Dissociative experiences from ketamine, often seen as undesirable side effects, may be essential for its antidepressant action in certain depression subtypes. The 'relaxed prior hypothesis' proposes that ketamine enhances sensitivity to bodily signals by blocking glutamate, improving short-term plasticity. Two patients with 'depersonalized depression' (Entfremdungsdepression) in a six-month esketamine program showed that induced dissociation, particularly disembodiment, could suspend ingrained patterns of feeling and behavior. This creates a window of psychological plasticity, allowing the body to regain responsiveness to emotional cues. The findings suggest esketamine's dissociative effects may be especially beneficial for those with compromised interoceptive awareness and interaffectivity.
Psychiatric urgency involves serious mental suffering and behavioral change requiring prompt treatment, while emergency is life-threatening. Although phenomenological psychopathology has neglected this area, the phenomenological method is essential for clinical management. The manuscript explores the phenomenological perspective of psychiatric emergencies, emphasizing the centrality of the encounter between clinician and patient as two subjects, not just doctor and patient. The affective space of intersubjectivity and intercorporeality enables transformative understanding. The emergency room atmosphere—full of haste, anxiety, and expectation—hinders authentic encounter, which must be recovered for diagnosis and therapy. Clinicians should immerse themselves in the patient's life-world, using the phenomenological method to grasp the crisis's meaning and help re-inscribe it within the patient's history.