A case for psychosomatic medicine.
Right now, I am undergoing what ayahuasca users call "integration." Following a ceremony, there's an indefinite period, maybe days or weeks, when the plant's lessons continue to seep in. People often tout taking part of an ayahuasca ceremony, or experimenting with any intense mind-altering substance, as "life changing." Integration, in a way, determines just how your life changes.
Ceremony induced a certain curiosity in the spiritual, a dimension that I had previously neglected. Even though Westerners tend to come to ayahuasca, a brew made primarily from the Banisteriopsis caapi vine, for its medicinal properties, the physical well-being they seek is preceded by a spiritual stirring. The ancient medicine's capacity extends past the physiological. It provides a different kind of healing.***
The term psychosomatic joins the Greek words for psykhe (mind) and somatikos (body). This coupling—the bond between our somatic, physiological body and the consciousness that animates it—remains one of the most divisive connections within philosophical thinking and medical teachings. To the patient, hearing psychosomatic as a diagnosis spells uncertainty, like some sort of mental trickery. It's the idea that some illnesses are "just in our heads." And that just makes the symptoms, the sickness, if not illegitimate, then at the very least a creepy manifestation of a darker ill within ourselves.
When ailments are physiological, when it's clearly our bodies that are diseased, we can abdicate some culpability. We're simply victims of our own biology, inhabiting a sack of flesh that inevitably disintegrates with disease.
What kind of treatments can we imagine when we value feelings over symptoms and experience over evidence?
In a 2013 lecture at the Multidisciplinary Association for Psychedelic Studies Conference, Dr. Gabo Mate, a Canadian physician who specializes in addiction treatment and child development, posed an alternative.
"What if we actually got that human beings are bio-psycho-social-spiritual creates by nature, which is to say that our biology is inseparable from our psychological, emotional, and spiritual existence?" Mate asked. "Therefore what manifests in the body is not some isolated and unique event or misfortune but a manifestation of what my life experience has been in interacting with my psychological and social and spiritual environment."
Mate argues that all illness—and all health—is psychosomatic. Our whole sense of well-being entangles both our brain and body, so much so that the distinction and isolation between each is arbitrary and unnecessary.
By looking at ancient healing traditions that dissolve dualistic assumptions, we can begin to sense the scope of what we lose when we forget that health is more than just a set of physiological symptoms. Currently, our healthcare system largely ignores the psychosomatic root of disease and promotes prescriptive dependency of chemical substances as cure. But slowly, we are unlearning Cartesian dualism, the assumption that our mind is separate from our matter, and testing healing practices, such as ayahuasca, that take the entanglement of soul and body as a given.
What kind of treatments can we imagine when we value feelings over symptoms and experience over evidence?***
Franz Alexander, a Hungarian-American psychoanalyst and physician (he analyzed Freud's son) "founded" psychosomatic medicine in the 1930s. Yet, the practice's underpinnings echo throughout ancient healing techniques.
In Western traditions, Hippocrates, and later Galen, connected physiological ailment with emotional distress. They developed humorism, a system of medicine rooted in Ayurveda, a system of natural healing originating in the Vedic cultures of India that pinned health as a balance of bodily "humors"—bile, blood, and phlegm. Bodily fluids aside, humorism's diagnostic approach always underscored the body's physiological susceptibility to feelings. Galen is even said to have first diagnosed "love sickness."
Their medicinal theories carried well into the Middle Ages. In 9th century Persia, famed geographer and physician Abu Zayd al-Balkhi introduced "mental hygiene" and connected it with spiritual health. In his Masalih al-Abdan wa al-Anfus (Sustenance for Body and Soul) he argued that "human existence cannot be healthy without the ishtibak [interweaving or entangling] of soul and body."
The resonance between psychosomatic therapy and spiritual well-being also grounds the ayahuasca experience. The Urarina people of the Peruvian Amazon use ayahuasca as a religious sacrament. Communing with the plant traditionally happens in ceremonies led by a shaman, who acts as both healer and spiritual guide. Rak Razam, a freelance journalist turned ayahuasca enthusiast after going on assignment to Peru, says this spiritual dimension radically separates this form of healing from Western therapy.
"When indigenous people who use ayahuasca say it's medicine, they understand that humans are spiritual beings," Razam tells me. "Even in the plants around them, while they have these essences and chemicals, they also contain a spirit. Healers align themselves with these spirits, wooing them through song and through ceremony on behalf of the healing of their patients. Ayahuasca does work if you take it in a lab on a neurochemical level, but if you want to deepen your experience, you must form a relationship with it. You must connect with it."
Psychoneuroimmunology is Western medicine's response to this synergy between our psychology and our nervous and immune systems. The science of stress, our "silent killer," illustrates sanity and immunity's interconnected natures. When we are faced with stressful scenarios, our bodies activate specific chemical reactions within our sympathetic nervous system. The brain's production of estrogen, testosterone, cortisol, dopamine, and serotonin responds to stress. A limited amount of these chemical releases are necessary to help our bodies adjust to a stressful environment.
But, when stress is excessively triggered, these same neurological reactions begin to backfire, directly impacting our ability to fight disease. Our brains, for example, secrete cortisol when stressed, which in turn lowers our metabolism and suppresses our immune systems.
Hungarian doctor and sociologist Ronald Grossarth-Maticek and German psychologist Hans Eysenck developed the The Grossarth-Maticek and Eysenck Personality Types, which correlate certain personality factors with recurring health issues. This causal mapping spawned varied research into identifying character traits that could predispose people to develop cancer and coronary heart disease. In one example, a 1993 study found that women who had a tendency to repress anger were more likely to develop breast cancer. Another found that stoic patients experienced an increased incidence of relapse.
"The science of psychoneuroimmunology," Mate explains, "has amply shown that you can't separate the mind from the body. When you repress yourself emotionally you actually diminish the activity of the immune system and are therefore less capable of responding to malignancy or to bacteria infection."
Healing with ayahuasca looks and feels like a release, an unburdening of the repressions that stunt our well-being. A loud cacophony of intense heaving often accompanies the healer's icaros during ceremony. Participants are encouraged to purge in order to activate the plant's cleansing properties and release any harmful energies they've ingested. Releasing also manifests on an emotional field. Often, the medicine releases and reenacts traumatic experiences during ceremony.
By unburdening repressed trauma under such an abnormally sensitive state, the medicine perhaps treats the root rather than the symptoms of disease. After conducting fMRI scans on participants, Brazilian neuroscientist Draulio Barros de Araujo found that the brain centers modulated by ayahuasca use help us process memory, vision, and intention. While Barros de Arujo is hesitant to scientifically link memory activation with healing, his research does suggest that ayahuasca induces visual stimulation, introspection, and heightened emotional sensitivity.
"The therapeutic insight comes from ayahuasca's introspective perspective. It's looking inside."
"I believe that a great part of the therapeutic aspect of ayahuasca comes from you getting in contact with yourself," he says. "The therapeutic insight comes from ayahuasca's introspective perspective. It's looking inside. And then you have your best psychotherapist."
More than that, rather than passively consuming treatments and prescriptions, ayahuasca puts patients in active relationship with their health. It prescribes us autonomy.
"That is the relationship ayahuasca helps us remember," Razam explains. "Health is a relationship with yourself, with what you put into your body. Yes, ayahuasca is a medicine, but it helps you unlock that you are the medicine as well."***
It's been three months since I first sat in ceremony. I've started cooking my own meals every day. I stopped drinking coffee, sipping instead a cinnamony brew of oolong tea and chai. I set a space for a small altar in my room, where I burn incense, mediate, light candles, or just sit and read. I'll smudge with sage in the mornings and dab myself with few drops of sweet Florida water before I leave the house, filling my room with the smoky musk of burnt herb and floral essences. I breathe in deeply.
Ayahuasca never prescribes a cure, and never diagnoses illness. With the plant medicine, well-being isn't reduced to a biological state of homeostasis, achieved under a cocktail of chemicals. One can't return to "being healthy" the same way that one can't pinpoint the moment they become ill. Sickness, and healing, instead describe a relationship, a connection.
To what, though? A "higher purpose"? Nature? All of creation? Even though I've sat in five ayahuasca ceremonies, I'm still unsure. But, slowly, I've begun to integrate rituals into my routines, fostering this connection. Ceremony taught me that we are all health practitioners and we can all practice health.
Lit Up is a series about heightening—and dulling—our sense of perception. Follow along here.