Death-Rebirth Psychotherapy of Neuroses With Ketamine (Ketalar) Administration

MAPS Bulletin Spring 1992 Vol. 03, No. 2 Small Steps, Gradual Progress, New Opportunities

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Psychotherapists working within a psychodynamic paradigm often encounter the following situation. After months of therapy, the patient on a logical, rational level can easily understand and explain from where his symptoms are originating but the symptoms continue to exist. Besides a logical understanding, human beings need intensive experiences to change. Full liberation from neurotic symptoms is impossible without deep personality alterations. It seems that life values and personality alter only through non-ordinary states of consciousness connected with profound experience.

Though most psychedelics are in Schedule 1, Ketamine (Ketalar), an interesting substance for transpersonal psychotherapy that is used in surgery as an anesthetic, is not. In doses 6-10 times lower than used in surgery, it induces profound transpersonal experiences which last 30 – 45 minutes. Ketamine is safe, short-acting and has a low addictive potential.

We have tried to use ketamine in psychotherapy of neuroses. In the beginning we undertook self-experimentation in order to find the most convenient doses for treatment. We prefer intramuscular injection because of the longer effect (in comparison with intravenous). My weight is 72 kilograms (kg) and I will indicate doses in total and in milligram per kilogram (mg/kg).

A dose of 50 mg (.7 mg/kg) induces a motion picture of colored images when eyes are closed. When eyes are open, ordinary reality remains but assumes an unusual air. Orientation is resolved. On 100-150 mg (1.4-2.1 mg/kg) ordinary reality disappears even when eyes opened. Perceptions of one’s own body also disappear. The subject discovers himself as a point of consciousness which moves in very strange worlds yet the feeling of self remains. On doses higher than 150 mg (2.1 mg/kg) intramuscularly, the feeling of individual self dissolves. The process of losing one’s individuality can be horrifying and felt as a real death. If the subject can relax and let go, this process may be ecstatic. After the loss of the feeling of one’s individual self, the experience is indescribable. There exists only "That which is aware of Itself."

Concerning the work of the psychotherapist during the session, we preferred the psychedelic paradigm because of the peculiarities of the action of ketamine. In terms of Stanislav Grof’s classification, ketamine usually catalyzes transpersonal experiences without engaging the psychodynamic level.

We have recently finished the planning of a research project, &qout;Psychotherapy of Neuroses with Ketamine Administration.&qout; We have since investigated only 9 patients, too few for statistical validity. To my regret, the completed test results have not yet been analyzed. Therefore, I will discuss our research plan and first impressions.

We plan to examine male and female patients (age 18-50) with the diagnosis of neurotic non-endogenous) depression and phobias. Two variants of therapy were considered: treatment with only one ketamine session and supportive psychotherapy, and repeated ketamine sessions when relapse occurs. So far, we have used only the first variant, with an intramuscular injection of between 1.9-2.2 mg/kg.

The patient is prepared for the session by individual psychotherapy existentially and transpersonally oriented. No psychotropic drugs are prescribed.

During the session, the patient is lying on a wide bed. We use music by Kitaro, Vangelis, and other New Age composers. Since at the doses used the patient usually has no contact with ordinary reality, the psychotherapists is simply sitting nearby ready to give any kind of support. Transpersonal experiences usually last 30-45 minutes and after this the patient gradually comes back into ordinary reality. The &qout;coming back&qout; period lasts about an hour and is also important. The psychotherapist gives emotional support and feedback. If the patient shares his/her experience there could be the beginning of interpretation. In the evening the patient writes the report of his/her experience and on the next day discussion and interpretation is conducted.

A set of psychological tests are administered before and after each session. Among the well-known tests are the MMPI and Zung Anxiety and Depression Scales. However, we are most interested in measuring life values and worldview alterations. For this purpose, we use the Self-Assessment Spirituality Scale by C. Whitefield and Questionnaire of Life Changes by Ken Ring. But the main tool of measuring deep subconscious alterations is the original version of Repertory Grids which was specially worked out for this purpose. It measures existential psychosemantic field alterations which reflect profound personality changes.

The preliminary results are auspicious. We treated 8 patients with neurotic reactive depression and 1 with phobia. We observed significant clinical improvement in 7 patients including the phobic. Two patients remained without alterations. Statistically valid declines in the Zung Anxiety and Depression Scales were observed. To our regret, our computer is broken we have not yet analyzed the results on our main tool – repertory grids. However, according to interviews and completed Questionnaire of Life Changes scores, we have noticed that a reduction of depression and other neurotic symptoms was mainly associated with alterations in life values, attitudes and worldviews.

Concerning the phenomenology of ketamine experiences, that is a topic for a separate article. We are only at the beginning of our interesting investigations.