Unknown Unknowns

Or the things we don't know that we don't know.

There are known knowns.

These are things we know that we know.

There are known unknowns.

That is to say, there are things that we know we don't know.

But there are also unknown unknowns.

There are things we don't know we don't know.

Donald Rumsfeld

Yesterday I had my 4th ketamine infusion.

My first two were very mild, in fact I fell asleep during both and felt like I didn’t remember anything at all about the time the medication as coursing through my veins. Then, about 12-24 hours later, I’d have a subconscious or idea and my first thought would be “hey, where did that come from, i don’t remember thinking about or visualizing or observing XX at all” and thats how I confirmed with myself that even if the ketamine experience went differently for me than I expected, I had to still be getting something out of it as I just wrote five pages on the deaths of people I’ve loved going back 23 years, or the ability to lean into discomfort which in truth I absolutely cannot stand - but I thought maybe, just maybe, my subconscious was taking away things, moving things that were in my pathway, so I could get to the part of me that needs my help, my support, my ketamine to lift it upward just enough that I can grab on and start facing it slowly with the help of my family and my therapist.

Tuesday, when I met with the doctor before my third dose and I told him about the two prior doses, he decided to do not just the regular 1 unit increase in dose for this series of infusions, but a 2 unit increase. And friends - it was just what I needed. It was the experience I’d been expecting to expect, and it did not disappoint. It wasn’t a high, or a foreign place, I was just disassociated enough to observe myself in a few scenarios, and to observe some other things (things I maybe wouldn’t ever be able to put words to) but again, it felt important. It took me longer to come out of the medication haze, but when I did I felt somewhat transformed.

About 48 hours, those feelings wore off and my depression and anxiety were again through the roof. And during this ketamine trial, I cannot use my anxiety medication as it can interfere with the neural pathways we are trying to fix or even recreate - and this left me in an incredibly vulnerable spot.

I’m always trying to figure out how to make things more comfortable, tolerable, easier for other people, but I realized I never do that to myself.

So going into yesterday’s dose, although maybe not in the headspace I had been in earlier in the week, my therapist and I set an intention and I started the treatment.

When it ended, I felt again like I had slept through it. I couldn’t remember anything that happened at all consciously or subconsciously after I put on my headphones and started my ketamine playlist (you’d likely be surprised at how many of these exist in the ether.) I felt so disappointed, and confused - we had upped the dose another unit, I had done the same things I’d done prior to the previous infusion, and yet somehow I deemed this one a “failure.” Black and white thinking, much?

This morning when I sat down to journal I kept trying to think about what I might’ve seen or felt or experienced during my time receiving the medication, and… I came up with this…

Maybe the point is just not knowing.

I HATE that. That’s literally the pinnacle of giving up control, which we’ve already discussed in length is no where near my jam.

I started thinking that maybe if I did or said x before receiving the medication, I’d have had y experience, or things a lot along that nature, and I realized that I felt ashamed that this experience I can’t actually control in nearly any way felt even more uncontrollable and maybe… like i was bad at it? I don’t exactly know what that means, but it means that writing for me today and in the days to come feels extra pivotal incase there’s something way down deep my subconscious might still latch onto?

In 2011, before heading off to what would turn out to be one semester of graduate school at the University of Michigan I blogged religiously. At some point, several years later, when my boyfriend (now husband) was trying to intimately get to know me, he read all of those blog backlogs, and he said of everything, this is what stuck out:

Sometimes, being brave means not having a plan.

At the time, the sentiment applied to moving away from everything I knew to pursue additional higher education that I was 75% sure I wanted to attain. I have never been one to fly by the seat of my pants, but there as enough unknown unknowns (what a perfect expression) that I was nervous about the steps ahead.

This quote came back up to me this morning.

In a different capacity, although I set an intention for my ketamine experience and I receive the medication it in a setting that is comfortable, relaxing and safe, I still can’t have a plan when the medication hits. Because what I’m learning, uncomfortably, is that it might take affect differently each time - even if none of the visible or outward variables have changed.

Even typing this makes me feel anxious. It makes me feel some level of shame that I couldn’t better control yesterdays experience (again, laughing out loud thinking I could control it ever at all) and that I was so disappointed and discouraged by an experience I went into without control over.

This feels like a hard lesson for my very weary, tender heart to navigate today or the next few days leading up to Tuesday’s infusion - and not only do I not have the energy to feed it like it needs, I also have a fear - what if I feed it, if I do “even more” of whats “in my control” and it still doesn’t end with the experience outcome I felt like I needed? (Yes, reader, I am unfortunately aware of the numerous parts of that sentence that are unreal or even downright laughable.

But if I don’t put this into words that I alone can resonate with, than my emotions and my feelings and my depression brain will continue to taunt me, assuming that I could do better and I’m not, or that the treatment isn’t working (people, I’m only 4 doses into what will be at least 12 loading doses).

I’m not looking for grace or compassion - from myself or from you either. I’m writing because I genuinely want to know:

If you are or have been this hard on yourself,

If you’ve worked without a plan and felt wrecked because of it,

How did you stand up and volley back?

What did that look like for you?

[One final note just incase it wasn’t clear : I have a pretty terrible track record with learning that there are things I didn’t know that I didn’t know.]