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How Ketamine Facilitates Healing

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by Dr. Reid Robison, MD MBA

If you haven’t checked it out yet, I highly recommend Michael Pollan’s 2018 book How to Change Your Mind. It’s a deep dive into the history, research, and resurgence of psychedelics as a valid modality of psychiatric treatment.

In chapter 5, Pollan explores what brain imaging has been teaching us about the effect of psychedelics on the brain. One of the most notable findings is that psychedelics lessen the activity of a series of neurological pathways in the brain known as the Default Mode Network (DMN).

The DMN serves a multitude of functions in navigating our daily lives and plays a major role in how we define the self (our definition of who we are), very similar to what is often referred to as the “ego.”

The DMN is also often referred to by psychologists as “The great orchestrator of the brain.” Let’s explore how psychedelics, like ketamine, affect these DMN functions and discuss why these effects can facilitate healing.

Daydreaming
Where does the mind go when it is not occupied by an immediate task?

Individuals suffering from depression may default to ruminations or feelings of worthlessness. People suffering from substance abuse may default to thoughts of guilt or the urge to use. Those battling eating disorders may default to obsessions with control and relentless thoughts about body image. People suffering from anxiety may default to an unrelenting need to get things done and have everything perfect.

This list could go on and on. For individuals whose minds tend to wander to such places, psychedelic medicine may help. Ketamine and other psychedelic medications reduce the activity of the DMN, allowing the mind to daydream in a different way and form new pathways for the brain to use.

A psychedelic experience can act as welcome reprieve from the unrelenting negative thoughts that many battle every day. It allows for a chance to cognitively and emotionally interact with life in a new way, and see ourselves with a fresh perspective.

The Self
The way each of us defines ourselves is wildly complex. In our brains is the wiring for thousands and thousands of rules and definitions that make up our unique experience of self (who we are).

Embedded in our sense of self are the rules and defense mechanisms for how we deal with things like guilt, shame, grief, and trauma. Many of our defense mechanisms were written in our minds when we were very young and entirely without our awareness.

Defense mechanisms that may have protected us as children may now only serve to drive our negative self-image. In a psychedelic experience, as the DMN is dialed down, the overpowering definitions of self are softened. This allows us to see and possibly even define ourselves in a new way. The ruts and trenches of how we think about ourselves are filled in and new definitions of who we are materialize and are given a chance to flourish.

The Great Orchestrator
Our brains receive and process enormous amounts of information. As a child, this information is not filtered. Over time, however, our brains learn to create short cuts and filter out extraneous information through a process called specialization.

This process is seen in language acquisition and motor skill development, as well as an assortment of other skills essential to daily life. As a part of specialization, the DMN comes online and orchestrates the cognitive short cuts or filters that are essential to daily life.

The downside to this is that the cognitive short cuts and filters imposed by the DMN make it more difficult to see the forest from the trees, so to speak. If we are perpetually seeing ourselves or the world in a negative way, then turning down the DMN through the use of psychedelics may facilitate new insights into life and a reframing of a negative self-image into a more honest and kinder one.

Mental health problems steal peace away from us in a myriad of ways. One of the most powerful tools for combatting this is found in our perception. Many people with mental illness wish they could change their reality.

To one degree or another, we all have a list of “I could-be-if…” statements. The problem with these statements is that they often give our power away. The world is never going to be perfect, but there is more than enough joy in it to have a rich and fulfilling life regardless of circumstances.

I once heard a man in a Narcotics Anonymous meeting share that he felt addiction could be defined as the inability to accept life on life’s terms. I think this profound statement can be expanded beyond the world of addiction to the struggles of life faced by many.

Ketamine may be a viable tool that enables us to come to terms with the world as it is. By quieting the DMN and its rigid response to the world, ketamine facilitates seeing our world and the suffering in it in a new way.

Reid Robison

About the author

Reid Robison, MDA MBA is the Chief Medical Officer at Novamind. He is a board-certified psychiatrist who was named Best Psychiatrist in Utah by Salt Lake City Weekly’s Best of Utah Body & Mind 2020.

Dr. Robison is the co-founder of Cedar Psychiatry and serves as the Medical Director for the Center for Change, a leading Eating Disorder center. He was previously a coordinating investigator for the MAPS-sponsored MDMA-assisted psychotherapy study of eating disorders.


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