In my February minutiae article I mentioned that the winter of 2025⁠–2026 had provided me with more personal drama than the rest of the 2020s put together, and said that “I may even write articles about bits of it (e.g., I did try a new potential treatment for my anhedonia, and it did not go well)”.  This is the article about that treatment.  I probably don’t need to write the follow­ing paragraph, because everything I’m about to say in it is old news to longtime readers of this site, and since I haven’t really done anything in the past quarter century or so to attract any new visitors, I have to assume that anyone who clicked on this article is a longtime reader.  Nevertheless, none of the rest of it will really make sense without paragraph two, so if the mention of the word “anhedonia” makes you think, “Yeah, yeah, yeah, I got it the last fifty thousand times you talked about it,” then feel free to skip to paragraph three.

So, I cannot feel physical pleasure.  This has not always been the case.  I had no idea that anything was wrong with me until I got into my first relationship at the age of 125 and discovered that the physical interactions that were supposed to be so delightful, from backrubs to intercourse, either felt like nothing to me or else felt absolutely amazing exactly once, at which point my brain would downregulate its reaction so that the second time, and every time thereafter, I would feel nothing.  This was a bum­mer, and it did do some practical harm, in that when I told my first partner about it, she took it as a personal insult and ended the physical aspect of our relationship.  But it didn’t catastrophi­cally affect my quality of life, in that I wasn’t actually feeling less than I had felt prior to finally getting a girlfriend.  If I wanted to feel pleasure, I could still get myself off.  The catastrophe hap­pened years later, at the end of 2012, just a few days after the Maya predicted it would.  That was when I abruptly lost the abil­ity to feel any physical pleasure at all, as if the link between my nerve endings and the reward center of my brain had been sev­ered entirely.  From what I could tell online, there seemed to be only one medical center in the world that was even aware that this condition existed, and luckily for me it was in San Diego rather than, like, Zurich, so I could get to it pretty easily.  So after a year with no improvement whatsoever, I went down there, got diagnosed with pleasure dissociation, and was given a list of different treatments to try: psychotherapy, physical therapy, and a whole raft of different drugs.

None of this helped at all.  Some of the medication had weird side effects.  One of the drugs I was prescribed made me incapable of enjoying music: even my favorite songs suddenly sounded like intolerable noise.  Another one made me compulsively stretch until I’d pulled a bunch of muscles.  One drug that was not on the clinic’s list, though, was brought to my attention by an email sent to me by someone I know who occasionally sends me arti­cles he has happened across.  This one originally appeared in Psychology Today, and announced that “In a recent paper […], researchers described how they used a noncompetitive inhibitor of the NMDA receptor and partial dopamine receptor agonist, ketamine […,] to rapidly reverse the symptoms of anhedonia in depressed patients.”  I wasn’t sure to what extent that applied to me⁠—my anhedonia was physical, not a symptom of depression.  And even if it did, what was I supposed to do with this informa­tion?  Take a copy of this article to my primary care physician and ask for a prescription?  So I didn’t act on the email, but I did keep it in my inbox, where it sat for well over a decade.

Then the Bad Thing came.

I’m not going to get into the details here.  Suffice it to say that in a culture in which the sensations produced by sexual interaction are taken as the physical manifestation of the emotions between two romantic partners, for one of the two to never feel any of those sensations is not great for the long-term health of the relationship.  I mean, nine years is a pretty long term as these things go, but that is cold comfort when those years have come and gone.  I did get into the details in talking to a very small number of friends, discussing how the anhedonia had actually gotten worse: “feels like nothing” had started to turn into “caus­es physical discomfort”, which turns out to be the sort of thing that puts a damper on the ol’ sex life.  And while a relationship may be able to survive if both partners are okay with an attenu­ated sex life, it probably can’t if only one is.  So had I done any­thing about it?, my friends asked.  I explained what I had done⁠—i.e., everything recommended by the clinic in San Diego⁠—and what I hadn’t, which chiefly meant the ketamine.  In the decade-plus since I had read that emailed article, ketamine-assisted psy­chotherapy had grown into a cottage industry, and I had book­marked an outfit in San Francisco town that seemed reasonably reputable.  I’d put it off because of the price⁠—every time I’d squirreled away the thousands upon thousands upon thousands of dollars that a full course of treatment would cost, I’d had to spend it on something else.  And here is where I got some feed­back I wasn’t expecting.  One of these friends is a therapist.  She said that her clients made it sound like ketamine therapy had worked miracles for them, and that the professional literature backed them up.  Another of these friends is a medical student, and she said that her classes had similarly talked up ketamine therapy as a breakthrough with amazing potential.  What I took away from these conversations was that the best time to give this a try would have been years earlier, the second best time would have been the day after the incident that kicked off the drama, and the third best time was immediately.  So I filled out the forms, went through a phone interview, had my application approved, and started the process.

The first step was the psychiatric intake: someone actually needed to prescribe me the ketamine, after all.  My one previous experience with psychiatry had come in the year following my initial visit to the San Diego clinic: part of the clinic’s instruc­tions had been to engage the services of a psychotherapist, and after a couple of months she had scheduled a psychiatric ap­pointment for me, which I understood to be so that I could get prescribed any medication that might be helpful.  Instead, I ran through my history with anhedonia and how it had dramatically worsened in 2012, and after about forty-five minutes, he reluc­tantly conceded, “Okay… you’re not crazy.”  Only then did he actually engage with anything I had told him, saying that he’d never heard of any cases like this before and had nothing to re­commend.  This time around was not much different apart from the session being held over a webcam.  This psychiatrist, again somewhat grudgingly, said that he hadn’t heard any red flags and so would prescribe me the ketamine, but warned that “this is not really the type of anhedonia that this is for”, and did not seem optimistic that it would do anything for me.  The next step was psychological intake, which paired me with a therapist; her job was to, again, make sure there were no red flags, but also to get to know my case in more detail because she would be guiding me through the KAP (ketamine-assisted psychotherapy) sessions.  And she also said that this was an unusual set of circumstances: normally people came in looking for help with intractable de­pression, i.e., when things had been the same for a long while⁠—not when going through major life changes.  As it turned out, the timelines of the therapy and of those major life changes wound up weaving together unrealistically tightly, like in the plot of a studio thriller.  On February 11 I had my preparation session, in which the therapist gave me a rundown of what the upcoming experience would consist of (“You’ll put the lozenge in your mouth, dissolve it with your saliva, and swish the medicated saliva around in your mouth for eighteen minutes”) and what I might experience (“You might think you’re a termite living on the side of a mountain”).  On February 12, Ellie Darling made it definitive that our nine years together were over and that in five weeks she would be moving not just out of the house but into another time zone.  On February 13, twelve hours after that conversation, it was time for me to travel much farther away from base reality than that.

One of the things the KAP center had made clear was that I would not be permitted to drive home from my appointment.  I was supposed to get a ride, either from a friend or from Uber.  Uber was out because I don’t have a smartphone.  Ellie doesn’t drive, and there had been multiple stretches of multiple days in the recent past that she hadn’t even been talking to me, includ­ing during the week leading up to February 12.  I asked the ther­apist whether I would be permitted to take public transportation home, and she said that would probably be fine, so as late as the evening of the 12th, that was my plan.  But the official breakup actually made things easier in a lot of ways.  We generally got along fine as housemates; what acrimony had arisen stemmed from Ellie’s sense of being pressured to make a romantic rela­tionship work that she was increasingly sure she no longer want­ed to be in.  Once she was definitively not my partner anymore, accompanying me to the KAP center was a matter of choice rather than obligation, and she said she now wanted to come along to make sure that I was able to get home safely.  So on the morning of February 13 we walked past the dog park to the El Cerrito del Norte BART station, got on a train, switched to a Muni train at Embarcadero, took that to the Castro, and walked to the KAP center.  The folks there seemed surprised that Ellie was planning to sit in the waiting room throughout my entire three-hour appointment, but she hadn’t wanted to find her way to a place she’d never been before on her own, and she’d wanted to catch up on her reading in any case.  We got there pretty early and exchanged quiet, nervous chitchat for a bit, and then at ten o’clock, I said goodbye to her and accompanied the therapist to the treatment room.

So, first came the woo.  The therapist had told me about the woo, and had said that it was optional, but I figured that if it made her feel comfortable, why not.  Some of the anhedonia treatments I had pursued in the 2010s had turned out to be nothing but woo, and that was certainly less than ideal, but in this case I knew that after the woo I was going to be ingesting a hallucinogenic quantity of a Schedule III drug⁠—i.e., something concrete was going to happen.  So, sure⁠—I sat there patiently while she burned some sage, and thanked the cardinal directions, and had me draw an “oracle card” (I got “The Unseen”), before putting on some New Age music and directing me to get ready for the session.  I was to put the lozenge under my tongue, then lie back on the couch, under two sets of covers, wearing a full blackout eyemask, and let the lozenge dissolve.  (This turned out to actually require some effort on my part⁠—it just sat like a rock in my mouth until the therapist had me agitate it a bit so it would come apart.)  As noted, I was supposed to swish the medicated saliva around in my mouth for eighteen minutes; when she called time, I didn’t really feel any different.  Then I was supposed to swallow the saliva.

Then I felt different.

On the 11th, I had asked whether this was going to be like a regular talk therapy session, just with me in an altered state, and she said that while it was possible that things might go that way since the dose for the first session was so low⁠—one hundred milligrams⁠—that was not the way things usually went.  More likely was that I would just be describing what I was experien­cing.  Even more likely than that was that I would be very quiet, and she said that she would check in with me every fifteen min­utes or so.  I said that I would do my best to keep talking⁠—while I didn’t put it as bluntly as this, I didn’t want to spend over a thousand dollars for her to watch me lie mutely on a couch.  But it proved to take a concerted effort to stay verbal, because keta­mine is an anesthetic, and so first I lost feeling in my extremi­ties⁠—I tapped my fingers together to verify that I could still control them, but I couldn’t actually feel the contact⁠—and then I just lost track of my body altogether, which made speaking difficult.  I felt like I was sinking down, out of the universe, much like the hypnosis scenes in the movie Get Out⁠—and I said so.  I felt like I was lost in a profound darkness, but intellectually I knew that there was a level of base reality in which I was lying on a sofa in a room in San Francisco⁠—I just couldn’t access it.  I said that too.  It wasn’t much of a conversation, though, because each of my utterances was a heavy lift, while the therapist’s replies were distorted hints of a voice on the barest fringes of my consciousness.  After an hour or so in the Sunken Place, I did very gradually begin to return to my body, starting with the aware­ness that my tongue was touching my teeth.  By the scheduled conclusion of the session at one o’clock, I was back to base reality, if a bit unsteady on my feet, and was ushered out to meet Ellie in the waiting room.

It might seem strange that a dissociative disorder would be treated with a dissociative drug.  Or maybe not, given that we treat hyperactivity with stimulants.  In any event, my under­standing is that the value is meant to be less in the actual disso­ciative experience than in the resulting neuroplasticity.  Appar­ently the theory is that ketamine allows the brain to rewire somewhat, as in its developmental stages.  Ellie told me later that my appearance in the waiting room really shook her up, in a way that dovetails with this theory.  She is always talking about ap­prehending people by their eyes, as in “so-and-so has nothing behind the eyes”; I don’t read people this way and confess that I don’t really understand what this means.  But she said that when I came into the waiting room, she saw someone completely different behind my eyes, which freaked her out⁠—until suddenly it clicked.  Ellie is a preschool teacher.  And she realized that I was looking at her with the eyes of a child.  I don’t really know what that means either⁠—I didn’t feel particularly childlike⁠—but she did later tell me that she was grateful that the course of events had put her in that waiting room, because the idea of me trying to make my own way home in that state now struck her as horrific.  I had been told not to eat anything for about half a day prior to the ketamine session⁠—even drinking water had been forbidden from sunrise onward⁠—but I was supposed to eat after­ward, so we headed to a nearby restaurant, with me occasionally stopping to sit on a bench or lean against a tree and recover.  At the restaurant the waiter commended Ellie and me on our quiet, thoughtful vibe.  Once I had some food in my stomach I felt almost entirely back to normal, so we took the train home.

While the psychiatrist had been skeptical, the therapist had sug­gested that I might be able to use the period of neuroplasticity the ketamine would bring about to establish the link between sexual interaction and pleasure that I had not been able to estab­lish during my celibate adolescence.  She recommended spending the couple of days following the session trying to establish that link.  Which meant that my nine-year sexual relationship ended at an exquisitely bad time.  Ellie did agree to spend the evening cuddling with me, fully clothed, to see whether that might ac­complish anything, which I guess is a pretty unorthodox way for a couple to spend the day after splitting up.  She even slept in my bed⁠—really above and beyond what would be reasonable to ex­pect under the circumstances.  Now, my dreams are generally about as boring as dreams get: they nearly always just recapitu­late the events of the preceding day.  If I spend the day tutoring, I dream that I’m tutoring.  If I spend the day playing Minesweeper, I dream that I’m playing Minesweeper.  On this night I dreamt that I was in San Francisco town, with the same streets and topography, but no buildings.  It was very late at night, and I was standing at a dimly lit intersection on a steep hill.  It was pretty dismal, but I didn’t want to leave, because in all four directions the streets disappeared into total darkness, and I knew that if I left what little light I’d found, I’d be lost forever.  I’m thinking you don’t need a certification from the Vienna Psychoanalytic Society to crack that code. 

Ten days passed.  Not only had the session had no discernible effect on my anhedonia, but it didn’t seem to have had much of an effect on me in general⁠—it was just something I’d done one Friday, memorable as a break from the usual, but no more so than having dinner at Kylie’s house the following Wednesday.  But the initial treatment was supposed to be a course of three sessions of increasing dosages, so perhaps this was like making a judgment call on the efficacy of the Moderna covid vaccine after getting only the first shot.  So on February 23 Ellie and I returned to the KAP center.  The initial steps were the same.  This time the oracle card I drew was “Anima Mundi”.  And this time I drew two lozenges out of the bubble pack, because this day’s dose was two hundred milligrams.  The therapist had cautioned me that every experience could be quite different even at the same dose, let alone when varying the amounts, but I prepared to head back into the dark…

…only to find that this time my disconnection from base reality was complete.  I have heard our experience of the universe com­pared to our experience of using a computer with a modern op­erating system.  We have been trained to think of computers as big filing cabinets full of manila folders stuffed with documents and photos, but those are all metaphors.  The reality is nothing but trillions of ones and zeroes⁠—except, no, that’s an abstrac­tion.  The physical reality behind those binary digits is an array of silicon capacitors with different levels of charge.  Or is it?  All we know about reality is what we perceive through our senses and understand with our minds, but our brains and sensory apparatus evolved for survival, not for the apprehension of some sort of cosmically objective truth.  Even on the most basic level, we see things not as they are but as we are, and that plain yellow flower looks very different to the bumblebee that can see the ultraviolet patterns on its petals.  So this universe of matter and energy might be the equivalent of a desktop environment with its files and folders, with something alien and incomprehensible behind it.  That’s the argument, anyway.  But under the influence of the ketamine, I saw this not as an ontological argument but as a manifest fact.  During my first KAP session, I had still acknow­ledged our universe as the “base reality” I had sunken away from; this time, it dissipated like a dream.  Everything I had previously known stood revealed as a temporary illusion, an epiphenomenon of what I was now experiencing… though that may not be the right way to put it, as it did not feel as though there was an “I” separate from the experience.  This “ego death” was one of the possibilities I had been told about during the preparation sessions, and in fact I was told that it was one of the main experiences this center’s therapists hoped the KAP sessions would bring about.  Even before I had ever heard of ketamine, I’d heard this put forward as one of the hallmarks of the psychedelic experience: the sense that separate identities are merely cases of limited vision, that we are all manifestations of a collective consciousness that animates the cosmos.  This actually came up a lot in my religious studies classes⁠—the idea that, sure, studying philosophy could give you an intellectual understanding of this wisdom, but only through mystical states, which in some tra­ditions were brought on with the aid of entheogenic drugs, could you directly experience it in all its profundity and grandeur.

That was not my experience.  There was no profundity.  There was no grandeur.  When the universe dropped away, what was left was… well, it is obviously hard to put into words, but the best I can do was that true reality stood revealed as an inter­action between a somewhat larger “P‑force” and a somewhat smaller “S‑force”, which both manifested as ethereal blobs in muted colors ranging from a dull bluish purple to a dull bluish green.  That’s it.  The universe in all its scope, billions of light years across and filled with wonders, was just a temporary glitch that reduced down to vague twitchings of some dark energy.  It was small, and sad, and solipsistic.  As the ketamine wore off, the fact that I had interpreted this through letters and colors sug­gested to me that I had in fact been regressed to early childhood, because graphemes and colors pretty much were the filters through with I saw the world when I was two.  Anyway, it was a good thing that I hadn’t signed up for this as a treatment for depression, because I have to think that, if anything, it would have made that depression worse.

And this time, even fifteen minutes after the clock had struck one, I couldn’t really get up off the couch⁠—I was still pretty heavily anesthetized.  The therapist said she actually had to leave for another appointment on the other side of town, and after ascertaining that the room I was in wasn’t booked for anything else in the immediate future, she brought Ellie in to help me get ready to leave.  Ellie got me to drink some water, and tried to get me to eat some bites of banana, but the latter was a bit beyond me still.  Forty-five minutes later it was nearly two o’clock and I still couldn’t stand upright or move my arms without flailing them around.  Ellie decided that it was time to go but that going back to the restaurant was not in the cards.  She called an Uber and escorted me downstairs⁠—to me it felt like we were outside in no time, but she later told me that getting me down to the sidewalk had taken ten minutes.  The car that came to pick us up seemed to have no shocks, and I felt like I was being jolted by every little pebble in the road.  As I lolled around in the back seat, the driver kept asking Ellie what was wrong with me, and Ellie kept explaining that I’d had a medical procedure and was still pretty anesthetized, but it turned out that the driver was deaf and couldn’t hear her answers, so she kept asking the same suspicious questions about why I seemed so out of it.  It actually took me a couple of days to fully recover.  On February 24, I still had a slight speech impediment (I couldn’t reliably make an S sound correctly) and some cognitive deficits (I had some tutor­ing appointments to run and I would sometimes have to hem and haw for a long moment while grasping for the word I wanted: “So as you can see here, the curve approaches, you know, the line that it never quite reaches, which is called, ah, as I’m sure you’ve already learned, the, ah, the… asymptote!”).  And, again, there was no effect on the anhedonia.

The idea of taking three hundred milligrams of this stuff on March 9 did not seem advisable.  I contacted the therapist to terminate my ketamine-assisted psychotherapy.  I expected that she would try to talk me out of it or to switch to the intramuscu­lar version, but to my surprise she said that if I hadn’t seen any improvement whatsoever after two sessions, she was not opti­mistic that a third would do me any good.  So that’s my data point: this medication may relieve intractable depression and the ennui of billionaires, but at least in my experience, its efficacy in restoring the ability to feel physical pleasure is zero.  I guess this is the part where the Trumpers write in to say that what I really should have tried was ivermectin.

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