Ketamine Treatment: D5 — Emotional Safety, Esketamine, and the Things We Carry

The previous six days have actually been pretty good.

By “good,” I mean I haven't been particularly emotionally distressed, and I've been relatively level. Which, at this point, I am learning to appreciate as a legitimate achievement rather than dismissing it as “well, nothing happened.”

Today, however, is a little more stressful.

And, as seems to be increasingly common during this ketamine treatment, the stress isn't necessarily coming from where I expected.

The Problem with Needing People

What a horrible section heading. But stay with me.

I am beginning to feel worse about asking friends to drive me back and forth to my treatments.

The closest reputable treatment center is 30 minutes away, and I am not supposed to drive after treatment.

That's not merely the clinic being fussy.

Esketamine can impair attention, judgment, thinking, reaction speed, and motor skills, and everything I have been told, everything I have read—including FDA protocols— says patients should not drive or operate machinery until the next day after a restful sleep.

My wife, for multiple reasons, is often unable to take me or pick me up.

So I have been juggling friends.

And trying very hard not to overtax them.

I've started breaking things up a little. One friend drops me off, and a different friend picks me up. I'm hoping that one hour sucked out of someone's day is easier for them to accommodate than two hours sucked out of their day.

This is probably a perfectly reasonable logistical solution.

My brain, however, has decided to turn it into an indictment of my fundamental worth as a human being.

Because apparently that's what brains do.

At least my brain.

It's one of those supremely stupid human things where, if a friend asked me to drive them to and from some appointment or treatment, I would gladly do it.

Because they are a friend, and they are worth it.

But I’m not, so why would my friends want to do the same for me?

The favor I would freely and lovingly do for them becomes, in my head, something they are begrudgingly doing for me while quietly developing a deep and abiding resentment.

Because, obviously, I am not worth it.

Yeah…

Working on that.

Emotional Safety Is Turning Out to Be a Thing

Over the last several days, one idea from my previous ketamine treatment session has continued to bounce around in my head:

I realized that I don't actually feel emotionally safe very often.

That's an interesting realization.

Physically, I generally feel safe. Intellectually, I generally feel safe.

Not that I think I could beat up a bear or outthink Einstein.

I don’t get that carried away.

But I live in a physically safe environment, and I work with people who are intellectually open and accepting.

Okay…vulnerability.

Not a fan.

When it’s coming from me.

When coming from someone else? Well, then it’s brave. Open. Coming from a deeper strength and character.

But not from me.

Well… here we go.

Emotionally safe?

That's a different story.

And it’s important to understand, especially if you’re a friend or acquaintance, it has nothing to with you.

My friends are my friends because they are nice, open, caring, and loving people.

My emotional insecurity, the feeling of peril, is wired deep—probably before you and I even met. It’s nothing to feel sorry for. It’s definitely nothing to show sympathy for. It’s nothing you’ve done, and there is nothing is you can do about it.

It’s my work to do.

And this is where the combination of ketamine treatment and psychotherapy gets particularly interesting for me.

As I think I mentioned in my last post, there is growing research into combining ketamine or esketamine treatment with psychotherapy. A 2023 article in the journal BJPsych Open* from Cambridge University Press found that outcomes were generally positive across studies combining ketamine with psychotherapy, although the researchers emphasized that the studies were highly variable and that there isn't yet enough evidence to establish exactly how these treatments should be combined.

As I also mentioned in my previous post, the 2026 systematic review by Veraart, Schimmers, Breeksema, Seybert, Kamphuis, Huber, Rota, Coerts, Oliviera-Maia, and Schoevers, reached a similarly cautious conclusion: there is considerable interest in ketamine-assisted psychotherapy, but relatively few randomized controlled trials and substantial differences between treatment approaches make it difficult to say exactly what works, for whom, and why.

In other words, science is basically saying:

Interesting! Possibly useful! Please conduct approximately a billion more studies.

Which is frustrating…I guess.

But also fair.

Because my personal experience is not a clinical trial.

It's just my weird little brain going through esketamine treatment and reporting back from the field.

Where Does Emotional Safety Come From?

My therapists have suggested that some of my difficulty with emotional safety may have roots in childhood.

Trope much?

I hate being so basic.

Yet, I also want to be careful with that.

I'm not claiming that every difficult childhood experience creates emotional trauma, or that I can neatly trace today's emotional reactions back to one particular event.

In fact, it has taken me years to finally buy into the idea that trauma is more than battlefield horrors, gruesome accidents, and unspeakable crimes. And I’m still working on it.

Human beings are considerably more complicated than that.

But there are certainly some things in my childhood that seem relevant.

Both of my parents kept secrets.

I'm sure that created some degree of stress.

And it also seemed, at least in my experience, that being sad was eine kleine verboten.

A little forbidden.

At least once, my father told me to stop crying because, “We don't do that.”

At least once, my mother slapped me when I was crying after losing a bunch of my papers—the Des Moines Register—in a winter wind. Paper route, you know.

And then there was the chain-link fence escapade.

I managed to impale my hands on one.

It’s a good story, but maybe later.

Anyhoo, after extracting myself from the fence, I ran home with blood slowing down my arms. My mother told me that if I didn't stop crying, she would take me to the hospital for a shot.

I was terrified of shots.

This was a particularly stupid threat because, as it turned out, impaling your hands on a chain-link fence necessitates both shots and stitches anyway.

So congratulations, childhood me.

You’re a stereotype of childhood trauma causing years of psychoanalysis.

My therapists have suggested that experiences like these may point toward deeper or more significant emotional experiences.

Probably.

I don't know.

I'm not trying to diagnose my childhood from a ketamine chair.

But I am starting to understand why “emotional safety” might be such a loaded concept for me.

---

Ketamine Treatment Day 5: “I Am Well”

Today's session was interesting, although it wasn't nearly as fulfilling as the previous one.

It was also later in the day.

I have no idea whether that affected the experience.

Maybe it did.

Maybe it didn't.

Maybe my brain simply decided that today was not the day to open the emotional filing cabinet.

For today's session, I used the Limitless app's Journey Macrodose, “I Am Well.”

It was lovely.

It was relaxing.

It just didn't have the same impact as the previous Journey Macrodose, “I Am Safe.”

(See my preceding section of this blog.)

That may be a more important realization from today's actual session.

The Sour Candy Experiment

Before I finish, I need to discuss something of enormous scientific importance.

I changed my candy.

That is correct.

This is the high level of cutting-edge field research we're doing here.

For anyone who hasn't been following along, the esketamine nasal spray has an absolutely goiter-shaking bitter taste.

And I mean horrible.

The treatment center suggests using sour candy to help counteract the taste.

It works.

I think.

But woe betide you if you decide to sniff hard to clear your nose during treatment.

The bitterness comes flowing down the back of your throat like Satan’s post-Taco Bell flatus.

     If you don’t’ know the word “flatus,” look it up. It’s a good one.

So far, my preferred solution has been a Sour Patch peach/strawberry mélange.

Today, however, I decided to experiment.

Why?

I don't know.

Perhaps ketamine has given me the confidence of a clinical researcher.

Unfortunately, the new candy was subpar.

It did not produce the same whole-body sour-candy experience as my usual selection.

Lesson learned.

Do not mess with the candy.

What I'm Taking Away from Ketamine Treatment Day 5

Today's session wasn't dramatic.

It wasn't particularly profound.

It didn't produce some giant revelation.

And I think that's important to document, too.

Ketamine treatment isn't necessarily a series of cinematic breakthroughs where every session ends with me staring into the middle distance while the secrets of the universe reveal themselves.

Unfortunately.

Sometimes the experience is simply:

Huh. That was interesting.

And then, hopefully, you spend the next six days realizing that something from the previous session has been quietly rearranging furniture in your brain.

Research into ketamine and esketamine supports their potential for relatively rapid antidepressant effects, but researchers are still trying to understand why some experiences seem to persist and how psychological treatment might interact with those effects.

That's one reason I'm finding the psychotherapy component so interesting.

Maybe the medication isn't simply supposed to make me feel better.

Maybe, at least for me, part of the opportunity is to notice things differently.

To recognize the patterns.

To question some of the assumptions.

To discover that the voice telling me my friends really have no reason to find worth within me might not actually be an objective investigative journalist.

And perhaps most importantly, to begin figuring out what emotional safety actually feels like.

I have one day off before the next treatment.

I'm feeling hopeful.

And I'm keeping the good candy.

---

*TANGENT:

BJPsych is my new go-to DJ name.

I am a name freak. I love names. I used to work for an insurance company photocopying and sorting insurance applications. I would collect names. Twins Showbird and Avalanche—not kidding. Fleenoil Lane—someone’s name, not their street.

One of my writing partners wrote a short detective noir story whose main character was named Colfax Mingo. Colfax Mingo happens to be a twp-town exit off I-80 between Des Moines and Iowa City. Pure genius.

So when I discovered the article “Ketamine and psychotherapy for the treatment of psychiatric disorders: systematic review” in a journal called BJPsych Open, I didn’t think it could get any better.

Then I read the list of authors.

There were, of course the basics: Porter and Douglas.

The slightly more interesting: Kew and Mentzel.

But, oh my goodness! Gold!

Paul Glue and Ben Beaglehole.

Glue is, of course, great.

But how is Benjamin Beaglehole not a great and well-known Dickens character.

Professor Beaglehole, if ever you are in Iowa, I beg you to contact me.

He also happens to be a professor and psychiatrist for the Anxiety Disorders Service for the Canterbury District Health Board.

So we would have at least two things to talk about.

Different Canterbury (New Zealand), but I’m sure we would manage that.

Call me.