Psychedelics have a bad reputation, associated with recreational consumption in the 60s. But they are increasingly used in health. Ketamine, as well as being a safe anesthetic, is also, in different doses, an antidepressant that "makes the brain more plastic.
Text by Marta Martins Silva
Photo by Sérgio Lemos
[Carla Mariz] é psicóloga clínica há 25 anos e, depois de ano e meio na equipa do Hospital Júlio de Matos que fundou uma unidade terapêutica com recurso à quetamina, juntou-se à primeira clínica privada em Portugal de psicoterapia assistida por este psicadélico, com ramificações em Londres, Oslo, Trondheim, Nova Iorque, Los Angeles e Toronto.
When did you start using ketamine in your professional life?
I was working in the geriatric psychiatry department at the Júlio de Matos Hospital when I was invited to join a project I was starting, the Ketamine Resistant Depression Unit. We developed and implemented this unit, and in the meantime, together with other partners, we started the private project The Clinic of Change, the first private ketamine-assisted psychotherapy clinic. When it opened, I stopped being part of that unit at the public hospital and dedicated myself entirely to private practice in the field of psychedelics. But I still work at the Lisbon Psychiatric Hospital Center (formerly Júlio de Matos) in the Geriatric Psychology service, assisting the caregivers of patients with dementia.
What fascinated you about ketamine to the point where you joined the founding team of The Clinic of Change?
What fascinated me and made me fall in love with this approach was the possibility, and I see this every day, of a significant improvement in the lives of the people I work with. It is known that ketamine has a disruptive effect on the brain and mind, not only in the way a person experiences and looks at their life and their suffering, but also in the way they relate to people and the world.
What do you mean?
The person initially experiences a state of what is called dissociation, they feel themselves leaving their body, they begin to have a catadupa of unusual thoughts, experiences, visions, sensations, associations and they begin to look at themselves and their issues in a different way; they don't get stuck in the sick, rigid narrative that characterizes less healthy mental thinking. A depressed person can't see/feel themselves as a person of value, they often feel incapable of dealing with their life, their work, taking care of their relationships. A person with mental health problems, whether chronic or recent, is a person who is fixed in a rigid narrative, in a logic of hopelessness, incapacity and lack of affection. And ketamine allows them to look at themselves in a different way, to detach themselves from that negative dogmatic narrative at the root of their suffering. They often think: "No, I'm not that incapable, that unloved, that unlovable." Ketamine-assisted psychotherapy makes it possible to have an experience in which the patient is not suffering and is therefore able to see things differently. Of course, this is only possible because it is guided by a structured psychotherapeutic process.
What does ketamine-assisted psychotherapy do?
Through the effect that ketamine has on the brain, the so-called increase in neuroplasticity (the brain's ability to adapt, learn and make changes), psychotherapy can act and enable deeper and more lasting changes in the patient, even beyond the effect of the medication. During the treatment process, from a psychotherapeutic point of view, the person takes a journey in which they get to the root of their problems and can thus try to resolve them more effectively. What psychedelics allow, in a safe and controlled clinical context, is an acceleration and deepening of the psychotherapeutic process. I have considerable experience of psychotherapy and psychoanalysis and I notice that most people make remarkable progress with psychotherapy, but in general it takes a long time and some people don't get the desired benefits. Here, what happens is that there is an acceleration of this process, the person is quickly placed in a very intense relationship with themselves and with the psychotherapist, and most people show considerable changes in the six-week treatment. This treatment can be revolutionary, allowing many people in great distress, often stuck in chronic states of depression, anxiety or substance abuse such as alcohol, to return to their psychiatrist and psychotherapist with other resources to deal with their problems and their lives.
Can there be risks even when all the safety conditions are met?
Not from a physical point of view. From a psychological point of view, highly experienced people with training in psychedelics should accompany the process.
But psychedelics have a bad reputation...
Psychedelics were substances that had their heyday in the 1960s, when they were used recreationally, which led to situations of extreme use and there were some deaths associated with this recreational use. Then there was a ban because the use of substances was also linked to the counter-culture of the Vietnam War and then came Nixon and then Reagan and there was a ban, and all the scientific research that was being done in parallel stopped. The beginning of the movement called the Psychedelic Renaissance came in 2000, with a very important study proving the efficacy of ketamine in treating depression.
(The interview continues in the paper version.)
[A The Clinic of Change é um prestador de cuidados de saúde com o n.º E166508, sediado na Rua das Picoas, 12 R/C, 1050-173 Lisboa, com licença de funcionamento n.º 22863/2023, inscrito na ERS com o n.º 39467.]
[Dra. Carla Mariz é Psicóloga Clinic, com cédula profissional n.º 007521, emitida pela Ordem dos Psicólogos Portugueses.]
