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What Is Dissociation and How Does Ketamine Create It?

What is dissociation
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The world around you becomes unreal, as if in a dream. You no longer feel as if you own your body. You feel detached from the world around you, as if some intervening medium is cutting you off from it. You feel dazed and confused, disjointed and disconnected. You feel as if you leave your body completely and become a disembodied viewer of the scene.This is a typical experience of dissociation. Dissociation, however, can take on multiple forms. This article explores what dissociation is and how ketamine produces it.

What Is Dissociation?

Dissociation is a natural psychological capacity that all humans possess. It evolved to help people cope with intensely stressful situations. If a person has been attacked by a lion, confronting the situation may be counterproductive, and it could push a person into a state of shock. Dissociation increases the chances of survival in overwhelming situations by psychologically distancing from the experience. Instead of feeling present and embodied we feel somehow removed from the situation and our experience of it.

How Is Dissociation Possible?

The human experience of the world is something like a controlled hallucination. Our minds generate an experience of a world and of ourselves within it.  We don’t typically notice this. When our conscious hallucination of the world is functioning correctly we just see through it and feel like we’re seeing the objective world beyond.  Our experience functions like an interface that allows us to navigate the world.  

The same process is happening when a person perceives their own body. They don’t perceive it directly, but the mind creates an image of the body and that is what is perceived. As a result, it is possible for the experience of oneself and the world to be profoundly altered. Your constructed sense of self can become distorted and you can even lose the sense of identification with the experience of the body completely.

Is Dissociation Unhealthy?

Dissociation isn’t inherently bad for you. It’s a psychological coping mechanism that evolved for a reason. Dissociation can be evidence of an underlying mental health issue, however. During traumatic events, people may dissociate in order to protect themselves psychologically. If someone cannot ground themself in a way that makes them feel safe after the event, they may be left with post-traumatic stress disorder (PTSD). 

Accordingly, dissociation can be a feature of PTSD. When the stress response produced by the traumatic event persists even when the event itself is over, mental and physical health can deteriorate. If someone dissociates often, it is worth exploring whether they might be suffering from a form of PTSD.

Dissociative Disorders

Some people suffer from dissociative disorders, which are characterized by persistent dissociation. In these cases, the main danger of dissociation is that the person may experience a fugue state in which they lose their sense of identity and their ability to form memories of events that took place during that state.

The experience of loss of memory in dissociative states is known as dissociative amnesia. Chronic experiences of loss of identity can also occur. This is known as dissociative identity disorder. Dissociative disorders can also be characterized by depersonalization, the feeling that one does not really exist. They can also result in states of derealization, in which the outside world feels unreal.

How to Cope With Dissociation

One common approach to coping with transient experiences of dissociation is grounding. Grounding involves intentionally connecting to the body’s experience and the environment to counteract the disconnected experience of dissociation. Once a person notices that they are dissociating, they can start this process by paying attention to objects in their environment using multiple sensory modalities. Naming the objects helps to make sure that they really are connecting and paying attention to them. 

One popular technique is to name five objects that can be seen, four that can be touched, three that are heard, two that are smelled and one that has taste. Following this exercise people often report a decrease in the feeling of dissociation. Feeling one’s feet on the ground physically can also be grounding psychologically. In more severe cases, therapy to address underlying traumatic material can help lessen dissociative symptoms.

Why Is Ketamine Considered a Dissociative?

What is it about the psychoactive effects of ketamine that make it dissociative? Ketamine can produce sensations of disconnection from the environment and the body to a profound extent. It is common to experience a floating sensation while on ketamine. At high enough doses ketamine can produce the feeling that one has left the body, often described as an out-of-body experience. As a result of its anesthetic properties, high doses can also produce the experience of a k-hole, in which one is profoundly disconnected and physically incapacitated by the effects of the drug.

Out-of-Body Experiences

During a ketamine-induced out-of-body experience, people typically feel as if their sense of self is no longer coinciding with their body. They may feel as if they are hovering slightly behind their body or even that they have completely left their body behind and are now in another place entirely. It helps to understand what is happening here by remembering that sense of self is actively constructed by the brain. People are not actually leaving their bodies. Instead, the process by which humans identify with certain parts of their experience in the world is being disrupted.

The K-Hole

High dose experiences of ketamine can result in one ending up in a k-hole. The idea of being stuck down a hole captures the inherently dissociative aspect of this experience. The world typically feels very distant as the powerful dissociative effects of ketamine interfere with the mind’s ability to connect to the experience to the outside world. There is also typically the feeling of being disconnected from the body. This state can be profoundly hallucinatory and one can have experiences of melting into the surrounding environment. During a k-hole one is also experiencing the powerful anesthetic power of ketamine, where the drug makes it difficult to speak and move.

How Does Ketamine Produce Dissociation?

Ketamine acts on a group of receptors in the brain known as NMDA receptors. These receptors are involved in learning and memory and are usually activated by glutamate, which mediates the majority of information processing and transmission in the brain. While, classical psychedelics–like LSD and psilocybin–act on the serotonin system to alter the perceptual experience of the world, targeting the glutamatergic system with ketamine seems to have strikingly different effects. 

The brain networks generate the controlled hallucination of the outside world and personal self signal using glutamate. The disruption of this process that occurs due to altering glutamate signaling with ketamine appears to be responsible for disrupting the sense of the reality of this controlled hallucination.

Can Dissociation Be Therapeutic?

Is dissociation a side effect of ketamine, or is it actually useful therapeutically? Ketamine has recently been found to work as a fast-acting antidepressant. Ketamine for depression is a very powerful remedy. Some studies have investigated whether dissociation may play a role in this effect. Researchers investigated this question by measuring the extent of dissociation and the anti-depressant effects in patients undergoing the therapy. 

Some of these studies found that the strength of dissociative effects correlated with the strength of the therapeutic outcomes. Other studies have not found the same effect, however. Science currently doesn’t know whether ketamine dissociation is an important part of the therapeutic effect or an irrelevant side effect.

Ketamine and Dissociation

Whether someone experiences dissociation in their daily life or as a result of taking ketamine, this strange altered state is deeply intriguing. While it doesn’t typically feel pleasant, it can be powerfully adaptive in situations where people feel overwhelmed. Ketamine-induced dissociation can range from a distortion of one’s experience of the world to out-of-body experiences, as well as the experience of the k-hole. 

All of these states prove that the way humans typically experience the world is a construct of the brain and one that can be profoundly altered by stress or a drug like ketamine. No matter how one encounters dissociation, it is good to familiarize oneself with this particular mental state in order to minimize distress if it happens personally.

ketamine-dissociative-infographic

Disclaimer: Ketamine is potentially categorized as an illegal drug. Reality Sandwich is not encouraging the use of these drugs where prohibited. However, we believe that providing information is imperative for the safety of those who choose to explore these substances. This guide is intended to give educational content and should in no way be viewed as medical recommendations.

Author

  • Dr. James Cooke

    Dr. James Cooke is a neuroscientist, writer, and speaker, whose work focuses on consciousness, with a particular interest in meditative and psychedelic states. He studied Experimental Psychology and Neuroscience at Oxford University and is passionate about exploring the relationship between science and spirituality, which he does via his writing and his YouTube channel, YouTube.com/DrJamesCooke. He splits his time between London and the mountains of Portugal where he is building a retreat centre, The Surrender Homestead, @TheSurrenderHomestead on Instagram. Find him @DrJamesCooke on Instagram, Twitter and Facebook, or at DrJamesCooke.com

2 thoughts on “What Is Dissociation and How Does Ketamine Create It?”

  1. Avatar

    This is in line with theories like that of the Psychologist Donald Hoffman that our experience of reality is the result of a simplifying interface created by the brain under evolutionary pressure and does not correspond to reality as it actually is, which in its abundance of raw stimuli would be overwhelming and unnavigable.

  2. Reality Sandwich
    Reality Sandwich

    @ DK, thank you so much for this insight! Reality, perception, and dissociation are truly complicated and interesting topics and we appreciate your contribution to the conversation.

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