any psychedelic therapy for that matter, cannot be left to the same division. A pill popped daily can do a good enough job to cover up the problem, even if it’s the wrong pill. Ketamine doesn’t have that luxury. As we inch closer to finally getting legalized, the naysayers and evangelists will start digging around to find those people who got high and nothing more, the ones who used ketamine and unalived themselves, and the rest who tried it but still ended up on Zoloft. They will scrape the societal fringes and find those living in addiction, committing crime, or harming themselves or others while having received ketamine therapy. They will prop up these examples, hoist their virtue signals high and become at best annoying, at worst problematic. Our best bet is to resign ourselves to the same fate other informed trailblazers have submitted to in the past; get ready to answer the same questions, patiently and relentlessly, from the most banal of askers. This is part of the work that we need to do. It is unavoidable, if unpleasant. The conversation around the importance of integration should not stop until it is as co-branded with psychedelics as neon mushroom imagery.
I sent my clinician two photos. One was of my entry on August 1st, my sloppy cursive lamenting being back on suicide watch. The second photo was 30 days later, finally finding my way out of the darkness. The ketamine was the same. The integration, a complete commitment and acceptance of being personally responsible for how I was experiencing life, was what I changed.
