This article was originally published at Kahpi.net here on 3 June 2020 and has been reproduced with their kind permission.

by David Dupuis (Hearing the Voice)

Hallucinations occur during what doctors call psychosis, but they can also manifest outside the corridors of what is considered sick and dysfuctional. They can occur across a broad spectrum of non-ordinary changes in perception and play an important role in spiritual and creative arts around the world.

At the virtual opposite space to hospitals and biomedical contexts, indigenous groups in the Americas voluntarly seek hallucinations by drinking psychoactive brews such as ayahuasca. In such types of shamanic contexts, hallucinations are valued as social, religious, and theraputic aspects of life.

But are the hallucinations described by users of psychiatric services similar to those perceived by Amazonian shamans? By considering these two different types of experience side-by-side, we can learn something about how people and culture attribute sickness to non-ordinary types of perception, whether auditory, visual, or other sensory twists.

There is also another special difference I would like to highlight. As psychologist Richard Noll indicated, the ability to control hallucinations appears to be one of the main tasks of being a shaman. Learning how shamans and others work to control hallucinations can likely help us better understand and treat psychosis. My goal in this article is to explore such a possiblity.

 

Shamans and the Quest to Control Ayahuasca Visions

In contrast to contemporary Euro-American societies, many cultures value hallucinations and place them at the heart of social life. Historical and ethnographic studies have documented the importance of hallucinations in Native American societies and the wide variety of techniques that can be used to induce them, such as fasting, isolation, sensory deprivation, or the use of psychotropic substances. Hallucinogenic plants such as ayahuasca occupy a central place in the life of some Amazonian societies, as do peyote and psilocybin mushrooms in the Mesoamerican region, or San Pedro cactus in the Andean world.

Experiences induced by so-called “hallucinogenic” or “psychedelic” substances such as ayahuasca have been traditionally used for many social and cultural purposes. These include divination, healing, initiation, hunting, recreation, and even warfare. It appears that the consumption of hallucinogenic substances can inspire similar experiences across cultures, such as geometric visual imagery. There are also important cultural differences in the experiences, including the feeling-tone and meaning or content of the hallucinations.

Many anthropologists have observed similarities in the features of hallucinatory experience within the same culture and have been led to defend a culturalist approach to psychedelic hallucinations. Claude Lévi Strauss proposed for instance to consider hallucinogens as “triggers and amplifiers of a latent discourse that each culture holds in reserve and for which drugs can allow or facilitate the elaboration.”.

But how exactly does culture shape hallucinatory content? This question is still being sorted out by anthropologists. Some suggest we focus on mythological and cosmological knowledge or kinship systems, iconographic representations, or ritual to make sense of how culture determines non-ordinary changes in perception. In previous work, I have proposed a model called the “socialization of hallucinations“, which looks at how verbal exchanges and ritual interactions shape hallucinations through the education of attention, expectation, and perception.

 

Ayahuasca vision by Howard G Charing, CC BY-NC. Inspired by ayahuasca.

 

In the traditional practices of indigenous groups in the Americas, hallucinations are most often perceived in very different ways from how psychiatry defines them. For the indigenous practitioner, the experiences include hearing special “voices” and seeing special “visions” that are communications from entities who are usually invisible. The so-called “hallucinogenic” substances are considered, from an indigenous point of view, as a tool used to develop lasting relationship with culturally significant supernatural beings.

Among indigenous shamanic practices of the Amazon, “voices” and “visions” are then often organized in a dual manner. They may be attributed to malevolence (such as evil spirits, sorcerers) or protective entities (such as plants and animal spirits). The shamanic initiation therefore implies the adoption of different kinds of relationships with these entities, ranging from alliance to opposition. During shamanic initiation, the apprentice is thus invited to engage in an active relationship with “voices” and “visions”  to cultivate allies and to repel those perceived as dangerous. The hallucinations are controlled by means of techniques transmitted during the initiation, which give a central place to singing. In his classical work on the indigenous Amazonian Yaminahua on the Yurua river, Graham Townsley has, for example, shown that the shaman’s use of metaphors in ritual song helps him to control the visionary content produced by the ayahuasca.

 

Ayahuasca brewing. Image credit: Wikicommons.

 

Some early anthropologists defined shamanic hallunications as culturally legitimated expressions of psychosis. If this view is not wrong then it is, at the very least, much more complicated. This is because in the context of shamanic initiation, apprentices learn how to control, to a certain extent, the occurrence, nature, intensity, and frequency of hallucinations. Non-ordinary perceptions are not necessarily expresions of a sick or deranged mind. They are a challenging horizon of experience that requires special techniques to maneuver within.

 

Can Anybody be Trained to Control Hallucinations?

The institutionalised use of hallucinogens such as ayahuasca, long confined to the Amazonian societies, has benefited since the second half of the 20th century from a growing interest from Euro-American societies. In the context of the psychedelic counter-cultural, these practices have gone global and mixed indigenous practices with intercultural dimensions, creating what is frequently referred to as “neoshamanic.” Hallucinations perceived in these contexts in Euro-American societies have represented types political emancipation, psychotherapy, personal development, or new forms of religiosity.

Inspired by the craze for ayahuasca and the mythicized image of the “primitive” forest, an influx of travellers headed towards the Peruvian Amazon from the 1990s onwards, giving rise to what some have called “shamanic tourism.” While studying the use of ayahuasca in the Peruvian Amazon for more than ten years, I observed that the international clientele was often learning to progressively control the hallucinations produced by ayahuasca.

During 18 months of ethnographic fieldwork conducted in one of the leading “shamanic center” of the Peruvian Amazon, I observed that after a certain training period, some of the international ayahuasca drinkers were able to cultivate “inner” voices and visions. These special abilities appear to offer them ways of improving their psychotropic experience. For instance, they achieve this by inducing joy from allied voices and visions and reducing (or even eliminating) disturbing experiences of voices and visions attributed to evil beings.

The people running the ceremonies encourage the guests to approach hallucinations as acts of communications from intentional “plant spirits” whose behaviour is likely to be affected by the way the participant relates to them. Guests are also invited to adopt control techniques designed to the occurrence, intensity, and frequency of voices and visions. These control strategies include active efforts to stand up to the voices of evil entities and try to control them in order to no longer perceive them. They may also consist of:

  • strategies of confrontation or opposition, achieved through dialoguing with the voices (intimation of a compelling voice to remain silent),
  • attempting to diminish or transform the emotional tone created by the perception of certain voices through the use of a vigilance strategy (directing attention to the disturbing voice in order to prevent and control it)
  • avoiding strategies involving alternative activities, (directing attention to other perceptions such as ritual songs or positive voices)
  • compensatory behaviors, like fleeing the ritual space, sleeping, praying, or using a protective spiritual object.

These techniques of learning how to control hallucinations are first experienced by participants during rituals and then “integrated” to benefit their daily lives. For instance, learning how to control the visions and voices “inside” an ayahuasca experience appears to help people have more control over their daily mental and emotional states and can consequently increase self-esteem and confidence.

 

Can Shamanic Techniques Enrich the Treatment of Psychosis?

As with Indigenous shamanic practices involving the use of ayahuasca, people diagnosed as psychotic frequently describe their so-called “hallucinations” as deeply felt acts of communication rather than simply perceptual signals. As in ayahuasca experiences, the voices heard during so-called psychotic episode are frequently experienced as coming from persons that have identities and free-will and who speak in a coherent manner. These acts of communication, which sometimes take the form of real conversations, are often expressed as commands.

Unlike in shamanic contexts, in so-called psychotic states, voices and visions are predominantly described in a negative way—as unpleasant or even horrific, frequently associated with anxiety, depression, fear, paranoia, sleep disruption, and even suicidality. The majority of people diagnosed as psychotic seem to have little ability to influence or control voices and their disruptive effects. Voices and visions are predominantly experienced in this context as invasive, abusive, or violent, and as having a negative impact on their relationships. This point does not usually change over time without the help of medical treatment or psychotherapeutic intervention. As Joseph Campbell observed: ‘The psychotic drowns in the same waters in which the mystic swims with delight.’

This brief comparison between neoshamanic and psychosis contexts first reminds us of one of the first psychiatric descriptions of the so-called “hallucinogenic drugs.” They were once called “psychomimetic” substances due to their alleged ability to mimic psychosis in healthy people. A question arises from comparing, say, the experience of drinking ayahuasca with the experience of a psychotic episode. Could the coping strategies observed in the neoshamanic practices, such as the ability to discriminate and control the frequency and content of their hallucinations, be able to benefit people diagnosed as psychotic, who also perceive non-ordinary phenomena as willful acts of communication from an external voice or image that sounds or appears like it’s coming from an independent person?

This is what new therapeutic techniques such as Avatar Therapy and Relating Therapy for Voices, or hearing voices peers groups, seem to suggest. These different techniques have a common approach in that they treat hallucinations not as perceptual phenomena, but as acts of communication, which are experienced as a social and a relational phenomenon. In this relational approach, voices are for instance defined primarily as types of communication. It points to a social understanding of altered states of consciousness.

As the experience of hearing voices is increasingly being understood within this relational framework, new methods such as Avatar Therapy invite the voice-hearer to relate to the voice and modify the hearer-voice relationship. It does this with the help of a computer program where the voice-hearer constructs a visual “avatar” around the experience. The relationship between hearer and heard in psychosis can involve conflict or alliance and is frequently characterized by domination and intrusion, with the voice-hearer feeling like they are in a passive and submissive position and persecuted by the voice.

The goal of these relational therapies is to transform such a relationship by enhancing awareness of its reciprocal nature and inviting the voice-hearer to engage voluntarily with voices through dialogue. The seminal studies about relational therapies show that these practices increase the controllability and decrease the distress linked to the voice-hearing phenomenon. In a nutshell, these studies show that the more the patient is engaging assertively with voices, the more he is able to control them. In addition, the better the control of voices, the lower is the distress and frequency of negative voices reported by the participants.

It is striking to observe that these emerging therapies propose to use some of the coping strategies that I have observed in neo-shamanic ayahuasca practices, such as directly instructing the voice to be silent. I also learned during conversations with members of international Hearing Voices Network with whom I have been collaborating that voice-hearers are sharing during peer support groups these kind of strategies of interaction with their voices, which often reduce distress.

These observations highlight the importance of documenting cultural practices surrounding the perception of hallucinations. They offer promising areas for the creation of an inventory of techniques used to control hallucinations that I am working on. In the context of the contemporary revival of “psychedelic science,” Indigenous traditional techniques setting the use of hallucinogens (i.e. rituals) can be approached as sources of inspiration in order to elaborate safe uses of these substances in the treatment of various disorders, such as depression, anxiety, and PTSD.. As I’ve tried to show here, the hallucination control techniques used in shamanic and neoshamanic practices could also have a potential clinical application, especially in treating psychosis. As they are likely to be learned, they appear indeed as potentially efficient alternative therapeutic tools in regulating the distress linked to hallucinations for so-called psychotic patients. Documenting these control techniques and the coping strategies they involve through anthropological surveys appears likely to enrich the repertoire of techniques for treating people who hear persecutory auditory hallucinations. This is especially true when they do not respond or respond minimally to antipsychotic medication.

A first step toward this direction is the Voice-Hearing Experiences Among Ayahuasca users study. This interdiscipinary study, that I am coordinating in collaboration with Durham University Anthropology Department and Hearing the Voice, aims to be an exploration of unusual perceptual experiences, such as hearing voices, reported by some users of ayahuasca. Through this study, we hope to learn more about the source and experience of voices, and how culture and society shape the relationship with voices. This can help us better understand why it is that some voices and not others are experienced as distressing, how they can change across the life course, and how voices are cultural and social forces.

This study of voice-hearing experiences among ayahuasca users can be considered as a very first step, because a lot of other practices value and seek hallucinations. Among evangelical prayer practices, imaginary friends in Euro-American societies, and ritual practices or Vajrayana Buddhism meditation practices, just to name a few, hallucinations are learned in social contexts. The social world can allow individuals to partially control the occurrence, nature, intensity, and frequency of hallucinations. As we can see, there is consequently still much work to be done to document hallucination control techniques and evaluate their potential use in distressing situations such as psychosis.

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