The Ketamine Chronicles, April 2019

There is absolutely difference between medical and recreational ketamine use, since the actual chemistry is unrelated - the high of the ketamine is not related to it's beneficial effect. Moreover, my ketamine use and schedule wouldn't make sense recreationally. The dose is just enough to be debilitating - the equivalent of 1/4-1/2 a line.

Ironically, due to the unfortunate nature of contemporary american society, regulatory capture has resulted in the FDA approved ketamine (s-ketamine aka esketamine) treatment being more inebriating and less effective antidepressant than recreationally consumed ketamine - which, being unpatentable is consequently unprofitable. A less inebriating, more effective antidepressant r-ketamine is 'in the wings', in order to let pharmaceutical companies milk as much money as they can from this otherwise cheap and effective drug. Hopefully psychiatrists will see through this, and start prescribing off-label ketamine once they have seen the effect that esketamine has on their treatment resistant patients.

Also, I don’t why y’all are acting like folks who use things like mdma and ketamine in a medical/therapeutic context haven’t also used them recreationally. It’s different, because the environment, intention, and often the dosage are all different. You taking drugs at a party is not the same, and using absolutist language to say otherwise when there’s actual medical research that contradicts you is an odd choice.

Otherwise, the big advantage of getting a nurse to do it is that they are in a position to treat you if one of the rare but potentially fatal side effects pops up.

Out of curiosity, where did you get these dosage numbers from?

The linked wiki page doesn't mention dosage and the source on wikipedia is paywalled.

Probably not only split on this one variate (externally or internally triggered), but it means that certain types of depression are usually triggered externally and certain types not externally.

It's like saying that "in some cases, a broken leg is not triggered by some external influence". Sure, you could develop some bone density issue and break a leg when walking normally, so we tend to distinguish treatment of these cases--we may recommend a more permanent solution for someone who is prone to breaking their leg.

How can we even falsify your statement? To do so would require self-reports or some sort of real-time 24/7 measurement of the brain, the first doesn't really falsify anything, and the second is not very viable at the present.

Self-reports can easily lie. They also may simply not remember, or be in denial.

The intersection between internal and external is not so clear.

What the ultimate cause is, who knows.

Is the idea of a ultimate cause is even a valid idea?

Personally I don't think so.

I felt this article did a well above-average job communicating details about what alternate states of consciousness are like, and how it can fundamentally change your thinking, in at least a semi-permanent manner. However, most of the comments on the article seem to be written very much from a scientific materialist perspectives, and are often utterly lacking in epistemic humility.

Take the very first sentence from the top voted comment in the thread:

>> I did a bunch of ketamine and mdma in the early 2000s. They’re miracle substances and they changed my life in positive ways that I can’t even begin to talk about, but they are not cures for depression. Eventually the effect wears off and all of the stuff that bothered you before will start bothering you again.

This is fairly representative of many comments. Some obvious questions:

- how does he know this to be true?

- it may be pedantically true that they aren't 100% cures on their own for every single person, but might they get us 75% or more of the way there for most people?

- it's true that the effect diminishes over time, but do you completely revert to the previous state? Can the improved state be maintained with ongoing usage (something which is rarely disputed for mainstream pharmaceuticals, but often seems to be considered unacceptable for psychedelics)

>> If you don’t figure out how to give your life meaning, the drugs aren’t going to do it for you.

This is another one of those comments that may be pedentically technically true, if read very generously, but also very misleading. Might the subconscious mind choose casual expressions like "do it for you" to maximize persuasion, while minimizing opportunity for criticism ("hey, I was speaking colloquially, man"). The next sentence appears to undo much of the harm, but what impression is left in the mind of an unknowing reader? Who knows. Does it matter? I think it probably does, and maybe a lot.

I would argue that result of this style of speaking is a kind of epistemological chaos - we are discussing substances that may finally offer at least a partial solutions for much of what ails the world, but the status quo aggregate opinion (~nothing particularly noteworthy to be seen here, just woo woo, move along citizen) in most threads like this seems completely incorrect to me. At least, there is a serious lack of epistemic humility - strong, conclusive opinions, on topics where the facts are currently unknown - literally. And no one can admit it (that such things are unknown). To me, this is a utterly surreal state of affairs, and it is incredibly frustrating to experience this, and then open the next thread on HN and hear people complaining about problem-of-the-day that could be fixed if group <x> would "just" stop being "stupid". The irony is bitter sweet.

>> Someone I’m sure is going to say that it’s a medicine and not a party drug now because a nurse is giving it and someone wrote a prescription, but it’s the same drug with the same effect.

Again, pedentically technically true as written (maybe, if read generously), but completely overlooks the essentially undisputed (among knowledgeable people) notion of the importance of set and setting. Ignorant and misleading comments like "not a party drug now because a nurse is giving it and someone wrote a prescription" getting heavily upvoted kind of disgusts me to be honest. I am of the opinion that that thinking like this, and the people that support it, are preventing the world from improving. And most likely, many of the people complaining about faults in the world are the very same people who refuse to consider alternative ways of thinking about issues, and downvote anyone who makes such a suggestion.

These substances, and articles like this, are finally giving us some new insights into possible underlying reasons of why people behave like they do, and believe the things they do (anti-vaxx, climate change deniers, I have no reason to be happy, etc), in spite of overwhelming and "obvious" (or so it seems) evidence to the contrary.

And it seems if you try to point this possibility out to people, they will get angry at you. What could explain these effects (of the substances), and this behavior (~refusal to even consider certain possibilites)? How about this: the human ego. The human ego often doesn't like to be disagreed with. This is clear as day, if one is willing to look. But it seems like the ego will only allow this on certain topics, almost as kind of a self-defense mechanism.

> It's not that it's incorrect, more like it's kind of non-sequitur-ish, as if you omitted a part of it that connects the comment to what it's commenting on.

I don't think it's so much that it's a non-sequitur (it isn't), but perhaps that it seems (but actually isn't, if one is willing to think, which is my point) irrelevant (or blatantly obvious) to the degree that it is considered useless. With any topic, if people refuse to use their minds (and that very much is the case), there's a good chance they won't understand the material. Mocking various out-groups for refusing to acknowledge facts and think properly is a popular pastime on HN, but rare is the individual who is able to even consider the possibility that they suffer from the very same psychological affliction.