Category Archives: Emotion

Ayahuasca Visions: The First Experience

Long ago there was a Quechua man hunting in the forest. He can across a jaguar and was preparing to shoot it with his bow and arrow when he saw the beast beginning to chew on a vine wrapping itself around a tree. He thought this was strange and instead of shooting stood silently and watched the jaguar. Next, the animal began to chew on a leafy, green plant that was nearby. The jaguar then lay on the ground without moving. The hunter came close and saw that the beast’s eyes were open even though it appeared to be sleeping. The hunter came forward and nudged the jaguar with his foot. The animal did not respond. “How strange, that the beast will not attack me even though I can tell it is not dead and its eyes are open!” thought the hunter. The hunter realized this must have something to do with the plants the animal had eaten, and he collected some of the two plants and brought them to his village. He told the people what he had saw and they were curious, so they ate some of the two plants- nothing happened. The shaman of the village decided to cook the two plants together, which shamans often do. He then gave the tea to the villagers and they entered a state of wonder and saw many visions and experienced profound revelations about life. The shaman and the people realized this was a strong, spiritual medicine and it was cherished and valued among the people.

Quechua myth concerning the discovery of ayahuasca

More than once I was fascinated by the discovery of mixing these two plants together. I had heard that shamans state that the plants sing to them. On one level I can accept this, on another level I cannot. One morning I was talking with Antonio, who was my shaman for my three ayahuasca ceremonies, and he related this story the Quechua tell of the hunter in the forest and the jaguar. This remains one of the great mysteries of anthropology.

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My Casita

My previous post gave some background information on ayahuasca; in this post I would like to relate my experience with the brew on April 23, 25, and 27 of 2016. I had met two backpackers while conducting research in the Bribrí community of Yorkín, and they told me of the amazing experience they had taking ayahuasca in Peru. I had been interested in the healing powers of ayahuasca (and indeed other psychoactive plants) for quite some time and decided to make a reservation, take a much needed break from fieldwork and grant writing, and head to Peru where ayahuasca is legal. I arrived at the lodge I would be staying at above the small community of San Roque, in the mountains above Tarapoto and was informed I could participate in a ceremony with the shaman Antonio Bracero and his teacher, a Shipibo indian named Virginia Vasquez Alavuelo. I was to be the only other person at the ceremony. I had a meeting with Antonio, who speaks English as well as Spanish, about what I could expect to experience and what my intentions were. He suggested that I remain open to whatever happens, as the medicine works in different ways with different people and different ways at different times.

Below is my word for word account of my first ceremony taken from my journal which was written the next day:

Rio Cumbaza

I am sitting by the river (Cumbaza); I just soaked for a while- it was colder than I expected- I am feeling pretty shaky- only slept a couple of hours- took a shower, ate some food, laid around listening to the Dead. Last night was fucking intense, I was lucky, as Antonio’s teacher, a Shipibo indian named Virginia was here and it was only me and them at the ceremony. I walked down the hill to the ceremony lodge, a thatch-roofed open-walled structure where Antonio lives upstairs. He gave me some pointers- focus on my breath if I start to freak out, try to remain quiet, ask for more if I want it (there will be a “last call”), keep my purge bucket handy, keep my body “open”, and if things get hard- know that it will pass.

When I arrived, Virginia was massaging Antonio with some oil and blowing mapacho (local pure tobacco) smoke over him. Antonio then purified the space with mapacho and called me to him to give me a shot glass of ayahuasca. I actually did not mind the taste- kinda sweet and bitter at the same time. I went and sat on my mat- before long I could start to feel it starting to take effect and I laid down flat on my back. I soon began to see black and white geometric patterns. Antonio then began to sing an icaro (song). Then Virginia sang- her icaro sounded almost Japanese; I had the impression it was very ancient, like from the dawn of human consciousness.

Ayahuasca visions
Ayahuasca visions

Soon my sense of self began to dissolve and all I could do was breathe and listen to the icaros- which they alternately sang, accompanied by various shakers and rattles- at one point Antonio played the guitar. I had the sense that other people were there with us, as the sounds seemed to be coming from all around me. Sometimes I felt people standing over me- all with positive and healing intent. I could barely move my hands to wipe sweat from my brow and eyes.

At some point Antonio asked me if I wanted more, I could barely answer “no”. I had no sense of time- sometimes it felt as if minutes went by between each breath. I sometimes perceived myself as being like one inch big- then in the next instant massive- then completely flat- then round- then no longer there. Then Antonio asked me if I wanted to sing, it took me a while to register what he said- but then I started to sing- I do not know how- I do not know the words or if they were words- it wasn’t English- I just kept going until Antonio exhaled loudly and my singing automatically stopped.

He then came to me and asked me to sit up and move forward on my mat. – It was a real struggle. He said he was going to purge the medicine from me and sang an icaro while he was tapping me with his feather bundle (shacapa).

Shacapa
Shacapa

They both then sang another icaro and I told him I was going to go to the bathroom. I started to crawl and he helped me stand up and I staggered to the outhouse and released diarrhea for a short time. I came back to the lodge and sat on my mat, then threw up just a little bit- they both began to sing another icaro. Then Virginia came over and rubbed me with oil- it felt very loving and nurturing.

Shamanka Virginia Vasquez Alavuelo
Shamanka Virginia Vasquez Alavuelo

After a bit I stood up and felt like I wanted to head back to my casita. Antonio suggested I sit with them a bit longer- I am glad because I started to feel more grounded. Virginia commented that I was now more “abajo” (low) and had been very “arriba” (high). I then gathered my stuff and slowly, shakily, walked up the hill to my casita, stopping once at the bathroom by the communal kitchen to have some more diarrhea.

The ceremony lasted from 7:00 pm to 1:00 in the morning. Some of the few thoughts I remember are “wonder” and “wonderment” and later “gratitude”. When I came down from the high I felt a little melancholy (if that is the right word- it was more like the Japanese term “mono no aware”) and I still feel a little like that today- but at peace. I am now going to head back up the hill and get something to eat.

p.s. – Last night I told Antonio how intense, but how ecstatic, joyful, and caring the medicine was and he said, “The medicine is just a reflection of yourself, it was a real good first ceremony.” I replied that makes me feel good about myself.

It just occurred to me that today I have been in a “liminal stage”- halfway between the physical and spiritual worlds. End quote from journal.

So, that was my first experience with the medicine. Looking back I see that the first experience was all about the wonder of being alive and the power of the medicine. I also felt gratitude at being a human and being able to experience such wonder. My next two ceremonies would prove to be similar, but also different in what I was thinking, feeling and the revelations which occurred to me. Read about them in my next post.

Ayahuasca: “La Medicina”

Ayahuasca was first described outside of Indigenous communities in the early 1950s by Harvard ethnobotanist Richard Evans Schultes, who had originally worked with the Kiowa in the U.S., participating in peyote ceremonies. Schultes was famous for ingesting all types of plants and their derivatives while traveling throughout the amazon. He was Wade Davis’ advisor, and sent Davis to the amazon to study coca. Ayahuasca is the Hispanicized style spelling of a word in the Quechua languages, which are spoken in the Andean states of Ecuador, Bolivia, Peru, and Colombia. Speakers of Quechua languages or of the Aymara language may prefer the spelling “ayawaska.” This word refers both to the liana Banisteriopsis caapi, and to the brew prepared from it. In the Quechua languages, aya means “spirit, soul”, “corpse, dead body”, and waska means “rope” and “woody vine”, “liana”. It is often referred to as “La Medicina”- the medicine.ayahuasca

People who have consumed ayahuasca report having spiritual revelations regarding their purpose on earth, the true nature of the universe, as well as attaining insights into their lives. Individuals also sometimes report connection to “spiritual” dimensions and make contact with various spiritual or extra-dimensional beings who act as guides or healers. In my experience, I did not sense other beings, but instead experienced aspects of my own mind which were very different from normal waking consciousness. I experienced profound emotional joy and bliss and insights into my life goals and behaviors. I will describe my three experiences (all somewhat different) in upcoming posts.

Ayahuasca is made by mixing Banisteriopsis caapi, a liana of the family Malpighiaceae, with Psychotria viridis, a leafy plant, and cooking it down to create a dark, bitter tasting liquid. Banisteriopsis caapi contains harmine, harmaline, and tetrahydroharmine, all of which are both beta-carboline harmala alkaloids and MAOIs. The MAOIs in B. caapi allow the primary psychoactive compound, DMT (which is introduced from the other primary ingredient in ayahuasca, the Psychotria viridis plant), to be orally active. Monoamine oxidase inhibitors (MAOIs) are chemicals which inhibit the activity of the monoamine oxidase enzyme family. MAOIs have been found to be effective in the treatment of panic disorder with agoraphobia, social phobia, atypical depression or mixed anxiety and depression, bulimia, and post-traumatic stress disorder. MAOIs appear to be particularly effective in the management of bipolar depression.Banisteriopsis caapicaapi

Psychotria viridis is a perennial shrub of the Rubiaceae family. In the Quechua languages it is called chacruna. It contains about 0.10–0.66% alkaloids, approximately 99% of that is dimethyltryptamine (DMT). N,N-Dimethyltryptamine (DMT or N,N-DMT) is a psychedelic compound of the tryptamine family. It is a structural analog of serotonin and melatonin and a functional analog of other psychedelic tryptamines such as 4-AcO-DMT, 5-MeO-DMT, 5-HO-DMT, psilocybin (4-PO-DMT), and psilocin (4-HO-DMT). DMT-containing plants (such as Psychotria viridis) remain inactive when drunk as a brew without a source of monoamine oxidase inhibitor (MAOI) such as B. caapi. DMT can produce powerful psychedelic experiences including intense visuals, euphoria and hallucinations.psychotria viridis

DMT is naturally occurring in small amounts in rat brain, human cerebrospinal fluid, and other tissues of humans and other mammals. A biochemical mechanism for this was proposed by the medical researcher J. C. Callaway, who suggested in 1988 that DMT might be connected with visual dream phenomena. A role of endogenous hallucinogens including DMT in higher level sensory processing and awareness was proposed by J. V. Wallach based on a hypothetical role of DMT as a neurotransmitter. Neurobiologist Andrew R. Gallimore suggests that while DMT might not have a modern neural function, it may have been an ancestral neuromodulator once secreted in psychedelic concentrations during REM sleep – a function now lost. The dependence potential of oral DMT and the risk of sustained psychological disturbance are minimal (Gable 2007).psychotria viridis 2

People often report profound positive life changes subsequent to consuming ayahuasca. Vomiting can follow ayahuasca ingestion; this purging is considered by many shamans and experienced users of ayahuasca to be an essential part of the experience, as it represents the release of negative energy and emotions built up over the course of one’s life. Others report purging in the form of nausea, diarrhea, and hot/cold flashes. The first time I used the medicine I had diarrhea after the ceremony and vomited a little bit, the second time I had diarrhea only, and the third time had neither.

The ingestion of ayahuasca can also cause significant, but temporary, emotional and psychological distress. Long-term negative effects are not known. A few deaths due to participation in the consumption of ayahuasca have been reported. The deaths may be due to preexisting heart conditions, as ayahuasca may increase pulse rates and blood pressure, or interaction with other medicines taken, such as antidepressants, and in some cases possibly a result of the addition of toé in the brew. I made sure that this plant was not included in the mixture I was going to consume beforehand, as I had read is it dangerous to ingest it orally. The mixture I ingested only contained the caapi and Psychotria. MAO-A inhibition reduces the breakdown of primarily serotonin, norepinephrine, and dopamine. Agents that act on serotonin if taken with another serotonin-enhancing agent may result in a potentially fatal interaction called serotonin syndrome. Therefore, persons using prescription drugs for bipolar disorder or depression should discontinue use before using ayahuasca. However, persons using dopamine blockers, often used for some forms of bipolar disorder and schizophrenia may not be under the same risk, but in my opinion should also discontinue use to avoid potential interactions.

Da Silveria et al. (2005) conducted a comparative study of adolescents subscribing to an indigenous Amazonian belief system that sacramentally used ayahuasca and their urban Brazilian counterparts. Da Silveria et al. measured psychological functioning on participants who used ayahuasca in a culturally specific manner twice per month and started doing so just at the onset of adolescence. These included substance abuse disorders, anxiety, depression, body image disorders, and attention deficit hyperactivity disorder. As compared to the control group, ayahuasca-using adolescents scored on average seven times less likely to experience these problems.

MAOIs can also be used in the treatment of Parkinson’s disease by targeting MAO-B in particular (therefore affecting dopaminergic neurons), as well as providing an alternative for migraine prophylaxis. MAOIs appear to be particularly indicated for outpatients with dysthymia complicated by panic disorder or hysteroid dysphoria, which involves repeated episodes of depressed mood in response to feeling rejected.

The legal status in the United States of DMT-containing plants is somewhat questionable. Ayahuasca plants and preparations are legal, as they contain no scheduled chemicals. However, brews made using DMT containing plants are illegal since DMT is a Schedule I drug. Some groups are challenging this, using arguments similar to those used by peyotist religious sects, such as the Native American Church. A Supreme Court decision allowed the União do Vegetal Church to import and use the tea for religious purposes in the United States pursuant to the Religious Freedom Restoration Act. In a similar case the Santo Daime church sued for their right to import and consume ayahuasca tea. In March 2009, U.S. District Court Judge Panner ruled in favor of the Santo Daime, acknowledging its protection from prosecution under the Religious Freedom Restoration Act. I went to Peru to use the tea legally; On June 24, 2008 the Peruvian National Institute of Culture declared that ritual ayahuasca ceremonies are part of the national cultural heritage of Peru and are to be protected.WP_20160427_001

All this sounds great, however there are problems concerning the booming ayahuasca tourism business. With the influx of money, there are now people providing the tea who have poor training or bad intent. There have been reports of molestation, rape, and negligence at the hands of predatory and inept shamans, if they really are shamans. In the past few years alone, a young German woman was allegedly raped and beaten by two men who had administered ayahuasca to her, two French citizens died while staying at ayahuasca lodges, and stories persist about unwanted sexual advances and people experiencing difficulties after being given overly potent doses. I would like to warn people who want to experience the medicine to only use it under the supervision of someone they know they can trust. I got the name of my shaman from friends who had worked with him and had positive experiences. I would be more than happy to connect people with this shaman at their request.

Stay tuned for a post about my personal experiences with ayahuasca.

Below are some references for further reading. I would also suggest Wade Davis’ “The River.”

Ayahuasca visions
Ayahuasca visions

Barbosa, PC; Cazorla, IM; Giglio, JS; Strassman, R (September 2009). “A six-month prospective evaluation of personality traits, psychiatric symptoms and quality of life in ayahuasca-naïve subjects.” Journal of Psychoactive Drugs 41 (3): 205–12.

Strassman R.J. (1996). “Human psychopharmacology of N,N-dimethyltryptamine” (PDF). Behavioural Brain Research 73 (1–2): 121–4.

Rick Strassman (2001). Dmt: the Spirit Molecule: A Doctor’s Revolutionary Research into the Biology of near-Death and Mystical Experiences.

Schultes R.E., Raffauf R.F. (1960). “Prestonia: An Amazon narcotic or not?”. Botanical Museum Leaflets, Harvard University 19 (5): 109–122.

Robert S. Gable (2007). “Risk assessment of ritual use of oral dimethyltryptamine (DMT) and harmala alkaloids”. Addiction 102 (1): 24–34

Ethnopsychology: Creation of Culturally Specific Treatments

Ethnopsychology—The cultural framing of the self, emotions, and suffering.

In an earlier post I discussed methodology which can elicit local idioms of distress in regard to psychological issues. In this post I will examine how treatment models can also be created which are culturally specific. One such example comes from the work done by Kohrt et al. 2012 with Bhutanese refugees. These researchers state that there is an extremely high rate of suicide among Nepali Bhutanese in the United States and that a culturally specific treatment modality is necessary to alleviate the psychological distress among this population. They propose a framework designed to increase awareness among mental health professionals about Nepali Bhutanese experiences and interpretations of psychological distress; therefore reducing suicide risk.

The Nepali Bhutanese conceive of the self differently than the Cartesian mind-body split common in Western culture. The self is organized as the physical body (Nepali: jiu or saarir), the heart–mind (man), the brain–mind (dimaag), the spirit (saato), the soul (atma), and one’s social status (ijjat). Other aspects of the self are the family (pariwaar), which includes the extended family, and the spiritual world, especially relationships with ancestral deities (kul devta). The authors suggest that for mental health treatment, the heart–mind and brain–mind divisions are key. They suggest that the heart–mind aspect is the locus of memory and emotions. In contrast, the brain–mind is the organ of cognition, attention, and social regulation. Where heart–mind problems are considered commonplace, brain–mind problems carry more social stigma. A person with a prolonged heart–mind problem may eventually develop a brain–mind problem. In Nepal there is a traditional healing practice conducted by shamans (dhamijhankri) in which the heart–mind is “ritualistically bound (man baadne) to calm its desires and intense emotions, ranging from jealousy to sadness to love, so that the brain–mind is not overpowered and socially acceptable behavior can be maintained” (2012:94).

Shamans play an important role as treatment options for Nepali Bhutanese. As is common among populations in Latin America and elsewhere, a person’s spirit may be lost (saato jaane, spirit goes) when they become frightened or possibly cursed. Also, as is the case in other populations who recognize soul loss, healing by shamans is used in these instances to call the saato back to the body in order to restore health and vitality. “The physical body (jiu, saarir) is the site of physical suffering and pain. For physical problems, individuals may seek home remedies, the care of a dhami-jhankri shaman, or go to a health clinic” (2012:95). Health care professionals should recognize the important role shamans play in the treatment of these issues and include them in the treatment plan.

The authors also discuss how they adapted two therapy modalities to work specifically with Nepali Bhutanese. The first was Cognitive Behavioral Therapy (CBT), which is commonly used in Western psychiatric medicine to treat depression and other forms of psychological distress. In their specific case the treatment goal was framed as minimizing worries in the heart–mind by changing thoughts and behaviors related to the individual’s perceived powerlessness, which then reduced brain–mind distress. Their second treatment modality was Interpersonal Therapy (IPT). The authors suggest that the syndrome that was being treated by IPT can best be described as manosamajik samasya or a “heart-mind—society problem.” Their culturally specific treatment plan highlights goals for modifying the individual’s social relations and suggests changes in the person’s emotional appraisal of those relations.

It is my opinion that not only is it important to extract local conceptualizations of psychological distress, but it is even more important to create treatment modalities and ways of managing psychological distress which are culturally and context specific. Thinking back to the group of people I worked with who were diagnosed with bipolar disorder, it became clear that they had their own model for what they could do to manage their psychological distress. I thought it was unfortunate that this model was not shared by their doctors and other health practitioners. This illustrates the importance of the work of psychological anthropologists which can inform the dominant health care system in which most people seek treatment.

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Kohrt, Brandon A., Sujen M. Maharjan, Damber Timsina, and James L. Griffith
2012 Applying Nepali Ethnopsychology to Psychotherapy for the Treatment of Mental Illness and Prevention of Suicide among Bhutanese Refugees. Annals of Anthropological Practice 36(1):88.

Models, Incongruity, Consonance, and Stress: Implications for Managing Illness

I had a eureka moment when I learned that Toni Copeland had conducted research showing that knowledge of (competence) and behavior which approximates aspects of (consonance) a model of managing HIV among women in Nairobi, Kenya has been shown to be correlated to positive health outcomes, even going so far as affecting T-counts (Copeland 2012). I had obtained similar results in my Master’s research among a group of individuals diagnosed with bipolar disorder and who were attending a peer support group. Among this group there was a shared model of what a person could do to manage their disorder. I found that people whose behavior more closely approximated the model also reported less depressive episodes, mania, anxiety, and stress. In my opinion, this has enormous implications for treatment, especially in the area of my focus – psychological distress. This blog will focus on how the distribution and relationship to individual cultural models relates to health outcomes, the role of stress, and the implications for treatment of psychological distress.

Reflecting what I believe to be a general dissatisfaction with psychotropic medications, the people I worked with in the peer support group often complained of the efficacy and side effects of the drug cocktails they were taking to treat the issues which came with their diagnosis of bipolar disorder. If it can be shown repeatedly that knowledge of a model of managing psychological distress and behavior approximating that model correlate to better health outcomes, a more holistic approach to treatment can be employed.

The concept of cultural models has proven extremely useful to research in the social sciences (Strauss and Quinn 1994; D’Andrade 1984, 1995). If we start with a theory of culture derived from cognitive anthropology which states, culture is that which one needs to know in order to function adequately in any given social system, then the next task of the researcher studying culture would be to determine what exactly is it that the person needs to know. This knowledge is organized in models, consisting of interrelated elements which together represent something (D’Andrade 1984, 1995). Cultural models are not formulated as explicit declarative knowledge (as in theory), but as implicit knowledge, based on schemas embedded in words but not formulated as explicit propositions. Models are actively used, interpreted, and are socially transmitted. It has been shown that people cognitively model their illness experiences in culturally salient ways.

Incongruence, or status inconsistency, to dominant models has been shown to adversely affect health (Janes 1990; Dressler 1992, 2004; McDade 2001, 2002). One example of this is when an individual’s material lifestyle exceeds their social and economic status. This is the classic example of “keeping up with the Joneses”, where there exists a dominant cultural model of what a successful lifestyle consists of, and an individual is stretched beyond his means trying to achieve it. Incongruence or status inconsistency can also happen as a result of rapid cultural and economic change. This happens as a result of emerging markers of social status conflicting with traditional markers, creating discord or stress.

To examine the strength and distribution of a cultural model, or the level to which it is shared among individuals which make up the culture, cultural consensus analysis can be employed. This method was developed by Romney, Weller, and Batchelder (1986) and measures the degree of sharing of knowledge and individuals’ relative degree of shared knowledge. A measure of consensus is then found, weighted by the competence of the respondents. The idea of competence (which was originally raised by Keesing in 1972) is important in that an individual’s ability to meet the expectations of and function within a cultural model affects his or her psychological and physical well-being.

Cultural consonance, or the degree to which an individual approximates, in his or her own beliefs and behaviors, the prototypical cultural model, can also be calculated (Dressler 2000; Dressler et al. 2004, 2007, 2009). In theory, cultural consonance illustrates the relationship of individual experience and culture. Individuals may know a model in a cultural context, but for a variety of reasons they may not be able to act on or achieve accordance with it. If we assume, that for most people, there exists a desire and drive to achieve that which is seen as good or desirable in the model, then the relative ability to meet those ends will have an effect on the individual. Following methods illustrated by Dressler and colleagues (2000, 2007, 2011), individual levels of consonance are shown to be correlated with health outcomes, including levels of psychological distress. These researchers have also found that low levels of cultural consonance to be correlated with high blood pressure.

Stress levels in individuals have long been associated with health outcomes (Cassel and Jenkins 1960; Cassel 1976; Mason 1975). This fact combined with the relationship of incongruity, status inconsistency, cultural competence, and finally cultural consonance to a shared model and stress, illustrates the interrelatedness and importance of the stress process. To create a working definition of the stress process, it is helpful to consider four contributing aspects (Dressler 2004). First of all there are inputs; these can be acute or chronic stressors which an individual perceives as threatening or challenging. Secondly, there are mediating factors which can be psychological or emotional, physiological, metabolic, or morphological. Thirdly, it is helpful to consider resistance resources; these include social support, psychological resources of the individual, and biological resistance factors. Finally, there are outcomes including disease or other chronic conditions. I am suggesting here that by mediating this stress process through either re-evaluating unreachable models of lifestyle or increasing competence and consonance to a model of managing illness, the psychological and biological health of individuals may be improved. In the end, culture matters in both the conception of the meaning of illness and ideas concerning how to manage the illness experience.

Cassel, J.C., Patrick R., and Jenkins C.D. (1960).  Epidemiological analysis of the health implications of culture change.  Annals of the New York Academy of Sciences 84:938-949.

Cassel, J.C. (1976) The Contribution of the Social Environment to Host Resistance. American Journal of Epidemiology 104:107-123.

Copeland, T. J. (2011). Poverty, nutrition, and a cultural model of managing HIV/AIDS among women in Nairobi, Kenya. Annals of Anthropological Practice, 35: 81-97.

Dressler, William W. (1992). Culture, stress, and depressive symptoms: building and testing a model        in a specific setting, pp. 19-33 in Anthropological Research: Process and Application.  John J. Poggie, Billie R. DeWalt, and William W. Dressler Eds. Albany, NY: State University of New York Press.

Dressler, W.W. and Bindon, J.R. (2000). The health consequences of cultural consonance. American Anthropologist 102:244-260.

Dressler, William W. (2004). Social or status incongruence, pp. 764-767 in The Encyclopedia of Health and Behavior. Norman B. Anderson, Ed. Thousand Oaks, CA: Sage Publications.

Dressler, William W. (2004). Culture, stress and cardiovascular disease, pp. 328-334 in The Encyclopedia of Medical Anthropology. Carol R. Ember and Melvin Ember, Eds. New York: Kluwer Academic/Plenum Publishers.

Dressler, William W., Rosane P. Ribeiro, Mauro C. Balieiro, Kathryn S. Oths, and José Ernesto Dos Santos. (2004). Eating, drinking and being depressed: The social, cultural and psychological context of alcohol consumption and nutrition in a Brazilian community. Social Science and Medicine 59:709-720.

Dressler, William W., Mauro C. Balieiro, Rosane P. Ribeiro, and José Ernesto Dos Santos. (2007). Cultural consonance and psychological distress: Examining the associations in multiple cultural domains. Culture, Medicine and Psychiatry 31:195-224.

Dressler, William W., Mauro C. Balieiro, Rosane P. Ribeiro and José Ernesto dos Santos. (2009). Cultural consonance, a 5HT2A receptor polymorphism, and depressive symptoms: A longitudinal study of gene x culture interaction in urban Brazil. American Journal of Human Biology 21:91-97.

Janes, Craig. (1990). Migration, changing gender roles, and stress: The Samoan case. Medical Anthropology 12: 217-248.

Mason, John. (1975). A historical view of the stress field. Journal of Human Stress 1:6-12; 22-36.

McDade, Thomas W. (2001). Lifestyle incongruity, social integration, and immune function among Samoan adolescents. Social Science and Medicine 53:1351-1362.

McDade, Thomas W. (2002). Status incongruity in Samoan youth: A biocultural analysis of culture change, stress and immune function. Medical Anthropology Quarterly 16:123-150.

Romney, A.K., S.A. Weller, and W.H. Batchelder. (1986). Culture as Consensus: A Theory of Culture and Informant Accuracy. American Anthropologist 88:313-338.

 

Ayahuasca: Soldiers Seeking Healing

To repeat from my previous post: “This week in my Neuroanthropology class we are focused on tobacco use and the cultural context of addiction. This got me thinking about other mind altering substances, in particular marijuana and ayahuasca, which have both in the news recently. In the case of marijuana, the results of the midterm elections revealed that voters in three states have decided to join Colorado and Washington in legalizing various amounts of marijuana and its consumption on private property. In the case of ayahuasca, I recently watched an episode of “This is Life with Lisa Lee” in which war veterans were using ayahuasca in Peru as a method of relieving symptoms of PTSD. Being very interested in the topic of the therapeutic use of mind altering substances, I decided to catch up on my required reading and examined several articles on marijuana and ayahuasca.”

Amazonian shamans use a psychedelic compound called ayahuasca which is consumed as a ritual beverage. The word ayahuasca is believed to have originated in the Quechua language (Beyer 2009, Madera 2009). The word huasca is a Quechua term for various species of vines. The word aya refers to a soul or the spirit of a dead person. That is why ayahuasca is often referred to as the “vine of the soul” or the “vine of the dead.” Ayahuasca is made by combining the Banisteriopsis caapi vine with the leaves of dimethyltryptamine (DMT) containing species of shrubs from the genus Psychotria. The mestizo shamans have understood how these plants work together to create the psychedelic compound for thousands of years. Shamans are able to judge the strength of their ayahuasca brew and it has been found that the usual dose contains between 25 to 36 mg of DMT (Callaway 2005). DMT is listed as a Schedule 1 drug by the United Nations which bans not only the use, but also research on the drug. Brazil and Peru are the only United Nations members which allow the use of ayahuasca. In a rare study allowed within the United States, Rick Strassman of the University of New Mexico conducted research on the effects of DMT on human volunteers. Participants in this study reported that they were aware of and interacted with human and nonhuman entities including animals, elves, and aliens while under the influence of the DMT (Strassman 1994). DMT is found in many trees and shrubs throughout the world. Interestingly, it is also found endogenously in mice, rats, and humans (Strassman 1994). Strassman also suggests that DMT is naturally released in the pineal gland during traumatic experiences such as birth and death. The pineal gland is the organ René Descartes considered the seat of the soul and the place where all our thoughts are created.

There are certain features which typify an ayahuasca experience. It is reported that ayahuasca does not affect the lucidity or clarity of thought processes. While under the influence of ayahuasca, time becomes dilated and ceremony participants report that time seems to pass much slower than the clock would indicate. People also report a sensory convergence of vision, sound, and smell. Auditory and visual hallucinations are common. As well as the DMT effects mentioned above in the Strassman research, ayahuasca ceremony participants also often report the presence of beings including spirits, elves, and aliens. These presences are described as being solid, three-dimensional, and very real (Beyer 2009, Madera 2009, White 2001).

It is thought that through use of the ayahuasca shamans can enter the spirit world and communicate with various spirit beings, including those of nature. It is suggested that the ayahuasca is good for the shamans’ health, that through it they can control energy (Beyer 2009 White 2001). The shamans also receive visions through the use of ayahuasca, which can be used in various ways including healing as well as psychological warfare against their enemies, which in the Amazon basin presently include oil companies. In this respect, shamans use ayahuasca to see where the enemy is and how to defeat them. The use of ayahuasca for spiritual growth and healing has also entered the academic field. Bonnie Glass- Coffin, A professor at Utah State, has conducted research on shamanism involving the use of ayahuasca and has written openly about her relationship with the practice as well as her experiences while under the influence of ayahuasca (Glass- Coffin 2010).

Harris and Gurel (2012) surveyed individuals who had used ayahuasca at least once in North America. They found similar spiritual experiences amongst the ayahuasca users and a comparison group of worshipers who had attended a Catholic spiritual retreat. They also found that the ayahuasca users had made life changes after their experience with ayahuasca. The researchers found that they had reduced their alcohol intake, ate healthier diets, experienced greater self-acceptance and improve mood as well as reporting an increase in the experience of love and compassion related to their relationships. They also stated that they received ongoing guidance and support from the spirit of the ayahuasca.

Santo Daime was founded in the 1930s in Brazil by Raimundo Irineu. Santo Daime combines folk Catholicism, African animism, and South American shamanism with its use of ayahuasca in their ceremonies. The practice has become a worldwide movement and preaches the doctrine of harmony, love, truth, and justice (Langdon and Santana de Rose 2012). Ceremonies involve the consumption of ayahuasca while sitting in silent concentration, singing collectively, and or dancing in geometrical formations. Rituals usually last several hours, as long as ayahuasca is taking effect (Langdon and Santana de Rose 2012). The Santo Daime church maintains relationships with the Guarani, an indigenous Amazonian group, to ease the sense that this neo-shamanic group is simply involved with appropriating an indigenous healing complex. The church has recently been involved with and one several court battles in various countries concerning the legal use of ayahuasca in their ceremonies (Langdon and Santana de Rose 2012).

As with the case of marijuana, the cultural construction surrounding the use of ayahuasca seems to be changing in the United States. I was moved by the stories of war veterans who were dissatisfied with the psychological care and drugs they were receiving to treat their trauma. Perhaps with further research, those in the mental health professions will begin to treat the sufferers in a more holistic manner, providing a safe place for emotional catharsis and spiritual healing.

Beyer, Steven V. (2009) Singing to the Plants: a Guide to Mestizo Shamanism. University of New Mexico Press.

Glass-Coffin Bonnie (2010) Anthropology, Shamanism, and Alternate Ways of Knowing–Being in the World: One Anthropologist’s Journey of Discovery and Transformation. Anthropology and Humanism 35(2):204–217.

Harris, Rachel and Lee Gurel (2012) A Study of Ayahuasca Use in North America. Journal of Psychoactive Drugs 44(3):209-215.

Langdon, Esther Jean and Isabel Santana de Rose (2012) (Neo)shamanic Dialogues: Encounters Between the Guarani and Ayahuasca. Nova Religio 15(4):36-59.

Madera, Lisa Maria (2009) Visions of Christ in the Amazon: The Gospel According to Ayahuasca and Santo Daime. Journal for the Study of Religion, Nature and Culture 3(1):66-98.

Strassman, Rick J. and Clifford R. Qualls (1994) Dose-Response Study of N,N-Dimethyltryptamine in Humans. Neuroendocrine, Autonomic, and Cardiovascular Effects. Archives of General Psychiatry 51(2):85-97.

White, Steven F. (2001) Shamanic Ayahuasca Narratives and the Production of Neo-Indigenista Literature. Latin American Indian Literatures Journal 17(2):111-123.

Marijuana: Drug of Abuse?

This week in my Neuroanthropology class we are focused on tobacco use and the cultural context of addiction. This got me thinking about other mind altering substances, in particular marijuana and ayahuasca, which have both in the news recently. In the case of marijuana, the results of the midterm elections revealed that voters in three states have decided to join Colorado and Washington in legalizing various amounts of marijuana and its consumption on private property. In the case of ayahuasca, I recently watched an episode of “This is Life with Lisa Lee” in which war veterans were using ayahuasca in Peru as a method of relieving symptoms of PTSD. Being very interested in the topic of the therapeutic use of mind altering substances, I decided to catch up on my required reading and examined several articles on marijuana and ayahuasca.

Twenty-three states and the District of Columbia currently have laws legalizing marijuana in some form. Four states have legalized marijuana for recreational use. Alaska and Oregon will become the next states after Colorado and Washington where recreational marijuana is legal after voters approved cannabis ballot measures set to become effective in 2015. District of Columbia voters also recently approved a ballot initiative legalizing recreational use of marijuana that will be subject to Congressional review.

Due to marijuana being classified as a Schedule 1 substance in the U.S., most research is being conducted in other countries, however, this seems to be changing as I was able to find a couple studies conducted in the U.S. One interesting study, (Chapkis 2007), interviewed medical marijuana (MMJ) patients in California. Chapkis found many of her respondents reported that they valued the consciousness altering properties of marijuana significantly more so than its other various reported therapeutic benefits (2007). These patients reported that the effects on mood and cognition were difficult to separate from its medical benefits. I theorize the consciousness altering properties allow patients to relax, dissociate, and ease the stress response from worrying over their pain or other conditions.

In research conducted by Vadhan et al. (2007) the complex cognitive functioning during marijuana intoxication under controlled laboratory conditions was examined on regular marijuana users. The subjects were given a controlled dosage of marijuana and were presented with various cognitive tasks and The Iowa Gambling Task, which is said to model real-life decision-making, forcing the participant to balance potential gains and losses. The researchers found that the participants required greater amounts of time to complete the tasks, but their primary performance on tasks of deductive reasoning, cognitive flexibility, and working memory were not altered during intoxication. In regards to the gambling task, the researchers found that marijuana did not disrupt advantageous card selection or money earned.

In Australia, Jones, Blagrove, and Parrott (2009) examined creative responses and self-perception of creativity in marijuana and ecstasy users while they were not under the influence of either drug. They found that marijuana users scored higher on “rare-creative” responses than a control group, but rated themselves as not more creative. Ecstasy users rated themselves as more creative, but rated lower on the creative responses test (Jones et al. 2009). This research begs the question, does marijuana actually lead to more creativity as many musicians and authors have suggested over the years? Perhaps it is the dissociative state which enables a person to remove himself from the immediate physical sensory stimulation and imagine novel ways of looking at things.

In research conducted by Ringen et al. (2009) effects of marijuana use on neurocognitive functioning was assessed in patients with Bipolar Disorder (BPD) and patients with schizophrenia. The researchers found that in the patients with BPD, marijuana use was associated with better cognitive functioning, while the opposite was the case for the patients with schizophrenia. This suggests two things; first, that there may be different neurocognitive mechanisms in play in BPD as opposed to schizophrenia, and second, that something about marijuana’s effect on neurochemistry benefits people with BPD.

Often marijuana is described as a “substance of abuse” and medicinal marijuana patients as “drug abusers.” What effect does the use of this language have on the self-perceptions of patients? Would it not be healthier for these patients to be thought of as people who are undergoing treatment for their various ailments? Does feeling like a patient and not an abuser lead to better health outcomes?

In the words of an acquaintance who has a prescription for medical marijuana in Colorado, “With marijuana you know what you get, you can track it back to the warehouse which is 20 miles away and you know exactly what’s in it. It has to be grown in state; it’s actually a local crop too. Everything a doctor prescribes you; they get a kickback from the prescription or insurance companies. With all the commercials and stuff it makes all these prescription painkillers socially acceptable when it’s just the exact same thing as taking heroin or something.”

I conclude that the cultural construction of meaning regarding the use of marijuana may finally be changing. This reflects the current issues in the U.S. concerning the rising abuse of prescription painkillers and increased recognition of the dangers of alcohol abuse. Hopefully this will open the doors to more scientific studies on the effects of marijuana use, allowing people to form opinions based on facts rather than propaganda.

Chapkis, Wendy (2007) Cannabis, Consciousness, and Healing. Contemporary Justice Review, 10(4):443-460.

Jones, Katy A., Blagrove, M., and A.C. Parrott (2009) Cannabis and Ecstasy/MDMA: Empirical measures of Creativity in Recreational Users. Journal of Psychoactive Drugs, 41(4):323-329.

Ringen, P.A., Vaskinn, A., Sundet, K., Engh, J.A., Jonsdottir, H., Simonsen, C., Friis, S., Opjordsmoen, S., Melle, I., and O.A.Andreassen. (2009)   Opposite Relationships between Cannabis Use and Neurocognitive Functioning in Bipolar Disorder and Schizophrenia. Psychological Medicine, 40:1337-1347.

Vadhan, Nehal P., C.L. Hart, W.G. Van Gorp, E.W. Gunderson, M. Haney, and R.W. Foltin. (2007) Acute Effects of Smoked Marijuana on Decision Making, as Assessed by a Modified Gambling Task, in Experienced Marijuana Users. Journal of Clinical & Experimental Neuropsychology 29(4):357-364.

 

Measuring Depression: The CES-D

In an earlier post I discussed methodology designed to create a measurement instrument which combines ethnographic and quantitative methods aimed at recognizing idioms of distress among individuals within a specific population. In today’s post I will discuss a measurement designed to work in various contexts to measure depression. This measure is called The Center for Epidemiologic Studies Depression Scale (CES-D). This scale was created in 1977 by Lenore Radloff. Radloff created the scale using items derived from previous depression scales. The items reflect components which were gleaned from studies of depression and include; depressed mood, feelings of hopelessness and helplessness, loss of appetite, sleep disturbance, and reduced psychomotor functioning. The CES-D uses a Likert scale ranging from 0 to 3, reflecting the frequency of occurrence of the items in the scale. There are 20 items in the scale, therefore the scores range from 0 to 60. A score of 16 or above is usually considered a marker for people who are at risk for clinical depression. Scores of 16 to 26 are usually considered indicative of mild depression and scores of 27 or more indicate major depression.

The scale has been used throughout the world and there have also been short form 10 item and 4 item scales developed. Of particular interest to me are short form versions of the scale which I intend to use in the Bribri village of Yorkin. Grzywacz et al. (2014) tested several versions of the 10 item CES-D among seven Mexican immigrant communities within the United States. They found consistent reliability of the scales among the various populations. Also of interest, Kim et al. (2011) found that Hispanics tend to endorse positive items in the scale more frequently than whites or blacks in the United States. Grzywacz et al. (2010) used the 4 item form among Latino farm workers in the U.S. and found a mean score of 6.17

To my knowledge there have been no studies published reporting the use of the scale among indigenous communities in Costa Rica and Panama, where the Bribri currently reside. It is my intention to use the scale in Yorkin and compare its results to a scale which I will develop using the methods previously described and published by Weaver and Kaiser (2014). By comparing the two scales I will be able to determine if what the Bribri are describing as “depresión” is the same as the concept of depression that the CES-D scale is measuring.

You can check out an online version of the scale here: http://cesd-r.com/

Below I have included the full 20 item scale.

Center for Epidemiologic Studies Depression Scale (CES-D), NIMH

Below is a list of the ways you might have felt or behaved. Please tell me how often you have felt this way during the past week.

Rarely or none of the time (less than1 day ) Some or a little of the time (1-2 days)Occasionally or a moderate amount of time (3-4 days) Most or all of the time (5-7 days)

  1. I was bothered by things that usually don’t bother me.
  2. I did not feel like eating; my appetite was poor.
  3. I felt that I could not shake off the blues even with help from my family or friends.
  4. I felt I was just as good as other people.
  5. I had trouble keeping my mind on what I was doing.
  6. I felt depressed.
  7. I felt that everything I did was an effort.
  8. I felt hopeful about the future.
  9. I thought my life had been a failure.
  10. I felt fearful.
  11. My sleep was restless.
  12. I was happy.
  13. I talked less than usual.
  14. I felt lonely.
  15. People were unfriendly.
  16. I enjoyed life.
  17. I had crying spells.
  18. I felt sad.
  19. I felt that people dislike me.
  20. I could not get “going.”

SCORING: zero for answers in the first column, 1 for answers in the second column, 2 for answers in the third column, 3 for answers in the fourth column. The scoring of positive items is reversed. Possible range of scores is zero to 60, with the higher scores indicating the presence of more symptomatology.

 

“Depresión”: What does it mean?

During my stay in Yorkin this past summer, it was mentioned by one of the women that there used to be a lot of “depresión” in the village before they started their ecotourism project. My initial reaction was, “I wonder what exactly they mean by “depresión”?” And then I started thinking about administering the CES-D, which is a depression scale that has been used in many contexts internationally, in the community. I also knew that some way, somehow, I would have to get at exactly what they mean by “depresión” but I was a little unsure of how to do this.

After my presentation of my pre-dissertation research in Yorkin, our new faculty member in the department of anthropology here at the University of Alabama, Lesley Jo Weaver, turned me on to an article she had just had published (Weaver and Kaiser 2014) describing the methodology that I was looking for. In this article she describes how a researcher can accomplish two major agendas of psychological anthropology, the first being the comparison of mental health between sites using standard measurement tools and the second focusing on identifying locally specific ways of discussing mental illness. In this paper she lays out the methodology used in two research sites which identified local idioms of distress, developed a locally derived mental health scale, evaluated the scale, and contextualized the findings with ethnographic data.

The first phase of this methodology involves ethnography. In this phase field notes and interviews are coded for themes and terms used to describe mental health and the frequency of usage is recorded. Also as part of the ethnographic work, participants were asked to create free lists of symptoms and characteristics which accompany particular idioms of distress, for example in the case of the Bribri, depresión. From this ethnographic data a survey questionnaire can then be developed asking participants to rate on a Likert scale the accuracy and frequency of various terms used to describe an idiom of distress. From this data, a scale can be created which reflects local terminology and understanding of culturally salient mental health domains, again in the case of the people in Yorkin, depresión.

In the next phase, the locally derived scale can be administered along with a standard scale, for example the CES-D for measuring depression. Quantitative analysis can then be administered; examining correlations between the results of the two scales, checking for internal consistency using Cronbach’s alpha, and using principal components analysis to examine those factors in the scale which are most relevant.

The authors suggest “This research agenda respects culturally defined illnesses and acknowledges the contextuality of all illness experiences while still maintaining the comparative enterprise of cross-cultural psychiatry” (Weaver and Kaiser 2014:12). I foresee using this methodology in my research in phase 2, after using participant observation to learn about and describe their ecotourism project while also collecting hair samples which will be used to examine levels of cortisol (as a biomarker for stress) among community members.

Weaver & Kaiser 2014
Weaver & Kaiser 2014

 

Behind Blue Eyes: No one knows what it’s like to feel these feelings…..

Recently I read an article by Carol Worthman of Emory University entitled “Emotions: You can feel the difference.” The article can be found as a chapter in the book “Biocultural approaches to the Emotions” which was published in 1999 and edited by Alexander Laban Hinton. As I read the article I was taken back to my first year as an undergraduate student sitting in a psychology class concerned with child development. In that class I was first exposed to the work of Jerome Kagan on temperament in infants and the work of Mary Ainsworth involving various types of attachment of children to their caregivers. The more recent work by Carol Worthman builds on these ideas and outlines a process in which an individual’s relationship to the environment is mediated by emotions and how the appraisal of this relationship has an effect on the individual’s mental and physical health. Ultimately, Worthman argues that emotions have a role in cognition and physical well-being.

Worthman begins with a description concerning what exactly emotions are and what they do. Emotions are involved in processing sensory information. Emotions influence the detection of stimuli and the amount of attention given to stimuli. Emotions are involved in learning, memory, and cognitive integration. Emotions also influence the cognitive drive of an individual, affecting motivation, organization, prioritization, and recruitment of cognitive structures. Emotions are also a signal to the self and to others. Emotions affect communication, relations, and self- representations. neuro-emotion

Emotion and the brain

Worthman introduces the ideas of Gregory Bateson, formed in 1958, concerning ethos and eidos. Ethos can be described as the affective-emotional landscape characterizing members of a culture. Contrary to this, eidos concerns the cognitive-propositional landscape characterizing working cultural logic of members of a culture. These ideas reflect a Western view of feeling and thinking being dichotomous or Cartesian. In this model, the two realms are mutually exclusive; as emotion increases cognition decreases, and as emotion decreases cognition increases. Worthman suggests that in addition to operating in this manner, there may also be a synergy between thinking and feeling. She suggests that emotions are crucial to preconscious processing wherein they direct attention, and are also involved in memory construction and retrieval.

Emotion influences what is remembered, how it is remembered, modulates the retrieval of information, and ultimately forms a “bridge to the unconscious.” Indeed, most processing of sensory information, including emotions, occurs in the unconscious and is therefore embodied outside of awareness.

Conscious vs. subconscious thinking

Worthman suggests that what becomes conscious is selective and it is emotion that shapes the selection. Consciousness is finite; the brain determines what to pay attention to and what to ignore or place in the background. Emotion plays a key role in selecting attention and prioritizing cognition. Emotions are integral to information processing. And finally both conscious and pre or unconscious information is embodied.

emotion-brain

Worthman proposes a “dual embodiment schema” in which culture or the social context has an influence on the body through the process of embodiment and in return the body has an influence on the culture or social context leading again to various forms of embodiment. As Worthman states, “as culture shapes persons, persons shape culture.” The process of this embodiment depends on individual motivation, perception, behavior, and physical attributes. It is the individual’s interpretation of events, not the facts themselves, which constitutes lived experience.

Individual differences in emotional valence and interpretation of emotion can be described as the individual’s temperament. Jerome Kagan was a pioneer in the idea of temperament and described how reactive-inhibited infants are more easily excited, difficult to soothe, and less readily habituated.

Jerome Kagan on temperament

This has also been shown to be true in primates, particularly rhesus monkeys. In research conducted by Suomi (1991) high-reactive rhesus monkey infants were found to be more influenced by rearing conditions than low-reactive infants. High-reactive infants raised by “average mothers” were socially avoidant and low in dominance. Contrarily, low-reactive infants assumed immediate status no matter what were their rearing conditions. It has also been found that rearing conditions exert enduring effects on hormonal stress patterns (Higley et al. 1992).

In conclusion, individual reactivity can be a product of genetic inheritance or of early experience. Long-term effects of early experience may be exhibited only in certain situations. Effects of early experience depend on individual temperament through the interaction of reactivity and the environment. Variation in affective responsiveness influences how information is perceived, evaluated, and acted upon. These ideas constitute a psycho behavioral and biological link. They also illustrate the importance of the individual’s personal makeup and the context or social environment. A person’s inherited genetic biology influences temperament, which in turn influences emotion and how the individual interacts with the environment, which in turn influences mental and physical health, with all aspects combining in a circular feedback loop. I have included a chart created by Worthman below, which was created a few years after the article under discussion. In my opinion, the chart goes a long way towards illustrating these ideas in a visual format.

worthman