By Greg Ferenstein
An Unrelenting Specter of Judgment
Tom* couldn’t shake his constant fear of being perceived as awkward and unworthy of friendship.
“I always felt like the outcast,” he recalls. The crippling self-doubt kept all of his relationships at a cold distance, even his wife.
In everyday social situations, even light-hearted water-cooler conversations at work, Tom was haunted by thoughts about why people right in front of him—freely engaging with him in conversation—silently judged him as unpleasant.
Tom had done the work to figure out the source of his dread. After years of therapy, he knew it came from an abusive childhood growing up in a religious culture that used shame and bullying to enforce conformity. As a result, he ran away as a teenager.
One notable symptom of trauma is “hyper-vigiliance”, or an over-sensitivity to threats in everyday situations.
“I was on high alert all the time," he remembers.
His relationships were shallow because he avoided social activities. Even surrounded by those who loved him, he was still alone and fearful.
Determined to be more social, Tom looked for solutions. While they did improve his anxiety, they also came with troubling trade-offs.
One was a popular and controversial legal drug, Phenibut, a synthetic anti-anxiety supplement originally synthesized in the USSR for cosmonauts.
Phenibut acts on the central nervous system by inhibiting the neurotransmitter, GABA. Essentially, it can dull reactions to perceived dangers. Because Tom was not in any true danger, it was a workable solution that gave him the confidence to be more social.
Unfortunately, Phenibut is highly addictive and there are reports of painful withdrawal. Tom remembers one occasion when he forgot to take one of his various anti-anxiety supplements on the way to a movie with his wife and they had to immediately turn back, making them late for the show.
Being tethered to addictive, unapproved medical treatments was clearly not helping him or his relationships.
Ketamine and a Feeling of Unconditional Love
Tom came across a Facebook ad for a new therapy at Novamind’s Cedar Psychiatry in Utah using ketamine, a surgical-grade general anesthesia that was being used to treat mental illness, including social anxiety disorder.
“I didn't quite know what to expect," he recalls of his general aversion to psychedelic-assisted therapy. “This was kind of my last hope."
Desperate for better options, Tom scheduled an appointment and brought his wife with him for support.
Tom remembers the luxury gravity chair that he sat in while the IV ketamine infusion was placed in his arm. He began drifting off into a dream-like state and felt as if he was tipping over backward in the chair, but the fear subsided.
“It’s ok, just let go," he recalls telling himself. For Tom, the psychedelic aspect of ketamine was not about wild hallucinations, but a feeling of ease. “I fell into this black space."
Tom’s thoughts drifted to his wife and he felt unconditional love. Prior to the appointment, he had worried about bringing her, since he felt silently judged for turning to psychedelics for treatment, even though she had never expressed skepticism about the approach.
But that feeling was replaced with one of acceptance. With ketamine, “You get to see yourself in third person," Tom explains. He experienced, at a visceral level, how others saw him and he knew they didn't judge him as he feared they did.
Instead, he could simply be beside his wife. “She held my hand; I felt so loved."
Feeling Less Judged
"Our marriage has skyrocketed," Tom says proudly. He also has more energy to enjoy swimming and going to the gym with his wife.
"I feel like going outside because I don't feel like there are eyes everywhere judging me."
Tom still has more ketamine treatments to go but feels he’s on a better path.
He seems to take challenging social experiences less personally. If someone disagrees with him, there is “zero emotion attached" to the argument.
Without constant rumination about what he’s doing wrong, he’s able to put challenges into perspective.
What Seemed to Work
Tom says that two things, in particular, stand out in his mind about what helped, aside from his wife being at his first treatment.
The first was listening to unfamiliar music. Music can have a calming, meditative effect during psychedelic episodes, allowing people to more deeply drop into a dream-like state. However, listening to familiar music can dredge up unpleasant memories that could distract from seeing oneself in a new light.
The second was Tom’s experience with mindfulness therapies prior to ketamine, including meditation and another called Eye Movement Desensitization and Reprocessing (EMDR).
The basis of both strategies is to embrace difficult thoughts and memories as they come up. Tom doesn’t know whether having these psychological tools in his toolbelt made the difference between successful and unsuccessful ketamine treatment, but he did have the honed skills to address challenging thoughts during the treatment.
So, it is worth noting that people who have come from therapy might be able to use the tools they’ve learned from previous counselors with ketamine. This is why Cedar Psychiatry is careful to prepare patients with the mindfulness tools they’ll need to navigate the psychedelic experience and integrate insights afterward.
It certainly seemed to work for Tom. "It changed my entire life," he concludes.
*Tom is a pseudonym. Some quotes edited for clarity
About the author
Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.
His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.
Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.