Ketamine’s Culture In Psychiatry

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Lithium, Zoloft, Prozac, Clozapine, and Risperidone. Modern medicine mainly views psychiatric conditions as organic diseases to be treated by molecular means. There is no doubt that taking pills can save lives. Countless people have been successfully treated by such methods, but given that these practices often come with some pretty weighty side effects, is it time for more sustainable and integrative solutions?

We know that everything is more than just the sum of its parts, and mental health is no different. The emotional, behavioral, and cultural ties to states of mental distress are often treated as an adjunct to an organic foundation. Most pharmaceutical methods target levels of neurotransmitters in the brain. 

However, the emergence of psychedelic approaches and their potential to shake up the medical model in its entirety could lead us toward a new paradigm that bridges the gaps between quantifiable Hippocratic (biochemical) and intangible Asclepian (emotional) dimensions [1]. We are creatures of our environment. It’s becoming increasingly clear that interdisciplinary approaches to health should not be limited to secular scientific departments or take an overly reductionist approach.

A truly bio-psycho-social model also extends an arm into the humanities and the existential. With the debate still open as to whether many psychiatric diagnoses are truly universal or relative to the prevailing culture, psychedelics help us to better question what it really means to live the human experience across a spectrum that does not respect the borders of the binary.  

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Clinical Culture

Culture influences our behaviors in diverse ways. It consists of the social ethics, principles, or morals seen in society and manifests as a way of living that encompasses beliefs, values, customs, language, and traditions. This is important because it provides the lens necessary for understanding how the mind, mental illness, and abnormal behavior are studied differently in varying cultural contexts. 

Within the medical sphere, there are three main components to consider: the culture of the patient, the physician, and the medical culture within which treatment is practiced. This can affect all of the diagnosis, prognosis, treatment expectations, compliance, and presentation. Studies show that mind (placebo) and drug are not separate psychological and physical processes; rather, they are part of a highly complex interaction between consciousness, genetics, environment, and the types of substances being used. [2]

An illustrative example is ‘culture-bound’ syndromes, which often have a special relationship with their setting. Culture-bound syndromes show no objective biochemical or structural alterations of organs or functions but a mix of behavioral and somatic symptoms. Examples include Hwabyeong and Ghost Sickness.

Hwabyeong is a Korean somatization disorder (mental illness) that occurs when people are unable to confront their anger as a result of conditions that they perceive to be unfair. It’s also known as ‘depression anger illness’ with symptoms including palpitations, anorexia, insomnia, and being easily agitated. Ghost Sickness is a term used among the Navajo of North America to describe a preoccupation with the deceased.

This manifests as loss of appetite, suffocation, recurring nightmares, and anxiety — culturally, it may be attributed to ghosts or witches. This view has an effect on treatment. In Creek culture, purification rituals for mourning focus on moving an energy called ‘Ibofanga’, which is supposedly obstructed between mind, body, and spirit — causing a prolonged emotional and physical drain. 

There are a variety of mainstream psychological theories about ‘ghosts’ and ‘spirits’ – emotional energies that may be viewed as being directly or indirectly related to the cause of an event, accident, or illness. What this shows is that culture is the container framing the entire experience of mental health for both the patient and clinician — molding the interpretations of thoughts, emotions and behaviors that rise to the level of symptoms. 

Culture and language equally set the standards for how we define abnormality – as a set of socially acceptable norms about expected ways of behaving according to the majority. A good example of the disconnect this can create is that of Schizophrenia, which may be considered a culture-bound illness. 

Whereas Western societies view Schizophrenia as a medical issue, there are still many Eastern cultures that treat this as a ‘spiritual’ or ‘supernatural’ phenomenon. In an age where we are seeing the demonstratable benefits of spiritual practices such as meditation on mental health, to simply disregard such a lens as primitive would clearly be a mistake. 

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Special K

Enter the integrative psychedelic lens. Clinically, trials for dosing and administration in the psychedelic sphere are still limited and require personalization. However, there is already promising data showing significant improvements in mental health issues such as depression and anxiety using ketamine, with effects lasting for months after the first dose [3].

Ketamine has been described as a breakthrough in psychiatric medicine because its action on the neurotransmitter system is entirely distinct from the pathways on which conventional SSRIs act using serotonin, norepinephrine, and dopamine. It works on the glutamate level—a crucial excitatory neurotransmitter with a role in neurodevelopment, memory, and nerve growth function. 

It has been found that depressed patients have elevated levels of glutamate in their blood and cerebrospinal fluid compared to healthy controls: changes that can be reversed. Under ketamine therapy, a patient receives 1-5 infusions, calibrated according to their receptivity [4]. 

Despite it being inexpensive compared to traditional methods, the side effect of psychosis is something that many clinicians and patients find difficult to manage. However, there is reason to suspect that this aspect is not necessarily something to be rejected. 

While many practitioners see the glutamate hypothesis as a reason to isolate ketamine’s effects, the role of the emergent, transpersonal, or mystical experience seems to pull its own weight. ‘No study to date, has demonstrated that, absent some degree of psycho-activity, there is an antidepressant effect [5].

A holistic systems science of the nervous system, therefore, is inclusive of cognition and consciousness, replacing the monolithic concept of psyche with an integrated systems operation of information, mind, self and life [6].

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A Shamanic Science

The off-label use of ketamine for depression in India is a prime case study for looking at the implications of combining medical, historical, existential, and cultural models in practice. 

It is in the home of the Taj Mahal that mental health and the psyche have been an area of exploration for centuries. This dates back to the Vedic period, where the human mind is described in relation to consciousness and the dynamics of human behavior. In other words, ‘abnormalities’ were often seen to be associated with beneficial psychic changes [6].

While ketamine is much more likely to be leveraged here, psychedelics are not considered standalone treatments. Delivery takes a more holistic approach, and the process of change may be allowed to run free within an existential context described as the ‘guru-chela relationship’ [7]. This relationship is similar to the container provided by a psychotherapist. 

Taken literally, the word ‘dissociative’ means ‘detached from reality’, occasionally leading to out-of-body phenomena, dream-like states or trances. These are experiences that patients may find hard to make sense of on their own, and an unstructured or chaotic approach to management has the potential to reinforce existing trauma.

The reason talk therapy is additive to this process is that as high neuroplasticity primes the brain for change, psychological guidance ensures that any novel wiring is structurally engineered to lead to positive destinations. The culture of the guide and participant, therefore, need to be aligned for the best outcome to be reached. 

Spiritual experiences can occasionally be organic and are not always instigated by psychedelic use. The term ‘spiritual emergence’ was first coined by psychiatrist Stanislav Grof because such experiences often presented a chance to ‘emerge’ with a higher level of spiritual and psychological awareness – if correctly supported, instead of being suppressed. [8]

Ketamine is also not a panacea and comes with its own bag of risks. However, this need must be weighed up against the potential bio-psycho-social harms caused by untreated mental health issues like chronic depression. 

Yet to avoid becoming just another thing on the conveyer belt of routinized care feeding a ‘magic pill’ approach, the ceremonial history of psychedelic medicine use and its focus on environment and cultural context must be brought to the fore. 

Such experiences have the potential to loosen up our usual filters and judgments and open our hearts to deeper and more authentic ways of relating to both others and ourselves. It is becoming increasingly evident that it is one element to be clinically cured, and another to be holistically healed.

References

[1] Morris, David (August 2007) Un-forgetting Asclepius: an erotics of illness. Retrieved from https://muse.jhu.edu/article/225315 

[2] Wager, Tor (July 2015) The neuroscience of placebo effects: connecting context, learning and health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6013051/ 

[3] Mandal, Suprio (September 2019) Efficacy of ketamine therapy in the treatment of depression. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767816/ 

[4] Sanacora, Gerard (January 2012) Towards a glutamate hypothesis of depression. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205453/ 

[5] Dore, Jennifer (Feb 15, 2019) Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy. Retrieved from https://www.tandfonline.com/doi/full/10.1080/02791072.2019.1587556  

[6] Mukhopadhyay, AK (November 2015) Neural Fabrics of The Mind: Systems Neuroscience, Systems psychology and consciousness. Retrieved from https://www.jscimedcentral.com/Psychiatry/psychiatry-3-1049.pdf 

[7] Neki, JS (1973) Guru-chela relationship: the possibility of a therapeutic paradigm. Retrieved from https://doi.apa.org/record/2013-41581-009?doi=1 

[8] Holotropic Association (August 2020) Retrieved from https://holotropic-association.eu/what-is-spiritual-emergency  

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Having Sex on MDMA: What You Need to Know
MDMA is known as the love drug… Read our guide to learn all about sex on MDMA and why it is beginning to makes its way into couple’s therapy.

How MDMA is Made: Common Procedures Explained
Ever wonder how to make MDMA? Read our guide to learn everything you need to know about the procedures of how MDMA is made.

Hippie Flipping: When Shrooms and Molly Meet
What is it, what does it feel like, and how long does it last? Explore the mechanics of hippie flipping and how to safely experiment.

How Cocaine is Made: Common Procedures Explained
Ever wonder how to make cocaine? Read our guide to learn everything you need to know about the procedures of how cocaine is made.

A Christmas Sweater with Santa and Cocaine
This week, Walmart came under fire for a “Let it Snow” Christmas sweater depicting Santa with lines of cocaine. Columbia is not merry about it.

Ultimate Cocaine Guide: Effects, Common Uses, Safety
This guide covers what you need to know about Cocaine, including common effects and uses, legality, safety precautions and top trends today.

NEWS: An FDA-Approved Cocaine Nasal Spray
The FDA approved a cocaine nasal spray called Numbrino, which has raised suspicions that the pharmaceutical company, Lannett Company Inc., paid off the FDA..

The Ultimate Guide to Cannabis Bioavailability
What is bioavailability and how can it affect the overall efficacy of a psychedelic substance? Read to learn more.

Cannabis Research Explains Sociability Behaviors
New research by Dr. Giovanni Marsicano shows social behavioral changes occur as a result of less energy available to the neurons. Read here to learn more.

The Cannabis Shaman
If recreational and medical use of marijuana is becoming accepted, can the spiritual use as well? Experiential journalist Rak Razam interviews Hamilton Souther, founder of the 420 Cannabis Shamanism movement…

Cannabis Guide: Effects, Common Uses, Safety
Our ultimate guide to Cannabis has everything you want to know about this popular substances that has psychedelic properties.

Cannabis and Ayahuasca: Mixing Entheogenic Plants
Cannabis and Ayahuasca: most people believe they shouldn’t be mixed. Read this personal experience peppered with thoughts from a procannabis Peruvian Shaman.

CBD-Rich Cannabis Versus Single-Molecule CBD
A ground-breaking study has documented the superior therapeutic properties of whole plant Cannabis extract as compared to synthetic cannabidiol (CBD), challenging the medical-industrial complex’s notion that “crude” botanical preparations are less effective than single-molecule compounds.

Cannabis Has Always Been a Medicine
Modern science has already confirmed the efficacy of cannabis for most uses described in the ancient medical texts, but prohibitionists still claim that medical cannabis is “just a ruse.”

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