The mental health crisis in America is staggering. The lack of access to services and dearth of providers is daunting. An August 2023 study demonstrated that 14-16% of veterans who served in Iraq and Afghanistan are suffering from PTSD and depression. These numbers don’t begin to speak to the service members we’ve lost to suicide from the most recent wars, let alone veterans of previous conflicts. We throw out numbers and try to describe the pain that individuals and families go through every day. We discuss trauma, emotional suffering, and the co-morbidity of clusters of diagnoses. What we miss in these discussions is resiliency, post traumatic growth, and the courage to get up every day. What’s missed in those are the ways that service members mask their symptoms. The ways they defend themselves from having to look at or deal with painful experiences. Sometimes, they tell themselves that no one will understand (honestly, some don’t), or that others will look at them as weak or vulnerable if they do. They might fear that they’ll lose themselves to the trauma and never find their way back. The face they put on to mask the turmoil that they try to outrun and out maneuver. The pain they hide from their families. They lose hope that things could get better, or that the intensity of symptoms could abate. Traditional talk therapy doesn’t touch it, because defenses are really good at protecting. Trauma therapy, including EMDR, might get close to it but they can also shut that down. It’s just too painful. It was overwhelming the first time, and they definitely don’t want to experience it again. The protective mechanisms that keep them safe also keep healing at bay. After years of trying therapy, medication, and their defensive mechanisms being activated over and over, they may be labeled by providers as having treatment resistant depression, anxiety, or PTSD. They’ve been prescribed multiple medications that take the edge off, help them to sleep without nightmares, shut down flashbacks, or dampen their trauma responses. Only to have their symptoms resurge with vengeance. They isolate because that’s also protective, but isolation cuts them off from others who can draw out and experience diffferent parts of them. They might understand brain functioning and the impact of trauma, but try as they might, they can’t force their brains to do something different. The feedback loops that keep them safe also reinforce and strengthen neural activity and patterns that keep them trapped and suffering. Avoidance of reminders is one of the diagnostic criteria for PTSD, and when left untreated, becomes a way of responding that interrupts and prevents healing.  

 

We’ve all heard of choosing the path of least resistance, and the truth is, this is what our brain does naturally. This is part of the reason that changes in how we think, behave, or handle situations are so difficult. Our brain follows what it knows and might need something to help it jump onto a new neural network. Ketamine assisted psychotherapy might be that something. When combined with psychotherapy, ketamine demonstrates significant positive outcomes for those experiencing treatment resistant PTSD, depression, and anxiety. Ketamine is classified as a dissociative anesthetic. Even though Ketamine can cause hallucinations, it impacts the brain in different ways than psychedelics. Ketamine interrupts the brain and stops it from using that default pathway. Because of the brain regions it activates and the changes in bioavailability of neurochemicals it causes in our brain, Ketamine actually helps to create new neural pathways. The neuroplasticity that’s created by Ketamine allows for lowering protective defenses and experiencing and incorporating different perspectives. All of which support a system reboot, that can help you to make changes in your life that further your healing. Working with a counselor trained to provide Ketamine assisted psychotherapy helps you to make meaning of what you experienced during the altered consciousness that Ketamine provides, and to integrate changes into your life. Because Ketamine for treatment resistant symptoms is “off label”, it’s not covered by insurance. However, there are advocates working to change that. If you’d like to explore if you are a candidate for Ketamine assisted psychotherapy, please reach out. I’ll provide resources that will help you to make an informed decision and get connected with a psychotherapist trained to work with trauma who also offers Ketamine Assisted Psychotherapy.