The Dissociative Dilemma: Ketamine and the Search for Transformation
Matt Hiller
University of Michigan Library 2026 DOI: 10.7302/dspace/30501 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Ethnography (dissertation; historical analysis plus approximately two years of ethnographic fieldwork as a psychotherapist in a ketamine clinic) Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Duration | Approximately two years of ethnographic research |
| Topics | Esketamine Ketamine |
| Key findings | Argues that the turn to ketamine as a source of hope in treating mental health conditions, addiction, and chronic pain creates "dissociative dilemmas," in which clinicians and patients are uncertain whether ketamine's dissociative disruption serves therapeutic aims or increases disorder. Clinicians sought to ward off these dilemmas by linking ketamine to framings such as neuroplasticity and trauma, and when this proved difficult faced ethical conflicts about abandoning ketamine or risking further distress or destabilization. |
Abstract
In this dissertation, I address the question of how ketamine has been taken up as a source of hope in the treatment of mental health conditions, addiction, and chronic physical pain. Known as a “dissociative anesthetic” for its consciousness-altering properties, the question of hope is relevant to ketamine because the drug has assumed multiple identities since it was first synthesized from phencyclidine (PCP) in 1962: a proxy for modeling psychosis, a surgical anesthetic, a “horse tranquilizer,” an illicit substance, an agent of addiction, a psychedelic, a breakthrough antidepressant, a catalyst for neuroplasticity, a weaponized tool of police violence, and a medicine for healing trauma. Drawing on historical sources and approximately two years of ethnographic research working as a psychotherapist in a ketamine clinic, I argue in this dissertation that the turn to ketamine as a source of hope for the aforementioned purposes creates what I call “dissociative dilemmas.” By this, I mean that clinicians and patients faced uncertainty about whether the therapeutic use of disruption through ketamine’s dissociative effects was bringing about desired aims or increasing levels of disorder. As I explore, clinicians sought to ward off dissociative dilemmas by linking ketamine to various explanatory framings—most notably neuroplasticity and trauma—that teleologically evoked the prospect that disruption could work in service of emergent coherence. Yet, at times when this proved difficult, clinicians were faced with ethical conflicts about whether to abandon ketamine as a source of hope or to risk further distress or destabilization. These clinic-level findings, I argue, point to a broader dissociative dilemma with ketamine: is it possible to reconcile its various identities and consistently harness its effects toward specific purposes? And beyond ketamine, these findings also touch on the larger question of how disruption operates as a source of hope under conditions of uncertainty.