What Is Dissociation and How Does Ketamine Create It?
Ketamine is known as a dissociative anaesthetic, but what is dissociation and how does ketamine produce it?
The experience of dissociation
The world around you becomes unreal, as if in a dream. You no longer feel as if you own your body. You feel detached from the world around you, as if some intervening medium is cutting you off from it. You feel dazed and confused, disjointed and disconnected. You feel as if you leave your body completely and become a disembodied viewer of the scene. This is a typical experience of dissociation. Dissociation, however, can take on multiple forms.
What is dissociation?
Dissociation is a natural psychological capacity that we all possess. It evolved in order to help us cope with intensely stressful situations. If you’ve been attacked by a lion, confronting the situation fully may be counterproductive, it could push you into a state of shock. Dissociation increases our chances of survival in overwhelming situations by psychologically distancing us from the experience. Instead of feeling present and embodied we feel somehow removed from the situation and our experience of it.
How is dissociation possible?
Our experience of the world is something like a controlled hallucination. Our minds generate an experience of a world and of ourselves within it. We don’t typically notice this. When our conscious hallucination of the world is functioning correctly we just see through it and feel like we’re seeing the objective world beyond. Our experience functions like an interface that allows us to navigate the world. The same process is happening when you perceive your body. You don’t perceive it directly, your mind creates an image of the body and that is what is perceived. As a result, it is possible for your experience of yourself and the world to be profoundly altered. Your constructed sense of self can become distorted and you can even lose the sense of identification with the experience of the body completely.
Is dissociation unhealthy?
Dissociation isn’t inherently bad for you, it’s a psychological coping mechanism that evolved for a reason. Dissociation can be evidence of an underlying mental health issue, however. During traumatic events we may dissociate in order to protect ourselves psychologically. If we cannot ground ourselves in a way that makes us feel safe after the event, we may be left with post-traumatic stress disorder (PTSD). Dissociation can be a feature of PTSD. When the stress response produced by the traumatic event persists even when the event itself is over, our mental and physical health can deteriorate. If you dissociate often, it is worth exploring whether you might be suffering from a form of PTSD.
Dissociative disorders
Some people suffer from dissociative disorders which are characterized by persistent dissociation. In these cases, the main danger of dissociation is that the person may experience a fugue state in which they lose their sense of identity and their ability to form memories of events that took place during that state. The experience of loss of memory in dissociative states is known as dissociative amnesia. Chronic experiences of loss of identity can also occur, this is known as dissociative identity disorder. Dissociative disorders can also be characters by depersonalization, the feeling that you do not really exist. They can also result in states of derealization, in which the outside world feels unreal.
How to cope with dissociation
One common approach to coping with transient experiences of dissociation is grounding. Grounding involves intentionally connecting to the experience of the body and the environment in order to counteract the disconnected experience of dissociation. Once you notice that you are dissociating you can start this process by paying attention to objects in your environment using multiple sensory modalities. Naming the objects helps to make sure that you really are connecting and paying attention to them. One popular technique is to name five objects you can see, four you can touch, three you can hear, two you can smell and one you can taste. Following this exercise people often report a decrease in the feeling of dissociation. Feeling one’s feet on the ground physically can also be grounding psychologically. In more severe cases, therapy to address underlying traumatic material can help lessen dissociative symptoms.
Why is ketamine considered a dissociative?
What is it about the psychoactive effects of ketamine that makes it a dissociative? Ketamine can produce sensations of disconnection from the environment and the body to a profound extent. It is common to experience a floating sensation while on ketamine. At high enough doses ketamine can produce the feeling that one has left the body, often described as an out-of-body experience. As a result of its anaesthetic properties high doses can also produce the experience of a k-hole, in which one is profoundly disconnected and physically incapacitated by the effects of the drug.
Out-of-body experiences
During a ketamine-induced out-of-body experience, people typically feel as if their sense of self is no longer coincident with their body. They may feel as if they are hovering slightly behind their body or even that they have completely left their body behind and are now in another place entirely. We can understand what is happening here by remembering that our sense of self is actively constructed by the brain. People are not actually leaving their body. Instead, the process by which we identify with certain parts of our experience of the world is being disrupted.
The k-hole
High dose experiences can result in one ending up in a k-hole. The idea of being stuck down a hole captures the inherently dissociative aspect of this experience. The world around us typically feels very distant as the powerful dissocaitive effects of the ketamine interfere with our ability to connect to our experience of the outside world. There is also typically the feeling of being disconnected from the body. This state can be profoundly hallucinatory and one can have experiences of melting into the surrounding environment. During a k-hole one is also experiencing the powerful anesthetic power of ketamine, with the drug making it difficult to speak and move.
How does ketamine produce dissociation?
Ketamine acts on a group of receptors in the brain known as NMDA receptors. These receptors are involved in learning and memory and are usually activated by glutamate, the chemical that mediates the majority of information processing and transmission in the brain. While the classical psychedelics like LSD and psilocybin act on the serotonin system to alter our perceptual experience of the world, targeting the glutamatergic system with ketamine seems to have strikingly different effects. The brain networks that generate our controlled hallucination of the outside world and of ourselves signal using glutamate. The disruption of this process that occurs as a result of altering glutamate signalling with ketamine appears to be responsible for disrupting the sense of the reality of this controlled hallucination.
Can dissociation be therapeutic?
Is dissociation a side effect of ketamine or is it actually useful therapeutically? Ketamine has recently been found to work as a fast-acting antidepressant. Some studies have investigated whether dissociation may play a role in this effect. Researchers investigated this question by measuring the extent of dissociation and the anti-depressant effects in patients undergoing the therapy. Some of these studies found that the strength of dissociative effects correlated with the strength of the therapeutic outcomes. Other studies have not found the same effect however. Science currently doesn’t know whether ketamine dissociation is an important part of the therapeutic effect or just an irrelevant side effect.
Ketamine and dissociation
Whether you experience dissociation in your daily life or as a result of taking ketamine, this strange altered state is deeply intriguing. While it doesn’t typically feel pleasant, it can be powerfully adaptive in situations where we feel overwhelmed. Ketamine induced dissociation can range from a distortion of one's experience of the world through to out-of-body experiences, as well as the experience of the k-hole. All of these states show us that the way we typically experience the world is a construct of the brain and one that can be profoundly altered by stress or a drug like ketamine. No matter where you encounter dissociation, it is good to familiarize yourself with this particular mental state in order to minimise distress if it ever happens to you.