Can Special K help you find your way?
A Sebastopol practice uses ketamine-assisted therapy to treat depression, anxiety, PTSD, and other mental illnesses
Liminal Medicine is Sebastopol’s only ketamine-assisted therapy practice. In every treatment room and even in the hallway, the walls are decorated with dandelion seeds drifting away in the wind or birds taking flight.
It’s a not-so-subliminal suggestion to patients to not attempt to control the psychedelic experience they’re about to have.
“It’s the idea of letting go,” said Dr. Suegee Tamar-Mattis DO, who owns the practice with her wife, attorney Anne Tamar-Mattis.
Dr. Tamar-Mattis is a board-certified family medicine physician. She spent most of her career treating underserved populations, such as the homeless in community health centers and Native Americans through the Indian Health Service. It was her work with these groups—seeing the extent of mental illness and the relative ineffectiveness of standard treatments—that led her to embrace alternative methodologies like ketamine.
In 2018, she did the California Institute of Integral Studies’ certification program in Psychedelic-Assisted Therapies & Research. Several of the therapists in the practice went through the same nine-month program. Tamar-Mattis requires all of her therapists to have training in ketamine-assisted therapy and to have taken ketamine themselves so they can understand what the patient is experiencing.
In addition to ketamine, the Integral Studies program covers the use of MDMA and psilocybin, but since ketamine is the only legal, doctor-prescribed psychedelic, that’s the only one Tamar-Mattis said she uses in her practice.
Ketamine was first synthesized in 1962. It was approved for use in the United States in 1970, and since then has been regularly used in veterinary medicine (ergo, its street reputation as a horse tranquilizer) and in wartime medicine.
“Ketamine is widely used as a battlefield anesthetic, because it’s really short-acting, and it’s really safe,” Dr. Tamar-Mattis said. “People protect their airways on ketamine so you don’t have to intubate…It’s been widely used as anesthetic in ERs and on the battlefield—and they started noticing that some people that had had ketamine as an anesthetic were not depressed anymore.”
The use of psychedelics to treat mental illness was pushed underground during the War on Drugs. It has only become “respectable” again in the last few years.
In a video about their practice, Dr. Tamar-Mattis says, “I’d like to acknowledge our debt and gratitude to the indigenous peoples and cultures who’ve used psychedelic medicines for eons and have brought this information forward to us to use at this point in time. We also acknowledge our debt and gratitude to the work of underground therapists, who’ve also been doing this work since the ’60s and at great personal risk, and who have been able to bring this work forward.”
As interest in psychedelics as medicine has grown over the years, ketamine clinics have proliferated in more psychologically adventurous parts of the country. The Sebastopol practice that is now Liminal Medicine was first founded as Evolve Mind Wellness by psychiatrist Dr. German F. Ascani. Dr. Tamar-Mattis worked at Evolve Mind Wellness. When Dr. Ascani moved his practice to Colorado, she and Anne started Liminal Medicine in the same spot.
Aside from the Tamar-Mattises, the clinic has four other employees: three psychotherapists and a part-time nurse. At Liminal Medicine, psychotherapy is an integral part of the process.
There are four treatment rooms and when they’re all full of patients, Dr. Tamar-Mattis flits from room to room. She checks on the patients’ medical status, while the clinic’s psychotherapists keep the patients company while they’re tripping. They take notes on anything the patient says or does and then helps them explore and discuss what they experienced while under the influence of ketamine.
“My job at the office is to get people the right amount of high,” Dr. Tamar-Mattis said. “It’s like, if you get too deep in there, you kind of hit this white-out stage, and you’re not going to remember anything. You’re not going to be able to bring it back. So you need to be deep enough in that you’re able to have that psychedelic experience and yet be able to remember it and bring it back to work on it.”
You can’t just walk in off the street and go tripping.
“There are three visits before you get ketamine,” Dr. Tamar-Mattis said. “The first visit is a medical intake with me. The second visit is a psychological intake with a therapist, and the next one is the prep session where the therapist you’re going to be working with will talk about how the medicine is going to go and just getting people ready for that. And then there’s the first medicine visit—and that’s two-and-a-half hours.”
The treatment rooms look more like therapists’ offices than doctors’ offices. Medical equipment is kept discreetly out of view. Patients sit in comfortable, rather elegant recliners and wear a soft eye mask to encourage them to focus on their inner experience. One of the practice’s psychotherapists stays with them throughout the entire experience.
Dr. Tamar-Mattis delivers the ketamine via intramuscular injection. She checks in with the patients throughout the experience to make sure they’ve achieved “the right amount of high.”
How much of that two-and-a-half-hour appointment is spent in a ketamine state and how much is spent talking about it?
“It really depends on the client,” said Moksha Donahue, MFT, one of the psychotherapists who works at Liminal Medicine. Donahue is also a graduate of the California Institute of Integral Studies’ Psychedelic-Assisted Therapies & Research program.
“Some people are so out there in the medicine that they’re not able to really respond or talk during that,” she said. “I would say that typically, they’re under the medicine for a good hour and 15 minutes, and then we’re helping them find their feet, remember the imagery and the feelings they felt, remember the things they saw and I’m recording that down.” Sometimes, if patients seem frightened or agitated during the ketamine experience, she holds their hand.
This treatment isn’t cheap. According to their website, the three initial intake visits are $875, and every ketamine visit is $950. “Most people do about four to six weeks of treatment, so that’s going to run about $5,000 to $8,000,” said Anne Tamar-Mattis, who runs the business side of the practice. (They sometimes offer special packages so check their website.)
Anne also noted that they do group ketamine therapy, which is considerably less expensive, coming in around $2,500.
Unlike traditional psychotherapy, ketamine therapy is meant to be a short-term treatment—weeks instead of months or years. It’s fast acting, Dr. Tamar-Mattis said, but it’s also not a permanent cure. After a while—three months to a year, depending on the person—it wears off, and clients may need to come back for another treatment. That boost is $450.
Donahue said that ketamine can work as a kind of shortcut in psychotherapy.
“Ketamine offers quicker access to the psyche, the undefended part of you that is actually working behind the scenes at all times. That’s the part of you that is pulling for something or pushing away from something,” she said. “And I think the ketamine really offers you a metaphorical glimpse into your psyche, like your psyche is kicking up all these metaphors to help you kind of see what your dilemmas are on a different level.”
In that way, it’s a bit like dream interpretation, but Donahue said that clients’ interpretations of the metaphors in their ketamine experience are purely individual. There’s no interpretive guide to what the symbols or metaphors mean (unless, of course, you’re a Jungian—but that’s a whole other article).
Dr. Tamar-Mattis says that ketamine has been successful in treating depression, anxiety, PTSD, OCD and some addictions. In interviews, both Dr. Tamar-Mattis and Donahue said it was particularly effective for people who suffer from suicidal ideation.
Their patients range in age from teens to seniors.
Like all medicines, there are sometimes unwanted side effects. Nausea is the most common, especially for people who suffer from motion sickness. (The eye mask helps with this.) Sometimes, people have extremely intense experiences under ketamine—that happens about once every three months or so, Dr. Tamar-Mattis said.
There are contraindications for ketamine treatment: While ketamine can be used for bipolar disorder, it is not advised during an active manic state. Ditto for psychosis or schizophrenia. Donahue said that some personality disorders are resistant to ketamine. “So people who are very stuck in a story of being sick and really blame a lot of people don’t typically do well with psychedelics,” she said.
“The important thing to know about psychedelics for treating any of these conditions is it’s not just the medicine; it’s the medicine and the therapy together,” Dr. Tamar-Mattis said.
She is frustrated with the standard medical/pharmaceutical approach of “‘You get a pill, you take it every day, and you just don’t talk to us anymore,’ and that’s it. This is not that type of medication.”
She also finds mainstream medicine’s distrust of anything psychedelic or mystical counterproductive.
“There are scientists trying to invent drugs like this that will not give you a trip,” she said. “There’s a pharmaceutical company right now that is about to start human trials with an LSD analog that’s supposed to not get you high but that should help with depression. But people have really profound insights sometimes during the psychedelic part…The research shows that if you get into that psychedelic effect, your outcomes are much better. And so we tend to dose up into that psychedelic effect, and we feel like that’s not just a good side effect, but that’s part of the healing experience.”
Learn more at liminal-med.com.
Isn't that the crap that Musk is taking?