Ketamine Infusion: Neuroplasticity as a Mythology of the Self

Matthew Hiller reflects on the growing use of ketamine in mental health care and its relationship to the ‘myth’ of neuroplasticity.

“I’ve spent a lot of my life in recovery and I refuse to surrender and use until I die. But sometimes my crack cravings are so intense that I break down and go on a binge. I’m hoping ketamine infusions might alter my brain circuits or something so I can get space from the cravings.”

A middle-aged man, who I call Tom[1], shared the above aspirations with me when reflecting on his decision to start ketamine infusion treatments. Ketamine is a surgical anaesthetic that is known to produce dissociative or “psychedelic” experiences at moderate doses (Kolp et al 2014, 84). While ketamine is known to many as a “horse tranquilliser” or by its street names “Special K” or “Ket,” it has been hailed over the decade as a “breakthrough” treatment for conditions such as major depressive disorder and post-traumatic stress disorder (Chen 2017; Goodrich & Mcrea 2021). In the United States, this has led to a proliferation of private clinics where patients receive ketamine through 50-minute intravenous infusions, though some physicians also offer the drug through intramuscular injections or oral lozenges (Peskin, Gudan, & Schatman 2023). Because sessions are rarely covered by private insurance, patients generally pay between $400 and $800 per treatment (Dodge 2021). While a common course is 6 to 8 infusions, some patients receive ongoing infusion treatments on a monthly or bi-weekly basis or have prescriptions for oral-ketamine lozenges (Dodge 2021).

I am an anthropologist and psychotherapist and I met Tom while conducting an ethnographic study on the use of ketamine as a mental health treatment in the United States. As part of my ethnography, I worked for two years as a “psychedelic integration” psychotherapist at a ketamine clinic. This involved meeting with patients during initial consultations at the clinic and providing psychotherapy during and between ketamine treatments.

Tom’s comments touch upon a claim I frequently encountered during my ethnography, that ketamine can spur neuroplasticity and help “rewire the brain” (Davis-Flynn 2023). Through my research on ketamine, I have come to view neuroplasticity as a myth that allows for hopes of remaking the brain and the psyche. While the word myth often denotes falsehood, I draw on anthropologist Claude Levi-Strauss’s conception of the term. For Levi-Strauss, myths are stories that reconcile contradictions between seemingly opposed aspects of the world (Strauss, 1967). As a myth, neuroplasticity reconciles two dominant conceptions of personhood: the “neurochemical self” (Rose 2007, 8) and the “autonomous individual” (Cunta 2004, 73)- both of which I will discuss below. The concept of neuroplasticity, I argue, offers a way to imagine personal agency within the determinist framework of biological psychiatry.

The Neurochemical Self

According to sociologist Nikolas Rose, the 1990s marked a turn towards ‘neurochemical’ understandings of the self that reduced subjectivity to biological processes (2007). There were many reasons for this shift. With the release of Prozac in 1987, it became common to assert that depression is caused by a serotonin ‘imbalance’ (Mukherjee 2012). Moreover, advances in neuroimaging in the 1980s and 1990s provided a way to visualise the brain (Dumit 2004). The initiation of the Human Genome Project in 1990 also raised the possibility of finding genes for mental illnesses, including addiction (Nestler & Landsman 2001). While these innovations inspired new interventions, they also instilled ideas that psychiatric conditions are ‘brain diseases’ rooted in a material/chemical basis (Martin 2010).

The Autonomous Individual

The determinism of the ‘neurochemical self’ is in tension with a conception of self that scholars refer to as the ‘autonomous individual’ (Cunta 2004, 73). There have been many variations of this concept in Western thought, from enlightenment ideals that individual reason should guide action, to romantic-era calls to express one’s truest self (Cunta 2004; Swaine 2016). Within the United States, ideas of autonomy have often focused on mastery over the material world. For example, late 18th century ‘mind-cure’ movements such as Christian Science and New Thought promoted the idea that positive thinking can transform the body (Duclow 2002, 45). These movements have had lasting influence on alternative healing approaches in the US (Duclow 2002), including those involving psychedelics (Davis 2019). Likewise, individual autonomy is central to the neoliberal ethos of self-efficacy. Slogans such as ‘if you can dream it, you can be it’ depict a vision of the self as undeterred by limitations. The concept of ‘neuroplasticity’ bridges ideas of the neurochemical self and the autonomous individual by presenting the brain as a malleable entity that can be shaped by the environment and the will (Rees 2016; Schuller & Gill-Peterson 2020).

Neuroplasticity at the Ketamine Clinic

Ketamine marketing often focuses on harnessing neuroplasticity. An infusion clinic named ‘Reset Ketamine’ states on their website that ketamine is like a ‘miracle-grow on your neural forest’ that provides an opportunity to ‘somewhat reprogram your brain into the way you want it to be.’ In my research, I have also witnessed how ketamine is linked to mythologies of neuroplasticity. Clinic patients frequently question whether neuroplasticity from ketamine may help change their ‘broken brains’ or allow them to stop taking psychiatric medications. As one interviewee despaired, ‘medications and therapy feel like shooting a water gun at the house fire of my brain.’ For these patients, the hope was that neuroplasticity might allow for more enduring changes.

Medical and psychotherapy staff at the clinic often responded to comments regarding neuroplasticity with cautious optimism. I myself have assured patients that some research suggests that ketamine induces neuroplasticity, which may allow some flexibility in changing patterns of thought, feeling, and behaviour. However, I would then pivot from the question to explore how a person hoped to change. If they were plastic, I would ask, how would they want to mould themselves? In doing this, I viewed myself as more of a practitioner of mythology than of evidence-based science. I was not alone in this view. Contrary to common marketing about ketamine, staff at the clinic tended not to hold dogmatic views about neuroplasticity. Many said that they viewed neuroplasticity as a metaphor or that the science was still nascent.

The concept of neuroplasticity provided a counter to patients’ claims about ‘broken brains’ and ‘doomed futures.’ It offered a way to envision autonomy within the framework of biological psychiatry. 

Neuroplasticity and Ketamine Research

In many ways, the agnostic view of neuroplasticity reflects the neuroscientific research about ketamine. Researchers are uncertain about whether neuroplasticity is a factor in ketamine’s antidepressant effects (Kang, Hawken, & Vazquez 2022). Though researchers can investigate immediate neurotransmitter interactions with ketamine, it is difficult to study the drug’s downstream effects in the brain (Matveychuck et al. 2020).

Additionally, much of the neuroscience research on ketamine comes from rat studies (Polis et al. 2022). Rats who are given ketamine have higher rates of neuronal growth. They are also able to tread water for longer periods and show less signs of brain stress in ‘forced swim tests,’ which measure how long a rat will resist drowning (Polis et al. 2022). However, rat brains are different from human ones and it is uncertain whether findings hold across species (Planchez, Surget, & Belzung 2019). And even if they do, the specific behavioral finding is that ketamine can make it easier to swim a bit longer before drowning.

Moreover, neuroplasticity is not necessarily therapeutic (Kolb & Gibb 2011). Cocaine, amphetamines, and opioids have all been found to promote neuroplasticity (Robinson & Kolb 2004). With these drugs, however, researchers believe neuroplasticity leads to reward-seeking behavior (Robinson & Kolb 2004). To this end, addiction specialists have raised alarms about whether ketamine may also have properties that lead to abuse or dependence (Cormier 2022). While ketamine is sometimes portrayed as a “miracle drug” (Chen 2017) in the United States, it is more associated with addiction in places like the United Kingdom and China due to its recreational status (Cormier 2022; Levi King 2021). As such, ketamine has been framed both as a medicine that grows the brain and a drug that rots it (Tang et al. nd).

None of this is to dismiss the fact that many people get immense therapeutic relief with ketamine, a finding that is supported by control studies and anecdotal evidence (Nikolin et al. 2023). For his part, Tom reported to me that he no longer uses crack cocaine, even months after stopping ketamine treatment. Tom felt that ketamine produced a shift in his brain and noted that his cravings stopped ‘almost immediately’ after he started treatment. However, he also attributed this shift to spiritual experiences that occurred during one infusion where he had a profound sense that he was ‘the spiritual being that rests at the seat of consciousness in this physical body.’ This insight, he shared, helped him stop identifying with the negative thoughts that motivated his drug use.

Conclusion

Tom’s story illustrates the idea of neuroplasticity as a myth, that the self can find expression through a malleable brain. His experiences with ketamine provided a sense of connecting with a deeper self beyond his body or social identity. But, he also felt that ketamine changed his brain in ways that allowed a greater flexibility of thought. By referring to neuroplasticity as a myth, I am not dismissing it as fantastical. Instead, I am exploring how neuroplasticity provides a way to imagine new possibilities.

Problems arise if neuroplasticity is the sole mythology for imagining psychic change. This may lead to views that the only hope for a ‘bad brain’ is induced neuroplasticity, and, by extension, ketamine. The hope of attaining neuroplasticity might also cause people to continue with ketamine treatments even if they find them distressing or financially burdensome. To adapt a phrase from French philosopher Michel Foucault, the pursuit of autonomy can draw individuals into forms of “psychedelic biopower” aimed at altering the brain and psyche.

By thinking of neuroplasticity as mythology, we can see it as one discourse for evoking possibility. But we can also remain attuned to how other kinds of “neuromythology” (Tallis 2000, 563)—such as ideas about ‘bad brains’ and ‘chemical imbalances’ — impose limits on what can be imagined. Perhaps what is needed is not just flexibility of the brain, but also flexibility in mythologies of the self.


[1] Tom is a pseudonym and I received written permission from his to write about his experiences. The quotes and comments are based on fieldnotes and recorded interviews and have been edited for clarity.

About the author

Matt Hiller is a PhD candidate in Social Work and Anthropology at the University of Michigan. His research focuses on the use of ketamine in mental health care and is supported by the National Science Foundation. Hiller also holds a master’s degree in social work from the University of Chicago and is a practicing psychotherapist.

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One thought on “Ketamine Infusion: Neuroplasticity as a Mythology of the Self

  1. Interesting. I am a person who has used ketamine infusions to fight suicidal depression, and I am currently considering trying troches as a way to increase neuroplasticity. I am also a metaphysical naturalist who however doesn’t find the deterministic model of the mind all that convincing and feel there are as many problems with it as the ghost in the machine view.

    I have been depressed so long I now feel there is no real internal self part of me apart from the depression. I have developed an j treat in psychedelics as a tool for self -exploration, but have no access to them other than ketamine. Ketamine changed certain of my automatic thoughts, but didn’t change my “self” a change I feel is necessary if I am to ever live successfully as a human being.

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