James: What Happens When We Become More Present?

A Note About This Story

This story reflects one person's experience with medically supervised IV ketamine treatment. James's experiences and interpretations should not be understood as evidence that another person will respond similarly. Where observations from Ketamine Lounge are discussed, they are identified as real-world clinical observations rather than findings from controlled clinical trials.

When Everything Arrives at Once

James is 63, retired and has lived in Miami Beach for more than two decades.

He grew up in Pittsburgh, spent approximately 20 years in Northern Virginia and the Washington, D.C. area, and moved to Miami Beach with the woman who would become his wife in 2002.

About a decade ago, several parts of his life began becoming difficult at the same time.

James says he became seriously ill and was eventually diagnosed with Lyme disease. Other health problems followed.

At approximately the same time, he was dealing with a major business problem.

“It felt like a storm of different things hitting me at once, physically and mentally.”

Depression and anxiety followed.

James sought help from psychologists and psychiatrists and tried several medications. But looking back, he describes his approach as fragmented.

He might address a physical problem.

Then a psychological one.

Then something else.

There wasn't a coherent plan.

Eventually, he realized he wanted to approach his health differently.

“I needed to become more intentional about it.”

His First Experience With Ketamine

James first discovered ketamine approximately six years ago while researching different approaches to his mental health.

Altered states weren't entirely unfamiliar to him. He had previously used psilocybin mushrooms recreationally.

Ketamine was different.

He completed six treatments at another clinic.

James remembers some of those experiences positively and believes the treatment helped him at the time. But he was also physically unwell.

And not every session was pleasant.

One was particularly difficult.

Some experiences felt so physically and psychologically intense that he remembers emerging almost as though he had been in a car accident.

Eventually, other health problems emerged and his anxiety began increasing again.

His wife remembered something.

She thought ketamine had helped him before.

She encouraged him to reconsider it.

Returning to Something You Already Know

Going back wasn't an easy decision.

James knew altered states could be unpredictable.

He had experienced both comfortable and uncomfortable psychedelic experiences, and his previous ketamine treatments had taught him the same lesson.

But when he began treatment again—this time at Ketamine Lounge—he describes the experience as markedly different.

“The environment, the people, the music, and the overall protocol made the experience feel much smoother and more supportive.”

James's comparison is particularly interesting because he had experienced IV ketamine treatment before.

There are important limitations to that comparison.

The treatments occurred years apart. His physical health was different. His psychological state was different. The clinics were different. We don't know which variables contributed to the difference he experienced.

But his story raises a question that reaches beyond James:

When a medication substantially alters consciousness, where does the treatment itself begin and end?

The Medicine and the Room

James is a musician by hobby.

He plays guitar, and music matters deeply to him.

During his first series of ketamine treatments, he chose his own soundtrack.

Looking back, he thinks some of it may have been too intense or dark for the state he was entering.

At Ketamine Lounge, he decided to use the music provided as part of the experience.

He found himself following it.

The experience became less confrontational.

He felt safer.

Eventually, he stopped trying to direct where his mind was going.

“Once I allowed myself to surrender to the experience, I felt completely safe.”

This distinction matters.

A medication and the experience of receiving that medication aren't necessarily the same thing.

There is a room.

Music or silence.

Preparation.

Expectation.

Fear.

Physical comfort.

Other people.

The person's health.

The dose.

And the degree to which the patient feels able to enter an unfamiliar altered state without fighting against it.

All of those factors can influence what an experience feels like.

The larger question is whether they can also influence what happens because of it.

An Observation From Nearly 4,000 Treatments

Ketamine Lounge has developed a working hypothesis from nearly 4,000 treatment encounters.

Its team has repeatedly observed what it believes are two potentially important dimensions of IV ketamine treatment.

The first occurs during the infusion.

Ketamine can produce a profound altered state involving changes in perception, sense of self, time, emotion and the relationship between the person and their surroundings.

In the Ketamine Lounge model, the environment surrounding that state is deliberately constructed rather than treated as incidental.

Preparation, privacy, physical comfort, lighting, music, staff interaction and the overall atmosphere are designed to reduce anxiety and allow the patient to remain comfortably engaged with the altered state throughout the infusion when medically appropriate.

The second dimension occurs after the infusion.

Ketamine produces rapid biological effects associated with changes in synaptic signaling and neuroplasticity. Researchers continue to investigate whether this temporary period of enhanced plasticity and cognitive flexibility may create an opportunity in which new learning, behavior, psychotherapy and psychological reframing can become particularly relevant.

Ketamine Lounge's working hypothesis is that these two dimensions may be complementary rather than competing explanations for the therapeutic potential of IV ketamine:

The acute experiential window.

And:

The post-treatment plasticity window.

Based on its real-world experience, the team believes that when medically appropriate dosing sustains an altered state and the surrounding environment allows the patient to experience that state with greater comfort, safety and less resistance, mood outcomes appear better.

That is an observation—not the conclusion of a randomized controlled trial.

Nearly 4,000 treatment encounters represent substantial real-world clinical experience, but they don't control for patient selection, dose, concurrent treatments, expectations, physical health, staff interaction or the many other variables capable of influencing outcomes.

Existing research examining the relationship between ketamine's subjective experience and antidepressant outcomes has also produced mixed results.

But the observation raises a testable question:

What would happen if the ketamine experience itself were treated as a therapeutic variable rather than an incidental side effect of drug administration?

James's story cannot answer that question.

It illustrates why the question may be worth asking.

The Ketamine Dream

James has his own name for what happens when he enters the altered state.

He calls it:

“The ketamine dream.”

There are colors.

Movement.

Forms.

Images that seem to move with music.

He retains some awareness that he is sitting in a chair, but describes much of his attention as being somewhere else.

“The best way I can describe it is as a dream.”

His more recent experiences have also intersected with his faith.

James describes himself as a strong person of faith, and some sessions have left him contemplating how much larger and more complex existence might be than he previously imagined.

He sometimes thinks about another life and what else might exist.

For James, those thoughts produce hope rather than fear.

They are meaningful personal and spiritual interpretations.

They aren't scientific evidence about consciousness, death or an afterlife.

Both things can be true at once.

An experience can profoundly affect what someone believes without establishing that the belief is objectively true.

The Gold Ball

One image stayed with him.

During a recent session, James saw a large golden ball being polished with a cloth.

It was bright.

And he immediately interpreted it as himself.

The larger problems, he felt, had already begun being addressed.

Now something was simply being polished.

The image isn't a clinical outcome.

But it became a metaphor through which James understood what was happening in his life.

His wife was noticing changes too.

At one point, she became emotional while talking about how much better she thought he was doing.

For James, having the person who knew him best notice something he was beginning to feel himself mattered enormously.

Then There Were the Dishes

Some of James's most interesting changes have nothing to do with extraordinary visions.

They involve a dishwasher.

James used to hate unloading it.

He joked with his wife that once she retired, he intended never to do dishes again.

Now he sometimes notices himself paying attention while doing them.

Not enduring them.

Actually experiencing them.

The same thing happens while watering plants.

“I feel much more capable of paying attention to whatever I'm doing instead of constantly being pulled somewhere else mentally.”

James calls that mindfulness.

It's a small word for something he considers a significant change.

His attention is more often where his body already is.

Attention Changes the Size of Things

James had another goal when he returned to treatment.

He wanted to become less reactive.

Small events could have disproportionate effects on him.

Someone cutting him off in traffic wasn't merely an irritation.

It could alter his mood far longer than he wanted.

James didn't want a life without frustrating drivers.

He wanted a different relationship with the frustration.

“I wanted to become more resilient and stop overreacting to things I couldn't control.”

He believes he's getting closer.

This resembles something we've encountered repeatedly in Human Experience stories.

The external world doesn't necessarily change.

The email still arrives.

The difficult person still exists.

Traffic remains traffic.

The dishwasher still needs unloading.

What changes is sometimes the amount of psychological territory those things are allowed to occupy.

What Else Was Changing?

There is an important complication in James's story.

Ketamine wasn't the only thing happening.

His physical health was improving.

He was eating differently.

He had lost weight.

He returned to running and weight training.

He was paying more attention to his overall health.

He had also stopped using marijuana after having used it for much of his life.

James says he had already decided he wanted to take a break from cannabis. After several ketamine treatments, he noticed that he simply wasn't particularly interested in it anymore.

It surprised him.

But he doesn't claim ketamine explains everything.

“I've been doing several things to improve my health at the same time.”

That sentence may be one of the most important in his interview.

Human beings don't live inside controlled experiments.

When someone improves, many things may be changing simultaneously.

Sleep affects mood.

Physical health affects psychological health.

Behavior affects attention.

Relationships matter.

Expectation matters.

Treatment may matter.

And improvement in one domain can make change in another easier.

James describes what happened as cumulative.

Ketamine, to him, was an important piece.

Not necessarily the entire puzzle.

Presence Is an Ordinary Thing

Mental-health treatment is often described using extraordinary language.

Breakthrough.

Transformation.

Remission.

Healing.

James's story ultimately gravitates toward something much less dramatic.

Presence.

Doing the dishes while doing the dishes.

Listening while listening.

Driving without allowing one stranger to determine the emotional tone of the next several hours.

Choosing more deliberately what he watches, hears and pays attention to.

James increasingly thinks of those things as inputs.

People.

Music.

Media.

Attention.

He has become more selective about what occupies his mind.

Not because he believes he can control everything that happens.

Quite the opposite.

“Life is going to be difficult sometimes, and things are going to happen that I can't control, but I can still be okay.”

Hopeful

At the end of his interview, James was asked for one word.

His answer:

Hopeful.

James is considering continuing treatment with his medical team and eventually moving to a maintenance schedule.

That is his individual treatment plan.

It isn't a recommendation for other patients.

Questions remain about optimal longer-term ketamine treatment, maintenance schedules, durability of response and how repeated treatment should best be monitored.

For James, though, hope isn't simply anticipation of another infusion.

It is the feeling that whatever arrives next doesn't necessarily have to overwhelm him.

“I feel like I can live my life and know that whatever comes along, I'm alright.”

The Question That Remains

We often associate presence with meditation retreats, silence or deliberately doing nothing.

But perhaps presence is easiest to recognize somewhere more ordinary.

A traffic light.

A guitar.

A plant.

A plate being placed back into a cabinet.

James's experience doesn't establish that ketamine creates mindfulness.

Nor can one person's experience establish that environment, music or the quality of an altered state produces better clinical outcomes.

But nearly 4,000 treatment encounters at Ketamine Lounge have produced a working hypothesis that deserves a more rigorous scientific question:

What if ketamine's therapeutic potential isn't only about what the molecule does to the brain—but also what a person experiences while the brain is temporarily being changed?

And James leaves us with another question that is smaller, but perhaps more personal.

If much of our life is ultimately composed of thousands of ordinary moments—

what changes when we're finally there for more of them?

Experience Disclaimer

This story reflects James's individual experience. Individual experiences should not be interpreted as evidence that ketamine, a particular treatment environment or another therapeutic approach will produce similar outcomes for others.

Medical Note

Ketamine is FDA-approved as an anesthetic. Racemic ketamine is not FDA-approved for psychiatric treatment; psychiatric use is off-label.

Maintenance or repeated ketamine treatment requires individualized medical assessment and supervision. This article does not recommend a particular dose, treatment frequency or maintenance schedule.

Disclosure

James received treatment at Ketamine Lounge. The founder and publisher of The Brazen Word is also a founder of Ketamine Lounge.

James previously received ketamine treatment at another clinic. His comparison between the two treatment experiences represents his personal account and should not be interpreted as a controlled comparison between clinics.

Observations attributed to Ketamine Lounge are based on the clinic's experience across nearly 4,000 treatment encounters and are presented as real-world observations and hypotheses rather than findings from randomized controlled research.

Research Context

Ketamine has substantial evidence supporting rapid antidepressant effects in some patients with depression, particularly treatment-resistant depression.

Researchers continue to investigate how much ketamine's acute subjective effects—including dissociation, altered perception and mystical-type experiences—contribute to therapeutic outcomes. Findings remain mixed.

The role of treatment environment, music, preparation, psychological support and integration is also an evolving area of research. Much of the traditional ketamine literature has focused primarily on pharmacological effects rather than systematically treating the surrounding therapeutic environment as an experimental variable.

Ketamine's effects on synaptic plasticity have also led researchers to investigate whether a temporary period following treatment may provide opportunities for psychological learning, behavioral change and psychotherapy. The existence of neuroplastic effects should not, however, be interpreted as evidence that any particular psychological intervention during this period is proven to improve outcomes.

James's reduced interest in cannabis is similarly presented as his personal experience. It does not establish that ketamine caused his change in cannabis use.