Ketamine Treatment: Treatment Day 8 — IFS, “I Am Safe,” and Some Very Strange Imagery

My IFS (Internal Family Systems) therapist has suggested that I listen to one of Richard Schwartz’s meditations or guided IFS audios. I thought I would preview one before today’s ketamine treatment session.

I’m not sure that I am in a place yet where I would know what is going on.

As far as IFS, I have found my critic—how could I not?—and I really don’t like him. He is clearly voicing his opinion of me with my every move.

I have also found my editor and at least one angry child.

Oh, and I found the fat woman that soothes her pain with pints of ice cream.

She is well ensconced.

So there is that.

Ketamine Treatment and IFS Therapy

One of the interesting things about this ketamine treatment experience has been trying to figure out how the medication, psychotherapy, and all of the other things I’m doing fit together.

IFS, or Internal Family Systems, is a psychotherapy approach developed by Richard Schwartz that conceptualizes the mind as containing different “parts,” including protective parts and wounded or vulnerable parts. The basic idea is not necessarily that these parts are pathological. Instead, the goal is to understand them and develop a different relationship with them.

I find the concept both fascinating and deeply annoying.

Because once you start looking for the parts, you apparently find them.

And then they have opinions.

Lots of opinions.

During the debrief after my last esketamine treatment, one of the nurses suggested that I could listen again to “I Am Safe” or “I Am Enough,” since those seemed to have been the most impactful for me so far.

I am feeling particularly emotionally unsafe today, so I think I may go with “I Am Safe.”

I also have my IFS therapy session this afternoon. But I suspect I may get more out of the meditation once I have a better understanding of the whole IFS thing.

At the moment, I’m basically wandering around the internal family reunion trying to figure out who everybody is.

And staying away from The Critic.

“I Am Safe” During Esketamine Treatment

Today’s session was very odd.

I chose to listen to “I Am Safe.”

I very much like her voice and the things she is saying. There is a wink in her voice.

By that, I mean that her voice sounds open and hopeful and welcoming and silly.

That combination works for me.

But today was something else.

There was a distinctly Tim Burton-esque tone to part of the session.

The meditation tells me that some unpleasant images and thoughts might bubble up. The idea is that we can acknowledge them and then simply let them float away rather than grabbing onto them and keeping them.

And that happened today.

Except I could actually see things bubble up.

Representative images of things would inflate and come toward me, almost as though I were lying on my back and they were balloons or beach balls that I was tossing into the air, only to have them fall back toward my face.

Like juggling while lying down.

It was incredibly cinematic.

And then one of those strange, inflated images was the face of my mother.

Typical crazy person, right?

Now I think I’m Napoleon because of my mother? * (See APPENDAGE)

Is Ketamine Treatment Actually Working?

Despite the weirdness—and despite the fact that I continue to wish for some giant, unmistakable THIS IS WORKING sign—I remain hopeful about this treatment.

As noted previously, research on ketamine and esketamine for treatment-resistant depression suggests that these treatments can produce relatively rapid improvements in depressive symptoms for some people. But the response isn't necessarily dramatic, linear, or permanent, and people can respond very differently.

That is important for me to remember.

Because I have a tendency to want a result that is obvious.

I want the clouds to part.

I want the orchestra to swell.

I want someone a gigantic Terry Gilliam god to appear and point to me saying,

“This one is fixed. Next!”

Apparently no one expects a sudden health transition.

There is clear evidence that esketamine can help people with treatment-resistant depression, including evidence that continuing treatment can reduce the risk of relapse among people who initially respond. But that doesn't mean every treatment session produces an obvious psychological breakthrough. The effects can be subtle, cumulative, inconsistent, or difficult to recognize while you are actually living through them.

And that is what I am experiencing.

Changes in the Old Knob

I am still hopeful.

The closest analogy I can come up with is living with someone whom other people only see periodically.

My child looks like my child.

I see him every day.

So I don't necessarily notice how much he has changed.

But someone who hasn't seen him in two years looks at him and thinks:

Holy shit. He’s taller.

Maybe that is what is happening with my brain.

Maybe I am too close to the process to recognize the changes.

I feel like something is happening in the old knob.

I just wish it were more dramatic.

I wish it were more telling.

I wish my brain would stop making me work so damn hard to find the plot.

For now, though, I am still showing up.

Still doing the treatment.

Still meeting the various residents of my internal family.

And apparently tossing beach balls of my mother's face into the air.

So, you know.

Progress?

* APPENDAGE

Napoleon.

Did you know that Napoleon’s mummified penis was purchased by a New Jersey urologist named John Lattimer?

According to TIME, the specimen was described as looking like “a maltreated strip of buckskin shoelace.”

Well, if I ever start a rockabilly band, I will name it Buckskin Shoelace.

I feel like that needs to be said.

But I digress.