I’m sitting on a blue plastic, wipe-down mattress with my back to a wooden pillar. Within arm’s reach on the floor is a small torch to light my way to the toilet during the night, on the other side an orange plastic bucket to puke into. As the light fades my four companions, each with his or her own plastic mattress and bucket, disappear from view while on every side the barks, croaks, growls and cries of jungle life grow louder. Twenty minutes ago I gulped down a draught of the bitter psychedelic brew known as ayahuasca and I have convinced myself that I can feel its hot, unstoppable progress through my body, from my seething guts into my veins and onwards to my brain.
This is hardly a recreational drug experience, what with the nausea, vomiting and diarrhoea, not to mention the possibility a truly terrifying trip, yet thousands now beat a path to Peru, Ecuador and Brazil every year to drink ayahuasca. Some are just looking for an exotic thrill, but others hope for enlightenment and healing from this ancient plant medicine. In the past few years, many of them have been war veterans desperate to escape the nightmares of post-traumatic stress disorder.
Combat-related PTSD is notoriously difficult to treat and in theory ayahuasca can work as a form of drug-assisted exposure therapy. When traumatised people repeatedly avoid fear-inducing situations this only serves to maintain and reinforce the deeply ingrained conditioning that underlies their illness. The idea is that by dredging up traumatic memories and exposing them to conscious awareness within a safe, controlled environment, ayahuasca allows the brain to reassess and extinguish conditioned fear responses.
Classic psychedelics such as DMT – an active component of ayahuasca – break the control that the prefrontal cortex normally holds over more primitive parts of the brain, triggering vivid hallucinatory memories and emotions. “That lets us go to places in our psyche or internal landscape that we wouldn’t normally allow ourselves to go,” says Gerald Thomas, who researches addiction at the University of Victoria, British Columbia. “In psychotherapy, it’s how we reconcile past events that have traumatised us.”
Thomas has conducted preliminary research suggesting that ayahuasca can reduce dependence on addictive drugs. Part of the explanation may be that it helps ease the pain of traumatic memories that people sometimes “self-medicate” with substances such as alcohol, tobacco and cocaine.
To date, any evidence that ayahuasca can do the same for people with PTSD has been anecdotal. But an ambitious study now under way at the Temple of the Way of Light in the Peruvian Amazon is monitoring its long-term effects on psychological wellbeing and may provide some answers. The research is a collaboration with the International Center for Ethnobotanical Research and Service in Spain and the Beckley Foundation in the UK. Around 580 retreat participants a year – among them combat veterans suffering from PTSD – are being recruited, making it the largest psychedelic study of its kind ever undertaken.
But the study highlights a problem. The Temple of the Way of Light rigorously screens applicants for any history of psychosis or mania, which can be triggered by ayahuasca. Adverse effects like these are rare, says bookings manager Karin Gingras, but the temple is in a remote jungle location far from the nearest hospital. “We have seen how difficult it can be to recover from psychosis for some of these folks and are very aware that we are not equipped with the professional psychological staff to safely support these individuals.”
Most ayahuasca retreat centres in Peru do not go to such lengths to screen applicants, and the cheaper ones advertised on the streets of tourist hotspots such as Iquitos and Cusco will take anyone’s money, no questions asked. They provide little or no psychological support.
“People should pursue using ayahuasca with great care and do thorough research to find reputable retreat centres,” advises Alli Feduccia of MAPS, the Multidisciplinary Association for Psychedelic Studies. “Counselling and support during and after ayahuasca retreats are necessary to integrate the intense experiences that can emerge,” she says. “People have been traumatised by ayahuasca experiences because this very needed support is lacking.”
Then there’s the risk of interactions with prescription drugs. In addition to DMT, ayahuasca contains potent monoamine oxidase inhibitors (MAOIs), which block an enzyme that usually breaks down neurotransmitters in the brain, including serotonin. As a result, taking ayahuasca while on an SSRI or MAOI antidepressant can cause potentially fatal “serotonin syndrome”. Under normal circumstances the enzyme also breaks down tyramine – found in pork, pickles, smoked and fermented foods, chocolate and alcoholic drinks – and excess tyramine can trigger a dangerous spike in blood pressure.
If you’ve got PTSD, it’s unlikely your doctor will send you on an ayahuasca retreat any time soon (you are more likely to be offered psychotherapy under the influence of MDMA). In the US, where DMT is outlawed as a schedule one drug, Feduccia says MAPS has faced major obstacles in its efforts to gain approval for a clinical trial of ayahuasca for PTSD. A perverse effect of the lack of research may be to drive desperate patients into the arms of dubious retreat centres in South America that will fail to screen them adequately, offer advice on potentially dangerous dietary and drug interactions, or provide the necessary psychological support.
My own encounter with ayahuasca was a happy one. I felt nauseous but didn’t vomit. I witnessed no earth-shattering visions, though I did experience perceptual distortions and a temporarily enhanced sense of meaning and beauty. The only long-term effect on my physical and psychological wellbeing appeared to be a persistent bout diarrhoea that lasted several days. Retreats like those at the Temple of the Way of Light usually involve a series of ceremonies over several days, but I attended just this one – at another reputable retreat centre near Iquitos – and requested a very low dose of the medicine. I have a family history of bipolar disorder, which can involve psychosis, so even though I don’t have the condition myself I was unwilling to take a major gamble with my mental health.
This article was edited on 6 April 2017 to make it clear that the author did not participate in a ceremony at the Temple of the Way of Light.
James Kingsland is the author of Siddhartha’s Brain: Unlocking the Ancient Science of Englightenment
A puke bucket and an ancient drug: is ayahuasca the future of PTSD treatment?
