States
There is a room with a white wall. The temperature is cool by design. The blinds are closed, curtains closed. A corner speaker purrs instrumentals. The back of a cat twitches. The room tilts toward a body, my body, with an eye mask and comforter in bed. Purple and blue throb under a fold in my mind.
I’m in my childhood home taking ketamine tablets—do not worry, this is clinically advised [1]—later feeling tranquil, grateful, asking, Why isn’t the potential healing power of this drug widely publicized as a first-line treatment option for depression? Or maybe the better question is, How did this kind of awareness fail to sprout from the circles of exposure I once lived?
About me, at my last psychiatry visit: This person is a 27 y/o female. Major depressive disorder, recurrent, in full remission. She presents as pleasant and friendly. She exhibits speech that is normal in rate, volume, and articulation and is coherent and spontaneous. Language skills are intact. Mood presents as normal with no signs of either depression or mood elevation. Affect is appropriate, full range, and congruent with mood. Suicidal ideas or intent are denied. Insight into problems appears normal. Judgment appears intact.
Scientists in San Francisco and London recall psychedelics’ ability to alter the brain [3]. I wanted to help mine loosen its grip on particular hopes, rules, and beliefs. I wanted to continue deepening into myself, uncovering closed rooms, stiff muscles, memories stuck and glitched. My brain was full, clogged. I needed a hard reset. I’d spent years on other medications. I’d stay up-to-date on mental health treatments, grew familiar with treatment-resistant depression (TRD) [2]. I met my psychiatrist. They prescribed me oral tablets.
Imagine an arid, hilly landscape. Deep and convoluted grooves. Tunnels that lead to restrictive space, a lack of air.
Now picture that same landscape with shades of green split by streams of water, slowing and speeding. I’d like to think ketamine helped my brain experience this landscape sooner than if it never melted on my tongue.
My cheeks cupped saliva for minutes. Then I went to space.
I don’t want to give the medicine too much power. I wanted to control the effects to the extent I could, make them long-lasting. As the medicine dissolved, I’d swallow a bit, hold, let the rest pour out of my mouth into a cup. I’d sink. The objects in the room blurred, melted.
Ketamine drew a dash from now to my birth. Memories came and I could touch and twist them, submerge elbow deep, full-body tears and laughs, wet gulps, dry sighs, still fear, still panic, still chest. Then move: inhale, exhale, peace.
My muscles relaxed, brain morphed, lifted properties, shapes, and images that I mostly suspect—heard from others—were already there, lingering, waiting to be noticed. I visualized myself sending a glow to an area of my back. I placed my hand on my heart and sent love to people I’ve met (those I hurt and love, those who hurt and love me).
Here is the still of the mind, now fluctuating.
If I go back in my story I can tell you the origins. I can try. That would mean recalling the circumstances that led to events to which my brain, mind, and body responded to. Patient is presenting subtle and massive changes that direct her mind to live. I can’t promise continuity from start to finish. Depression leaves us holding fragments.
Here is a thick worm climbing through my throat, a weight inching, a ball at the base, little tips of fingers from the insides of my thighs pressing against the roof of my skin, a pang and shake between shoulder blades—twitch pulsating the index finger, a film of cold covering the body, this sink, scrape, gulp in my chest, an arm of hot air reaching down my throat, now a stretch of hot air, a giant bowl pressing down the center of the chest, against the diaphragm, stomach heat swirling then evaporating, fingers from the base of the stomach squeezing intestines, breath to back, pulsing.
Here is a mixture of fear and want to take more medicine, asking, What is too much or little for my circumstance, symptoms, pain, body chemistry, weight? If I’m working to trust myself, where is the line between clinical judgment and intuition?
Here is what you want it to be. Here is what I don’t know. Here is what I need it to be.
Is this coherent, logical, or relevant? My questions are genuine. What truths are you experiencing?
A prescriber offers to send more of the SNRI if symptoms return. Parts of me want to experience my symptoms in their entirety, let them fluctuate, rise, shake, spasm, fall, settle, mute, ring. Parts of my body don’t want to view medication as the thing that will or should save me. These parts understand these reactions make sense, given what’s happened. These parts fear this kind of dependency. I could string a web of the varying dependencies across my life—pick one: media, work, relationships. Or would it make sense to call the medication a potential dependency? Is this question indicative of a mercurial or disordered mind?
This doesn’t have to be either-or. This question can be too narrow. Try rejecting the question altogether. You don’t need my permission.
There is a block, a cling: prefrontal collapse. Is this thought content within normal limits? Intact and appropriate? If my words don’t make sense in a literal way, do they make sense intuitively? I’m trying to bite the urge to find the science or diagnostic criteria to back this up.
If I can learn to master my mind, I can influence the symptoms I experience.
I want to use medicine to reveal myself (the hums and purrs of an elongated topography evaporated above the earth, now beside you, connected) not hide—even as the symptoms are a reveal, an internal response, the consequence of what has happened. Picture me cradling my amygdala, my index finger nudging it, singing softly. Picture a wide lush garden germinating from my thighs, potent smells and colors abound. Points of pain live here. Points of pain lived here. The pain disappeared. It returns. It returned. See what my mind did?
Can you detect when I’m masking my symptoms? Is my affect mood congruent? How about now? I’ve just left an appointment. When this story ends, what do you not see? What do I endorse?
Here I am not knowing what role medicine plays in my life. Time has passed since the ketamine. People—experts and non—have their thoughts. I’m still sorting mine. I’m mostly alert and oriented to person, place, and time. This is one perception, one reality, one thought, one form of judgment, one slice of time. I want to know if you believe me. Here is a calm nervous system. I’m cooperative and appropriate.
Here is a brain not knowing, answers and pathways shifting, with and without medicine [4].
The brain talks to cells, holds neurons and synapses, hears bones, blood, and water.
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Themed month logo by Honey Gilmore, essay art by Carl Dimitri