Psychedelics Today has withdrawn support and endorsement for MycoMeditations, a legal psychedelic retreat company located in Jamaica
We have been to the facility in Jamaica and worked with their team in May 2018. Since we have completed our obligations to the company we now want to make it known that Psychedelics Today no longer will support or endorse MycoMeditations.
Read the full community discussion on facebook here
The team seems to have great intentions, but there are some missing pieces around safety that have made us not willing to endorse the company any further. Safety around psychedelic facilitation is a very complex subject and is a key element for us to endorse any facility with the intention of psychedelic therapy and healing.
It saddens us to have to make this statement. Psychedelics Today had high hopes for MycoMeditations based on conversations with their leadership and feedback from others who had visited the facility before we had. While their company is still young and growing, we wish them the best with their operations.
After working with MycoMeditations and hearing other people’s experiences, we believe that it is important to make this statement. It has not been an easy decision on our part, but we believe it is our responsibility to let others know that our vision, mission, and framework does not align with the scope of practices at MycoMeditations.
We have extensively promoted this company through Psychedelics Today and now need to let people know that it does not meet our standards. We are very sorry for this change in position. Please know that it has been a very long discussion internally and it involved a real soul-searching journey for us (Kyle and Joe) to make this statement. Our deepest apologies to anyone who spent their hard earned money, and time to journey there on our word only to have that endorsement recalled. We know that this doesn’t look the best on us and again, terribly sorry.
You have our promise that we will be far more careful going forward about endorsements. We appreciate your trust tremendously and love the community we have been able to build with you so far.
Please note, if you are considering attending a MycoMeditations retreat, please understand that as of October 2018. Psychedelics Today does not endorse this facility for those who are seeking psychedelic therapy for the treatment of mental health issues.
by Malin Vedøy Uthaug, Ph.D. student at the University of Maastricht, Department of Neuropsychology & Psychopharmacology.
The consumption of 5-MeO-DMT by inhaling bufotoxins from the Colorado River toad (lat. Incilius Alvarius), also known as “Bufo Alvarius”, “El Sapo/Sapito”, “Bufo”, and “Toad”, has become increasingly popular in a variety of underground ceremonial settings in recent years. Furthermore, due to the realization of the potential 5-MeO-DMT holds for therapy it has also become a new interest in psychedelic research.
When I started psychedelic research for my dissertation at Maastricht University in fall 2017, there was no research addressing the subjective effects from inhalation of bufotoxins in humans. Thus, I brought it upon myself to investigate this further as the consumption of the so-called “toad-medicine” was booming worldwide.
The primary aim of the study was to investigate whether the bufotoxins from the toad, which is known to contain significant amounts of 5-MeO-DMT, as well as other compounds, produces long-lasting changes on affect and thinking style. The second objective was to assess whether the acute and long-term effects of the bufotoxins depend on the degree of ego dissolution and altered states of consciousness that was experienced during the ceremony. The preliminary evidence of this study was presented at the Beyond Psychedelics conference in Prague in June, and the recording of this presentation is now circling around on the web.
Even though the study results are very interesting and important to highlight due to the consumption of the “toad-medicine” worldwide, I think it is of equal importance, if not more, to shed light on another side of the story. A side of the story that for once does not focus on humans.
This article aims to share information, increase awareness, and stimulate reflection about how the consumption of bufotoxins affect the toad.
5-methoxydimethyltryptamine (5-MeO-DMT) is a potent, fast-acting, natural psychoactive indolealkymine substance, which acts as a serotonin (5-HT-1-A/5-HT-2A) receptor agonist (Shen, Jiang et al. 2010, Szabo, Kovacs et al. 2014). 5-MeO-DMT was initially isolated from the bark of Dictyoloma incanescens (Pachter 1959), and has also been found in the milky-white secretion that protects the Incilius Alvarius toad against predators (Weil and Davis 1994).
This toad, also known as Bufo Alvarius, has become well-known worldwide as a “5-MeO-DMT-making-machine”. Its secretion, when inhaled through vaporization, has proven to be powerfully psychoactive within 15 seconds, causing an experience of unity reported by participants in underground ceremonies in the most repeated soundbite “we are all one” (Weil and Davis 1994).
The presence of 5-MeO-DMT in the secretion is not the only substance that makes the toad so interesting. In fact, it is also the only species whose skin contains 5-methoxyindolealkylamines as well as 5-hydroxyindole-O-methyl transferase activity (Erspamer, Vitali et al. 1967). This enzyme, among other reactions, converts bufotenine (5-OH-DMT) to the potent hallucinogen 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) (Weil and Davis 1994).
That being said, bufotoxins are the name of a collection of compounds which can be found on the toad’s skin, and in the two glands behind the eyes called the parotid glands (Tyler 1976). Several types of toxic and non-toxic substances can be found in the bufotoxins and they include the following; cardioactive agents such as for example bufagins (bufandienolides), catecholamines such as epinephrine and norepinephrine, indolealkylamines such as bufothionine, serotonin, cinobufotenine, bufotenine and dehydrobufotenine, and finally noncardiac sterols, which are non-toxic, such as cholesterol, provitamin D, gamma sitosteral and ergosterol (Chen and Kovaříková 1967). Moreover, as illustrated in the work for Erspamer and colleagues (1967) using paper chromatography, the bufotoxins include not only 5-MeO-DMT but also many other compounds. As previously mentioned, these compounds protect the toad from predators, and can, for this reason, have fatal consequences as demonstrated by reports of animals that have died after biting toads.
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Although these bufotoxins are a natural defense mechanism of the toad, humans have found a way of using them for a different purpose. At the present time, a number of people are smoking bufotoxins at underground ceremonies. Moreover, many also make use of 5-MeO-DMT from plant extract (i.e. yopo) or from a synthetic origin. A recent survey by Johns Hopkins demonstrates that use of 5-MeO-DMT, from either toad, plant extract or synthetic origin, is used infrequently and primarily for spiritual exploration (Davis, Barsuglia et al. 2018). Anecdotal, and empirical evidence demonstrates that people also use 5-MeO-DMT for treating psychiatric conditions such as depression, anxiety, posttraumatic stress disorder and substance abuse (Psychedelic Times, 2016). The resulting subjective effects appear to be due to the compounds ability to induce mystical experiences which have been demonstrated to have lasting beneficial effects (Garcia-Romeu, R Griffiths et al. 2014).
To be able to inhale the bufotoxins one would have to “milk the toad.” It is worth noting that the toads hibernate for most of the year, and generally appear just before summer showers, and congregate when the rains begin for reproduction (Fouquette Jr 1970). This is the time when they can be found and milked. The pamphlet titled “Bufo Alvarius, the Psychedelic Toad of the Sonoran Desert” outlines detailed instructions for collecting and drying the venom;
“You hold it [wearing gloves] over a flat glass plate or any other smooth, nonporous surface at least 12-inches square, the toad is held in front of the plate, which is fixed in a vertical position. In this manner, “the venom can be collected on the glass plate, free of dirt and liquid released when the toad is handled” (Most 1984).
Moreover, from the article Weil and Davis from 1994;
“One Bufo Alvarius yield 0.25-0.5 gram of dried venom. Since concentrations of 5-MeO-DMT may be as high as 15% one toad may yield 75 mg of an hallucogenic drug that, when smoked, is effective in humans at doses of 3-5 mg. In other words, a single toad produces 15 or more doses of one of the most potent psychoactive drugs found I nature. A matchbox sized container would represent thousands of effective doses”.
With this in mind, it is no wonder that the harvest and consumption of the toad’s bufotoxins have increased.
The harvesting of the toad’s bufotoxins happens not only from the hands of facilitators of ceremonies, or consumers but also from toad-hunters such as the ones filmed in “Hamilton’s Pharmacopeia: The Psychedelic Toad” who after harvesting the bufotoxins sell it (VICELAND 2017). In the video clip, the toad-hunters report that they have collected around 500 grams of bufotoxins over the years. This equals 5,000 doses if one dose is 100 milligrams of bufotoxin, and means that in order for one person to have the experience at least two toads must be milked.
Now how does the harvesting and consumption of bufotoxins impact the toad?
At this point in time (October 2018) the toads are classified as “least concern” on the IUCN Red List of Threatened Species (Hammerson & Santos-Barrera, 2004). Although this may be true, these assessments are from 2004, and is therefore very likely to be outdated. A new assessment about the toad’s population size is highly warranted given the attention the toad has received and the consumption of the toads’ bufotoxins worldwide.
Nevertheless, it is not old news that the amphibian population worldwide is declining. Actually, their global decline was first recognized in the early 1990s (Wake 1991). As of 2010, 32% of the world’s nearly 6600 amphibian species are threatened with extinction, 43% are experiencing declines and for another 22%, there are insufficient data (Stuart, Chanson et al. 2004). This phenomenon represents the Earth’s sixth mass extinction (Wake and Vredenburg 2008). That being said, there is no single cause to the global amphibian decline, rather there may be several contributing factors (Hayes, Falso et al. 2010). As outlined in the paper by Hayes and colleagues, there are three levels of possible factors for the amphibian decline.
The first level involves 1) death (or removal) of individuals and 2) reduced recruitment within a population. (Editors note: recruitment occurs when juvenile organisms survive to be added to a population, by birth or immigration, usually a stage whereby the organisms are settled and able to be detected by an observer. Source – Wikipedia
The second level involves 1) increased disease rate, 2) decrease in nutrition, 3) predation, 4) human exploitation 5) “other mortality”, which represent everything from the death of older individuals, incidental death, to catastrophic events.
Finally, the third level involves 1) atmospheric change, 2) environmental pollutants, 3) habitat loss, 4) invasive species, and finally 5) pathogens. These levels are also suggested to interact with one another.
It is not rocket science that the above-mentioned factors also have an impact on the toad. The increasing demand for the bufotoxins for inhalation has made the toad susceptible to not only ecological disturbance through the invasion of habitat and excessive milking, but also amphibian-trafficking and black-market dynamics. Additionally, according to herpetologist Robert Anthony Villa, the largest toads are most likely to be spotted and collected over smaller toads, and if you remove the biggest toads, you remove the population’s ability to sustain itself as the bigger toads have a lot of eggs (Psychedelic Today 2018). Moreover, based on studies on snakes, we know that 80% of snakes die if you catch them, move them to a different territory and let them go. Similarly, toads have an inner-GPS that they rely on, and if a toad is taken out of their territory for milking, and then set free elsewhere, they are very likely to die because they are either simply lost, could get run over by a car, or eaten by predators. The latter is more likely to successfully happen when the toad has been deprived of their main defense mechanism.
Along with that, Villa reports that the toad is very likely to be impacted negatively by pathogens, such as for example chytridiomycosis, which is exposed to them by people when they are collected for milking and can spread to the rest of the toad population. Additionally, as the surviving toads depend on the genetic variety of other populations to sustain themselves, the toads would inbreed themselves to extinction if there are no other populations to copulate with. Finally, keeping a toad as a pet, or many in large conservations for breeding, is a huge disservice to the toad as they do not do well in captivity, and due to the factors previously stated.
Given the circumstances, it seems to me that the harvesting and consumption of bufotoxins or so-called “toad medicine” is very much the case of the “double effect” principle; with a good act, comes a bad consequence. The aforementioned are all alarming factors that could very well lead toward population decline and so to extinction. This is all startling information that calls for action.
A discontinuation of “toad medicine” in favor of synthetic 5-MeO-DMT use can diminish the current unnecessary and excessive harassment of the Incilius Alvarius species. Switching from using toad bufotoxin to synthetic 5-MeO-DMT is better for many other reasons. First, synthetic 5-MeO-DMT does not contain a cocktail of other compounds and is therefore much safer to use. Likewise, it will be much easier for researchers to re-schedule and legalize a pure substance for medical use than a complex bufotoxin. Second, synthetic 5-MeO-DMT is not any different from “toad-medicine”. In fact, the argument that “toad-medicine” is better than synthetic is a claim that is drawn from personal experience and is not a good enough argument to extend to a generality.
I personally think it is important that we start to reflect upon the implications our actions have on the toads and take action. It is not necessary to wait until the toads are classified as endangered before we act.
My hope and wish for the future is that all of us, be it, consumers, researchers, organizers, or facilitators, will think twice about whether experiencing 5-MeO-DMT at the expense of a species’ continued presence on this planet is worth it. Especially when there is an alternative way which is much safer to use, not any different from the effects of the bufotoxins, and does not contribute to ecocide.
The book “Homo Deus; A Brief History of Tomorrow” highlights several important and interesting topics. One of them is the power human beings have, and how this power can affect the future of the planet. One thing that Harari points out, which seems to be very fitting for this moment, is that humans have the capability to do many things, but that question is not “what we can do?”, but rather; “what should we do?” (Harari 2015).
Chen, K. and A. Kovaříková (1967). “Pharmacology and toxicology of toad venom.” Journal of pharmaceutical sciences56(12): 1535-1541.
Davis, A. K., J. P. Barsuglia, R. Lancelotta, R. M. Grant and E. Renn (2018). “The epidemiology of 5-methoxy-N, N-dimethyltryptamine (5-MeO-DMT) use: Benefits, consequences, patterns of use, subjective effects, and reasons for consumption.” Journal of Psychopharmacology: 0269881118769063.
Erspamer, V., T. Vitali, M. Roseghini and J. M. Cei (1967). “5-Methoxy-and 5-hydroxyindoles in the skin of Bufo alvarius.” Biochemical pharmacology16(7): 1149-1164.
Fouquette Jr, M. (1970). “Bufo alvarius.” Catalogue of American Amphibians and Reptiles (CAAR).
Garcia-Romeu, A., R. R Griffiths and M. W Johnson (2014). “Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction.” Current drug abuse reviews7(3): 157-164.
Harari (2015). Homo Deus: A Brief History of Tomorrow.
Hayes, T., P. Falso, S. Gallipeau and M. Stice (2010). “The cause of global amphibian declines: a developmental endocrinologist’s perspective.” Journal of Experimental Biology213(6): 921-933.
Most, A. (1984). Bufo alvarius: The psychedelic toad of the Sonoran desert, Venom Press.
Pachter, I. J. Z., D.E.Ribeiro, O. (1959). “Indole alkaloids of acer saccharinum (the Silver Maple), Dictyoloma incanescens, Piptadenia colubrina, and Mimosa hostilis.” J Org Chem24: 1285-1287.
Shen, H. W., X. L. Jiang, J. C. Winter and A. M. Yu (2010). “Psychedelic 5-methoxy-N,N-dimethyltryptamine: metabolism, pharmacokinetics, drug interactions, and pharmacological actions.” Curr Drug Metab11(8): 659-666.
Stuart, S. N., J. S. Chanson, N. A. Cox, B. E. Young, A. S. Rodrigues, D. L. Fischman and R. W. Waller (2004). “Status and trends of amphibian declines and extinctions worldwide.” Science306(5702): 1783-1786.
Szabo, A., A. Kovacs, E. Frecska and E. Rajnavolgyi (2014). “Psychedelic N, N-dimethyltryptamine and 5-methoxy-N, N-dimethyltryptamine modulate innate and adaptive inflammatory responses through the sigma-1 receptor of human monocyte-derived dendritic cells.” PloS one9(8): e106533.
Wake, D. B. (1991). “Declining amphibian populations.” Science253(5022): 860-861.
Wake, D. B. and V. T. Vredenburg (2008). “Are we in the midst of the sixth mass extinction? A view from the world of amphibians.” Proceedings of the National Academy of Sciences.
Weil, A. T. and W. Davis (1994). “Bufo alvarius: a potent hallucinogen of animal origin.” Journal of ethnopharmacology41(1-2): 1-8.
About Malin Vedøy Uthaug
Malin Vedøy Uthaug is a Ph.D. student at the University of Maastricht, Department of Neuropsychology & Psychopharmacology. She has a background in health and social psychology and is currently researching psychedelic (ayahuasca, 5-MeO-DMT, DMT, and mescaline) and yoga-induced improvements of mental health. On the side of being a student and researcher, she is a life coach and public speaker. She started her coaching project titled Love & Gratitude in September 2016 which serves as a platform to spread information related to positive psychology, and transpersonal psychology. Love & Gratitude has also become a way to bring about information about psychedelics and help to destigmatize them. She has since September 2016 delivered talks, webinars and workshops in Belgium, The Netherlands, Czech Republic, Norway, United States of America, and Colombia.
You can find more from Malin on Psychedelics Today here.
For the first time in nearly three decades, novel classes of medication are being offered to those suffering from chronic refractory mental health conditions. Studies have shown that 60% to 70% of people with treatment-resistant depression respond positively to ketamine, and some encouraging results are being found with OCD, PTSD, and alcohol dependence.
Though this discovery has been hailed as a massive boon to those living with persistent mental health concerns, their loved ones, and clinicians alike, it may also behoove us to explore the potential unintended consequence of these effective, fast-acting antidepressants.
Many welcome rapid recovery with relief and gratitude in being able to return to their lives; however, in our work with Ketamine-Assisted Psychotherapy, we have noticed that a small percentage of clients also experience a period of disequilibrium and difficulty in adjusting to these changes.
These reactions can range from over-reliance on older coping styles that no longer match one’s current state, to the distress that comes from the loss of a habituated identity (“I don’t even know who I am anymore, without my old buddy, Depression”). I have come to refer to this response metaphorically as “the therapeutic bends,” as a way to suggest the effects that can occur when we ascend rapidly from great depths. In two decades of clinical work, I have seen a variety of ambivalent-to-negative reactions to the prospect of “getting better.” Psychotherapy generally offers recovery as a gradual process, with adequate time to adjust and be supported; the “instant cure” has been seen as both unattainable and potentially illusory. The advent of these new treatments requires a shift in how we guide people through this work. I would like to discuss here some possible layers where distress can occur, and interventions for both clients and providers to consider at each level.
Confronting Reality: Cognitive-Behavioral Layer
Ketamine infusion pioneer and psychiatrist Dr. Steven Levine has been noting this reaction for some time; in a recent blog post, he encourages providers to set expectations with clients that “even good change is stressful (marriages, moving homes, new jobs, and the birth of children are some of life’s most stressful events).” More dramatically, he describes a process in which one emerges from a depressive episode, then becomes overwhelmed by the herculean tasks ahead:
[W]hen one looks around, one sees with new eyes the surrounding devastation and the casualties from an incapacity to do anything about the growing problems…[this] is akin to a poorly prepared survivor of a nuclear apocalypse stepping out of his bunker into a lonely world of destruction.
Dr. Raquel Bennett, a psychologist and founder of the KRIYA Institute, has also been observing the effects of therapeutic ketamine on one’s sense of self for many years. She echos Dr. Levine’s observations that:
Resistance can come up for some people; they get a little better, and then can get scared, sometimes retreating back into a remission, which is actually more psychological than chemical… People wake up and realize how much time was lost to their illness, how much money was spent, how many relationships ruined, how many opportunities missed… We need to think about how painful it is to just be with that, what this condition has done to one’s life (personal communication, August 12th, 2018).
Additionally, those accustomed to very brief respites from symptoms may have a habitual tendency to throw themselves headlong into intense task completion mode the moment remission begins, in an effort to “get everything that piled up done before the storm hits again.”
FOR PROVIDERS: Dr. Levine writes that “even a ‘magic bullet’ leaves a wound that requires a period of recovery,” and that key components to this recovery are social support and ongoing therapy. Therapy should, in part, focus on “teaching new skills to challenge and combat depressive thoughts, and working towards achieving successes that help rebuild self-esteem.“ Similarly, Dr. Wesley Ryan states that he frames ketamine treatment as something that can provide a catalyst for change, transiently lifting depression, and allowing people to more easily engage in other activities that will protect against relapse. He encourages “regular exercise, healthy eating, socialization, behavioral activation, structure/volunteering/work, work/life balance, addressing activities or relationships that clash with personal values (such as work, for some people), potentially setting better boundaries” (personal communication, August 13, 2018). Providers may want to focus here on slowing the work down so as to not trigger overwhelm, cognitively reframing approaches to task completion, and teaching new ways to manage the demands of life. Psychotherapists may also invite expressions of regret and grief around the sense of lost opportunities as a way to work through these feelings effectively. FOR CLIENTS: As stated above, it is important to not overwhelm yourself at this stage. Trust that you will have the opportunity to make repairs and address life tasks over time, and please access as much support as possible to assist you in this undertaking. This is an excellent time to begin practicing new self-care habits that will ensure longer-term change. Additionally, you may benefit from making space in your life to acknowledge and feel any difficult emotions you may have around what has happened and talking to someone you trust who can listen without judgment. You may want assistance from a therapist, support group, or a good self-help guide in shifting how you think about yourself and your life.
Readjusting Roles: Interpersonal Layer
Dr. Bennett notes that often people’s intimate relationships become organized around the care-giving other people provide, and that “as soon as they start to improve, expectations and the relationship dynamics start to change.”
In family therapy perspectives, the “identified patient” (also “symptom bearer” or “scapegoat”) is a member of a dysfunctional system that has been unconsciously selected to express the distress of that system. Other members may profess concern for the identified patient, but may also react instinctively (and unintentionally) to any improvement by working to reinstate the status quo. What once seemed like an entirely biochemical illness can often be revealed as multiply determined when we notice loved ones’ discomfort with their ward slipping out of “sick role.” I have often felt concern in watching someone achieve remission, and then return to the same stressful environment in which the initial problems flourished. In less pathologizing terms, let us remember that there is a social expectation in the continuity of the self over time. People around us have adapted to how we typically act and express ourselves, and react with surprise when that shifts. Those reactions may subtly encourage us to return to our previous baseline. This is rarely intentional, but is extremely important to recognize. FOR PROVIDERS: Potential interventions to navigate through this period might include family therapy, couples therapy, or psychoeducation on the nature of family systems or group dynamics. We can assist clients in setting appropriate boundaries, and support them in having difficult conversations. FOR CLIENTS: If this is something you would like to address in your life, please talk to your providers about your specific situation and best practice interventions. It may be helpful to talk through how your relationships might change if your mood improves, or any fears of what might be expected of you if your condition shifts. In general, reading about and practicing Nonviolent Communication is a good way to improve relationships with the people around you.
Exploring Identity: Personal Layer
Much like our intimate others, we also have an expectation in the continuity of the self. When one has lived with a longer-term condition, there are ways in which it can get woven into one’s own identity. We become habituated to our capacities for activity and relating, and depend on our ability to predict how we might think and feel in any given situation.
It can be incredibly disorienting when a cluster of your regular experiences disappears overnight, and can foster a sense of not knowing yourself at all anymore. (This may be partly responsible for the “rubber band effect”–the tendency to return to our usual modes of being–that Dr. Phil Wolfson discusses in The Ketamine Papers.) Participation in online forums and support groups can provide invaluable insight and camaraderie; as helpful as this can be, it may also reify one’s social role as a fellow sufferer. We come to define ourselves as a depressed person, as someone struggling with fibromyalgia, as a recipient of Social Security or disability benefits. (Perhaps this is not such a novel occurrence, after all, as a similar phenomenon emerged with the advent of SSRIs. Peter Kramer noted in his 1997 book Listening to Prozac how his perspective on the nature of temperament was altered by witnessing responses to medication: “I was used to seeing patients’ personalities change slowly, through painfully acquired insight and hard practice in the world. But recently I had seen personalities altered almost instantly, by medication.” He reported similar disorientation and adjustment periods.) FOR PROVIDERS: Just as we would allow space for someone to discover new aspects of the self during a coming-out process, recognize that the remission period is also a fruitful period for exploration. Identity-making is an ongoing conversation throughout the lifespan. Acknowledge that with every new gain made, there are losses, and parts of our selves and lives that we are saying goodbye to. Inquire about the feelings that might arise during this phase. In our practice, we draw upon Internal Family Systems (IFS) techniques to help people have productive dialogues with different parts of their psyche, and discover (without judgment) what attachment to a depressed identity might mean for them. FOR CLIENTS: This is a time to look deeper at the beliefs you hold about yourself, and question their accuracy. You may consider getting reflections from someone who can listen neutrally and without agendas for your direction. A great self-help resource for IFS-style work is Jay Earley’s Self-Therapy. If you are concerned about returning to the workforce, many communities offer peer and professional support for those returning to work after a period of unemployment. This type of support should encourage autonomy, allow exploration of ability and identity, and avoid perpetuating disempowering ideas about what those with mental health struggles are able to contribute.
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Letting it Out: Emotional Layer
Classic psychoanalytic conceptualizations regarding depression as “anger turned inward” can help frame the irritability or distress that may surface unexpectedly when symptoms remit. We have supported clients who, once they were relieved of depressive burdens, were then able to confront and feel appropriate anger stemming from past trauma, abandonment, or loss. This can be an incredibly healing process if one is supported by providers who understand the emerging emotional responses in context, but can be difficult to navigate on one’s own. Dr. Bennett has also observed anger and/or grief reactions, with people suddenly feeling “angry at God for making them sick, or at the situation, or all the doctors that didn’t help them previously…[W]hen this is buried or held down in the depression, and then starts to come up and out following treatment, people need therapeutic support to address that.” Though we think about depression as “sadness” and recovery as “happiness,” the reality is often not as simple. Depression can present with a numbing or flattening of emotions, and recovery may mean regaining access to a wide range of different feeling-states. Learning to navigate these states is essential. FOR PROVIDERS: Set expectations for all involved that recovery may involve unearthing unanticipated feelings and memories. Trauma-informed treatment is essential when working with some of these frozen states. Encourage safe expression of affect in session, and offer psychoeducation around appropriate assertiveness, boundary-setting, and anger management techniques. Teaching and practicing grounding exercises, such as the ones in the Seeking Safety protocol, can help people learn to re-regulate themselves when distressed. Additionally, Dr. Bennett notes that some continue to have suicidal ideation, but a critical shift occurs in its source, moving from a ruminative, painful “voice in your head that tells you that you’re better off dead,” to a response of grief, loss, or anger. She emphasizes the critical importance of attuned listening by clinicians to differentiate these sources, rather than assuming that the treatment was unsuccessful. FOR CLIENTS: If strong feelings are emerging during your treatment, please talk to your providers and request specific support for these states. If you are feeling suicidal, please reach out for help from your support network, call a hotline, or access urgent/emergency care. We recommend you do not navigate this process on your own. If you would like to learn techniques to manage anger, you may find an Anger Management Workbook useful. Interpersonal process groups and assertiveness trainings may also be appropriate. We highly recommend the grounding techniques from the Seeking Safety protocol for those looking to manage the overwhelm that results from a history of trauma.
Digging Deeper: Unconscious Layer
Above all, we must make space for the deeply personal and idiosyncratic responses people have to both their symptoms and the remission of those symptoms. We can not assume that this process has identical meaning for everyone we see. Honoring the uniqueness of the self and its adaptations to life’s challenges is part of what gives this work its beauty and depth.
Furthermore, meaning is held both consciously and unconsciously. Deep structures of the self are laid down early in life, in the interactions between temperament and environment, and are rarely available for immediate reflection. It is the work of ongoing inquiry in the therapeutic relationship to bring these templates into awareness. For example, I have had the experience of working with people who were eventually able to articulate their depression as the only link remaining with a lost loved one; there is a way in which these symptoms served as tributes to the depth of their connection. Rapid removal of these mood states may then trigger responses of loss and abandonment. Other clients have also formulated depressions as a coping tool itself: as a protective layer that prevents one from having to engage fully in life, an escape from having to make difficult choices, or an avoidance of confronting painful realities. Another example is indicated by psychoanalyst Patrick Casement in On Learning from the Patient:
I have noticed, with a number of patients, that the experience of feeling better is sometimes treated by the patient as a signal for further anxiety. Some analysts might treat this as a fear of losing the “secondary gains from illness.” Others might regard it as “negative therapeutic reaction.” However, I believe there are some occasions when a patient is indicating that an unconscious link has been formed between an earlier experience of trauma and the prior sense of safety, as if that “safety” had been a warning signal for the pending disaster. Perhaps an unconscious set is formed in which feeling safe and the subsequent catastrophe are seen as forever linked (1992, p. 364).
FOR PROVIDERS: Although psychoanalytic and psychodynamic frameworks are fundamental to understanding the operation of these deep templates, dogmatic adherence to any one theoretical system forecloses the open exploration of individualized responses. Curious inquiry and a desire to hear about any potential meanings that may arise go much farther than the most brilliant textbook formulation. In essence: “what does this mean for YOU?” It can be helpful to explore the relationship someone has with their depression, and how that relationship has changed over time. Narrative therapy ideas and practices can assist people in re-writing the stories of their lives into a more integrated personal mythology. FOR CLIENTS: Part of recovery inherently involves an investigation into the myriad internal, interlocking factors that keep us stuck in old ways of being. Though your situation will be completely unique, you are in fine company with the rest of humanity, as we all struggle to move out of safety and towards growth. If you sense that there have been ways in which depression has protected you from confronting difficult aspects of life, please make sure you begin to discuss this with your providers. Together, you may begin to re-author the tale of your history in a way that conveys respect for your resilience, as well as hope for the future.
Spiritual Crisis: Transpersonal Layer
We know that higher-dose journeys with ketamine can produce psychedelic, dissociative states, facilitating a profound transpersonal or mystical peak experience and expanding one’s sense of self and understanding of existence. Dr. Bennett shares that for some, this “contact with the Divine” can be intense and overwhelming, especially if there has not been much preparation for this self-expansion, and if one has been “out of touch with God for 30 or 40 years.” She also notes that the changes one can be called to make in one’s life following a peak experience can be disorienting. Psychic and spiritual content–especially following the use of psychedelics–can be mistaken for symptoms of psychosis in our highly secular culture. It is extremely important to differentiate between an illness process, and an enhanced sensitivity to transpersonal material. When held in a supportive context, these experiences can be extraordinarily meaningful to people. FOR PROVIDERS: Have conversations during the preparation phase about your client’s existential concerns, spiritual encounters, and beliefs about the nature of reality or the universe. Familiarize yourself with the techniques and mindset necessary for supporting someone during a spiritual emergence or crisis process. Contemplate the differences between a dark night of the soul vs. depression. Work to bracket your own belief systems in order to allow for free expression. FOR CLIENTS: Again, adequate preparation for working with ketamine, especially at higher doses, is essential. Please choose your guides wisely, and work closely with them to help you navigate these experiences. If you are troubled by existential or spiritual concerns following a journey and could use a framework for integration, contact the Spiritual Emergence Network for more resources, including spiritual coaches and helpful reading material. You could work with a provider that specializes in psychedelic integration, or attend a community integration circle. You may also want to seek spiritual guidance within an organized or non-organized tradition (whether Western, Eastern, indigenous, or other). The above linked material on grounding can be helpful if you are experiencing a great deal of energetic activation following treatment.
In practice, these layers are obviously intertwined, and interventions at one level may affect all others, as we present as whole beings, bringing surface-to-depth concerns to every interaction. As a final note: please know that none of this is intended to frighten you away from obtaining ketamine treatment, but rather to assure you that should you have these experiences, you are not alone, and that there are many ways to move through this phase without necessitating a relapse or causing untoward effects in your life. Being prepared for the possibility of the therapeutic bends often helps people feel less surprised or destabilized, and collaborating with your support team on how to handle this, should it arise, is of paramount importance.
Thank you so much for reading this post, and we welcome your questions and comments!
Dr. Jessica Katzman is a licensed Clinical Psychologist with 19 years of experience as a therapist, and was trained at California Institute of Integral Studies (CIIS) in both traditional and transpersonal perspectives on healing. She is also certified as a Spiritual Emergence Coach, and approaches altered states of consciousness from a nonjudgmental, exploratory stance.
In her private practice, she specializes in integrating psychedelic experiences, supporting LGBTQQIAAP communities and gender-creative folks, addressing alcohol and substance use from a harm reduction perspective, body image issues, mood/anxiety disorders, social justice conversations, and navigating non-traditional relationships and sexuality.
After assisting a local ketamine infusion clinic with psychotherapy program development, she and our medical doctor joined forces to provide integrated Ketamine Assisted Psychotherapy for Healing Realms. She is supported by information received at the KRIYA Conference, an advanced training in therapeutic ketamine, and ongoing consultation with her colleagues in the field.