“DEATH-REBIRTH” PSYCHOTHERAPY
WITH KETAMINE

Igor Kungurtsev, M. D.

The recent changes in the former Soviet Union have allowed Russian and American researchers to communicate freely for the first time since the October Revolution. Prior to these changes, the story of Russian psychedelic research had remained a mystery in the West. The following article is one of the first reports of psychedelic research to emerge from Russia as well as the first published outcome study of ketamine-assisted psychotherapy.

Igor Kungurtsev, M.D. is a research associate at the Bekhterev Psychoneurological Research Institute in St. Petersburg, Russia, and a psychiatrist in private practice. Kungurtsev is also Vice Chairman of the St. Petersburg Transpersonal Association, and a member of the Board of Advisors of the Albert Hofmann Foundation.

About five years ago, our research team obtained permission from the Central Pharmacological Committee in Moscow to use ketamine as an adjunct to psychotherapy with alcoholics. Ketamine is an anesthetic used in modern medicine which can also be used in subanesthetic doses to safely and reliably induce transpersonal states with profound healing potential. This paper will review the phenomenology of the ketamine state, the procedure for ketamine-assisted psychotherapy, and the preliminary results of our study with alcoholic and neurotic patients.

Ketamine, 2-(o-chlorophenyl)-2-(methyl-amino) cyclohexanone HCL, has several advantages over other psychedelics as an adjunct to psychotherapy. It is short acting, the psychoactive effects lasting about an hour. In addition, ketamine is not scheduled like other psychedelics. In lower doses (about one sixth to one tenth of that usually used in surgery), it induces profound transpersonal states. My colleagues and I adopted the transpersonal paradigm as a result of our personal and clinical experience with ketamine before we had become acquainted with the literature on psychedelics and altered states of consciousness.

At first, we attempted to use ketamine solely as a means of increasing the patient's suggestibility. The psychotherapist could then place suggestions of sobriety more deeply into the patient's subconscious.

Anesthesiologists have reported that ketamine frequently induces states of confusion, feelings of death and dying, and unpleasant hallucinations. This is known as the “emergence reaction”, and is considered to be a negative side effect of ketamine in surgical patients who are unprepared for these psychological effects.

Subsequently, we had the idea that we could associate these feelings of death and dying with the smell and taste of alcohol (an aversive conditioning model). Not long after we started our research, however, we came across situations which were incompatible with this paradigm. After ketamine injections, many of our patients reported very strange experiences. They began to report that they felt disconnected from their bodies, and that they were “floating” in strange worlds. Some of them, for the first time in their lives, spoke about God, the meaning of life, and their relationships. Although we tried to help our patients form negative associations and develop an aversion to alcohol, their experience was more profound and mystical, sometimes with no relationship to our suggestions or psychotherapy.

At this point, I undertook a series of self-administrations which completely changed my conception of the ketamine experience. I tried various dosages in order to choose the level most appropriate for our patients. Three or four minutes after the first injection, I felt this world begin to disappear, and I experienced myself as a point of consciousness which was floating in strange worlds. The most unusual feeling was that I had no body, yet somehow “I” existed. The next development was indescribable. During the first stage, I seemed to exist only as a point of consciousness, but still, “I” existed. Then there was a stage where even this disembodied sense of self began to disappear, and I felt a real terror of dying. At that moment I managed to surrender and let go. All that remained was awareness; there was no “I” as me, as an individual point of consciousness. It was as if there existed only that which was aware of itself.

This experience profoundly changed my view of ketamine, and gave me new insight into some esoteric concepts of Buddhism and other Eastern philosophies. It profoundly changed my understanding of death and dying as well.

For several days after this session, I had a feeling of inner surrender, as if my life was a game that I was playing very easily. While I performed my daily activities, I was very calm and centered inside. It was a remarkable feeling. After this self-experimentation, we changed our paradigm and adopted a transpersonal approach. We now refer to this treatment as “Death-Rebirth” Psychotherapy.

The research is done in a comparatively large hospital for the treatment of alcoholics near St. Petersburg. The patients in this hospital are all voluntary. The psychotherapy is usually limited to the area of alcohol abuse, and the goal of treatment is overcoming their so-called “alcohol denial.”

A typical patient in our ketamine program stays in the hospital about one month. During the first phase of therapy, we treat their alcohol withdrawal syndrome and any related anxiety or affective disorders. Then, we start rational, cognitive psychotherapy in order to establish a mental set of sobriety and a negative attitude toward alcohol. However, we go beyond the problem of alcohol abuse to explore broader issues including the patient's life history, relationships, and world view.

Later in the program, we tell them that they will undergo a new treatment which will allow them to see and feel the subconscious roots of their problems. We help our patients understand that their alcohol problem is only a superficial symptom - the manifestation of more deeply rooted problems.

On the day of the session, we give the patient an intragluteal injection of about 150 mg. of ketamine (approx. 2 mg. per kg.). We prefer the intramuscular route because the effect is more gradual, and the transpersonal state lasts longer. With an intravenous injection, the effect lasts only about fifteen to twenty minutes, but after an intramuscular injection, it lasts from about forty-five minutes to an hour.

We tell the patient that they will enter some unusual states of consciousness and that they may feel detached from their body. We also instruct them to surrender fully to the experience. I gave up our original approach of trying to induce something specific in the patient during the session. Under the influence of ketamine, especially in these doses, one has no direct contact with ordinary reality. The psychotherapist can try to influence the experience, but it will be in vain. We are available, however, to give emotional support if the patient requests it.

As with other psychedelics, music also enhances the ketamine experience. We have found composers whose music is particularly conducive for ketamine sessions, such as Jean Michael Jarre or Kitaro. After forty-five minutes to an hour, the patient slowly comes back from the experience. During the recovery period, which takes about an hour and a half or two hours, the patient begins to feel ordinary reality returning, but part of their consciousness is still in another world, another dimension. At this point in the session, the patient usually begins to describe their experience, and we begin some interpretation. After the session, the patient goes to rest, and we ask them to write down a detailed report of their experience that evening. The next day, we have a follow-up session which includes an in-depth discussion of their experience. When several patients have ketamine sessions on the same day, we do it as group therapy. We gather these patients in a group the day before treatment and the day after, because when they all share the experience, it is usually more powerful.

Regarding spiritual experiences induced by ketamine, it is interesting that many people who never thought about spirituality or the meaning of life reported having experiences that one might read about only in spiritual texts or Eastern teachings. At the beginning of ketamine sessions, people often experience the separation of consciousness from the body and the dissolving of the body ego. For many patients, it is a profound insight that they can exist without their bodies as pure consciousness or pure spirit. Many of them said that as a result of their experience, they understood the Christian notion of the separation of the soul and the body, and that they now believe some part of them will continue to exist after death. There were several cases where people reported contact with God, but this is usually not an anthropomorphic figure. They describe an ocean of brilliant white light, sometimes a golden white light, which is filled with love, bliss and energy. After coming back to ordinary consciousness, they feel sure that they have had contact with a higher power. There were also several cases where people saw Jesus Christ approaching them. It seems ironic that so many of our patients, through their own experience, were converted to a more spiritual approach to life, despite living in a country where people have been brought up for generations with atheism.

A second observation is that many patients report the existence of other dimensions or other worlds that are parallel to ours. They usually report that these other dimensions seem as real or more real than our own. Some patients experience this “ego death”, or the dissolving of the individual sense of self, which 1 had experienced. Of course they do not use these terms. They might say, “I ceased to exist, I disappeared, yet still something existed. It was like I became the whole universe or the whole cosmos”. In my experience, I also got the feeling of the collapse of space and time, and I really felt that space and time were illusions. It was as if I had collapsed into a single point with no space and no time, and it was from this point that the whole universe seemed to be manifesting.

Another interesting observation, although not a topic of our research, is the correlation between the type of personality and the type of experience under the influence of ketamine. People who are very controlled and have difficulties letting go, or who have problems with relationships, often have negative experiences with ketamine. For them, the dissolving of the individual sense of self is horrible. For other patients who are more relaxed and able to surrender, who have a deep capacity to love, the experience is usually blissful, even ecstatic.

The action of ketamine is somewhat unique in comparison with other psychoactive substances. Stanislav Grof has divided the psychedelic experience and other experiences of altered states of consciousness into three main categories; the psychodynamic level, where people recall the past events of their lives, especially childhood memories; the perinatal level, or the recollection of the birth experience; and the transpersonal level, which includes the mystical experience. “Transpersonal” refers to experiences which go beyond one's individual personality and involve the transcendence of the spatial or temporal boundaries of ordinary consciousness. One might also experience mythological themes or archetypal figures like the god or goddess, or the expansion of consciousness to encompass the whole cosmos, etc.

Ketamine differs from other psychedelics in that in medium doses, it usually it does not engage the psychodynamic level. Instead, it almost “throws” one into the transpersonal realm. The other major psychedelics, such as LSD or mescaline, are more gradual and gentle, and in medium doses they usually engage the psychodynamic level. To induce transpersonal states, higher doses of these substances are normally required.

Of course, the effects of ketamine are also a function of dosage. In low doses, one remains in contact with ordinary reality, but with eyes closed one can see some strange images. They are not human forms, but usually geometric shapes like spheres or triangles, or simply open spaces.

Following treatment, the patient is released from the hospital. Every two or three months, we see them for follow-up visits. We have collected data on patients who have undergone ketamine-assisted psychotherapy after spending one month in the hospital. About sixty eight per cent of these patients remain sober for one year following treatment. This is a very high success rate in comparison with other programs for alcoholism. In the control group, which was composed of patients who were in the same hospital, who were the same average age, and who were in the same stage of the development of alcoholism, the percentage who remained sober for one year was about forty-five to fifty per cent. So we have proven statistically that the ketamine experience is very useful. We believe that these positive results in maintaining sobriety were not achieved simply because we were more successful in establishing a set of sobriety and a deeper negative attitude toward alcohol, but rather because of changes in the values, relationships, and world view of these patients. They began to see other goals, other values, other pleasures in their lives, and this was the main reason for their sobriety. For us, this was much more interesting than the limited issue of keeping sober.

We also administered several psychological tests before and after the ketamine treatment. We gave patients the MMPI, and after the session the scales which indicated anxiety and depression decreased statistically, even though these patients were not primarily neurotic or depressive. The same results were also confirmed by the Zung anxiety and depression scales, but we were interested in more than these clinical symptoms. We also tried to measure changes in values and world view after treatment. It was difficult to find an instrument to measure these changes, but the two scales we found most useful were the Omega Life Changes Questionnaire by Kenneth Ring, and the Self-Assessment Spirituality Scale by Charles Whitfield. Kenneth Ring is a professor of psychology at the University of Connecticut who has done extensive research on near-death experiences, and he created The Life Changes Questionnaire. It consists of some thirty questions that assess the individual's values, goals, and attitudes toward material things, etc. Our patients showed the most significant changes in exactly this scale. According to the results of this questionnaire, they shifted to a more spiritual world view. We also used the Self-Assessment Spirituality Scale by Charles Whitfield, an American researcher who has tried to introduce spirituality into recovery from alcoholism. In addition, we developed our own instrument, called the “repertory grid”, which measures psychosemantic fields. It measures the meanings of key words such as life, love, death, despair, Jesus Christ, etc. Through this tool, we can measure changes in the patient's attitude toward various aspects of life. This scale also showed that our patients shifted to a wider, more spiritual world view.

Our anecdotal observations also confirmed these changes. Some patients began to write poems after their ketamine sessions, while others began to paint. Many of them began to feel more connected with nature and reported, for example, that after treatment they went to the countryside more often. When some patients went back to their families, they noticed problems in their relationships, or certain idiosyncrasies of their spouses and relatives which they were unaware of before treatment. Ketamine seems to increase the capacity for detached observation.

I would also like to relate some unusual anecdotes connected with our research. About one year after we began our study, a group composed of two men and one woman appeared at our hospital who were very strange looking, wore strange clothes, and had strange, shiny eyes that seemed out of focus. They called themselves “magicians”, and said that they sensed in their meditations and magic practice that in this hospital, some people were throwing other souls into the “astral plane”. They had come to see what we were doing, like “astral police”. Prior to this, we had not published the results of our work, and only a few professionals knew about it. Also, this hospital is situated in the suburbs of St. Petersburg, and is not widely known. So we described our work and showed them our hospital. They approved! They also told us that they themselves used ketamine for their underground magic practice. As far as I understood from our conversations, their practice to some extent imitates or closely parallels the practice of Carlos Casteneda. They had gone into the forest and found power spots and power plants, and practiced meditation there. This acquaintance was useful for us because, as it turned out, they had a tremendous volume of underground psychedelic literature, translated into Russian. When we shifted to the transpersonal paradigm, we began a literature search, and we sent requests to several libraries, including the main state library in Moscow. Although they probably had this literature, it was two or three years ago, before the changes in Russia, and they didn't send it to us. So the magicians gave us, for example, Peter Stafford's Psychedelics Encyclopedia. Later, there was another interesting episode with these magicians. One of the men told me that they also used mushrooms growing in the forest near the region of St. Petersburg to induce psychedelic states. At first I didn't believe him, but he gave me a dried specimen, and I identified it in the Psychedelics Encyclopedia as Psilocybe semilanceata.

To date, the total number of patients treated with this method is about four hundred. Our results show that ketamine-assisted psychotherapy is significantly more effective in treating alcoholism than standard non-drug psychotherapy. In addition, ketamine-assisted psychotherapy results in positive life changes which go beyond the limited goal of maintaining sobriety, including profound changes in values, relationships, and world view. In the near future, we plan to continue our work with alcoholic patients and to develop this approach further with neurotic patients using repeated ketamine sessions.

Note: The author would like to thank Robert Zanger and Blackbird Willow for their assistance in the preparation of this article.

Reprinted from the Fall 1991 issue of the Albert Hofmann Foundation bulletin.