Ethical ketamine treatment involves understanding the bio-psycho-spiritual aspects of care. Join Dr. Manoj Doss of the Institute for Integrative Therapies in exploring holistic treatment and the future of care. Watch the video or read the highlights from the interview here.
Getting to Know Dr. Manoj Doss, Institute for Integrative Therapies (IIT), & Ethical Ketamine Treatment
Dr. Manoj Doss is the Founder and Medical Director of the Institute for Integrative Therapies, or IIT, the first psychedelic medicine clinic in Minnesota. IIT applies a bio-psycho-spiritual approach to care in order to produce small, incremental changes in how patients think, react, and behave, which ultimately leads to living a more purposeful and content life. Dr. Doss is a board-certified physician whose passion in psychedelic medicine stems from a recognition that many of his patients were suffering from depression, anxiety and trauma, but were not realizing significant benefits from current treatment options. As this field grows, he wants the IIT clinic to be a standard in the ethical practice of psychedelic medicine.
Dr. Doss was first exposed to psychedelic medicine through Michael Pollan’s book, How to Change Your Mind. “My first thoughts were, ‘This is completely preposterous.’ I thought this was hippie medicine, and I didn’t really connect with it at the beginning. The thing that got me [connected] was reading the literature about it and listening to some of the experts, like Dr. Robin Carhart-Harris [of the Imperial College]. I look at things with a broader perspective. I have a public health background, and I’m an urban planner by training as well.
The one thing that you see from the data is that suicide is in the top 10 causes of death in America. But more importantly, it’s one of three in the top 10 that is actually increasing. We just haven’t had great tools with psychiatric medications and therapies over the last 30 years. I see it as the role of healthcare and the mental health system is to meet the demands of its population, and we are not currently meeting their needs. We are in desperate need of new tools. One of my goals going into this is to start an ethical clinic that could provide [ethical ketamine treatment] in a safe environment and provided by someone like myself, that [actually understands the importance] and how to truly utilize these medicines.
Bio-Psycho-Spiritual & Ethical Ketamine Treatment
Dr. Doss takes his role in health seriously and shares his expertise with his community through his role on a health services advisory committee for St. Paul and Ramsey County, advising the Mayor and the Board of Commissions on public health issues. In that capacity, he utilizes the bio-psycho-social model. At the Institute for Integrative Therapies, Dr. Doss and his team use the bio-psycho-spiritual model. “Bio is the [patient] and the ketamine, psycho is the psychological integration support that the patients go through with their therapist, and spiritual is the transpersonal journey that the patients go on.”
“When we talk about the biologic part of it, ketamine has some really tremendous effects on the brain. Neuroplasticity is a word that gets thrown out a lot, it’s literally the brain’s ability to make new connections and create new circuits. That’s really important for two reasons. [First,] psychedelics are medications that have been shown to create these neuroplastic effects…But the spiritual part is important too.
What we’ve seen in a lot of these psychedelic studies is that it didn’t matter how much ketamine was given. It didn’t matter if the patient had a dissociative event. It didn’t matter if they had a near death experience. The thing that correlated the highest with having a global improvement in their symptoms was whether or not they had a mystical experience [1]. [This] means that there’s a therapeutic benefit just in the consciousness-expanding experience. That has nothing to do with the biologic, nothing to do with the psychologic.
It’s okay if we don’t quite understand what’s going on – we don’t understand a lot of the mechanisms of actions of the drugs that we give people. We still don’t even really know how Tylenol works for treating pain.I really see this as treating the patient on three different levels – biologically, psychologically, and spiritually. That’s the value-add that we give patients. We see people holistically, and we can treat people holistically with this medicine, which we really haven’t been able to do with other types of psychiatric medications.”
Fixed Ideas in Medicine
Mainstream medicine is trying to adjust to the potential of new psychedelic medicines, both legal medicines like the ethical ketamine treatment provided at IIT and the substance currently being researched, such as MDMA and psilocybin. As Dr. Doss describes, this transition is not always smooth. “[One issue] is privileging the commercialization of these drugs by the pharmaceutical companies and dismissing altered states of consciousness. There are psychedelic companies now that are trying to create psychedelic medications that don’t have a psychedelic experience. The spiritual part of this therapy is one of the therapeutic benefits, and the medicine is almost like a mediator.
So, to take that out of the process altogether, we’re creating a huge disservice for our patients. There’s the overlooking of the psychological mechanisms in play [and] of the set and setting protocols that all the studies have been using. Set and setting matter for therapeutic healing.my patients recognize that as being fundamental to this process.
We have all these pretty images with functional MRIs, and it’s important to know what these medicines are doing in the brain, but we also have to recognize that these things are indirect measurements, [they don’t] directly tell us what’s happening in the brain. It’s okay if we don’t completely understand it. So that’s the brain model [in medicine], and then there’s the mind model…The agitated mind is a terminology used in things like Ayurvedic medicine and Buddhist practices. Basically, this agitated state of mind creates suffering and that gets in the way of contentment. In my practice, I don’t like to look at things in silos, and that includes cultures that have typically used psychoactive medications for spiritual healing.”
“We treat the spiritual component as one part of the therapeutic process. We’re really looking at this therapy as the perfect bridge between these two worlds. I think that the current medicine in Western practice, we sometimes dismiss [these alternative models] as wu-wu, when in fact they kind of lean on each other. In Ayurvedic medicine, there’s the three doshas. If you read a little bit about it, they have a physiologic and a mental and an emotional component to all three. That really interplays perfectly with psychedelic medicine.”
Preparing for the Post-Approval Landscape
As approval for medicines like MDMA and psilocybin move closer, clinics like IIT offering ethical ketamine treatment are preparing to grow their services. “We’re going to be adding additional services that compliment psychedelic medicine, things like integrative medicine, integrative wellness coaching, somatic therapy and acupuncture. We’re creating the infrastructure for psychedelic assisted therapy right now. We have a good model where I’m the physician, and I treat the body….And, we have a team of therapists that work with me in the clinic.
I talk to the MAPS team quite often. I’m really wanting to stay up to date on what we can do to prepare so on day one we can be operating. We have every therapist from IIT that applies to be in the [MDMA Therapy] training program get in…what we’re doing is a good blueprint for what this therapy might look like in the future.”
“I wish I could show you our treatment rooms. There’s a big emphasis on artwork in the rooms, there’s a lot of natural wood…We pay homage to the cultures that have used psychoactive medicines for spiritual purposes. We have real plants and trees in the treatment rooms. The tree in the room is the Banyan tree…In Buddhism, it’s the tree under which the Buddha found enlightenment. It’s also the tree under which the first Jain found spiritual enlightenment. We don’t have any religious overtones or dogmas to the work we do, but we do appreciate the symbolism.
We choose music particularly for this experience. We read a lot of literature and it’s come up about how important music is – I consider music one of the guides. So, it’s a little bit different approach than what the psychedelic research clinics have done thus far. But what we’re doing will be kind of groundbreaking. We speak to the patient through a microphone through their headset, and we don’t have to take it off to talk to them or check in on them or give them affirmations. We’re able to communicate directly with them, which keeps them immersed in the process.”
“The one other part is that it’s going to be important for a lot of these companies that get into psychedelic medicine to help increase the data that’s available for research and be part of clinical trials. We’re trying to build up that infrastructure to do research. We’re in the process of becoming a clinical trial site for some of the research going on right now. Eventually, [we will] do our own primary research through the Institute. It’s really important to build credibility in this field and be able to contribute to the academic component of it as well.”
Healing the Healers
Dr. Doss sees psychedelics as a healing tool not only for patients, but also for health workers and medical professionals. “After I’d read Michael Pollan’s book and learned more about psychedelic medicine and its use in behavioral health, one of my friends that I trained ended up taking her own life. She was really close to my wife too, and so it really devastated our family. After that, I tried to seek answers on what can we do to change this. I went to a professional conference and there were three sessions on physician burnout, depression, and suicide – three of them in one conference. It was kind of unheard of.
In each one of them during the Q & A session, there was always someone that stood up and commented that burnout didn’t start 10 years into my practice, burnout started in my first year of training. My long-term goal professionally would be to do some research using things like MDMA and psilocybin on residents and health care practitioners early on in their career and do a study to see if we can find ways to help people find self-compassion or regain self-compassion and dismiss the ideas that they have of imposter syndrome.
My larger goal would be to start a program where MDMA therapy is done at the end of every training year. In the end, that’s going to end up saving lives. We’ve had two physicians just in the last six months in the Twin Cities take their lives. It’s a topic that’s near and dear to my heart, and I think that these medications can go a long way [towards] saving some lives.
Connecting with IIT & Ethical Ketamine Treatment
Dr. Doss and his IIT team would be happy to connect with you to share more about ethical ketamine treatment. Visit the website to learn more and reach out. “There’s a form online form that you can fill out if you have questions or comments or want to learn more. We get back to people very quickly and you can talk to me or one of my partners within 48 hours and we’ll be glad to tell you everything.
We tailor everything to the patient, and we have a variety of therapists that focus on different niches as well. We have someone that focuses on LGBTQ, on religious trauma,…so there’s different people that can connect with you on whatever you’re dealing with in life. We also do group sessions that can make things a little bit more accessible for people, too. If you want to learn more, we’ll be glad to put you in touch.
References
- Rothberg, R. L., Azhari, N., Haug, N. A., & Dakwar, E. (2021). Mystical-type experiences occasioned by ketamine mediate its impact on at-risk drinking: results from a randomized, controlled trial. Journal of Psychopharmacology, 35(2), 150-158. https://doi.org/10.1177/0269881120970879
