all right hi everybody so for those of you who don't know me I'm Carl Bonnet I the founder and medical director of Claris and today I am joined by Dr Zachary tedar s psychologist of meet your mind ATX and Zach and I been working together for like was it been eight years now Z years years so uh yeah so Zach is super experienced in the ketamine space uh was a therapist prior to getting his Sid we work together in our Austin Clinic doing uh a lot of Kine assistant psychotherapy has seen a ton of patients and actually did his dissertation on camine assisted Psychotherapy at Capella University so welcome Zach good see thank you so much for having me Carl I I really appreciate it and anytime I get to talk about ketamine I'm really excited so exactly oh man yeah it's great to see you man so here uh so what I want to talk about you know obviously Matthew Perry's got a lot of uh press right and and my fear is that as you and I know ketamine has ketamine and other psychedelics have the the ability to revolutionize mental health care this whole idea of changing one's mental perspective and Paradigm whatever and and of course the first study came out on camine in 2000 so we've got like 24 almost 25 years of of studies on ketamine and the sensationalism now of Matthew Perry and people jumping all over this and just you know saying oh K me and this K and that you know has me concerned and one specific topic that I want to talk to you about today is you know in his autobiography he talked about the the death of the ego all right so he talked about how uh I'll read his quote off my other screen here as the music played the K ran through me it became all about the ego and the death of the ego now my concern is that people are going to misunderstand that and misinterpret that you know in my clinical experience I know in talking to you you know ego disruption this this concept of of uh leveraging the disruption of the ego can be very beneficial but my fear is two things one that he doesn't have the same definition of ego disruption that you and and I and many other clinicians are using and number two I have a feeling that the clinicians who are working with them also did not have a good understanding of how to use that and then certainly once he unfortunately went down the pathway of self- administration his assistant had no idea how to and was completely unqualified to do this so Zach let me just I'll throw the ball in your court man what do you first of all could you just tell us ego disruption ego you know this whole thing you know what role does it play in the process yeah and you know and this is something that I I really struggle to Define during my dissertation writing process was how do we look at ego from a perspective of therapeutic intervention and what are we looking to overcome in order to address those underlying issues and I think one of the ways I've approached looking at it is what I call ego disillusionment versus ego death because death implies that it's not coming back and I think that that's a really big misnomer because ego is something we all have you know it goes back to fian Psycho analytics we understand ego from a perspective of how it is a a barrier or a protective factor for people from the outside world so when we're looking at things like trauma or history of depression or treatment resistant depression we have to understand that that ego has gotten to a point where it's almost insurmountable it is there in a way that protects our our own sense of self from being destroyed by the world around us so it's that protective layer and we want to be able to have that to have effective functioning the problem is is that when it's dysfunctional when it's based in trauma when it's based in phobia when it's based in anxiety it's not serving us a good purpose so we're able to actually bring that layer down through the use of ketamine in order to address some of those underlying issues and one of the things I think is so important is looking at why therapeutic intervention during ketamine infusion is so beneficial it's beneficial because we're able to actually over come the the psyche's ability to say nope we're not going to deal with that nope we're not going to look at that and instead we're we're able to kind of see it for what it is and redefine it in a way that is less stinging that is less uh it's holding less uh of a of a control in our daily functioning so in in this aspect where Matthew Perry was doing this at home where he was utilizing ketamine at unknown rates um you know we don't really know he was also using Suboxone which you know can have a synergestic effect or even a delerious effect is can definitely really affect how ketamine Works um but we don't know how much she was actually utilizing so when I read these reports about you know how there was this effect of ketamine it's like well yes but there are other things at play too yeah and I think that's the thing that has been missed the most is how those other effects may have really played the final kind of you know outcome where we are now yeah yeah and and that's that's a great point and I guess my next question be it's going be a loaded question obviously you're going see where I'm going with this but uh I love loaded questions Carl um H how important is it for patients to sort of understand the process and what we're trying to achieve before we start giving ketamine like should they know about ego disrupt or sorry ego disillusion as you reference it I you know I I think that is such a a big component of informed consent you know when we give people drugs even s you know psychiatric drugs we want to make sure that they're aware of what the potential side effects are what the potential outcomes could be you know you may not feel right for four to six weeks you may have a period of adjustment we give all of that kind of con informed consent to patients so that they're aware and can make decisions based off that information ketamine should be not be any different you know when we do therapy with people we have to give them informed consent say hey we may jog loose some things that are uncomfortable we may jog loose some things that you know might pop up in your day-to-day life that have been in bed for a while so we want to make sure that people understand why this is beneficial and why this is helpful you know uh when we look at different therapeutic modalities we're looking at ways to bring down those those severities in order for people's improve uh daily function to improve um ketamine can definitely be a a a fast trck to Improvement overall uh but it needs to also be met with some kind of intervention to help people process through those things that are coming up you know if we are jogging loose some of these old historic traumas uh we don't want to just leave people with that you know it's like going to therapy in the last five minutes unboxing all of your worst fears from childhood and then walking out the door and you know crying in your car for an hour we don't want to do that um but I think that if we can do it in a way that is therapeutic that is intervening that is kind of being able to bring down the severity especially in the context of utilizing a facilitate like ketamine uh we should have a a controlled outcome or at least a mitigated outcome to be able to give somebody an idea of what to expect afterwards yeah right have you seen and I don't mean to put you on spot here but have you seen any patients in your practice who despite sort of like getting an understand or you explaining what you think is going to happen with regards to e disillusion and whatnot that they still just kind of don't understand it and it it can end up sort of working against them yeah and you know I think that that's when people get really uncomfortable you know that it's all of a sudden these things that have been avoided or have been you know completely disregarded as you know the the the experiences that have fulfilled their life all of a sudden now are under the spotlight and we have to kind of justify why these things have happened so it can kind of work against people if if they're not utilizing that uh that therapeutic process to really understand why these things have have been so you know difficult for them take the fear of flying you know it doesn't just come out of nowhere it definitely had a Genesis point and so looking at what that Genesis point was can be beneficial in overcoming that fear same thing with trauma when we have those really uncomfortable experiences or those those really life definining experiences sometimes we don't want to look at those and so when we put them under the spotlight like that we want to be able to give people tools to be able to overcome those and and rewrite that the script a little bit on how they respond to it yeah yeah that's that's great and you know the the one the one last thing I I'll ask you about that's interesting when I looked at Matthew Perry and just looking at my own clinical experience is and it's it's interesting I'm actually I'm about to put out a series of videos on who fails ketamine and one one of them is actually uh it's a little bit tongue and- Chek I don't want to say people fail it but you know sometimes people who have extreme wealth we have some difficulty right cuz if you especially my in my humble opinion if you look at kind of the common view of the ego like I'm someone's egotistical you know when they have a tremendous amount of uh financial resources at disposal that can kind of just blow off your treatment plan I mean I know you and I had one patient a few years ago who had tremendous wealth in his disposal and just actually there's two people now come to mind but I can think of a couple for sure yeah exactly just it's just very challenging because like you know we can talk to them about hey here's your treatment plan is what you need to do and like hey screww you I'm going to fly to Vegas and do whatever and then and that makes it challenging what what role do you think that plays I'm getting a phone call sorry about that it's all good uh what role does that play and is there a way to mitigate that you know it it's funny I think that that's where you have to really have good solid defined goals what are we really trying to accomplish here what are we really trying to uh to observe or even get to the bottom of you know and and granted stresses of um um you know of wealth and wealth accumulation can definitely have an effect on people um and I think that trying to redefine their identity can always be challenging you know we look at personality as such a persistent part of somebody's experience that it takes an arduous amount of time in order to overcome those issues um and that's with any personality disorder you know when we get to that level of of Personality dysfunction um when we kind of contextualize it in you know I don't have the daily struggles of worrying where I'm going to eat tonight or what I'm going to eat tonight you know those those challenges become very different uh it reminds me of a study that I read in college or in graduate school about um about suicide amongst highly wealthy individuals during the 2008 financial crisis and what it found was was what we had to kind of determine what reasons to live were in the context of high achieving individuals and something that found really extraordinary was all of my classmates were like well they're rich what problems could they possibly have you know and and so it kind of there is this kind of stigma that comes around that and so you know we that that doesn't mean that they don't have their own struggles that they haven't had their own issues with parental alienation or you know other kind of issues from childhood that you know affect that that perception on life and in the context of of Mental Health Care yeah there may be a lot more um kind of extraneous variables that we have to consider in in making sure that they are staying compliant um you know and and ensuring that they're just receiving the level of care that they need in order to be successful and I think that's where you know informed consent is still important and I think that we have to be able to determine a really rigid uh treatment plan and not be afraid to fire patients if they're not following it yeah yeah great points so well cool well thanks Z I mean I'll uh I'll give you the last word to see if there's anything else you want to say regarding the concept of you know ego dis illusion ego deaths it relates to Matthew Perry uh anything else we haven't covered you know I think it's just really pointing out that ketamine has such a beneficial effect uh when done appropriately and I think that that's the thing that we're seeing why these potential issues are arising is a lack of appropriate treatment strategies and following through with what we know to be true and good medicine and good treatment um you know follow the the advice of your doctor ensure that we're doing this in a controlled environment set and setting is so crucial and important to beneficial treatment and we want to just be able to make sure that people are safe we don't want you to be using ketamine in your hot tub let's just be fair I mean right you know not a good idea um you know yes have a bath after your experience but make sure you're you you've come down a little bit before that H just it just as a interesting aside when I first heard that it just reminded me of you know Michael Jackson his bedroom with prop fall and just like we're having the same discussion right I mean propal is a amazingly safe anesthetic agent when used in an emergency department or in an operating room but uh in your bedroom not so much so same thing with fenel you know people we we use fentanyl in a medical capacity every single day uh without any complications and you know when we start putting it in the hands of people on the street and with no oversight we see the kind of the the outcomes that occur yeah it's so tragic just my heart goes out to uh Matthew's family this is this is horrible but anyway well Zach thank you so much as always great to get your perspective if uh anyone uh would like to see you in Austin Texas how do they get a hold of you uh we are at meety yourmind atx.com meety yourmind ATX I'll put the link in the uh show notes as well and again thanks so much for your time Zach my pleasure my friend thank you so much see you next time take care