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Key points
- To integrate psychedelic medicine into patients’ treatment plans, healers must evolve therapeutic language.
- Providers often say things like “let the medication teach you…” or “trust the wisdom of the medication.”
- Such language may alienate patients of spiritual faith. Ketamine is not a replacement for faith.
The past decade has seen a surge of innovation within the mental health landscape.
A fundamental shift is well underway that spans the fields of medicine and psychology. This shift involves the adoption of a new model of care that combines the power of biological approaches like stellate ganglion block and ketamine with psychological approaches.
Additional biological treatment options are soon to follow, including the use of psilocybin and MDMA for therapeutic purposes. For the present, however, ketamine is a psychoactive medicine that is legally used in an off-label way to address psychological symptoms.
Ketamine was initially developed as an anesthetic medication. Given its documented safety profile, it continues to frequently be used in this way, along with other anesthetic medications. Ketamine has psychoactive effects, but when ketamine is used as part of general anesthesia, an individual has no conscious awareness of ketamine’s associated psychoactive effects.
As part of integrating kKetamine into patients’ treatment plans, healers are evolving a new lexicon, or therapeutic language, to describe how these new approaches work.
There is an observed tendency among some healers to “reify” the medication itself by imbuing it with God-like characteristics.
For example, some healers will say things like “let the medication teach you…” or “trust the inherent wisdom of the medication.”
While well-intended, this kind of language can alienate those of spiritual faith who often struggle to understand how these new treatment approaches align with their personal faith.
To these patients, I would say this: Ketamine is not God nor a replacement for personal faith.
A patient-centered approach suggests that we adopt a healing lexicon that is inclusive of all patients.
All patients need a clear understanding of how ketamine works to help them heal, and many patients will also need support to understand that ketamine need not create a conflict with their faith.
I suggest some new explanatory language based on my framework as a classically trained psychologist with an integrative, interdisciplinary focus.
Ketamine is a psychoactive medication that primes people for new insights and altered perceptions that can help them navigate a variety of emotional, psychological, and spiritual challenges.
Just as caffeine facilitates certain cognitive processes, ketamine facilitates a new level of fluid thought.
Ketamine is classified as a psychedelic medication. The word “psychedelic” simply means to reveal (“delic”) the psyche (“psyche”).
Far from being inconsistent with the practice of faith, many of my patients have found that ketamine facilitates an awareness of spiritual themes that can be addressed once they are uncovered. In other words, psychedelic approaches are uniquely positioned to help patients address spiritual warfare, moral injury, and other wounds to the soul.
What happens during a ketamine session may indeed feel wondrous, and this is precisely what makes this a potentially powerful intervention for spiritual and moral injury concerns.
Psychedelics can also help re-center people in their faith. A patient can go into a psychedelic medication session with an intention that is spiritual in nature.
Here are some examples of intentions that are spiritual:
“I want to feel close to God.”
“I want to increase my trust in God.”
“I want to decrease fear of a situation in my life and experience a sense of spiritual peace.”
“I want to forgive (this person) who has hurt me.”
“I want a vision for God’s purpose in the next chapter of my life.”
How does ketamine facilitate such spiritual intentions?
Ketamine operates in a few different ways.
First, research suggests that ketamine lowers ther biological fear response. This can allow people to approach things that they would normally avoid, due to an otherwise aversive escalation of anxiety.
As a dissociative type of medication, ketamine creates a dreamlike state that can give a helpful distance from the intensity of feelings and memories, thereby allowing people to see their challenges in a new light without being overtaken by the body’s fight-or-flight response.
A critical insight is that fear cuts off the ability to develop new insights. When we are in a state of fear, we are laser-focused on a potential threat. Fear short-circuits our ability to perceive a range of options for responding to a situation. We often see just three options: fight, flight, or freeze.
When the fear response abates, we start to see that there are many ways to respond to the challenges in our lives. I’ve seen this phenomenon play out many times in couples’ therapy. Once the couple is able to listen and share without going into the tailspin of fight-or-flight, the couple comes up with lots of creative options for resolving even longstanding conflicts.
Ketamine not only decreases the obstacle to approaching our challenges by decreasing fear, it also facilitates new insights by activating additional areas of the brain that don’t often communicate with each other.
With the coactivation of new areas of the brain, we may be able to:
- Shift our perspective on a longstanding personal problem,
- Make a new emotional connection between a traumatic memory and other life experiences, or
- Perceive underlying themes in our lives that lead to a profoundly positive identity shift, a shift that can be long-lasting or even permanent.
The idea that there is “wisdom in the medication” could easily be replaced with a line of thinking that is common across therapeutic orientations. This concept is that under the right conditions, we instinctively move towards improved health.
In other words, our mind-body system is geared towards helpful adaptation.
As an example, therapists who use EMDR (Eye Movement Desensitization and Reprocessing) do bilateral stimulation in the belief that it facilitates processing of memories in a way that will be inherently adaptive. EMDR therapists, and many other talk therapists, believe that we have an innate capacity to heal, and that therapy creates the conditions that allow us to heal. This line of thinking is not new, nor is it limited to the use of ketamine therapy.
By adapting our language and explanatory models to be inclusive of all patients, including those of faith, we can demystify a range of promising new options for treatment and bring an end to suffering for countless people.
References
McIntyre RS, Rosenblat JD, Nemeroff CB, Sanacora G, Murrough JW, Berk M, Brietzke E, Dodd S, Gorwood P, Ho R, Iosifescu DV, Lopez Jaramillo C, Kasper S, Kratiuk K, Lee JG, Lee Y, Lui LMW, Mansur RB, Papakostas GI, Subramaniapillai M, Thase M, Vieta E, Young AH, Zarate CA Jr, Stahl S. Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. Am J Psychiatry. 2021 May 1;178(5):383-399. doi: 10.1176/appi.ajp.2020.20081251. Epub 2021 Mar 17. PMID: 33726522; PMCID: PMC9635017.
Stella White Paper. Published by Drs. Shauna Springer and Eugene Lipov (2021). Source here
