engage him with questions, he remained a rumpled lump sitting on the sofa. Not easily discouraged, I noticed he was barely breathing and asked if we could do some bodywork to improve his respiration. He was too depressed to resist, and I cajoled him to lie on the carpeted floor and focus on the movement of his ribs, feeling them expand with every inhale. He was able to take in bigger breaths and to relax with every long, slow exhale. I was encouraged. Perhaps a body-oriented approach could reach him.
Then I’m not sure what happened. I might have said, “Find a position that feels the most comfortable to you.” With renewed energy, he made his way into a pile of pillows I had stacked against a wall. He burrowed in deep, creating a cave for himself, and leaving me alone on the floor in the center of the room. I had lost my client.
Undaunted, I moved closer to the stack of pillows and encouraged him to come out. I tried metaphors — a bear hibernating and awakening to the spring thaw, an infant waiting to be born. I whispered for him to rest and rejuvenate in his cave, to gather his strength in the quiet darkness before he emerged into the light. No movement ensued.
Finally, I asked, “What would entice you to come out?” Silence. “Not even your four-year-old daughter?” Blond curls, full of life. No response.
This is how I learned about treatment-resistant depression. It doesn’t budge. Nothing helps. The suffering is terrible. We usually think of depression as similar to our “bad days” when our self-critic goes into overdrive or perhaps when we encounter multiple discouraging disappointments. Not even close. My client’s depression was of a totally different order, practically unimaginable, like comparing a torn cuticle to a spinal cord injury. I knew that one hour a week of psychotherapy would not help him. He, like others with this kind of depression, would have to suffer silently or seek alternative treatments.
In 2006, National Geographic Adventure published a story called “Peru: Hell and Back” by Kira Salak, who journeyed to Peru to participate in an ayahuasca ceremony with a shaman.3 Afterward, this story received more inquiries than any other article in the history of the magazine. Why? The article said ayahuasca could cure depression. Salak wrote, “The severe depression that had ruled my life since childhood had miraculously vanished.” That one sentence not only described intractable depression but also created hope for fellow sufferers.
The mother of one of those sufferers emailed me during the course of my ayahuasca research. A psychiatric nurse practitioner, she could write prescriptions for antidepressants, which is more than I can do as a psychologist, and yet she was unable to find help for her young adult daughter, who had been suffering with intractable depression for most of her life.
I responded to her email as a colleague, but I also identified with her as a mother. The irony of being able to help others but not one’s own is sometimes too much to bear. I called her, and she told me a now-familiar story. Her daughter had seen many therapists, tried an array of psychotropic meds. Nothing helped. She wanted to try ayahuasca.
I explained that, as a researcher, I was open to sharing my own experiences with Grandmother Ayahuasca, but I had made the decision not to help people find a source for the medicine. This remains true. For one thing, my sources are confidential, but mostly I don’t want to be in the position of referring people I have never met to an illegal drug.
However, I could give the woman advice about ayahuasca itself. First of all, drinking it is a challenging experience, replete with explosive diarrhea and vomiting. Second, there’s no way to find a shaman or practitioner you can trust except by reputation, and even that’s not always trustworthy. Third, there’s no way to know what dosage or potency you’re getting, since every batch of ayahuasca tea is different.
Furthermore, using ayahuasca within the United States almost invariably means you’re breaking the law, since it is classified as a Schedule I drug. The only exceptions to this are two ayahuasca churches in New Mexico and Oregon, which have attained the legal right to use ayahuasca under the Religious Freedom Restoration Act.4 If you are a member of these churches, you can legally take ayahuasca as part of a church ceremony, but these groups are relatively small, and they constitute a unique situation.
Finally, if you travel to the Amazon to drink ayahuasca, you’ll have to navigate a wildly different culture, you’ll be more vulnerable to environmental dangers, and you’ll have fewer options in case of emergency.
You would think this rather discouraging advice would stop people in their tracks, but then you’d underestimate the extent of people’s desperation.
My strongest advice for this woman was “Don’t go to the Amazon.” Then, as now, I’ve heard too many stories of shamans raping young women, and I’ve seen too many slick promotional videos by narcissistic Westerners, who were supposedly trained by indigenous shamans, opening retreat centers. In addition, untrained local entrepreneurs will pass themselves off as shamans with signs at the airport for “authentic” ayahuasca healings, but their dark, mysterious brews don’t amount to much. “Too many known unknowns in Peru,” I told her. Most importantly in her case, what if her daughter needed more than a few ceremonies? Stories of immediate “cures” are the most dramatic and the most often repeated, but not everyone experiences this. Her daughter couldn’t commute to Peru for ongoing treatment.
I said, “Find a connection here in the States so your daughter can do a series of ceremonies at least once or twice a month for a few months. And then reevaluate.”
A year later, I followed up and learned that the young woman had found a connection to a shamanic group and was making progress, but that her progress was quite slow and this frustrated her. Her mother said, “She keeps looking back at all the time she’s lost in her life due to depression.”
I was glad to hear the daughter had found some relief, even though she hadn’t experienced one of those spontaneous, miraculous cures. The fact that ayahuasca helped, when years of Western medicine hadn’t, is important and significant. This remains the kind of personal story that inspires further research into the medicine.
The young woman’s expressed regret over the time she’d lost due to depression was an unmistakable call for therapy. She needed to mourn the life she had missed before she could look forward to her future. Ideally, a person like this could find a psychotherapist who has had his or her own experiences with the medicine and is conversant with Grandmother Ayahuasca. Such a therapist could maximize the person’s shamanic experiences within a therapeutic process and would know how to work with and integrate psychological material from the ceremonies into daily life. The therapist would know how to work on multiple levels of reality: sometimes in practical ways akin to cognitive therapy; sometimes with images from visions in a more Jungian framework; and sometimes shamanically, as in, “Let’s ask Grandmother Ayahuasca for help on this issue.”
Psychiatric research has consistently found that it’s the combination of psychotherapy and psychotropic meds that’s the most effective approach to depression, and this dual approach is likely to hold true for ayahuasca as well.5 Current research studies into the therapeutic benefits of psilocybin, LSD, and MDMA (or ecstasy)6 build on this finding by conducting sessions within a therapeutic setting. They structure preparatory interviews and follow-up sessions directly into the protocols in order to maximize the dual approach of using drugs plus counseling.
At this time, there is no existing treatment setting for using ayahuasca in combination with psychotherapy in North America. Maybe one day, but not yet. Right now there are very few ayahuasca-experienced therapists for people in the ayahuasca underground to consult. Most people process and integrate their experiences on their own without the added benefit of psychotherapy. This means that they miss the time of greatest therapeutic opportunity — the first few weeks after a ceremony when the psyche is most flexible and open. Unfortunately, most people return to
