It’s Not a Thinking Problem: Scenic City on New Mental Health Treatments
Tennesseeans have always seemed to speak a different language from their stateside neighbors. Shopping carts are called buggies. The chicken’s not spicy, it’s hot. Chattanooga, the go-to spot for both locals and tourists, is no exception to this naming convention. It’s known as, depending on who you might ask, anything from Gig City and River City to even more informal names like Chattown. The nickname that stood out the most to me as I made the hour-and-a-half drive from the KetaView corporate office to Chattanooga was of course, Scenic City.
Treatment-resistant mood conditions play no favorites. They don’t care if you’re surrounded by beautiful vistas or tourist destinations. For thousands of Chattanooga residents, just Making it through the day can be a Herculean task thanks to the symptoms they endure. They’re only a fraction of the hundreds of millions of people across the globe who feel this way, but they are all equally deserving of effective treatment options for their disorders.
This was the reason for my trek into Chattanooga. Not to visit the Chattanooga Choo-Choo Hotel or visit their world-famous aquarium, but to gain insight into a treatment center that’s offering a new kind of hope for those who have gone so long without any.
“My first thoughts as I pulled into the parking lot of Scenic City Neurotherapy’s office were that of pleasant surprise. While their office initially seemed unassuming, the interior of their facility could not have been more relaxing. The lights and decor made me want to take a nap – not a stress nap or an exhaustion nap, but one of those rare naps where you wake up actually feeling better than you did before. I sat down with the clinic’s founder, Charles Miller, to talk about his operation and his commitment to the use of ketamine therapy for the treatment of mood and pain disorders. Miller is somehow both calculated and compassionate, a much-needed juxtaposition of a disposition when it comes to healthcare providers. Miller is a certified nurse anesthetist (CRNA), with credentials from the Middle Tennessee School of Anesthesia. He spent time at local hospitals in Chattanooga and “exploring non-opioid, non-narcotic treatments for improving pain management.” His shift to using ketamine infusions for pain management was a gradual one, he says.
““In my research, I learned more about how this works for mood disorders, [and] I knew that one of my other classmates that I graduated with in 2016 opened up the Memphis Ketamine Clinic. So I wandered out there and spent some time with her because I needed to see for myself that the results are real, that this is really what it claims to be because I’m the ultimate skeptic.” Seeing the results of ketamine infusion firsthand was a bit of a gamechanger for Miller.
“When I saw the benefit…[we’re] in a market that is so rife with a lack of results. We’re seeing your typical patient – 35% of people – respond well with your typical antidepressant therapy, but that leaves the other 65% either only partially responding or classified as ‘treatment-resistant.”
Scenic City Neurotherapy opened its doors in June of 2019, and Miller and the staff soon set their sights on overcoming the challenges sometimes posed by this treatment option.
“Pain patients get their own mood treatment kind of built into [their pain treatment], so we’re going in this to help them transition off their opioid-based pain therapies to a non-opioid, non-narcotic option. But then they’re also going through getting the actual emotional trauma to surface and to be addressed, and so it ends up turning into a mood/chronic pain treatment.
And the process is something that at the beginning of the connection hadn’t initially been made. So we’ve learned how to adapt as we see problems come up. We see patients who are struggling with treatment and we’ve found better ways to make people comfortable. We’ve enhanced the actual experience to help people relax and get to that fade-away level, the brain level that we need to reach to get optimal protein release. We’ve also added in the headphones playing relaxing music and specialized monitoring that’s not a cuff that squeezes you constantly. But we’re still able to get plenty of data to make sure that the patient is tolerating it well and their blood pressure isn’t going through the roof because we added the Caretaker monitoring to all our patients.”
The Caretaker monitoring system has been an invaluable part of their commitment to patient care and comfort.
“With the Caretakers, once we calibrate them it just holds a small amount of pressure on the finger to measure the pulse pressure changes in the finger. So it’s this continuous little pressure instead of frequent clicking and squeezing every five minutes. [This way] it doesn’t disturb the patient. We’ve learned the optimal lighting is [turning] off the overhead lights, [turning on] lamps that have special bulbs [specifically designed to] keep the lumens at a certain dimness. It’s also important that the orientation of the room [is] very symmetrical.
We’ve specially insulated the rooms to minimize noise and we make sure all our employees are silent in the hallways. So the environment is as optimized as we can make it to enhance the patient’s outcome.”
How essential is the infusion environment to the success of these treatments? “So I tell everyone the same thing, there’s nothing you can do to ruin the actual treatment. The only thing you can ruin is your experience in the chair. The protein release is going to happen, but in the chair, you can make your experience much more comfortable or you can make it uncomfortable depending on how much stimulation you let into your experience. If you sit there and browse on your phone the whole time, the experience is lessened. But if you are able to lay back and relax and take that forty minutes to kind of go into a meditative state and sink deep into yourself, that is the most comfortable way for people to go through. Understanding all of that, patients do better, they are tolerating the treatments better, and it has dramatically improved our outcomes on the backend.”
Miller reminds me that ketamine infusion is only one part of a comprehensive treatment plan (including group therapy and and more) should be respected as such.
“This is not a magical fix. And as special as it feels, it takes work. And having that support on the backend makes it very attainable for everyone who does it. Everyone who takes that first step to do the work, the rest of us are here to kind of push them along and help them get there.”
The team at Scenic City Neurotherapy makes it a top priority to provide education about the truth of this treatment. “I had somebody on Facebook reach out to me and say, ‘is this Special K?’ My response was, ‘Well, it is special.’ And then I go into how ketamine was approved by the FDA and started to be used in hospitals across the country since the 1970s. It’s one of our primary anesthetics for children, it has the highest ratio safety among all our anesthetics because it’s the only anesthetic that supports the vital functions as opposed to all the others that depress them.”
Ketamine is not without its fair share of undeserved stigma, but prominent voices in the industry continue to speak out about its efficacy, Miller points out to me.
“It’s the biggest breakthrough we’d had in over fifty years. And that’s not my words, that’s the director of the National Institute of Mental Health. Don’t just listen to me. That’s what I tell everyone. It’s not my words, it’s somebody that knows way more than me about mental health.”
Even though the clinic has only been open since 2019, Miller and his entire team already have an impressive collection of success stories and many proud memories. Scenic City Neurotherapy operates from a “patient-oriented” model of delivering treatment.
“So that’s our goal, to perpetuate this being done properly and ethically, and to educate everyone on what this really is and understand how their brains work. There’s this stigma, and the stigma around mental health has to go.”.
But then there’s gonna be this follow-up, and then you have to unlearn the habits that you’ve learned, you have to be objective about what you can add to your day-to-day or take away from your day-to-day to make sure you’re getting optimal mental health support for yourself, but still be functional.”
Miller then shares with me that the profound transformations he’s seen have impacted him personally as well in his own life.
“I thought it was just some thinking problem, or even an emotional frailty that some people have compared to others, and it’s not that simple at all. It’s actually a tangible, physiological, measurable lesion on the brain. That’s what we’re correcting, these lesions that developed with periods of high stress. It’s just like a broken bone, and so we facilitate an environment of healing. So we reset the bone. And then the brain takes care of itself to a large extent.
It’s not a thinking problem. It’s not something that they can actually do. The will of some of these people is incredible. The amount of effort they’re putting in just to get through their day is triple what I put in just to get through [mine], and I realize that there’s an actual barrier that they can’t get past. [So] what we do is we try to help them remove the barrier. Then once the barrier’s gone, it’s like they’re hesitant to cross it, but that’s where that follow-up support helps them succeed.
[There have] been several research studies that have been published specifically where ketamine infusion therapy is a fantastic treatment for alcohol addictions. People reach out for an escape, and by addressing it for what it really is… as opposed to a psychological weakness or an inability to cope, people lean too heavily into that.”
The success we have with pain is one of the things that makes our clinic unique. [Very] few places are having success with pain like we’re having. A psychiatric-run clinic, they don’t know about all the other adjuncts that go along with a pain infusion. They think, ‘Well, I’ll just give them ketamine for six hours.’
There’s so much more to it, and you can optimize that treatment by […] adding in other adjuncts like a gram or two of magnesium or toroidals or steroidals or whatever. That’s where an anesthesia background can help. Pain is my specialty. So coming at it from that, I’m able to kind of tailor things, and I’ve learned a lot. I’ve learned a lot about the neuropathic pain disorders that I didn’t know before. It’s an ever-evolving field, but fortunately, we’re kind of connected with the right groups to keep this up to par.”
Miller and his team keep themselves busy with treating patients, and it was soon time to end our conversation so they could return to the important work they’re doing. Miller reiterated the clinic’s commitment to treatment and education and shared with me his hope for the future.