Photograph by Juliet Sanders

“The best way to describe it is that it feels completely out of body. I saw shadows. It felt like I was moving, like someone was physically moving me around the room.”

Nineteen-year-old Sara looks like the ‘70s supermodel Twiggy minus the bob cut. Her blonde hair is long and wavy and falls halfway down her back. She has a sprinkle of freckles that fan across her cheeks and over the the bridge of her nose. Her eyes are saucerlike and dreamy, outlined by long lashes. She is beautiful but does not know it.

Illustration by Abby Ouellette

Sara is the kind of person that you meet and find yourself wanting to take care of. You want to make sure no cars are coming when she crosses the street and that her jacket is zipped when she heads outside. That’s funny, because Sara is strong-willed and thoughtful. She doesn’t need looking after. Her delicateness is deceiving. But it is true that a kind of daintiness has consumed her life. Sara has struggled with bulimia nervosa since entering her teens. She began extreme dieting at 15, and soon after, she started binging and purging. After trying psychotherapy, outpatient treatment, and inpatient eating disorder clinics with no success, Sara decided to treat her eating disorder through ketamine therapy.

* * *

Cave drawings suggest that the ritualistic use of psychedelics goes back thousands of years. The hippie culture of the ‘60s and ‘70s made a lot of people see them as more recreational than therapeutic, but in recent years, there has been a psychedelic renaissance. Medical professionals are touting drugs like ketamine, psilocybin and MDMA as useful for treating mental health. Institutions like John Hopkins, Yale, and the University of California San Francisco are currently conducting studies using ketamine and other psychedelics to treat depression. In 2018, The FDA granted breakthrough therapy designation for psilocybin-assisted therapy for treatment-resistant depression, signaling a shift in regulatory attitudes toward psychedelics.

There are roughly 2500 legal ketamine clinics in the United States; many are in California. Medical professionals administer the drug, usually in conjunction with psychotherapy. Part of the reason ketamine has grown in popularity is because it works faster than antidepressants, which take weeks to kick in. Ketamine is instant. Who doesn’t want that? Additionally, studies show that ketamine is less addictive than opioids. It is believed to improve mood and appetite regulation, as well as healing damaged dopamine pathways in the brain. Medical professionals believe that by improving how brain cells talk with one another, ketamine could remedy a variety of brain functions damaged by those suffering with eating disorders, and even alter their motivations.

* * *

Sara’s decision to try ketamine came after what her mother Cori describes as “months of research, coming from a place of desperation and love after other forms of treatment failed her.” The first signs of Sara’s eating disorder appeared back in 2020, during quarantine. At that time, Sara was living in San Carlos with her mom, grandma, and older sister. All three of them began seeing evidence that Sara was suffering from bulimia nervosa. Sara’s older sister Ruby explains, “In 2020, TikTok got bigger, and we were seeing all these people post things like, ‘This is what I eat in a day. These are all my workouts.’ Sara got sucked into that.”

Sara nods, laughing and sheepishly adding, “That sparked it! But to be fair, that winter, I gained some holiday weight.”

Ruby rolls her eyes, making it clear that she is equal parts horrified and annoyed by Sara’s last statement. “You were a baby! You were 15 years old!! You still had a baby face!” The two girls are sitting in the living room of Ruby’s La Mesa apartment on a trendy pink-and-cream checkered rug. They tease each other in the way sisters often do, but their closeness is evident from their openness and ability to speak honestly about Sara’s eating disorder.

Sara replies, “I was a chubby 15-year-old. I was also kind of obsessed with this guy, so I wanted to lose weight because of that. I would sit around scrolling TikTok, seeing everyone work out and watching all those Chloe Ting videos. Obviously, that was going to spark [my eating disorder]. I ended up getting down to around 95 pounds from 115 pounds.” However, “once my weight got down to where I could’ve been happy, I just kept on going and going. The lower I got, the happier I was. At first, it was about my looks, but somewhere along the way, I got to the point where seeing that number on the scale drop was sort of a way that I could control a part of my life. I felt the best at my skinniest. I never felt pretty in any way, but being skinny [helped]. Even when I got to the point later where I could feel that my body was declining, I kept losing weight.”

For her part, Cori says that it took her some time to realize that her daughter was suffering from body issues. “I remember one day in particular; Sara was having a bunch of friends over to swim. I saw her standing in front of a mirror. She was in her bathing suit, and I could tell by the look on her face that she was being really hard on herself and her body.” Cori realized that her daughter needed help. “I did not know what to do. Sara was on a severe and restrictive diet. She would get constipated, so then she was taking Ex-Lax. Then she started bingeing. Thank God she was not very careful, and we could see the evidence of it in the toilet.”

Sara’s (right) decision to try ketamine came after what her mother Cori (left) describes as “months of research, coming from a place of desperation and love after other forms of treatment failed her.”

Photograph by Juliet Sanders

Cori began taking Sara to the doctor regularly for weigh-ins. “Sara was resistant to getting help. When I would take her to the doctor, she would bawl on the way there. They had her do blind weigh-ins. We were told to get rid of all the scales in the house. I did, but Sara had one that she hid. Nothing was changing.”

During one appointment, Sara’s blood pressure and heart rate was very low. Over concern for her health, the doctor made the decision that Sara needed to be hospitalized. “Sara was hospitalized for ten days,” Cori recalls. “While in the hospital, Sara decided to do exactly what they told her to do, so she could get out. She gained just enough weight to be discharged.”

Prior to her hospitalization, Sara had done an outpatient treatment at the Kaiser Eating Disorder Program. “[Her case manager] was doom and gloom the whole time. He would tell Sara, ‘You are going to die if you don’t get help.’ Every week, he would say the same thing. It was the same talk track over and over. We got tired of that. It wasn’t helping. It was Covid, so it was virtual. Thy had a nutritionist and a psychologist. Basically, all they did was give me some print outs on nutrition, and the psychologist would meet with Sara for like five minutes. He would ask if she wanted to go on [antidepressants]. Sara would say no, and he would say okay. It was very sterile. It was not very personal.”

When neither the outpatient nor inpatient treatments worked, Cori tried to find Sara a therapist. “Every therapist we saw would say that Sara was not ready or willing to [seek treatment]. They would tell me that she needed a higher level of care, and they could not continue seeing her. The more therapists we saw, the less Sara liked them. And 90% of the time, the therapists were not covered by insurance. I am a single mom. I make decent money, but I was struggling. It was really discouraging. I felt there was nothing I could do.”

Despite her struggles, Sara managed to get accepted to Cal Poly. Recalls Cori, “I was so stressed out when we dropped her off at Cal Poly for school. I wasn’t sure if we were doing the right thing. Sara has a huge fear of the unknown. I knew the moment we dropped her at school that it would exacerbate her situation.”

She was right. “She called me every single night, telling me how depressed she was. All I kept thinking was, ‘I hope she is eating!’ I told her she could come home, but she said, ‘No I am finishing out this quarter and then I will move back.’ I was worried constantly. When the quarter ended and I went to pick Sara up from school, she weighed 84 pounds! She is 5’1 and she has always been thin, but 84 pounds was a fucking shock!”

Cori found a doctor that specialized in eating disorders and took Sara in for a check-up. The doctor advised Sara to enter an eight-week treatment program that day. “I don’t think it ever really hit me that I had a serious problem until I went to the doctor, and she told me I needed to be hospitalized,” says Sara. “I told her no. I wanted to celebrate Christmas with my family. The doctor said she was scared that I was not going to make it to my birthday — I mean, that was scary to hear, but I was still so resistant. I didn’t want to go to the hospital. I knew I would gain weight in a way that wasn’t going to be sustainable or make me any happier, because I had done that before. It didn’t work.”

* * *

When Cori first began her research into alternative treatments for Sara, she was convinced that psylocibin was the answer. She found an FDA study that would use psylocibin to treat eating disorders. She contacted the organizers. Sara even met with the researchers. “I was hopeful that the psylocibin study would really make a difference,” says Cori. “I even went as far as taking mushrooms myself, because I did not want Sara to go through something I had no knowledge of.”

After a lot of coaxing, Sara agreed to do the study. “However, the study had two groups: two-thirds of the participants would receive the psylocibin, while the other one-third, a placebo.” Not wanting to risk Sara’s health and invest a large chunk of time only for her to be part of the placebo group, Cori reluctantly decided to pull Sara out of the clinical trial.

Then came ketamine. Cori found a clinic in San Diego whose founder worked for the UCSD eating disorder clinic. She also directed an intensive family treatment program geared toward young adults with eating disorders, and took part in clinical research at UCSD evaluating novel psychiatric treatments — including psychedelic-assisted psychotherapy and family-focused eating disorder treatment.

* * *

Part of the reason Sara agreed to ketamine after refusing other forms of therapy was because of her experience with marijuana. “One night I was sleeping at a friend’s house, and I could not sleep. I was feeling anxious about everything, so I decided to smoke some pot. I got a little high, and for whatever reason, I had a breakthrough. It was the first time ever that I felt like I wanted to get better. It was the first time I started thinking of myself as an almost twenty-year-old. Before that, I thought of myself as a little girl. Being skinny affected that. I had not had my period in over a year. I just didn’t feel like I was a woman. I realized I wanted to start looking like a [woman]. I started looking back at my memories on Snapchat. It was almost like an out of body experience, because before that, I had never been able to really see what I looked like. Seeing all those pictures through the years, I just thought, ‘I don’t want to be this skinny anymore.’”

Sara is telling me all this in late November, shortly before beginning her ketamine treatments. “I have been gaining weight and doing a lot better, but this last week has been hard. I have been eating a lot because of Thanksgiving. I am glad I am starting the treatments soon, because these last couple of days, I feel myself sliding back into those habits. I am excited and nervous to do the ketamine. I am optimistic. I am anticipating a change of some sort. I expect it to be more positive than negative, but I don’t want to go into it expecting an outcome. I’m also a little worried that I am going to freak out.”

* * *

Now it’s December, and I’m sitting with Cori while Sara undergoes her second round of ketamine. “Sara got a shot instead of an infusion this time,” Cori says. Sara’s first treatment was two days ago. It did not go as expected. “It didn’t get to the level where it reached her brain. Sara was only feeling it in her body, so she is not convinced that she wants to continue treatment.” Cori’s voice is unsteady. “I said to Sara, ‘It is only three weeks for you to potentially have amazing results!’ She didn’t want to talk about it.”

Still, Cori is hopeful. “I don’t want to have expectations of a cure, but all the research I have done on ketamine for eating disorders show amazing results. Sara has been progressing so much already; I can only imagine how helpful the ketamine treatments will be for her.”

Cori’s phone rings; it’s Sara. I can see pain in Cori’s face, “I guess she is done. Already. That was quick!” Her voice drips with disappointment. “Maybe the dose was too low again, I don’t know?”

* * *

Eight weeks later and six ketamine treatments down, I meet Sara at Ruby’s apartment. She is wearing sweats, and her hair is tied back into a high ponytail. She seems different: steadier and more assured. I ask her if her first treatment went the way she expected. Sara shakes her head, saying, “Not at all.” A smile creeps across her face, evidence that she is more amused than upset over the reality verses the fantasy. “I was so nervous! I was anxious about the setting. In my head, I was expecting to go somewhere that looked medical, like a doctor’s office. Instead, we walked into a small office building. The first thing I saw was a hippie-looking guy sitting on a couch. I thought he was there for an appointment, but then he got up and greeted us. He worked there,” Sara says, the shock still in her voice.

When Sara was ushered into her treatment room, she was surprised again. “The room was a lot less professional looking than I thought it would be. I mean, there were galaxy lights. I tried not to let it stress me out, but I got really nervous. I was thinking, ‘What is going to happen? Is this legit?’”

The doctor administered her ketamine dose via IV. Sara donned an eye mask and headphones. She found the juxtaposition of rain forest sounds and chant jarring. She couldn’t turn her brain off. She kept wondering how she was supposed to be feeling. She wondered if the thoughts in her mind were her own or the result of ketamine. “I just tried not to think about anything too hard, because the more I did, the more I thought, ‘Oh, my god, what am I doing?’ They said it probably was not a high enough dose, because I was mind conscious the whole time.” The second treatment was similarly disappointing.

“My third treatment was with a group. I cried before I went in. I was very, very, anxious. The idea of doing it with other people really scared me. I wondered if the other people would be weirdos. I had no idea what to expect. I knew that instead of an IV, I would get a shot in my arm. That made me nervous, too.” There were six mats laid out in a big space. Everyone had a pillow, a blanket, an eye mask, and headphones. Sara was the first one there, so she found a spot and sat down. People started coming in: more men than women, a wide age range.

Sara settled down onto her mat and listened while a nurse laid out the ground rules. “She told us, ‘If you need something, let us know. Be cautious of people around you. If you are having a bad experience, we will come to you.’” The nurse led the participants in a breathing exercise and mediation. Then nurses came by and injected everyone with ketamine. Patients were instructed to put their eye masks on and their headphones in. Sara turned up her music and tried not to think about the people around her. “Some of them were a little odd, and I got a weird feeling from them. At the same time, I thought they were probably looking at me like, ‘What is a twelve-year-old doing here?’”

During those first sessions, she says, “I did not have any big breakthroughs. There is no denying that I was taking an unusual journey, but I was unsure of the effects it had on my mind, or the effects it would have on my attitude and behavior afterward. During group therapy, I was the first one in the room to come out of it each time. I would get up a little wobbly. They would take my vitals and then they would talk to me about my experience. They would always say, ‘You need a higher dose and blah, blah, blah,’ and then I would leave.”

Eventually, she did begin to feel like the drug was working. “I started looking forward to my treatments. I was getting excited for them — which made me nervous. That was the same time Matthew Perry’s [autopsy results came out]. He had ketamine in his system when he died. I thought, ‘Oh no! Am I going to get addicted to this?’ I worried that maybe it might become a thing I started searching out to do.” She felt better when she learned that while Perry was receiving ketamine treatment, the amount he had in his system when he died indicated that he was self-medicating outside of treatment.

As far as what ketamine felt like; Sara found it difficult to describe. “The best way to describe it is that it feels completely out of body. I saw shadows. It felt like I was moving, like someone was physically moving me around the room. It felt like my mind got taken out of my body. I did come out of my final sessions feeling pretty good, but the effects of ketamine don’t last that long. Originally, I thought that the treatment was just six times, and that was it. I was a little discouraged to learn that you’re supposed to come back every month to do it. Like everyone who works [at the clinic] still does it like once a month. You have to upkeep it.”

I ask Sara if she is glad she did it. “I don’t know? I think it was a good experience for me to try, even if the actual experience did not do anything for me long-term. Now I can say I tried. If I hadn’t, I am sure I would have thought, ‘Maybe if I had done the ketamine, it would’ve helped.’”

Did she think it would cure her eating disorder? “I didn’t feel like it would be a cure, but I thought there would be a tangible moment that I could point to and say, ‘That was it, that was the moment.’ I thought there would be some big breakthrough. I expected something crazier to come out of it, instead of just being a good positive experience that made me feel better for a few days afterward. I wasn’t like, ‘Oh my God, Ketamine saved my life!’”

Where does she go from here? “Just today, my mom was saying, ‘Maybe we can still do the psilocybin trial.’ That is just not something I am antsy to do. I think I want to find a regular therapist, not one that specializes in eating disorders, just someone I can talk to. Now that outwardly my eating disorder seems under control and I am not super depressed all the time, everyone thinks they don’t have to worry anymore, that I am fine. I almost feel more alone. That is not something I expected to come out of this. I don’t know why I am feeling that.” Sara shrugs and looks down for a second before looking back up to add, “Talking about all this makes people uncomfortable. Well, not my mom. But Ruby never liked to hear about this. I think it makes her sad. So yeah, a therapist would help.”

* * *

The day after Sara’s final Ketamine treatment, I meet with Cori. She looks defeated. She runs her fingers through her cropped blonde hair and slides her chucky black rimmed glasses up the bridge of her nose before letting out a lengthy sigh. “I am discouraged.” she says, “Sara is still depressed, and I worry about her like crazy. I don’t know what else to say. It’s fucking hard. It’s emotionally draining. I mean, we are 100% better than we were six months ago, but it’s still challenging, and I am still heartbroken by it.”

Cori starts to cry. She tries to compose herself before adding solemnly, “You don’t want to think there is this miracle out there, but I was really hoping ketamine would be it. Sara was on a good journey of recovery prior to the treatment. I thought this would catapult that even more. Depression is tough. Her depression worries me more than the eating disorder. My biggest fear isn’t that her weight will get so low that she will keel over and die. My worry is that she tumbles down into her depression, and it will kill her, either intentionally or unintentionally.”

Now what? “I want to keep Sara in therapy with [the doctor from the clinical trial] but she charges $500 a session. I can’t afford that four times a month. I am a single mom. Hopefully the doctor will continue doing group sessions with Sara, because that is a lot cheaper. I need to figure it out, because it is so expensive and stupid insurance does not cover it.” (Insurance did not cover Sara’s ketamine treatments either, which were $200 per group session and $500 for solo sessions.)

“My biggest disappointment is that the world is finally talking about mental health, and most of it still isn’t covered by insurance! That is bullshit. Mental health treatment should not be just for the rich. It should be for everybody, and it does not feel like it is.”

Is Cori glad that Sara did the ketamine regime? She answers thoughtfully, “The conclusion is that people with eating disorders go into remission. They don’t get healed. It’s endless. Sara has learned a lot, and has a better hold on what she needs. She is happier. She does not binge and purge every day. I knew from the get-go that this would be a rollercoaster. It’s a journey, and we are still on it. That is pretty much it.”