Dance of the four bodies: An enactive-individuative approach to ketamine assisted psychotherapy

In this paper, which is in part intended as a speculative provocation and which combines philosophy of science, clinical practice and psychedelic therapy in a novel manner, we examine ketamine-assisted psychotherapy (KAP) through the lens of an expanded model of enactive cognition. While much work within both KAP and psychedelic-assisted therapy (PAT) in general has relied upon broadly computationalist models of the brain, including most recently the predictive coding and Bayesian style approaches that inform contemporary theories like REBUS and CANALs, we argue that such models poorly typify transformative psychedelic experiences and that enactivism offers a potentially more useful and biologically compelling framework. To this end, we examine and apply contemporary enactivism’s theorisation of living systems as comprised of multiple adaptive bodies, specifically, in the case of human beings, what are described as our organic, sensorimotor and linguistic bodies. Via the philosopher of science Gilbert Simondon, we expand this enactivist model to include a fourth body: the individuative or pre-individual body, which, as we show, has been gestured towards within recent enactive literature as the adjacent possible and is similar to work in complex systems theory, including Stuart Kauffman’s theorisation of res potentia and Alicia Juarrero’s work on emergent constraint regimes. We explore the effects of ketamine through these four bodies. We discuss how different dosage thresholds and experiential dynamics may entail distinct arrangements of these bodies. We further examine how such arrangements are informed by what is commonly described in the psychedelic literature as set and setting. Finally, we offer a provisional complication of this notion by applying enactivism’s core idea of self-making as ongoing autopoietic–adaptive responsiveness to the precarious environments with which selves are entangled.