by Richard M. Furr
Consider this hypothetical situation: Cynthia, a 32-year old woman suffering from depression, wants to try her first ayahuasca ceremony. She’s tried a lot of things to address her depression but nothing has quite done the trick. Cynthia’s friend told her about ayahuasca. She signs up for a retreat and schedules her first ceremony. This could go one of two ways:
In the best-case scenario, Cynthia receives the right dose and has an experienced facilitator. She has some deep cathartic emotional releases and feels that her depression lifts significantly after the first ceremony. This begins a long healing process that may relieve symptoms of the depression while also simultaneously allowing more access to deep emotion.
In the worst-case scenario, Cynthia receives too high of a dose, has an inexperienced or unqualified facilitator, and/or is held in an unsupportive container. In this case, she could feel much worse after her first ceremony, experiencing panic attacks and anxiety, dissociation, worsening symptoms of depression, and nightmares for months afterward. In extreme circumstances, conventional therapy, drastic life change, or psychiatric medication might be needed to bring Cynthia back to baseline.
Ayahuasca has become increasingly popular and even trendy in recent years. It’s seen exponential growth as a tourism industry and has gained some mainstream recognition and acknowledgment of its potential for helping with mental health issues. There has also been a growing trend in the mainstream world around alternative mental health treatments and holistic therapies rather than psychiatric treatments, with research focusing on psychedelics like MDMA, LSD, Psilocybin and ayahuasca at well-recognized universities. [1,2]
While the conversation is overwhelmingly positive, focusing on the positive effects and outcomes after decades of negative or nonexistent publicity, the reality “in the trenches” is that the outcomes are not always positive, despite the best intentions of those involved. This article will discuss potential outcomes and propose ways individuals, communities, and facilitators can help optimize them toward the positive side and reduce the risk of harmful or negative outcomes.
Best Case Scenarios
Anecdotal evidence shows us that when ayahuasca helps mental health, there is often a major emotionally cathartic experience or transpersonal experience that leaves a person over the short term (2-4 weeks) with dramatically reduced symptoms of depression and anxiety, a quieter mind, an elevated mood, more access to emotion, and feeling more present and grounded in their body. Often the people in their lives report that they seem different, more humble and more accessible.
Over the long term, people may notice improvements in their overall mental and even physical health. Also improvements in life that come from living more in alignment with deeper values and making better life choices around career, relationships, diet and exercise, and asking for help. People often find it easier to make the changes they’ve known and been wanting to make but didn’t have the strength to actually do before. This can set people’s lives on an entirely different trajectory. The alleviation of psychosomatic physical symptoms and unexplained health problems is also widely reported, though not thoroughly understood.
The factors that contribute to these positive outcomes are related both to the individual and their readiness as well as the environment that the experience is held in and the experience and integrity of the facilitator. People who have a significant background of inner exploration–whether it be through psychotherapy, meditative practice, or personal development work–tend to be more likely to have a positive outcome. I call this “pre-integration work” and find it significantly more important than “post-integration” work.
Some people seem to do much better in a one-off experience with time to integrate afterwards. Others, particularly those who are struggling with addiction to hard drugs or alcohol, do better with a series of ceremonies in a longer term container combined with other therapies. There are many ways to achieve a positive outcome with ayahuasca.
It’s likely that most people hope for a positive experience like this when they enter a ceremony. Unfortunately, things sometimes go sideways. For those looking to ayahuasca to treat mental health, the results can be devastating.
Worst Case Scenarios
When ayahuasca hurts mental health, it can leave people confused, distraught, and traumatized. Some have a sense they have been blown out or that their nervous system has been scorched. They’re physically and emotionally overloaded. In extreme circumstances, this can trigger panic attacks, hallucinations and dissociative experiences that significantly interfere with their lives. This can have a negative impact on their career, relationships, and daily functioning for 1-4 weeks, or occasionally much longer.
In the short term, this can look like having a full range of PTSD symptoms such as agitation, irritability, hostility, hypervigilance, self-destructive behavior, social isolation, flashbacks, fear, severe anxiety, or mistrust, paranoia, loss of interest or pleasure in activities, guilt, loneliness, insomnia, nightmares, emotional detachment, or unwanted thoughts.
Over the long term, this can cause massive disruption and setbacks in people’s lives, ranging from needing to be psychiatrically hospitalized or medicated to having to lose a job or an important relationship, or having grown-up high functioning adults regressing to the point where they need to move back in with and be cared for by their parents.
Another possibility that is not often recognized is long-term psychopathology or worsening/amplification of existing personality disorders. Ayahuasca ceremonies can trigger states of delusion, mania, or grandiosity, exacerbating narcissism and latent or pre-existing personality disorders. This may alleviate the individual’s experience of depression, but at the cost of those who interact with them.
The factors that contribute to these negative outcomes can be attributed to the individual, their readiness for the experience, and their mental health history. It can also be attributed to factors that are easier to control: too high (or even too low) of a dose, a lack of a supportive framework to understand the experience, and/or an inexperienced facilitator and an undesirable setting or environment.
Guiding toward a positive outcome
While in pursuit of a positive outcome, the following factors should be considered:
Dosage
Proper dosage is a key component of a positive experience and outcome. Too little or too much can be harmful and everyone’s needs are unique. Be aware of the dosage that works best for you, that gets you in deep enough to do the work without risking blowing you out or having negative consequences. Don’t hesitate to ask about the ingredients and strength of a specific batch and what dosage others are taking. Don’t hesitate to ask for less or to leave the ceremony if you feel unsafe about a particular facilitator’s approach.
Community support is important. It’s time to weed out any form of “dosage shaming” or “dosage pride” in the culture. The variation of dose-response can be very large based on genetic differences in liver metabolism, neurochemical gating strength, the general strength of psychological defense structure, and potentially other unknown factors. [3,4,5,6] Everyone should be encouraged to find the dose that is right for them. People who are drawn to dissociative peak-state experiences should be encouraged to take less by their peers.
Facilitators, above all, need to understand and respect dosage sensitivity. Anyone pouring ayahuasca should be prepared to disclose the strength and to honor the needs of the individual. If a facilitator has reason to believe someone is perpetually taking small doses out of fear, it is okay to invite them to try a little more–and carefully watch them.
“Clean” Facilitation
A facilitator or guide must be well experienced and disciplined, yet not overly elevated. While many facilitators and guides are well qualified and doing their work, it’s the responsibility of individuals to carefully screen who they approach for healing. It’s the responsibility of communities to support this by not putting their leaders on too much of a pedestal, allowing them the space to be human and encouraging them to keep doing their own shadow work to stay “clean,” or clear of unconscious motives.
Facilitators have the toughest job of all: they need to take responsibility for being properly qualified in a landscape that doesn’t have any clear requirements. While a standard for qualification hasn’t been universally established, it’s safe to say that if one hasn’t had at least three years of experience and dozens of ceremonies, one shouldn’t be facilitating or even assisting someone else facilitating these kinds of experiences yet. Anyone engaged in service this early would do well to humbly stop and focus on their own process for a few years before considering it again. The actual level of experience needed may take more than a decade, at minimum, though that doesn’t guarantee anything.
The work must also be ongoing. It’s important for facilitators to never think that they’ve made it or crossed some threshold where they don’t need to do their own work. They should continue to do their own psychotherapy or shadow work in order to stay clean. Facilitators who were once very clean, healthy, and trustworthy can become less so after years of neglecting their own process and being put on a pedestal by their community–this is natural. The work to counteract such an experience must therefore be preventative.
Trauma-Informed Leadership
Trauma awareness and education can help people understand and integrate difficult experiences.
While there is certainly something beautiful and important about really questioning, deconstructing and suspending our western belief systems and frameworks and immersing ourselves in and learning about a foreign culture, for the sake of psychological safety we must acknowledge that many who participate in ayahuasca ceremonies are also simultaneously WEIRD (Western, Educated, Industrialized, Rich, and Democratic) and living in WEIRD cultural landscapes. [7]
It’s one thing if you choose to opt-out and live solely in an indigenous community. If, however, we are continuing to blend and try to place our feet in two worlds, then it’s also important that we acknowledge some of the great work of western pioneers in the field of psychedelics and trauma, such as Stanislav Grof and Peter Levine.
Education can be extremely helpful in navigating the territory we are dealing with as we use psychedelics for mental health. It’s critical to understand the landscape of the unconscious that we are accessing, as well as how the body metabolizes trauma.
Understanding the role of birth trauma in the psychedelic experience, the basis for most of Grof’s work, is extremely helpful for comprehending some very difficult and disturbing experiences that are universal to humans. [8]
Consider shaking, for example. Individuals, groups, and facilitators need to understand and always allow/make space for the common psychogenic tremoring that ayahuasca can trigger. It is precisely the mechanism which Levine has highlighted as the body’s natural way of releasing trauma. [9]
Awareness of Interpersonal Complications
Projection and Countertransference awareness can help minimize some of the messy and unsafe interpersonal dynamics that can be harmful or traumatic.
A leader, guide, or facilitator needs to have equanimity and acceptance for the full range of emotional experiences that come up without having any sort of countertransference reaction. If a guide is inexperienced or avoiding certain aspects of their own history and unconscious, then that facilitator may unconsciously have a countertransference reaction that disrupts the healthy sequencing of trauma in the patient or participant.
Someone who has many years of experience doing their own inner work will be able to be properly attuned to the patient while they are going through any emotional experience which is very helpful in having a positive outcome.
For those that aren’t familiar with the term countertransference:
From wikipedia “The phenomenon of countertransference (German: Gegenübertragung) was first defined publicly by Sigmund Freud in 1910 (The Future Prospects of Psycho-Analytic Therapy) as being “a result of the patient’s influence on [the physician’s] unconscious feelings.” [10]
It basically means that one person’s feeling is a reaction to someone else’s feeling. It’s originally used in the context of psychotherapy or psychoanalysis, but could be applied in many contexts.
For example, countertransference reactions can also occur among and between participants in a group ceremony. A good facilitator can set a proper container to minimize this, but it can still happen none the less and have a detrimental impact. If one person in the room is having an uncomfortable emotional reaction to another person’s vulnerable process it can in some cases be detrimental in the sequencing of that trauma in the participant.
For those, that aren’t familiar with the concept of psychological projection:
From wikipedia: “Psychological projection is a defense mechanism in which the ego defends itself against unconscious impulses or qualities (both positive and negative) by denying their existence in themselves and attributing them to others.” [11]
Psychological projection or projection bias is a psychological defense mechanism wherein a person subconsciously denies his or her own attributes, thoughts, and emotions, which are then ascribed to the outside world, usually to other people. Thus, projection involves imagining or projecting the belief that others originate those feelings.
Projection reduces anxiety by allowing the expression of the unwanted unconscious impulses or desires without letting the conscious mind recognize them.
That means if a feeling comes up in the context of a ceremony that is for whatever reason too much to handle, we may project it onto others. This can happen for both the participant, the facilitator or guide, or other participants in the room.
“Observations from LSD psychotherapy suggest very strongly that the intensity of transference is directly proportional to the resistance to facing the original traumatic material.
Most of the technical problems in the sessions occur when the client, instead of treating the experience as an internal process, projects the emerging unconscious material onto the sitters and the treatment situation.” – Stanislav Grof.[8]
It’s imperative that all roles understand the nature of the unconscious and the concepts of projection, transference, and countertransference and hold an active inquiry into how these play out in every experience.
Conclusion: Ayahuasca can help our global mental health crisis.
Ayahuasca has much potential to be a radical catalyst for mental health in our current landscape, but caution, education and discipline must be followed to reduce risks of harm.
Consider the hypothetical Cynthia, who is about to attend her first ceremony to address her depression. By now you can see how she could have a spectrum of experiences based on several factors. On one end we have the possibility for very rapid alleviation of serious mental health issues and on the other end we have the potential for massive disruption and regression.
Individuals need to take radical responsibility for their own psychological safety and reducing risk. It’s imperative that patients and participants get the right dose and take responsibility. It’s the responsibility of the individual to seek out a qualified and trusted leader or guide.
Groups and communities need to take responsibility for educating each other on trauma and projection and eliminate any form of dosage shaming or pride. They need to stop idolizing or pedestalizing their facilitators, encouraging them to continue their own work.
Leaders and facilitators need to be experienced and also humble and respectful of an individual’s differences and sensitivities. They need to always continue making space to come out of their role and continue doing their own inner work and shadow excavation.
If all these issues are addressed, there is potential for this new wave of interest and expansion of ayahuasca for mental health to become a potent force of goodness that alleviates a lot of suffering. We know this medicine helps us humans treat each other better. Through combining ancient wisdom with modern understanding, we are on the precipice of a new evolution of mental healthcare that humanity has never known before.
References:
- Palhano-Fontes, F. Barreto, D. Onias, H. Andrade, K. Novaes, M. Pessoa, J. (2019). Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: a randomized placebo-controlled trial. Psycholological Medicine. 49(4): 655–663.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378413/ - Frood, A. (2015, April 6). Ayahuasca psychedelic tested for depression. Nature.com
https://www.nature.com/articles/nature.2015.17252 - Callaway, JC. Raymon, LP. Hearn, WL. McKenna, DJ. Grob, CS. Brito, GS. Mash, DC. (1996) Quantitation of N,N-dimethyltryptamine and harmala alkaloids in human plasma after oral dosing with ayahuasca. Journal of Analytical Toxicolology. (6):492-7.
https://pubmed.ncbi.nlm.nih.gov/8889686/ - Ott J. (1999). Pharmahuasca: human pharmacology of oral DMT plus harmine. Journal of Psychoactive Drugs. 31(2):171-7.
https://pubmed.ncbi.nlm.nih.gov/10438001/ - Riba J, McIlhenny EH, Valle M, Bouso JC, Barker SA. (2012). Metabolism and disposition of N,N-dimethyltryptamine and harmala alkaloids after oral administration of ayahuasca. Drug Test Analysis. 4(7-8):610-6.
https://pubmed.ncbi.nlm.nih.gov/22514127/ - Callaway JC. (2005). Fast and slow metabolizers of Hoasca. Ayahuasca: Psychological and Physiologic Effects, Pharmacology and Potential Uses in Addiction and Mental Illness. Journal of Psychoactive Drugs. 37(2):157-61.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343205/ -
Heinrich, J. (2020). The WEIRDest People in the World. Farrar, Straus and Giroux.
-
Grof, S. (1980,1994). LSD Psychotherapy. Hunter House.
- Levine, P. (1997). Waking the Tiger: Healing Trauma. North Atlantic Books.
- Countertransference. (2021, June 12). In Wikipedia.
https://en.wikipedia.org/wiki/Countertransference - Psychological Projection. (2021, May 19). In Wikipedia.
https://en.wikipedia.org/wiki/Psychological_projection
About the Author
Richard M. Furr is a speaker, writer and facilitator who works with groups and individuals at the cutting edge of post-traumatic growth. With a training background ranging from traditional psychotherapy to shamanic healing, Richard holds a deep curiosity about what it takes for each of us to be clear, at the moment of death, that we have lived well. Full Bio