Ketamine and a Cartography of the Psyche - Dr. Grant
I put some client experiences during ketamine into a framework that originated with the grandfather of psychedelic assisted psychotherapy, Stan Grof, who pioneered LSD psychotherapy in the 1960s and holotropic breathwork in the 1970s. He describes the framework as a cartography of the psyche, or a map of the mind. These maps show up during ketamine too.
Stanislov Grof's "Cartography of the Psyche" includes 4 scenes that illustrate important emotional and developmental states, called "basic perinatal matrices or BPMs".
Clients who receive ketamine assisted pscyhotherapy often describe images and emotions that correspond to these stages. I present them here to describe how these experiences can be important for the healing process, whether one is healing from depression, trauma, anxiety, or the weariness of life.
(Note to my academic self: Psychological frameworks abound. Examples include psychodynamic, transpersonal, behavioral, internal family systems, and so many more. These theories are often implicit, hidden from view, and not thoroughly discussed with clients. Putting the theory in the background can be a blessing for people who are properly focused on practical outcomes (Am I happier? Less anxious? Better connected with people I love, or at least like?). Yet, ideas about how the mind works can be fun, and sometimes provide a map for ways forward. The goal of this blog is to have fun and provide some maps, and not to defend one true map).
The Amniotic Universe (BPM 1)
During a ketamine journey, this experience can feel oceanic - a warm loving calmness, reassurance, unconditional love, and peaceful. Some clients may literally feel themselves floating in a spatial liquid of calm and nourishing love. There may be stars above and warm water or open spaces.
Relationships with your mother are always complicated. As such, this experience will be most nourishing if you ease into the pool and not interrogate its origins or intentions. Accessing this space is calming and this resource is particularly important for people who have anxiety or depression. Savoring the calmness is the goal, and some of this can be remembered when fears arise.
Cosmic Engulfment and No Exit (BPM 2)
Most of us understand the feeling of being overwhelmed. There is too much happening and we lose orientation about how to deal with it. Some of it hurts. Severe anxiety, like what happens with post-traumatic stress disorder, can be like this: you are holding up and getting along and suddenly some trigger sets you off. You are undone.
Ketamine can provide a fast moving experience that takes clients from scene to scene quickly. Clients may experience rapid transitions, as in dreams, from one emotional state and scene to another very different scene. Sometimes the transition is to a place that is unpleasant or frightening. We have heard clients say "I want to go back."
These transitions are not to be controlled. One can be reassured that a transition to a difficult scene during ketamine treatment will pass rapidly (unlike labor); ketamine is short acting and most journeys last less than an hour. A frighting scene will typically last only a few moments.
We counsel clients that if a door or window appears, they might see it as an invitation to pass through. The scene on the other side is usually different. The client may also signal that they would like for their hand to be held or their foot be squeezed - just holding out your hand is enough. This kind of calm grounding connection can help.
This experience happens as part of the healing process, and will provide you and your therapist material. The fears that arise will eventually provide a wealth of opportunities; although in the moment, they are just scary. The squeezing is the beginning of the birth or rebirth process.... Breath and keep going.
The Death-Rebirth Struggle (BPM 3)
This is a transitionary state. With ketamine, these states are often very fast. The sense of the body and any claustrophobia has been left behind, as ketamine is a dissociative anesthetic that releases the mind from the fears of the body.
Getting curious about where this process will lead, and imagining your psyche to be flexible and escape from anything that binds you will help you stay free and engaged in this most adventurous scene. Where does it lead?
The Rebirth (BPM 4)
The emotions are joy and relief from struggles and suffering. There is freedom to roam and explore. These moments are sometimes sunny and sometimes starry and sometimes oceanic. There is always lots of air to breath - one of the advantages of ketamine is that it does not generally suppress the respiratory drive - indeed, many will breath deeply.
These scenes are opportunities for emergence from depression or anxious states. Some people with lifelong depression have said that their time toward the end of the ketamine session, and extending for days or hopefully weeks afterward, are the first real sensation of life without depression. There can be a lightness and a sense that anything is possible - a happier life, some serenity, connection with others, and some freedom from addiction. These are learning opportunities, and integrating the lessons learned into ones daily practice can prolong the benefits of ketamine.
The ketamine experience is highly variable between people, and varies from session to session for the same person. The ketamine experience usually is a surprise. Once you have found a safe set and setting, it is best to surrender, immerse, savor, behold, and relish your ketamine experience.
Before taking ketamine, I recommend that you look for a therapist that you trust and has experience, and is willing to stay present with you. If you have a mental health care team, make sure that everyone is talking with each other. Ask and check for references and credentials. Administration of ketamine requires that health care providers have a prescribing license for DEA level 3 medications. Such providers are medical doctors or nurse practitioners. Teams of prescribers and psychotherapists make for a good psychosocial and medical safety net.
Once you find the right setting, ask as many questions as come up. Listen for answers, and if you are not satisfied, ask again. Your concerns arise from your protecting internal parts, and you are wise to be grateful for them (even if they can be overbearing sometimes). Work with your concerns, not against them. Many people ask to record their sessions, on audio and video, to help remember and to be reassured about everything that happens.
I believe that ketamine acts to facilitate a healing capacity that already exists within all people. A surgeon might sew up a cut, but she does not cause the skin to heal - that is a native process. Similarly, ketamine is just facilitating the mending of parts of the psyche that may have been torn apart by trauma, substance misuse, abuse, neglect, depression, or anxiety. If you feel better after ketamine, please give yourself the credit as this is your work and joy.
Blog authored by Robert M Grant, MD on April 29, 2018.