The Ethnopharmacology of Ayahuasca by Research Signpost

The Ethnopharmacology of Ayahuasca Editor

Rafael Guimarães dos Santos Human Experimental Neuropsychopharmacology and Centre d’Investigació de Medicaments (CIM-Sant Pau), Institut d’Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Calle Sant Antoni Maria Claret 167, Pabellón 18, Segunda planta Barcelona, 08025, Spain

Transworld Research Network, T.C. 37/661 (2), Fort P.O., Trivandrum-695 023 Kerala, India

Published by Transworld Research Network 2011; Rights Reserved Transworld Research Network T.C. 37/661(2), Fort P.O., Trivandrum-695 023, Kerala, India Editor Rafael Guimar達es dos Santos Managing Editor S.G. Pandalai Publication Manager A. Gayathri Transworld Research Network and the Editor assume no responsibility for the opinions and statements advanced by contributors ISBN: 978-81-7895-526-1

This book is dedicated to Manel J. Barbanoj (in memoriam). With gratitude and respect.

Foreword

Ayahuasca and Ethnopharmacology Ethnopharmacology is a relatively new science that studies the cultural aspects of substances (plants, animals, minerals) and their biological characteristics and activities. While investigating and identifying compounds and the various uses they have in indigenous and non-indigenous groups, this science is also involved in studying the bio-activity of these materials. Ethnopharmacology is connected with other ethno-sciences, especially ethnobotany, which studies the uses of plants by human groups and their chemical and biological aspects. Plant development is part of nature but also part of the human culture, since man has been selecting plant materials from millennia for their qualities and characteristics. Humans use plants to eat, to hunt, to build houses, for killing, and from the rich variety of uses man had been given to plants, some kinds of uses involves the magical. Ayahuasca, a psychoactive Amazonian plant preparation, had been and still is used within the context of the sacred, the religious, the divinatory and the therapeutic. Ayahuasca is an excellent bio-active material to be investigated from an ethnopharmacological point of view, since its various uses, in the past and in the present, by many different human groups and for a high diversity of objectives, warrant an interdisciplinary approach. Although many human groups have been using different kinds of flora for reaching and connecting with the sacred, the hallucinogenic botany seems to occupy a very special place in some cultures. The high relevance of these substances is evident in many human groups. In the present book, several authors present to us some of the uses that ayahuasca had and still has in indigenous, mestizo and urban groups. Also, other chapters illustrate the various uses that ayahuasca have in modern science. This pan-Amazonian brew is used actually not only in Brazil, Colombia, Peru or Ecuador, where indigenous groups have been using this plant preparation for centuries, but in North America, Europe and Asia, where non-indigenous groups have been using this brew for many years now. It is an attempt of the present work to try to show the rich diversity that exists around ayahuasca. Because ethnopharmacology involves social aspects of bio-active compounds, the two first articles of the book are made considering the anthropological, cultural and social aspects of ayahuasca. In the first article,

Luis Eduardo Luna shows how ayahuasca is used by indigenous and mestizo populations and in the second article Sandra Lucia Goulart discusses the context of the Brazilian ayahuasca religions. Luna and Goulart illustrate the diversity of concepts and ideas that these groups have regarding ayahuasca, discuss concepts and practices of healing and disease in these groups, and compare the ways in which ayahuasca is experienced and explained in these groups. The next articles are about pharmacological aspects of ayahuasca, to complement the social and cultural aspects. On the third article, José Carlos Bouso and Jordi Riba describe the pharmacological and neuropsychiatric aspects of this Amazonian brew. Their work is based in many years of clinical trials with acute ayahuasca administration to healthy volunteers and also on the investigations regarding the possible consequences of the long term consumption of this centenary potion. On the fourth article, Paulo César Ribeiro Barbosa illustrates a case report of a person that has taken ayahuasca for the first time. The possible therapeutic effects of ayahuasca are investigated in the context of the acute and post-acute effects of the brew. On the fifth article, Flávia de Lima Osório and collaborators explore the therapeutic potentials of one of the main ayahuasca alkaloids – harmine – for the treatment of depression, and they also discuss the curative potentials of the brew itself in this psychological disequilibrium. Still on the pharmacological perspective, but also involving psychiatry, the last two articles talk about the possible interactions of ayahuasca and cannabis in humans. One of the articles, which was wrote by me, is a theoretical overview of the eventual interactions – positive, neutral, or negative – that can potentially happen when humans take ayahuasca and cannabis together. The last article, wrote by me and Rick J. Strassman, shows a case report of a young man that had psychotic episodes related directly to the consumption of ayahuasca and cannabis. It is the main intention of the present book to make accurate and easy information regarding as many as possible aspects of ayahuasca accessible to the public. It is hoped that this little book will bring light to an issue that, in many cases, is still debated in obscurity. Barcelona, January, 2011

Rafael Guimarães dos Santos

Contents

Chapter 1 Indigenous and mestizo use of ayahuasca. An overview Luis Eduardo Luna

Chapter 2 The notion of cure in the Brazilian ayahuasca religions Sandra Lucia Goulart

Chapter 3 An overview of the literature on the pharmacology and neuropsychiatric long term effects of ayahuasca José Carlos Bouso and Jordi Riba Chapter 4 Therapeutic perspectives on the acute and post-acute effects of ritual experience with ayahuasca: A case study Paulo César Ribeiro Barbosa Chapter 5 The therapeutic potential of harmine and ayahuasca in depression: Evidence from exploratory animal and human studies Flávia de Lima Osório, Ligia Ribeiro Horta de Macedo João Paulo Machado de Sousa, Joel Porfírio Pinto, João Quevedo José Alexandre de Souza Crippa and Jaime Eduardo C. Hallak Chapter 6 Possible risks and interactions of the consumption of ayahuasca and cannabis in humans Rafael Guimarães dos Santos Chapter 7 Ayahuasca and psychosis Rafael Guimarães dos Santos and Rick J. Strassman

Transworld Research Network 37/661 (2), Fort P.O. Trivandrum-695 023 Kerala, India

The Ethnopharmacology of Ayahuasca, 2011: 1-21 ISBN: 978-81-7895-526-1 Editor: Rafael Guimar茫es dos Santos

1. Indigenous and mestizo use of ayahuasca. An overview Luis Eduardo Luna

Wasiwaska, Research Center for the Study of Psychointegrator Plants Visionary Art and Consciousness, Florian贸polis, Brazil

Abstract. Ayahuasca, a psychotropic beverage used by numerous indigenous groups of the Upper Amazon, the Orinoco Basin and the Pacific Lowlands of Colombia and Ecuador, has an important role in their medico-religious, artistic and social lives. Its use was later incorporated in healing ceremonies among the mestizo population of Peru, Ecuador and Colombia. This chapter presents an overview of such uses among some indigenous groups as well as that of contemporary practitioners in the Peruvian Amazon region.

1. Introduction It is my intention to give an overview of indigenous use of ayahuasca, and a discussion on the so-called vegetalismo phenomenon among the mestizo population of the Peruvian Amazon. I will also add a brief commentary about Correspondence/Reprint request: Dr. Luis Eduardo Luna, Wasiwaska, Research Center for the Study of Psychointegrator Plants, Visionary Art and Consciousness. Florian贸polis, Brazil E-mail: leluna47@hotmail.com and www.wasiwaska.org

Luis Eduardo Luna

the so-called “ayahuasca tourism” phenomenon. The part related to the indigenous realm is mostly based on written sources, as my first-hand experience was limited to short stays with few indigenous groups1. The part related to vegetalismo is mostly based on my own fieldwork during 19801988. I was unfortunately not able to fully examine an excellent recent in study on the phenomenon by Beyer[1].

2. Part I: Indigenous use of ayahuasca 2.1. European perception of sacred plants in the Americas Although Europeans learned very early about the use of psychotropic plants among the indigenous population of the Americas, they ignored their properties, with exception of tobacco. These plants were used in a spiritual/religious context, a realm that in Spain was in the hands of the Catholic Church, which judged them as vehicles of communication with the Devil, a perception that basically has not changed in our contemporary world, in which Amerindian sacred plants have been, with exceptions, criminalized. The first book written in Spanish in the New World (1497-8) was the Chronicle of Catalan friar Ramón Pané’s, at the orders of Columbus, and partially dedicated to the description of the believes and ceremonies of the Taíno, on the island of La Española (now-a-days Haiti and Santo Domingo)[2], an indigenous population originally from the Orinoco region who populated the Antilles, taking with them the use of cohoba (Anadenanthera peregrina). Pané was the first European to describe how their shamans “came out of their minds” to communicate with the cenis or spirits. Juan Cárdenas, a chronicler, wrote on 1591 in reference to peyotl (Lophophora williamsii) that the natives who eat it “lose their senses, see visions of terrifying sights like the devil, and are able to prophesy their future with ‘satanic trickery’”[3]. In a religious manual of 1760 there were questions that equated the eating of peyote with cannibalism[4]. 1

From the onset I have to point out that my personal experience with indigenous use of ayahuasca is restricted to one session – for me life changing – with Don Apolinar Jacanamijoy, an Ingano “taita” whom I knew since childhood, and his son Roberto Jacanamijoy; one period of a month in the Sibundoy Valley with two Kamsá shamans, Don Salvador Chindoy and Don Miguel Chindoy, father and son; another month in Santa Rosa de Pirococha, a Shipibo small settlement, under the care of Don Basilio Gordon; perhaps half a dozen sessions with Don Benito Arévalo, a Shipibo, and later a few with his son Don Guillermo Arévalo; finally two weeks with a Campa shaman in Rio Palcazú, when I was in isolation doing the diet. The rest of my fieldwork, carried out during 1981-1988, was with mestizo practitioners.

Indigenous and mestizo use of ayahuasca

There was a similar perception by the religious authorities regarding ayahuasca. One of the earliest sources is from Father José Chantre y Herrera in his history of the Jesuit missions from the late seventeen and early eighteen centuries, who speaks about a “diabolic brew”[5]. Missionaries of the Montfortian Congregation, most of them Dutchmen, established in 1914 among the Tukano, Desana, and Pira-Tapuka of the Papurí River immediately prohibited the use of yajé and destroyed most of its ritual paraphernalia[6]. This persecution by the part of religious missionaries comes to our days. In the mid eighties I heard similar stories in the Peruvian Amazon as carried out by members of the Summer Institute of Linguistics, and in the nineties near Manaus, Brazil, a group of Tukanos complained to me that Salesian missionaries prohibit them to take caapi. 2.2. A question of terminology The Quichua term ayahuasca (also spelled ayawaska), from aya = spirit, ancestor and waska = vine, is not precise. In contemporary literature it is used to refer to the concoction of Banisteriopsis caapi plus Psychotria viridis. It is also sometimes used to refer to a beverage – a concoction or a cold infusion – made of B. caapi plus Diplopterys cabrerana (known as chagropanga, chiripanga or other vernacular names), which is locally known as yajé (also spelled yagé). To complicate matters both the term ayahuasca and yajé are used to refer to Banisteriopsis caapi by itself. I propose to use the term ayahuasca, common in Peru, Bolivia, Brazil and parts of Ecuador, when referring to the first preparation. The term yajé will designate the second preparation. We use the term caapi when referring to a preparation made only of Banisteriopsis caapi, as well as to the plant itself. Given that this vine is the essential element, when referring to the whole phenomenon I will talk about the caapi complex. It is relevant to point out that indigenous groups distinguish several “kinds” of vines to refer to what western botanists see as just one species. This means they have a much more refined taxonomy, based not only on the morphology of the plant, but also on its effects, which may differ according to the type of soils it grows, the part of the plant used, the season and the moon in which the vine is harvested, and other factors. Langdon examined yajé classification among the Siona of the Colombian southeast[7]. There hasnot been, as far as I know, any inter-ethnic comprehensive study focusing on the vernacular taxonomy of Banisteriopsis caapi. We have to view the caapi complex in the context of the use of other psychotropic plants, such as tobacco, Anadenanthera and Virola snuffs, as well

Luis Eduardo Luna

as other plants, psychotropic or not, with religious/spiritual significance2. No doubt many Amazonian indigenous groups have a great interest in mindaltering plants. They are specialists in the pharmacology of consciousness. A bibliographical investigation in 1986 resulted in references to the use of B. caapi with or without additives among seventy-two indigenous groups belonging to several linguistic families[10]. This list is most probably not exhaustive. The use of B. caapi has been adopted in later times by some of these groups, and it is still expanding, even outside of the Amazon area, for example among the Guarani of southern Brazil[11]. Bravec de Mori argues for the relative recent introduction of ayahuasca south of Iquitos[12]. The point of dispersion of the use of Banisteriopsis caapi is not known, or when this might have happened. The origin of its use may forever remain a mystery. We have no evidence of indigenous group using ayahuasca outside the Upper Amazon. In the early nineties I heard that natives of Marajó, the large island located at the mouth of the Amazon River (no specific ethnic group was named) sold Banisteriopsis caapi to Umbanda (an Afro-Brazilian religion) centers, to be used for herbal baths, and I saw it being cultivated for this purpose at an Umbanda center in Porto Velho, in the Brazilian State of Rondônia. No fieldwork in this area has been carried out on this subject. Ayahuasca and yajé have many other vernacular names[10,13]. In Brazil religious organizations that use ayahuasca as a sacrament call it either santo daime or vegetal. 2.3. Importance of the caapi complex Richard Evans Schultes (1915-2001), a pioneer in the study of Amazonian psychoactive plants, summarizes thus the importance of caapi among Indian tribes: “Probably no other New World hallucinogen – even peyote – alters consciousness in ways that have been so deeply and completely evaluated and interpreted. Caapi truly enters into every aspect of living. It reaches into prenatal life, influences life after death, operates during earthly existence, plays roles not only in health and sickness, but in relations between individuals, villages and tribes, in peace and war, at home and in travel, in hunting and in agriculture. In fact, one can name hardly any aspect of living or dying, wakefulness or sleep, where caapi hallucinogens do not play a vital, nay, overwhelming, role”[14]. 2

For a comprehensive discussion of the botany of ayahuasca see Ott[8,9].

Indigenous and mestizo use of ayahuasca

Reichel-Dolmatoff, whose studies of the Tukano indigenous groups of the Colombian Vaupés threw new light to the role of caapi in those societies, wrote the following: “The use to which these hallucinatory trances are put by the different Indian tribes varies from curing rituals to initiation ceremonies, and from the violent frenzy of warriors to ecstatic religious experiences. In all cases, it seems, yajé is thought to provide a means of being transported to another dimension of consciousness, which, in the daily life of the individual or of the group, acquires great importance. It would seem, then, that without exploring this dimension, a knowledge of aboriginal culture is impossible”[6]. It is not surprising that the origin of caapi is found in the myths3. Here two examples. The first myth is from the Tukano of the Colombian Vaupés territory, an agriculturist indigenous group that lived in relative isolation when Reichel-Dolmatoff collected it in the late sixties[6], and which was recited in many ceremonies. Here a highly abbreviated form based on the narratives he collected: It happened in the beginning of time, when Anaconda-Canoe was ascending the rivers to settle mankind. Yajé woman, the first woman of creation, had come with the men, the ancestors of the Tukano. She was impregnated through the eye by the intense yellow light of the Sun Father, the phallus, the Master of Yajé, in the House of Waters, the first maloca [communal house], by a roaring and foaming fall. The woman left the maloca while the men were preparing cashiri beer and gave birth to the yajé vine in the form of the a radiant child. She then enters the maloca with her child, the men becoming dizzy, seeing red colors, the blood of childbirth, and losing their senses. The woman asked: “Who is the father of this child”? One man had kept a clear head. He said: “I am his father”. He took one of his copper earrings and broke it in a half, and with the sharp edge he cut the umbilical cord, a large piece, which is why yajé comes in the shape of a vine. The others grabbed him by his fingers, arms and legs, tearing him into peaces, each getting his own kind of yajé, and which give their identity to various groups within the Tukano and the rules by which to live. 3

When Steven White and I were preparing Ayahuasca Reader: Encounter with the Amazon’s Sacred Vine [15], we noticed that the indigenous myths we found were referring to B. caapi. We did not find any myth referring solely either to Psychotria viridis or Diplopterys cabrerana. This is interesting given that it is the admixture plants that contain the visionary alkaloid (DMT).

Luis Eduardo Luna

Even though at first sight we would have among the Tukano a heavenly origin of caapi, the abode of Father Sun is in ahpikondiá, the underworld, and the source from which all life springs and to which the souls of the virtuous return after the body’s death. An underwater origin of nishi pai (ayahuasca) is found among the Cashinawa and other indigenous groups of the Pano linguistic family of the Peruvian and Brazilian Amazon. There are several variations on this myth. Here in an abridged form, based on a narrative collected by Lagrou in the Purus River[16]: Yube, the ancestor of the Cashinahua, went hunting by a lake not far from a genipap tree [Genipa americana, used by indigenous groups to paint their bodies]. While he was hiding a tapir arrived, took a genipap fruit in his mouth and threw it to the lake. An anaconda rose from the lake and as she left the water turned into a beautiful woman, her body covered by genipap designs. They made love. When Yube went back home he did not eat any of the food his wife had prepared, nor was able to sleep, his mind on the beautiful woman he had seen. The next morning he went to the lake, took three pieces of fruit and threw them in the water, and as the woman came out he tried to lay her down. The woman resisted and transformed into the anaconda, almost suffocating him. Yube explained why he had come, and lied saying he was single. The woman said that she was looking for a husband. If he wanted to make love to her he had to live with her in the lake. He agreed, made love to her, and the woman squeezed the sap of a leaf in his eyes so that he would not be afraid. She had him climb on her back and took him to her family in the lake. Yube got used to living with the anacondas, work for his father-in-law and made three children with her wife. One day the snake people were going to take nishi pai (ayahuasca) and his wife warned him against taking it, but he insisted he would take it. He went with his father-in-law to collect the vine and the leaves. When he drank the brew he became afraid and cried: “The snakes are swallowing me”. The snake people were offended and nobody wanted to speak with him any longer, nor gave him food. He went to the forest where he met the little fish that told him he was in great danger, as the snakes were going to kill him. The fish put the juice from a leaf in Yube’s eye and took him to a stream where his previous wife use to go to cry for him since he disappearance three years ago. She recognized him, gave him food, and he lived there for a whole year hiding from the snakes. Then a child was born. He went to the forest to find genipap to paint his newborn child but it rained and the rivers began to rise. He slipped into a stream and a snake, his youngest son, got hold of his big toe. Then his oldest daughter swallowed his whole foot, and his snake wife gulped down his whole body until his armpits. He cried for help, his kin rescued him, but his bones were broken. He wanted to know when he was going to die and asked them to bring all sorts of vines and leaves until he

Indigenous and mestizo use of ayahuasca

recognized the right ones to prepare nishi pai. He gave his people the brew, who learned how to make it. During three nights he sang the songs he had learned from the snake people and then he died. He was buried and kawa leaves [Psychotria viridis] came out of his eyes and four kinds of vine grew from his limbs. His people prepared the drink but did not know the songs. One of the boys who had not taken the brew with the ancestor, but who had listened carefully, remember the songs, which is the reason why the Cashinahua know these songs. Among Záparo and Peruvian mestizo vegetalistas the origin of the two plants involved in the preparation of ayahuasca come from the bones and blood (or simply from the grave) of a human being. A variation of this myth was later incorporated as the central myth of the União do Vegetal, one of the Brazilian organizations using ayahuasca. The fact there are such myths may indicate that the caapi complex is probably old, but we have no certainty, as the earliest unequivocal record is from the eighteen century. The botanical distribution of Banisteriopsis caapi encompasses a huge area, and it is easily cultivated, as exemplify by the use of pildé, one of the vernacular names given to the beverage, by indigenous groups of the Pacific lowlands of Colombia and Peru[6], where it must have been introduced, as the plant could not have migrated naturally across the Andes Mountains. Recent studies are showing that large areas of the Amazon Basin were probably heavily populated. Extensive areas of the so-called terra preta do indio, anthropogenic soils of extraordinary quality for intense cultivation, reveal perhaps large human populations. In Beni, in the Bolivian Amazon, huge areas were dedicated to raised agricultural fields, dikes and reservoirs and fishcorralling fences, demolishing the theory that the Amazon had not enough protein to sustain large human populations[17,18]. Numerous geoglyphs in Acre, in the Brazilian Amazon, reveal habitation – and therefore resources – in areas paradoxically now dedicated to cattle ranching. Certainly the astonishing ceramics found along the Amazon River (for example those of Santarem and Marajó), which Fray Gaspar de Carvajal in 1513 praised as “the best in the world, better than those of Malaga”4, reveal huge cultural 4

Here the original Spanish text: “En este pueblo estaba una casa de placer, dentro de la cual había mucha loza de diversas hechuras, así de tinajas como de cántaros muy grandes de más de veinti cinco arrobas, y otras vasijas pequeñas como platos y escudillas y candeleros desta loza de la mejor que se ha visto en el mundo, porque la de Málaga no se iguala con ella, porque es toda vidriada y esmaltada de todas colores y tan vivas que espantan, y demás desto los dibujos y pinturas que en ellas hacen son tan compasados que naturalmente labran y dibujan todo como lo romano”. (p. 69)

Luis Eduardo Luna

sophistication[19]. What role Banisteriopsis caapi may have had in culturally diverse pre-Columbian Amazon we donâ&#x20AC;&#x2122;t know. Near Santarem were found beautifully made ceramics with the jaguar and other shamanic motives in which a small drink was used obviously ceremonially. As far as I know there has been no identification of what drink these ceramics may have contained. 2.4. Indigenous spirituality and shamanism Indigenous ayahuasca use can only be understood within the context of indigenous spirituality. According to its worldview there is an underlying spiritual aspect to everything that exists, an intimate relationship and even dependency between the seen and the unseen, between the world of nature and human creation on one side, and normally invisible and intelligent forces. The preservation of the individual and the community, and therefore human action, depends on finding the proper balance in this complex reality. Sacred plants, such as ayahuasca, facilitate the perception of such complexity. Gifted individuals may establish alliances with spiritual forces and interact for the benefit (or detriment) of others. They are able to interpret natural phenomenon finding hints that reveal the development of unseen forces that determine human existence. They are curious, interested in plants and animals, weather conditions, natural phenomena and the traditions of his community. They are therefore the recipients of the myths, narratives, songs, and spells. They have clear visions when under the influence of sacred plants, or are able to shed light upon the visions and experiences of others. They are intellectuals and humanists. These are the shamans or payĂŠs, both feared and seek for when the situation thus requires it. They undergo especial training, which implies dietary restrictions, the avoidance of sex, sojourns with shamans of neighboring indigenous groups and the acquisition of helping spirits, powerful objects, magical arrows and metaphors that help them in their practice. They are both knowledgeable of their natural environment as the masters of complex normally unseen supernatural realms. 2.5. Types of rituals Reichel-Dolmatoff[6] pointed out that among the Tukano there are two kinds of caapi rituals. On one hand there are the great collective ceremonies involving one or more exogamic units which involve dancing, singing, and recitations, accompanied by rattles, flutes, fifes and other musical instruments, and which emphasizes the divine origin of their social laws, also the ceremonies connected with the individuals life cycle such as initiations

Indigenous and mestizo use of ayahuasca

and burials, and above all the ancestor-communication Yuruparí ceremonies. On the other hand the more intimate sessions devoted to shamanic practices, such as healing and divination, finding game or learning about the plans of the enemy during warfare, and involving just a few individuals. He also indicated that in the Vaupés only Banisteriopsis caapi was used in collective rituals, while in shamanic séances, in which “special effects” are desirable, Banisteriopsis rusbyana (and old name for Diplopterys cabrerana) was also added. Collective rituals taking place in 1923 were described by Karsten among the Shuar of Ecuador[20], particularly those related to victory feasts, and in 1934 by Goldman among the Cubeo of the Colombian Vaupés region[21], related to ancestor cults. Due to the missionary activity and other western influences, most collective rituals do not exist any longer. It is the intimate shamanic use that has been preserved and transformed, with external influences, in the sessions of mestizo ayahuasqueros. 2.6. Uses of the caapi complex Many publications have dealt in one way or another with the use of yajé/ayahuasca by indigenous groups. It is not my intention to summarize here such studies. I will rather present the main uses, taken from indigenous groups belonging to several linguistic families and cultural subdivisions (hunter gatherers, agriculturists, savanna dwellers, etc.). Not all elements are necessarily present in each indigenous group, and some of them are deeply intertwined, so that differentiation is difficult. This will give us an idea of the range of uses among the indigenous populations of the Amazon and Orinoco Basins, and the Pacific lowlands of Colombia. 2.7. Contact with the primordial spiritual realm The main function of ayahuasca/yajé is to enter into contact with the unseen side of reality. Harner[22], referring to the Shuar of the Ecuadorian Amazon, points out that the true forces behind daily life are in the supernatural realm, the true reality, and can only be accessed through the psychedelic experience. For the Cubeo, according to Goldman[21], the exaltation of intoxication and frenzied emotional experience is sacred, and caapi is used primarily to enter into contact with the ancestors. Harner calls this modified state of consciousness “shamanic state of consciousness”[23]. Winkelman[24] proposes the term “integrative consciousness” using a highly convincing neurophenomenological approach to shamanism that bridges the realm traditionally found within anthropological and religious studies, with the neurosciences.

Luis Eduardo Luna

Traveling to other dimensions and helping others to undertake without danger journeys to the other side of reality is the specialty of the shaman. In the case of the Siona, according to Langdon[25,26], the shaman conducting the ritual, through his songs, take the assembly into specific region of their cosmos, each characterized by its particular sounds, rhythms, music, smells and colors. The process of entering the other side of reality may be experienced in terms of dismembering, death, and resurrection, a common motive found in shamanistic traditions globally. Referring to the Tukano of the Colombian Vaupés, Reichel-Dolmatoff writes the following: “Recognizing that the individual must pass from one dimension of existence – or cosmic plane – to another to communicate with the spiritual or invisible world, the Tukanos take caapi to effect this transport. The trip represents to them the process of birth and breaking through the wall that separates the two cosmic planes and signifies, according to anthropological studies, the rupture of the placenta. Drinking caapi is often interpreted as returning to the ‘cosmic uterus’. Since they insist that they sometimes come to know death while under the influence of the drug, the Tukanos consider the return to the cosmic uterus as an anticipation of death which permits contact with the divinity or visitation with the source and origin of all things”[6]. A related metaphor is found among the Kamsá of the Colombian Putumayo. After birth the baby’s umbilical chord is severed, separating him from his mother’s placenta. According to their view, yajé is like a new umbilical chord connecting the person to the whole cosmos. 2.8. Transformation and communication with the animal and plant world A common motive in shamanism everywhere is transformation into an animal to perform certain tasks. In the Amazonian region one of the main shamanic motives is that of jaguar transformation, especially to attack enemies. In some cases the shamans may become other great predators, such as the harpy eagle and the anaconda. These three animals crown the Amazonian trophic pyramid. The shaman may either transform into an animal, or an animal or a plant may adopt anthropomorphic features to communicate with humans. We are here confronted with a radically different epistemology, one that presupposes the possibility of perceiving the world from the point of view of a non-human creature, something which cannot be rejected as a totally far-fetched way of thinking, even though difficult to

Indigenous and mestizo use of ayahuasca

comprehend without direct experience of the states of consciousness in which it is based. A dialogue of worldviews is needed, one that goes beyond ethnographic curiosity and which accepts that other approaches to reality are indeed possible. Western science, due to prejudices, is largely totally ignorant about the possibility of acquiring actual information about the natural world in non-ordinary states of consciousness. 2.9. Divination, healing and warfare Getting information from other realms is indeed one of the main functions of the caapi complex. It is used to locate animals in the forest, to find out about relatives in distant places, to know the cause or etiology of illness, to get to know the plans of the enemies, etc. When Karsten asked the Shuar why they drink natéma, he got the following answer: “It is in order that the people may not die away”. He then adds the following commentary: “By this kind of divination they try to find out what dangers are threatening the family, whether enemies are planning an attack against them, whether evil sorcerers are operating against them, whether they will be successful in their own undertakings, and so forth”[20]. Ayahuasca/yajé is used to diagnosis and to look for the deeper cause of illness. Sometimes also the patient may take it to contribute to find the etiology of the ailment. Sucking, blowing tobacco smoke over the patient or over the medicinal plants used, songs and incantations are usually essential. Some indigenous groups may use it in conjunction with other plants. Such is the case of the Tukano, who use vihó, a DMT containing snuff prepared from the sap of Virola species. Often medicinal plants are collected under certain dietary conditions, for example before dawn and without having eaten anything, as well as after invoking the spirits of the plants or making offerings to them. Given that illness is usually thought as the result of the action of an animated agent, fighting it is part of the healing process. The shaman has the double role of healer and sorcerer, protecting his community but at the same time attacking its enemies, either by transforming into a jaguar, or by sending back the illness to the person who sent it, or through helping spirit animals. It seems that among some indigenous groups caapi was used with warfare. Spruce described in 1852 how the person who has taken caapi would “bursts into a perspiration, and seems possessed with reckless fury, seizes whatever arms are at hand, his murucú, bow and arrows, or cutlass, and rushes to the doorway, where he inflicts violent blows on the ground or the doorposts, calling out all the while, ‘Thus would I do to mine enemy

Luis Eduardo Luna

naming him by his name) were were this he!5’” Calavia[27] pointed out that Yaminahua memories of life before the pax branca (the peace imposed by whites), suggest a conception of ayahuasca that might seem strange or perhaps even scandalous in another context: the plant-substance is a bloodthirsty agent associated with war and vengeance that eventually is tempered by the blood of a dead relative. It is also the instrument of an aggressive shamanism in which therapy is defense and counter-attack. Not keeping dietary prescriptions when hunting, having contact with menstruating women or childbearing women, not paying respect to the spirits when approaching special places in the forest, may cause illness. 2.10. Acquisition of songs and designs In some indigenous groups there seem to be an intimate relationship between the experiences in other realms through yajé/ayahuasca and visual expressions in body painting and the patterns used in the ornamentation of communal houses, weapons, paddles, stamping tubes, ceramics, and other objects. Songs and dances are also said to derive from experiences on the other side of this reality. According to Father Plácido de Calella, a missionary who worked among the Siona, in the beginning of the 20th century, “during these hallucinations the shaman and the other participants claim to see large crows of people, called “yajé people” (yagé-pai) and who sing and play musical instruments. When the trance is over the men copy the design motifs of the body paint of these spirit-beings and use them to adorn their own faces”[28]. Langdon later confirmed this idea, while also by reporting that most Siona narratives can be characterized as shamanic, in the sense that they deal with shamans and/or with experiences in the occult world when dreaming or taking yagé. Reichel-Dolmatoff[6], when discussing with a Tukano of the Colombian Vaupés Territory the colorful designs on the exterior of one of the communal

It has always puzzled me the rapid reaction in the persons taking caapi described by Spruce, who wrote: “This is all I have seen and learnt of aya-huasca. I regret being unable to tell what is the peculiar narcotic principle that produces such extraordinary effects. Opium and hemp are its most obvious analogues, but caapi would operate on the nervous system far more rapidly and violently than either”. Such rapids effects are not at all what I have observed throughout the years participating in yajé and ayahuasca rituals, where usually between half and hour and an hours pass before feeling the effects. Could it be that the type of diet held has such a direct diverse effect among indigenous populations and more westernized participants? More studies are needed to elucidate this apparent anomaly.

Indigenous and mestizo use of ayahuasca

houses, received the following explanation: “We see these things when we drink yajé”. A subsequent study of the patterns reveled that certain motifs had meaning, almost always phrased in terms of fertility symbolism. ReichelDolmatoff compared Tukano designs with phosphenes (light patterns originated within the eye and the brain) isolated by Knoll[6,29]. “The similarities are such [he concludes] that there can be no doubt left: The decorative patterns of the Tukano are almost whole derived from druginduced inner light experiences”. The geometrical patterns would only represent the initial stage of neurophysiologic stimulation. A second stage would be marked with the onset of figurative representations, in turn culturally modeled. Among the Shipibo of the Ucayali River (Peru), the extraordinary designs that cover the ceramics, skirts, and previously other material objects of this culture, are inspired by nishi-pai. According to Gebhart-Sayer the shaman ascends to higher realms where he listens the melodies from the spirits and sing with them. Those songs have a visual manifestation that the women transmit in their art[30]. The Shipibo believe their bodies are covered by invisible designs. Illness is the disruption of the patterns, and the songs of the shaman restore their order and beauty. Healing is thus an aesthetic endeavor. While doing fieldwork in Santa Rosa de Pirococha, a Shipibo settlement by the Ucayali River, I asked Don Basilio Gordon, a shaman, about the plants he used to heal his patients. He said that it is enough to know the songs of the plants to be able to cure. The plants are needed only if you do not know their song. 2.11. Promotion of social order Caapi and other sacred plants are considered among some indigenous groups as promoting social order. Brown[31,32] referring to the Aguaruna of Peru writes: “Adults sometimes remark that their children control more knowledge (e.g., the ability to read and write) because they attend school, but that they are often “stupid” (anentáimchau, literally “without thought”) because they no longer undergo the rigorous training linked to the use of hallucinogenic plants. This lack of thought manifests itself in such antisocial behavior as fighting with close kinsmen, attempting suicide, maintaining an unseemly interest in sexual adventures, and otherwise affronting traditional morality”. For the Aguaruna, it is not enough simply to know facts; one must learn to think well by bringing together the body, the emotions, and the intellect in the epiphanous context of the visionary experience. According to Reichel-Dolmatoff yajé gave the Tukano their life, the rules by which they should live, their way of life. Karsten reports that among the

Luis Eduardo Luna

Shuar “both men and women are, by drinking natéma, made strong and clever for their different occupations and duties, the men for hunting, fishing, war, etc., the latter for agriculture, for the education of the children, for the care of the domestic animals, and for other domestic work incumbent on them”[20]. For the Siona yagé is central to their notions of well being and health, as well as their acquisition of knowledge[26].

3. Part II: Mestizo use of ayahuasca 3.1. The use of ayahuasca among the mestizo population of the Peruvian Amazon Although there has been missionary activity in the Amazon region since the middle of the 16th century, the greatest and most devastating western influence in this region took place during the so-called rubber booms in 1879-1912 and 1945-47. The great demand of rubber caused by the industrial revolution created chaos among indigenous populations, many subjected to slavery and moved around to other Amazonian regions. There was also a period of intense biological and cultural mixture of westerners and the indigenous people. Practitioners appeared conducting healing rituals in which indigenous Amazonian ideas and the use of ayahuasca (and other plants) were integrated with Andean and Christian beliefs. This is the so-called vegetalismo phenomenon, from vegetal, the name given to plants with extraordinary properties, such as ayahuasca. I dedicated several years to the study of this tradition in the period between 1981-1988, and was the subject of my doctoral dissertation and several other publications[33,34]. My main informant and friend was Don Emilio Andrade Gómez, a mestizo vegetalista who lived 12 kilometers from Iquitos, by the road that now connects the city with Nauta, in the south, where he received patients Tuesdays and Fridays, at times (not always) drinking ayahuasca. I became a sort of apprentice, as well as that of Don José Coral, a vegetalista friend of his, who lived a few kilometers away. This took place before the current flux of westerners arriving to Iquitos in search for ayahuasca. As an educated Westerner I think I was alone in this quest at that time. As a mestizo (I was born in the Colombian Amazon, of non-Amazonian parents) I was simply part of a tradition, now at least one hundred years old. Don Emilio took ayahuasca for the first time in 1937 at the age of fourteen. His teacher was Don Juan Hidalgo Nina, also a mestizo, who in turn had Don José Benavides Sánchez as his teacher.

Indigenous and mestizo use of ayahuasca

3.2. Plant teachers For me the greatest discovery was the concept of plant-teachers. Don Emilio considered ayahuasca as one of many doctores, plant-teachers, plants that give knowledge6. He called these plants doctores: ojé (Ficus anthelmintica), toé (Brugmansia sp.), catahua (Hura crepitans), clavohuasca (Tynanthus parunensis), ayahúman (Courupitas guianensis), and many others. Don Emilio called them collectively as vegetales, hence the name vegetalista, which refers to a person that has learned from those plants. Within vegetalistas there are specialists in one or other plant, for example tabaqueros, toeros. There are also paleros (specialists in certain large trees, or palos), who have great reputation, or perfumeros, specialized in the use of perfumes from certain plants in order to heal. The bark or other plant of these trees may be added to the ayahuasca when it is being prepared, or may be taken also independently. Don Emilio use to say that he was only an “ayahuasquerito”, a little ayahuasquero, but there were others with greater powers, those who learned from big trees in which ayahuasca may climb and grow. These plants can also be taken for medicinal purposes, or solely in order to make the body strong, not necessarily to learn from them. 3.3. Initiation In order to learn from the plants it is necessary to dietar (maintain a certain diet). This term implies not only food restrictions, but also sexual segregation (if possible isolation, or at least not having sexual intercourse) and certain ritual procedures. The initiate must abstain salt, sugar, fruits and fish containing much fat. Basically it should be manioc or rice, plantains, and just a little fish from time to time. It is a process of purification that opens the contact to the spirits of the plants. Vomiting is conceived as helping the purification process. The shaman is there first of all to protect the initiate. Sometimes, as a result from an illness, a person may go into diet and isolation by himself (I use here the masculine, but there are also cases of female practitioners), and in the process becoming a healer. It is often said that the initiate is first tempted by spirits to receive certain powers. If taken, the initiate may become a brujo, a sorcerer. If the initiate refuse those powers and continue his training then he becomes a healer. 6

The idea of ayahuasca as a teacher is present in Brazil among practitioners of Santo Daime, “o professor dos professors”, “o mestre de todos os ensinos”[35].

Luis Eduardo Luna

3.4. Icaros, the magic phlegm and concepts of illness In this tradition the essence of power and wisdom is in the icaros, the songs the spirits of the plants (or other spirits) teach the initiate, either when taking ayahuasca or other plants, or in the dreams that follow such ingestion. Icaros may have various functions. They may be invoked for protection, to call certain spirits, to heal particular illnesses, to travel to specific places, to give strength or to diminish the effects of ayahuasca, etc. A vegetalista may possess dozens of icaros, their complexity often being an indication of his power. Icaros are an essential part of the work of a vegetalista. An icaro is always sung over the ayahuasca brew before taking it, and ceremonies basically consist of a vegetalista singing during several hours his icaros, often accompanied by a schacapa, a bundle made of Pariana leaves, a tradition found among indigenous practitioners such as the Kamsá or Ingano in Colombia. Icaros must often are learned directly from the plants, particularly during the initiation period or when the vegetalista decides to spend time in isolation to replenish his healing energies. They may be also learned from other practitioners. It is said that icaros my leave a person all-together to go into another one. They can be stolen from another person, or being forgotten due to some sort of sorcery from the part of envious practitioners. During initiation the neophyte may receive from his teacher (or from plant-spirits) a magic phlegm called mariri, yausa or yachay. This is said to be planted like a tree, growing inside the initiated to extract the illness from his patients, which may be cause either by the intrusion of a pathogenic object, often called a virote, the name given to the arrows Spaniards shot with their crossbows, in an area where powder often got wet making fire weapons unusable. It is also possible to harvest those virotes and keep them in the phlegm for later use as a weapon. Sucking and blowing are essential elements in a healing session, especially certain areas of the body such as the boca del estómago (solar plexus), the top of the head, the temples, and along arms and legs. As in other traditions, hiding an insect or a small thorn in the mouth and pretending it was extracted from the body of a patient, is part of the tools of the vegetalistas to elicit a psychosomatic response. Some practitioners may use certain stones, called encantos, to help in the extraction of illness. Illness may be also conceived as the result of soul loss due to fright or sorcery. Since illness is conceived as caused by an animate agent – human or supernatural –, healing is often associated with defense and counter-attack. Vegetalistas are particularly vulnerable during ayahuasca sessions. Stories about practitioners being wounded or killed during such sessions abound. Protection is then necessary. Through certain songs – as is also the case with

Indigenous and mestizo use of ayahuasca

the Shipibo of the Ucayali River – the person may be covered by an arkana, described as some sort of metal shirt covering the body of a person, thus protecting her from pathogenic darts. It is also normal, especially in difficult situations, to invoke Jesus and Mary, angels with swords, animal protectors (Amazonian as well as lions, elephants, and the like), soldiers with guns, war airplanes, flying saucers, etc. Whenever a new symbol of power emerges, it is easily incorporated in this highly syncretic tradition. The concept of illness may apply also to bad luck in business or in love, and special ceremonies are held to treat those situations that include the use of magnets (to make the person attractive), perfumes and certain plants. There are also ideas found in other parts of the Americas. For example certain winds or vientos, or whirlpools may cause the illness. Unexpected encounters with spirits may cause fevers and even death. In all situations icaros are essential in the healing process as well as protecting the person from further attacks. 3.5. Spirits Seeing beings seems to be a universal feature of ayahuasca intake. Spirits may adopt any shape, as indigenous people or as people from any part of the world. They may be also animal, therianthropes, or completely alien and believed to be of extraterrestrial origin or living in other realms within our world, in the forest, the bottom of lakes or rivers, the interior of the Earth, etc. Their dresses may seem royal, ancient or futuristic, luminous, huge or small, benevolent or at times threatening, fully visible or composed of appearing and disappearing lights of any colors. Often they communicate telepathically, with gestures or with words (less common). Obviously, their appearance depends on human culture. The plasticity of Peruvian vegetalismo can be seen in the adoption of modern technology. They may communicate with the language of radio, like described by Chevalier[36], or in “computer language” as reported by Beyer[1]. Don Emilio told me that the first time he took ayahuasca he saw luxurious cars, trains, boats, helicopters and peoples of all kinds. Later he saw “doctores” who came from all over the world: “They all came, French, English, Americans, Chinese, Japanese, Spanish, Chileans, these doctors were from all places”. The adoption of modern technology has been observed by Chaumeil[37] in contemporary Yagua medical practices. He describes innovations like telephones, parabolic antennae, syringes etc. as being used by nowadays Yagua “shamans” for communication with spirits, for spiritual operations.

Luis Eduardo Luna

Particular spirits are believed to live in the surrounding forests, lakes and rivers. This was perhaps even more when I was conducting my fieldwork than today, due to the continued deforestation and urbanization process. The Chullachaqui (uneven foot in Quechua) may adopt the shape of a relative or a friend to lure a person walking alone into his forest realm, never to return. If this spirit is offended he may produce dangerous storms or make people sick. The Chullachaqui is believed to have as its dwelling in what they call supay chacras, areas where only Duroia hirsute grows, a small tree that through its chemistry prevents the growth of other plants nearby. The water realm is especially powerful. Mermaids may seduce men or pink dolphins may seduce women to take them into their world. Two giant serpents preside those two realms: the Sachamama or mother of the forest, and the Yakumama or mother of the water. They are ambivalent with respect of human beings, but vegetalistas may establish a rapport with them for the benefit of their patients.

4. A comment on ayahuasca tourism I would like to end with a brief commentary on the phenomenon currently known as â&#x20AC;&#x153;ayahuasca tourismâ&#x20AC;?, and which is taking place first of all in the Peruvian Amazon, especially around Iquitos. It is an occurrence with international repercussions, given the number of practitioners of many nationalities emerging from this tradition that are conducting ceremonies in non-Amazonian countries. My knowledge of this phenomenon is superficial. In July 2005 I was invited as a speaker to a conference in Iquitos, a city I had not visited for many years. Having done fieldwork (and experiential training) in that area in the early eighties, I was nearly shocked to see the buses full of people from all over the world going to participate in ceremonies with this or that indigenous or mestizo practitioner. Obviously much had happened during this twenty-five year gap in which I had been absent. New studies have emerged, most notably those of Dobkin de Rios, who has taken what is in my view an extreme position. Given that DMT, the visionary agent present in both Psychotria viridis and Diplopterys cabrerana is an illegal substance, emanating from 1970 Control Substances Act of the United States of America, she considers this phenomenon as a manifestation of international drug trafficking. People arriving to Iquitos are empty souls looking for a high, while most practitioners meeting the demand simply charlatans looking for profit and taking advantage of female participants[38,39]. I see this phenomenon in a different way, rather as a

Indigenous and mestizo use of ayahuasca

sort of continuation of the vegetalismo tradition turned international, with positive as well as negative aspects. It is not my intention to examine here such a complex phenomenon. I rather prefer to point out to a recent study, which I find most welcomed. I am referring to Evgenia Fotiou’s doctoral dissertation about ayahuasca tourism in Iquitos. She writes: “Through my data I show that the western interest in ayahuasca is much more than a pretext for drug use but rather is often perceived as a pilgrimage and should be looked at in the context of a new paradigm, or rather a shift in the discourse about plant hallucinogens, a discourse that tackles them as sacraments, in sharp contrast to chemical drugs. Ritual in this context is instrumental but not as something that reproduces social structure; rather it fosters self transformation while at the same time challenging the participants’ very cultural constructs and basic assumptions about the world”[40]. Fotiou sees ayahuasca tourism as a two-way avenue in which indigenous and mestizo ayahuasqueros absorb –once more- certain western ideas and adapt their practices to the expectations of non-Amazonians, while people from other countries adopt indigenous ideas about intelligent plant spirits and the like. This is not at all something new. As we have seen earlier, exchange of symbols and power metaphors have been an essential part of Amazonian shamanism. We are now in a phase beyond ayahuasca tourism. Ayahuasca is becoming –in a modest scale, of course- a global phenomenon, with practitioners coming from various traditions, such as the Brazilian religious organizations, and with the absorption of a number of therapeutic techniques. There is an increasing number of people who for one reason or another decided to conduct rituals in their own settings. It is my impression, corroborated by a study by Winkelman[41] that more often than not most of the people taking ayahuasca now-a-days do it with the intention of finding guidance from within, for personal growth, or in search of spiritual experiences. Claudio Naranjo observed in 1967 when doing experiments with harmaline, an alkaloid mostly found in trace amounts, but also present in significant amounts in certain brews, pointed out that “concern with religious and philosophical questions is frequent”[42]. Shanon[43] has pointed out similar ideas regarding ayahuasca intake among Westerners, a position I also ratify. More so, I believe ayahuasca/yagé, as well as other sacred plant preparations from the Americas and beyond, have extraordinary potential in the study of consciousness and as cognitive tools. More studies should be conducted, as well as public discussions as how to deal, in a positive way, with one of the greatest discoveries of Amazonian people.

Luis Eduardo Luna

References 1. 2.

3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.

18. 19. 20. 21.

Beyer, S.V. 2009, Singing to the Plants. A Guide to Mestizo Shamanism in the Upper Amazon, University of New Mexico Press, Albuquerque. Pané, R. 1944, In: Historia del Almirante de las Indias Don Cristóbal Colón – Colección de fuentes para la Historia de América, F. Colón, Editorial Bakel, Buenos Aires, 163. Cárdenas, J. 1591, Primera Parte des Segretos Maravilosos de las Indias, México. Schultes, R.E., and Hofmann, A. 1979, Plants of the Gods – Origins of Hallucinogenic Use, Alfred van der Marck Editions, New York. Chantre y Herrera, J. 1901, Historia de las Misiones de la Compañía de Jesús en el Marañón español – 1637-1767, Madrid. Reichel-Dolmatoff, G. 1975, The Shaman and The Jaguar – A Study of Narcotic Drugs Among the Indians of Colombia, Temple University Press, Philadelphia. Langdon, J.E. 1986, Las clasificaciones del yajé dentro del grupo Siona: etnobotánica, etnoquímica e historia. América Indígena, vol. XLVI. Ott. J. 1993, Pharmacotheon – Entheogenic Drugs, their Plant Sources and History, Natural Products CO., Kennevick. Ott, J. 1994, Ayahuasca Analogues – Pangaen Entheogens, Natural Products CO., Kennevick. Luna, L.E. 1986, Vegetalismo – Shamanism Among the Mestizo Population of the Peruvian Amazon, Almqvist & Wiksell International, Stockholm. Brabec de Mori, B. 2011, In: The globalization of the uses of Ayahuasca, H. Jungaberle and B.C. Labate, (Eds.), Göttingen-Bern-Wien-Oxford, Hogrefe. Rose, I.S., and Langdon, E.J. 2010, Diálogos (neo)xamânicos: encontros entre os Guarani e a ayahuasca. Revista Tellus, 18, 83. Rätsch, C. 2005, The Encyclopedia of Psychoactive Plants – Ethnopharmacology and Its Applications, Park Street Press, Rochester. Schultes, R.E. 1982., J. Psychoactive Drugs, 14, 205. Luna, L.E., and White, S. 2000, Ayahuasca Reader – Encounters with the Amazon’s Sacred Brew, Synergetic Press, Santa Fe. Lagrou, E. 2000, In: Ayahuasca Reader – Encounters with the Amazon’s Sacred Vine, L.E. Luna and S.F. White, Synergetic Press, Santa Fe. Balé, W., and Erickson, C.L. (Eds.). 2005, Time and Complexity in Historical Ecology: Studies in the Neotropical Lowlands, Columbia University Press, New York. Erickson, C.L. 2005, In: Time and Complexity in Historical Ecology: Studies in the Neotropical Lowlands, W. Balé and C.L. Erickson (Eds.), Columbia University Press, New York. Carvajal, G. 1986 [written 1542], In: La aventura del Amazonas, A. Carvajal and A. de Rojas (Eds.), Ed. de Rafael Díaz, Madrid. Karsten, R. 1935, The Headhunters of Western Amazonas – The Life and Culture of the Jibaro Indians of Eastern Ecuador and Peru. Societas Scientiarum Fennica. Commentationes Humanarum Litterarum VII. 1. Helsinki. Goldman, I. 1963, The Cubeo, Indians of Northwest Amazon. The University of Illinois Press, Urbana.

Indigenous and mestizo use of ayahuasca

22. Harner, M.J. 1972, The Jívaro: People of the Sacred Waterfalls, University of California Press, Berkeley. 23. Harner, M.J. 1980, The Way of the Shaman – A Guide to Power and Healing, Bantam Books, Toronto, New York. 24. Winkelman, M. 2010, Shamanism: A Biopsychosocial Paradigm of Consciousness and Healing, ABC-CLIO Publishers, Santa Barbara. 25. Langdon, J. 1992, In: Portals of Power: Shamanism in South America, J. Langdon and G. Baer (Eds.), University of New Mexico Press, Albuquerque. 26. Langdon, J.E. 1979, In: Spirits, Shamans and Stars, D. Browman and R.A. Schwartz (Eds.), Mouton Publishers. 27. Calavia, O. 2000, In: Ayahuasca Reader – Encounters with the Amazon’s Sacred Brew, L.E. Luna and S. White (Eds.), Synergetic Press, Santa Fe. 28. Calella, P. 1935, Boletín de Estudios Históricos, 73-4, 49. 29. Reichel-Dolmatoff, G. 1978, Beyond the Milky Way, UCLA Latin American Center, Los Angeles. 30. Gebhart-Sayer, A. 1986, Amazonía Indígena, 46. 31. Brown, M.F. 1978, In: The Nature and Status of Ethnobotany, R.I. Ford (Ed.), Michigan, Museum of Anthropology, University of Michigan. Anthropological Papers No. 67, 1, 118. 32. Brown, M.F. 1985, Tsewa's Gift: Magic and Meaning in an Amazonian Society, Smithsonian Institution Press, Washington. 33. Luna, L.E. 1984, J. Ethnopharmacol., 11, 135. 34. Luna, L.E., and Amaringo, P.C. 1991, Ayahuasca Visions: The Religious Iconography of a Peruvian Shaman, North Atlantic Books, Berkeley. 35. Albuquerque, M.B. 2011, Epistemologia e saberes da ayahuasca, Eduepa, Belém. 36. Chevalier, J.M. 1982, Civilization and the Stolen Gift: Capital, Kin, and Cult in Eastern Peru, University of Toronto Press. 37. Chaumei, J.P. 1983, Voir, Savoir, Pouvoir – Le chamanisme chez les Yagua du Nord-Est peruvien. Éditions de l'École des Hautes Études en Sciences Sociales, Paris. 38. Dobkin de Rios, M. 2006, Mea Culpa: Drug Tourism and the Anthropologist's Responsibility, Anthropology News. 39. Dobkin de Rios, M., and Rumrrill, R. 2008, A Hallucinogenic Tea, Laced with Controversy – Ayahuasca in the Amazon and the United States, Praeger, Westport Connecticut and London. 40. Fotiou, E. 2010, From medicine men to day trippers: Shamanic tourism in Iquitos, Peru. Doctoral dissertation. Dept. of Anthropology, University of Wisconsin-Madison. 41. Winkelman, M. 2005, J. Psychoactive Drugs, 37, 209. 42. Naranjo, C. 1967, In: Ethnopharmacological Search for Psychoactive Drugs, D.H. Efron (Ed.), Public Health Service Public. No. 1645, Washington. 43. Shanon, B. 2002, The Antipodes of the Mind – Charting the Phenomenology of the Ayahuasca Experience, Oxford University Press.

Transworld Research Network 37/661 (2), Fort P.O. Trivandrum-695 023 Kerala, India

The Ethnopharmacology of Ayahuasca, 2011: 23-53 ISBN: 978-81-7895-526-1 Editor: Rafael Guimarães dos Santos

2. The notion of cure in the Brazilian ayahuasca religions Sandra Lucia Goulart

Assistant Professor at Cásper Líbero College, São Paulo, Brazil and researcher in NEIP (Psychoactives Interdisciplinary Study Group), São Paulo, Brazil

Abstract. This article discusses concepts and practices of healing in Brazilian religions which have in common the use of a psychoactive beverage mainly known by the names of Daime, Vegetal and Ayahuasca. These religions are elaborated from the same set of cultural traditions which nonetheless unfolds in different ways. All of them originate in the Brazilian Amazon region and in some cases, these processes expand to other parts of Brazil and abroad. We compare here the ways in which the healing is experienced and explained in these religions, emphasizing the representations concerning this beverage used in all of them. The case of these religions points to the complexity of the relation between both scientific and religious medicines.

1. Introduction In this article we intend to develop an analysis of the therapeutic concepts present in some religious cults emerged in the Brazilian Amazon region Correspondence/Reprint request: Dr. Sandra Lucia Goulart, Assistant Professor at Cásper Líbero College, São Paulo, Brazil and researcher in NEIP (Psychoactives Interdisciplinary Study Group), São Paulo, Brazil E-mail: sgoular@uol.com.br

Sandra Lucia Goulart

starting from 1930. All these cults have in common the use of the same psychoactive beverage, made by brewing a combination of two plants, a liana whose scientific name is Banisteriopsis caapi and the leaves of a bush, Psychotria viridis1. In all of them this beverage also receives different designations. Thus, in some of them the beverage is named Daime, in others as Vegetal. The main habitat of the Banisteriopsis caapi is the East of the Andes, Peru, Bolivia, the whole Northwest of the Amazon, the Colombian and Brazilian Amazon, Ecuador and Venezuela. Outside the context of these Brazilian religions, the term ayahuasca is one of the most known and used for such psychoactive beverage. The term is quite widespread in Peru and comes from Quechua. Aya means persona, soul, “espíritu muerto”, and Wasca means rope, “enredadera”, “parra”, “liana”. The name is used to designate both the beverage and one of the plants composing it: the liana Banisteriopsis caapi[1]. Therefore ayahuasca can be literally translated to Portuguese, as “the rope of the spirits” or “the rope of the dead” and also as “the liana of the spirits or the dead”. Nowadays, the term “ayahuasca religions” is also used by many scholars to refer to cults which have arisen in Brazil. Within the indigenous context, the beverage is mainly consumed in the Pano linguistic trunk groups (Eastern Peru / South Acre), Arawak (Peru), and Tukano (Colombia), receiving different names in these different contexts. Nowadays, throughout the Amazon, there are about seventy indigenous groups making use of this beverage. The contexts of these practices vary considerably. Although there are extensive and ancient indigenous and mestizo traditions in the use of this beverage, the emergence 1

The liana Banisteriopsis caapi contains three beta-carboline alkaloids: harmaline, harmine and tetrahydroharmine. The plant species Psychotria viridis, a bush, has as its active ingredient another alkaloid, DMT (N,N-dimethyltryptamine), substance considered as the main responsible for the visionary effect or the hallucinogenic aspect of this beverage. However, it is known that DMT has no effect when ingested orally, as it is deactivated by an enzyme present in the human digestive tract, the MAO (monoamine oxidase). Hence, precisely, the importance of the alkaloids present in the liana, which has the function to temporarily disable the MAO, allowing the DMT to activate the central nervous system, thus producing its visionary effects. It is also important to remember that since 1971, the Convention on Psychotropic Substances, signed in Vienna has included the DMT on its top list of forbidden drugs, considered highly dangerous. The ban involves many intricate and controversial discussions[2]. Just to mention some issues, it is worth noting that in addition to Psychotria viridis, several other species also have certain amounts of DMT, such as some kinds of fungi, fish and mammals, including man himself, but suffer no prohibition.

Cure in the Brazilian ayahuasca religions

of organized, urban, non-indigenous, religions based on its consumption, is an exclusive phenomenon of the Brazilian region.

2. Mestre Irineu’s daime Historically, the first of these religions was organized by Raimundo Irineu Serra in the city of Rio Branco, capital of Acre state, in 1930. He, who would later become known as Mestre Irineu was native from the state of Maranhão, Northeast of Brazil. As most Northeastern people, he migrated to the Amazon region, still early in the first decade of the twentieth century, to work with the extraction of rubber. It is during the period in which he works as a rubber tapper, in a border region between Brazil, Bolivia and Peru that Mestre Irineu gets in contact with a whole culture of the use of this beverage which would be central in the new religious cult founded by him. Between 1915 and 1918, more specifically in Brasiléia, Mestre Irineu would have not only his first experiences with ayahuasca, but also begin to develop the principles of worship that would later become known by the names of Alto Santo, Daime or Santo Daime2. That is when the use of the beverage provides him a set of mystical experiences, which feature the vision of a female entity that gives him the doctrinal basis of the new cult based on the use of the beverage, now called Daime. This entity who would later be identified by Mestre Irineu as the Virgin Mary, from the Catholic tradition, would have clarified that the real name of that beverage was “Daime”, whose meaning comes from a request or invocation made by those who consume the beverage to the spiritual being who reigns it. Thus, the believers would ask: “Give me light”, “Give Me Love”, “Give me wisdom”, “Give me health” etc. This explanation of the name Daime, already points to the importance that the psychoactive beverage takes in the definition of the religious experience of this cult believers. It indicates that the Daime is assigned a crucial role in obtaining mystical, doctrinaire teachings or healing revelations - spiritual or 2

Only in 1970, shortly before his death that Mestre Irineu had his group notarized as a religious institution, under the name of CICLU (Centro da Iluminação Cristã Luz Universal – Christian Enlightening Center Universal Light). Previously, in 1945, Mestre Irineu received a property donation, the Custódio Freire colony, located in the rural suburbs of Rio Branco. He shared this land among his followers and built his church at this site. The location, the church and, in some situations, the cult itself, became known as Alto Santo. However, over time and even with the emergence of new groups in this religious tradition, the group originally founded by Mestre Irineu is also identified in some situations as “Daime” or “Santo Daime”. In this article this term will be frequently used in order to refer to the religion created by Mestre Irineu.

Sandra Lucia Goulart

material. During this period, in Brasiléia, Mestre Ireneu organized along with two fellows from Maranhão: André and Antonio Costa, the Centro de Regeneração e Fé (Center for Regeneration and Faith), which had as its main point of practices the consumption of ayahuasca. Nevertheless, the daimist cult only begins to be effectively organized in 1930, when Mestre Ireneu already lives in Rio Branco. At that time, he was established in the district of Vila Ivonete, rural area of the Acre capital which, in that period, housed rubber plants and small agricultural colonies, whose tenants were mostly former rubber tappers. Mestre Irineu, as well as several of the first members of his cult, had, by then, small colonies. As shown in other studies[3-5], to a certain extent, the religious group founded by Mestre Irineu, in Rio Branco, expressed both the material reorganization of former rubber tappers that, in a new environment, began to engage in the agriculture activity, as the rescue of a group of ancient regional cultural elements, which were resignified according to this context. At this time, issues related to health, disease and healing problems, gained prominence. Accordingly, the cult founded by Mestre Irineu appears, initially as a healing cult. In the early years that marked the organization of his religious group in Rio Branco, Mestre Irineu performed especially “healing works” with the Daime. It was through this kind of practice that he and his new cult were gradually becoming known, gathering followers in the region. Many of those who sought the guidance of Mestre Irineu, at that time, brought up requests related to health problems and, in most cases, those were typical of diseases from the region and from a social layer of low income, with little access to the official medicine. Thereby, the first believers of the group founded by Mestre Irineu were converted, especially as they felt their misfortunes and ailments were cured or solved. This was the case of Antonio Ribeiro (and part of his family), one of the earliest supporters of the cult of Mestre Irineu. In an interview with me, his daughter, Percília Ribeiro, reported that her father sought Mestre Irineu in 1934 because he suffered from malaria, and could not have it cured through the conventional medical treatments. In her words: “There was no medicine to cure that (...) Dad went only from home to the hospital, just taking drugs... And none of them made him better (...) Then he went to meet Mestre (...) It was when he took the Daime. Soon he was cured (...)” This kind of statement is often repeated among many of those who became disciples of Mestre Irineu in those early days. For them, Mestre Irineu’s guidance, using the Daime, was usually preferred and more valued

Cure in the Brazilian ayahuasca religions

when compared to a medicine considered poor, inefficient or even absent, revealing the lack of access of a certain population to medical services. Often, even when such access was possible, the narratives point to the existence of a distance between the doctors’ speech and the universe of the patient, which ended up hindering the cure. In some statements, the interviewees stated similarly to the testimonial above that doctors would not “understand” or “figure out” what were the illnesses which afflicted him, therefore not being able to “find” the proper medicine needed to cure them. Also accordingly, the Daime would appear, for these believers, both as a remedy and a kind of oracle, through which one could have the “revelation” of the required treatment for a particular case. The so “revealed” and prescribed remedies could be from teas or herbal compresses to even allopathic pills and tablets. In the same statement quoted above, Mrs. Percília Ribeiro tells that, besides her father, she herself was cured with the use of Daime through Mestre Irineu’s guidelines. In her case however the cure came with the “revelation” of the “right medicine”, obtained by Mestre Irineu through the use of the Daime. So she tells us: “One day Mestre Irineu told dad: 'look, this one here is her medication. She’ll take a box and she’ll be better'. And I took all those pills, the whole box, as Mestre Irineu said, and I finally got better. It was like that ... sometimes the medicine was the Daime, when not Mestre would see one’s remedy. He would get one’s remedy through the Daime (...) It was like that, and who was with Mestre did not need another doctor (...)” The term “miração” seems to come from the Spanish verb “mirar” which can be translated into English as “see” or “look”. In the border regions of Brazil with Spanish-speaking countries such as Peru and Bolivia, the use of words in two languages is usual, in this case Portuguese and Spanish. As seen, the religious cult founded by Mestre Irineu is in its origin, related to the cultural context of a border region among Brazil, Bolivia and Peru, and so, perhaps, some expressions and categories of this religious universe refer to the Spanish language. “Miração” is a daimist fundamental category, which refers to the effects of the Daime, especially the visual ones, meaning the pinnacle of the beverage effects, marking a crucial moment of contact between the believer and the sacred world. The idea of “see” the right remedy for a particular disease “through the Daime”, seems close to a set of concepts sustaining the oldest uses of ayahuasca, which preceded the formation of Mestre Irineu's cult. This is the case of traditions that were largely formed from the upper Amazon

Sandra Lucia Goulart

watershed as a result of the contact among the indigenous Christianized groups, riverside mestizo populations and mainly rubber tappers, who began to occupy the region from the mid-nineteenth century. According to Luis Eduardo Luna[1] it was exactly this cultural exchange among these different groups that allowed the emergence of a new set of practices around the use of the ayahuasca beverage. These new practices, developed in a different context from the tribes or villages of the indigenous groups, and started emphasizing the use of the ayahuasca for therapeutic purposes. Mainly for the tappers who started to live in a new and hostile environment, in poor survival conditions, the ayahuasca started to be configured as a remedy for all kinds of ailments[1]. Thus, the new occupant groups of the Amazon region resignified the uses of this beverage, originally drank by the indigenous peoples. Studies such as Luna’s suggest that actually, the consumption of the ayahuasca in this new context, deeply influenced by a mestizo rubber tapping culture, becomes relevant when compared to its ancient indigenous use. Also accordingly, Luna says his informers from the Peruvian region often used to say that the “caucheiros” discovered the ayahuasca[1]. Yet, Nunes Pereira[6] called the ayahuasca as “yerba del cauchero” (cauchero’s herb). Luna[1] studied the shamanic healers from the Peruvian jungle, mainly from Iquitos and Pucallpa, locally called as “vegetalists”. The “vegetalists” are so called because it is sustained that all their knowledge comes from the spirits of certain plants, which would be the real teachers of these healing agents. For this reason, these plants are called “doctors” or “master plants”. From all of these, the ayahuasca is the most used and most relevant one. There are many differences between the Peruvian ayahuasca vegetalism and the Daime cult founded by Mestre Irineu, however at the same time, there are common points between them. As argued before[3-5] the cult founded by Mestre Irineu in the thirties in Rio Branco resulted in an ambiguous process where some aspects of this vegetalist tradition were abandoned or denied, while others were rescued and reinterpreted. The idea of a symbiosis between man and vegetable species, expressed in the vegetalist concept that all aspiring shamans should ritually turn into a “spirit plant”[1] and the very notion of “teaching plans”, were essential elements in the constitution of the new religion created by Mestre Irineu. In the daimist cult the idea that the Daime is a plant that teaches, therefore “teacher” par excellence, is reiterated in the hymns which organize most of the rituals, the exegeses of the believers, their experiences drinking it, and in the myths about the initiation of Mestre Irineu with the ayahuasca. The concept, equally fundamental in this religious universe, of the Daime as a crucial agent in the treatment processes as well as of the cure of several

Cure in the Brazilian ayahuasca religions

illnesses is associated with this idea of the Daime as a “plant that teaches”. Accordingly, the Daime is a vegetable animated being that teaches and can therefore reveal the presence of a disease, sometimes even unknown, in the body of the one who ingests it. It can help the healing, working as a drug to treat a specific disease, also having an oracle role when it points, in some cases, to the need for administration of other drugs. However, it is important to highlight that the elements of the traditions of the Peruvian ayahuasca vegetalismo are resignified in the daimist cult, now appearing associated with conceptions and practices of another cultural and religious complex. Besides the ayahuasca vegetalism, a whole set of elements of the so called popular Brazilian Catholicism was triggered for the formation of the new religion founded by Mestre Irineu in Rio Branco, as highlighted in other studies[3,5]. Based on the analysis made by different authors[7,8], it is possible to identify in the organization of the Daime rituals, many aspects of the tradition of popular Catholicism saint festivals, strongly disseminated throughout the ancient rural Brazil. Ancient forms of worship, such as celebrating a saint’s day with dance and a feast of typical regional food were being associated with the use of the Daime. Therefore the “work of hymnals” originates, which consisted in the gathering of the believers to sing and dance hymnals in a set of specific dates, generally following the Christian calendar, especially dates that celebrate some saints. As mentioned, when Mestre Irineu begins to organize his cult in Rio Branco, his ceremonies consisted primarily in healing “works” or “sessions” with the Daime. The structure of these “works” involved a few elements, the main one being the consumption of the Daime itself done either by the patient as by other participants. Gradually, however, the ritual structure of this religion becomes more complex. Mestre Irineu starts summarizing his experiences with the Daime in hymns, songs that are understood by these followers as a result of the connection with the spiritual world. Over time, several of the early followers of the cult founded by Mestre Irineu will also express their experiences with the Daime in the same fashion “receiving” their own hymns. This first group of daimists, led by Mestre Irineu, gradually organizes the whole ritual of this religion. Meetings were made to “take” the Daime and sing with fervor the hymns received by Mestre Irineu and some of his followers. The tradition of festivals for Christian saints was followed with enthusiasm by both Mestre Irineu and many of these early believers of the daimist cult. So, gradually, some dates that celebrated Christian saints were selected for the times when taking Daime and singing hymns were wanted. Thereby, a Daime ritual calendar was being made and over time, the work of hymnals with their specific dances was being elaborated.

Sandra Lucia Goulart

The meaning of the work with hymnals differs from the healing work with the Daime, which marks the original mode of the daimist cult. While these were made for specific cases, individual diseases, the work of hymnals were made for the community of believers. They mark the meeting of the whole brotherhood, affirm and strengthen the teaching, the doctrine and morality principles of this religion as well as its mythology and finally of all those elements that are emphasized in the hymns sung during such ceremonies. Accordingly, giving visibility to the daimist community itself as well as to the main foundations of this religion, which are not only expressed but, above all, experienced and internalized by the believers who participate in these works. However, this more collective character of the work of hymnals does not stop them from being also related to therapeutic and healing processes. Moreover, in a fashion, the very experience of internalizing and living the doctrinal principles enables these ceremonies, facilitating the emergence of such processes. These principles gain at this time a more personal sense, being interpreted by each believer according to their personal stories and experiences. For this reason, there are frequent reports in which the person, during the hymnal work, taking the Daime, finds out that he or she is sick, seeing in the “miração”, which is his or her illness and in which body part it is located. Similarly, the stories describing healings during hymnals are constant. There are several statements where people say that, during the “miração” at the hymnal work they were operated by spiritual beings and thus, cured. In order to illustrate that, follows below a piece of an interview I did with a lady who joined the Mestre Irineu’s religious group in Rio Branco in the 1960s. A native from Rio Branco, said that she decided to convert herself after she got the cure for both stomach and liver diseases that afflicted her at that time. “I had a dream about Mestre Irineu’s church. Only I did not know where the Mestre’s church was (...) I told my husband I knew where this place from the dream was. He was the one who took me there (...) I got there, I was kind of scared because I did not know (...) Then Mestre gave me only a little Daime. I thought nothing would happen (...) After a while it started (...) The miração came (…) that was when I got operated (...) I found myself in a hospital, on an operating table. It was all clean, very light. Two doctors arrived, accompanied by some nurses, with all the equipment to operate. Then a lady came (...), a very enlightened being, she smoked all over me. She did this smoking and handed me to those spiritual beings, that operated on me (...) I received this treatment though the Daime…from inside the Daime... And I’m here today (...)”

Cure in the Brazilian ayahuasca religions

These “spiritual” or “astral operations” testimonials are common among the daimists. Something that can be noticed in this sort of statement is the presence of metaphors relating to the official medicine and its officials such as doctors or nurses as well as references to their work tools and acting facilities, e.g. hospitals. Here is observed an ambiguity in these believers’ statements. On the one hand, there is a distrust regarding the official medicine and its officials, as well as a misunderstanding of its logic, on the other hand, there is a recurrence of the official medicine universe elements in the construction of exegeses on therapeutic processes, and of obtaining healing, experienced by those believers. In this aspect we can make some analogies between the daimist cult and other religious cults developed in Brazil. Firstly, many authors have pointed to the importance of either healing or its quest aspects, as for the presence of the imaginary related to the scientific or official medicine in the experience of the believers of the religions practiced in Brazil. Regarding the so-called African-Brazilian cults, such as Umbanda and Candomblé3, different scholars have observed that the desire for a cure or relief for a number of afflictions, also understood as organic, is a major cause of accession to these cults. That is the finding of Paula Montero[11] in a study about diseases and magic-religious therapeutic practices in the umbandist universe in São Paulo. According to Montero[11], 45% of the interviewees claim to have become umbandists “because of an illness”. José Guilherme Magnani[12], in a research on the treatment of mental illnesses in Umbanda, made in terreiros4 from São Paulo, also makes a similar statement. For him, most people who 3

Umbanda and Candomblé are religions formed in Brazil from the intercrossing of different elements from various traditions. Umbanda has been organized initially in the Southeast of Brazil, in cities as Rio de Janeiro and São Paulo, according to some researchers since the 1920’s[9]. Umbanda is composed of elements from African religions, as well as practices from Brazilian indigenous traditions, popular Catholicism and the Spiritism developed by Alan Kardec conceptions. Yet the Candomblé started to spread at the end of slavery in 1888, particularly in the Brazil Northeast. In the Candomblé originally from Iorubá (Nago) which initially spread in Brazil, the Orishas - intermediaries between the supreme God (OLORUN) and men who represent the forces of nature - are not worshiped. Currently, both the Candomblé and the Umbanda are found all over Brazil, although some types of Candomblé are yet stronger in the Northeast[10]. 4

Terreiro means the place where all ritual cult activities are performed, the house, with its yard and all the buildings. The term is used in different African-Brazilian cults. Often with a similar sense, the terms “house” or “center” [10] can also be used.

Sandra Lucia Goulart

turn not only to Umbanda terreiros, but also to Candomblé houses and spiritist centers5 do it for the healing of illnesses of the body or the soul[12]. At the same time, some of these authors also detect in the speech of African-Brazilian cult followers, especially of Umbanda, the same ambiguity we found in the case of the daimist cult in the matter of official medicine. The African-Brazilian cult followers would express simultaneously a dissatisfaction regarding the official medicine performance, including a skepticism regarding their therapeutic results and conversely, the frequent use of aspects specific to this medicine. In the same study mentioned earlier, Paula Montero[11] tries to show how this process takes place, concluding that the scientific medical speech and practice work either as a counterpoint or as a model for Umbanda healing activities. Accordingly, for example, fathers or mothers of a saint6 refer to themselves as “doctors” - either from the soul or spirit - and the terreiro is often seen or called as an “emergence room”, the apparel used by the followers is generally white, reminding to some extent, the also white uniforms, of the official medical professionals. Besides that, Montero and many others have often recorded the presence of “spiritual operations” - similar to those described by the daimists - in the healing statements from the umbandists. For Montero the ambiguous relationship that Umbanda keeps with the world of official medicine is explained by the fact that the magic-therapeutic practices applied by the first must necessarily take into account the dominant position of the second. In other words, while official medicine, official precisely for being dominant and hegemonic, is self-referential, the popular medicines, such as those of Umbanda, are subordinate. So they build their exercise through a constant reference to the official medicine model.

Spiritist center here refers to the Kardecist religion. This was organized by Hippolyte Rivail, a French pedagogue who adopted the pseudonym of Allan Kardec. From the mid-nineteenth century, Kardec starts to structure his doctrine which he classified as, religion, philosophy and science simultaneously; it is denominated spiritism due to the belief in the intervention of spirits of the dead driving some phenomena in the world of the living. Kardec’s Spiritism included a series of esoteric and spiritual beliefs that circulated in Europe and the United States especially since the late eighteenth century, as the theories of magnetism or the psyche. In Brazil, Kardec’s doctrine, also known as Allan Kardec, diffuses from the late nineteenth century, primarily among urban upper and middle layers, and then widely spread in different regions of the country and among several sectors of the population. 6

The two designations are used to refer to spiritual leaders of African-Brazilian cults, either in Umbanda or Candomblé.

Cure in the Brazilian ayahuasca religions

It is necessary to record that not only African-Brazilian cults, but several religions developed in Brazil would be deeply linked to the demand for the cure of diseases. Through different perspectives, studies which approach the consolidation and growth of the kardecism in Brazil hold in this matter. We can already see it in the classic study of Candido Procópio[13], on mediumistic religions7 in Brazil. For this author, there would be in the Brazilian society, a mediunic continuum, ranging from the African forms of worship (such as Umbanda) to those more Westernized and white (such as the orthodox spiritualism), being the different types of therapies for major diseases, elements in the limiting points of this continuum. Other authors highlight that the peculiarities of the kardecism in Brazil is a more remarkably therapeutic feature. Liana Trindade[15], for example, examines how, in the early expansion of kardecism in Brazil, kardecist notions and ideas, such as the “magnetic fluid”, adapt and blend to the old magictherapeutic beliefs from the lower layers of society, as the belief in the healing power of the spirits of the dead or their ancestors. Likewise, in the tradition of the popular Catholicism, especially in the worshiping practiced to the saints, the demands related to diseases and the search of their healing are emphasized, as other authors have already demonstrated[8,16]. Even religions that have grown more recently in Brazil, as the new protestant sects, the so-called Pentecostal services, also maintains this therapeutic aspect, since good part of its expansion is given in function of demands for the cure of illnesses and varied misfortunes. It has even made some scholars classify some religious cults such as the Brazilian Umbanda, Candomblé, Kardecism and Pentecostalism as “cults of affliction”[17,18]. Accordingly, the cult founded by Mestre Irineu continues one of the main forms of expression of the popular religiosity in Brazil which, as previously seen, is strongly linked to the issue of healing. Similarly, as a manifestation of popular medicines or therapies, comes also in a tense and ambiguous relationship with the scientific, hegemonic medicine. Here it is important to clarify that in both ayahuasca cults as in other religions, the constant reference to elements and notions of the official medicine universe does not 7

The mediumistic religions are founded on the notion of “mediunity”, which is understood as a gift which can express itself in different ways, through hearing, vision, dreams, intuition of the presence of spirits and souls of the dead, or even through incorporation of them in certain believers who are called mediums. These notions come from the Kardecism, however they were widely adopted in the Umbanda environment. In the kardecism, the typical mode of manifestation of the spirits of the dead is given through the word[10,14].

Sandra Lucia Goulart

mean a simple incorporation or reproduction of the biomedical logic. Instead, when it regards for example, the African-Brazilian cults, many authors state that when aspects of the conventional medicine are used by their believers they start having completely different meanings. Thus, Montero[11], despite viewing an inevitable subordination in the therapeutic umbandist practices, also contends that the Umbanda religious medicine acts in the gaps, the interstices of the official medicine, to surreptitiously deny and overcome this inferiority. The umbandist distinction between “material diseases” and “spiritual diseases” would express this simultaneous movement of affirmation and denial of the official medical practices domain. The material illnesses would be related to the official medicine performance, while the spiritual diseases would be from the religious sphere. From this perspective a complementarity among official medical practices and religious therapeutic practices is established. However, the assertion of this complementarity ends up culminating in a second stage, into the idea of superiority of the religious therapy. Montero shows that in the umbandist speech invariably, the official medicine is seen as capable of treating only the consequences of the diseases, while the religious sphere should have the role of treating their true causes. Actually, this brings us to another aspect of the religious therapeutic practices. As also shown by several studies, these practices tend to have a broader purpose other than just treating an organic problem. It is exactly because they have religious foundations, their answers and solutions are linked to broader ordinations, i.e. to cosmological explanations. The religious therapies offer an integrating principle[12], which enables the unfortunates to relate their woes to a larger context, and thus start providing them sense and coherence. The case of the daimist cult is no exception. Commonly these believers understand that their diseases are somehow related to other problems - not necessarily organic - which afflict them. They are seen therefore as signals, indications of the need for a personal transformation which implies in a change of behavior that concerns the subject’s life as a whole. Accordingly, in a general way, every healing process in the context of the daimist cult, involves a moral transformation of the patient. It is also in this manner that diseases are often viewed as a necessary suffering or, as the daimists say, “probations” which they must go through in order to transform spiritually. In another excerpt of the same statement quoted earlier, of the daimist who reports being operated spiritually “through the Daime”, we find an example of this kind of logic. “The Daime cured me (...) The Daime showed me everything that was wrong in my life ... Because there was so much wrong ... with my family, my children, with my husband, not only with me, you know ... That

Cure in the Brazilian ayahuasca religions

disease was like a burden, an ordeal, a suffering that I had to go through to reach the Daime and leave that life I used to lead (...) After that I decided to follow this doctrine and everything has improved in my life. It was like the being who manifested to me and said at the end of my operation, ‘here is your place. In this house, with these teachings, you’ll be forever cured’”. Here, the manifestation of the disease is intrinsically linked to the process of conversion and transformation that it entails. Although the interviewee reported earlier her disease was an organic state, i.e. that it was expressed through an imbalance of some of the organs of her body (stomach, liver), in a second part of the statement the disease is linked to broader situations of her life and her “cure” is thereby the starting point for her conversion to the daimist cult. At this point we can identify some changes in the conceptions about illnesses, healing and the role of the Daime in the therapeutic processes, in the cult founded by Mestre Irineu, regarding the ancient traditions of the ayahuasca use, as for example, the Peruvian vegetalism. The latter was based on an extensive knowledge of the natural environment in its thorough classification according to a hierarchy that associated and separated the different vegetable species. Thus, the cure also implied into the respect to the classification of the vegetable species, by making specific dietary requirements during the process where the patient was submitted to a treatment with the vegetalist and the ayahuasca. Furthermore, more generally, the use of the ayahuasca, within this Peruvian context, has the meaning of a physical “cleaning”. Ayahuasca is even called by many as “la purge”, emphasizing here its purpose is to detoxify the body. In the specific case of the curator, i.e. the vegetalist, his initiation involved the implementation of a longer and more strict diet, which included a series of food prohibitions (including alcoholic abstinence), in addition to sexual abstinence and the constant ingestion of the ayahuasca itself as well as other psychoactive plants. In the case of the daimist cult, there is also the requirement to hold a diet for those who consume the Daime. This diet was one of the first ritual precepts established by Mestre Irineu in the formation of his new cult in Rio Branco. However, the diet set by the Mestre Irineu refers only to the alcoholic and sex abstinence, three days before and after you drink the Daime. It does not imply, as in the Peruvian vegetalism, in more classifications of nature and plant species which led, in this case, to a number of other dietary requirements. It is true that the initiation of Mestre Irineu with the ayahuasca would have required a much longer and more restrictive diet regarding food consumption. Testimonials of his initiation which occurred yet in the region of Brasiléia, say

Sandra Lucia Goulart

that the Mestre Irineu was isolated inside the forest for several days, consuming in this period, only saltless manioc and the ayahuasca itself. Throughout his isolation in the forest, it is told that Mestre Irineu acquired the power to communicate with plants and animals. It was this diet and isolation in the forest that led to the revelation of the foundations of the Daime doctrine, made by a female entity to Mestre Irineu. In the Daime cult however, only the requirements related to alcohol and sex were kept. Moreover, they now gain a new meaning. Instead of being linked to other dietary rules, resulted from a whole magic classification of nature, these prohibitions refer to other morality. They are seen as a “cleaning”, in a more general character. It is not just about detoxifying the body, but rather “cleaning the impurities of the matter” so that the spirit can reach the “astral”. “Matter”, “spirit” and “astral” are fundamental categories of the daimist cosmology. “Matter” and “spirit” makes up a duality that guides and means the believers’ life and his behavior in this religion. The “matter” encompasses not only the physical body, but the whole sphere of “material earth life” associated in the daimist perspective to a “world of illusions”. The “spirit” opposes to the matter, pure and free from the “illusions” of the earthly life. The spirit relates to the “astral” world, a higher plan in which the spirit beings and deities live. Consuming the Daime is seen as a means of approaching the “astral world”. For this, one must move away from the “matter affection” and the “world of illusions”, which includes “addictions” and “bad habits” as daimists and several of its hymns lyrics often say. Sex, alcohol use, and attitudes that indicate greed, vanity, pride, are classified as “bad habits” which bind us to the matter preventing the spirit from reaching the “astral”. Accordingly, both the diet related to the use of Daime as the conceptions about diseases and their cures, in the daimist cult, are related to a more ascetic morality, in which aspects seen as mundane or secular are devalued and classified as inferior, impure or still sinful. The presence of some elements of this morality in turn, binds the daimist cult to broader processes that affected and transformed all the Brazilian old popular religious culture, from the 1930s. Indeed, several scholars of the subject show that, during this period, a new religious ethic emerges - in both urban and rural areas. This new ethic is expressed in different ways, either through the transformation of ancient religiosity as also through the emergence of new religions. Maria Isaura Pereira de Queiroz[19], for example, tried to show how from that moment a more ascetic moral came to dominate the popular Catholic practices that were once deeply marked by the sacralization of the festive aspects. Regarding in particular the Amazonian context, some authors, such as Galvão[7], highlight the transformation of traditional religious forms, such

Cure in the Brazilian ayahuasca religions

as the beliefs in the Amazonian shamanism (pajelança amazônica)8 that started to merge with Catholic practices or elements of the Kardecism which began to spread at this time precisely. Also in the Peruvian region, we may record a set of similar transformations in the practices of the ayahuasca vegetalism. Thus, Luna[1] states that from the early twentieth century, a new generation of vegetalists who incorporate a considerable amount of Christian elements in their ayahuasca sessions (such as prayers and summons to the Virgin Mary and Jesus) will be spread. However, in spite of these changes, the religion of Santo Daime also expresses many continuities in relation to earlier traditions of the ayahuasca use, as the Peruvian vegetalism. Despite the distinctions between the meaning of the daimista diet and the sense of the vegetal diet, the cult created by Mestre Irineu is based on the use of a “spirit plant”. As mentioned before, the Daime, this “divine being”, is understood as a plant that teaches and can heal or disclose the proper remedies for certain diseases. It remains, therefore, the idea of “conductor plant” in the vegetalist context. The use of the Daime is not linked to thorough classifications of the natural environment and different vegetable species (as in the vegetalism), but ultimately, the whole daimist experience with the beverage implies in a process of properties absorption of the latter by those who consume it. Thus, the Daime - the vegetable beverage - has “strength”, “power”, “light”, “knowledge”, as emphasized, moreover, in the hymns of that religion. By drinking the Daime during a “work”, the believer aims precisely at achieving many of these properties of the beverage: “strength”, “power”, “light” or “knowledge”. Simultaneously, the idea of “transforming in the Daime” leads the religious experience of the believer in this religion. As attempted to demonstrate earlier[3,5], the transformation in the Daime beverage is a theme emphasized in the mythical statements surrounding the initiation of Mestre Irineu with the ayahuasca. A common notion to this religious world is that “Mestre Irineu” is the Daime itself. This theme is reiterated in the personal experiences of each believer with the beverage. Testimonials of the “miração” for example, are common in which

It is called Amazonian shamanism a set of practices and conceptions of the cabocla population, which in Brazil express the results of the contact between the indigenous peoples and other groups that occupied the Amazon. Cabocla populations have here a more cultural sense. The Amazonian shamanism encompasses beliefs in spiritual beings (the “enchanted ones”) that inhabit natural places such as rivers, forests etc., as well as a whole concept of reciprocal relationships between men and natural environment[7].

Sandra Lucia Goulart

those who drink the Daime, claim to have become the liana (i.e. in Banisteriopsis caapi) or being transported to jagube and rainha plantations9. There are other relations between Mestre Irineu’s Santo Daime cult and the practices of the Peruvian ayahuasca vegetalism. So the great importance that the music in the form of hymns, has in structuring the Daime ritual has its parallel in the vegetalist context. The vegetalist healers, as shown by Luna[1], organized their ayahuasca sessions through songs, called “icaros”. These are magic musical melodies transmitted to the vegetalist through the master plants themselves. Just as the icaros, the Daime hymns during the rituals guide the experiences of the believers with the Daime, as well as the sensations caused by its use, especially those expressed through visions. In general, also in the Santo Daime context, a close relationship between the process of transmission and the use of Daime hymns is established. The main characteristic of the icaros is its healing power. The meaning of the term itself already points to the healing function of these melodies. Icarus, from the Quichua “ikaray”, means “blow smoke to heal”[1]. Likewise, the daimist hymns are closely related to the healing processes experienced in this religion scope. First because they are key elements in the structure and meaning of the experiences of the believers with the Daime, allowing the internalization of the doctrinaire principles of the religion in ritual moments. Second, because there are specific healing hymns, sung by the community of believers in specific ceremonies. Of course, as seen, the concepts of disease and cure acquire new meanings in the daimist context. However, there is equally a continuity regarding the vegetalist beliefs about the appearance of illnesses or misfortunes. Thus, as the latter, especially in older daimist statements, the record of stories about illnesses caused by the action of others through acts such as the introduction of magic - through spell - of strange objects or animals - mostly insects - in the patient's body is common. In fact, what is important to emphasize here is that the Santo Daime religion organized by Mestre Irineu in 1930’s in Rio Branco, relates to a broader context of Amazonian traditions, which also embraces the use of ayahuasca. The conceptions related to diseases and therapeutic processes, expressed in the cult created by Mestre Irineu, establish a direct link with a shamanic ayahuasca healing. This, according to Peter Gow[20], from about three hundred years, began to be outlined in some Amazon regions most affected by the transformations generated by the colonial contact and the rubber exploitation international economy. This new shamanism would be more emphatically focused on the 9

Jagube and Rainha are designations created by these believers when referring to the Banisteriopsis caapi liana plantations and the leaves of Psychotria viridis respectively.

Cure in the Brazilian ayahuasca religions

purpose of healing and the ayahuasca would take a central role in it, being conceived now, above all, as a therapeutic agent. So we also realize that in the religion created by Mestre Irineu, the Daime is one of the key elements in the explaining and ordering of diseases, misfortunes, and healings. More than that, the beverage is the main source of the doctrinal and cosmological exegesis of this religion. The difference related to other ancient Amazon ayahuasca traditions, is that in the daimist cult, the cure involves a process of conversion to a religious community, yet it is a religion that has at its core the experience with a vegetable beverage, seen as a teacher plant that heals.

3. The cure in other ayahuasca religions From the 1940’s other ayahuasca religions will start to appear in the Amazon region. In 1945, the group created by Daniel Pereira de Mattos (Mestre Daniel) also arises in Rio Branco, which will be known as Barquinha. In 1961, the União do Vegetal or UDV10 appears, founded by José Gabriel da Costa, Mestre Gabriel, in Rondônia, Porto Velho. In the UDV the ayahuasca is called Vegetal, not Daime. While the Santo Daime and the Barquinha cult have their formation processes related, the UDV had a somewhat more autonomous development11. There are different explanations for the term Barquinha. At first, it seems to be associated with one of the jobs carried out by the founder of the cult who before arriving in Acre, was a boat pilot. In addition, images and meanings associated to the sea and its sailors are highlighted in this religion. The clothes worn in rituals - called “uniforms” - resemble the sailors’ apparel, many of the psalms sung in ceremonies speak constantly of a “boat”, navigation and the sea. According to Araújo[22], Barquinha comes from the “boat” and is associated with Mestre Daniels’ followers mission, while the sea, in this religion, is associated with the tea itself, which is also called Daime here. Mestre Daniel attended Mestre Irineu’s daimist cult for about ten years. Over time, however, his experiences with the Daime led to the revelation that he had another “religious mission”, which would only be fully accomplished with the creation of a new cult around the use of the Daime[5,22]. This was 10

In 1970, the UDV is notarized by its founder, and its designation becomes Centro Espírita Beneficente União do Vegetal - Beneficent Spiritual Center Vegetable Union (CEBUDV).

On the history and cultural traditions formation that make up the religion of the UDV, I recommend reading an article which I published in the magazine Fieldwork in Religion[21].

Sandra Lucia Goulart

gradually being organized, at the beginning at Daniel’s own residence, located in a rural forest area in Rio Branco. The use of the Daime was being introduced gradually. It is said that initially, Mestre Daniel was locally known as a “praying person” sought to take away “quebranto” from children and “panama”12 from hunters, travelers and rubber tappers who passed through that region. Some of these people became the first followers of his cult. The prayers, the Daime, the received hymns, made people increasingly seek for Mestre Daniel to be “cured”. “People were saying that in this part there was a little old man, who prayed very well (...) That’s how his service was approved, and he healed so many people”, says Antonio Geraldo, who was one of the main leaders of this religion[24]. Over time, Mestre Daniel allied the consumption of the Daime to their prayers and blessings. The ceremonies were also becoming more complex. As in the case of the Santo Daime cult, they began to involve the singing of hymns. Just as occurred with Mestre Irineu, Mestre Daniel received his hymns in a process of mystical revelation stimulated by the consumption of the Daime. One of the most remarkable features of the ayahuasca religion founded by Mestre Daniel is its evident approach in practices and beliefs from African-Brazilian religions such as Umbanda. Many entities worshiped in Barquinha groups come from the pantheon of these religions, such as pretovelhos, caboclos, charms of the sea, mermaids, princes or orishas such as Oxun, Iemanjá, Xango, which are revered in some kinds of Umbanda and Candomblé13. Just as in African-Brazilian religions, in Barquinha these 12

As demonstrated by several authors, “panama” and “quebranto” consist in beliefs of the Amazon culture quite often used to explain the origin of certain types of diseases or misfortunes. The “panema” refers exactly to hunters’ bad luck in hunting or fishing[7,23], while the “quebranto”, particularly affects infants and children, referring to the breaking of rules that regulate and labels many social relationships, such as neighborhood and kinship. In both cases, it depends on the actions of agents as “healers” or “praying people”, who were characterized by the knowledge of Catholic and other kinds of prayers as well as magical practices, linked to European pagan and indigenous traditions. They used this knowledge to cure a whole range of illnesses typical from the old Brazilian rural world. 13

In the Umbanda some of the Orishas originated in Candomblé are worshiped, but the uniqueness of the umbandist religion is another type of entity, such as “preto-velhos” and “caboclos”, which are purified spirits of the dead. “Preto-velhos” are the spirits of former African slaves in Brazil and “caboclos” are the spirits of Native Brazilians. They are not gods as the Orishas. While the latter express their incorporation in the believers only through a kind of gesture and a dance, “preto-velhos” and “caboclos” use the word to communicate with men, providing advice and acting to cure their ailments. Today, there are in Brazil different types of Umbanda and Candomblé, which adopt and merge in varying degrees, these various entities[10].

Cure in the Brazilian ayahuasca religions

beings express their presence through a mediunic manifestation. This is understood, in general, as the ability of someone (the medium) to communicate with spiritual beings and feel their presence. The forms taken by this mediunic communication and the ways which spiritual beings manifest themselves may vary. In some Barquinha rituals, there is a dance - called “dance” or “play’ very similar to the “spins” of the African-Brazilian cults, in which spiritual entities - called “guides” - appear to incorporate the mediums (the “apparatus”) of “the house”14. In this case, the medium expresses his mediumship by incorporating spiritual entities, which is given through a typical way of dancing. However, at other Barquinha ritual moments, the mediunic communication can be manifested in different ways. The “guides” can speak through mediums, through lectures, or specific guidelines given to those who consult them etc., thus transmitting their messages. In all these cases, however the manifestation of these entities implies a certain degree of transformation of the mediums, in particular their physical expression. Therefore, the presence of the entity may be indicated by factors such as changes in the voice tone, the use of certain expressions and a kind of language, a particular facial expression or by the recurrence of certain props and objects - such as certain apparel or the use of tobacco smoked in a pipe. Anyway, these factors indicate that the “apparatus” is to a greater or lesser degree, expressing traits that are not his but his “guide’s”, who manifests itself somehow possessing his body at that moment. The spiritual work highlighted by Mestre Daniel in Barquinha aimed mainly at the mediunic development of the believers. This development of the believers’ mediunic abilities is indeed intrinsically related to the process of conversion to this religion. Though of course, not every Barquinha follower is a medium, there are many cases where the entrance into that cult is explained as the result of an “undeveloped mediumship”. This was in fact the situation of various group leaders from Barquinha. In some cases, the undeveloped mediumship was expressed initially by a disease that could manifest itself through organic imbalances. However, this disease is being explained as of an “spiritual order” and its healing will imply in a whole 14

“Spin”, “guides”, “apparatus”, “house” are all terms used in African-Brazilian cults, especially in Umbanda. The “spin” is a ritual session that is shaped like a circle dance in which spiritual entities come (down) the land and incorporate some of the believers. These can be called “apparatus” or “horses”. In some cases, in Umbanda, the entities who always incorporate the same “apparatus”, are called “guides”. “Home”, as seen, may be synonymous for “terreiro” and “center”.

Sandra Lucia Goulart

ordination of the spirituality of the medium. Thus, for example, the disease can mean the need for “indoctrination” of a soul, an entity, or even the “baptism” of pagan entities15. In all these cases it is considered that these beings are still considerably attached to the earthly, material life, and therefore would need spiritual “light”. The work of the medium consists precisely in providing “light” for such entities. In a certain way, the disease is seen as a sign that the patient is an undeveloped medium, whom different types of spirits attempt to communicate with. The absence of specific codes for the performance of this medium communication with the entities is what can generate the disease. In this sense, the cure consists in training, organization and regularization of the relations between the medium and its entities (his “guides”). As shown by several authors[11], this way of explaining the disease and its cure is typical of the umbandist universe. Let’s take the example of Mrs. Francisca Gabriel who is now a group leader in Barquinha, Rio Branco. As I reported in an interview, Francisca Gabriel met Mestre Daniel and his cult in 1957, having sought them due to a disease that afflicted her at the time. Although Francisca Gabriel has not provided us with details about this disease, she ensured that on that occasion, “she had already been undeceived by the doctors”. According to her, Mestre Daniel prescribed her a treatment which involved the combined use of “herbal” and “pharmacy medicines”. These directions were the result of “revelations” received by Mestre Daniel’s sessions with the Daime. Francisca Gabriel said, moreover, that her main medicine at that time was the Daime. She tells Mestre Daniel recommended her small daily doses of Daime - approximately three teaspoons - which she took for several months. “He ensured that I was going to be good, but it would take time. So, at first, he gave me just a little Daime. It was a small dose of medicine”. The amount of Daime given to Francisca Gabriel increased as her health improved. At the same time, the change in the dose of Daime seemed to relate to the deepening of her “spiritual work”. As she 15

The idea of “baptism of pagan entities” implies in the conception that some beings would be on a lower spiritual level and therefore in order to “evolve spiritually” would need to be “indoctrinated”. This “indoctrination” implies in a series of changes in the behavior of the entity and its way of manifesting when incorporated to its “apparatus”. Many times, the manifestations linked to the use of material objects such as tobacco smoking or the consumption of alcoholic beverages such as cachaça as well as the recurrence of ritual practices implicating in the deaths of animals are seen as expressions of little evolution. This kind of notion is present in a greater or lesser degree, in some forms of Umbanda, and indicates a great influence in the latter, of kardecism concepts.

Cure in the Brazilian ayahuasca religions

explained, “When I started to feel stronger, Mestre Daniel started to give me more Daime, so I could develop my “preparo”, knowing the entities that I had to work with”. The notion of “prepare” in this Barquinha universe refers to the particular process of mediunic development which certain believers (mediums) should go through. It is the “prepare” that allows the organization and regularization of relations between a medium and his “guides”, and its duration may even be long. It is possible to notice in this short statement, similarities between the processes of healing experienced by the followers of Barquinha and the Santo Daime of Mestre Irineu. Thus, in both cases we find that the Daime beverage has an important role in treating the disease, providing a remedy meaning, or also functioning as an oracle, i.e. as a means of revealing the drugs and procedures necessary for the healing. However, in Barquinha the Daime importance as a therapeutic agent is qualified by many other factors and in particular by the concept of mediumship. As seen, it is the development and regulation of the mediunic ability of the medium that in many cases, can lead to cure a disease. In this regard, it is important to clarify that, in Barquinha the development of mediumship implies in a healing process for both the medium and the spiritual entities which he works with. In order to regularize their mediunic abilities through a series of guidelines, procedures and ritual requirements (the “preparo”), the medium also does “charity work” for entities which need to evolve spiritually. His mediunic enhancement leads to the spiritual “indoctrination” of these entities. As explained by a leader of another Barquinha group, Mr. Antonio Geraldo. “(...) Sometimes a person with encosto showed up (..) Encosto16 is like this, one feels the symptoms of a disease. Then the person goes to medicalexamination, takes medication, spends money here and there and nothing. Until she comes to a center and finds out ... Sometimes it is a ghost of a relative, someone who died of an illness and is there, leaning (...) Because many times the person disembodies but finds no light, he or she is in the darkness and then keeps trying to grab those who are in this world (...) It can also be a being who needs indoctrination accompanying that person... They are beings who are asking for help, charity”. 16

The notion of “encosto” comes from Umbanda and refers to the action provoked by a spirit of a dead person (a “ghost”) in a person’s life, who was usually bonded to the first. This action always produces negative effects, among them a possible disease. In Portuguese it can mean support (“lean on someone”) or touch (“touching someone”) and also having a pejorative sense as “being dependent on or economically exploit someone”.

Sandra Lucia Goulart

However, once these entities are “indoctrinated” they can also start healing those who need and seek their assistance through mediums. As a matter of fact, the therapeutic action of these entities is actually what underlies much of the set of practices and conceptions of Barquinha, similar to what occurs in the Umbanda religion. As such, the cult of Barquinha is characterized by a set of rituals in which certain spiritual entities, incorporated in the mediums, provide guidance and advice to the believers, focusing mainly on issues related to diseases and their cures. These rituals are “charity works”, a designation that also comes from Umbanda. In them, the entities serve all who seek for them during private appointments. They speak through the bodies of mediums, and usually on these occasions prescribe, for those who are sick, teas, herbal baths, natural compresses, besides prescribing prayers, spiritual guidance and procedures. An essential element of these appointments provided by the entities is the “spiritual pass”. Identically to what happens in Umbanda, the mediums, now owned by the entity, passes their hands all over the body of the sufferer or unfortunate, many times also smoking him or her with his pipe or cigar. The intent is to pass good vibrations to the patient, eliminating the bad fluids that may be impregnating his or her body and spirit. Thus, the entity gives the pass and usually finishes the appointment. Whereas in the Santo Daime religion organized by Mestre Irineu, the concept of mediumship is not set as an important element in defining the relationship between the believers and spiritual beings. The idea that some believers would have special attributes is not highlighted, which would enable them to communicate more closely with spiritual entities. The Daime assumes then, a key role in establishing the contact between the believers and the spiritual world. It is the sacred beverage, “plant-spirit” and “teacher plant” which allows the daimists during their ceremonies, to deeper understand the meanings of their hymns, doctrine as well as “elevating themselves” to the “astral”. In the cult founded by Mestre Irineu, the Daime also inspires the revelation of hymns. While in Barquinha hymns are understood primarily as the result of a mediunic process. The spiritual entities are the ones who broadcast the lyrics and melodies of these songs to mediums. Therefore, compared to the Barquinha cult, in the religion created by Mestre Irineu, the Daime also assumes a much more central role with regard to the elaboration of concepts about diseases and their cures. The very idea of Daime as a remedy or as a revelation channel of the disease and its treatment is much stronger there than in the universe of Barquinha. Even because as seen in Barquinha, there are other major players in the disease solution process. The development of mediumship, the therapeutic

Cure in the Brazilian ayahuasca religions

action of spiritual entities, and the extensive recurrence of herbal knowledge, expressed in prescriptions provided by these entities when incorporated in mediums compete with the Daime, attenuating its importance as a therapeutic agent.

4. Final remarks A first aspect that we wish to emphasize here is that the ayahuasca cults are consistent with a whole way of Brazilian religiosity closely related to the matter of curing diseases. As mentioned, the desire to solve diseases is a major reason for conversion into various religions developed in Brazil, from the popular Catholicism to the current Pentecostal sects, as well as in African-Brazilian cults, in the Kardecism, and also in typical practices of certain regions, such as the caboclo Amazonian shamanism. That even makes the theme of Brazilian religions bound to the study of “religious medicines”, a term used by different authors to refer to the set of concepts and practices, present in these cults, aiming at the relief and explanation of diseases and several problems related to those[25]. In this discussion, a point highlighted by some authors[11,26] is the existence of an ambiguity in the relations that these religious medicines establish with the scientific medicine, which is the official one. So we see that Montero[11] detects this ambiguity in the umbandist healing practice, which is understood by her as a popular religious medicine. For the fact that they are in a subaltern and peripheral position, the therapeutic practices of Umbanda cannot ignore the realm of scientific medicine and therefore absorb many of its elements. Conversely, they subvert the biomedical logic when resignifying notions of the latter. They end up, in fact, contesting their subordinate position when asserting the religious superiority of their explanation opposite to the biomedical explanation on the disease. That same ambiguous process can be noticed in the ayahuasca religions commented here. Thereby, it can be observed that the process of curing or treating diseases experienced in both Santo Daime and Barquinha cults imply in the frequent recurrence of expressions, characters (doctors, nurses etc.), tools, procedures and concepts of the scientific medicine. At the same time, the elements and the logic of biomedicine, since entering the universe of these religions are submitted to its cosmological order. The physical discomfort turns into “mediunic” which needs to be developed, or in an “encosto” which has to be taken away from the “patient” and in an “ordeal” required for a particular process of religious conversion. Thereby, as a Barquinha group leader quoted in this article, “it ends up that the disease wasn’t actually a disease”. Furthermore, therapies developed in these

Sandra Lucia Goulart

ayahuasca religions, from the perspective of their believers, process and solve problems and diseases that the scientific medicine is unable to cure. As seen in the testimonials exposed, many come to these cults “undeceived” by the doctors or after having undergone various medical treatments without obtaining relief from their woes, which will only occur with the acceptance of new religious therapeutic practices. A notion that expresses this ambiguous relationship between ayahuasca religions and biomedical logic is the one of the “remedy”. We notice that the idea of remedy appears frequently in testimonials of these religions followers, to support explanations about treatments for varied diseases and misfortunes. It is very much associated with the Daime - the beverage. Thus in both Santo Daime and Barquinha, the Daime is seen as a remedy, i.e. a drug that can treat and heal an organic disease. Various statements, quoted here, highlight that idea. Many of these believers, as verified, say that drinking the Daime cured them or that the Daime was their main remedy. Continuing this kind of speech, also in many of these statements as seen, the use of the Daime remedy is similar to the use of modern official medicines. In this sense, the followers of these cults assert they have often used the Daime, similarly to the medicines prescribed by doctors, in “low doses”, and both Mestre Irineu as Mestre Daniel could decide, in accordance with the case, whether to prescribe the use of the Daime or the use of “pharmacy medicines”. However, a more thorough analysis of these reports shows that the Daime is a remedy for such believes in a very different fashion from the drugs used by the scientific medicine. Therefore, as already seen, it is said, for example, that Mestre Irineu often “saw” through the Daime which “pharmacy medicines” patients should consume. The Daime emerges then as a remedy of quite different characteristics from the official medicine drugs. It is a drug-oracle that reveals, magically, the existence of a disease, as well as how to cure it, discovering and pointing out the procedures and medications needed for each case. It teaches, explains, shows, enlights; in conclusion the Daime relates to the one who consumes it. Both establish a relationship of communication. It is, after all, a remedy that is a “plant-spirit” with “power”, “light” and “knowledge”. That is why, for the believers of these cults, it can heal better than the scientific medicine drugs. Yet on the relation between religious and scientific medicine drugs, it is worth remembering that after the end of slavery and the inauguration of the Republican regime in Brazil, a new penal code would also be established in this country in 1890. Where the illegal practice of medicine, low spiritism, magic and shamanism are strictly prohibited

Cure in the Brazilian ayahuasca religions

institutionalizing the repression of these activities and classifying them, generally, as quackery[27]17. This would directly affect the practices of African-Brazilian cults early in their formation. It is the case of Umbanda which as shown by several authors [9,11,27], suffered severe persecution at the time of its appearance, even in the twenties of the last century, when several of its practices involved healing and phytotherapy issues, labeled as “low spiritism”, “faith healing” and “quackery”. The ayahuasca religions were not immune to the impact of the new Penal Code. Thus, especially in the period within the thirties and the fifties, any occasional persecution and stigma suffered by Santo Daime and Barquinha cults in Rio Branco, were related to the association between use of the Daime and “faith healing” or “quackery” activities. In the case of Barquinha mainly, not just the use of the Daime, but the recurrence to a variety of other plants for medicinal purposes aggravated the identification of the cult as “faith healing”. The evident approach of Barquinha with African-Brazilian cults such as Umbanda, on the other hand stimulated the labeling of its rituals as “low spiritism” or “voodoo”. As argued by authors such as Maggie[27] and Negrão[9], among others, certain religions such as the African-Brazilian, were stigmatized as involving the presence of a set of common therapeutic practices whose struggle was of interest for the consolidation of an official scientific medicine. It is also worth mentioning that these practices started to be seen as signs of a “delayed” mentality and as an obstacle to the consolidation of a more “white”, “rational” and “modern” new Brazilian society18. Although these authors’ analyses are restricted to the AfricanBrazilian cults, we can extend it to the ayahuasca religions, which arise more or less at the same time as Umbanda, despite being in another region of the country19. 17

Article 157 of the Penal Code established penalties for those who practiced the “spiritualism, magic spells and their charms (...) to arouse feelings of hate or love, inculcate cures for curable or incurable diseases, and finally to dazzle and overwhelm the public credulity”. The penalty was 1-6 months in a prison cell[27]. 18

That is the conclusion of Renato Ortiz on the process that led to the formation of Umbanda and its adoption of aspects of the Kardecism which, according to the author, would be more appropriate to the progress aspirations of this emerging Brazilian society of the first decades of the twentieth century[28]. 19

I developed this thought more thoroughly in another work[29]. On the analogy between the processes of repression of the African-Brazilian and ayahuasca cults, after the promulgation of the 1890 Criminal Code, see also article by Edward MacRae[30].

Sandra Lucia Goulart

Also, the União do Vegetal, which appears in a later period, the sixties, in Porto Velho, Rondônia, may be related at least in part, to the process by which certain popular religious practices are being suppressed when categorized as “faith healing” and both are associated to a delayed mentality. In a way, maybe we can verify in this ayahuasca religion when compared to the other two commented here, a major effort regarding a distance from a set of therapeutic practices, understood as “quackery”. This is evidenced both in some ritual practices of the UDV, as in attitudes and assumptions of its followers, and especially in the pronouncements of its leaders as well as texts and documents20 prepared by them and eventually addressed to an outside audience. As I mentioned in an earlier work[21], this attitude is largely explained due to the existence of affection to a science speech in the UDV21. Although in the Brazilian Penal Code, the current ban on illegal medical practice, the low spiritism, magic and shamanism remains, it is noteworthy that the social image of the religious cults previously associated to these practices, e.g. the African-Brazilian ones, changed significantly. One aspect that points to this change is a greater membership of people from middle and upper classes to Umbanda and Candomblé, from the seventies. Negrão, for example, examined this process also showing how this period marks a growth of Umbanda in Brazil, in terms of numbers of believers and religious communities, also expressing a more positive impact of this religion and its practices in the national press[9]. 20

In the first official UDV publication, the book Hoasca - Fundamentos e Objetivos[31] establishes a complete distinction between body and spiritual healings, emphasizing that this institution is characterized by the use of the Vegetable only for spiritual healing not to cure the material, i.e. the “body”. It is explicitly stated that the UDV does not proclaim “the curative properties of the tea” and “does not practice or spread faith healing actions”[31]. However, as shown in some investigations[5], the UDV relation with healing practices connected to a phytotherapic knowledge is ambiguous. On the one hand, this kind of scientistic speech marks a distance from these practices, on the other hand, the presence of a number of elements in this cult indicates continuity with the logic that reigned the recurrence to those practices. 21

This is a scientificity ideal, very similar to the one which according to Renato Ortiz[28] guided the consolidation and dissemination of the Kardecism in Brazil. In this, according to Ortiz, concepts such as “science”, “evolution” of a “more conscious mediumship”, as well as less material and spell - e.g. the use of herbs for healing, or the artifacts, alcoholic beverages or tobacco by spiritual entities who were demonstrating - practices fulfilled the role of signaling a link to this ideal of scientificity[28,32].

Cure in the Brazilian ayahuasca religions

The case of the ayahuasca religions is a little different, since its emergence, expansion and growth are given after cults such as Umbanda. Moreover, its spread to other regions of Brazil besides the Amazon, involves new aspects. Among these, the association of religion with the drug issue in the contemporary society is highlighted. The expansion of these ayahuasca religions and their greater visibility in the Brazilian society, do not coincide with the outline of a positive social image of them. Instead, when they become more visible, being no longer restricted to the Amazon region, they begin to be analyzed by the Brazilian media in an extremely negative way. However, despite this fact, as in the case of the African-Brazilian cults, the spread of the ayahuasca religions also imply in a change of their believers’ sociocultural profile. When they reach the South and Southeast regions of the country, they start being embraced by individuals from higher social classes who express a very different lifestyle from those believers connected to the origin of these religions. Not all ayahuasca religions are involved with this movement of expansion and diversification of the profile of its followers. The UDV and CEFLURIS (Centro Eclético da Fluente Luz Universal Raimundo Irineu Serra), which is a division of the cult of Mestre Irineu’s Santo Daime that emerged in Rio Branco, Acre, in 197822, are the most related to this movement. Both the UDV and CEFLURIS have today groups in several other countries. The CEFLURIS is present in countries such as Argentina, United States, Japan, Spain, Portugal, Italy, Greece, England, Wales, France, Belgium, Holland, Switzerland and Germany23. The UDV has followers in the United States and Spain. The fact that the ayahuasca cults embrace today believers of different social strata brings new elements to the question on relations between subaltern religious therapeutic practices and an official and hegemonic scientific medicine. In this regard, we consider important to highlight that the marginalization of some of the practices of these cults is sustained despite the 22

The CEFLURIS was created by Sebastião Mota de Melo, who was known by his followers as “Padrinho Sebastião” and died in 1990. Sebastião Mota de Melo was born in Amazonas state and was part of the group created and led by Mestre Irineu. With his decease, he appeared as one of his possible successors. However, after a series of conflicts and disputes concerning the successor of Mestre Irineu in the group originally created, Sebastião Mota de Melo breaks with them and creates his own Daime center in Rio Branco. Today CEFLURIS is run by his sons. 23

Alberto Groisman[33] asserts that by 1996 there were twenty-eight groups associated with CEFLURIS in Europe and around five hundred people between followers and occasional attendees of their rituals.

Sandra Lucia Goulart

change in the socioeconomic profile of their believers. This occurs due to different factors. In particular, in contemporary complex societies we can identify a great heterogeneity of behavioral patterns, not only determined by economic conditions, which have a larger or smaller acceptance, according to different situations and historical moments. Regarding the recurrence of therapeutic activities it is possible to identify those generally called alternative therapies in relation to biomedicine. The recurrence of these alternative therapeutic approaches occurs relatively frequently in these ayahuasca religion groups that express an expansion and diversification motion of their socio-cultural followers. Rose[34], for example, studied a group linked to CEFLURIS located in Minas Gerais which has as one of its peculiarities, a strong presence of believers in the health and medicine area who also work with this kind of therapy. The author showed that an intersection between the uses and meanings of these alternative therapies and the daimist spiritual therapies occurs. As mentioned by other authors, nevertheless, the great difference between official medical practices and magic-religious medicines is that the latter offer principles and integrating responses to the misfortunes and illnesses experienced by the subjects, making them more meaningful and bearable. The religious medicine expresses a holistic view of the disease. Instead, the official medicine therapies act from a logic of specialization that separates, divides and classifies the sick body, understood as just a biological entity[12,35]. Finally, it is important to emphasize that the religious medicine expressed through the cults discussed in this article is deeply marked by the use of the psychoactive beverage called Daime or Vegetal in the different groups. As we can see by what has been stated here, for the believers of these cults the referred beverage ranges through a variety of meanings that infer and does not remit necessarily to its psychoactive or pharmacological characteristics. However, mainly from the expansion process of these religions, they are now identified, in the more comprehensive society, to the use of a drug or hallucinogen. At this point it is worth clarifying that in Brazil, the use of the ayahuasca has been under threat of a legal ban in several occasions. In 1985, it was even suspended, and the ayahuasca was on a list of psychotropic substances prohibited for a period of almost one year. In 1987, however, after a long survey conducted by a team of specialists from different scientific areas, the use of the beverage was liberated again, but only for religious and ritual purposes. The last document approved by the Brazilian government on this issue in January 2010 (Resolution No 01, January 2010/CONAD)24, was 24

This resolution was published in the DiĂĄrio Oficial da UniĂŁo (Federal Official Gazette), No. 17 from January 26, 2010, page 58.

Cure in the Brazilian ayahuasca religions

prepared by CONAD (Conselho Nacional de Políticas sobre Drogas National Drug Council)25. The preparation of the document resulted from discussions and assessments developed by a working group composed of experts on the subject, especially in biomedicine but also in humanities and counted also with the participation of representatives of major groups of these religions. The CONAD document legally sanctions the religious use of the beverage, based on the principle that assures the right to free exercise any cult or faith, established in the Brazilian constitution. Furthermore, the document contains a set of principles that constitute in recommendations for the appropriate use of the beverage, which should be followed by all ayahuasca cults. This document regulates the use of the ayahuasca in Brazil. Concerning the therapeutic use of the ayahuasca, providing continuity to a logic characterized by these cults, the CONAD document establishes that first, the so-called healing activities practiced in these cults consist of an “act of faith”, with a strict religious sense, a right therefore guaranteed by the Brazilian constitution, and on which the state cannot intervene. In this aspect the rules of CONAD continues the logic characterized by the ayahuasca cults, remembering that it was also elaborated from the considerations of the representatives of these cults’ perspective. Secondly, the CONAD regulation determines that the use of the ayahuasca for therapeutic purposes other than those strictly religious aiming at health or cure, are not allowed. The document clarifies that the use of the ayahuasca for this other purpose can only be made under confirmation of scientific research undertaken at academic institutions. It is true that the latest Brazilian government regulations on the use of the ayahuasca partly continue the arguments of the ayahuasca cult believers, by admitting that the therapeutic practices exercised in their contexts have a strictly religious meaning. However, the logic and mindset that support these practices differ considerably from the fundamentals that guide governmental decisions and opinions. As we tried to show throughout this article, the therapeutic activities of these cults merge different conceptions and practices, implying both in a phytotherapic experimentalism as in spiritual explanations 25

CONAD is the regulatory agency of the Sistema Nacional de Políticas Públicas sobre Drogas (National System of Public Policies on Drugs) - SISNAD - which is in charge of the drugs policy in Brazil. Both were created in 1998 to replace other agencies with a similar function. The CONAD is linked to the Presidential Institutional Security Office and consists of members who participate in government institutions as well as NGOs. Its function is to provide guidance, advice and recommendations on the drugs subject

Sandra Lucia Goulart

of diseases and also in the recurrence to scientific medicine procedures. At the same time, we saw that the elements of the scientific medicine, when part of the set of ayahuasca cult practices are reinterpreted by them and submitted to their cosmology. The Brazilian ayahuasca cults, accordingly, express and consolidate a therapeutic knowledge that is not only from a different order (religion) from that one perpetuated by biomedicine, but also stands as a counterpoint to this one, by moving from a logic and from quite distinct elements. With the present discussion we believe therefore, to be contributing to the reflection between the possible relations between religious and scientific medicines.

References 1. 2. 3. 4. 5. 6.

7. 8. 9. 10. 11. 12. 13. 14. 15.

Luna, L.E. 1986, Vegetalismo: shamanism among the mestizo population of the peruvian Amazon, Almqvist and Wiksell International, Stocolm. Labate, B.C. 2005, In: O Uso Ritual das Plantas de Poder, B.C. Labate and S.L. Goulart, (Eds.), Mercado de Letras, Campinas, 397. Goulart, S.L. 1996, As Raízes Culturais do Santo Daime. FFLCH, Universidade de São Paulo, São Paulo. Goulart, S.L. 2002, In: O Uso Ritual da Ayahuasca, B.C. Labate and W. Sena Araújo, (Eds.), Mercado de Letras, Campinas, 313. Goulart, S.L. 2004, Contrastes e continuidades em uma tradição amazônica: as religiões da ayahuasca. IFCH, UNICAMP, Campinas. Pereira Nunes, M. 1979 (1947), A Casa das Minas: contribuição ao estudo das sobrevivências do culto dos voduns do panteão daomeano, no estado do Maranhão, 2nd ed., Vozes, Petrópolis. Galvão, E. 1955, Santos e Visagens, Companhia Editora Nacional, São Paulo. Zaluar, A. 1983, Os Homens de Deus: um estudo dos santos e das festas no catolicismo popular, Zahar, Rio de Janeiro. Negrão, L. 1996, Entre a cruz e a encruzilhada: formação do campo umbandista em São Paulo, EDUSP, São Paulo. Cacciatore, O.G. 1988, Dicionário de Cultos Afro-Brasileiros, 3rd ed., Forense Universitária, Rio de Janeiro. Montero, P. 1985, Da Doença à Desordem: a magia na Umbanda, Graal, Rio de Janeiro. Magnani, J.G. 2002, Revista do Programa de Pós-graduação em Ciências Sociais, 40/41. Procópio, C. 1961, Kardecismo e Umbanda, Livraria Pioneira Editora, São Paulo. Cavalcanti, M.L.V.d.C. 1983, O Mundo Invisível: cosmologia, sistema ritual e noção de pessoa no espiritismo, Zahar, Rio de Janeiro. Trindade, L. 1991, Construções Míticas e História: estudo sobre as representações simbólicas e relações raciais em São Paulo do século XVIII à atualidade. FFLCH, Universidade de São Paulo, São Paulo.

Cure in the Brazilian ayahuasca religions

16. Brandão, C.R. 1981, Sacerdotes de Viola: rituais religiosos do catolicismo popular em São Paulo e Minas Gerais. Vozes, Petrópolis. 17. Fry, P. and N. Howe. 1975, Duas respostas à aflição: umbanda e pentecostalismo. Debate e Crítica, 6, 47. 18. Brumana, F.G. and E.G. Martínez. 1991, Marginália Sagrada, Ed. da Unicamp, Campinas. 19. Queiroz, M.I.P.d. 1978, Cultura, Sociedade Rural, Sociedade Urbana no Brasil, EDUSP, São Paulo. 20. Gow, P. 1996, In: Shamanism, History and the State, N. Thomas and C. Humphrey, (Eds), The University of Michigan Press, Ann Harbor, 90. 21. Goulart, S.L. 2006, Religious Matrices of the União do Vegetal. Fieldwork in Religion, 2, 286. 22. Sena Araújo, W. 1999, Navegando sobre as ondas do Daime: história, cosmologia e ritual da Barquinha. Editora da Unicamp/Centro de Memória, Campinas. 23. Da Matta, R. 1973, Panema: uma tentativa de análise estrutural. Ensaios de Antropologia Estrutural, Vozes: Petrópolis. 24. Figueiredo, E., et al. 1996, Mestre Antonio Geraldo e o Santo Daime. Centro Espírita Daniel Pereira de Matos “Barquinha”, Rio Branco. 25. Canesqui, A.M. 2003, Ciencia e Saúde Coletiva, 8. 26. Araújo, M.A.M. 2002, Das Ervas Medicinais à Fitoterapia, Ateliê Editorial, São Paulo. 27. Maggie, Y. 1992, Medo do feitiço: relações entre magia e poder no Brasil, Arquivo Nacional, Rio de Janeiro. 28. Ortiz, R. 1978, A morte branca do feiticeiro negro: umbanda, integração de uma religião numa sociedade de classes, Vozes, Petrópolis. 29. Goulart, S. L. 2008, In: Drogas e Cultura: novas perspectivas, B.C. Labate, et al., (Eds), Ed. da Universidade Federal da Bahia, Salvador, 251. 30. MacRae, E. 2008, In: Drogas e Cultura: novas perspectivas, B.C. Labate, et al., (Eds), Ed. da Universidade Federal da Bahia, Salvador, 289. 31. CEBUDV. 1989, Hoasca: Fundamentos e objetivos. Sede Geral, Brasília. 32. Ortiz, R. 1977, Religião e Sociedade, 1. 33. Groisman, A. 2000, Santo Daime in the Netherlands: an anthropological study of a new world religion in a european setting. University of London, London. 34. Rose, I. S.d. 2005, Espiritualidade, Terapia e Cura: um estudo sobre a expressão da experiência no Santo Daime. PhD in Antropologia Social, Centro de Ciências Humanas Universidade Federal de Santa Catarina, Florianopolis, Brasil. 35. Magnani, J.G. 1980, Doença e Cura na Religião Umbandista, Unicamp, Campinas.

Transworld Research Network 37/661 (2), Fort P.O. Trivandrum-695 023 Kerala, India

The Ethnopharmacology of Ayahuasca, 2011: 55-63 ISBN: 978-81-7895-526-1 Editor: Rafael Guimarães dos Santos

3. An overview of the literature on the pharmacology and neuropsychiatric long term effects of ayahuasca José Carlos Bouso and Jordi Riba

Human Experimental Neuropsychopharmacology and Centre d’Investigació de Medicaments (CIM-Sant Pau), Institut d’Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain

Abstract. The last two decades have seen a steady increase in the number of publications devoted to ayahuasca. This fascinating psychotropic plant tea has attracted the attention of biomedical and psychological scientists. Researchers have gathered data on the physiological impact of ayahuasca administration to humans and have assessed the consequences of long term regular use. Acute administration studies have provided information on the fate of the alkaloids in the organism, the modification of vital signs, neuroendocrine and immunological parameters and neurophysiological variables. For the first time, neuroimaging techniques have shown us which brain areas “light up” during the most intense phases of the ayahuasca experience. Also, the popularization of ayahuasca has raised concerns that its regular use may cause neuropsychiatric and addiction-related problems for Correspondence/Reprint request: Dr. Jordi Riba, Human Experimental Neuropsychopharmacology and Centre d’Investigació de Medicaments (CIM-Sant Pau), Institut d’Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain. E-mail: JRiba@santpau.cat

José Carlos Bouso & Jordi Riba

users. An increasing number of studies have tried to address these concerns. In the present chapter we aim to give an overview of the available literature on the human pharmacology of acute ayahuasca intake and on the neuropsychiatric and psychosocial consequences of its long-term use.

1. The human pharmacology of ayahuasca By temporarily modifying serotonergic neurotransmission, ayahuasca exerts a powerful action on the central nervous system. These neurochemical modifications constitute the basis of the unique experience reported by users. Scientific inquiry into the workings of ayahuasca, and all psychoactive drugs in general, is greatly advanced by the study of these substances in the only species that can accurately report on the diverse facets of the psychedelicinduced experience, i.e., human beings. By administering these compounds in known dosages to carefully selected individuals valuable information has been obtained on their impact on the human body and psyche. The clinical investigation of ayahuasca was initiated by a field study conducted in the early 1990s by Callaway, Grob, McKenna and colleagues, and aimed to assess the subjective and physiological impact of acute ayahuasca administration in regular users. In the study a 2 ml/kg dose of ayahuasca was given to a group of 15 long-term members of a Brazilian ayahuasca church known as União do Vegetal. Subjective effects were measured with the Hallucinogen Rating Scale (HRS; an instrument originally developed by Strassman and colleagues[1] to assess the effects of intravenous dimethyltryptamine [DMT])[2]. The authors also assessed various physiological parameters and the pharmacokinetic profile of ayahuasca alkaloids[3]. The HRS measurements provided information on six different spheres of the psychedelic-induced experience: Somaesthesia, reflecting somatic effects; Affect, sensitive to emotional and affective responses; Volition, indicating the volunteer’s degree of incapacitation; Cognition, describing modifications in thought processes or content; Perception, measuring visual, auditory, gustatory, and olfactory experiences; and, finally, Intensity, which reflects the strength of the overall experience. Scores on the six subscales showed that at the administered dose ayahuasca was able to induce distinct psychedelic effects, with the intensity of the experience falling on “the mild end of the spectrum when contrasted to the highly potent, shortacting intravenous DMT”[2]. This pioneering study found measurable plasma levels of the four main alkaloids (DMT, harmine, harmaline and tetrahydroharmine [THH]), described their pattern of variation with time and how this related with timedependent modifications which for the most part reached a maximum

Pharmacology and neuropsychiatry of ayahuasca

between one and two hours and had disappeared at 24 hours after ayahuasca ingestion[3]. More recently, research has been conducted by Riba and coworkers at the Hospital de Sant Pau in Barcelona. Since 1999 this team has performed a series of studies which have tried to better characterize the neuropharmacological profile of ayahuasca. The group started by analyzing the psychometric characteristics of the HRS and obtaining subjective ratings of ayahuasca[4]. A pilot study was then undertaken to assess the tolerability of ayahuasca within a range of dosages, from which safe and pharmacologically effective doses were selected for subsequent studies involving a larger number of volunteers[5]. A method to determine ayahuasca alkaloids in plasma was perfected to now include several metabolites which had not been measured previously in humans[6]. These initial efforts were followed by a series of clinical trials which have provided information on the pharmacokinetics, the subjective and cardiovascular effects of different doses of ayahuasca[7], and various psychophysiological measures[8-11]. For the first time in the centuries-long history of ayahuasca use, the neuroimaging study conducted by this team[12] identified the brain areas specifically involved in the genesis of ayahuasca effects. A review of their studies and findings between 1999 and 2004 can be found in Riba and Barbanoj (2005)[13]. In the last five years the same group has conducted additional studies on the sleep, neuroendocrine and immunological effects of ayahuasca, as well as on the pharmacology of repeated ayahuasca intake. Several of these studies are still pending publication[14]. As would be expected from conventional drugs and somewhat in contrast to popular belief, when administered in a clinical setting and carefully controlling for expectancy (blind designs) ayahuasca was found to act in a dose-dependent manner. This was the case for physiological (cardiovascular), pharmacokinetic and psychological variables (assessed with the HRS; with the ARCI – Addiction Research Centre Inventory, another rating scale to assess subjective effects of drugs; and with VAS – Visual Analogue Scales, a simple method to assess subjective effects of drugs consisting of 100-mm horizontal lines with different labels as “any effect”, “good effects”, “liking”, “visions”, etc., that subjects must mark depending on the intensity of a given effect as experienced while under the effects of the drug). In these studies, DMT plasma concentrations reached their peak coinciding with the maximum intensity of the subjective effects. An unexpected result was the very low levels of harmine found in plasma for the majority of participants. This is suggestive of intense metabolism and also indicative that, at least in some people, the contribution of harmine to the overall central effects of ayahuasca would be small[7]. Ayahuasca induced cardiovascular effects, basically consisting of elevations of

JosĂŠ Carlos Bouso & Jordi Riba

diastolic blood pressure. While these increases were moderate, caution should be exerted by people who have elevated blood pressure or other cardiovascular problems. This is even more relevant considering recent reports in the media concerning the unexplained deaths of people participating in ayahuasca rituals[15-17]. It should be noted that the clinical data which has been published to date is from young healthy volunteers. Safety results might be different in older people or individuals with pre-existing conditions. At the psychophysiological level ayahuasca induces significant effects, shifting the energy distribution in the electroencephalogram (EEG), i.e., the spontaneous electrical activity of the brain, towards the higher end of the power spectrum. This shift towards the so-called faster frequencies of the EEG can be measured as an increase in the relative power of the EEG beta band[10]. While this effect can be interpreted as reflecting enhanced Central Nervous System (CNS) activity, this activation is unique to psychedelics and different from that induced by traditional psychostimulants. Unpublished data from a study comparing ayahuasca with d-amphetamine (d-AMPH), a classical psychostimulant enhancing dopaminergic and noradrenergic neurotransmission, show that d-AMPH has no effect whatsoever on relative beta power[14]. Whereas both drugs share some sympathomimetic effects, such as increasing pupillary diameter and elevating blood pressure, the distinct effects of ayahuasca on the EEG would relate to its specific serotonergic mechanism. Differences in neurochemical mechanism are also evidenced by ayahuasca, but not d-AMPH, significantly increasing prolactin levels (a hormone whose release is enhanced by serotonergic drugs and inhibited by dopaminergic drugs). Despite these differences, both ayahuasca and d-AMPH induce a stress-like reaction increasing cortisol levels, the increment induced by ayahuasca being higher. Another interesting finding is that ayahuasca is able to modulate the cell immune system. This effect appears to be non-specific as both ayahuasca and amphetamine induce similar time-dependent modifications on lymphocyte subpopulations: the percentages of CD4 and CD3 cells decrease, while the percentage of NK cells increase. These changes reach a maximum at around 2 hours postadministration and return to baseline levels at 24 hours[14]. No studies have yet assessed the possible impact of these acute physiological modifications on the health of long term ayahuasca users. Perhaps the most interesting finding from the mentioned clinical trials is the identification of the brain areas where ayahuasca acts. Using the neuroimaging technique SPECT (single photon emission tomography) researchers found that ayahuasca acts almost exclusively on the cerebral cortex without acting on subcortical areas. Ayahuasca increases the activity of the anterior insula bilaterally, with greater intensity in the right

Pharmacology and neuropsychiatry of ayahuasca

hemisphere. It also hyperactivates the anterior cingulate/frontomedial cortex of the right hemisphere, areas previously known to be implicated in somatic awareness, subjective feeling states, the processing of emotional information and emotional arousal. Additional increases were observed in the left amygdala/parahippocampal gyrus, structures also involved in emotional arousal and the processing of memories[12].

2. Neuropsychiatric long term effects of ayahuasca Since personality and neuropsychological function are to a great extent regulated by the prefrontal cortex, the study of personality, psychopathological status and neuropsychological functions in long term ayahuasca users is essential to ascertain whether regular ayahuasca use has some impact on mental health. A few studies have been conducted assessing the consequences of regular ayahuasca use in the long term. The data available is limited and would need replication in larger samples. One preliminary study led by Charles Grob assessed personality and neuropsychological function using the TPQ (Tridimensional Personality Questionnaire) and the WHO-UCLA Auditory Verbal Learning Test. The questionnaires were administered to a sample of 15 regular users with more than 10 years of experience with ayahuasca and to a comparison group of 15 non-users. No personality alterations or neuropsychological deficits were found in the ayahuasca-using subjects, though there were personality differences between groups, which the authors did not interpret as pathological. No information was given as to whether the scores fell within the normal range according to normative data[2]. A typical problem with this kind of studies lies in the interpretation of results. It is difficult to establish whether the scores obtained with the TPQ reflect the impact of ayahuasca use or rather pre-use personality. In the study by Grob and coworkers the authors also used the structured psychiatric interview known as CIDI (Composite International Diagnostic Interview) and found that 11 out of the 15 participants had a history of moderate to severe past alcohol use. Five of them reported episodes of associated violent behavior and a diagnosis of alcohol abuse disorder prior to their involvement with an ayahuasca church. Four subjects also reported previous use of other drugs of abuse, including cocaine and amphetamines, and 8 of the 11 subjects who had a history of alcohol and other drug use and misuse were addicted to nicotine at the time of their first ayahuasca session. According to the authors, all these addiction problems resolved after they began their regular use of ayahuasca. Ayahuasca participants did not meet diagnostic criteria either for

José Carlos Bouso & Jordi Riba

addiction or for any other psychiatric disorder at the moment of the assessment. A recent study on 32 regular ayahuasca users belonging to the Igreja do Santo Daime in Oregon, USA, did not find psychiatric alterations as measured by a series of rating scales and compared to normative US data. As occurred in the study by Grob and colleagues[2], most of the ayahuasca users had shown some psychiatric disorder or some drug or alcohol abuse disorder in the past, which at the time of the assessment was not present. This was interpreted again as a direct benefit of participating in the Santo Daime ceremonies[18]. Since the subjects in this study were not compared with matched non-users, the findings should be interpreted with caution. Finally, two papers have been published regarding the long term psychopathological and neuropsychological effects of regular ayahuasca in adolescents. Each study involved 40 adolescents with a two-year history of ayahuasca use, and a comparison group of 40 matched non-users. No statistical differences were found in psychopathology scores[19] or in measures of neuropsychological function[20]. In sum, while no deletereous effects have been demonstrated, due to the small number of studies conducted on regular ayahuasca users the potential impact of sustained ayahuasca use on mental health remains an open question.

3. Additional studies Several studies have assessed the impact of acute ayahuasca on psychological traits and measures, psychopathology, personality and spirituality, all in a naturalistic context. In one study of first-time users of ayahuasca in the ritual context of the Brazilian churches of the Santo Daime (19 subjects) and the União do Vegetal (nine subjects), significant reductions of minor psychiatric symptoms and positive changes in behavior were found in the four days following ayahuasca use[21]. Another study found reductions in the scores of panic and hopelessness one hour after ayahuasca ingestion, as compared to baseline[22]. Still in another study, 49 participants without previous experience with ayahuasca attended different ayahuasca ceremonies after which quantitative and qualitative assessments of spiritual experiences were conducted. The rating scales measuring changes in spirituality were not significantly modified after the sessions, though many subjects experienced spiritual themes according to the qualitative data obtained[23]. One study did a six-month follow-up of participants who had consumed ayahuasca for the first time in the context of a Brazilian ayahuasca church (Santo Daime and União do Vegetal). The study found a general improvement in several

Pharmacology and neuropsychiatry of ayahuasca

psychological measures at the end of the study. Most of the subjects continued to consume ayahuasca after the six-month study period. Additionally, the authors found positive correlations between ayahuasca use and positive psychological attitudes. Ayahuasca use did not appear to cause any adverse effects[24]. Finally, a naturalistic study found that ayahuasca alters binocular rivalry, a perceptual measure of cognitive processing[25]. One recently published study used the Addiction Severity Index (ASI) as a measurement instrument. The ASI is a semi-structured interview designed to assess the impact of drug use in a multi-dimensional fashion. It assesses the participant’s Medical Status, Employment/Support, Drug and Alcohol Use, Legal Status, Family/Social Relationships, and Psychiatric Status, and provides general information on the participant’s current condition and his/her level of deterioration. The ASI was administered to two different samples of regular ayahuasca users. This study assessed the largest sample studied to date, i.e., a total of 112 regular ayahuasca users. These users belonged to two different ayahuasca churches – the Santo Daime and the Barquinha – and they were assessed in two different settings – jungle and urban-based, respectively. They had a 15-year history of use and they were compared with 115 matched controls. Assessments were repeated one year later as a follow-up. The study concluded that “the ritual use of ayahuasca, as assessed with the ASI in currently active users, does not seem to be associated with the psychosocial problems that other drugs of abuse typically cause”[26]. This research group recently presented a conference paper[27] reporting that they did not find evidence of neuropsychological deficits or personality and psychiatric disorders in their sample.

4. Final remarks Though no serious adverse events were attributed either to acute or chronic ayahuasca use in the published studies reviewed, a note of caution should be made regarding ayahuasca safety. The clinical trials cited in this chapter were performed in healthy young volunteers who had extensive experience in psychedelic drug use and did not present any sequelae derived from this use. The conclusions cannot be extrapolated to the general population, and especially not to ayahuasca-naive individuals. Ayahuasca has shown to moderately increase several cardiovascular parameters and such increases could have deletereous effects on people with cardiovascular conditions. Furthermore, although only one subject in the clinical trials suffered an episode of disorientation, a case report describes a patient who presented a psychotic breakdown after acute ayahuasca intake. Antipsychotic

José Carlos Bouso & Jordi Riba

medication was needed until its remission, and the same individual suffered a second psychotic crisis after subsequent ayahuasca use[28]. Other cases of psychiatric adverse psychiatric reactions, including psychotic disorders, have been reported following acute ayahuasca ingestion[29]. It is necessary to take into account the anecdotal evidence available on its potential dangers in order to get a complete picture of the possible negative psychiatric consequences. Regarding the studies of long term effects, it should be noted that the participant samples studied in the reviewed papers may have suffered from a self-selection bias. This would mean that the assessed individuals may have been those who did not experience any negative neuropsychiatric consequences derived from their maintained ayahuasca use. Subject experiencing adverse consequences might have given up ayahuasca use altogether and would consequently not be accessible to researchers. To conclude, the scientific investigation of ayahuasca has only found a moderate risk associated to acute ayahuasca administration and has even reported psychological improvements after long-term use. Future investigation into the neuropsychiatric safety of regular ayahuasca use should ideally also include people who used ayahuasca regularly in the past but decided to discontinue its use.

References 1. 2.

4. 5.

6. 7. 8. 9.

Strassman, R.J., Qualls, C.R., Uhlenhuth, E.H., and Kellner, R. 1994, Arch. Gen. Psychiatry, 51, 98. Grob, C.S., McKenna, D.J., Callaway, J.C., Brito, G.S., Neves, E.S., Oberlaender, G., Saide, O.L., Labigalini, E., Tacla, C., Miranda, C.T., Strassman, R.J., and Boone, K.B. 1996, J. Nerv. Ment. Dis., 184, 86. Callaway, J.C., McKenna, D.J., Grob, C.S., Brito, G.S., Raymon, L.P., Poland, R.E., Andrade, E.N., Andrade, E.O., and Mash, D.C. 1999, J. Ethnopharmacol., 65, 243. Riba, J., Rodríguez-Fornells, A., Strassman, R.J., and Barbanoj, M.J. 2001, Drug Alcohol Depend., 62, 215. Riba, J., Rodríguez-Fornells, A., Urbano, G., Morte, A., Antonijoan, R., Montero, M., Callaway, J.C., and Barbanoj, M.J. 2001, Psychopharmacology (Berl), 154, 85. Yritia, M., Riba, J., Ortuño, J., Ramirez, A., Castillo, A., Alfaro, Y., de la Torre, R., and Barbanoj, M.J. 2002, J. Chromatogr. B., 779, 271. Riba, J., Valle, M., Urbano, G., Yritia, M., Morte, A., and Barbanoj, M.J. 2003, J. Pharmacol. Exp. Ther., 306, 73. Barbanoj, M.J., Riba, J., Clos, S., Giménez, S., Grasa, E., and Romero, S. 2008, Psychopharmacology (Berl), 196, 315. Riba, J., Rodríguez-Fornells, A., and Barbanoj, M.J. 2002, Psychopharmacology (Berl), 165, 18.

Pharmacology and neuropsychiatry of ayahuasca

10. Riba, J., Anderer, P., Morte, A., Urbano, G., Jané, F., Saletu, B., and Barbanoj, M.J. 2002, Br. J. Clin. Pharmacol., 53, 613. 11. Riba, J., Anderer, P., Jané, F., Saletu, B., and Barbanoj, M.J. 2004, Neuropsychobiology, 50, 89. 12. Riba, J., Romero, S., Grasa, E., Mena, E., Carrió, I., and Barbanoj, M.J. 2006, Psychopharmacology (Berl), 186, 93. 13. Riba, J., and Barbanoj, M.J. 2005, J. Psychoactive Drugs, 37, 219. 14. Santos, R.G., Valle, M., Bouso, J.C., Nomdedéu, J.F., Rodríguez-Espinosa, J., McIlhenny, E.H., Barker, S.A., Barbanoj, M.J., and Riba, J. 2011. [Submitted] 15. Neto, J.S. 2009, Polícia de Goiás investiga morte de universitário após tomar chá do Santo Daime. O Globo, November 18. 16. Gomes, H. 2010, A encruzilhada do Daime. Isto É, February 05. 17. Vera, G.H. 2010, Hombre que quería “arreglar su matrimonio”, murió tomando yagé. El Espacio, November 16. 18. Halpern, J.H., Sherwood, A.R., Passie, T., Blackwell, K.C., and Ruttenber, A.J., 2008. Med. Sci. Monit., 14, SR15. 19. Da Silveira, D.X., Grob, C.S., de Rios, M.D., Lopez, E., Alonso, L.K., Tacla, C., and Doering-Silveira, E., 2005. J. Psychoactive Drugs 37, 129. 20. Doering-Silveira, E., Lopez, E., Grob, C.S., de Rios, M.D., Alonso, L.K., Tacla, C., Shirakawa, I., Bertolucci, P.H., and Da Silveira, D.X., 2005. J. Psychoactive Drugs, 37, 123. 21. Barbosa P.C., Giglio J.S., and Dalgalarrondo, P. 2005, J Psychoactive Drugs, 37, 193. 22. Santos, R.G., Landeira-Fernandez, J., Strassman, R.J., Motta, V., and Cruz, A.P. 2007, J. Ethnopharmacol., 112, 507. 23. Trichter, S., Klimo, J., and Krippner, S. 2009, J. Psychoactive Drugs, 41, 121. 24. Barbosa, P.C., Cazorla, I.M., Giglio, J.S., and Strassman, R. 2009, J. Psychoactive Drugs, 41, 205. 25. Frecska, E., White, K.D., and Luna, L.E. 2004, Psychopharmacology (Berl), 173, 79. 26. Fábregas, J.M., González, D., Fondevila, S., Cutchet, M., Fernández, X., Barbosa, P.C., Alcázar-Córcoles, M.A., Barbanoj, M.J., Riba, J., and Bouso, J.C. 2010, Drug Alcohol Depend., 111, 257. 27. Fábregas, J.M. Long Term Effects on Mental Health of Ayahuasca Ritual Use. Psychedelic Science in the 21st Century. MAPS, San Jose, CA, April 16-18. 28. Santos, R.G., and Strassman, R.J. 2008, Br. J. Psychiatry (Online), 3 December. [See the final article in the present book] 29. Lima, F,. Naves, M., Motta, J., Migueli, J., Brito, G., et cols. 2002, Rev. Bras. Psiquiatr., 24, suppl. 2.

Transworld Research Network 37/661 (2), Fort P.O. Trivandrum-695 023 Kerala, India

The Ethnopharmacology of Ayahuasca, 2011: 65-74 ISBN: 978-81-7895-526-1 Editor: Rafael Guimarães dos Santos

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

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 1970. 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. Paulo César Ribeiro Barbosa, Adjunct professor and member of the Mental Health Research Group, State University of Santa Cruz, Ilhéus, Bahia, Brazil E-mail: pcesarr@yahoo.com.br

Paulo César Ribeiro Barbosa

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

Therapeutic perspectives on ayahuasca

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

Paulo César Ribeiro Barbosa

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.

Therapeutic perspectives on ayahuasca

3.2. States of consciousness induced by the ritual use of ayahuasca 3.2.1. 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. 2.

Perplexity toward the apparent nonsense of going to an environment that seems to have no relation to her way of life; The sudden subsequent change, characterized by a sense of familiarity with the environment and with ritual behaviors.

3.2.2. 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

Paulo César Ribeiro Barbosa

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. 3.2.3. 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.’”

Therapeutic perspectives on ayahuasca

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

Paulo César Ribeiro Barbosa

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

Therapeutic perspectives on ayahuasca

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. 2. 3. 4. 5.

Ott, J. 1994, Ayahuasca Analogues, Natural Products Co., Kennewick. Callaway, J.C. 1999, In: Ayahuasca: Hallucinogens, Consciousness and the Spirit of Nature, R. Metzner (Ed.), Thunder’s Mouth Press, New York, 250. Luz, P. 2002, In: O Uso Ritual da Ayahuasca, B.C. Labate and W.S. Araújo (Eds.), Mercado de Letras, Campinas, 37. Dobkin de Rios, M. 1989, J. Psychoactive Drugs, 21: 91. Reichel-Dolmatoff, G. 1975, The Shaman and the Jaguar: A Study of Narcotic Drugs Among the Indians of Colombia, Temple University Press, Philadelphia.

6. 7.

8. 9. 10. 11. 12. 13.

14. 15. 16. 17. 18. 19. 20. 21. 22.

Paulo César Ribeiro Barbosa

Araújo, W.S. 1999, Navegando Sobre as Ondas do Daime: História, Cosmologia e Ritual da Barquinha, Editora da Unicamp, Campinas. Brissac, S.C.T. 1999, A Estrela do Norte Iluminando até o Sul: Uma Etnografia da União do Vegetal em um Contexto Urbano, Museu Nacional/Universidade Federal do Rio de Janeiro. Labigalini Jr., E. and Dunn, J. 1995, Psychiatr. Bull., 19, 313. MacRae, E. 1992, Guiado Pela Lua: Xamanismo e Uso Ritual da Ayahuasca no Culto do Santo Daime. Brasiliense, São Paulo. Labate, B.C. and Araújo, W.S. 2004, O uso ritual da ayahuasca, 2th ed., Mercado de Letras, Campinas. Cazenave, S.O.S. 2000, Ver. Psiquiatr. Clín., 27, 32. Sá, D.B.G.S. 1996, Discursos Sediciosos 2, 145. Grob, C.S., Mckenna, D.J., Callaway, J.C., Brito, G.S., Neves, E.S., Oberlaender, G., Saide, O.L., Labigalini, E., Tacla, C., Miranda, C.T., Strassman, R.J., and Boone, K.B. 1996, J. Nerv. Ment. Dis., 184, 86. Groisman, A. 1991, Eu Venho da Floresta: Ecletismo e Práxis Xamânica no Céu do Mapiá, Masters Dissertation, Universidade Federal de Santa Catarina. Bravo, G. and Grob, C.S. 1989, J. Psychoactive Drugs 21, 123. Sandison, R. 1997, Psychedelia Britannica, Melechi, A. (Ed.), Turnaround, London, 53. Grinspoon, L. and Bakalar, J.B. 1979, Psychedelic Drugs Reconsidered, Basic Books, New York. Barbosa, P.C.R., Giglio, J.S., and Dalgalarrondo, P. 2005, J. Psychoactive Drugs, 37, 193. Strassman, R.J. 1995, J. Nerv. Ment. Dis., 183, 127. Santos, R.G., Landeira-Fernandez, J., Strassman, R.J., Motta, V., and Cruz, A.P.M. 2007, J. Ethnopharmacol., 112, 507. Strassman, R.J., Qualls, C.R., Uhlenhuth, E.H., and Kellner, R. 1994, Arch. Gen. Psychiatry, 51, 98. Tart, C. 1975, States of Consciousness. Dutton, New York.

Transworld Research Network 37/661 (2), Fort P.O. Trivandrum-695 023 Kerala, India

The Ethnopharmacology of Ayahuasca, 2011: 75-85 ISBN: 978-81-7895-526-1 Editor: Rafael Guimarães dos Santos

5. The therapeutic potential of harmine and ayahuasca in depression: Evidence from exploratory animal and human studies

Flávia de Lima Osório1,2, Ligia Ribeiro Horta de Macedo1,2 João Paulo Machado de Sousa1,2, Joel Porfírio Pinto1,2 João Quevedo2,3, José Alexandre de Souza Crippa1,2 and Jaime Eduardo C. Hallak1,2

Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo; 2National Institute for Translational Medicine (INCT-TM), CNPq , Brazil 3 Laboratory of Neurosciences, Postgraduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, 88806-000 Criciúma, SC, Brazil

Abstract. The high prevalence and the socio-functional impairment associated with depressive disorders, added to the limitations of currently available treatments, justify the search for novel pharmacological strategies for the management of depression. This chapter presents the major results of animal and human studies conducted by a group of Brazilian researchers concerning the antidepressant potential of harmine, an alkaloid belonging to the group of β-carbolines and present in Ayahuasca (AYA), a tea with hallucinogenic properties used for religious and medicinal purposes Correspondence/Reprint request: Dr. Jaime Eduardo C. Hallak, Department of Neurosciences and Behavior Ribeirão Preto Medical School, University of São Paulo, Brazil. E-mail: jechallak@rnp.fmrp.usp.br

FlĂĄvia de Lima OsĂłrio et al.

by peoples from the Amazon. The results obtained thus far suggest that harmine and other substances present in AYA might have antidepressant-like effects in the central nervous system of animals and human patients, pointing out the possibility of the therapeutic use of AYA in humans.

1. Depressive disorders â&#x20AC;&#x201C; Clinical aspects Depression is a highly frequent psychiatric disorder with a lifetime prevalence of 17%, being twice as prevalent among women as compared with men. Onset usually occurs in the third decade of life, but the disorder can affect individuals at any age. It is a recurring condition and around 20-25% of patients become chronically ill[1]. Depressive disorders are associated with intense suffering, high morbidity rates, and increased mortality[2]. According to a study of the World Health Organization (WHO), depression is currently the fourth leading cause of morbidity and, within a ten-year period, it might rank second among the disorders affecting productive life[1]. According to the current Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (DSM-IV)[3], the diagnosis of a depressive episode requires the presence of depressed mood and/or anhedonia for a minimum of two weeks, accompanied by at least four of the following symptoms: significant weight loss or gain (5% of body weight); psychomotor agitation or retardation; insomnia or hypersomnia; fatigue or diminished energy; low self-esteem or inappropriate feelings of guilt; difficulties to think, concentrate or make decisions; and thoughts of death and suicide ideation or attempt. The symptoms must be associated with significant suffering and/or impairment in social, occupational or other functional areas, cannot be caused by a general medical condition or substance use, or fulfill the criteria for a mixed episode (episode in which the diagnostic criteria for both depression and mania are simultaneously satisfied). Clinically, depressive disorders are divided into single episode (if only one episode has occurred in life), recurring (when at least two episodes occurred), and chronic (if an episode lasts for two years or more)[3]. In terms of severity, depressive episodes are divided into mild, moderate, and severe. In mild episodes, few or no additional criteria besides those necessary for diagnosis are fulfilled and functional impairment is minor; in severe episodes a variety of symptoms are present, with significant functional impairment and possible association with psychotic symptoms; in moderate episodes, both the number of symptoms and the ensuing functional impairment lie on an intermediate level between the two former categories[3].

Harmine, ayahuasca and depression

2. Etiologic factors and neurobiology of depression The vulnerability to develop depression is connected with environmental factors such as early parental loss, childhood history of traumatic events, personality traits, family and personal history of depression, recent traumatic events, and genetic factors[1]. One of the main hypotheses to explain the neurobiology of depression was proposed following the discovery of the mechanisms of action of early antidepressant agents, which were accidentally discovered in the 1950s during the development of antihistamine (imipramine â&#x2020;&#x2019; tricyclic antidepressant) and antituberculosis (iproniazid â&#x2020;&#x2019; monoamine oxidase (MAO) inhibitor) drugs. Added to this, the comprehension of the action of three substances on the central nervous system (CNS), namely, imipramine (inhibiting neuronal reuptake of noradrenaline and serotonin), reserpine (depleting monoamines and causing depressive symptoms), and amphetamine (releasing noradrenalin and inhibiting its neuronal reuptake, causing euphoria) led to the proposition, in the 1960s, of the classic monoamine theory of depression, according to which the disorder would be caused by decreased availability of noradrenaline and serotonin in the brain[4]. These discoveries were followed by the development of new antidepressants, with similar mechanisms of action but better side-effect profiles and easier management, which are widely used in todayâ&#x20AC;&#x2122;s practice, such as serotonin and noradrenaline selective reuptake inhibitors[5]. The serotonergic and noradrenergic systems, which are involved in the pharmacology of antidepressants, project from nuclei located in the brain stem onto wide areas in the midbrain. Noradrenergic neurons project from the locus coeruleus, whereas serotonergic neurons project from the raphe nuclei[4]. Fourteen serotonin receptors, divided into seven classes, have been identified to date. Together with other neurotransmitters, serotonin mediates such diverse aspects as mood, anxiety, sleep, body temperature, eating and sexual behavior, gastrointestinal motility, and others[6]. Many antidepressant drugs act primarily by increasing extracellular concentrations of serotonin, which leads to alterations in many receptors, resulting in therapeutic effects secondary to late neurochemical alterations. The activation of pre-synaptic 5-HT1A receptors in the raphe nuclei normally leads to decreased serotonin release. Antidepressant drugs that act by inhibiting the reuptake of serotonin cause the desensitization of these receptors, thus stimulating the release of serotonin by neurons and increasing the serotonergic neurotransmission. This hypothesis would explain the time

Flávia de Lima Osório et al.

required for antidepressant drugs to present their therapeutic effects, since these are dependent on neurochemical adaptations[6].

3. Treatment of depression A number of alternatives are available today to treat depression, encompassing antidepressant drugs, psychotherapy, electroconvulsive therapy, and other somatic treatments. In respect to the pharmacological management of the disorder, it is clear that the discovery of antidepressants in the 1950s brought about a revolution in the treatment of depression, standing out among the other therapies available[2]. Currently, different classes of antidepressant agents are available, which are classified according to their effects on the neuronal synapse, their action on MAO or on their chemical structure. Tricyclic antidepressants (TCA) and MAO inhibitors (MAOI) are known as “first generation” or “classic” antidepressants. Both these groups act by increasing the extracellular availability of monoamines – TCAs via inhibition of serotonin and noradrenaline reuptake, and MAOIs via inhibition of the metabolism of these neurotransmitters[7]. Besides the action described above, which is responsible for their therapeutic effects, TCAs act upon many other receptors, presenting antimuscarinic, antihistaminic, and anti-α2 adrenergic effects that may cause undesirable reactions such as urinary retention, constipation, orthostatic hypotension, weight gain, and somnolence. Additionally, TCAs block the sodium channels, interfering on nervous transmission and being potentially arrhythmogenic[4,7]. Concerning MAOIs, their main adverse effect is the risk of hypertension crises triggered by the intake of food containing tyramine, a sympathomimetic amine occurring in large quantities in certain foods and which is metabolized by MAO[4]. Newer antidepressants have been designed to be more selective. Among these are the selective serotonin reuptake inhibitors (SSRIs: fluoxetine, paroxetine), selective noradrenaline reuptake inhibitors (reboxetine), serotonin-noradrenaline reuptake inhibitors (venlafaxine, minalcipran, duloxetine), and other antidepressants with multiple mechanisms of action, such as mirtazapine, which acts as a pre-synaptic α2-noradrenergic antagonist and as an antagonist of serotonin receptors (5-HT2 e 5-HT3), and nefazodone, which acts both by inhibiting the reuptake of serotonin and noradrenaline and by antagonizing α2 and 5-HT receptors[7]. Although the side-effects of these drugs are not as significant as those of earlier antidepressants, they are still present in more recently developed psychopharmacological agents[3].

Harmine, ayahuasca and depression

The efficacy of newer antidepressants is not different from the efficacy of compounds developed earlier, and although around 80% of the patients respond to the treatment with antidepressants, only 50% present full remission[5]. In summary, the limitations associated with the currently available pharmacological treatments of depression are: low response rates, sideeffects, and time required until therapeutic effects are attained. Thus, novel pharmacological strategies, especially those with acute effects, would have an important impact on the treatment of depression[8].

4. Ayahuasca Ayahuasca (AYA) is a beverage with hallucinogenic properties used for religious and medicinal purposes by peoples of South America, markedly in the Amazon, and there is evidence of its use since antiquity[9]. Ayahuasca is made from sections of the Banisteriopsis spp. vine usually boiled with other plants. The species of these plants most commonly used in the preparation are Banisteriopsis caapi and Psychotria viridis[10]. Banisteriopsis caapi contains the alkaloids harmine, tetrahydroharmine (THH) and, in a lower quantity, harmaline, all of which belong to the group of β-carbolines; whereas Psychotria viridis supplies the hallucinogenic substances tryptamine N,Ndimethyltryptamine (DMT) [10-12]. The hallucinogenic effect of AYA derives from the potent serotonergic action of DMT in the CNS, particularly on 5-HT2A and 5-HT2C receptors[10,13-15]. The psychoactive effects of AYA are thus mediated by the action of β-carbolines, specifically harmine and harmaline, which act upon MAO [9,10,12]. Tetrahydroharmine (THH), the second most concentrated β-carboline in AYA, acts as a weak serotonin reuptake and MAO inhibitor[10]. Peripheral inhibition of MAO allows the proper levels of DMT in the beverage to reach the CNS, causing intense – however short-lasting – perceptual, cognitive, and affect alterations. The main of such alterations are a predominant sensation of well-being; a fleeting feeling of apprehension; complex thoughts; novel experiences about one’s identity; vivid images (visible even when the eyes are closed); visual alterations of color, shape, and movement of objects; a sensation of having a clearer perception of sound; and an altered sense of touch. These subjective effects start 35-40 minutes after the ingestion of the tea, reaching maximal intensity between 90 and 120 minutes and ending after 4 hours[11,12,16]. Differently from what happens with other hallucinogenic substances, the repeated administration of DMT is

Flávia de Lima Osório et al.

not associated with the development of tolerance to its psychotomimetic effects, and there is no desensitization of 5-HT2A receptors[13,17]. Scientific investigations on AYA from the perspective of its interest to pharmacology and mental health began in the 1970s. Investigations involving members of the União do Vegetal (Vegetal Union) religious group underscored the high prevalence of psychiatric disorders prior to the beginning of the ritual use of the beverage, comprising particularly alcohol and substance abuse and dependence, but also depression and social phobia. Nevertheless, there are no reports of members presenting with current psychiatric disorders at the time of evaluation, with reports of remission following the beginning of the use of the tea. It is important to highlight that there were no reports of recurrent substance use since the beginning of tea intake (for periods over 10 years) and that there are no reports of AYA abstinence[10,11]. One study investigated the acute effects of the ingestion of AYA in members of the Santo Daime (Holy Daime) religion using measures of anxiety, panic, and hopelessness. The authors found that those participants who were under the effects of AYA had lower ratings of these symptoms compared with participants receiving placebo[18]. Together, these reports encourage the investigation of the possible therapeutic applications of AYA in humans.

5. Ayahuasca and depression 5.1. Antidepressant-like effects of β-carbolines and serotonergic agonists Harmine, the β-carboline with the highest concentration in AYA, interacts with distinct systems: in the CNS, harmine actions have been reported on MAO-A, 5-HT2A and imidazoline receptors (I1 and I2 sites), and cyclin-dependent kinases (CDK1, 2, and 5), but its wide pharmacological spectrum also includes antiplasmodial, antimutagenic, and antigenotoxic activity, and antioxidative, antidiabetic, and antiplatelet properties[19]. Animal studies conducted by Brazilian researchers investigated the antidepressant-like effects of harmine. Fortunato and colleagues[20] used the depression-inducing forced swimming test in rodents to compare the behavioral and molecular effects of acute harmine administration with imipramine and placebo. The forced swimming test is performed using a cylindrical water tank in which the animal is placed and behavioral parameters are measured (immobility, climbing, and swimming time). Figure 1 shows that acute treatments with harmine and imipramine were associated with decreased immobility time and increased swimming and climbing.

Harmine, ayahuasca and depression

Figure 1. Effects of acute administration of harmine and imipramine on immobility time (a); swimming time (b), climbing time (c), number of crossings (d), number of rearings (e) and BDFN levels (f) in the hippocampus of rats subjected to the openfield test (adapted from Fortunato et al, 2009).

The acute treatment with harmine, but not imipramine, was also associated with increased levels of brain derived neurotrophic factor (BDNF) - which has an antidepressant action in the brain - in the rat hippocampus. Since these findings could reflect a general increase in spontaneous locomotor activity, the rats were submitted to the open-field test, and harmine and imipramine were not found to provoke increased spontaneous locomotion, which indicates a specific action of both compounds on the behavioral parameters related to depression in the forced swimming test. Another study, also conducted by Fortunato and colleagues[19], was aimed at assessing the antidepressant properties of harmine using an animal model known as chronic mild stress (CMS). This model is believed to induce anhedonia (loss of interest or pleasure), a major feature of depression, reflected by the decreased intake of sucrose by rats. During a 40-day period, the animals were submitted to the following stressors: food and water deprivation, forced

Fl谩via de Lima Os贸rio et al.

swimming, flashing light, isolation, physical restraint, and cold. Figure 2 shows that the test was successful in inducing anhedonia, in addition to increasing adrenal gland weight and ACTH and BDNF levels. The administration of harmine was associated with reversal of all these effects. The findings of these studies lend support to the view that harmine is an important candidate for the pharmacological management of depression and encourage new studies involving the use of this compound in humans.

Figure 2. Effects of the CMS procedure on sweet food consumption (A), number of crossings (B), rearings (C), adrenal gland weight (D), adrenocorticotropic hormone (ACTH) (E), and BDNF levels in hippocampus (F) in rats chronically treated with harmine or saline(adapted from Fortunato et al, 2010).

Harmine, ayahuasca and depression

5.2. Therapeutic trials with AYA in humans Taking into account the positive findings concerning the antidepressantlike effects of harmine in animal studies and the components and mechanisms of action of AYA in the CNS, studies with humans are currently underway to investigate their therapeutic potential in people with depression. An exploratory study was conducted involving three female participants with a clinical diagnosis of recurring depressive disorder and current mild/severe depressive episode without psychotic symptoms. The subjects had not been in treatment with antidepressants for two weeks and received an oral dose of 2ml/Kg of AYA. The participantsâ&#x20AC;&#x2122; mental state was assessed by means of psychiatric scales, including the Hamilton Depression Scale (HAM-D), 10 minutes prior to AYA administration and 40, 80, 140, and 180 minutes after intake, as well as on days 1, 2, 7, 14, and 28 after drinking the tea. The distribution of the subjectsâ&#x20AC;&#x2122; scores in the HAM-D is shown in Figure 3. A significant decrease in the scores over time can be seen, starting at 40 minutes after intake, pointing out a reduction in depressive symptoms regardless of episode severity. A sustained reduction in the scores of depressive symptoms is observed from day 1 (of around 79% in relation to baseline) to day 14 (around 66% below baseline), when an expressive increase in depressive symptoms is seen towards baseline levels.

Figure 3. Effects of AYA intake on the final score of the HAM-D.

Flávia de Lima Osório et al.

The items suffering the greatest variations over the duration of the experiment were those related to depressed mood, guilt feelings, suicidal ideation, difficulties at work activities, psychic anxiety, and genital symptoms. It is important to mention that, although adverse effects associated with AYA were not systematically evaluated, they were not spontaneously reported by the participants during the evaluation period. Effects associated with psychotic experiences, related to thought and sensory-perceptual alterations, were punctual and short-lived, signalizing the safety and good tolerability of AYA mentioned by some authors[9-12,16]. The data of the latter study suggest that AYA has antidepressant properties - mediated by its action on serotonergic pathways - that seem to have an acute profile. However, this evidence must be considered with caution because of the intrinsic limitations of exploratory studies involving small samples. Future investigations involving larger samples and control groups are warranted in order to further our current knowledge on the therapeutic potential of AYA and its side-effect and action profiles over a larger time span.

References 1. 2. 3.

Fava, M., and Kendler, K.S. 2000, Neuron, 29, 335. Ebmeier, K.P., Donaghey, C., and Steele, D. 2006, Lancet, 367, 153. American Psychiatric Association. 2000, Diagnostic and statistical manual of mental disorders, 4th ed., Washington. 4. Graeff, F.G., and Guimarães, F.S. (Eds.). 2000, Fundamentos de Psicofarmacologia, Editora Atheneu, São Paulo. 5. Nestler, E.J., Barrot, M., DiLeone, J., Eisch, A.J., Gold, S.J., and Monteggia, L.M. 2002, Neuron, 34, 13. 6. Stahl, S.M. 1998, J. Affect. Disord., 51, 215. 7. Schatzberg, A.F., and Nemeroff, C.B. 2004, Textbook of Psychopharmacology, 3th ed., American Psychiatric Publishing, Arlington. 8. Zarate, C.A., Singh, J.B., Carlson, P.J., Brutsche, N.E., Rezvan, A., Luckenbaugh, D.A., Charney, D.S., and Manji, H.K. 2006, Arch. Gen. Psychiatry, 63, 856. 9. Callaway, J.C., McKenna, D.J., Grob, C.S., Brito, G.S., Raymon, L.P., Poland, R.E., Andrade, E.N., Andrade, E.O., and Mash, D.C. 1999, J. Ethnopharmacol., 65, 243. 10. McKenna, D.J., Callaway, J.C., and Grob, C.S. 1998, Heffter Rev. Psychedelic Res., 1, 65. 11. Grob, C.S., Mckenna, D.J., Callaway, J.C., Brito, G.S., Neves, E.S., Oberlaender, G., Saide, O.L., Labigalini, E., Tacla, C., Miranda, C.T., Strassman, R.J., and Boone, K.B. 1996, J. Nerv. Ment. Dis., 184, 86.

Harmine, ayahuasca and depression

12. Riba, J., Rodríguez-Fornells, A., Urbano, G., Morte. A., Antonijoan, R., Montero, M., Callaway, J.C., and Barbanoj, M.J. 2001, Psychopharmacology (Berl), 54, 85. 13. Smith, R.L., Canton, H., Barret, R.J., and Sanders-Bush, E. 1998, Pharmacol. Biochem. Behav., 61, 323. 14. Yritia, M., Riba, J., Ortuno, J., Ramirez, A., Castillo, A., Alfaro, Y., de la Torre, R., and Barbanoj, M. 2002, J. Chromatogr. B., 779, 271. 15. Fantegrossi, W.E., Harrington, A.W., Kiessel, C.L., Eckler, J.R., Rabin, R.A., Winter, J.C., Coop, A., Rice, K.C., and Woods, J.H. 2006, Pharmacol. Biochem. Behav., 83, 122. 16. Riba, J., Valle, M., Urbano, G., Yritia, M., Morte, A., and Barbanoj, MJ. 2003, J. Pharmacol. Exp. Ther., 306, 73. 17. Strassman, R.J., Qualls, C.R., and Berg, L.M. 1996, Biol. Psychiatry, 39, 784. 18. Santos, R.G., Landeira-Fernandez, J., Strassman, R.J., Motta, V., and Cruz, A.P.M. 2007, J. Ethnopharmacol., 112, 507. 19. Fortunato, J.J., Réus, G.Z., Kirsch, T.R., Stringari, R.B., Fries, G.R., Kapczinski, F., Hallak, J.E., Zuardi, A.W., Crippa, J.A.S., and Quevedo, J. 2010, Brain. Res. Bull., 81, 491. 20. Fortunato, J.J., Réus, G.Z., Kirsch, T.R., Stringari, R.B., Stertz, L., Kapczinski, F., Pinto, J.P., Hallak, J.E., Zuardi, A.W., Crippa, J.A.S., and Quevedo, J. 2010, Prog. Neuro-Psychopharmacol. Biol. Psychiatry, 33, 1425.

Transworld Research Network 37/661 (2), Fort P.O. Trivandrum-695 023 Kerala, India

The Ethnopharmacology of Ayahuasca, 2011: 87-95 ISBN: 978-81-7895-526-1 Editor: Rafael Guimarães dos Santos

6. Possible risks and interactions of the consumption of ayahuasca and cannabis in humans Rafael Guimarães dos Santos

Abstract. There is not much literature regarding the possible effects and interactions of the pan-Amazonian hallucinogenic brew ayahuasca and cannabis, except for some anthropological research. One specific Brazilian religious group had used both substances as sacraments in the past, so here it is reported a brief theoretical scientific overview of the possible interactions and risks between those two substances in humans. The main risks were found to be associated with the possible occurrence of cardiac problems, anxiety and panic reactions, and also psychotic reactions. Nevertheless, some “positive” and neutral interactions are also commented. Correspondence/Reprint request: Rafael Guimarães dos Santos, PhD candidate in Pharmacology at the Universitat Autònoma de Barcelona, Spain; Human Experimental Neuropsychopharmacology and Centre d’Investigació de Medicaments (CIM-Sant Pau), Institut d’Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain. E-mail: banisteria@gmail.com

Rafael Guimarães dos Santos

1. Introduction Ayahuasca and cannabis are psychoactive substances that have been used for therapeutic and ritual objectives by different human groups. Nevertheless, cannabis had been used ritually by one branch of the Santo Daime religion, a Brazilian ayahuasca religious group[1-3]. This branch, called CEFLURIS, used to call cannabis as Santa Maria (Saint Mary or Holly Mary). The use of Santa Maria, it should be noted, is officially forbidden within the rituals of this group since the 1980s in Brazil, because in this country cannabis is illegal. In this specific religious group, it is important to say that, according to one of its leaders, ayahuasca works with the spiritual male energy of Christ, and cannabis represents the female energy of the Virgin.

2. Possible psychological, psychiatric and neuropsychological interactions Up to this moment, there are limited studies about the possible risks or “positive” interactions between ayahuasca and cannabis. It is possible, however, to consider some characteristics of each substance. One possibility is that the effects of cannabis would potentiate the psychoactive properties of ayahuasca, producing an experience with more hallucinogenic properties, since both substances can produce these kinds of effects[4,5]. In fact, in pre-clinical studies, there is lack of cross-tolerance between Δ9-tetrahydrocannabinol (THC), cannabis extract, mescaline and lysergic acid diethylamide (LSD-25 or LSD)[6]. Also, in clinical studies, there is lack of cross-tolerance between THC and LSD[7]. Mescaline, LSD and DMT have similar mechanism of action[8]. According to these data, it is possible to speculate that a lack of cross-tolerance would also happen between ayahuasca and cannabis. Finally, consumption of ayahuasca and cannabis have been considered by members of CEFLURIS to produce “very good effects”, and, according to them, the consumption of cannabis after ayahuasca would propitiate “visions”[1]. It is also possible to speculate that the consumption of cannabis could alleviate some possible anxiety produced by some kinds of ayahuasca experiences[9,10], since cannabis can produce relaxation[11,12]. The consumption of cannabis after ayahuasca in the CEFLURIS context have been described to “lead to a felling of ‘unblockedge’” and act as a “soother in moments of difficulty”[1]. Nevertheless, the consumption of both substances could produce cases where people would feel extremely anxious, or with panic, or even with psychotic symptoms, especially, but not exclusively,

Ayahuasca and cannabis risks and interactions

those with genetic or psychological predisposition. This hypothesis is based on several arguments. First, there are several studies that suggest that the most common adverse reactions to hallucinogens are anxiety episodes, or even panic episodes and, in rare cases, prolonged psychotic reactions[13-18]. In the case of ayahuasca, the incidence of psychopathology seems to be rare, in adults or even in adolescents[19-24]. Nevertheless, Lima and collaborators[20,21] showed data from 951 ayahuasca consumers, from three Brazilian cities, on the period from 1995 to 2000, and registered 20 psychiatric events (2.1% in the total population), where 7 cases were psychotic reactions (0.73% in the total population). Other study[23] reported that in a period of five years, a Brazilian ayahuasca religious group registered, in an estimated 25000 ayahuasca doses, 13 to 24 cases (0.052-0.096%) where ayahuasca might have contributed in a psychotic episode. Second, other studies showed that ayahuasca can produce, in some people, anxiety and feelings of “suspiciousness” and “threat”, even in a controlled setting[9,10]. Like with other hallucinogens, those episodes seem to be rare and can be controlled without the necessity of medical intervention[16]. Third, some investigations suggest that cannabis can also produce acute episodes of anxiety, panic, or even experiences with psychotic symptoms, especially in people with predispositions or in novice consumers, and other studies speculate that the chronic use of cannabis can even produce psychosis, although a causal relations is still controversial[4,25-32]. Finally, there is one case report where the consumption of ayahuasca and cannabis produced a psychotic episode[33]. From a neuropsychological perspective, the chronic consumption of cannabis can produce some subtle deficits, especially in memory[31,34-36,]. In the case of ayahuasca, studies with adults or even with adolescents did not found any neuropsychological deficit[19,37]. In fact, the adult study showed that ayahuasca consumers produced better results than the controls in one of the memory tests[19]. The consumption of ayahuasca in combination with cannabis could produce, for example, no ill effects at all, and ayahuasca could, maybe, act as a “neuroprotetor” against the effects of cannabis. In fact, there is evidence that the hallucinogens 5-methoxy-N,N-dimethyltryptamine (5-MeODMT) and 2,5-dimethoxy-4-iodoamphetamine (DOI), which have a mechanism of action similar to DMT, attenuated the THC-induced impairment of spatial memory[38]. Moreover, the authors even suggested that this kind of drugs could be effective in the treatment of THC-induced memory deficits. Of

Rafael Guimarães dos Santos

course, this is just a hypothesis, and further studies are urgent needed to clarify this topic. Finally, regarding the potential to produce a dependence syndrome, there is no evidence that ayahuasca can produce it[39]. In fact, there is some limited evidence that ayahuasca can be used to treat dependence[2,19]. In the case of cannabis, it is suggested that about 10% of its users will became dependent on it[28,31]. Considering these factors, there is no apparent reason to assume that ayahuasca might enhance the dependence potential of cannabis. On the other hand, the ritual use of ayahuasca might, maybe, protect against the dependence potential of cannabis[2]. Of course, further studies are needed to better explore this topic.

3. Possible physiological interactions On the clinical level, one obvious possibility is that the antiemetic properties of cannabis[12,40,41] would alleviate or even eliminate the nausea and the emetic properties of ayahuasca[5,42]. In Colombia ayahuasca is known as la purga (“the purge”). Still on a clinical level, Riba et al.[10] assessed the effects of ayahuasca in a single-blind placebo-controlled clinical study in which three increasing doses of encapsulated freeze-dried ayahuasca (0.5, 0.75, and 1 mg DMT/kg body weight) were administered to six healthy male volunteers with prior experience in the use of the brew. The laboratory analyses conducted after each session did not find any clinically relevant alterations in hematological indices or biochemical indicators of liver function or other standard analytical parameters (cellular counting, plasmatic bilirubin, and hepatic enzymes). Another clinical evaluation did not show any clinically relevant findings among long-term (at least 10 years) consumers of ayahuasca in all organic systems evaluated: neurosensory, endocrine, circulatory (cardiac/respiratory), gastrointestinal (digestive), hepatic and renal, suggesting the absence of any injurious effect induced or caused by long-term ritual use of ayahuasca[43]. Compared to the controls, there were no significant differences in the blood analysis in several parameters tested – hemoglobin, hematocrit, total leukocytes, glycemia (during fasting), creatinine, sodium, potassium, calcium, bilirubin (total, direct and indirect), alkaline phosphatase, glutamic oxalacetic transaminase (GOT), glutamic piruvic transaminase (GPT), lactate dehydrogenase (LDH) and cholesterol (total and HDL fraction) – except for the platelets, which, although significantly higher in the control group (359.000/mm3 compared to 271.000/mm3; p<0.05), were all inside the normality limit.

Ayahuasca and cannabis risks and interactions

In this same study, seven electrocardiographic alterations were found in the ayahuasca group: one case of right branch bundle block, one of left branch bundle block, one of diffuse ventricular repolarization disturbance, and four of sinusal bradycardia. Among the controls, there was only a case of sinusal bradycardia. Although these alterations were not clinically relevant, and even considering the possibility that the cases of right and left branch bundle block could be attributed to other factors not evaluated in the study (such as Chagasâ&#x20AC;&#x2122; disease), more studies are needed to better clarify these findings. Riba and Barbanoj[44] reported that in their pilot and final study combined [10,45], two volunteers showed systolic blood pressure values above 140 mm Hg at some point and four showed diastolic blood pressure values above 90 mm Hg, the diagnostic criteria for hypertension. One volunteer showed heart rate values above 100 bpm, the diagnostic criterion of tachycardia. The maximum values recorded at any time point were 146 mm Hg for systolic blood pressure, 96 mm Hg for diastolic blood pressure and 101 bpm for heart rate. Other study also showed that the acute cardiac effects of ayahuasca are moderate, although in this study there were also values of diastolic blood pressure above 90 mm Hg[46]. Riba and Barbanoj[44] concluded in view of the moderate cardiovascular effects found in their studies that ayahuasca seems relatively safe from a cardiovascular point of view, but they also reported that the results refer only to single dose administrations in young healthy volunteers and recorded in the absence of any physical exercise. They suggested that the cardiovascular picture could be different following repeated dose administration, while performing physical exercise such as dancing, if ayahuasca were ingested by older individuals or by those with cardiovascular conditions/dysfunctions. Repeated administration, dancing, and older people taking ayahuasca is a very common practice in ayahuasca religions. Nevertheless, there is no published data on clinically relevant cardiovascular alterations associated with acute or even long-term ayahuasca consumption. Indeed, the evidence available suggests its safety in long-term adult use[43]. In the case of cannabis, the consumption of this substance, even in a chronic way, does not seem to commonly produce clinically relevant alterations[12,28,31,40]. Nevertheless, the act of smoking cannabis produces an acute, rapid, and consistent rise of 20-100% in heart rate, which begins around 10 minutes after smoking and lasts for two to three hours[28,47,48]. After repeated use, there is the development of tolerance for this effect, although it disappears rapidly after stop smoking[28,31,47]. Cardiac alterations of clinical value are not common among cannabis consumers;

Rafael Guimar達es dos Santos

although there are some rare cases where serious cardiac problems were documented[31,47]. Taking into consideration these data, it is possible to speculate that the cardiac effects of cannabis could potentiate the moderate cardiac effects of ayahuasca. This effect could be even more intense considering that in some ayahuasca rituals there is dancing for several hours. Finally, it must be considered that there are some adverse reactions that can potentially happen when people present some health conditions that are not indicated when consuming a monoamine oxidase inhibitor (IMAO): severe damage to the liver or kidneys, hypertension, cardiac problems, and brain pathologies[49]. Some of these same preoccupations also can be applied to cannabis consumption, and, of course, for the consumption of both substances together.

4. Conclusions Even considering the positive descriptions of some users of ayahuasca and cannabis[1], these cases and studies are very limited in number and do not present hard evidence, from a scientific point of view. Also, the majority of interactions described here were not investigated rigorously, so the evidence points only to speculative potential risks of the combination of ayahuasca with cannabis. The main risks appear to be the production of anxiety reactions, panic attacks, psychotic episodes, and cardiac problems. Nevertheless, except for the case of a psychotic episode, where there is a case report published[33], all the other risks are only hypothetical. It would be wise to advise people with predisposition to psychotic symptoms not to consume ayahuasca with cannabis. It is also important to note that the ayahuasca religious have their own guidelines to prevent people with psychological/psychiatric problems to consume the brew[20,21,50]. Finally, it must be acknowledged that some of the people who consume ayahuasca with Santa Maria also enjoy this combination[1].

References 1. 2.

MacRae, E. 1998, Int. J. Drug Policy, 9, 325. Labate, B.C., Santos, R.G., Anderson, B., Mercante, M., and Barbosa, P.C.R. 2010, In: Ayahuasca, ritual and religion in Brazil, B.C. Labate, and E. MacRae (Eds.), Equinox, London/ Oakville, 205. Groisman, A. 2000, Santo Daime in the Netherlands: An anthropological study of a new world religion in a European setting, University of London.

Ayahuasca and cannabis risks and interactions

4. 5. 6. 7. 8. 9.

10.

11.

12. 13. 14. 15. 16. 17.

18. 19.

20. 21. 22. 23. 24. 25. 26. 27.

D’Souza, D.C., Sewell, R.A., and Ranganathan, M. 2009, Eur. Arch. Psychiatry Clin. Neurosci., 259, 413. Riba, J. 2003, Human Pharmacology of Ayahuasca, Universitat Autònoma de Barcelona. Teresa, M., Silva, A., Carlini, E.A., Claussen, U., and Korte, F. 1968, Psychopharmacologia, 13, 332. Isbell, H., and Jasinski,. D.R. 1969, Psychopharmacologia, 14, 115. Nichols, D.E. 2004, Pharmacol. Ther., 101, 131. Riba, J., and Barbanoj, M.J. 2006, Tratado SET de Transtornos Adictivos, J.C. Peris, J.C. Zurián, G.C. Martínez, and G.R. Valladolid (Eds.), Ed. Médica Panamericana, Madrid, 321. Riba, J., Rodrigues-Fornells, A., Urbano, G., Morte, A., Antonijoan, R., Monteiro, M., Callaway, J.C., and Barbanoj, M.J. 2001, Psychopharmacology (Berl), 154, 85. Crippa, J.A., and Zuardi, A.W. 2008, In: Cannabis e saúde mental: uma revisão sobre a droga de abuso e o medicamento, A.W. Zuardi, J.A. Crippa, and F.S. Guimarães (Eds.), FUNPEC, São Paulo, 135. Spinella, M. 2001, The psychopharmacology of herbal medicine: plant drugs that alter mind, brain and behavior, The MIT Press, London. Cohen, S. 1960, J. Nerv. Ment. Dis., 130, 30. Smart, R.G., and Bateman, K. 1967, C.M.A.J., 97, 1214. Malleson, N. 1971, Br. J. Psychiatry, 118, 229. Strassman, R.J. 1984, J. Nerv. Ment. Dis., 172, 577. Frecska, E. 2007, In: Psychedelic Medicine: new evidence for hallucinogenic substances as treatments, vol. 1, M.J. Winkelman, and T.B. Roberts (Eds.), Praeger, Westport/London, 69. Johnson, M.W., Richards, W.A., and Griffiths, R.R. 2008, J. Psychopharmacol., 22, 603. Grob, C.S., McKenna, D.J., Callaway, J.C., Brito, G.S., Neves, E.S., Oberlaender, G., Saide, O.L., Labigalini, E., Tacla, C., Miranda, C.T., Strassman, R.J., and Boone, K.B. 1996, J. Nerv. Ment. Dis., 184, 86. Lima, F., Naves, M., Motta, J., Migueli, J., Brito, G., et. cols. 1998, XVI Congresso Brasileiro de Psiquiatria, São Paulo. Lima, F., Naves, M., Motta, J., Migueli, J., Brito, G., et cols. 2002, Rev. Bras. Psiquiatr., 24 (2 Suppl.). Da Silveira, D.X., Grob, C.S., Dobkin de Rios, M., Lopez, E., Alonso, L.K., Tacla, C., and Doering-Silveira, E. 2005, J. Psychoactive Drugs, 37, 129. Gable, R.S. Addiction, 102, 24. Halpern, J.H., Sherwood, A.R., Passie, T., Blackwell, K.C., and Ruttenber, A.J. 2008, Med. Sci. Monit., 14, SR15. Antance, J.A.R. (Ed.). 2007, Aspectos psiquiátricos del consumo de Cannabis, Sociedad Española de Investigación en Cannabinoides (SEIC), Madrid. Ben Amar, M., and Potvin, S. 2007, J. Psychoactive Drugs, 39, 131. Moore, T.H., Zammit, S., Lingford-Hughes, A., Barnes, T.R., Jones, P.B., Burke, M., and Lewis, G. 2007, Lancet 370, 319.

Rafael Guimarães dos Santos

28. Advisory Council on the Misuse of Drugs (ACMD). 2008, Cannabis: classification and public health. Home Office, London. 29. Barkus, E., and Lewis, S. 2008, Psychol. Med., 38, 1267. 30. Hallak, J.E., Bressan, R.A., Crippa, J.A., and Zuardi, A.W. 2008, In: Cannabis e saúde mental: uma revisão sobre a droga de abuso e o medicamento, A.W. Zuardi, J.A. Crippa, and F.S. Guimarães (Eds.), FUNPEC, São Paulo, 159. 31. Room, R., Fischer, B., Hall, W., Lenton, S., Reuter, P., and Feilding, A. 2008, The Global Cannabis Commission Report – Cannabis policy: moving beyond stalemate. The Beckley Foundation, Oxford. 32. Mason, O., Morgan, C.J., Dhiman, S.K., Patel, A., Parti, N., Patel, A., and Curran, H.V. 2009, Psychol. Med., 39, 951. 33. Santos, R.G., and Strassman, R.J. 2008, Br. J. Psychiatry (Online), 3 December. [See the next article in the present book] 34. Grant, I., Gonzalez, R., Carey, C.L., Natarajan, L., and Wolfson, T. 2003, J.I.N.S., 9, 679. 35. Novaes, M.A., Lacerda, A.L., and Bressan, R.A. 2008, In: Cannabis e saúde mental: uma revisão sobre a droga de abuso e o medicamento, A.W. Zuardi, J.A. Crippa, and F.S. Guimarães (Eds.), FUNPEC, São Paulo, 73. 36. Solowij, N., and Battisti, R. 2008, Curr. Drug Abuse Rev., 1, 81. 37. Doering-Silveira, E., Lopez, E., Grob, C.S., Dobkin de Rios, M., Alonso, L.K., Tacla, C., Shirakawa, I., Bertolucci, P.H., and Da Silveira, D.X. 2005, J. Psychoactive Drugs, 37, 123. 38. Egashira, N., Koushi, E., Mishima, K., Iwasaki, K., Oishi, R., and Fujiwara, M. 2007, J. Pharmacol. Sci., 105, 361. 39. Fábregas, J.M., González, D., Fondevila, S., Cutchet, M., Fernández, X., Barbosa, P.C.R., Alcázar-Córles, M.A., Barbanoj, M.J., Riba, J. and Bouso, J.C. 2010, Drug Alcohol Depend., 111, 257. 40. Abrams, D.I. 2007, In: Psychedelic Medicine: new evidence for hallucinogenic substances as treatments, vol. 1, M.J. Winkelman, and T.B. Roberts (Eds.), Praeger, Westport/London, 191. 41. Honório, K.M., Arroio, A., and da Silva, A.B.F. 2006, Quím. Nova, 29, 318. 42. Shanon, B. 2002, The Antipodes of the Mind: charting the phenomenology of the ayahuasca experience. Oxford University Press, New York. 43. Andrade, E.N., Brito, G.S., Andrade, E.O., Neves, E.S., McKenna, D., Cavalcante, J.W., Okimura, L., Grob, C., and Callaway, J.C. 2004, In: O uso ritual da ayahuasca, B.C. Labate, and W.S. Araújo (Eds.), 2th ed., Mercado de Letras, Campinas, 671. 44. Riba, J., and Barbanoj, M.J. 2005, J. Psychoactive Drugs, 37, 219. 45. Riba, J., Valle, M., Urbano, G., Yritia, M., Morte, A., and Barbanoj, M.J. 2003, J. Pharmacol. Exp. Ther., 306, 73. 46. Callaway, J.C., McKenna, D.J., Grob, C.S., Brito, G.S., Raymon, L.P., Poland, R.E., Andrade, E.N., Andrade, E.O., and Mash, D.C. 1999, J. Ethnopharmacol., 65, 243. 47. Jones, R.T. 2002, J. Clin. Pharmacol., 42 (11 Suppl.), 58S.

Ayahuasca and cannabis risks and interactions

48. Zuurman, L., Ippel, A.E., Moin, E., and van Germen, J.M. 2008, Br. J. Clin. Pharmacol., 67, 5. 49. Savinelli, A., and Halpern, J.H. 1995, MAPS Newsletter, 6, 58. 50. Lima, F. 1996-7, MAPS Newsletter, 7, 25.

Transworld Research Network 37/661 (2), Fort P.O. Trivandrum-695 023 Kerala, India

The Ethnopharmacology of Ayahuasca, 2011: 97-99 ISBN: 978-81-7895-526-1 Editor: Rafael Guimarães dos Santos

7. Ayahuasca and psychosis 1

Rafael Guimarães dos Santos1 and Rick J. Strassman2

PhD candidate in Pharmacology at the Universitat Autònoma de Barcelona, Spain Human Experimental Neuropsychopharmacology and Centre d’Investigació de Medicaments (CIM-Sant Pau), Institut d’Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain 2 Department of Psychiatry, University of New Mexico School of Medicine and Cottonwood Research Foundation, Taos, New Mexico, USA

Ayahuasca is a botanical hallucinogenic beverage used by indigenous groups throughout the Northwestern Amazon. Active ingredients include the tryptamine hallucinogen DMT, and beta-carboline monoamine oxidase inhibitors which allow for oral activity of DMT[1]. In Brazil, its use occurs also within syncretic religious organizations and its religious consumption is protected by law[2]. In the last decades, religious use of ayahuasca has spread from South America to the United States and Europe. In these new environments, therapeutic and recreational use also occur. Here we report the case of a young adult male, who experienced two psychotic paranoid episodes – separated by one year – during and after participation in ayahuasca rituals. Neither the subject, Mr. A, 21 years old at the time of his first episode, nor his parents had a history of psychosis. He had consumed other hallucinogens (LSD and psilocybin) on multiple occasions, Correspondence/Reprint request: Rafael Guimarães dos Santos, PhD candidate in Pharmacology at the Universitat Autònoma de Barcelona, Spain; Human Experimental Neuropsychopharmacology and Centre d’Investigació de Medicaments (CIM-Sant Pau), Institut d’Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain. E-mail: banisteria@gmail.com

Rafael Guimarães dos Santos & Rick J. Strassman

and had been a nearly-daily marijuana smoker for the preceding six years with no significant adverse effects. At the time, he was obtaining graduate training in a Brazilian university. Before the first episode, he had already used ayahuasca “more or less twice per month, for about two years,” sometimes using marijuana concurrently, without incident. During one particular ayahuasca ritual, he again combined its use with marijuana and experienced very intense paranoid and suicidal ideas – “these people are going to kill me in order to make me a human sacrifice;” “I will be operated upon and they will open my body;” “I have sinned and the spirits are persecuting me;” “I should kill myself right now before they do.” These feelings were so intense that he superficially cut himself with a sharp-edged ceremonial item during the ayahuasca ritual. Symptoms persisted for two to three weeks and resolved after treatment with risperidone, 6 mg daily, gradually being reduced to 0.5 mg daily. Treatment lasted approximately one year, during which time he did not use any psychoactives, and remained free of paranoid symptoms. After discontinuing risperidone, he resumed participation in ayahuasca rituals. During the third of these subsequent sessions, while not using concurrent marijuana, he again experienced similar paranoid and suicidal ideation, which persisted for another two to three weeks, which again responded well to a similar course of risperidone maintained for the next year. Regular use of ayahuasca in research and naturalistic settings has not been routinely associated with psychopathological reactions[3]. One literature review[4] reported that over a five-year period there were documented between 13 and 24 cases in which ayahuasca may have contributed to an undefined psychotic incident. These were reported from a cumulative estimated 25,000 ayahuasca sessions, and represent a rate less than 0.1% (0.052-0.096%). This is comparable to the incidence of transient psychoses reported by Cohen in his 1960 survey of researchers who had administered LSD in a controlled environment[5]. Given the low incidence of, but potentially high morbidity associated with, transient drug-induced psychosis, both research and religious use of ayahuasca should be contraindicated in people with a history of psychosis.

Acknowledgement The editor is grateful to the British Journal of Psychiatry for the authorization for the reprint of this text in the present book. The original citation for this text is: Santos, R.G., and Strassman, R.J. 2008, Br. J. Psychiatry (Online), 3 December. Available at http://bjp.rcpsych.org/cgi/eletters/190/1/81-a#22556.

Ayahuasca and psychosis

References 1. 2. 3. 4. 5.

McKenna, D.J. 2004, Pharmacol. Ther., 102, 111. Labate, B.C., Rose, I.S., and Santos, R.G., 2008, Religiões ayahuasqueiras: um balanço bibliográfico, Mercado de Letras, Campinas. Dobkin de Rios, M., and Grob, C.S. (Eds.). 2005, J. Psychoactive Drugs, 37. Gable, R.S. 2007, Addiction, 102, 24. Cohen, S. 1969, J. Nerv. Ment. Dis., 130, 30.