What if they're already doing the work? What if they were always doing the work? There is a myth with mental illness that if you just try hard enough then you'll get a good outcome. We are told that if you talk about your pain enough, take just the right drug combo (and you're expected to keep trying new ones no matter how horrific the side effects), and "work on yourself", that there will be some special moment when you are now happy and want to live. And if these things don't work for you, it's now your fault, your lack of effort, "if you weren't so negative...".
8 years since Anthony Bourdain committed suicide. Successful, adored, good looking....yet the darkness never left. "...he continued to struggle with his mental health. He often brought up death, wondering out loud how he would die and how he would kill himself if he decided to end his own life." I can't claim any special knowledge as to how our brains work, and can only speak to my own experience, but I wonder if for some of us there is a wire that just doesn't fire up correctly.
I frequently hear an expected recovery arc where people think:
- Hit rock bottom
- Seek help
- "Do the work"
- Get better
- Become grateful for the experience
- Be hopeful, be inspirational, and tell us you learned a fucking lesson
- Cue uplifting music and credits
The recovery-arc mindset often has no place for the complexity that comes with a damaged and broken mind. It wants before-and-after photos. It wants transformation. It wants closure. People who are mentally and emotionally suffering, and have shared what is happening, are expected to perform progress. I realize while writing this, and feeling angry and punchy, that what I'm feeling is the surface. At the core is the terror that I never get "better". That I'll always that annoying and exasperating sad Eeoyre friend. (I know I'm a nightmare to be around. I hate people that whine and cry all the time. Yet that's me.) That the darkness will come back with a vengeance. That everyone will leave me.
There it is; if I can't conquer my mental health then I'll be abandoned. I'll be unwanted. And shit...I don't want me. Yet that hasn't been what's happened. I have been shown so much kindness, love, and support that it overwhelms me to my core. It terrifies me as I don't know that I'll ever be able to pay it back (and I hate feeling I owe someone). I have to have drivers taking 3-4 hours of their day to haul my ketamine snorting ass around. I cry and whine and moan over the same things incessantly. I look at it all and think "Who would ever want you in any way at all?"
I finally told my youngest brother today. We were estranged for a time and working to get our relationship back as we were very close. I feared telling him. He met me with kindness and understanding. After our call he sent me this text "Good luck! Having been single for the majority of my adult life, I know it can feel like you're all alone. You're not though and very loved." I think it's the first time he said he loved me.
But I'm "doing the work". I feel so much shame when the sadness and dark thoughts come back, as they still do. I feel I should be farther along, and fear I just won't make it. I live in fear every day of my life as to what's going to happen to me.
I'm trying though. I'm trying so hard to stay alive.
How ketamine works chemically in the brain
Ketamine works primarily by affecting the brain’s glutamate system, which is the main system responsible for learning, adaptation, and neural communication.
Most traditional antidepressants work on serotonin or dopamine and take weeks to gradually adjust levels. Ketamine works differently. It acts upstream, at the level of neural connectivity itself.
1. Ketamine temporarily blocks NMDA receptors
NMDA receptors normally regulate glutamate activity. Ketamine blocks these receptors briefly, which creates a controlled disruption in the brain’s usual signaling patterns.
This interruption prevents the brain from running its habitual loops in the same rigid way. (I'm a hard ruminator. Even when having a good time, in conversation, doing anything, the thoughts are incessant.)
2. This causes a surge of glutamate release
Because NMDA receptors are blocked, the brain releases more glutamate through other pathways, particularly AMPA receptors.
Glutamate is not a “mood chemical.” It’s a plasticity chemical.
It tells the brain:
“Pay attention. Something new is happening. Adapt.”
3. This activates repair and growth mechanisms
The glutamate surge triggers downstream processes, including the release of a protein called BDNF (brain-derived neurotrophic factor).
BDNF supports:
-
growth of new synaptic connections
-
strengthening of healthy neural pathways
-
repair of stress-damaged circuits
Chronic depression and trauma tend to weaken and prune neural connections. Ketamine temporarily reverses that pattern. (Temporarily. I just had my gut clench in fear of what happens when this ends. I wonder if you do enough of these sessions that it actually allows for repair.)
4. The brain becomes more flexible
For a period of hours to days after treatment, the brain enters a state of increased neuroplasticity.
This means neural pathways are less rigid and more capable of reorganizing.
Thought patterns that previously felt automatic and inescapable may loosen. Emotional responses may no longer trigger the same intensity of physiological alarm.
This flexibility allows the brain to update itself.
Why effort is not required
This process is chemical and cellular. It does not depend on conscious effort. (This is a hard one for me. I've been told for so long that my mental state is from my lack of effort while I'm always trying.)
You cannot “force” neuroplasticity through concentration or willpower during a session.
The beneficial effects come from the biological cascade:
-
NMDA receptor blockade
-
glutamate release
-
BDNF activation
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synaptic remodeling
These processes occur regardless of whether your mind is quiet, busy, creative, or distracted.
Trying to control your thoughts does not enhance the effect. In fact, excessive effort activates control networks that can interfere with the nervous system’s ability to settle.
The brain repairs itself best when it is not being micromanaged. (I straight up laughed out loud on this one! I absolutely micromanage my brain.)
What you may notice subjectively
Because the brain becomes less locked into old patterns, people often experience:
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more space between thoughts and reactions
-
reduced rumination
-
emotional distance from previously overwhelming material
-
increased ability to choose responses instead of being driven by reflex (Though mostly responsible, I'm a highly impulsive person. I've been judged harshly "Why would you do that?". I don't fucking know!)
These changes often emerge gradually, not all at once.
The key point
Ketamine does not insert happiness into the brain.
It restores the brain’s ability to change.
Once flexibility is restored, the nervous system is no longer trapped in fixed survival patterns. New responses become possible.
And importantly, this process happens whether you try to make it happen or not.

















