4. Therapeutic perspectives on the acute and post-acute effects of ritual experience with ayahuasca: A case study

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1 T Transworld Research Network 37/661 (2), Fort P.O. Trivandrum Kerala, India The Ethnopharmacology of Ayahuasca, 2011: ISBN: Editor: Rafael Guimarães dos Santos 4. Therapeutic perspectives on the acute and post-acute effects of ritual experience with ayahuasca: A case study Adjunct professor and member of the Mental Health Research Group State University of Santa Cruz, Ilhéus, Bahia, Brazil Abstract. Introduction: Psychedelics, which are currently considered to lack medical efficacy and to be, as a rule, dangerous, were once used as therapeutic adjuncts in the so-called psycholytic and psychedelic therapies of the years between 1950 and The expansion of religious use of the psychedelic drink ayahuasca in Brazil and elsewhere has been increasing interest in the investigation of ostensible therapeutic properties which are attributed to this drink by its users. Objectives: To explore the therapeutic potential of first experiences with ayahuasca. Methods: Case study, in which in-depth interview techniques were used to elicit the parameters and meaning of first experiences with ayahuasca in Santo Daime (CEFLURIS branch) and its behavioral consequences in the following week. Correspondence/Reprint request: Dr., Adjunct professor and member of the Mental Health Research Group, State University of Santa Cruz, Ilhéus, Bahia, Brazil pcesarr@yahoo.com.br

2 66 Conclusions: The states of consciousness induced by first experiences with ayahuasca point to therapeutic potential because, according to the subject s selfreport, they stimulated processes of self-knowledge and insight about aspects of the subject s biography. It was noteworthy that, unlike psycholytic and psychedelic therapies, this insight occurred in association with feelings of peace and in the absence of the visionary experiences typical of psychedelics. The tranquilizing properties of ayahuasca, as well as aspects of the ritual and environmental setting, contribute to the elaboration of interpretive hypotheses about the experience. 1. Introduction Ayahuasca is a hallucinogenic drink made from the decoction of the root bark and, sometimes, the outer layer of stems of the vine Banisteriopsis caapi (which contains the harmala alkaloids harmine, harmaline, and tetrahydroharmine), together with the leaves of the Psychotria viridis bush, which contains the alkaloid N,N-dimethytryptamine[1]. The hallucinogenic properties of this combination of alkaloids have been explained as a function of their particular means of affecting the serotonergic system[2]. Ethnographic data have detailed the ritual use of the drink for magicoreligious purposes in the western Amazon basin by Amerindian and mestizo populations[3-5]. Throughout the 20th century, emigrants from northeastern Brazil who went to Amazonia assimilated Amerindian / Amazonian mestizo religious use of ayahuasca to their existing religious beliefs. This cultural process resulted in the advent of several modern urban religions, such as the Centro Eclético Fluente Luz Universal Raimundo Irineu Serra [Raimundo Irineu Serra Eclectic Center of the Universal Flowing Light] (also known as CEFLURIS or Santo Daime), the União do Vegetal (also known as the UDV), and the Barquinha, which are characterized by a combination of Christian, Afro-Brazilian, reincarnationist Spiritism, and the use of ayahuasca as means to spiritual development[6-10]. Over the last three decades, UDV and Santo Daime temples spread beyond the Amazonian region to the large cities in every region of Brazil. This process made the ritual-religious use of ayahuasca accessible to a large number of people whose predominant cultural background did not include the religious use of hallucinogens. Reactions to the use of ayahuasca among mental health professionals have been polarized. On one side are those, supported by the currently dominant perspective of mental health, who express concern about adverse physical and mental effects resulting from the use of the drink[11,12]. On the other side are those who consider the possible therapeutic uses of this

3 Therapeutic perspectives on ayahuasca 67 substance, supported by encouraging results in observational studies of long-term users of ayahuasca[13,14] and by the programs of psycholytic and psychedelic therapies based on the use of hallucinogenic substances. These programs, in vogue at the end of the 1950s and the start of the 1960s, proposed that positive transformations of daily behavior could result from the insights produced by hallucinogens in therapeutic settings[15]. The psycholytic paradigm was dominant in Europe. This approach relied on psychodynamic theories, advocated moderate doses of hallucinogens to help reduce psychological defenses, and emphasized the imagistic effects of the substances as symbolic resources to achieve insight[16]. The psychedelic paradigm, which was predominant in North America, argued that the use of high doses of hallucinogens could induce an intense, powerfully transformative mystico-religious experience, and that this potential should be used in psychotherapy[15,17]. This paper seeks to explore the therapeutic possibilities of ayahuasca through a detailed report of a young woman s first ritual experience with ayahuasca in the CEFLURIS branch of Santo Daime in the city of São Paulo, Brazil. 2. Methods In 2005, we reported a study that evaluated the psychological effects of first-time ayahuasca use in twenty-eight subjects. In that study, information was collected about aspects of the set (prior individual attitudes toward the experience with ayahuasca), the acute effects of the drink experienced during the ritual, and the post-acute effects experienced in the week following the ritual[18]. This work develops little-explored aspects of that project through a detailed description of the case of Tanya (a pseudonym), one of the subjects in that sample. Tanya is 37 years old, single, white, educated, and professionally successful. She was born in the city of São Paulo and currently lives in one of its upper-middle class neighborhoods. Tanya was evaluated two days before her first experience with ayahuasca and seven days after it. Semi-structured interviews were used for data collection. At T0 Tanya s motivations and expectations for the imminent experience with ayahuasca were elicited, as well as her emotional state and her attitudes along various psychosocial dimensions (family, professional and financial, interpersonal, self-esteem, stressor events, and perceptions of her physical wellbeing. At T1, the state of mood and attitudes were again elicited, as well as dimensions of the ritual experience with ayahuasca: affectivity, thought process and content, sense of identity, exteroception, enteroception, volition / control, and

4 68 spatiotemporal sense. The analysis consisted in the identification of themes that link each of the experiential dimensions in the three phases covered by the investigation: prior to the experience with ayahuasca, the acute effects (that is, experiences during the ritual), and the short-term, post-acute effects (that is, during the week following the experience). All novices to Santo Daime must go through a prior interview, conducted by the religion s acolytes, aimed at evaluating the candidate and giving guidance about the procedures to be adopted during the ritual. Tanya s recruitment for the study took place within an agreement with the CEFLURIS church that was to organize the ritual within which she would have her first experience with ayahuasca. The person responsible for the interview was to send the novice for evaluation. As happens with the majority of novices, Tanya tried ayahuasca in a CEFLURIS church, in a wooded area on the outskirts of São Paulo. The ritual began at 9:30 p.m. and ended at 9:30 a.m. the next morning. Tanya ingested four doses of the drink throughout the ritual, which, like the other rituals in this denomination, was marked by constant singing of songs, called hymns, in praise of God, Christian saints, nature, and moral virtues, and was accompanied by the synchronized movement of all the participants (called the bailado, or dance ). 3. Results 3.1. Set: Motives for trying Daime and attitudes prior to the experience I am going to try Daime to see if... It is a search for self-knowledge (...) to understand why I fight with people who have nothing to do with my problems. This was Tanya s response when asked about her motives for trying ayahuasca. Next, she related the situation that currently leads to her fighting with people who have nothing to do with her problems. There had been a recent romantic breakup, which involved a financial debt, incurred during the relationship, that her ex-boyfriend owed her. Her ex-boyfriend s run-around in resolving the debt, and constant arguments about the situation, constituted a source of much irritation and frustration for Tanya, who could not bring the matter to a conclusion. This particular situation was linked with feelings of low self-esteem, as for some time she had been unable to bring about changes in her habits, such as dieting and stopping smoking.

5 Therapeutic perspectives on ayahuasca States of consciousness induced by the ritual use of ayahuasca Transition to the states of consciousness induced by the ritual use of ayahuasca At the beginning I looked around there and I thought, What am I doing here? This here doesn t...this has nothing to do with me. And suddenly, there I was. I was there, dancing with them, singing all the hymns and feeling good about it. So I thought it was strange because, at first, like, I got weirded out, you know? Later I was fine, I calmed down, kept going like I had always been a part of that. This statement reveals that the initial phase of Tanya s ritual experience with ayahuasca was marked by a sense of transition between the ordinary state of consciousness in which she found herself in the everyday and the special consciousness experienced during the ritual. Two aspects stand out in this phase: 1. Perplexity toward the apparent nonsense of going to an environment that seems to have no relation to her way of life; 2. The sudden subsequent change, characterized by a sense of familiarity with the environment and with ritual behaviors Stabilization of the state of consciousness induced by the ritual use of ayahuasca I was feeling very good. I became quite calm during the whole ceremony... during the whole work I felt very tranquil almost the whole time (...) there was no kind of hallucination, things like that. I didn t have any of that. Absolutely nothing. The only thing I had was that I felt very, very tranquil. I didn t think about my life outside at all, about the money my exboyfriend owes me, work, nothing. I thought a lot about my whole life. But not that I felt I was living through it again. I was just thinking. Normal memories (...), all the things I did and all the relationships I ve had (...) from about seventeen years old. I became very calm and I could examine a series of attitudes I had, of things that I had done in my life, what I thought was right, what was wrong. It was like I was having a conversation with myself the whole night. There were no visions, no hearing things. I thought about all the relationships I ve had. That has always been a tough area for me, always very painful. So I

6 70 thought about that, about why it s like that. I found a good feeling to be able to assess all of that. To be able to see that I was wrong about a bunch of things, you know, in all the relationships that I ve had. A kind of patterned behavior (...) And all of a sudden I began to evaluate the things I did and I saw that they were all similar, no, wait a second, I m wrong about some things. I appeared as a very authoritarian and demanding person. Things have to be the way I want, otherwise I m not happy, I start a fight. I always put that into every relationship. I don t think you can be so radical; it can t be that thing like, I know it all. In these passages from Tanya s interview an experience of stabilization in a new state of consciousness is seen to follow the transition phase. The stabilization is marked by three inter-related dimensions: 1) A state of peace lasting throughout the ritual; 2) Cessation of everyday worries, the ex-boyfriend s debt being the most dominant one at the time; 3) Memories of all her previous romantic relationships since adolescence; 4) Insight resulting from the discovery of an authoritarian behavioral pattern in all her relationships, and the recognition of the pattern s error. The interview further emphasizes the negation of exteroceptive experiences visions, voices which she had previously been told were typical effects of ayahuasca Return to the everyday (Throughout the week) I felt well in relation to this because I saw that I am not like this, for example, with my friendships. With my friends, I don t have this authoritarianism, I don t have this...you know, this thing of saying, no, it has to be my way. I have very good friendships, I like my friends a lot. So, since I can t put myself across in romantic relationships like this, which is something that always bothered me (...) I thought about this a lot all week. This week I felt much calmer. I didn t get irritated so easily with things. I had that conversation with the guy [she refers to a conversation with her exboyfriend about his debt to her]. Every time it was a fight, I d get irritated and in a bad mood. It was the same conversation I d had. It was, like, calm, tranquil. I didn t fight. He even thought it was weird. He even said, man, did something happen to you? I said, no. He said, are you alright? I said, I m great.

7 Therapeutic perspectives on ayahuasca 71 Two dimensions stand out in Tanya s narrative about her return to daily life: 1) Assimilation and continuity of insights about her behavior in romantic relationships, comparing them with her behavior with friends; 2) Change in attitude in dealing with the problem of the ex-boyfriend s debt, substituting serenity for ire, anguish, and anxiety. 4. Discussion Tanya s case raises intriguing questions about the use of psychedelics in general, and of ayahuasca in particular, as therapeutic resources. On one side, Tanya s experiences during the ritual and her behavior in the following week corroborate proposals for the use of psychedelics as therapeutic adjuncts based on their capacity to facilitate associative and mnemonic processes[19]. However, these experiences are very far from the psycholytic and psychedelic models, cited in the introduction, which advocate visionary and mystical experiences induced by hallucinogens as catalysts of insight and behavioral change[15,16]. Tanya emphasized the absence of any extraordinary visual phenomena throughout her experience with ayahuasca, and nowhere in her report is there any reference to numinous experiences or mystical ecstasies. Rather, the state of calm established by the experience reconfigured the earlier state of immersion in the conflicted situation. Feelings of anguish and ire were substituted by a state of critical emotional distancing that allowed rational consideration of, and learning about, her behavior in romantic relationships. The presence of insight associated with states of peace and, at the same time, with the absence of phenomena considered typical of psychedelics, raises new interpretive possibilities about the therapeutic potentials of the ritual use of ayahuasca. The central role played by the state of peace in configuring Tanya s experience dovetails with growing evidence that one of the key effects of ayahuasca may be the induction of states tending toward the anxiolytic spectrum, including the arousal of states of serenity[18] and attenuating the effects of panic signals[20]. Throughout the history of research into the functioning of ayahuasca s alkaloids, scholars have found harmine and harmaline to have sedative, CNS-depressing properties[1]. However, these properties have been obscured by the surprising discovery that betacarbolines inhibit the activity of the enzyme monoamine oxidase, turning the potent N,N-dimethyltryptamine (DMT) orally active, and explaining the

8 72 reason for the powerful visionary effects that ayahuasca frequently provokes. Thus, the role of the beta-carbolines in the subjective effects of the drink was relegated to a secondary plane, in which they performed the basic function of MAO inhibition to permit the action of what came to be considered the central psychoactive substance in ayahuasca, DMT. In recent years, however, the function of the beta-carbolines in ayahuasca psychoactivity has been reconsidered. It has been suggested that the role of IMAO of the beta-carbolines in ayahuasca, by increasing the bioavailability of serotonin in the CNS, may oppose and modify the violent visionary and dissociative effects typical of pure DMT use[21], allowing greater insight into the experience[2]. Might it not be useful to ask whether, in Tanya s experience, the activation of associative and mnemonic processes in combination with states of peace may have occurred as a function of the combination of the psychedelic qualities of DMT with the tranquilizing properties of the beta-carbolines? As sedatives, might the latter have a key modulating function in the drink, softening the effects of the DMT[18] and contributing to the emergence of insights? Aspects of the ritual setting and environment also seem to have a decisive influence on the configuration of Tanya s experience. Her initial perplexity before the absurdity of finding herself in an environment with no relationship to her life, followed by a rapid, radical change to a sense of familiarity and adoption of ritual behaviors, and her consequent stabilization in a pattern of calm and reflection on her life are meaningful indications of how changes in environment and behavior may influence the configuration of states of consciousness. In States of Consciousness, Charles Tart[22] offers an explanatory model of the dynamics of changing states of consciousness that considers the question of environmental and behavioral influences. According to this model, the stabilization of a given state depends on a semi-arbitrary adaptation to environmental demands. The expression semi-arbitrary signals the fact that consciousness, if it must on the one hand respond appropriately to certain unavoidable environmental discomforts no one of sound mind questions the consequences of a jump from a 50-meter cliff on the other hand, it is constituted through the specific demands of our socio-cultural milieu, which select, from among the multiplicity of possible experiential configurations in the field of consciousness, those which are adapted to the performance of socially constructed and sanctioned roles. Therefore, according to Tart[22], there is a constant feedback loop between the maintenance of a given configuration of states of consciousness and environmental demands. Thus, Tanya s movement from her habitual environment to a strange one may have contributed to the change in configuration of her state of

9 Therapeutic perspectives on ayahuasca 73 consciousness. Her initial perplexity may reflect disorientation stemming from the mismatch of configuration of her state of consciousness to a completely novel environment. The urban locus of the feedback which maintained quarrelsome attitudes and feelings of anguish and low selfesteem were left behind. In their place, nature and a ritual marked by expressions of praise for moral elevation mitigated those conditions, opening the way for the reconfiguration of a state marked by serenity and self-reflection. 5. Conclusions A notable limitation of this study is the fact that Tanya s evaluation was restricted to a one-week period, which imposed restrictions on the breadth of the biographical points raised and, consequently, on the ability to make inferences about the impact of the ritual experience of ayahuasca on her life. It should be taken into account, however, that as one would expect in using case studies, the objective of this report was the exploration of new phenomena and associations, which, in this study, meant the exploration of new associations involving the possibilities for therapeutic use of ayahuasca. In this way the study revealed that Tanya s experience with ayahuasca represented an unequivocal rupture, at least temporarily, with a prior dysfunctional state, and an unequivocal experience of insight involving awareness of problematic aspects of her own behavior. The novelty consisted in the fact that these experiences occurred in association with a mood state marked by serenity, and in the absence of the visionary, mystical, and symbolic characteristics propounded by the psychedelic and psycholytic therapeutic projects. This fact points toward the systematic exploration of extra-hallucinogenic aspects to the therapeutic possibilities stemming from the ritual use of ayahuasca: the sedative properties of the drink and the environmental and ritual setting. References 1. Ott, J. 1994, Ayahuasca Analogues, Natural Products Co., Kennewick. 2. Callaway, J.C. 1999, In: Ayahuasca: Hallucinogens, Consciousness and the Spirit of Nature, R. Metzner (Ed.), Thunder s Mouth Press, New York, Luz, P. 2002, In: O Uso Ritual da Ayahuasca, B.C. Labate and W.S. Araújo (Eds.), Mercado de Letras, Campinas, Dobkin de Rios, M. 1989, J. Psychoactive Drugs, 21: Reichel-Dolmatoff, G. 1975, The Shaman and the Jaguar: A Study of Narcotic Drugs Among the Indians of Colombia, Temple University Press, Philadelphia.

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