Welcome to Back from the Abyss. I'm Dr. Craig Hecock.

Today I'm doing a mini episode on what I think might be the most important question in a psychiatric visit.

But before I start with that,

I wanted to digress a little bit and talk more about ketamine. I've been thinking a lot about

when and how ketamine gets difficult. And I think I'm seeing ketamine break down into four

predictable stages where people might struggle. The first one, think I'm seeing ketamine break down into four predictable stages where people

might struggle. The first one, which I've mentioned on the podcast before, I would describe that

as reaching escape velocity. So in the early minutes of the treatment as the body, the ego, time

is starting to dissolve. For some people, that is a really

discombobulating experience. It almost feels like a small death. And it doesn't last long,

maybe two to four or five minutes, but that can be scary for people until they are

fully in the dissociative experience of ketamine.

The second stage where I often see ketamine get difficult is what I call re-entry.

And that's where people are coming out of the fully dissociated ketamine matrix and coming back into their body, back into the room, back into their ego.

And that's actually difficult for a different reason for some people.

It's not about a fear of loss of control, like the reaching escape velocity.

It's actually the opposite.

I've had people as they're coming back into the now, start to cry, start to say no, no, and thrash.

And I've had people punch themselves and scratch themselves and try to fling themselves out of the chair.

And in the first, you know, maybe 10, 15 times this happened, I thought, what is going wrong?

Is this some kind of

ketamine effect? But as I started to interview people, what they described was the deep peace,

...