Throughout the history of medicine we find that many cures have been effective despite the irrational concepts of disease that members of a society might hold. To the Western observer it might appear in fact that ayahuasca use is totally irrational in terms of the magical world view in which such healing occurs. After all, how can "spirits" of inanimate nature or the malice of people possibly make one ill, when microbes, viruses, organic malfunctions, and the like are the true offenders? Yet, to the Amazonian man or woman whose beliefs are thus oriented, ayahuasca can only be viewed as a valuable adjunct in reaffirming one's own suspicions about illness and its etiology. Once the premises concerning the philosophy of causation are accepted, the system of healing itself has an inner rationale that is quite in accordance with a richly developed historical tradition.

Healing Techniques

The use of ayahuasca to heal does not include a well-defined sense of the hallucinogen as a curative agent, per se. Rather, the vine is seen to operate as a powerful means to a desired end--it gives the healer entry into the culturally important area of disease causality, enabling him to identify the nature of the illness from which a person is suffering, and then to deflect or neutralize the evil magic which is deemed responsible for illness. When we examine the successes attributed to the healer, we fine that in general terms a selection process is at work in which healers accept patients whom they feel they will have a good chance of reaching. Simple illnesses are rarely treated with the drug, but herbs, plants, and store-bought medicines are prescribed by the healer for these types of affliction. Nor are psychotic patients given ayahuasca.

Needless to say, drug healers do not accept all patients who come to them for help, nor are they able to cure everyone with an infusion of ayahuasca. But many of the patients who do find their way to the jungle sessions are precisely those whose anxieties, fears, projections of hostility and hatred toward others would in Western medicine be grist for psychiatric help. Drug healing in the Peruvian jungle in many ways represents a very old and honored tradition of dealing with psychological problems that predates Freudian analysis by centuries.

In addition to the use of the powerful vine, a healer will practice time-honored curing traditions, including whistling, singing, praying, and reciting orations, called icaros, which are believed to be preventative, to assure a patient that no evil will befall him from a friend's betrayal or a spouse's scorn. Acting as counters to evil magic, icaros may be used for diverse ends. A healer may also suck at afflicted regions of the body to extract thistles that have been magically placed there to cause illness, or else blow mapacho cigarette smoke over the body of the patient.

Ayahuasqueros often make an immediate diagnosis by taking a patient's pulse without the use of a clock or watch. They say that such activity tells them what type of illness the sick man or woman is suffering from and may be one way to determine the presence of deep anxiety stemming from belief in witchcraft. Healers often prescribe a drink of cane alcohol mixed with camphor, which acts to "pep-up" or stimulate and is often prescribed in daily dosages. It is a cerebral excitant (Lewin, 1964: 145) and can produce some mild euphoria. In addition, ayahuasqueros use varied techniques such as reassurance, important in many cases, to offer at least temporary help. On the negative side of the ledger, depending on the degree of anxiety, this kind of reassurance must be constantly repeated to be effective (Weiss and English, 1956: 12). Suggestion and persuasion are also of great importance in order to convince a patient that the healer's advice is good and that benefits will accrue to him, should he follow his advice (Ibid.: 154).

To return to an earlier point, ayahuasca is not the only hallucinogenic substance used in healing. Other plants such as a leaf called chacruna (B. rusbyana. believed to contain N-N-dimethyltryptamine) may be added to the preparation to increase the effects. Others may use a substance called toe' (Datura suavoleons), which by itself is strong enough to alter states of consciousness. Not very much is known at present about the effects of mixing together various hallucinogenic substances, but different healers in the rain forest prefer those mixtures they know best from their apprenticeship days. At times a tobacco that has hallucinogenic effects and feelings of mareacion (dizziness) and probably containing Nicotiana tabacum may be used by a healer for particular cases. This latter substance grown in the rain forest is several times stronger in effect than similar species grown in North America (see Janiger and Dobkin de Rios, Md.).

Ayahuasca and the Non-Verbal

Very much a part of healing techniques is the use to which special songs or whistling incantations are put. Although some recent psychological studies of drug therapy have focused upon the importance of the non-verbal (see in particular Eisner, 1966), many drug-adjuncted therapeutic sessions in Western society are closely directed situations in which talking plays a most important role. Yet, as Eisner argues, during the most crucial moments of life words often interfere with the main flow of communication. In fact, much of the therapeutic interaction can and does take place at the non-verbal level (Ibid.: 542). While verbal performance in Western society may be highly valued and rewarded, Peruvian rain forest residents are much less geared to verbal excesses. During many of the ayahuasca sessions, for example, patients are left to themselves to experience the effects of the drug with little if any verbal prodding on the part of the healer. Caldwell (1968) points at the similarity in some European clinics today where hallucinogens are incorporated into psychotherapy. When music is part of the drug experience, it is probable that the experience, per se, is a more integrative one. Music may actually potentiate the drug experience, removing it from the realm of the intellectual and into the area of pure feelings. Music, of course, can also help to manipulate mood. Both modern and traditional healers who use such auditory aids in many ways enrich the experience by presenting stimuli that can enter all channels of a person's perception. The use of perfumed water (agua florida), which is drunk by the patient during the ayahuasca session, is no doubt another way in which nonverbal olfactory aspects are capitalized upon.

Comments

Ayahuasca music is utilized only in drug ceremonies, and contrasts musicologically to the considerable corpus of music which falls within a secular category. This latter group comprises music played on happy occasions, such as religious festivals within the Roman Catholic Church, and melodies played during wakes. On the latter occasions, friends and relatives accompany the body of the deceased throughout an evening to dawn vigil. Such melodies are generally played with a drum (tambor), quena (wooden reedless flute found in the Andean highlands), and a four-string violin, probably of Spanish origin. It is tempting to suggest a comparison between ayahuasca whistling incantations and such music as the Gregorian chants, at least insofar as basic function goes. Just as one can argue that Gregorian chants and ecclesiastical modes represent tonal relationships in which scales are structured so as to evoke a spiritual experience within the context of Christianity, so too might the ayahuasca music be viewed as an essential component of a non-ordinary reality sustained by the sensory overload inherent in drug-induced alteration in consciousness. Such music, of course, cannot be divorced from its social context. We should reflect, for a moment, on the nature of hallucinogenic experience, per se, and the quality of reality alteration for the individual. Such phenomena as the slowing down or changing of time perception (see Ludwig, 1969: 14) must be related to how music is perceived by the individual under the effects of the powerful alkaloids present in the ayahuasca potion. The number of metronomic markings in a given piece of music may not, indeed, be perceived as they would be in an ordinary state. In fact, during my own experience under ayahuasca, some interesting aspects of the relationship of the music and the content of my visions could be determined. Fast-moving visions and detailed panorama of primary colors and variegated forms, difficult to focus on, could be correlated with my perception of the speed of the healer's music. When don Antonio slowed down his pace and a full-sized portrait of a woman appeared before me, I could, on later reflection, relate the vision's appearance to the slowing down of the healer's whistling incantations. Visions do change frequently from fast to slow, and seem to be controlled or evoked by the healer who is the creative force in deciding which melodies to call upon. When I was further into the drug experience and became nauseous and vomited, don Antonio reassured me that his continuing melodies would alleviate the nausea and cause it to pass away.

During ayahuasca sessions, both healer and patient take the drug together. Nonetheless, the healer is generally quite occupied in the performance of his ritual activities mentioned earlier and leaves his patients generally seated by themselves for major portions of the ceremony, only occasionally counseling or treating them directly. Healers state that certain melodies evoke certain types of visions. As I illustrated above, slower incantations may be responsible for the often-reported visions of men and women who are later identified as evil-doers. Perhaps, and one can only speculate here, faster incantations are crucial in the changeover from one reality to another. Such sensory overload has been frequently reported to produce anxiety in the individual, especially in initial drug-induced states. In Western society, LSD-like substances have been utilized in psychotherapy, often by Freudian-oriented analysts. Vomiting and nausea, which may occur in such cases, have occasionally been related to the inability of individuals to deal with anxiety generated by rapid access to unconscious realms. It may be that the role of such music as the whistling incantations during such anxiety states is to help carry the individual more easily into this second realm.

One additional facet of drug-induced experience that should be mentioned is the role that the guide or guru plays as an important other, toward whom the patient may turn in an anxious or highly suggestible state as the result of his alteration in consciousness. Masters and Houston (1966) discuss the vital place of the guru in guiding such sessions. It is possible that augmented suggestibility on the part of the patient encounters in the presence of the healer a creative source and origin of music which alleviates anxiety, tranquilizes, and causes a turning inward, by the musical evocation of particular visions.(1) I might further speculate that fearful visions in an ayahuasca session could generally be attributed to the inadequate musical ability on the part of a particular healer.

Placebo Effects of the Ayahuasca Potion

When people who believe they have been bewitched visit a healer, they are frequently given a potion of ayahuasca to help them see who it is that has caused their illness. As with other hallucinogenic drugs, a non-ordinary state of reality fills the hours of drug experience and is one that is unlike any other than most men or women have ever had.

The possibility suggests itself that the plant operates merely as a placebo an inactive or inert drug given merely to produce a "satisfying" effect upon the patient. Is it possible that faith in the curative power of the drug itself is enough to cure? I think we have to dismiss this possibility, which may enter into a discussion of LSD therapy in the United States and Canada. There, insights into personal problems have often been examined by an analyst who guides the session.(2) Ayahuasca is not used to obtain verbal insight, and external rather than internal forces are viewed as responsible for disease. Man is, in effect, absolved from any responsibility. Especially in cases of saladera and situations involving interpersonal stress, the impact of such external forces is most clearly seen. Moreover, little of the biochemical effects of ayahuasca's healing properties are known. From my own personal experience, I would guess that strong hallucinogens like ayahuasca manage to relieve feelings of anxiety and tension which can build up to intolerable levels. Yet, although one would hesitate to call the purge a healing hallucinogen, it is possible that future evidence may point up more clearly the curative potential of the drug from a pharmacological point of view.

Nonetheless, both healer and patient are crucially concerned with identifying the nature of the illness, which in psychosomatic disorders may be very generalized pains and aches throughout the body. When people known to the patient or even total strangers appear in his visions, a skilled healer will attribute his patient's illness to such apparitions. Generalized, free-floating anxiety which immobilizes can then be changed into straightforward fear and placed squarely on the shoulders of the acknowledged evil person or spirit. A healer is especially successful in those cases when his patient believes him to be imnipotent and if an aura of personal success surrounds him. Thus, the healer may be able to relieve his patient's symptoms quickly and dramatically, when the patient believes the healer is powerful enough to counteract the evil magic directed against himself.

People rarely focus upon ayahuasca by itself as a curative agent. The hallucinogen is a means toward an end--a way in which healing can begin. Special diets, rituals, orations, particular spells, and counter magic are the ways in which healing takes place. Reassurance, suggestion, counseling as well as other techniques to be discussed shortly are all part of the cure, but the drug's role throughout is strongly diagnostic and revelatory.

The Omnipotence of the Healer

Attempts are made by the healer to radiate total control and mastery over the unknown, especially in the realm of illness. Although he may turn to magical means in his healing procedures, nonetheless he employs very definite pragmatic means such as modern medicines, herb baths, and teas as well as a host of plants whose effects he has studied. The role of ayahuasca is connected to the aura of omnipotence surrounding the healer. Certainly the purge is a powerful persuader in its own right. Yet, given the belief system existing in the jungle, what seems to be most important to his patients is the healer's ability to deflect evil magic and neutralize its effect, or diagnose the sickness by means of the drug. Ayahuasca gives him entry into a world of magic by which he can effect his cures all that much more effectively. Even techniques such as his subtle reassurance, boasting in a generally non-boasting society, an all-knowing manner, subtle use of cues to let present and perspective patients know of his successes, his show of wealth, and his skills all enter into the picture.

Two examples that illustrate healers' techniques come to mind here. In one case connected with dona Teresa mentioned earlier, after she had taken ayahuasca and her hemorrhage stopped, she was able to move about and take on some of her daily household chores. The next time her healer stopped by to see how she was doing, he stayed only a short while, as he had to visit another patient who was really ill (the healer's emphasis), and not nearly as well and thriving and about to recover as Teresa was. She repeated this conversation to several of her neighbors and family during the next few days and in fact did feel much better, no doubt in part because of this reassurance and support that the healer provided her.

In another case, I was present at a preliminary interview in which a healer chatted with two girls who had love problems and were looking for his help to try to capture their boyfriends' souls once and for all. Don Fernando, the healer, sat comfortably on a bench and talked about his many successes in healing. He boasted that in his home, an expensive fishing net costing well over $100 was sitting idle and rotting. Although he could make a good living at fishing, he was forced to give it up by the press of patients, he said, who came to him to be healed. Both girls were visibly impressed by his stated affluence and by his confident, assured manner, which indicated to them that he would and most definitely could help them in their love problems. The myth of the omnipotence of some healers has become so strong that tales of ayahuasca millionaires have grown up and become repeated with some frequency. Both Iquitos and Pucallpa are known for at least one such ayahuasca millionaire men who achieved fame in healing and who overnight built fine brick houses for themselves and their families. One famous healer in Pucallpa was imprisoned by the local police, finally to be released when a political demonstration followed in the wake of this incident. A spiritualist healer in Iquitos recounted the story of another colleague who had recently died. He had made his fortune in ayahuasca. Multiple property holdings and an affluent family attested to this healer's success with the purge.

Peruvian medical writers, much closer in time and space to folk healing than their American counterparts, are quite aware of its influence on large segments of their society and at times become threatened by the apparent successes and popularity of drug healers. Many such writers, in fact, have labeled both drug-adjuncted and popular folk healing charlatanism. One writer makes a fine distinction between highland healers who work within the confines of their Indian peasant community and the so-called charlatans of other regions. Tricking patients while under the effects of drug used in healing has been another accusation that has been leveled. These aspects of folk healing are difficult to dismiss lightly. Collective belief in the efficacy of the drug, the suggestibility engendered by such drug use and the skill of the healer who effects cures to patients often suffering from psychosomatic or psychoneurotic illness must be taken into account. Whether these cures are temporary remissions are not important here. The first-rate empirical knowledge of many healers concerning the rich pharmacopoeia available to them is undeniable.

The ability of the healer, whose skills are well-touted, his firm and confident manner in dealing with his patients, his boasts of the healing he has and will achieve--in short, the potency of the suggestive phenomena at work cannot be ignored. Certainly artifice is employed in the curer's art. One writer has maintained that "cultural symbols and values are the medium through which the individual patient approaches what is offered to him in a psychotherapy situation and that his response to the strategies of the therapist will be circumscribed by the meaning they have for him in terms of his general life view." Healers do work within a belief system held by their patients and are able to manipulate the symbols shared by their patients in order to heal them that much more effectively.

For example, before allowing their patients to take the purge, many healers will undergo periods of up to a week of exorcising the evil believed to afflict such patients. This becomes a very necessary part of therapy because many people in this community operate in a confused social reality where magical beliefs function close to and at times in competition with scientific ones. The healer, in order to alleviate anxiety generated by emotionally precipitated illness, must retain his omnipotent stance. Should a patient be a doubting Thomas, something which is not at all unusual initially, the chances of the treatment being effective will be lessened. Using a series of exorcistic rituals which often include prescribing the tobacco mentioned earlier (which gives no visions but induces a feeling of non-ordinary reality), the healer can elaborate his treatment before the actual drug experience is undertaken. Prospective patients may then attend a few sessions in which others take ayahuasca in order to acquire an awareness or expectation of what people say happen to them under the drug.

To repeat an earlier point, the reappearance of certain elements in the drug experience by innumerable patients points to the important role that cultural expectations play. It is possible that the focus of the healer on a boa or another snake as the mother spirit of the vine which is beginning to heal or to anticipate healing by her appearance verifies and consolidates the magical learning that has taken place prior to the ayahuasca ingestion. Peoples' expectations that they will, in fact, be visited by such a boa or snake, as well as their belief in the curative prediction of success anticipated by that snake's appearance provides them with reassurance that healing is indeed occurring. In many ways, the omnipotence of the healer is increased by his symbolic presentations--his insistence upon the magical world of spirits or allies which he controls and that he can conjure up through his particular songs and incantations to appear before his patient. At sessions one often hears a healer advising his patient who is experiencing visions that the next song will cause a certain event to happen, or that a difficult moment will pass, with pleasant visions to follow. The healer in many ways is conditioning the patients. Given a widely-shared belief system among members of the community and those versed in esoteric healing lore, these remarks of the healer must be seen in terms of their full impact upon the patient. Called upon as a creative source to interpret the symbols that may visually appear to a patient under his care, the healer sees in his patient's productions his own set of symbols, which he attributes to the magical causality of misfortune or disease.

This kind of occurrence, which Ehrenwald (1966), a medical historian, has called "doctrinal compliance," is important to consider in this context. In an interesting book tracing the continuity between present day scientific therapy and primitive healing, he coins this term to explain the fact that in Western therapy, despite the particular school of allegiance to which a psychiatrist may subscribe, his patient ends up doing what his doctor wants him to. If, for example, a healer is a Freudian, his patients' dreams tend to recreate early memories of childhood or family conflict. The patient in many ways complies with the therapist's unconscious wishes and expectations in order to validate his analyst's theories. Unlike the phenomenon of suggestion, which on the part of the therapist, at any rate, operates on a conscious level, doctrinal compliance seems to be an unconscious process, occurring in both magical and modern therapy procedures. This would seem to be the case in Peruvian healing with hallucinogens, since patients tend to see certain kinds of visions while under the effects of ayahuasca, after working with healers who share a common tradition of magical etiology.

Finally, Ludwig's comments on suggestibility are applicable here (1969: 17). He maintains that sensory overload, inherent in an hallucinogenic experience, can cause a person to attend most specifically to a guide's advice and counsel for reassurance in moments when he is in an altered state of consciousness.

The Healer as Moral Arbiter of the Society

If we look at the kinds of health and social problems that the ayahuasquero treats, it is evident that much of his role is that of moral arbiter of society. This is especially so in light of the philosophy of causation which attributes illness and bad fortune to witchcraft. Not only is the healer's job to restore people to health, but he must take upon himself the omnipotent power and responsibility to punish evil doings. These healers who have made their moral commitment to paths of socially valued behavior often state they are deeply religious and will not perpetrate evil upon others. This contrasts, nonetheless, to their quickness to accept patients who believe they have been wronged. In the name of their patients, such men will not hesitate to punish others for their evil through the application of counter-magic. Although witches maintain that ayahuasca can give a man unlimited sexual access to women, nonetheless another important function of ayahuasqueros is to use their powers when under the drug to bring recalcitrant spouses who have strayed back to their homes once again.

As Herskovitz pointed out long ago (1946), Western dualistic categories of good and evil often do not properly convey non-literate and folk beliefs concerning magic. For example, although most ayahuasqueros are called upon to heal patients who believe they have been bewitched, there is an element of true moral arbitration on the part of a healer who often uses counter magic to return evil to its perpetrator in order to relieve symptoms of illness. Easy categorization of good and evil does not adequately deal with the subtleties of ayahuasca use among Peruvian Mestizo populations in the rain forest region.

Ayahuasca Healing and Psychotherapy

Perhaps the term psychotherapy is inadequate to describe and categorize the type of drug healing which is the subject of this book. This term is generally used in psychology to delineate a relationship between doctor and patient in which words play a very prominent part in the healing process. Although a certain amount of verbal exchange between healer and patient in the form of counseling, advising, suggesting, and exhorting does occur in Iquitos, many of the drug sessions described earlier are extremely subjective activities. The man or woman who takes the potion is left much to himself during the major part of the experience. As pointed out earlier, drug-adjuncted therapy in Western medicine employs much more directed verbal therapy.

Psychotherapy is seen by some as a learning process where new attitudes, feelings and behavior enter into a person's readaptation after he comes to a realization that his present way of life is distressing, ineffective, or damaging. Maladaptation marks the habits of a lifetime and must be changed in order for healing to occur. In considering the role that relearning plays in ayahuasca healing, we see that such therapy is of a short-term nature compared to the much longer periods of counseling involved in Western-type psychotherapy. Jungle patients may remain in treatment for only a week or two, with the longest periods of healing rarely running more than a few months in duration. The desire for the relief of symptoms seems to be the most pressing motivation for people to enter such sessions, accounting for the relatively short period of treatment time when compared to Euro-American psychological healing.

Another factor should be taken into consideration. During my fieldwork in Belen, I constantly listened to complaints of physical illness, anxiety, lack of appetite, and the like, complaints comparable to those reported by other investigators working among urban poor throughout Peru. High rates of psychosomatic complaints characterize the life of the destitute poor throughout much of South America and some research even sees such stress as necessary for effective modernization (see Kellert et at, 1967). When such daily stress and anxiety reaches intolerable levels, a person may look for help from a healer. Yet, we should keep in mind that the constant companion of many such people may be organic pain, discomfort, free-floating anxiety, general debility, and lack of energy coming from the many parasitical disorders with which they live. When such men and women finally find themselves in an ayahuasca session, they tend to look for relief of immediate problems. In speaking to both healers and patients, one rarely if ever hears these problems acknowledged to be personal maladjustment. Explaining illness as individual responsibility for misfortune or citing chance as a major factor does not occur. Rather, illness or misfortune is attributed to the evil of others--either malicious men and women who have brought magical harm, or else capricious, uncontrollable natural spirits that have punished a person who has violated a taboo.

Another important component of psychotherapy in Western medicine is the nature of the transference experience between a patient and his therapist, generally emerging after a reasonably long period of treatment. During this period, an emotional relationship to the therapist may be established, childhood memories may be recalled, abreaction of emotion may take place, and a new orientation for future living take place. As Freud wrote long ago, transference is usually described as the patient's tendency to see in his analyst the reincarnation of some important figure out of his childhood past, with the patient transferring to him feelings and reactions that undoubtedly applied to his model. In this way, the analyst may become the target of the patient's love or resentment which may have originally been directed to a parent. In short-term ayahuasca healing, the mechanism of transference that is so important to theoretical conceptions of Western psychoanalysis is practically non-existent. It is quite true that healers tend to be older men or women who may have a relatively high status accorded them because of age, and who may serve as a parent-substitute. However, the short amount of time in which the patient is in treatment and the nature of the healing itself differ immensely from Western techniques we have been discussing.

As Kiev has pointed out (1968: 176), "the kind of illness that an individual has and how it may be treated is a function of his culture." The culture-specific methods used to reduce anxiety that characterize universally valid strategies throughout the world are no doubt enhanced by the properties of the hallucinogen itself. Reactions to both good and bad experiences--namely a feeling of relaxation, well-being, and ease with others can only reflect to the healer's benefit.

Ayahuasca is indeed a powerful hallucinogen that is used effectively in Peruvian rain forest healing. It has not been the purpose of this book to present statistics showing how many patients have been "cured" by this hallucinogen in emotional or psychological illness. Rather, it is hoped that the setting and background in which such healing takes place throws some light on the therapeutic potential of many different plant substances. In particular, the role of cultural variables such as beliefs, attitudes, and expectations in determining subjective experiences are important to stress. In some superficial ways, ayahuasca healing is comparable to Western techniques of psychotherapy, but such a comparison is doomed to an uncomfortable fit of theory with recalcitrant fact. The use of directed verbal interchange between therapist and patient in Euro-American society contrasts markedly with mechanisms of healing utilized in a society held together by a magical order of things.

Conclusions

We have looked at the plant hallucinogen, ayahuasca, as an example of man's traditional use of such substances in the treatment of disease. As I pointed out at the beginning of this book, although it is convenient to separate out categories of drug use in which disease is viewed apart from supernatural concerns, it is important to reiterate here that ayahuasca healing in the Peruvian Amazon has very definite supernatural components of etiology, diag- nosis, and cure as well as being viewed by healers and patients alike in terms of a philosophy of causation. The visions induced by the plant are interpreted by the ayahuasca healer to be the personal or spiritual force responsible for illness, a major concern prior to the effecting of any cure.

Although it is tempting to conclude that ayahuasca is functionally related to the social stresses and economic problems that beset members of the slum community and the jungle region today, one might hesitate to state that interpersonal strife is less now than it may have been or is presently among primitive populations in scattered rain forest villages. Perhaps a more convincing argument is that throughout time this powerful hallucinogen has been used in similar ways. Anxiety and stress, both today and in the past, can reach intolerable levels, so that a drug healer receives a call to ameliorate acute symptoms. In such situations of distress, ayahuasca has received its most varied elaboration-entering into the realm of tenuous, uneasy interpersonal relations and acting as a restorer of equilibrium in difficult situations.

(Originally OCR'd by GluckSpilz)