Ayahuasca and the Science of Healing

In what way do traditional healing practices differ from trendy wellness retreats?

Accessibility, for one thing.

In the summer of 1951, William S. Burroughs spent two months slogging through the jungles of Panama and Ecuador, searching unsuccessfully for users of the psychdelic drug yagé, more commonly known as ayahuasca ("eye-uh-WAH-skuh").

Nowadays, Burroughs would need less than two minutes to open Tripadvisor and find dozens of ayahuasca ceremonies. Retreat.guru lists more than a thousand.

Judging from websites and reviews, and from the first-hand experiences of my friend Jay, people are drawn to ayahuasca for different reasons. A common theme is healing. Spiritual healing. Relief from addiction, or grief, some other demon.

You might raise an eyebrow at some of their attitudes. One reviewer complained that ayahuasca made him hallucinate animals he could've seen on The Discovery Channel. But the suffering that drives people to dabble in psychedelic tourism is surely real, and you can't blame anyone for seeking relief.

In Jay's case, it was the loss of his girlfriend in an auto accident. As he explains it, he was looking for peace, but he also yearned to see her one more time and say goodbye.

In this newsletter I'll be describing the latest addition to a growing literature on the use of ayahuasca to support mental health. This study illustrates how science, with help from statistics, can bridge the gap between traditional and contemporary approaches to healing.

Some context

Scientific interest in the psychological effects of psychedelics began to increase during World War II. By 1951, while Burroughs was stumbling around the Amazon, LSD alone had been the focus of over 100 studies published in medical journals.

Mainstream America didn't appreciate Burroughs and his Beat generation pals, much less the hippies that succeeded them. Countercultural glorification of drug use helped motivate the Controlled Substances Act of 1970, and research on psychedelics foundered.

A key obstacle was the CSA's classification of many psychedelic drugs as "Schedule I" – illegal even for doctors to prescribe – under the assumption that they have no acceptable medical use but a high potential for being abused.

Researchers nonetheless managed to cobble together evidence from animal studies and other sources that some psychedelics (e.g., psilocybin) might aid therapy for some kinds of problems (e.g., depression) under controlled conditions, with little evidence of harm.

Ayahuasca is one of those psychedelics. Because the brew typically contains a substance called DMT, it remains a Schedule I drug and thus illegal in the U.S., although exemptions are made for religious groups who conduct ayahuasca ceremonies. Meanwhile, research on the psychological effects of ayahuasca and its chemical compounds is flourishing.

Ayahuasca

The name "ayahuasca" comes from a Quechua term meaning "vine of the soul", as it's typically brewed from strips of a large vine (B. caapi) mixed with the leaves of a bush (P. viridis). The leaves are the ingredient that contains DMT but, as I'll explain at the end, compounds in the vine have psychoactive properties as well.

Ayahuasca has been used in spiritual and communal ceremonies for thousands of years, and more than 70 indigenous groups in the Northwestern Amazon region, including parts of Peru, Ecuador, Columbia, and Brazil, keep the tradition alive.

The purpose of an ayahuasca ceremony varies from group to group and may include divination, communication with dead or distant kin, conflict resolution, and the diagnosis or treatment of disease.

(Don't tell the psychedelic tourists this, but in traditional ceremonies, it's often the healer rather than the patient who drinker the beverage!)

Ayahuasca is said to be bitter-tasting, with a muddy texture. My friend Jay, who partook in 2004, compared it to blackstrap molasses without the sweetness. His experience illustrates why scientists, therapists, and psychonauts have all become interested in the healing potential of the brew.

An individual experience

Jay was in Rio de Janeiro at the time, participating in an ayahuasca ceremony at a small church. Six or seven people, including Jay, were guided through the ceremony by a church father.

Jay's experience was typical in some respects and deeply personal in others.

"The first thing that happened was I got nauseated. I puked, one time. It wasn't too bad. We had buckets...

Then I started to feel good. Like a sense of relief that just kept welling up. It was like I was opening up and all the heavy shit was just floating away. It felt so light and peaceful...

For a while I could hear the people around me, and I could smell the wood, and there were some weird sensations, but I was still in the room... Then I sort of entered this alternative reality where it was the middle of the night and I was alone in the jungle and all the trees were breathing, and I knew somehow that every living thing, every plant and animal, even the caterpillars, could speak to me. They did speak but I'm not sure what they said...but it wasn't threatening. Then I saw her. She came to me through the trees and stood right in front of me. I cried and told her that I loved her and I was so sorry she had gone... Then she put her arms around me and said "It's ok, I'm here." And I held her again. I could smell her perfume. It was the most amazing feeling. Then we looked into each others' eyes, and I said goodbye...

I felt a lot better after that. I mean, I still miss her, sometimes a lot, but [the ceremony] gave me closure. Maybe it's not true, but I feel like I was able to be with her one last time and actually say goodbye..."

I was deeply moved by Jay's experience. As I said, it's understandable why anyone would consider ayahuasca a potential source of healing. But Jay is just one person. Not everyone responds positively to ayahuasca ceremonies. Those who do may be benefitting from placebo effects, or the power of community, or something else other than the neurochemical effects of the tea.

The new study

The new study appears in the most recent issue of Journal of Psychopharmacology. (An online version has been available for a few months, making it less "new" than studies I usually review.)

In this study, Dr. Manoj Doss (affiliated with UT Austin and Johns Hopkins) and his colleagues tested 24 members of the Santo Daime, an Brazilian-based church that has been conducting ayahuasca ceremonies for nearly a century.

The purpose of Doss and colleagues' study was to understand how ayahuasca affects the ability to notice and remember the details of specific situations.

That may not sound exciting, but it represents a place where traditional healing practices and contemporary science converge.

Indigenous peoples of the Northwestern Amazon (and tourists like Jay) would say that the ayahuasca ceremony is healing. But, for most of us, taking ayahuasca is neither practical nor legal, and a shaman or church leader probably can't say anything about the brew that would allow us to recreate the ayahuasca experience at home.

Science offers a way of exploring whether anything about the ceremony and/or the ayahuasca itself can be incorporated into one of our most prevalent healing ceremonies – namely, psychotherapy.

Memory is critical to the therapeutic process, but data on the role of psychedelics is complicated and incomplete. For instance:

—Some psychedelics may enable or enhance the recollection of traumatic events.

—Some psychedelics may increase cognitive flexibility, helping people to reflect on past experiences and reframe unpleasant memories.

—Some psychedelics may reverse the memory impairments arising from depression and other mental health issues.

In spite of these potential positives, Doss and colleagues were pessimistic.

Based on what's known about psilocybin and LSD, which are similar to ayahuasca in the way they affect neural receptors, the researchers predicted that ayahuasca would undermine encoding and recollection, and render people susceptible to false memories. (I'll explain what this means in a moment.)

Methods

I invite you now to participate in an abbreviated version of Doss and colleagues' study.

Have a look at the drawing below, taken from the study materials. Look closely; I'll be asking you some questions later about the details.

Doss and colleagues presented three pictures like this to each participant.

—One set of pictures was presented to the participant while sober.

—Another set was presented to the participant shortly after they'd finished an ayahuasca ceremony and were still under the influence.

The participant then listened to a 30-second description of each picture supposedly recorded by another participant but actually created by the researchers themselves.

For instance, the participant might hear something like the following. (Don't look back at the picture as you read this.)

I saw a lot of people on the beach in front of a hotel. It was a sunny day. Some of the people were playing volleyball; others were swimming or just lying on beach towels. One kid was building a sand castle. One the left were tables where people were eating; on the right a vendor was selling ice cream. There was also a lifeguard. Overall it looked like a pleasant afternoon at the beach.

After completing a separate, unrelated task, participants were asked questions about each picture they'd seen. They were reminded to rely on their memory of the picture rather than the 30-second narrative.

Now it's your turn. Regarding the picture I showed you earlier...

(1) Did you see any snorkels?

(2) Did you see any beach towels?

(3) Did you see any volleyball games?

(4) Did you see any fish?

The correct answers are:

(1) yes

(2) no

(3) yes

(4) no

The first and second questions concern details that were mentioned in the 30-second narrative. But there were no beach towels. The second question was designed to create a false memory.

Decades of cognitive psychology research show that false memories can be easily created this way. Some people will not only answer "yes" to the question about beach towels, but later, when asked to describe the scene in their own words, they will spontaneously mention the non-existent towels.

In therapy, false memories crop up when a person's recollections are unintentionally distorted by questions or statements from the therapist. As I mentioned, Doss and colleagues expected ayahuasca to increase false memory effects.

Main findings

To their surprise, Doss and colleagues found that ayahuasca boosted memory without causing impairments. Here are three of the main findings:

1. While under the influence of ayahuasca, participants were significantly better at recognizing details from the pictures.

This effect emerged regardless of whether or not those details were mentioned in the 30-second narrative. For instance, ayahuasca would lead to more "yes" responses for questions 1 and 3 above.

2. While under the influence of ayahuasca, participants tended to be better at denying the presence of details that were neither found in the pictures nor mentioned in the 30-second narrative.

For instance, ayahuasca would lead to slightly more "no" responses for question 4.

3. Ayahuasca did not influence false memory rates (e.g., responses to question 2).

Practical implications

Just as the reports of people like William S. Burroughs and my friend Jay helped spur the psychedelic tourism industry, so one can imagine studies like this inspiring the use of ayahuasca as a memory hack.

For instance, if ayahuasca is ever legalized (e.g., as a Schedule II drug that can be prescribed for mental health treatment), we might expect some folks to misuse it for the same reasons that students and others sometimes resort to Adderal and other prescription stimulants.

Using ayahuasca this way doesn't seem advisable. Those who benefitted in the new study were experienced users, and the effects weren't overly strong. Moreover, as lead author Manoj Doss noted in an email to me, any benefits may be accompanied by risks. The vine used in a typical ayahuasca brew contains a MAO inhibitor that would be dangerous if taken in combination with certain drugs and foods. Ingesting the vine on a daily basis and then stopping could also, in theory, create withdrawal effects.

Meanwhile, lots of other things can boost your memory in modest but useful ways: A little caffeine, a short nap, mnemonic strategies. It's a long list.

The implications of the new study, and the potential for ayahuasca as a therapeutic tool, may depend on how each ingredient affects the user's brain.

As I mentioned, the main ingredients consist of a vine (B. caapi) and the leaves of a bush (P. viridis). Doss and colleagues speculated that one or both ingredients could be beneficial. Here, in not-so-plain English, are two of their suggestions:

––Among experienced ayahuasca users, DMT in the P. viridis leaves blocks the action of neurons in the hippocampus that impair recollection.

––As long as dosages are low, β-carbolines in the B. caapi vine inhibit MAO-A receptors and thereby enhance recollection.

If you found that, hard to follow, as I did, no worries. It's just highly sophisticated speculation. The key point is that the vines and the leaves may enhance brain function in different ways, depending on the experience level of the person drinking the ayahuasca and the specific composition of the brew.

As you can see, science is taking small steps toward understanding the highly specific mechanisms by which ayahuasca could support mental health.

Hacking brain function can be risky (though I don't view it that way when I drink coffee), and not all experts are thrilled by the prospect of psychedelics being incorporated into psychotherapy. Some studies question the safety and/or effectiveness of psilocybin, for instance. Meanwhile, Oregon and Colorado already allow it to be used in supervised therapeutic settings.

Fortunately, the FDA has been granting breakthrough therapy designation to Schedule I drugs like psilocybin, a formal classification that expedites their development and review, and ultimately yields more data. Hopefully ayahuasca will soon achieve the same status. Although my friend Jay is just one person, it would be great to know whether ayahuasca or its constituents, if administered properly, can genuinely alleviate the suffering of others as well.

Thanks for reading!