Gita Vaid on Ketamine

any type of thruth. Hello, Psychoactive listeners. Today we returned to the subject of kenemine and kenemine assistant psychotherapy. Today's guest is Dr Gitavaid. I've known you for a few years. I heard her speak at the Horizon Psychedelics conference in

New York a month ago. She of a brilliant talk, really talking about the role of kenamine in psychotherapy and how it's changing the way we think about psychoanalysis and psychotherapy and psychiatry, and so I wanted to really get into this with her about what that's all about, What are the benefits, how does it work, how does it compare to other psychedelics and I should tell you. I mean, she's a key figure nationally in this now, I mean, you you google her, you'll see all over the place.

She's a member of the Mount Sinai Psychedelic Psychotherapy Research Group. She's a leader instructor at the Kenemine Training Center. She's a co founder of the Center for Natural Intelligence, which is a multi disappointed lab that's dedicated to psychedelic psychotherapy, innovation and clinical practice. So she is truly one of the world's leading experts in this. So, Gita, thank you so much for joining me today. Well, thank you for

inviting me to come and talk and psychoactive with you. Ethan, it's a pleasure to be here. Well, I'm really glad you're here. So let's just start off by by setting this date. So you just explain in Layman's terms as best you can, what is kenemine actually what distinguishes it from opioids or normally antidepressants or other drugs used for an anesthesiology. I mean, what what is it? I think

that really there's different ways we look at medicines. You look at the neurotransmitters they're working on, and in that way, kenemine is a little bit of a dirty drug because it hits a bunch of different receptors. But I would say what's different about it um in high doses you

can really have anesthetic effects. In lower doses is what I'm more interested in is it's kind of has its psychedelic properties, which I feel are incredibly important aspect of work in psychiatry and psychotherapy for expanded states of consciousness.

But at lower doses, I oftentimes wonder is dissociation the right word, because sometimes I feel like it can be at higher doses where you have that disconnect action, but also I feel like there's a differentiation almost that happens where you can actually have more access to parts of yourself and more of almost distinguishing that allows one to access more fully different parts of oneself. So it's an

interesting term, but it has been used as a dissociative anesthetic. Basically, if somebody's having surgery, it basically allows that person to feel that the part of their body that's being operated on is sort of separate from the rest of themselves. Now, I think at the high doses you just kind of lose consciousness completely, so you're you know, completely outright and in you know and lower doses you kind of don't

feel your body. You feel like sometimes people even have the experiences and low doses of not having a body or being out at their body or hovering over their body until they suddenly have no consciousness at all, you know, And you can tailor it to drop out of thinking mind and to travel through the different layers of self to beyond self until you kind of go further and further out to having no awareness. And is it using combination with other drugs, whether it's in surgery or pay

management or treating depression. Oftentimes it is used as a cocktail in anesthesia and also even in psychiatry, you know, certainly Spravado, which is the only fday proved version of ketamine, they use it with other antidepressants as part of their protocol for treatment resistant depression. And that's one of the nice things about ketamine is that it has very few interactions with other antidepressants, so it does allow one to potentially,

if necessary, combined with other medications. And does that also mean when it is being used also illicitly that unlike say alcohol or opioids or benzos, where if you combine them with one another, some other drugs can be very dangerous. That ketamine is maybe more like marijuana in the sense that you're not going to be dying from a mixture. That's a really good point. Yes, it's it really helps with the safety of it because you don't have to worry so much about them bumping up other levels with

most of the compounds or else. What can happen with some of the other psychedelics, a blocking effect where you have very little efficacy because another drug that's working on serotonin is in the air and interferes aciddenly happens with the ss rise for example, and psilocybin or some of the classic psychedelic medicines. So it's really helpful for being able to have much more control over what you're dosing

and fewer side effects and interactions. It just tell us a little something about the diversity of ways in which kenemine has been used outside the psychotherapeutic context. I mean it used to be describing the media is the animal tranquilizer, right, But it's also been used widely around the world, I think in pain management. It's been used in medicine on

the battle fields. Well, kean has an interesting history because it did start off being developed as an anesthetic, and so it has a really interesting background and that it kind of entered into the psychedelic world in medicine through a whole different route, which I think makes it very unique and has had a lot of implications and how

it's being practiced in the current moment. It's a very powerful anesthetic and it's one that's very unusual because you don't have to worry about its cardiovascular effects or its respiratory depression, so it makes it very versatile and easy to use not only for surgeries, but also in the battlefield, almost like the body system because you don't have to have such intense monitoring. It's also effective for pain and analgesia,

so it's used in the emergency room. It's been used very safely and studied with children who seem to do much better with what they call the emergent phenomena or the psychedelic phenomena. So it has, you know, had a lot of use in ears operating room around the world, and it's in those contexts very widely available and very affordable.

And remember, you know, there's all the stuff back in the nineties, I think in the kind of rave scenes and then also in the gay club scene in New York, remember, in other places, so it had that other role right of being a popular as a kind of you know, party drug. And also I think it's gotten a bit of a bad reputation even though it's been used a lot in the rave scene and as a party drug, because you know, in higher doses one can have what's called a cahole or kind of actually pass out on

the floor. It's a very unattractive look, which I think hasn't really represented kennemine well because I think it's gotten

worse reputation and perhaps other recreational drugs. I was watching recently Hamilton's Pharmacopeia, the TV show by Hamilton Morris, and he has an episode on kenemine, and he's talking with somebody who has been deeply committed to kenemine for for decades, and one of the points he makes is, you know, the odd thing about kennemine is it doesn't have a kind of coherent narrative historically in the way to say l s D or even mushrooms or peyote do, and

that maybe there's something about it's incredibly varied uses and reputations and context men that somehow it avoided the labeling or the stigmatizing to the same degree as other psychedelics and and and it's all typically did not become criminalized in the same way. What do you think about that. I think that's that's true. I think it has kind

of evaded some of those kind of connotations. On the other hand, it has stuck with some of a different kind of reputational kind of flavor, such as it being an anesthetic or tranquilizer. But it has kind of checkerboard past I would say. And when we're talking about different applications, I can't resist mentioning how ketamine was also the drug used to rescue the tai boys who were trapped in

the cave. Do you remember that event vaguely? Tell us, Well, they were like some kids who were trapped in a cave and they had to rescue them, and they used ketamine as the anesthetic to be able to get them out of these caves that I think had collapsed at the time. And once again, you know, it's used really well with children as an anesthetic. But that was an interesting way. Kenemine also showed up in the news. Uh huh, you know you said before their children deal with the

psychoactive effects maybe better than adults. I get is that what was that the point you were saying, and that therefore this is one of those ones where there might be a lot more latitude for administering kennemine to children into teens. I won't know if it's even latitude, as much as it's been used really comfortably with children, and even now and e os is used because it's so safe and shorter acting and well tolerated, and kids don't

get disturbed by the kind of psychedelic experiences. Maybe because their minds and their subjective experiences are much more fluid, they seem to roll with it a lot more comfortably than adults who are not prepared for it. You can have really strange visitations with aliens and get freaked out pretty easily, particularly they're not expecting them and they're just sort of going in for a procedure. I see, So like when kids, he's an Alien's like, hey, like what right? Well,

so now I guess to to move forward. Then is it what ten fifteen years ago, when research really begins to emerge that ketamine can be remarkably effective in dealing with intractable depression. Yes, it's been really interesting to see the studies at Yale where they recognized it for its antidepressant property, and I think that's really where this groundbreaking research started. And I think that really kind of opened

up an important movement I think in psychiatry. When there's been such a paucity of new antidepressants or treatment approaches for such a long time, as depression is escalating at a very very unfortunate rate, how did they come up with the idea of thinking about kenemine to treat depression. Was it that they were seeing that people were giving ketamine for other reasons just seemed to benefit in terms

of mood? I mean where that is that where the hints were well, I think it was record noised also from anesthesia, the observations of the antidepressant effect in individuals who were receiving recognitions, which is where a lot of these findings emerge. That you kind of start paying attention and taking notes. So for you, Dr Geteraveid, tell me about your evolution into this. Is it that you yourself were using, you know, experimenting various psychedelics and curious about

them and tried ketamine. Um, for personal use. Was it a professional frustration in what you could accomplish as a psychotherapist dealing with your patients through traditional models of analysis? I mean, how what brought you to ketamine? Actually it's none of those answers. I was working very well in my private practice in New York City as a psychiatrist

and a psychoanalyst, really enjoying my work. So there was definitely no frustration and I felt very gratified by the work I was doing, but a very interest in the research that was, you know, coming out about psychedelics and their efficacy, and I think my interest in them really sparked. There was some of my colleagues who were also psychoanalysts that I were working with who are older, really shared with me about their early career experiences. You know, some

of them had worked in the sixties. One in politicular, a really good friend of mine. He talked about working with Humphrey Osmond back in the sixties on some of his alcohol studies with LSD and Humphrey Husband, as I'm sure you know, is the Canadian psychiatrist who coined the term psychedelics, and so hearing some of those stories that

was extraordinary mind blowing and exciting. So to see and hear this research emerging got me very interested, and through my own work, I met a patient that I saw very infrequently, maybe twice a year, for medication management, and just sitting with him was so different my experience of him that I kept trying to dig around to figure out what had aged in his life. And after spending quite a lot of time asking a bunch of questions and not finding much satisfaction, he finally said, what are

you trying to get at? And I said to him exactly as I'm telling you, how different the experience of sitting with him was, and I couldn't account for it because nothing seemed to have changed in his life. And he sort of said, well, how am I different? And I said, I can have emotional contact with you in a way I've never experienced you before. And I've known this man for several years, even though we saw each other relatively and frequently. And he sort of said, well,

since you've noticed, i'll explain to you. I'm working with an underground facilitator. And you know, he was an owner gentleman had been also intrigued by the end of life studies and found an underground facilitators and and had amazing results. So I had asked him, would you mind introducing this fellow to me if he's comfortable, And that led to a lot of conversations and you know, research on my

own part. And actually, when I first tried these medicines, I had such a huge expansive experience that I was vibrating for a month. But I immediately knew from that experience just having my own access the therapeutic implications. So I immediately was on this path and excited admission to find out everything about it, who was working in the underground, the overground, the research, and wanted to learn everything and

get involved with everything. We'll be talking more after we hear this ad So Keita, imagine you don't know me and I come in. I've been diagnosed with intractable depression. What does our interaction look like? And how does that lead into the first session? And how do you decide whether I'm taking it in? What doose are? How? Just walk me through that. I'm happy to do so. So usually I meet someone I would just want to get

to know you. I mean, I have been in practice for a long time, so I don't have to go through a checklist. We'd have a nice conversation and I asked you to tell me about yourself so I could understand where you are in your life presently and what's going on, and what needs you into seeing me, and what are you currently dealing with, And in that way, I'm trying to get a comprehensive history. I'm also in the moment trying to assess the person's capacities for self reflection, introspection,

self knowledge. Do they have a sort of sense of their own narratives, Do they have a sense of the patterns in their life? And so that can pretty much inform right away whether the person might need a little bit more preparation to set the stage for a psychedelic experience or have they already done that. Have they already done enough and have enough skills to really go into a session. So that sort of sets the stage, and

that will determine how many sessions we might need. Oftentimes, if someone seems to have a lot of knowledge and awareness, the issue and I have all my questions answered, which sometimes can happen even in the course of the session, the issue gets to be about relationship building and safety.

So I will suggest meeting. However, many times makes sense to develop a relationship with a person to let them know who I am, how I work, to explain about the treatment, to understand what they might imagine would happen, to get clear on them, being clear on their obstacles and emphasizing them so that we could understand how this might be a way of them liberating themselves from those patterns, and to sometimes I like to identify them, not even so much as to know that's what we're working on,

to go into it as much as the opposite. It sort of turns it upside down to these are the patterns that we want to help you break out of. So after we have that sorted out, it really is about preparing for the session, and on the session itself. A person will come to my office for the three hour session, fasting beforehand and they will come and we

will sit and talk. For the first forty five minutes or so, we're really just talking about what's on the person's mind, what to expect, where they are, what's come up for them, and we'll sit with each other so that the person feels comfortable before they're invited to lie on the couch and I'll play music and have eyeshades, and then I will dose them while sharing with them what's going to happen. Oftentimes, i'll start with a tiny dose because I like to have a testers to know

how they're going to respond. A low dose, just to assess how they're doing. Within three minutes it will come on. In that three minutes, I might invite the person to go through a body scan, so I will bring their awareness to their body so they can start focusing on themselves, gather their thoughts, and start the process of really deep listening to themselves. And by the time the medicine comes on,

we'll have gone through the body scan. And I like the smaller doses because you can assess how sensitive they are so I can tailor it. If someone's really sensitive, they'll go quite deep. If it's very mild, it's like a bringing themselves into an experience. Their body softens, they start relaxing, the chatter of the mind starts dissolving, and they start becoming more present to themselves. And also they can feel my attention being with them and my presence.

I'm just breathing with them, I'm just listening to them. I'm trying to listen to how they're doing, what it feels like. You can really feel the energetic shifts between two people, very much like when you have children. You know, you can feel when a child is hyper or when they're relaxed, and where they are. So it's really nice to follow where the person is and the movement of the energy between the person, and then I'll check in

with them. If I send someone's anxious, I might intervene earlier, hold their hand, and I'll listen to what the process is like. If someone's in a really beautiful space, I will let them stay where they are and I will check in with them. If they're very mild, I might say, would you mind if I give you a little bit more, and I will adjust it so we can go deeper,

but I follow the person's process. If someone's in an ecstatic state and doing incredibly well, I will, you know, just check in with them or stay with them, and when I feel it sort of shifting, I might ask them where they are and what they mind if I

give them more to keep them at that platform. And then when the person slowly comes out of the session, I'll encourage them to really take their time to linger in the experience and to notice as much as possible how they start reconstituting, how the anxiety comes back, how the chatter comes back. It's a really interesting way of

discovering from leaving yourself of how you put together. It's almost like you start stepping back into yourself and studying the whole structure of yourself from experience, and it's really structural. You'll sometimes people be like, Wow, the anxiety just suddenly lodged back in my chest. It's really shocking how we how we don't usually have a chance to notice how

we're assembled, and this is a really amazing discovery. And then at the end of the session, when the person comes out slowly, we'll have a lot of time to sit together and talk about what they experienced, as well as me share with them what I saw happen. We'll try and not to put too much into words, because sometimes that can really condense and squastion experience that is really expensive. But we will cover of the pieces that they may want to share with me, or want to

report to me, or have me remember. And I also like to share while we're in that moment, because in that space, it's not only an exchange of really trying to understand what happened both parties, both the patient themselves is in a very open and defended state, as am I in residence. So it's just really nice to be in each other's presence, and that felt sense of being with each other after that experience is incredibly beautiful and very healing. I think in and of itself, it's a

very important part of it. And I won't let a person leave my office until they're really safe to leave. When you see a minister, is it always intravene as trip or is it another form? I either use lozenges or intramuscular, But I'm a big fan of intramuscular dosing because I can really tailor it. It's very precise, it comes on in three minutes and I can really give a little bit more or I can't take it away. So I like to really no sensitivity engage that so

I can really guide the person. And on the music, is that you determinate or is there a discussion or can I say I don't really like that music, or how does that happen. I'm very open when it comes to music, but I have a playlist that's pretty neutral and I go from there and guide it based on what the person. Sometimes people don't like the music and I'm happy to shift it to what works for them, including I had one person say can I have the rolling Stones? Which I really thought was a bad idea,

and it turned out they thought so too. But I was happy to say, well, we can try it, and if it doesn't work out, can we then move it. But I think it's really important to have that be a tuned to the person and the person feel heard. And usually you can tell when the music it really gets into energy and the tone and the quality. If you're listening carefully, it's really quite easy to know where it goes. One of the things that I always keep an eye on is when someone is really open, the

music is part of the whole experience. It's it's like we're all vibration, and so it's really an interesting element. And in terms of talking, are some patients talking a lot during this session on other people barely talking at all. Do you encourage some people to talk more to talk less. Yes, it's very varied. I really encourage people to do what

they feel would be most valuable for them. I do start off with saying, you know, I do sometimes find then when people talk a lot, it can take them out of the session because you know, you're almost in two places in one it can actually limit the space and the involvement going deeper within themselves. Um So I do make that suggestion that if they're comfortable, I'm not going to intervene, and feel free not to talk to me. But I also let them know if they would prefer

to talk to me, and that facilitates their presence. Have had people want to talk to me because it helps them feel safer to listen and feel really free to do what feels right to them. And it's so variable. I have some people who feel liberated at the chance of not having to be bothered to take care of me and to just focus on themselves. And one person who actually said, I'd prefer you don't talk to me at all and really stay there on my treatment as

other people want to talk the whole time. You know, it's standing up can be a little challenging because ketamines effect on balance and wobbly legs and all this. But otherwise, I mean, do people tend to just lie on their back or do they move around, get onto their stomach on their side sit up. Most people lie down, although I have had some people who have to really move and stretch out, so I also keep some mattresses when

that happens. I oftentimes, when I know that's going to be a thing, I have a mattress on the floor because it's nice to be able to move for those who like to move, and it can be really nice to move, and some people get very mobile on it, so it's so so variable, and then people who are very active the next session, it can be the complete opposite.

And you learn a lot from observing how their bodies move or don't move during the session, absolutely paying really close attention to every aspect what they're saying, but also the energy in the room, what's happening in their body. And oftentimes they're beautiful mood ras. It's almost as a communication from their being through their hands and through their whole body. But really the hands are very important. In

Ketamine's sessions. You will oftentimes see expressions moodra's preyful gestures, really elegant, almost like prayers from the body, and it's really interesting what comes through. It sounds like a lot more fun than sitting in a psychotherapist chair. Across from somebody on a coult or chair and just having a verbal conversation. GETA. Honestly, it really is. It's the most spectacular, amazing event. Each one is so unique and so beautifully rich. GETA.

When you're talking to somebody during this Kereemine session, is there something fundamentally different about the quality of that compared to ordinary psychotherapy without Kenemine. Yeah, I think pretty much everything.

It's ways of really being in resonance and in contact and support and using all of these different modalities to do so, and ideally not words because that puts you back into your head, and these people when they're on when we're on the couch in that stage, you're not really in a thinking place, and it's hard to articulate, and it's actually hard to think in that cognitive way.

You know. The session is so remotely different. If I'm talking to someone, it really is based on checking in on them or seeing where they are, or if I'm noticing they're anxious, and the communication is different. I might choose words, sometimes I might choose the piece of music

just to touch someone. I'll give you an example. I had a fellow who got really, really anxious I could feel he was so anxious in the session, and actually his body started shaking a little bit, so I kind of checked in with him and asked him if he was okay, and he didn't seem to be responding to that. I asked him if I could hold his hand, which I could also feel like he couldn't really receive it. Even though he let me do it, I didn't feel

like it was soothing him. So ultimately I shifted the music to what was, you know, a very gentle lullaby, and he immediately calmed down, and his whole nervous system calmed down. At the end of the session, you know, I felt that allowed him to make contact. So that's

an example of ways of communicating with someone. At the end of the session, he told me that, you know, we talked about it, and he said he got really anxious and felt alone and had memories of being abandoned in his crib, and he didn't remember me actually reaching out to him or retouching him, but he thought I was singing to him. He actually thought the lullaby and the music was me singing to him as his mother

or as myself. It was some confused combination and was really shocked, and I think so that he disappointed to realize I hadn't sung. And so that's in a good example of how it varies and what the communication it's like in the process itself. It's an art form. It's not cookie cut. It's a little bit like having children. If you have a parent who's by the book and it's just having the person on a schedule that's not going to be a great parent. You really have to

try and listen to someone. And it's really the dance between two people. That's where the music is. That's where something can happen. And I've always felt this, even when I was a regular psychotherapist in New York City with

none of these psychedelics. I felt we would come together, the two people would have this encounter and we would talk about, you know, what was going on in a person's life, and I would listen, and I would often offer some clever ideas or interpretations and try and say smart things, show I was listening, come up with some clever way of understanding and showing how I understood what was happening, or some insights into behavior, recognizing almost that

that was the that was almost the exchange that had to happen for something secret that was going to go on between the two of us were real other process was happening where we could learn to trust each other, learned to know each other, and when there were moments when the defenses have both dropped in both parties and you could have this strong emotional connection, that's where the

magic would happen. And so that's always been the kind of dance of the practice in my experience, and with psychedelics, you're right in that field right away. So it's it's a really interesting exciting idea to then just go further and feel how can you utilize that space better, how can you step into it? And to me, it feels like it shifts the field into one of a very

different quality of work. And I do think one thing that you hear a lot about in this field is the mystic click experience or the liminal kind of experience that happens in these in these sublime experiences, because I

think that's a very important dimension. It does shift the healing work into almost spiritual work, and I think we need to get better at conceiving of how to how to really have methodologies which are not DSM based only, but different structures to really house the process better and

to take advantage of the field that's at play. I mean, it sounds like what's similar with other psycholics, I guess in some respects is people can obviously derive enormous benefits from using these psychedelics, using them all by themselves right or with a friend, without being in psychotherapy of any sort. And we know that kenemine is sufficiently powerful that even when it's done without any psychotherapy, can still have a major positive effect in alleviating depression, at least for some

period of time thereafter. But that the advantage of integrating the use of ketamine or the psychedelic with psychotherapy be is that you increase the chances of a positive outcome and maybe a positive longer outcome, and you decrease the risk. Is that a fair sonation. Yeah, I would say that's

probably fair. At the same time, I would say, as much as I think anyone can have a powerful experience with ketamine, and I've certainly seen that without any kind of preparation really or guidance or limited guidance, let's just say I think that at times I do wonder how much of that is a bit of a false friend in that, yes, you have an experience, but it's almost a lost opportunity or even at times can almost close the possibility to make make one almost like a little

bit dulled to the nuances of what's actually being available in an experience. So it's almost moves you further away

from a deeper inquiry, you know. So I have my questions about that, actually, I mean, I do see so many people use these medicines recreationally, and you know, I don't have any kind of questions about that, but I do question of people actually getting relief and are they actually more enlightened or healthier or is it more of making the unbearable bearable, you know what I mean, and helping one cope, which is fine, But that's still a little bit different than actually a deeper inquiry that could

be even more useful or more radical in terms of possibilities of growth and openings. I mean, it does appear that the effect wears off after a couple of weeks, and so therefore people come back in sometimes multiple times. Is it just very dramatically person or person? Are there times when a single session is enough to cure somebody of depression for a very long period of time. It's

incredibly variable as of just an antidepressant. If we're just using it as a pure antidepressant with very limited psychotherapy, it is going to have limited effects, even though they might be the rare person who's just going to have a radical experience that sustained. I think that it gets to be very different and enhanced when you augmented with psychotherapy, when there really is a psychotherapy process. I've had people just have very powerful experiences and then have come back

and needed a second session several months later. Sometimes, you know, one session even is so profound that they need a lot of time to integrate it. And so it's really very variable. But that's not just employing it as an one off administration of medicine. That's with a fuller process, which which can take, you know, not that much longer.

You know, my sessions tend to be three hours, so there's plenty of time, but it's a different process where you're kind of actually having a little bit more of these other threads that are in the experience, not only a discovery that is tailored to the individual with some tools of knowing how to navigate it and they drawn integrated. But I think also the experience of being with the person and having being seen and having the certain functions provided,

which I think is what the psychotherapy shifts are. You can suddenly have a much different process which can be really quite profound and tailored to the individual. I would never have guessed, really how much healing is possible with these medicines, the creativity, the mysteries, the poetry of people, and the natural healing capacities and the wisdom that's held in the bodies. I'm every day blown away. Every day I'm blown away. I never thought this would have been

possible in a million years. I am so shocked and so blown away, and so in awe of human beings. I have to say, I'm just I'm so grateful to do my work because I feel like I learned so much from people every day, because the intelligence and the creativity is just mind blowing to me. Can you give me a few, I'm happy too. There's actually two people that come to mind who have very different stories, but

a little bit of an overlap. One is a young woman I saw who was quite brilliant at an Ivy League college, who had been in tons and tons of therapy because she had had a terrible history of two rape experiences, once in high school and once early in her college life, and you know, had coped well and had done tons of therapy over this and felt she dealt with it pretty much, even though she was still incredibly traumatized and disturbed by the episode and triggered whenever

there would be events that would ignite recognition, and she was in the same environment so that would happen fairly regularly. She had the most moving discovery in the session of seeing herself as a kind of a woven fabric, and she saw there was a stain on the fabric, which is where she had the rape. But she also saw this intricate fabric with roidry and so much richness and so much stitching, and saw how much that stain had become her center of gravity and not all the other

stitches of the whole unfolding tapestry. And she immediately felt almost relieved of having to have that be such a big force in her life. And she sort of said to me, when she was walking over to my office, a fellow had said to her, you know, admired her and said, you know, something kind of very flattering to her, and hadn't asked for her number, hadn't imposed upon her, just had complimented her, And she questioned, why wasn't that

her center of gravity? This generous you know, appreciation of who she was, with no strings attached, and she was, you know, just so brilliant in her creative ability to take possession of her life and re reframe it for herself in this most elegant creative way that really stuck

with her. Another session, which I think is just as powerful, is with an older woman who had done a lot of practice with yoga, in fact, that was her profession, and when she came and did the session, she actually had a lot of vibration in her pelvis and felt energy was being released from it and saw for herself how early childhood rape of her life that she thought she had dealt with and put aside, actually was still being held in her body, and she felt she was

able to release it, along with a recognition in ways that she could see somehow revealed to her in her experience, not in language, but more in images. She had download of understanding of how much that event had in fact shaped her life. This is a woman in her sixties and how much it had impacted her in a myriad of ways, culminating with her recognizing how she had kept her self small, how she didn't have a voice, how she had been afraid, all of which she had been

kind of oblivious to. And it wasn't a situation of feeling sorry for herself. It was more of deep compassion for herself and almost an awakening as well as a repair simultaneously with the acknowledgingment and the release of some of the trauma in her body energetically, of a reclaiming of herself. I have to say, what's really moving about working with psychedelic assisted psychotherapy ketamine? But I think all

of the medicines is. It's so beautiful these stories. But actually at the end of the session she even looked stronger and more self possessed in her being. It wasn't just descriptive or intellectual. It was really embodied. And so that's another example. I have many examples. It's very exciting work.

It really allows one to find the essence of oneself as well as a disconnect from these narratives or these distractions that hijacked her us or are too dominant in our lives, so you can have a balance and a chance to really, you know, I think, take possession of one's life and responsibility or right the chapter of your life that you want, instead of being stuck on these

earlier narratives. And I think that's very unique about Academy and because it really allows, I think, a way of really breaking out of some of these patterns and habits and conditioning and being able to open up new possibilities in a very direct way. And the way you listen and observe your patients has that changed in major ways, major ways, you know. I've I've been always a psychoanalyst, which is a very particular training for those who don't know.

Aside from being a psychiatrist and residency training and all of that fellowship, it's a whole additional training where you have to have a lot of didactics, but in addition to that, you have to have your own analysis as well as treat a bunch of patients and analysis which is endless, four or five days a week on the couch,

and so it's about a ten year additional training. So that's always been my orientation and that has changed completely because the work that I did in that domain is not enough really if you want to do the deeper process.

It becomes a different mode of listening, which of course requires an equivalent kind of knowledge of yourself with these medicines, but I really feel like you can listen with your whole being, and you can really meditate with another person and be in a synchronized state with another person, and it's just so exciting the space between two people and the knowledge that can come through you. It's a very

different way of listening. I feel like you can almost listen with your soul, or listen with your being and here and understand the music of another person, not just their mind, which is one thread of what's being communicated

at any given moment. Let's take a break here and go to an ad you know, I mean, my experience with ketamine is so limited, but um, you know, last year I had an experience with ketamine and it was a friend of mine and of yours who's who's also doing you know, sket immune sists psychotherapy and offered to you know, sit with me for a session. And there were a few things that really struck me about it. I mean, normally, even when I do say, say mushrooms

at a very high dose. I mean, where I may look psychotic, but even when I do that, I remain quite grounded. I know where I am. I don't go off into some metisphere or something like that. With ketamine was struck me. I mean, after the initial discomfort of having to dissolve these lozenges in my mouth because we weren't doing I V or I AM administration that when I came on. First of all, it came on so

remarkably gently. That was one of the first things that struck me about it, And then parts of it became like a sort of mushroom me psychedelic trip was some intense focus on some things, But there was this moment in my experience when the whole thing I lasted forty five minutes. I guess a little bit more. Where I found myself in this situation, which I guess is not

totally uncommon. It was almost like that movie Avatar, the imagery of the Avatar, and and in it, I'm in this kind of almost underwater, this almost like swab and I'm there and I'm thinking I'm underwater. I can't breathe, And then I thought, but I'm breathing and then I'm kind of, you know, swimming for and it's darkness, murky, and I can't see anything, and I'm going, God, this is like this should be scary. I mean, there could be underwater snakes and things, and I have no idea

that black would said, but I wasn't scared. And then I had this feeling. I said, Oh, my god, so this is how I could pass through life into death. And it was this first time I've ever had that sensation or that thought, or that feeling of moving from life into death, and if doing so in a way was rather being filled with some sense of fear or or horror, just seemed almost gentle and accepting in a way,

and it was liberating in regard. And so I've since read some stuff about ketamine and people's you know, how they relate to death. But I wonder in your therapeutic practice, you know, how have you have you encounter things like this in people in terms of that element of freedom or in terms of how they think and approach death. Absolutely, and thank you for sharing your account. It's such a

beautiful description of ketamine that you provide. It isn't very gentle medicine, and I think it's really good for those of us. And I think both you and I fall into this category ethan of being. You know very much in our heads a lot of the time, and so to actually have a chance to actually drop out of your thinking mind and find a lot of the knowledge and wisdom and beauty in other sensual realms and other kind of ways of knowing and navigating is quite profound

and a big expansion. And I love your insight about transition into death. And there's a lot of work being done actually in this area about end of life issues, particularly with ketamine. So I'm excited that you bring that up.

And there's actually even an FDA study that Ketamine Training Center had just got a proved for for conscious dying, which is very exciting that a bunch of sort of sites across the US are going to be really offering a protocol with ketamine assisted psychotherapy for end of life. And you know, I've had an incredible experience with a few patients working with ketamine for end of life issues.

I'm very interested in weaving it together with meditation. Deepark Chopra, who's a partner and a colleague of mine, He and I have been working on a protocol looking at ketamine assisted psychotherapy for end of life issues with meditation. And I'll offer another vignette because this is a person who wanted me to share this with the field working with

her when she was approaching actual death. This was a lifelong meditator who had really wanted to die consciously and didn't understand why she was encountering so much anxiety since she had a really full life and had twenty year history of breast cancer, so she had a lot of time to prepared for it and felt satisfied by her life, but felt really anxious when she was coming down to have to decide when to go into hospice, and so she reached out to Deep park on me and we

did a session together. It was one of the most beautiful experiences of a guided meditation talking about the nature of reality and then actually going into academine experience and she, like you kind of felt like she was going into a tunnel, and then talked about feeling as if she suddenly left her body, which was for her extraordinary because she was in so much pain at the time. To just not have a body and to be in the

music was she said, just so freeing of anxiety. But what she did teach me, which I thought was really interesting, was she actually felt the piece that of her aside from having that experience which felt so relieving and the transition to death that made her feel hopeful and open to to death, was she felt actually the presence of having to facilitators supporting her and accompanying her through death was perhaps the most single variable that she felt was helpful.

Even though she was surrounded by people, she felt so alone in having to actually take this path towards death because she didn't want to upset all her family members of sharing what it was like for her, what she was encountering, what her fears were. So to have a place to really hold hands with people who cared about her and were able to almost act as duelers in this transition was just as important. You know, I was

watching recently to talk. You gave a video at the Icon School of Medicine in New York, and you're going through it talking I think, to people who were in psychiatry. But then there was a kind of summing up of many of the small points, and the one word you wrote next to it all was the word freedom. But I think it's really an important concept because I think this medicine really makes me aware of freedom, liberation, or

you know, you can think about it in different ways. Really, I think we all imagine we have free choice, but how much of our worlds are dominated by our conditioning or our habits or calma, however you want to think about it. You know, we kind of shape our worlds through these particular lenses we're wearing. As a psychiatrist, and I think anyone who's been in psychotherapy is very aware of how there are certain patterns that one finds throughout

the course of one life. There's a relationship passion of how we tend to the problems we tend to get into over and over again. The hope is in psychotherapy, if you're aware of them, you're going to stop making those patterns. And sometimes that happens. Most often, you know,

we have more insight and awareness. I really feel psychedelic psychotherapy allows one to really have a chance to almost find the door out of our prison, which are our patterns, our characters are conditioning, and to have new possibilities and an emergence into the full aspects of who we are, not based on our survival based strategies from childhood and the environments we grew in, So I really feel it is a process of liberation and growth and new possibilities

now here you're deeply involved in training others in kenemine assisted psychotherapy. What's that like setting up these training programs? Do you get people who show up at these things and you think they shouldn't be here? And if so, how do you deal with that? What is it you're trying to convey? Who are these people? They mostly physicians or others. Have many of them already been trained in m DMA psychotherapy? What can you say about your your trainees?

It is a really interesting training because it's a retreat style training where there's an unfolding process that happens for the whole group, and it's very experiential. Everyone experiences a low dose and administers a low dose as well as

the high dose and administers a high dose. So you get a lot of knowledge from the sharings, and by the end of the five days, you've had so much access to different experiences and what people have encountered, as well as listening and experiencing yourself and the unfolding safety and trust in the emergence within the group, so it's a really rich experience, not to mention tons of didactics thrown in there, so it's quite quite an intense experience.

And to your point of who applies, there's so much demand for training and knowledge in these new medicines, particularly ketamine. It's really open to practitioners, so a lot of them are psychiatrists. Sometimes we have and es, thesiologists who even have clinics and want to understand more about the process or experience it themselves, e R doctors, nurse practitioners, psychotherapists. We really are multidisciplinary but now open to healthcare workers

and medical professionals generally speaking. How much do you all need to be worried about the risk? I mean, we know that among people using ketamine in an illicit or unregulated context that there are issues of dependence and addiction and some harms. We know it's not as dangerous as opioid addiction, for example, and there aren't the same risks of mixing with other drugs, but it is an issue. Um, what's your thoughts about that? I think it's it's definitely

an issue. I think that we have to be much wiser about how are we prescribing all of these different medicines and ketamine, And I think that's what makes me a bit concerned as well about the more biological roots, because I think that does push someone more in that direction rather than opening up a process which which I

think is still an accelerated psychotherapy process. But I do think we have to be concerned and more knowledgeable and responsible about how we're prescribing and what the risks are and to identify how to best support individuals who do have a wild risk for substance abuse or dependency, because this can be an incredibly good treatment in that population too. It just has to be handled more thoughtfully and carefully. You know, I wonder I mean thinking about the areas

of methane and booper. I mean methodone is is crazily over regulated area in the United States. It has really impeded, you know, the effort to make it access as accessible as possible. And you know, while we're phrasing an opioid epidemic, boupern orphane has required physicians, I think, to get some level of training, although maybe some of that is shifting in Kenemine right now, there's no requirement right that you have any training, Do you think there should be some

requirement mandated by medical boards or other regulatory agencies. Now that's a really good question. I think training would be very helpful. Depends on what you've been trained for. I mean, that's the thing is that you don't need any training. People come to our training because they want to learn,

not because they're mandated to really learn. And then there's so many trainings popping up that you know, it's hard for consumers to understand which is the right training to go to, because having a beautiful website doesn't really tell you very much. So I think training would be really important. Certainly, I can speak for myself. I can't imagine just becoming academy and provider for psychotherapy without having a lot of

experience and seeking that out. I tend to be on the more very responsible side, so that's my character anyway. But I do think some training is really important because I think you can really in terms of first do no harm, get into trouble if you don't know what you're doing or what the doses are, what the concerns are. There is such a focus on scaling and access and so much commercial gain that's centering into the field, which might have its benefits to the problem I see in

this real mad rush of access and commercial gain. Are we going to have a predictable backlash to that so instead of actually winding up ahead that everything is going to if things get very sloppy and there's casualties popping

up an addiction and dependency. Are we going to have a short lived moment of this growth when everything then has to come back and swim to the other direction of being regulated and medicalized and shut down and limited, which maybe is an important balancing act, But I think it would be nice to have a little bit more thought in deciding instead of, you know, having the decisions made because people are rushing too quickly and carelessly. Well,

geta listen. I love what you're doing. I love the way you think about this, I love the way you describe it in the terms of dancing choreography, and I love your vision for it. So thank you ever so much for being my guest Let's Psychoact. It's been a pleasure to be here. Thank you. I'm joy talking to Ethan. We love to hear from our listeners. If you'd like

to share your own stories, comments and ideas. Then leave us a message at one eight three three seven seven nine sixty that's eight three three psycho zero, or you can email us at psychoactive at protozoa dot com or find me on Twitter at Ethan natal Man. You can also find contact information in our show notes. Next week, I'll talk with Hamilton's Morris, the brilliant young journalist, scientific

researcher and creator of Hamilton's Pharmacopeia. I even would go so far as to say I became a journalist as a reason to talk to Alexander Shalgan. You know, that was that was probably one of the holy motivators, was you know, why would he talk to me? Well, maybe he talked to me if I were writing an article about him, or you know, maybe then that would be

some incentive. And that was kind of one of the main things that interested me about journalism at the beginning, was that it was a license to be curious about things that otherwise you would have no legitimate reason to ask questions about why would somebody talk to and annoying college student about their work. They have better things to do, they're busy. But if he's working for a magazine, and he's writing an article or making a short documentary. Well

maybe they'll We'll give him a couple of hours. Subscribe to Cycleactive now see it, don't miss it. Psychoactive is a production of I Heart Radio and Protozoa Pictures. It's hosted by me Ethan Nadelman. It's produced by no him Osband and Josh Stain. The executive producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren Aronofsky from Protozoa Pictures, Alex Williams and Matt Frederick from My Heart Radio and

me Ethan Nadelman. Our music is by Ari Blucien and a special thanks to Avivi Brioseph Bianca Grimshaw and Robert B. B