A broad introduction to Ketamine through a socio-ecological perspective
Ketamine-assisted psychotherapy, also known as KAP, can be considered a pioneer psychedelic modality within the current era of drug policy change. A pioneer group is a biological term for a type of life form that moves into an area that has been highly disturbed or disrupted. Pioneer species share characteristics such as being able to operate or thrive with little external support. One example in the Central Coast of California regions, is the French broom plant which is in the Fabaceae or legume family. This plant thrives in highly disturbed areas and is considered by many to be invasive as it is non-native and takes over an area quite easily. French broom is also a nitrogen fixer which is a characteristic of many plants that help restore damaged soils to support biodiversity in the future. Although this plant takes over an area very easily, ecologists have also noticed that over time, other species of plants are able to integrate after the French broom has served its purpose, so to speak.1
I am using the analogy of a pioneer species around the psychedelic movement because many attributes of modern culture have actually thwarted individuals’ abilities to explore and develop their own consciousness. Within our social landscape, our abilities to collectively develop have been oppressed so this cultural ecology could be considered a disturbed or disrupted area. The substance known as ketamine has been entering into this social landscape more and more for the past few years, acting as a pioneer species for the Psychedelic movement. While cannabis has also served on the front lines, opening up the doors for perception, there is a lot more social stigma around that substance that ketamine simply does not have. Also, because ketamine is manufactured by pharmaceutical companies there is already a well established economic and legal infrastructure to promote its use.
It is important to note that an article came out from the FDA this past October 2023 warning healthcare practitioners and recipients about the dangers of off-label use of ketamine for psychiatric “disorders”. I do know that it is common practice for medicines to be used for off-label use. In fact, Ketamine has been used with great success around mental health challenges such as PTSD, depression, suicidality and anxiety for over 20 years at this point. I mention this FDA warning because there is a lot of conflicting and just plain confusing information out there. In 2019, the FDA approved Ketamine in the form of a nasal spray, brand name Spravato aka esketamine, so this recent warning offers a directly conflicting message to citizens.
Since exploitative capitalism has integrated with the healthcare systems, this inherent conflict of interest leads to misleading information and ethical challenges.
In any case, it is important to be aware of polarizing arguments when it comes to policy or access to client centered care. Long-term mood stabilizers, herbs and preventative care modalities, psychedelics, community centered care, and other health care options ought to ideally be available for all, so that each person may have autonomy and choice in their personal care journey. Now, with the recent tragic loss of actor Matthew Perry, we may see Ketamine being demonized as the cause even though it has been well known he was struggling with various substances and the actual cause of death was drowning. Providing education and judgment free spaces for any person managing health challenges is key for mitigating harm. Please, always be cautious around mixing substances as contraindications, such as alcohol and ketamine, can have extremely harmful, and sometimes fatal, impacts. Also, be careful to not be alone, use the sober buddy system, when exploring altered states, for safer harm reduction practices.
Another relevant note here around specific therapy frameworks; the acronym KAP is used to refer to Ketamine-assisted psychotherapy and it is also used to refer to a Kink Aware Professional. My private practice is centered around harm-reduction in the form of education and supporting clients in curating their own experience based on how they relate to safety. Because of the abundance of Ketamine options at this point and because of the regulatory nature of the pharmaceutical drug, I only work with Ketamine if my client has their own prescription and is looking for some additional support. I also do not advertise as a kink aware professional not because I am not kink aware, but mostly because it is not a niche or speciality of mine. I am comfortable and familiar with kink in general, or as I like to say ‘kink light’, I can support folks with desire discrepancy or healing with kink explorations. The work may be around sexual healing, emotional, communication skills, and we may use somatics, psychedelics, herbal allies or other tools. Often these various avenues for relating to ourselves, the body and each other are inextricably linked and it is just a matter of finding which tools are a good fit for one’s tendencies and established comfort zone.
Regardless of one’s personal goals or challenges we may be orienting around, the somatic tools can be great to use with the softening, or pain reducing, impacts of Ketamine. These tools can be utilized before or after a session to prepare or integrate as well as while the client is experiencing Ketamine as long as they continue to have access to cognitive functioning. In other words, if the journeyer begins to drift into a dissociative or other alternative conscious space, it is not ethical for a practitioner to be manipulating or ‘guiding’ them with any agenda. This ethical boundary can be applied to any altered state experience regardless of the substance or lack thereof. This ethics perspective could also be applied to the altered state feeling that can come along with somatic exploration and therefore be applied to identity, sexual, or other personal explorations. If you are a practitioner or recipient within the mental health realm and wish for additional support around psychedelics, client centered care, ethics, somatics or herbalism I offer liberation education and empowerment in gaining personal experience safely.
While I do not think it’s fair to reduce the experience of being on ketamine to dissociation, dissociation is a quality in many people’s experience with the substance. Just as I personally would not label ketamine as a psychedelic, the experience does have psychedelic characteristics. While this might seem like splitting semantics hairs, I do think it’s important to note so that as folks are becoming more educated within the field of psychedelics we aren’t just simply lumping all these different medicines into one psychoactive psychedelic experience that really consists of many different types of experiences. The essences of these mind-altering substances hold within them Nature’s technology that goes far beyond our human understanding or the aspects for human use. If we are considering systems thinking and deep ecology that encompasses our social landscape and current context, then we might want to consider how these various consciousnesses or medicines are actually working with each other for the betterment of all life, not just us humans. Once again, perhaps ketamine is acting as a pioneer species standing at the forefront of the movement, taking a lot of flak perhaps as the cultural prison doors are reopening. Just as many other entities, people or organizations are acting as bridges between worlds, ketamine does so in many ways, including showing up prolifically in both under and above ground spaces.
The rich, organic soil produced in the layer connecting the above and underground spaces are known ecologically as humus or ‘duff’. An ‘ecotone’ is a space where two biomes meet. For example, where the forest meets the meadow is an ecotone. The duff is an ecotone. In nature, ecotones are where the most diversity happens, the intertidal zones, where life arose from the depths, or where the deer is eaten as they step out from the shelter of the twigs, all offer a merging of difference and opportunity for more life. This concept is true in our relationships and society as well. The amplification of life affirming ideas or sharing cultural wisdoms, all point to expedited adaptation and co-evolution. This is what I dream for the psychedelic revolution. That the medicalized, above ground world, and the organic underground can learn and support each other in this forging ahead towards an integrated society. We absolutely all have something to learn from each other and when healthy power dynamics can play off each other, instead of grabbing at each other, we will increase our potential for healthy societies by the nth degree. After all, is dissolving of perceived separateness not a core lesson of the psychedelic experience itself?
Dissociation can be considered the disconnection from one thing to another. This mechanism of our bodies or nervous systems supports us from becoming overwhelmed. Dissociation can show up for someone in a way that is chronic or acute, that causes regular problems or that goes unnoticed. An example of acute dissociation might look like a person feeling numb or detached from their own self, physical, mental or emotional, during a sexual experience. One way that dissociation shows up in our culture at large could be how we manage living with high population density. Dunbar’s number is an anthropological idea around how humans have evolved in groups of approximately 150 individuals and that that is the number of healthy relationships each of us can maintain. Because we live in neighborhoods where we’re exposed to much higher numbers of individuals, it is easy for us to become chronically dissociated to help our nervous systems manage the large amount of information that we did not necessarily evolve to be able to process. In my opinion, this is one of the reasons why psychedelics are integrating into the mainstream at this time to support our efficient adaptation to modernity and the challenges that it creates.
One of the main tenets of client-centered healthcare is meeting people where they are at. If we have a cultural epidemic of dissociation, of people lacking embodiment skills or using screens to live a life of spectacle22, then we must take this into consideration within our health care frameworks. This is one reason why ketamine has been able to integrate and support so many people because of its ability to meet people where they are at around dissociative tendencies. When folks are able to have a bird’s eye view of their troubles, this objective perspective can offer great relief and breathing room to alleviate suffering. And while people, everyone, deserves relief from suffering, this is a fine line to walk in supporting mental health care because of the potential for simply replacing one form of dissociation with another. While I am not necessarily concerned about this on an individual level because of my values around harm reduction, I see this more as a larger movement issue that there is not more conversation in the mental health field around the core issues causing mental health problems. In other words, most people are suffering from mental health challenges as symptoms of living within late capitalism and over-individualization (at least in the U.S.A.) versus not doing enough psychedelics. The wellness industrial complex and the nonprofit industrial complex are very real manifestations of enabling harm for the sake of job creation or maintaining the status quo within a culture that basically devalues nature. I do not mean to disparage those, including myself, doing great care or social work, I just need to highlight that only focusing on the symptoms of a problem and not its roots is a sign of lacking integrity within an organization if holistic care is a stated value.
I am an advocate for harm reduction principles meaning individuals ought to have autonomy and free choice around their healthcare decisions. Harm reduction values allow folks to choose what feels empowering for them as opposed to prescribing an overarching standardized protocol for every person. So considering harm reduction values we need people to be able to reduce symptoms, mitigate harm and also make choices for themselves. The value of harm reduction could be compared to the value of abstinence which has in recent history been the only supporting tactic for above ground mental health service offered to those suffering from addiction. While abstinence might be the best choice for many, it most certainly is not even a realistic choice for most. If a person becomes dependent or just interested in regularly consuming a substance as a coping mechanism to exist in today’s world, that person deserves just as much dignity, respect and support as folks who become addicted to working or hoarding material wealth. I am saying that with somewhat of a tongue and cheek tone to make a point around the reversed stigma in our society that has been created to enable abuse of power around economic classism; this being the actual core cause of most healthcare challenges for both individuals and groups.
If you, a loved one or your mental health provider could use support around psychedelic liberation education or other mental health support, please schedule your free consultation call here.
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- To learn more about regenerative design, deep ecology & systems thinking please check out “Beyond the War on Invasive Species – A Permaculture Approach to Ecosystem Restoration” by Tao Orion.
↩︎ - Spectacle (critical theory) can also refer to a society that critics describe as dominated by electronic media, consumption, and surveillance, reducing citizens to spectators by political neutralization. Ref. https://en.wikipedia.org/. Please also see ‘commodity fetishism’ for more insight around consequences of unchecked political economy. ↩︎