Returning From the Outer Reaches

My relationship to the mysterious is one of wonder and expectant understanding. I have always figured that it was a matter of time before we, as a species, came to learn the things we don’t know. I can recall Stephen Hawking’s conjecture that we were wrong about black holes, but we were, in fact, quite correct that gravity can cause a star to implode itself, for all practical purposes, inside out.

As we like to say, knowledge is power, but these days, given my thirst for knowledge and lack of interest in power, I can’t help but wonder if knowledge isn’t sometimes something as simple as peace.

When I began my treatments for depression with Ketamine last fall, all I really wanted was peace. That may sound like peace is a small, achievable thing, but my quest didn’t lack for ambition. I wanted peace for me and the peace that would bleed into the lives of those around me.

I still recall the unsettling epiphany on my drive home from my intake interview, at the end of which I was taken on as a patient, when I realized that if they were accepting me as a patient then I was showing some significant objective measure of depression. Even as I thought I was in a pretty good place, I was still depressed and anxious enough to merit a severe intervention. Disquieting that realization is.

I now have a baker’s dozen (that sounds so much better than unlucky number 13) Ketamine sessions under my brain pan. The changes are numerous, though no one who hasn’t seen me in a year would fail to recognize me over the phone. Those who are close to me note a brighter tone to my voice, as if Miles Davis finally put down that infernal mute. I laugh more easily. I’m more patient. When my feathers get ruffled, it’s possible that mine are the last in the room to ruffle. I’m also more confident, so much so that when I don’t feel confident its absence is uncomfortable and I go quiet. It’s a bit like putting on a very old pair of jeans from before I lost 50 lbs. Ugh.

What I’m about to report is why if you are experiencing depression, this treatment is worth considering and if you know someone experiencing depression, I encourage you to share this and the other posts tagged “Ketamine” with those you love.

I went to the clinic where I’ve been treated these last six months. Upon arriving I filled out the various forms that measure dimensions like depression, anxiety and trauma that I score before each session. To give you a clear indication of just how far I’ve progressed since I began this treatment, the Hamilton Anxiety Scale (Often referred to as the HAM-A) is a standard form with 14 questions graded from 0 (no symptoms present) to 4 (severe). Originally, I scored 28, high enough that during what I considered to be a decided upswing in my mental health I still qualified as moderately depressed. I can assure you that at the beginning of 2019 I’d have scored even higher.

But on what I planned to be my final session for the foreseeable future, I went through the form making circles with my pen. Circle after circle, and then a single strike: 1. I scored exactly one point on the HAM-A. My other forms scored similarly low responses.

I sat there, looking at my responses, dumbfounded.

It is easily possible to lie on such a form. I am, however, aware that to do so is highly counterproductive. I have nothing to prove to anyone. The primary reason to do this work is for my own benefit, so lying on it is a disservice solely to me. A corollary: Back in 2012 when I crashed on Tuna Canyon, the first paramedic on scene asked me if I had lost consciousness. I said, “No.” He asked me how I knew. I told him, “There are no gaps in my memory. And, I’d really prefer to be unconscious right now.” Then he asked why he should trust my answers. I responded, “I’ve fucked up pretty badly. I am in need of a lot of help right now. To get that help, you need the best possible data set to work from, so it’s in my interest to be honest with you.”

“Good answer,” he said.

So, with no real reason to lie, I sat in the waiting room looking at my responses (and taking pictures of the forms because I was so shocked by my responses). I don’t walk around asking myself if I’m anxious or if I’m particularly fearful. Asking me the question provokes a mini-inventory, though, and—holy crap—who knew that I wasn’t particularly jumpy anymore?

This conveyed an absolute measure of my recovery, one that I couldn’t really argue with. If I’d been asked for a sense of the improvement for which I hoped, I don’t know how I would have responded, but I can assure you that my hope would have been tempered by a form of modesty. Considering the HAM-A as a way to judge said recovery, I might have said something like a seven or an eight. Maybe? I’m not confident on this point, but there is no way I’d have said, “I want to score just a single point.” That seems either arrogant or delusional. Possibly both.

My treatment with Ketamine has carried two separate recovery paths, ones that sometimes run parallel and sometimes diverge. The first path is exceedingly passive. As long as the Ketamine is coursing through my system, it’s making regions of my brain talk to each other that had long frozen each other out. I don’t need to do any introspection at all for that part to happen. Just showing up and taking the medicine makes a big difference. The second path is active. It depends on my introspection, my desire to move beyond where I am, contains a requirement that I be honest with myself, and my counselors. When I have visions of a great stone giant or a former partner cradled in love, that’s the work that requires me to be present and to sit with those visions to process them. That I knew what those things represented on an instinctive level I consider to be a sign of just how hard I’d been working before I ever got to that clinic.

What I have come to appreciate is that those visions are what have brought me a kind of present-tense peace, a phenomenon I consider different from the eradication of the symptoms of depression. Sure, to not be depressed is to find peace, but those visions were the experiences that caused me to stroll down the sidewalk in San Anselmo grinning like a kid with an ice cream cone. The visions made my soul glow. And to have your soul glow is to feel something so profoundly supernatural that the desire to experience it again is tempered only by the difficulty of the journey.

What my final session taught me was that there is a kind of sweet-spot to dosing Ketamine. I’d had some challenges with coming out of the K-hole rather quickly due to disruptions caused by bad music choices. A random shuffle is not the way to go, boys and girls. I thought that the solution was a more powerful dose, not more carefully curated music, though I decided to address that as well.

For that session, I was instructed that I’d receive a two-part injection; first, I’d receive an injection of 65ml and then, 12 minutes later, I’d receive a second injection of 30ml. I depart for dimensions unknown very quickly, about two minutes after injection. Several minutes later I feel what I call liftoff, or departure, which is when I begin to dissociate, to wink out of existence. I don’t have any clear memories of what I was experiencing but one of my counselors reported after the fact that I was just saying, “Love, love, love,” over and over.

I was told I’d probably experience a slight prick with the second injection and that I would gradually go deeper. The goal was to deposit me deep in a K-hole so that the insights might be as profound as possible. This was when I learned that for the last three or four sessions I’d had, the dosage was simply too high. Previously, I’d experienced things moving too quickly and a number of non-referential experiences that cannot be described in any great detail with man-made language. Everything I knew about this world broke down. And experiences would pile on top of experiences more quickly than I could register them. I wasn’t clear on the cause of this, but when I received the second injection: A) I did not feel any prick of the needle. I was fully dissociated, and B) I accelerated through this other dimension like I’d been launched from an aircraft carrier in an F-15 Tomcat. What had been a lovely 15 mph ride on a beach cruiser became top fuel dragster with a green light through one event after another.

At some point the music stopped, which is to say that the first track from Brian Eno’s “Ambient One: Music for Airports” ended. When the music ended the world went blank, dark, and all activity stopped. Music is the gas in the engine of the K-hole and without it, that vehicle comes to a stop, which is to say, I rather suddenly found myself in a void of no light and no dark and no form at all. Music makes the world around me in a K-hole. Yes, I know how that sounds.

The point at which space starts to break down, the separateness between people checks out, is intensely strange. I’ll find myself trying to think, to reason through what I’m experiencing, to process it and understand what is taking place, and even wondering why something I’ve suddenly seen is so simple it isn’t a truth the people in my life all appreciate. I think this is the outer limit of the useful universe that Ketamine can deliver me to. I’ve realized, though, that there is yet another realm well past that.

I can tell you there is a place there. I can tell you things take place, happen. I can’t tell you if any of it is volitional, if there are other beings in any sense of the word. I can’t tell you if there is love, hate, happiness or malice there. Those concepts don’t seem to apply. Indifferent is a word that fits. The only thing approaching a visual memory I recall from that part of my K-hole was something sort of green, made from a stone or dull metal. It was blocky, think three-dimensional Tetris and the blocks would slide into positions and back out of them, but without any sort of rhythm; this wasn’t like the movements of pistons in an internal combustion engine.

What happened next is largely shrouded from my memory, but I have a fleeting sense that something was going to dismantle me, take me apart. This wasn’t ego dissolution, but assimilation into something else. I was not digging this and was resisting it, and once again could not recall the advice to embrace that which frightens me. At one point I called out for help. Some tiny shred of me still knew that I was at the clinic and that my counselors were nearby and I called out to them for help. They told me afterward they were by my side and spoke to me, and I have some sense that my ears picked up sound, but they could not reach me. Whatever was happening passed.

When I emerged from my K-hole, I was reasonably disoriented and I kept the blindfold on for some time because looking at the world through that lens isn’t what I’d call recreational. We talked about what I’d seen, and as I mentioned, they told me about some of what I’d done and said while I was in the K-hole. In the room I felt a strong sense that we were wrapping up a long process. This was the epilogue. They encouraged me to remain in touch and that if I ever needed their guidance, I can always make an appointment. I’ll continue to have a prescription for Ketamine that will allow me home sessions as I feel a need to deal with issues.

As a method of treatment, I have to give this five stars out of five. It was demanding, physically difficult, and made for a challenging conversation to initiate. I’m willing to tell anyone that I’ve done this work, but I prefer only to have the conversation with people who are sympathetic. If I hear someone call cannabis the work of the devil, I’m apt to keep quiet about my personal journey. This treatment has been as effective as a round of antibiotics, and just as rough on my stomach. I find it curious that when I look at how much time I’ve been under the influence of Ketamine, only about 10 percent of that time has been spent having a mystical experience. Most of the rest of that time, spent in the after-effects of the drug, is as pleasant as a post-bender hangover.

I will say that I think this treatment is likely to work best for people who have already pursued counseling. It would be difficult to get all of what’s possible out of this work if the patient hasn’t really identified all of their issues.

So what’s different for me in the wake of this treatment? First, my capacity for love and how it can inform compassion, kindness and empathy has grown by an order of magnitude, maybe two. I’m more relaxed and patient, and more obviously, more centered and calm. Peace is the perfect word with the power to gather all of these changes and organize them according to a larger principle. Events can still overwhelm me. I can still experience enough frustration to feel anger, and I’m definitely still an animated person. I remain, as ever, an imperfect being, but one who is entirely more comfortable with my limitations and much more comfortable embracing the world—limitations be damned.

Truly, the easiest way to define what is different for me is to say I am more peaceful and love more readily. What this means is that I’ve achieved a place where I can be happy, that I can cultivate it within myself and I don’t need to look elsewhere for what makes me happy. To the degree that work remains to be done, I can see that the path before me calls on me to be happiness, to embody that so that everywhere I go and everyone I encounter results in me leaving behind happiness like the scent of a perfume that lingers in a room. Honestly, I don’t know how I can reach that place. It strikes me as something only the Dalai Lama could hope to achieve. But here’s what I do know: I now occupy a mental space that I thought out of reach a year ago, a place of such equanimity I thought anyone who could engage their world this way to be superior to myself. This journey isn’t over, and the next voyage may prove more surprising than this one.