Author P.E. Moskowitz on March 11, 2021, in Brooklyn, New York. Photos by Yael Malka for Elemental

A Good Drug for a Bad World

Why ketamine is just right for these dissociative times

For legal reasons, I’ll just say the last time I did ketamine was not that long ago, at a house, with two friends, as we played gin rummy and chatted (about what, I do not remember). We each insufflated little bumps off my house key. Soon, the gin rummy stopped. FKA Twigs videos were summoned onto a large TV, and listening to the music felt like when you’re in a hotel pool and you’re 10 years old and you float on your back and your ears dip above and below the surface and you feel all the pain and resentment of your life coalescing around you, concentrating within you, and then you release it, while your dad watches on from a deck chair, not knowing the chaos in your head, only seeing the serenity.

Then I went to bed.

Very hard to describe ketamine, which, unlike shrooms or LSD, does not really make you hallucinate, and unlike MDMA, does not make you warm and fuzzy and want to hug everyone. It’s a dissociative, but dissociation is an inadequate way to describe what it does to your sense of the world. One person told me it feels like your brain is a few seconds ahead of what’s actually happening. Another told me it’s like when you’re dreaming and the person in the dream is you, but not quite you, and your life in the dream is your life, but not quite your life. Also, your body feels like rubber. Another said that our brains are trained to think logically, especially in this algorithmic era, and ketamine kind of randomizes everything, scrambles the code.

Harder still to describe the days after ketamine, and those days, rather than the experience itself, are the reason I’m writing this love letter of sorts to the substance (as opposed to any of the other myriad consciousness-obliterating drugs out there).

Have you ever pressed that little button on a computer monitor where it refreshes, the screen changes color for a split second, and it makes a weird zrrp sound? That’s how my brain feels the morning after doing ketamine. Refreshed. Everything a bit brighter, my head a bit lighter on my shoulders, the world a bit less filled with doom — a miracle, given how much doom the world is filled with and my predisposition to always be thinking about that fact.

The doominess of the world makes it probably unsurprising that a drug with the potential to treat depression in a matter of minutes instead of months, with very little addictive potential or danger for overdose, has exploded in popularity over the past few years.

Imperfect but interesting metrics for the rise of K: Police seizures of the drug were up 30% from 2017 to 2018 in the U.K. Google searches for the drug have doubled in the past five years. And while searches for MDMA have started trending downward during quarantine, ketamine searches have held steady. It’s obviously not a scientific datum, but this disparity brings up something telling that, from personal experience, rings true: People are doing fewer club drugs like MDMA because we’re not going to clubs. But ketamine has survived the pandemic and made its way out of the club and into our household lives. To me, this signals that ketamine’s rise is not just about a fun escape but about coping with our new world.

The doominess of the world makes it probably unsurprising that a drug with the potential to treat depression in a matter of minutes instead of months… has exploded in popularity over the past few years.

Now, as ketamine has grown in popularity, so too has our collective knowledge that drugs, and drug experiences, like everything in this world, are not equal. While marijuana gets legalized in state after state, countless people, mostly people of color, sit in prison on marijuana charges. And while ketamine becomes the drug du jour for so many of us (myself included), the police are still using it to forcibly restrain people.

Ketamine helped save my life. But there is nothing inherently liberatory about it. It’s a good drug in a bad world. And the world, no matter how much perspective or healing or joy we get through drugs, is still very, very bad.

Ketamine was created like a lot of drugs of the mid-20th century: Scientists at universities and pharmaceutical corporations were given free rein to play around with existing chemical compounds and try to come up with new psychoactive substances. (Many of the psychotropic drugs we have today are variations of drugs created during this heyday of experimentation, which was only allowed to happen in part because the safety standards for animal and human trials were lower and the red tape at universities and pharmaceutical companies less thick than they are today.)

Researchers in Detroit in the mid-1950s were attempting to find an effective anesthetic and came up with PCP. The drug sedated people, but it also created psychosis in some — not ideal for surgery scenarios. In 1962, after a few years of playing around with derivatives of PCP, Calvin Stevens, who worked for the pharma company Parke-Davis, synthesized what they would christen ketamine, named for its structure, composed of a ketone and an amine.

Ketamine worked as a short-acting anesthetic, helped relieve pain, didn’t knock people out for too long, and didn’t cause hallucinations like PCP. It was quickly adapted by the medical community and, as the violence of the Vietnam War ramped up, became a popular anesthetic on the battlefield.

Ketamine remained popular as an anesthetic, and scientists began using it to see if they could mimic the effects of schizophrenia in the brain in order to study the disorder, but researchers performing those studies noticed that some of the participants in their studies also reported less depression after being given ketamine.

Recent studies have found that ketamine helps many people for whom traditional antidepressant treatments fail.

In 2000, researchers performed the first-ever placebo-controlled study for ketamine as an antidepressant. Seven people with major depression were given either intravenous ketamine or a saline solution. Each participant who took ketamine showed a marked improvement in mood after their infusions. The study was tiny, but it showed the potential for ketamine as a medication that, unlike traditional antidepressants, worked quickly with one dose.

Since then, studies have found that ketamine also works for many people for whom traditional antidepressant treatments fail.

The research on how ketamine alleviates depression is limited: There are only four studies on its efficacy as compared to a placebo. Researchers who have studied the ways ketamine affects the brain have come back with a long list of findings, none of which are definitive proof of its method of action against depression.

It might be a frustrating answer for those looking for specificity, but one of the possible reasons ketamine works is that it’s a “dirty” drug: When ketamine enters your nose, muscles, or veins, it causes hundreds of little reactions, affecting dozens of neurotransmitters — any of which, or a combination of which, might be responsible for depression.

“It could be that one of the 10 or 20 proteins that ketamine is hitting is [the] key, but we don’t know what one is right, or it could be that we do want to be hitting five or six things in the brain,” Bita Moghaddam, PhD, chair of behavioral neuroscience at Oregon Health and Science University and the author of a forthcoming book on the science of ketamine, told me.

In 2019, the FDA did something very rare for a mental health medication: It fast-tracked ketamine through its approval process, making a nasal spray version patented by Johnson & Johnson subsidiary Janssen available to Americans via prescription.

The approval was hailed by some advocates who see ketamine as a breakthrough treatment for depression and PTSD, but it was also an odd move, considering there aren’t very many studies on the psychiatric uses of ketamine (at least as compared to traditional antidepressants) and the fact that even the scientists who study it are unsure of how the drug actually works.

But the approval might be part of a trend in how experts are starting to think about depression and mental health in general: It doesn’t really matter why something works—if it works, use it.

“If the drug is working to alleviate the symptoms of depression, it should be used even if we don’t know the mechanisms of action,” Moghaddam said. “People who are prone to anxiety or depression know: Oh my god, if anything helps, yes.”

Moghaddam says it’s in many ways just too complex to know why drugs work. She calls this the “peach principal.” Let’s say you’re eating a peach. The peach is really good. You love peaches. (Just play along if you don’t.) But why do you love them? There’s the smell, the taste (and within taste, there are many tastes: sweetness, tartness). The peach might also satiate your hunger. There’s really no way to say, “This is why you love peaches.” And the same is true for ketamine (along with other drugs being studied for depression, like MDMA and psilocybin). Do they work because of one receptor or another? Because they produce psychedelic effects? Because they allow you to imagine yourself floating above your own body, rebuilding your brain like a psychedelic architect? Or all of the above?

It could be that ketamine works a lot more like electroshock therapy than the most popular treatment for depression, selective serotonin reuptake inhibitors (SSRIs): It jolts a bunch of stuff in the brain. Some neurons are excited. Others get sleepy. They move around. Crash into each other. And when they resettle, they resettle differently.

The least scientifically satisfying answer to ketamine and mental health is also the most correct one: It’s extremely complicated.

In any case, it doesn’t really matter if we know how a drug works. If it works, use it. If you like peaches, eat ’em. We’ll never understand the ethereal beauty of a peach through science. And we’ll never fully understand why drugs like ketamine help our brains solely through science. Because science cannot describe the out-of-body experience, the spiritual revelations, the mindfuck of a drug like ketamine. And that — the mindfuck — just as much as its chemistry, is key to ketamine’s power.

Sad, then, that drug companies are now trying to remove the pleasurable parts of drugs. Researchers are hard at work trying to separate the components of recreational drugs and see if they can be used to treat depression without also causing you to have fun.

It’s a through line in most American medicine, Zachary Siegel, a prominent writer on U.S. drug policy, told me. We think things that are medicinal shouldn’t be fun, and vice versa.

“There’s this constant line of research to remove the pleasure from the drug that helps people,” Siegel said. “What research gets funded, so much of it’s guided by this pursuit to remove pleasure and euphoria from drugs that help people.”

It’s a shame that our puritanical culture views fun and medicine as incompatible. Because I’m pretty sure the reason ketamine worked on me had less to do with the chemical changes to my brain and more to do with it allowing me to see my life completely differently.

“All of a sudden, you don’t live on the timeline where everything is so shitty and everything that can possibly go wrong ever will go wrong.”

On ketamine, even during the dark trips, especially during the dark trips, I was able to have revelations that might’ve taken me years to get to in therapy. I remember Mardi Gras in New Orleans a few years ago, taking what ended up being too much, stumbling through a crowd of masked revelers, and then all of a sudden realizing that a good chunk of my constant depression was due to the fact that the world was dying. I kept blathering on about global warming, to my friends’ chagrin. (It was Mardi Gras—we were just trying to have fun.) I woke up the next day feeling more at peace, knowing that some of what I’d been trying to work out in my brain subconsciously I’d simply have to let go of and accept.

But to make an exceedingly obvious point: Ketamine helped me come to terms with my global warming anxiety, but it didn’t solve global warming.

A few weeks ago, Marie Arias left her house in Denver and took an Uber to a nondescript two-story office building on the outskirts of the city, next a pho restaurant and 7-Eleven. There, she was directed into a little room with a leather recliner and a TV playing videos of the aurora borealis. Then a nurse came in and injected her with a high dose of ketamine, left her alone for 15 minutes, then came back and gave her another one.

“They just leave you alone for like 45 minutes while you trip balls in this room by yourself,” Arias told me.

Arias has had a hard life, brain-wise. She’s dealt with and survived multiple traumas. At one point she was homeless. And for a while, she, like many traumatized youths (including me), was into drugs. She tried ketamine for the first time when she was 18 or 19, recreationally. It was the last drug she did for a while, because right after trying it, she decided to get her life together and largely succeeded.

It was only in hindsight that she linked the two: After taking ketamine, she had a period of six months where she felt good enough that she’d forgotten to be depressed.

But eventually the depression returned, and Marie tried to keep it at bay with different drugs, this time legal ones — including Seroquel, Zoloft, and Lamictal. None seemed to help her enough. It wasn’t until 2020, at age 26, after a divorce, a move to Colorado, and a realization that she was still feeling depressed despite all the psychiatric interventions, that Arias started looking for other solutions. And then an Instagram ad popped up. An ad for ketamine.

The clinic was called Klarisana. Price tag: expensive — $1,850 for six treatments over two weeks. Who would pay that much, Arias wondered. A few weeks later, when her depression wasn’t going away, she realized who would pay that much: She would.

After her first few sessions, Arias realized she was smiling at things that would usually make her angry. Not in a Stepford Wives kind of way, but in a “pleasant resilience” way.

“It kind of feels like I’ve woken up from a dream,” Arias told me. “Maybe not into reality, but into a slightly better dream, where everything still looks the same, nothing dramatic has changed… but I’m seeing a little bit more through a rose-tinted glass.”

Moskowitz found ketamine to be a blessing in their ability to process and live with stress, trauma, and severe depression.

It’s like you’ve jumped timelines, she said. “All of a sudden you don’t live on the timeline where everything is so shitty and everything that can possibly go wrong ever will go wrong. Now you’re in a timeline where things are just perfectly absurd, and it comes together in a really good way sometimes, and it comes together in a chaotic way other times, but you just run through it a little bit easier because it’s not so heavy.”

That sense of a different reality — one where fewer things matter and everything feels lighter—was a description I’d heard from other people, too. It’s not that ketamine just chemically lifts all this weight, it’s that it shifts your perspective so radically for the half-hour or so that you’re on it that the experience becomes a tool, a reference point, for a new life.

“There was the really dark reality of what my life was like,” one ketamine user named Emma told me. “With ketamine, I was able to see a potential alternate reality… something to look forward to, a future where life could be like this.”

Another recreational K user, who’s seen it grow in popularity on dance floors and at home among his friends, said there’s something very of-the-moment about that reality shift: It’s not just a break from reality—it’s a peek into a new one.

“We’re inundated by social media and the internet, and we’re constantly fed things that are algorithmically geared to be given to us,” the user said. “It’s nice to be able to do something that kind of randomizes what you get in your brain.”

“If you think that all we need to do is tweak the serotonin receptors of a person who’s undergone some major psychological trauma, that just doesn’t make sense.”

Carl Bonnett, who founded the clinic Arias went to and four others like it, told me that it’s impossible to separate these philosophical and spiritual effects of ketamine from their chemical effects. Before starting Klarisana, Bonnett was an emergency room physician and was in the National Guard for 20 years. He saw four deployments to Iraq and Afghanistan. A lot of his friends came back with PTSD. To Bonnett, it’s obvious that the altered reality created by ketamine is the key to its impressive effects. That’s why he makes sure his clinics feel relaxing and that the TVs in them are playing trippy visuals.

Patients who have gone through trauma aren’t just chemically broken, Bonnett said; they are trying to answer some basic fundamental questions about life: Why did this happen to me? How can the world be so cruel?

“If you think that all we need to do is tweak the serotonin receptors of a person who’s undergone some major psychological trauma, that just doesn’t make sense,” Bonnett said. “When I put you into a psychedelic space, when I show you the string above the puppets, when I give you a backstage pass to your life, when I let you see things differently — that’s what can potentially answer that question.”

We’re all being traumatized right now, to varying degrees, thanks to a yearlong pandemic. And we’re all asking these humongous questions: Why are so many people dying around us? How did life get this stressful? Is humanity always going to be this cursed? It makes perfect sense to me that the drug of the moment wouldn’t be something that just takes you out of reality, but one that gives you a different world to look forward to.

About three and a half years ago, I had to run for my life as a white supremacist terrorist plowed his car into a crowd of people in Charlottesville, Virginia. I saw broken bones and blood. I thought I was going to die. And it was, surprisingly even to me now, not the first terror attack I’ve nearly been killed by. When I was 13, I ran from the first collapsing Twin Tower with seven of my friends and one mom as we exited our middle school a few blocks away from the World Trade Center. There were other traumas, too, including the general lifetime of stress that comes with being trans, but that’s not what this story is really about. (I accept your sympathies, thank you.)

What it’s about is alternate realities and the benefits of them, a subject I became an expert in when, one month after Charlottesville, I had a complete mental breakdown. I simply woke up one day and my normal reality was gone. Everything — colors, sounds, smells — felt different, scarier, foreign to me. I could not sleep. I could not eat. I was technically alive, but I thought I had crossed into some spirit realm, as if I was with all the people I’d seen die around me. Physically in this world, visually, mentally, in one where I was processing massive amounts of trauma. At certain points, I could feel the spirits within me — I’d close my eyes and see my ancestors who’d been killed in the Holocaust staring at me, which both terrified me but also made me feel held, unalone. In short, I was batshit crazy.

The lesson I learned, the one I’m still learning, is that drugs aren’t the only thing that create alternate realities. Your brain can easily create one, or several, on its own. And these realities have a purpose, I’ve come to believe. They’re not just ways of feeling; they can be modalities of healing.

Some days I would feel like I was in Depression Reality: the colors and sounds of the world muted so that my brain could focus all its energy on working out my myriad traumas. Other days I would feel Anxiety Reality: so focused on possible outcomes of the future and what could possibly kill me that it became a kind of exercise in retraining my brain to believe that not everything would be a life-or-death experience. And still other days, and especially now during the pandemic, I have been in Dissociation Reality, which is kind of like an unfun version of ketamine: my brain floating above itself in bird’s-eye view so it could see the big picture and make connections that my “normal” state of consciousness could not.

And so I’ve begun to see ketamine, and many other drugs, less like a psychoactive substance and more like a steroid. The brain is already capable of going to great ends, expanding and warping, to comprehend the fucked-up world we live in; ketamine just gives it a boost, presses fast-forward, gives the brain a temporary armor to don as it goes to its scariest but most illuminating corners. What a nice thing. What a blessing to have help like that in a world like ours.

The problem (if it can be called that) with ketamine—and, really, every drug—is that you can keep expanding your brain to understand the traumas and complexities of your environment, but that doesn’t change anything but yourself. When your alternate reality ends, the real reality — the one where everyone’s dying all the time and our politicians don’t seem to care about us — is still right there, waiting for you. You can stay in the air, examining the earth and all its oceans and mountains and forests, for only so long before you come crashing down.

“You may be able to have a beautiful, psychedelic experience in which you have all these powerful breakthroughs,” Erica Zelfand, a naturopath who helps guide people through psychedelic experiences, told me. “Then you have to come back to the toxic elements of our culture that can’t always be escaped. And hopefully you’re coming back with different tools and new ways of relating to, working with, and transmuting that toxicity, but it’s still there.”

The world is still there. There’s no true cure to depression, to PTSD, because the source of these disorders is not in your brain but in the world. Researchers can come up with as many drugs as they want. Some will help; none will solve the main problem, which is that the world really sucks.

Some have posited that ketamine is the perfect drug for our late-capitalist era: It’s short-acting, so you can still remain productive after you do it. There’s not much, if any, of a hangover, so you can go to work the next day. It’s not dangerous like opiates, and people don’t usually end up with ruined relationships or lives over it, unlike, say, with meth or cocaine. It gives you a break without actually breaking down any structure in your life that would prevent you from being a functioning, productive member of society.

There is something of-the-moment about ketamine for sure.

In 2014, the British anarchist collective Plan C argued that every era of capitalism has its predominant affect. During the industrial era, it was misery — people grinding away in factories until their muscles were worn and their spirits crushed. Then came the postwar period and, with it, boredom — mass consumerism, sterilized suburban life. The 1960s and ’70s can be seen as a response to that — people rebelling against their boredom with tie-dye and free love. And then came the age of anxiety, in which job precarity became the norm and social structures like unions began breaking down, leaving people isolated and scared. And each era had its of-the-moment drugs — alcohol for the factory workers, pills for the housewives, weed and psychedelics for the hippies, Xanax to calm you down and Adderall to speed you up for the overworked and anxious precarious worker of the 2000s.

The brain is already capable of going to great ends, expanding and warping, to comprehend the fucked-up world we live in. Ketamine just gives it a boost, presses fast-forward… What a nice thing.

I’d argue that we’ve moved into a new affective age in the past few years, accelerated by the global pandemic: the dissociative era, in which the political complexity of the world and the proliferation of internet technologies has made us feel constantly overwhelmed and underwater, unable to get a grasp on a former sense of stability. It makes sense that ketamine would proliferate in this era and that it would even increase in popularity as we all were forced to become shut-ins. It’s a drug that allows us to rise above the water and have a moment to breathe before being plunged back in.

But to assign a moral weight to a drug, any drug, kind of misses the point. If your metric for a drug is whether it helps support capitalism, you should write off alcohol. You might also write off diabetes medications and lung cancer treatments, as they all have helped keep people alive from diseases largely caused by living in industrialized, unequal societies. Technologies can be used for good or evil, and drugs are technologies. Ketamine is no different.

After mulling over our interview for a few weeks, Marie Arias wrote to me with a more sober assessment of her journey. Yes, ketamine had helped her. But she couldn’t stop thinking about Elijah McClain, the 23-year-old Black man who was killed by police in 2019. McClain also lived in Colorado. He played violin, as does Arias. And police forcibly subdued McClain with ketamine before putting him in a chokehold, which is what ultimately killed him.

During a recent treatment, while sitting in the leather chair in Klarisana, Arias tried to square knowing that “the substance that is helping my life become renewed is also an instrument of death.” She took an Uber back home by herself, feeling isolated from the rest of the world and broke after spending so much on her treatments.

She feels better than she ever has, but still something felt off: The ketamine had worked, but everything else was still broken.

writer, author. moskowitz.xyz

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