How Do They Heal?
I don’t know what you learned from books, but the most important thing I learned from my grandfathers was that there is a part of the mind that we really don’t know about and it is that part that is most important in whether we become sick or remain well.
—Thomas Large Whiskers, Navaho Medicine Man
Shamans are healers. As Sandra Harner summarized: “Oral reports, ethnographic studies, travelers’ records, comparative religion studies, and living experience among some indigenous peoples today testify that, worldwide, the shaman works with spirits to cure.”156
But how do they cure? While the spiritual domain is paramount, as the world’s most enduring general practitioners they also draw from the gamut of physical, social, and psychological therapies. Much of their effectiveness may reflect social and psychological factors since, like many healers, they use suggestions and support, skillful psychotherapy techniques, and a variety of rituals, all of which can elicit psychosomatic and placebo effects.
Shamans have often been called our first psychotherapists, which is not surprising, considering the many activities encompassed by the definition:
Psychotherapy is a planned, emotionally charged, confiding interaction between a trained, socially sanctioned healer and a sufferer. During this interaction the healer seeks to relieve the sufferer’s distress and disability through symbolic communications, primarily words but also sometimes bodily activities. The healer may or may not involve the patient’s relatives and others in the healing rituals. Psychotherapy also often includes helping the patient to accept and endure suffering as an inevitable aspect of life that can be used as an opportunity for personal growth....All psychotherapeutic methods are elaborations and variations of age-old procedures of psychological healing.104
BENEFITS OF PSYCHOLOGICAL HEALING
Psychological treatments are surprisingly helpful in a wide array of illnesses for several reasons. First, many patients who complain of physical ills are suffering from psychological or psychosomatic problems. In fact, approximately half the visits to Western general practitioners are motivated by psychological factors. Likewise, a study of native healers in Taiwan found that 90 percent of their patients suffered from psychological disorders and almost half of their physical complaints were traced to psychosomatic causes.194 This finding is consistent with the shamanic belief that much healing involves treating “soul loss,” a condition of being dispirited or disheartened.
Of course the process can also work in the opposite (somatopsychic) direction. Physical illness can produce disabling anxiety or depression that, in turn, may exacerbate the physical symptoms, thus setting up a vicious cycle that psychological help can break.
Social and psychological interventions may be treatments of choice for existential anxiety and guilt, which in tribal cultures can be overwhelming. In such societies “the strain for survival may be intense, the structure of the society may be intricate and frustrating and the fear of the unknown may be terrifying.”311 Life is hedged in by countless taboos, and the least infringement may mean sickness, suffering, and death. No wonder shamans devised an array of rituals and techniques to allay these threats, and no wonder psychological factors play such a major role.
INVITING HEALING:
THE NATURE AND EFFECTS OF RITUALS
Ritual, through its formal properties, can traditionalize or sacrilize anything….Rituals always provide meaning.
—Encyclopedia of Cultural Anthropology 88
Much shamanic healing occurs within the context of ritual, which is defined as “formal, patterned, and stereotyped public performances.”86 Ritual is part of every society, and just as habit is the flywheel of psychological stability, so ritual is the flywheel of social stability.
Rituals embody and express a people’s worldview: their “big picture” understanding of reality. Healing rituals focus on expressing beliefs about the cause and cure of illness.
Healing rituals have both technical and symbolic components. The technical element can be a straightforward intervention such as bone setting or massage, but even a simple technique is often embedded in a symbolic context. The symbolic component seeks to effect change—in the patient, the world, or the spiritual realm—via manipulation of symbols: objects that represent important forces or beings. Both technical and symbolic components can be therapeutic.
Anthropologists often divide the effects of rituals into manifest and latent. Manifest effects are obvious to both participants and observers. However, latent effects are subtle, secondary, and may be unsought or even unrecognized by participants. Examples of latent effects of rituals might include social stability and the affirmation of power structures.
An integral approach is helpful in recognizing the many effects of ritual. Ken Wilber’s integral theory emphasizes the importance of four domains of reality: collective culture, objective society, individual subjective experience, and individual objective phenomena.410
In the collective culture, rituals evoke communitas: a sense of shared concern, contribution, and humanity. Importantly, psychotherapy studies find that cohesion is a crucial factor in determining the healing power of groups.
In the objective world of society, rituals can repair relationships, solidify and stabilize social structures, and affirm or challenge authority. In fact, in contemporary anthropology, ritual is increasingly seen as “a symbolic device integral to the communication and construction of power….ritual and ritual symbols are increasingly understood as a complex battleground in the struggle for hegemony…”88
Healing rituals transform the inner world of participants, especially of patients. Rituals change experience and expectations, nourish a sense of relationship and support, and encourage reconciliation with the spirits and the sacred. These subjective experiences mediate and evoke objective effects on the body and its disease.
Rituals can exert remarkably wide-ranging effects on the body via “symbolic penetration.”208 Because of their highly charged meaning, the symbolic elements that are used in rituals penetrate into the mind-body system and elicit powerful psychological responses. These in turn can cause a cascade of corresponding biological responses throughout the body. These responses extend across organ systems such as the brain, endocrines, and autonomic nervous system, and across biological levels from organs to physiology to biochemistry and even down to gene expression (the ways in which genes create new cellular building blocks).
The emerging field of psychosocial genomics explores how “psychotherapy and related cultural processes and rituals (such as meditation, prayer, and the deeply meaningful humanistic experiences of art, drama, dance, music, poetry, etc.) can modulate alternative gene expression to facilitate health, rehabilitation, and healing.”314 For example, the amount and even type of neurotransmitter enzymes can be thrown out of balance by stress and can presumably be brought back into healthy homeostasis by stress-relieving rituals.314 The Nobel Laureate Eric Kandel summarized the new understanding:
Simply stated, the regulation of gene expression by social factors makes all bodily functions, including all functions of the brain, susceptible to social influences.190
Because its effects penetrate so widely, an effective healing ritual at its best is simultaneously:
• Cultural Therapy: Healing and cohering culture and creating communitas
• Sociotherapy: Repairing relationships, harmonizing social structures, and stabilizing society
• Psychosomatic Therapy: Diminishing disease and its complications
• Gene Therapy: Modulation of gene expression
• Psychotherapy: Healing the subjective dis-ease of illness
• Spiritual Therapy: Relieving a sense of alienation and estrangement from the universe, creating a sense of connection and alignment with the sacred, and fostering a transpersonal/transegoic sense of identity.
This spiritual element, so often overlooked in contemporary medicine, is central to shamanism and probably crucial to thoroughgoing healing. As Abraham Maslow put it: “Without the transcendent and the transpersonal, we get sick, violent, and nihilistic, or else hopeless and apathetic.”225
At their best, shamanic rituals probably induce this full panoply of healing responses, and they do so through a rich array of technical and symbolic methods.
SHAMANIC RITUALS AND TECHNIQUES
The healing ritual must be preceded by careful preparation, and both preparation and ritual are steeped in faith-inspiring symbolism. In Western medicine, patients are usually treated in privacy, whereas shamans often assemble the family and even the whole tribe. The patient thereby becomes the center of attention and receives considerable community support. Participants may be required to confess their breaches of taboo, resulting in a shared healing catharsis and communitas.
Music and song may be central. The recognition that music can heal is an ancient one. In Greece, both Plato and Aristotle ascribed curative power to certain melodies, while Apollo was the god of both medicine and music. “With song, one can open the gates of heaven,” claimed a Jewish Hassidic teacher.162
Today, music therapy is a valued healing aid, while there has been both enormous excitement and nonsense spawned by research suggesting that music can improve intellectual function. This “Mozart effect,” so called because Mozart’s music was played in the original research, has been used to sell all kinds of musical snake oil. However, while music can undoubtedly transform mood, enhance well-being, and induce altered states, its cognitive benefits seem limited and brief.49 In short, despite the breathless media headlines, hold off on buying a new stereo system for your fetal Einstein.
In Latin America, either shaman or patient or both may take yage to obtain a spirit vision that reveals the cause of illness. Once recognized, the shaman corrects the problem by, for example, intervening with troublesome spirits, retrieving the patient’s soul, or exorcism to remove spiritual intrusions.
Patients may also have to pay the shaman, make offerings to the spirits, and adhere to rigid rituals, restricting diets, and meticulous taboos. This may increase the effectiveness of treatment, or at least patients’ belief in its effectiveness, since due to expectation and cognitive dissonance, the more people pay for something the more they are likely to value it.
Some of these healing rituals are both arduous and time-consuming, and sessions can last through the night. Clearly a shaman who uses these techniques gives enormous time and attention and can see very few patients. The result is that “the more popular a shaman becomes, the less time he is able to devote to any one patient. This results in the paradoxical situation that the elaborate healing rituals described in loving detail by social anthropologists are carried out by those healers who have very few patients.”341
ASCs in Patients
Shamans enter altered states, and their patients may do likewise418 in at least three ways: through ritual, music, and psychedelics. Healing suggestions given during their ASC could produce hypnosis, which can have considerable therapeutic benefit.
The neurological basis of hypnosis is only now coming to light. Since similar neural mechanisms may underlie the placebo effect and other therapeutic processes crucial to shamanism, it is worth examining them.
Information first flows in from our sense organs to primary sensory centers in the brain. There it is processed and then forwarded to higher brain centers in a “feedforward” flow of information. At the same time, “feedback” information flows downward from higher centers to filter, modulate, and interpret this data.
The big surprise has been the sheer amount of feedback. There are some ten times as many neural fibers devoted to feedback (running from top to bottom) as feedforward,26 which means that a remarkable portion of our experience is based on what neuroscientists call “top down processing.” This explains why expectations, beliefs, and conditioning are so potent in shaping our experience and why hypnotic and placebo effects can be so far-reaching. Our reality owes as much to creation as reception, and believing that we simply see things the way they really are is exactly what philosophers call it: “naïve realism.”
THE PLACEBO EFFECT
A cheerful heart is good medicine, but a crushed spirit dries up the bones.
—Proverbs 17:22
The word placebo comes from the Latin meaning “I shall please.” It refers to
a poorly understood process in which psychological factors such as belief and expectation trigger a healing response that can be as powerful as any conventional therapy—be it drugs, surgery or psychotherapy—for a wide range of medical and psychological problems.170
Consider, for example, the humble wart. It can be dissolved by hypnosis, incantations, burying a rag at the crossroads under a full moon, in fact by almost any treatment, provided only that patients believe it will work. Yet no one understands how mind and body produce this minor miracle. Many people assume that since the placebo effect relies on something so ethereal as mere belief it must be a weak effect, but consider the following:
In the l950s a man dying of advanced cancer was given a highly publicized experimental drug called krebiozen. After a single dose, his huge cancers “melted like snowballs on a hot stove” and he was able to resume normal activities.
Then studies of krebiozen showed it to be ineffective. When the patient learned this, his cancer began spreading again. At this stage his doctor tried an experiment. He announced that there was now a new “improved” krebiozen and proceeded to give it to his patient. Once again the man’s tumors shrunk. Yet the doctor had given him only water.196
Clearly, placebo effects can be powerful, even lifesaving. They are also widespread, and approximately one-third of people treated with completely inactive placebos improve.170 Even an effective drug may gain part of its impact from the patients’ and doctors’ expectations of cure. Indeed, the placebo effect has probably been a major factor in most therapies through human history.
In the past, various useless agents were believed to be effective against disease: lizard’s blood, crushed spiders, putrid meat, crocodile dung, bear fat, fox lungs, eunuch fat, and moss from the skull of a hanged criminal. Likewise, cupping, blistering, plastering and leaching had their day. When both physician and patient believed in them, these remedies could indeed have been helpful some of the time.23
But beliefs can also be negative and produce negative (nocebo) effects, including sickness and death. For example, a common complication of chemotherapy is hair loss, and in one study 31 percent of cancer patients who received only a placebo did in fact lose some of their hair.95 The nocebo effect is probably the basis for so-called voodoo sickness or voodoo death, which can occur when tribal people are hexed.
Urban dwellers are also at risk. Believers in Chinese astrology, but not disbelievers, die significantly earlier if they contract a disease that their astrological chart considers ill-fated.286 Expectation is so powerful that believing negative astrological health predictions can actually hasten death.
How the placebo works its remarkable effects is unclear. What is clear is that the process is, as the physician Lewis Thomas put it, “absolutely astonishing.” The intelligence directing such a healing process must combine the skills of a world-class cell biologist, immunologist, surgeon, and executive officer. This, says Thomas, points to “a kind of superintelligence that exists in each of us, infinitely smarter and possessed of technical know-how far beyond our present understanding.”367
Certainly expectations and beliefs are key forces in the placebo response. Beliefs can harm or heal, and native healers seem well aware of this. A Navaho medicine man made the point about as succinctly as anyone could: “If the patient really has confidence in me, then he gets cured. If he has no confidence, then that is his problem.”319
The patient’s confidence is affected by the entire healing context. The personality, status, and beliefs of the therapist as well as the nature of the ritual and audience all play a role. Skillful healers have long recognized this and sought to bolster what Jerome Frank calls “the healing power of expectant faith” through whatever means they could. In light of this, the tricks and sleight of hand so widely used by shamans to impress their patients may actually enhance expectant faith and healing. Clearly the placebo effect has been a powerful healing force throughout history, and shamans were among the first to harness it.
HOW SUCCESSFUL ARE THEY?
Shamans have not always been the world’s most humble healers, and some have claimed to be virtually infallible. On the other hand, more modest practitioners see themselves as instruments of the spirits to whom true credit is due.146
Just how successful are they? The short answer is “we don’t really know.” We have virtually no research data, and the only systematic studies have been done not on patients of tribal shamans but on Westerners doing shamanic journeys. These neoshamans reported feeling better after their journeys156, 204 and had elevated levels of salivary immunoglobulin A (a measure of immune function).155 However, the studies are preliminary, and the results are difficult to extrapolate to tribal patients. Therefore, the best we can do at present to assess tribal healing is to make estimates drawn from general principles.
One principle we need to keep in mind is the distinction between helping subjective illness and curing objective disease. This distinction is embedded in the medical aspiration “to cure sometimes, but to help always.”
There is no question that many patients feel helped. There are ample reports of this, and shamans have managed to stay in business longer than any other healing institution. Of course, none of these facts prove cure. For hundreds of years, some of both Western and Oriental medicine’s most bizarre treatments—such as bloodletting or mercury ingestion—killed thousands of grateful patients.
However, there are several shamanic practices that should produce considerable healing and some cures. These include careful selection of cases, skillful use of social and psychological interventions, hypnosis, the placebo effect, and the harmlessness of interventions.
Shamans try desperately to avoid taking hopeless cases. After all, their livelihood and even their lives depend on success, and in some cultures the shaman who loses a patient may also lose his life.311 Treating only patients likely to recover certainly bolsters one’s success rate.
Importantly, shamanic interventions are relatively harmless. This is no small claim. One of Western medicine’s golden rules is “first do no harm.” However, this rule was unwittingly broken for centuries by physicians whose well-intended but deadly nostrums sometimes did considerable harm. Even today, side effects from effective drugs kill many thousands of people worldwide, even when used carefully and cautiously. There are no free therapeutic lunches. By comparison, the low-tech and highly spiritual treatments of shamans seem most benign.
Skillful use of the placebo effect would also bolster success rates. Many rituals seem admirably designed to elicit it, since the effect is most likely when therapies are elaborate, time-consuming, expensive, fashionable, or esoteric.170
What types of success rates would general principles such as these lead us to predict? Of course this will vary with the disorder being treated. For psychological problems, such as mild anxiety or depression that respond well to psychological interventions and social support, success rates might approach those of contemporary psychotherapies. For other disorders that, according to Western theories, require drugs or surgery, we would expect success rates that approximate placebo rates.
Of course these claims would make little sense to shamans. For them, the pains their patients suffer are primarily spiritual in origin and consequently require spiritual responses. Once again we face a paradigm clash. For the questions of how, and how well, shamanic healing works will be answered very differently by shamans and Western physicians, whose spiritual and mechanistic worldviews are largely meaningless to each other.
The shaman’s worldview is far from meaningless to patients who share it. It is this sharing that constitutes a so-called “shared healing myth” or “shared healing story” within which therapy can take place. Because of this shared healing myth, shamans have long been a source of hope and help for problems ranging from physical illness to spiritual crises. For the tribe, the shaman is a guide, a healer, a source of social cohesion, and a keeper of myths. In a world of vast incomprehensible forces, the shaman offers hope that these forces might be mastered and that humans need not be helpless victims of an uncaring universe, but that illness might be healed, guilt assuaged, spirits mollified, and even death robbed of some of its sting. What an extraordinary symbol of hope the shaman must have been for thousands of years.