Another interesting conversation with my wife this morning.
We are preparing to teach a weekend about psychedelic therapy, we use high dose psilocybin role play scenarios as central to teaching how to use these medicines.
We were contrasting the various drugs used in so called psychedelic therapies, MDMA, which is not a true psychedelic, perhaps better labeled as an empathogen, ketamine which has been labeled a dissociative anesthetic, compared to the classic psychedelics, psilocybin, LSD, mescaline, DMT.
Ketamine is being used with exponential growth as a therapy, as it is not in a schedule 1 category.
Ketamine can be given orally, intramuscularly, and by intravenous routes.
Ketamine differs from all the other drugs mentioned above by also having an anesthetic quality, at certain doses the body can feel wooden.
My argument here is that ketamine is no more dissociative than MDMA, or any of the classic psychedelics.
What is dissociation?
“Psychiatry Separation of some aspects of mental functioning from conscious awareness, leading to a degree of mental dysfunction or to mental conditions including dissociative identity disorder.”
https://www.lexico.com/en/definition/dissociation
Dissociation is central to what we are treating with psychedelic therapy.
In PTSD, as well as in “normal neurosis,” parts of our experiences become unconscious, repressed, hidden away from our conscious day to day living. We then “project” these hidden parts of ourselves onto others.
“The term psychedelic, from the Greek for “mind-manifesting”, was coined by Humphry Osmond, a British psychiatrist working in Canada in the 1950s.”
https://www.newscientist.com/definition/psychedelic/
These medications seem to function to help make unconscious thoughts, feelings, experiences, accessible to the conscious mind, resulting in healing the dissociation.
MDMA, seems to act through enhancing feelings of empathy and bonding to decrease the emotional flooding that originally prevented the unconscious from being accessed by the conscious mind.
Ketamine may act in different ways, depending on route and dose. However, at certain doses ketamine clearly can act in a similar manner to classic psychedelics.
The CADSS looks at dissociative symptoms such as:
• Feeling like things are in slow motion or seem unreal.
• Feeling separated from reality.
• Feeling as if looking at things from outside the body.
• Feeling like you are a spectator or like you are observed.
• Objects looking different.
• Colors seeming duller or brighter than usual.
• Time speeding up or slowing down.
• Seeing things through a fog or having tunnel vision.
• Losing track of time or what is happening in the environment.
• Feeling as though your body has changed.
These are all effects that can be seen with the classic psychedelics…
This article discusses that the dissociative effects, as measured by the CADSS, may not relate to the anti-depressant effects of ketamine:
https://www.nature.com/articles/s41467-020-20190-4
So, the dissociation, as measured by the CADSS, is clearly a different experience than the dissociation as defined by psychiatry.
My argument here is that the dissociation, as defined in psychiatry, is what we are trying to break through, using these therapies.
The dissociation that is defined by the CADSS is very different and is a reflection of the softening of the ego defenses, which prevent accessing the unconscious information needed for healing.
http://enlightenedmdphd.blogspot.com/2015/10/psychedelics-meditation-and-death.html
Therefore, these medications, when used in the proper set and setting, are actually “integrative.”
These methods lead to the integration of repressed unconscious information back into the conscious mind. Resulting in healing.
Hence, my proposal to designate these medications as “Integratives.”
Namaste
