Well, it's been more than month since my last session. The coronavirus has turned the world upside-down, and it complicates getting more ketamine. I'm also not eager to re-experience anything like my last session. This uncertainty makes the future of this blog uncertain. Will this be the last entry? Even I don't know the answer to that question. In fact, the uncertainty of this blog reminds me of the uncertainty of life.
My life has deviated quite a bit from the way I thought it'd be a long time ago, and every time things turned out differently, it's always been for the worse. 20 years of that coupled with an active mind has made me see evidence of death and destruction all around.
At some point, I realized that civilization is built on thousands of years' worth of violence. It's been made possible through slavery and slaughter. Enslaving people and animals created the first cities, and every building is on some land seized through violence and protected by the threat thereof. It's horrifying to think that so much of what we enjoy today was only made possible through murder and torture.
The dark side of humanity has helped me see just how contrived the trappings of civilization are. Order seems to be held in place by some invisible scaffolding I can't believe I hadn't noticed far earlier.
And nature isn't so wonderful either. It's full of predators and parasites.
The only thing I'm certain about my life is that my best days are long behind me. I have nothing to look forward to. I remember when dying seemed like such a big deal to me. That was many years ago.
Well, I had my ketamine session for the first time at this new place in Palo Alto. The people there were nice enough, but the actual ketamine experience this time was terrible.
I'd rather not get into the specifics, but it dredged up all the pain I've felt in the past related to my depression. I ended up reliving the past 20 years of pain in the course of an hour or two. It was like a band-aid being ripped off me and having what was kept inside me burst out. It felt traumatic.
There have been times where ketamine did me little or no good. But this is the first time it's ever made me feel worse. The thought that I could still be alive 40 years from now fills me with dread. I feel envious of the dead. They don't suffer at all.
In the past few weeks, I've seen my new psychiatrist and my new therapist, and I've set up my next ketamine session.
The only thing of note in regards to my psychiatrist is that when I told him about my experience off Strattera, he diagnosed me with ADHD. "Really?" I asked.
"Yes," he replied. "In fact, the fact that you respond to Strattera at all is very strong evidence that you have it." Interestingly enough, Mark, the autistic co-worker who advised me to contact my old psychiatrist for a refill while I waited to see my new psychiatrist for the first time, told me I have ADHD when I told him what had happened.
When I was 9, some psychiatrist diagnosed me with ADD and prescribed me Ritalin, which didn't work. My mom simply didn't think I had it, though, because I'd focus intently on things that interested me, an autistic trait as a matter of fact.
Well, the psychiatrist who diagnosed me back then sent to some other psychiatrist for further evaluation, and she quickly diagnosed me with Asperger's Syndrome, which, in the United States, has been lumped with everything that's considered autistic. When she told my mom it was a form of autism, she said, "I knew it!" because of her own independent research. Apparently, no one considered the possibility that I could have autism and AD(H)D!
I've seen my new therapist three or four times so far. She was Kerry's mentor actually. She's read my autobiography and two short essays I wrote at Kerry's suggestion when I was still seeing her, an essay on my mind and one about lessons I've learned from life. We're currently focusing on what purpose I might find in life. She thinks it'll be related to writing as she says I'm fantastic at it.
I've also finally set up my next ketamine session at some place in Palo Alto in early March.
I have finally made an appointment to meet my new psychiatrist, who I'll be seeing through Aetna. It's little more than a week from now. I've left a message asking for ketamine from Lenox Hill TMS. I was originally going to wait to get it in March because that's apparently when they'll start doing it once again in San Mateo, but I've decided I can't wait. So I'll try to get it in February even though that will mean having to go to San Francisco in the mean time.
During open enrollment, I switched from Kaiser to Aetna because, as I've said before, Kaiser is lousy at treating mental health. I got pretty sick and tired of having to go to San Francisco just to get ketamine. Unfortunately, though, there was a little misunderstanding with my old psychiatrist. I thought I had one more refill of Strattera (because that's what it said on the bottle!) when, in fact, I didn’t.
Days before December 21st, which is when I would leave for Thousand Oaks for the holidays, I went to Kaiser’s pharmacy to get one last refill for Strattera, only to be informed I didn’t have any left (even though my bottle of said otherwise!). It turned out that I’d waited so long to get my next refill that my psychiatrist therefore thought I didn’t need any more. (The reason I took so long, BTW, is because my bottle of Strattera had lots of pills in it, so I didn’t see the need to do it sooner.)
I was informed I could some more through some emergency procedure, but, by the time I could get more that way, I’d already be in TO, and picking it up after coming back wouldn’t be an option because I’d no longer be under Kaiser. So I decided to start rationing what I had. I decided I’d take none while on vacation.
At first, I couldn’t get a good night’s sleep. On the third night, I slept soundly because of how exhausted I’d become. Then it alternated a bit before I could finally sleep soundly consistently. I tried to see if I could get by without when I came back here.
Strangely, right after I came back here on the train, I started feeling constantly hungry, and I started eating a lot more. Then I found mind racing a lot. I felt like a pinball bouncing from one topic in my mind to another except that I felt like I was moving through an associative web of topics rather than a pinball machine. Thinking about topics at such a hyper pace made me feel like the fast-talking man from the Micro Machines commercials. I simply couldn’t focus on one thing at length because of my mind racing. Also time just whizzed right by. My first weekend back was over before I knew it.
Yet I also felt more creative, but I didn't have the presence of mind to use voice recording to record the thoughts I was churning out.
Although I could control my focus on the 3rd (the day I got back), by the 7th, it’d become completely uncontrollable. I tried things like relaxing and exercise. None of it worked.
So on the night of the 7th, I took a single pill of Strattera, and I noticed a huge improvement the following day. I was in a bit of a tizzy at first, but things mostly stabilized on the 9th.
On the 7th, I tried to get a new psychiatrist through Aetna, only to informed that I'd need someone to refer me to him. The following day, I informed a fellow autistic co-worker what had happened and what I'd be doing to get the new psychiatrist. He suggested, among other things, I should get my former psychiatrist to write a prescription for me.
It worked, and my former psychiatrist also wrote a report about for my chosen psychiatrist to read. I picked up my meds yesterday. (They were covered under my new plan.) The disaster is over. I have thought about experimenting by taking less Strattera on the weekends, but I'll run that idea past my new psychiatrist first!
My ketamine session on the 19th was the last one I’ll ever have with Kaiser Permanente. That’s because, during my work’s open enrollment, I decided to switch to Aetna because Kaiser is so atrocious when it comes to dealing with mental health. Since Aetna has no doctors of its own, that also means my last session was also the last one I’ll have in San Francisco! With any luck, I’ll have future sessions in San Mateo just as I originally did.
Well, my latest session was like a milder version of the previous one, probably because they were only a week apart. I had much the same thoughts as before, but I felt less of an impact. There were a few new thoughts this time, however.
I thought about how much time I spend thinking with a bird’s eye or grand view of the world and often lose focus of what’s happening around me. Not just our eyes but our focus seem to work like camera lenses. Zooming into something in our immediate vicinity can cause the bigger picture to go out of focus while zooming out can cause it to come into focus but obscure the details. We can see the forest or certain trees but not both at the same time.
I also thought about how we always need to map or tie some concept to something else. We are much worse at abstract reasoning than at reasoning about concrete things, and that’s why we often need examples. Even our memories are that way. We have an easier time recalling the person, the face, and so forth more easily than the person’s name.
But why? An entire person is far more complex than a name. Kids learn addition and subtraction by working with fake money to illustrate the Arabic numeral system works, but even money is more complex than the number 1 or 13.
Well, when we consciously think of tangible, real-world objects like people, we don’t try to think of all the aspects of components of people, generally speaking. We only vaguely think of their outward appearance and broad personality traits. We don’t of how their digestive systems must work in great detail or how the molecules that make up their heart must be interacting with each other. Our prefrontal cortex (PFC) only thinks about the concept of a person in broad strokes. But why is that concept easier for the PFC to comprehend than a number? Is it really any simpler?
No, but there is no “number 1” out there in physical space, so we turn to something else to tie it to. If we can’t tie a concept to something tangible, it can feel as though we are trying to work with nothing in terms of trying to understand it. That's why understanding something abstract is more intellectually demanding if there’s nothing concrete to tie the concepts or rules to.
It ultimately comes down to what our senses can perceive, it seems. The tethering of concepts generally ends with something that could be perceived through our senses. Based on what this article on object identification, this video on slime molds, and that video on quantum computing say, I suspect parts of our brain function like a slime mold’s “intelligence”, which is like bubble in that a bubble is a mindless thing that has great computational power to find the most efficient surface area for the shape of an object dipped into it.
Bubbles simply wiggle around until they minimize their energy. Quantum computers similarly can be programmed to map problems onto quantum objects, thereby exploiting nature’s way of quickly and efficiently finding the optimal solution. To find the smallest possible surface for something computationally can be a very complex and involved process, requiring sophisticated mathematics.
For the PFC, trying to, say, identify objects in the real world would be like a classical computer trying to find the smallest surface area that can be stretched over some bizarre shape. It would require complex mathematics and be far too slow and mentally dreaming. That must be why it’s so much easier for us to understand concepts if we can map them to tangible objects. Something far “smarter” than our PFC has done most of the heavy lifting for it.
Anyway, the session had a small impact on my ability to think clearly and a smaller one on my mood.
On Thursday, I had a ketamine session that I’ll write about in a post in the near future, but, for now, I’d like to write about my therapist Kerry De Lima. I saw her for the last time on Wednesday because she’s going into private practice.
I met her through a wonderful program called EvoLibri, a program created by Jan Johnston-Tyler, whose son is autistic. One Kerry’s focuses is autism, and I’m sure that’s one reason we clicked so well. She and another therapist, Alan Fridlund, are my two favorite therapists ever.
After she got to know me to a certain extent, she encouraged me to start writing, first about what lessons I’d learned in life and then about my life story. She enjoyed reading my 24-page autobiography so much she encouraged me to write more as a way for me to do something I enjoy and give some meaning to my life. As a result, I’ve started writing a short story titled The Effigy and a political-philosophy book. In fact, I’m sure it was due to my life lessons and political philosophy that she said how I wasn’t some cookie-cutter patient and said I challenged her to expand her own thinking and perspectives.
We had some “debates” where she tried to offer a different perspective on my life, but I’d be quick with a counter-point, but, regardless of whether we made a major breakthrough or hardly any progress, seeing her was always my favorite time of the week.
Below are some of the emails she sent to me
Regarding the Ketamine, I noticed that you had more seemingly positive energy and expressing yourself seemed more fluid. It also seemed that the effects were not as visible to you and did not occur immediately as you have experienced in the past. You were in a very low place and following the Ketamine (the time before last) you seemed to engage in your life more. Overall there still seems to be evidence that Ketamine is helpful to you.
In terms of all that you have to offer, despite or regardless of your earlier challenges in life and disappointments, it’s my hope that you are able to recognize these things as well. It is supportive that people around you can easily identify and share them with you. However, your embracing them is what matters most and will be the most impacting on how you move forward in life. In support, here are just a few of the positive qualities and strengths that you have to offer in my experience of you….
These types of things continue to reveal themselves as I get to know you more. It is my hope that one day, in the not so distant future, you are able to define your life by the whole of it and the potential that is in your hands.
I was telling you that it has been such a pleasure to work with you and that you have been a unique client. I appreciate the way you think and the words you use to express yourself. You are open to discussing things and wrestling with meaning. You challenge me to expand my own thinking and perspectives. I look forward to our sessions. I had hoped to continue our work and to support your writing and the things that do bring you some enjoyment and meaning in your life.
While we have had some rich discussions and you have worked hard to grow and consider things that might help your emotional experience in life, I do also worry about your level of depression and suicidal thinking. I see you as a successful person who has beat many odds and I don’t want you to give up. Maybe the world is in bad shape in some ways but it is a better place with you in it.
I’m wishing you the best and that you keep trying to add meaning to your life. I hope you enjoy your time back home and may 2020 surprise you in some great ways!
I haven't felt such an impact since January (the session mentioned in "Suzy, 12/11/1935" to be exact). I felt an immediate but modest improvement to my mood. For now at least, I don't feel so suicidal I have major difficulty concentrating on anything.
I found myself being able to think clearer once again, and this session felt like an accelerated journey through my earlier sessions: I felt a floating sensation (Fifth Post and Fear and Underwhelming) and had a bird's eye view of the world ("Suzy, 12/11/1935"), for instance.
Yet, unlike other sessions (This Is Getting Monotonous) where I experienced the same thoughts I had in earlier sessions, this did not feel monotonous.
For instance, revisiting my obsessive fear of certain things (Third Session, Fifth Post, Sixth Post, and Fear and Underwhelming) has made realize how far I've come since then. As I explained in Fear and Underwhelming, a major problem of mine has been going through certain thought patterns over and over again as a result of my brain becoming wired that way over the years. Ultimately, this is a neurological, rather than psychological, problem, though.
I've come to realize that the way the brain works really is analogous to the way muscles work in one respect. It seems that just as moving your muscles a certain way repeatedly thickens the myofibrils used for that activity (such as a boxer doing punches whenever he jogs), thinking certain thoughts over and over thickens the axons used for thinking that thought (such as my getting used to the worst scenario that may happen for some situation (Third Session and Fifth Post) practically becoming my assuming that it will happen). That realization has made me better at catching those thought cycles and nipping them in the bud.
That's not the only line of thinking I've revisited in a meaningful way, however. I've re-experienced clearing the clutter that's come from over-relying on conscious thought and revisiting the sense of Zen that comes from letting your subconscious do the thinking (The Self). Just as I've gotten better at nipping the thought cycles responsible for the fears mentioned in the previous paragraph in the bud, I've gotten better nipping the one responsible for overthinking in the bud. I still have along way to go before I can be confident I've those problems, however.
I also revisited the "theme" of self-referentiality mentioned in The Self. This time, though, I had some new thoughts. As I thought about how self-referentiality might have to led to consciousness via self-awareness, I started to wonder how that would work on a physical level. How can our minds be conscious when our brains consist only of unconscious molecules? Could it be like water being wet even though a single water molecule isn't? That seems too passive to be a satisfactory explanation. The brain generating the mind could be like a crowd generating a wave, but what specifically could make subjective experiences possible? Quantum mechanics, as I understand, is key to solving this mystery. As I thought about how, though, I ended up thinking about other topics.
When it was done, the nurse unhooked me and told me I was free to go. I was surprised. Other times, I'd asked the nurse administering it to me in San Francisco how much longer I'd have to wait before I'd be allowed to go. Apparently, I'd taken longer than usual to recover. So much longer, in fact, that I didn't have to wait impatiently before got the go-to to leave.
When I had ketamine on Friday, at first, I felt nothing. This was so for so long I wondered if I'd built up a tolerance to it, but then I started feeling it. It definitely made more of an impact this time than the last two times.
I felt I could think more clearly, but I've felt only slightly better although I felt NO better all day yesterday. It seems the effect sometimes is delayed.
I thought the same thoughts as I have in previous sessions. I wish I had more to say, but I actually forgot a lot of the experience before I could write it down. I always forget some of it, but this was much more than usual.
I had my ketamine session today. It did nothing to improve my mood. I still find myself feeling just as suicidal afterwards as before. However, I still felt a definite impact in that I found myself being able to think more clearly, especially during the treatment. It definitely wasn't as impactful as my first few sessions ever, but I still felt a difference this time.