Ayahuasca in the treatment of long-term early childhood sexual abuse and bipolar disorder—A retrospective case study

Abstract

This paper is now included as Chapter 8 in the book 'Psychedelic Therapy in Practice: Case Studies of Self-Treatment, Individual Therapy, and Group Therapy', available for free and without registration as a PDF file at: https://www.researchgate.net/publication/385040342

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Ayahuasca in the treatment of bipolar disorder with psychotic features
Mika Turkia
mika.turkia@alumni.helsinki.fi, psychedelictherapy.fi, March 8, 2023
Abstract
Ayahuasca is a plant-based brew of indigenous Amazonian origin. It has psychedelic, anti-inflammatory, neuropro-
tective, cytotoxic, and anti-parasitic effects, which are primarily due to monoamine oxidase inhibitors (MAOIs) and
N,N-dimethyltryptamine (DMT). This retrospective case study describes the case of a woman in her late thirties
with complex trauma due to severe, years-long sexual abuse in early childhood, resulting in a decades-long chronic
condition involving suicidality. She was diagnosed with bipolar disorder and borderline personality disorder, but
refused to accept either of them. She presented with delusional parasitosis and deep dissociation. Despite being
severely psychotic in private, she appeared high-functioning in public, hiding most of her symptoms.
In her mid-thirties, she participated in an ayahuasca ceremony in a legal setting. It resolved her suicidality, eliminated
her social isolation, and reduced her shame related to her early trauma. Nine more ceremonies alleviated her distress
further. Her abuser also participated in an ayahuasca ceremony and confirmed her memories of childhood abuse.
The first interview was conducted 1.5 years after her first ceremony, and a follow-up interview 2.5 years later. She
had experienced sixteen additional ceremonies, recognized the validity of her bipolar disorder diagnosis, and believed
her early trauma to be its sole cause. Her core trauma remained partially unresolved, but her dissociative symptoms
continued to decrease. She had observed several other instances of psychosis and bipolar disorder in which ayahuasca
had resulted in positive effects. This case study contributes to a better understanding of the use of ayahuasca in
bipolar disorder and severe traumatization. It also reviews the current state-of-the-art in the treatment of bipolar
disorder using low-dose ayahuasca, and a case in which bipolar disorder was resolved with LSD.
Keywords: ayahuasca, psychedelics, psychedelic therapy, childhood sexual abuse, complex post-traumatic stress
disorder, bipolar disorder, psychosis, delusional parasitosis, LSD
Introduction
Documented examples of the treatment of psychoses and bipolar disorder with psychedelics are currently rare. A
recent study by the author featured a teenager with complex post-traumatic stress disorder (C-PTSD), genetic
predisposition to schizophrenia, psychosis triggered by cannabis use, and acute suicidality (Turkia, 2022b). He
successfully resolved acute suicidality with a single unsupervised session with 100–200 µg of LSD carried out alone
at home. Subsequently, he resolved his C-PTSD with five more similar LSD sessions, and a few months of almost
daily low-dose (psycholytic) N,N-dimethyltryptamine (DMT) sessions. While some residual auditory hallucinations
remained, the teenager interpreted them as representations of unprocessed adverse childhood experiences (ACEs),
and considered the information contained in these representations helpful in recognizing the remaining unprocessed
material. After one year of such unsupervised self-treatment, he had acquired the capability to study and work.
The article also featured a general discussion about the role of self-treatment and harm reduction policies, the
safety of LSD, a proposed mechanism of action of psychedelics in healing C-PTSD, comparisons of various models of
psychedelic therapy, and examples of successful treatment of severely psychotic children with LSD and psilocybin in
the 1960s and 1970s (Turkia, 2022b).
According to the article, the primary ’mechanism of action’ of psychedelic therapy was to revive or bring back to
life repressed or dissociated traumatic events. These events were not only ‘remembered’ as cognitive memories but
relived as embodied experiences, with their original, associated physical feelings (another interpretation could be
that psychedelics acted as ’anti-dissociatives’). When these unresolved traumas originated at a very young age, they
could present themselves as psychotic symptoms. A psychotic state could be understood as a partial regression into
the conceptual framework of the age of the original trauma. The conceptual framework of that age could consist of
undeveloped and vague concepts, including vague concepts of time and causality, unsuitable for navigating the adult
world.
It was also proposed that distorted, psychotic ideas could simply result from learning the features of one’s childhood
environment, which was too different from the other environments in which one later tried to apply these learned
models. These ’biased’ models could not produce reliable predictions, i.e., could not enable correct reasoning about
the behaviors of other people and the features of one’s current living environment. If the magnitude of these prediction
Preprint; doi: 10.13140/RG.2.2.21294.18243 or 10.31234/osf.io/65se9; link: https://doi.org/mmf2

errors was high, the condition of a person could have been deemed psychotic, whereas errors of lesser magnitude
could have been labeled personality disorders or, say, ’being a difficult person’.
The current case bears similarities to the above case featuring the teenager, but the outcome was achieved with
ayahuasca, an Amazonian psychedelic plant-based brew, administered in a group setting (Frecska et al., 2016; Hamill
et al., 2019; Palhano-Fontes et al., 2018; dos Santos et al., 2017, 2016; Wolff, 2020). The effects of ayahuasca are
considered to be mostly due to monoamine oxidase inhibitors (MAOIs) harmine (originally known as ’telepathine’),
harmaline, tetrahydroharmine, and other harmala alkaloids, as well as DMT (Durante et al., 2021; Kaasik et al.,
2020). The effects of ayahuasca are not limited to psychedelic effects but include, for example, anti-inflammatory,
neuroprotective, cytotoxic, and anti-parasitic effects (Flanagan and Nichols, 2018; Katchborian-Neto et al., 2022,
2020; Santos et al., 2022; Sim˜ao et al., 2020). In people with dissociative disorders, it appears to exert an ’anti-
dissociative’ effect.
Concerning the physiological safety of ayahuasca, coadministration with SSRIs, some psychedelic tryptamines (5-
MeO-xxT, such as 5-MeO-DMT (Reckweg et al., 2022)), amphetamines, MDMA (Sottile and Vida, 2022), cocaine
(Simon and Kreek, 2016), tramadol, and dextromethorphan (DXM) is considered dangerous (Tripsit.me, 2022).
Coadministration with alcohol and methoxetamine (MXE) is considered unsafe (Tripsit.me, 2022). Caution is advised
in combination with cannabis, mescaline, substituted amphetamines (DOx), substituted phenethylamines (NBOM),
psychedelic phenethylamines (2C-x, 2C-T-x), ketamine, and opioids (Tripsit.me, 2022). Coadministration of DMT
with lithium may cause seizures (Nayak et al., 2021).
In practice, people using SSRIs have attended ayahuasca ceremonies without adverse consequences. Ruffell noted that
there wasn’t a single known case of serotonin toxicity recorded in the literature (Ruffell, 2022). Recently, Malcolm
and Thomas have reviewed the serotonin toxicity of serotonergic psychedelics in detail (Malcolm and Thomas, 2021).
They noted that little information is available on the circumstances of severe toxicities, but ayahuasca by itself is
unlikely to pose a high risk of serotonin toxicity, and its propensity to induce vomiting may also limit the ability
to consume large quantities. Also, psilocybin and LSD appear to be relatively safe in combination with ayahuasca.
Henr´ıquez-Hern´andez et al. recently discussed general aspects of toxicology of psychedelics (Henr´ıquez-Hern´andez
et al., 2023).
A systematic review by dos Santos et al. found three case series concerning members of the Brazilian syncretic
ayahuasca church Uni˜ao do Vegetal (UDV) and two case reports describing psychotic episodes associated with
ayahuasca intake (dos Santos et al., 2017). The overall incidence of psychotic episodes in the UDV context was
estimated to be less than 0.1% (0.052–0.096%), and cannabis use could not be excluded as a contributing factor.
They noted that the incidence of psychotic episodes appeared rare in both ritual and recreational/uncontrolled set-
tings. An European case series of presentations to emergency departments dealing with acute recreational drug and
novel psychoactive substance toxicity (n=5529) did not mention ayahuasca (Vallersnes et al., 2016).
The use of ayahuasca has spread internationally in the 2000s (Labate and Cavnar, 2013; Labate and Jungaberle, 2011).
It is typically used in ritualized group settings, i.e., ’ceremonies’, in which trained psychedelic guides direct partici-
pants’ experiences by singing (Beyer, 2009; de Mori, 2009; Turkia, 2022b). In Western societies, ceremonies typically
happen overnight during weekends, beginning on Friday evening and ending on Sunday morning. Participants usually
present with treatment-resistant psychiatric conditions such as treatment-resistant depression, post-traumatic stress
disorder (PTSD), and complex post-traumatic stress disorder (C-PTSD), and they have exhausted other, official
options for treatment. Usually, people with psychotic and bipolar conditions are excluded, primarily due to a lack
of sufficient resources for follow-up, and increased legal risks for the organizers. In the present case, however, the
psychotic patient attended tens of ceremonies without complications.
In many cases, ayahuasca ceremonies organized elsewhere still follow various Amazonian indigenous traditions, most
of which remain either sparsely documented or undocumented in the scientific literature. One documented example
of such a tradition is the Shipibo tradition (Gonzalez et al., 2021), although in Europe, ceremonies adhering to this
tradition have appeared relatively rare.
O’Shaughnessy and Berlowitz studied ’plant diet’ practices of Peruvian Amazonian medicine (O’Shaughnessy and
Berlowitz, 2021). Graham et al. investigated the phenomenology of listening to ’icaros’, or medicine songs, during
an ayahuasca ceremony (Graham et al., 2022). Callon et al. discussed ayahuasca ceremony leaders’ perspectives
on preparation and integration practices for participants (Callon et al., 2021). Sapoznikow et al. noted that cross-
cultural ceremonial use may have advantages relative to psychonautic (individual) use (Sapoznikow et al., 2019).
Kaasik described ayahuasca ceremony culture in Estonia (Kaasik and Kreegipuu, 2020), and analyzed the chemical
composition of traditional and analog ayahuasca (Kaasik et al., 2020). Byrska et al. noted that the chemical
composition of ayahuasca seized in Poland varied (Byrska et al., 2022). Pontual et al. studied the importance of
non-pharmacological factors such as the setting to induce or promote mystical experiences or challenging experiences
among ayahuasca users in neoshamanic and syncretic church contexts in the Netherlands and Brazil (de Deus Pontual
et al., 2022).
Dobkin de Rios et al. described how the Uni˜ao do Vegetal (UDV), a Brazilian syncretic church, was granted a
permission for the ritual and religious use of ayahuasca in the US Supreme Court (Dobkin de Rios and Rumrrill, 2008).
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Their book also discusses the Santo Daime church of Brazil, the traditional use of ayahuasca by indigenous peoples,
’neoshamanism’, and the globalization of ayahuasca. Groisman et al. described the corresponding legal process
concerning the Santo Daime church in the US Supreme Court (Groisman and Dobkin de Rios, 2007). Groisman et
al. analyzed the healing, neurophenomenological, and therapeutic aspects of the ritual and religious use of ayahuasca
in the Santo Daime church (Groisman and Sell, 1996).
A book edited by Roberts discussed ceremonial use of psychedelics more generally (Roberts, 2020). Alcantarilla
et al. presented a case of psychosis following the use of ayahuasca (Alcantarilla et al., 2022); Neyra-Ontaneda
presented another case (Neyra-Ontaneda, 2017). Williams et al. discussed indigenous ontologies (Williams et al.,
2022). Devenot et al. discussed an open source alternative to psychedelic capitalism (Devenot et al., 2022a). Fotiou
warned against idealizing South American indigenous tribes (Fotiou, 2016). Som´e discussed the treatment of first
psychosis in an indigenous African context, emphasizing the importance of rituals (Som´e, 1997).
James et al. provided a narrative review about the current status of medical ayahuasca research (James et al.,
2022). A recent handbook of medical hallucinogens edited by Grob et al. covered a wide range of aspects related
to psychedelic therapy (Grob and Grigsby, 2021). Devenot et al. examined how therapeutic frameworks interact
with the psychedelic substance in ways that can rapidly reshape participants’ identity and sense of self (Devenot
et al., 2022b). Friesen discussed historical entanglements and contemporary contrasts between psychosis research
and psychedelic therapy research (Friesen, 2022). Nemu discussed biases and prejudices in the academic study of
ayahuasca (Nemu, 2019). Maia et al. recently reviewed ayahuasca’s therapeutic potential (Maia et al., 2023). Perkins
et al. presented the results of a naturalistic longitudinal study concerning changes in mental health, wellbeing,
and personality following ayahuasca consumption, concluding that ayahuasca consumption in na¨ıve participants may
precipitate wide-ranging improvements in mental health, relationships, personality structure, and alcohol use (Perkins
et al., 2022). Perkins et al. also discussed psychotherapeutic and neurobiological processes associated with ayahuasca
(Perkins et al., 2023). Bouso et al. reported survey results on adverse effects (Bouso et al., 2022). Mastinu et al.
reviewed the ethnobotanical uses of the best-known psychedelic plants and the pharmacological mechanisms of the
main active ingredients they contained (Mastinu et al., 2023). The pharmacopoeia of the Huni Kuin tribe of Brazil
featured over a hundred plant medicines (Muru and Quinet, 2019).
Ona et al. described the essential features and benefits of traditional practices and the importance of incorporating
them into a ’Global Mental Health’ movement (Ona et al., 2021). Group therapy and communal aspects were
discussed by Hartogsohn (Hartogsohn, 2021, 2022), Gonzalez et al. (Gonzalez et al., 2021), and Meckel Fischer
(Meckel Fischer, 2015; Sessa and Meckel Fischer, 2015). Oehen and Gasser described the treatment of patients
with C-PTSD in Switzerland since 2014 (Oehen and Gasser, 2022). General aspects of the use of psychedelics in
psychotherapy have been discussed in a recent book edited by Read et al. (Read and Papaspyrou, 2021). Danforth
discussed focusing-oriented psychotherapy as a supplement to preparation for psychedelic therapy (Danforth, 2009).
Dolezal et al. suggested that shame-sensitive practice is essential for the trauma-informed approach (Dolezal, 2022;
Dolezal and Gibson, 2022).
Bosch et al. reviewed psychedelics in the treatment of bipolar depression, commenting that the integration of these
promising and fascinating substances into contemporary biomedicine seems feasible and even desirable (Bosch et al.,
2022). Szmulewicz et al. reported a case of mania after ayahuasca consumption in a man with bipolar disorder
(Szmulewicz et al., 2015); Oliveira et al. reported a similar case (Oliveira et al., 2018). Wrobel et al. surveyed
childhood trauma and depressive symptoms in bipolar disorder, noting that feelings of worthlessness emerged as
a key symptom among participants with—but not without—a history of childhood trauma (Wrobel et al., 2023).
Janikian investigated the potential and risks of psychedelics in bipolar disorder (Janikian, 2020). Blackwell presented
’bipolar breathwork’ method: an adaptation of holotropic breathwork developed for bipolar patients (Blackwell, 2011;
Bray, 2018; Grof, 2010). Young et al. discussed the neurobiology of bipolar disorder (Young and Juruena, 2020).
Healy reviewed the history of bipolar disorder (Healy, 2008). A preprint by McCutcheon et al. presented a new,
receptor affinity-based classification system for antipsychotic medication (McCutcheon et al., 2023).
An article by Fusar-Poli et al., co-written by experts by experience and academics, reviewed the lived experience of
psychosis using a bottom-up method (deriving a theory from ethnographic material) rather than a top-down method
(trying to overlay a theory onto data) (Fusar-Poli et al., 2022). Utilizing the same method, Estrad´e et al. reviewed
the lived experiences of family members and carers of people with psychosis (Estrad´e et al., 2023). Sips also discussed
the phenomenology and the lived experience of psychosis (Sips, 2022). A book edited by Moskowitz et al. discussed
the relationship between psychosis, trauma, and dissociation (Moskowitz et al., 2019). A book edited by Dorahy et
al. brought together current thinking and conceptualizations on dissociation and the dissociative disorders (Dorahy
et al., 2023). A book edited by Vermetten et al. discussed the neurobiology and treatment of traumatic dissociation
(Vermetten et al., 2007); Vermetten et al. also studied MDMA-assisted psychotherapy for PTSD (Vermetten and
Yehuda, 2019). Beutler et al. reviewed the knowledge on the relationship between trauma-related dissociation and
the autonomic nervous system (Beutler et al., 2022). Trauma and dissociation have also been discussed by van der
Hart (van der Hart, 2021). Ratcliffe discussed hallucinations, trauma, and trust (Ratcliffe, 2017). A book edited by
Woods et al. discussed voices in psychosis from an interdisciplinary perspective (Woods et al., 2022). A book by
Lanius et al. discussed the impact of early life trauma on health and disease, considering it to be a ’hidden epidemic’
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(Lanius et al., 2010). Ritunnano et al. noted that delusions have and give meaning (Ritunnano and Bortolotti, 2021).
Bourgeois et al. noted that sexually abused youth were ten times more at risk of receiving a diagnosis of psychotic
disorder than youth from the general population (Bourgeois et al., 2018). Rhodes et al. discussed the relation-
ship between psychosis and trauma, including the relationship between psychosis and child sexual abuse (Rhodes,
2022; Rhodes et al., 2018); however, the cases appeared to differ significantly from the present case. McLaren de-
scribed methods for (self-)treatment of the consequences of childhood sexual abuse using the ’spiritual’ terminology
(McLaren, 1997). Mat´e discussed ’spiritual’ roots of trauma, considering that the cause of any mental disorder was
(transgenerational) trauma (Mat´e, 2018, 2019). Youngman et al. discussed modeling complex adaptive systems
in the humanities (Youngman and Hadzikadic, 2014); in this context, Turkia previously presented a computational
model of emotions (Turkia, 2009). Dourron et al. presented a novel theory, the self-entropic broadening theory,
examining how psychedelics could be therapeutic while mimicking symptoms of psychosis (Dourron et al., 2022).
Kettner et al. noted that intersubjective experience during psychedelic group sessions predicted enduring changes
in psychological wellbeing and social connectedness (Kettner et al., 2021). Brennan et al. presented a qualitative
exploration of relational ethical challenges and practices in psychedelic healing (Brennan et al., 2021). Aixal`a wrote
about post-session psychedelic integration in detail (Aixal`a, 2022). Hendricks proposed awe as a putative mechanism
of action (Hendricks, 2018). Scull noted that ’the limitations of the psychiatric enterprise to date rest in part on the
depths of our ignorance about the etiology of mental disturbances’ (Scull, 2022); the present case study also aims at
enlightening etiological aspects.
Schwartz described the Internal Family Systems (IFS) therapy approach (Schwartz, 2021; Schwartz and Sweezy,
2020). Yugler discussed psychedelics in the context of IFS (Yugler, 2021), noting that ’parts’ (subpersonalities,
alters) corresponded to ’entities’, ’beings’, or ’spirits’ in the psychedelic context. Hallucinatory voices originated
from the parts/entities. In addition to parts, there was also an unchanging, boundless source of energy called ’the
Self’ whose energy was characterized by compassion, curiosity, calm, clarity, courage, connectedness, confidence, and
creativity (8 C’s). In the end, any therapeutic outcome was due to the energy of the Self, not to a therapist or
substance. Everyone, regardless of the severity of their past trauma, had the ability to heal. Yugler also described
the concepts of ’unburdening’, ’polarization’, and ’blending’. IFS was a method or ’toolkit’ for ’navigating’ any
experiences, including psychedelic ones.
Wolynn reviewed current research into the epigenetic inheritance of trauma, i.e., the evidence on the genetic trans-
generational inheritance of trauma (Wolynn, 2016). Research on mice indicated that trauma triggers could be
epigenetically inherited by the offspring (Dias and Ressler, 2013; Morin et al., 2021). Levine, the inventor of the
somatic experiencing method (Kuhfuß et al., 2021; Winblad et al., 2018), provided an introductory overview of the
role of memory in trauma, including the long history of the role of the phylogenetically more ancient structures of
the brain in trauma (Levine, 2015).
The low-dose maintenance treatment method of Mudge
Mudge has developed a method for the treatment of bipolar disorder with ayahuasca, and has utilized it himself for
his own bipolar disorder for years (Janikian, 2020; Mudge, 2016, 2022; Saiardi and Mudge, 2018). Since his teenage
years, describing himself as a ’compliant patient in the mainstream psychiatry’, he unsuccessfully tried seventeen
different pharmaceutical medications. He said that their adverse effects were downplayed or ignored. In his youth,
SSRIs had triggered mania which was ignored by his psychiatrist who doubled of the dose. This led to full-blown
manic episode with psychotic features. He was hospitalized and injected with antipsychotics. In the following years,
he was administered seventeen different medications without results. Eventually, after experiencing ’massive’ adverse
effects, he quit.
After finding ayahuasca around 2006, he had not used pharmaceutical drugs (Buller et al., 2021). Initially, he used
it with psychedelic doses in ceremonies a few months apart. However, the effect did not last for months; therefore,
he invented a more regular low-dose self-treatment practice. He initiated a research program, and as a part of his
PhD studies, he tested various ayahuasca preparations on himself.
All in all, Mudge has 15 years of experience on the use of ayahuasca and on brewing it himself in various formulations,
using different varieties of the ayahuasca vine, resulting in different ratios of the MAOIs harmine, harmaline, and
tetrahydroharmine. Different ratios produced different effects: stimulating, sedative, or balancing. He was currently
analyzing 50 different varieties in a laboratory. Mudge had also received ceremony facilitator training in the contexts
of Santo Daime, and various indigenous traditions including Huni Kuin (Muru and Quinet, 2019), Shipibo (Gonzalez
et al., 2021), and Yawanaw´a (Oikarinen, 2020; P´erez-Gil, 2001). He was planning on creating a manual for guiding
ceremonies for bipolar people.
The main risk was that in bipolar people, psychedelics could induce mania, even psychotic mania. However, a few
cases did not imply that all bipolar people should be excluded from the use of psychedelics (an overgeneralization).
Also, adverse effects had often been exaggerated; some were due to taking ayahuasca four nights in a row and not
sleeping, for example (Buller et al., 2021). Mugde stated that the exclusion of bipolar people was not only illogical
but also dangerous because bipolar people were highly suicidal. The ’do no harm’ principle was applied illogically.
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By treating bipolar disorder as a contraindication, patients were given a message: ’We’re just going to ignore you’,
depriving them of hope.
Another consequence was that bipolar people were ’doing it anyway, in a messy way’, for example, by lying in the
screening for ceremonies and ending up in a wrong kind of ceremony for them, with a variety of ayahuasca which was
not designed to have a balancing effect but, say, stimulating. Therefore, bipolar people should be included but their
special needs taken into account. In addition to bipolar people, the exclusion issue also applied to schizophrenics.
Mudge stated that ’doing nothing did not equal to doing no harm’; in effect, it implied avoidance of responsibility.
The fact that ethics committee had prevented Mudge from offering his medication to suicidal people in need, had
led him to ’question the whole concept of ethics as defined by an institutional committee of experts, as opposed to
peer ethics based on compassion’. Mudge did not see any logical, ethical reason for bipolar people not being allowed
to help each other out. Also, who had the right to decide what risks they could take? Avoiding suicidality was more
important than preventing mania. According to Mudge, no-one had the right to say they they could not try a possibly
life-saving medicine. He added that ’psychedelics experts had taken on this patronizing attitude from psychiatrists’.
Due to mainstreaming of psychedelics, there was no longer need to be overly cautious about appearances; instead, it
was time to be more brave.
Mudge had been deeply involved with the Brazilian syncretic church Santo Daime (Hartogsohn, 2021), as well as with
several indigenous tribes of the Amazonian area. He described himself as ’post-bipolar’, mentioning that developing
his method was complicated and challenging, but it had been ’incredibly beneficial’ for him (Janikian et al., 2021).
He concluded that due to its short binding time to 5-HT2Areceptor, DMT did not induce mania in people with
bipolar disorder, but instead acted as a mood enhancer/stabilizer. Tetrahydroharmine, in turn, provided a SSRI-like
effect.
Mudge commented that he went ’seriously manic’ on LSD or mescaline, and ’borderline manic in a funny way’ on
psilocybin (Buller et al., 2021). With MDMA, he ’felt terrible afterwards’; ketamine appeared slightly better. With
ayahuasca, it appeared that the balancing effect was due to the MAOIs; subsequently, he could ’get the psychedelic
benefits in a balanced context’. Through ayahuasca, he had learned to recognize when he was about to escalate
into mania, and could then stop the process in time. In other words, he had less ’self-denial’. He had also become
more compassionate or aware of the adverse social consequences of manic episodes, i.e. harm to others close him;
this motivated him to stop things that escalated mania. The increasing self-compassion, it had also reduced self-
destructive behaviors and suicidality.
In summary, self-awareness was the key. The irony was that it was the opposite of numbing oneself with phar-
maceutical drugs. Numbing prevented access to trauma: ’the reason why bipolar people got depressed in the first
place’. Interestingly, he commented that there was ’an epidemic of sexual trauma’, particularly affecting women, and
there was a large statistical correlation between sexual trauma and bipolar disorder. Mudge had a friend who had
previously been given 65 different pharmaceutical drugs and 50 applications of electroconvulsive therapy without
result. In the process, her sexual trauma had never been addressed. The trauma was eventually treated by a Shipibo
woman in an ayahuasca ceremony. Currently, she was ’getting great results with ayahuasca’. Thus, psychosocial
healing could happen with psychedelics that basically eliminated the underlying triggers. Diet and lifestyle (sleep
habit) changes had also been resulted from the use of ayahuasca.
Based on qualitative interview data about 75 bipolar people who had consumed ayahuasca, Mudge acknowledged
numerous cases of bipolar people becoming manic, but his detailed analysis indicated that many of these were false
negative results, and that the majority of bipolar people had therapeutically positive experiences with ayahuasca
(Mudge, 2022). Adverse events were due to either unsuitable mindsets and/or environments, or pharmaceutical
differences resulting from differences in preparation methods.
Mudge concluded that the crucial determining factor for people with bipolar disorder was the cooking technique,
because cooking variations affected the ratios of the four major psychoactive ingredients. Also, it was essential that
ayahuasca did not ferment, in order to avoid alcohol forming in it (Janikian et al., 2021). Alcohol triggered depressive
episodes (Buller et al., 2021). With these enhancements, adverse effects could be minimized or avoided.
It was also critical to avoid using any other psychoactive agents at the same time, particularly cannabis/tetrahydro-
cannabinol (THC), tobacco (rap´e) (de Mori, 2020; Narby and Pizuri, 2021), and even caffeine, chocolate, sports
supplements, and incense. THC could overstimulate the dopaminergic system and induce paranoia and psychoses.
The concurrent use of MAOIs amplified this effect of THC. This combination had been linked to four incidents of
violence or homicide. Regardless, although a large part of the population attending ceremonies consume cannabis
regularly, and many tribes and syncretic churches consume cannabis in ceremonies, such incidents are very rare and
may only concern people with bipolar disorder.
Mudge’s mother was a professor of neurobiology who specialized in bipolar disorder after her son was diagnosed with
it. She found that mood swings corresponded to modulations in the frequency of the phosphoinositide turnover cycle
in cortical neurons; as the cyclic process speeded up and slowed down, mood swung up and down (Saiardi and Mudge,
2018). Lithium and fluoxetine regulated the rate of phosphoinositide synthesis in neurons. 5-HT2Areceptor appeared
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to stimulate phosphoinositide hydrolysis (da Costa et al., 2020; Rabin et al., 2002). Ayahuasca likely also contained
a counteracting component and thus modulated phosphoinositide synthesis in the same way that the combination of
lithium and fluoxetine did, thus resulting in the previously mentioned mood-enhancing and stabilizing effect.
Mudge mentioned that there was currently an unfounded ’community belief’ functioning as a ’cultural taboo’ that
psychedelics and bipolar people were contraindicated. Mudge mentioned that due to bureaucracy and ’ethics approval’
related obstacles, conducting clinical trials had proved impossible for him, and he had only been able to produce
pre-clinical studies. In the meantime, five of his 75 interviewees had committed suicide. Mudge was ’not willing to
wait fifteen years’ before people could be treated. In terms of academia/community, Mudge felt having ’struggled
against taboos, getting mixed responses’. Some conferences had appeared supportive, others ’just hadn’t wanted
to know’: the subject was ’too controversial’. Mudge described that earlier, a professor of psychiatry, after reading
his abstract, had commented: ’So, a bipolar person thinks that he’s worked out a treatment for bipolar disorder by
himself, and he thinks it’s ayahuasca. Well, that sounds like a grandiose delusion, doesn’t it?’ Two years later, after
hearing Mudge’s presentation, the professor acknowledged Mudge’s work as ’very progressive’.
Young, a leading bipolar disorder expert in the UK (Young and Juruena, 2020), had recently become involved with
ayahuasca research (Ruffell et al., 2020, 2021). There was also a project by Standish aimed at getting a standardized
ayahuasca product approved by the FDA, produced from ayahuasca wine grown in Hawaii (Standish, 2019); however,
according to Mudge, their current recipe was likely unsuitable for bipolar disorder. There was also initial interest
and ’unofficial encouragement’ in the subject but no resources at the Multidisciplinary Association for Psychedelic
Studies (MAPS). Yet, no individual or institution, outside the PhD supervisory panel, had yet officially backed
Mudge’s study. Mudge considered the current mainstream research practices ’playing a reductionist game’.
About the idea of using a synthetic product containing only DMT, or DMT and harmine, Mudge commented that
a product without harmaline, tetrahydroharmine, and other components would be unlikely to provide the required
balancing effect. Also, the ritualistic-ceremonial concept was central to him. However, acquiring a specific ratio of
components would be easier. All in all, as a prescription option, even such a ’substandard’ mass-producible synthetic
product would be a significant improvement over the current situation, i.e., the use of antipsychotics. Also, initially,
Mudge himself had only been able to acquire products that he now considered substandard.
The maintenance protocol consisted of ’microceremonies’: taking a low dose of ayahuasca before going to sleep, in
a self-organized, uninterrupted meditation ritual, held approximately once every one to two weeks, according to the
need, i.e., depending on the intensity of depression. After such a ritual, the ’afterglow’, or calming and uplifting effect,
usually lasted for a week or two. With regard to dosing, the dose required for a balancing effect was significantly lower
than that required for psychedelic effects. Mudge recommended taking 1/8 of the ’standard’ dose (approximately a
spoonful). According to Mudge, this maintenance treatment would likely need to be ongoing.
With regard to the indigenous roots of ayahuasca, Mudge pointed to the extreme poverty of the tribes, the lack of
even clean drinking water, their cynicism about biopiracy by commercial companies (as happened with psilocybin
in Mexico), and ’active government policies of genocide against indigenous populations’ in some countries. On the
other hand, bipolar people were also ’desperate and life-threatened’, but Mudge ’did not see why there couldn’t be
a win-win situation if it was just done right, with ethics’.
There were a lot of controversial issues: a synthetic product would essentially be biopiracy, unless a large part of
the profits were given to the indigenous people. There was also a conflict between for-profit companies possibly
getting the medicine to market faster and universities possibly providing a non-profit product a decade or so later.
An advantage of for-profit companies was that they didn’t care about academic reputation or taboos. Over USD
200 billion was spent annually in the US on the treatment of bipolar disorder, the vast majority of which went to
pharmaceutical companies and psychiatrists. Mudge commented that there were ’a lot of people profiting from my
people’s illness’.
Psychedelics startups were slightly separated from traditional pharmaceutical businesses, and, as an example, a hedge
fund manager whose wife was bipolar had mentioned that maybe he could ’help out’. Mudge proposed an alternative
model to the university-led and business-led models: founding a new church that would take into account the specific
needs of bipolar people, which the Santo Daime church had not accommodated. The day before, he had received
three calls from three suicidal friends.
Aspects of the present case
The dosing strategy presented by Mudge was non-psychedelic, intended for balancing the mood without accessing
traumatic memories, and utilized without support at home in regular, self-organized ’microceremonies’, depending
on subjectively perceived need. This dosing might be called sub-psycholytic, somewhere between ’microdosing’ and
’psycholytic’ (Passie et al., 2022). The ayahuasca was made according to a special recipe developed for the treatment
of bipolar disorder.
In contrast, in the present case, the dosing was psychedelic, intended for accessing the traumatic memories, and
utilized in a group ceremony context. The ayahuasca ceremonies were ’neoshamanic’, i.e., not strictly adhering to
any specific traditional lineage of the Amazonian area. The patient always attended the same group, organized by
6

the same non-indigenous facilitator. In total, she participated in 26 ceremonies over the course of four years. There
was one nine-month break between ceremonies, but on average, she attended a ceremony once every two months.
The ayahuasca was always brewed by the same person but it was not specifically prepared for bipolar patients and
would likely have been considered substandard by Mudge’s standards. There was no maintenance treatment with
ayahuasca between the ceremonies. The described ceremonies were arranged in a legal setting; further details are
omitted for the purposes of anonymization.
Information was acquired from a 20-minute audio recording produced by the interviewee in 2019, and two semi-
structured retrospective interviews with a total duration of approximately three hours conducted in 2020. Diagnoses
and prescriptions were confirmed from medical record excerpts provided by the patient. In general, with the exception
of the last two years, her contact with the psychiatric healthcare system had been sporadic and shallow. Thorough
follow-up discussions and a review of all data were conducted in 2023.
The interviewee favored the term ’spiritual’. Pollan proposed ’egoistic’ as the antonym of ’spiritual’ (Pollan, 2018).
In this presentation, the ’spiritual roots’ of trauma roughly correspond to ’having to do with the loss of individual
agency’. Similarly, the term ’awakening’ refers to remembering trauma memories, or their re-emergence from the
subconscious. Assumed to re-emerge in their original, age-specific form, such memories might appear incomprehen-
sible.
One intention of this article is the facilitation of a shared conceptual framework, i.e., a preliminary fusion of several
paradigms. Concepts were adopted from IFS (Schwartz and Sweezy, 2020), the object relations paradigm (T¨ahk¨a,
1993, 2006), the paradigm of psychosis as a ’spiritual awakening’ (Blackwell, 2011; Grof, 1990), the Open Dialogue
approach (Bergstr¨om et al., 2022; Mosse et al., 2023), and various indigenous ayahuasca traditions.
The present case description is not to be taken as a treatment guideline or a recommendation. Even though the
described methods produced a feasible result for this person and in another case briefly reviewed in the discussion
section, a degree of unpredictability lies in the nature of psychedelics, and the same approaches might not produce
the same results in others with a different background and characteristics. The intention of the present study is to
open new perspectives and lines of research on C-PTSD, psychosis, and bipolar disorder. The role of case studies in
the context of the current paradigm, evidence-based medicine (EBM), has been discussed in the author’s previous
article (Turkia, 2022b).
Case description
At the time of the interview, the female interviewee was in her late thirties. Since early childhood, she had been
exposed to continuing, severe sexual abuse by an older male sibling from the mother’s previous marriage. The boy
did not get along with his stepfather (the girl’s father). The abuse had been frequent and ongoing for several years.
As her life had felt unbearable, she had ’invented a wonderful world’ which she ’blended with this one’ in order to
be able ’to breathe, to escape an unescapable situation, to gain some control’, i.e., agency.
Her parents had been either unaware of or unresponsive to the abuse. She described that she loved her parents and
wanted to make them happy by being happy herself. In her words, ’I understood that being happy was the greatest
gift you could give to the people you love. So I took it as my duty. But I couldn’t be happy if I lived in this world,
so I built another one, or chose to see it, and chose to disappear from this world every time the door to that tiny
room would close and I knew what was coming next. I chose to love my brother and to forget everything for years.
Although I never actually forgot.’
In her memory, the abuse had been ongoing. She could not say exactly when it had began but based on certain
events, she timed its beginning at the age of five or six. She described that a child did not have a memory of life
being any other way; a part of the child’s mind assumed that such a life was normal. Yet there was another part
that had the information that such abuse was not ok. These two parts were in conflict. According to her, for these
reasons, early trauma was difficult to handle or treat, and resided at the root of all psychiatric diagnoses.
Her relationship to her parents was ’good’. She was always ’a good girl’, behaving nicely and not causing problems.
She was ’perfect at school and with friends’. Occasionally, however, her behavior rapidly changed, and she became
impulsive and physically violent, yet she returned to normalcy just as rapidly. Her parents did not recognize the
ongoing abuse. All through her childhood, they dismissed her symptoms as a sign of her having been ’spoiled’. She
believed that her parents ’had not wanted to see; if they really would have wanted to see, they would have seen’. She
described that as her environment did not ’see her’, her mind adopted the same mechanism and applied it to herself.
The part that had not been acknowledged, ie. ’seen’, was ’split’ as a separate part. This process of ’splitting’ led to
problems.
I was abused in one room. When my parents returned home, I had to pretend to be happy and act like
a good girl. At school, I appeared to be a perfect student. But at night, my life was completely different
from the daytime. This created a huge internal conflict: a split. One cannot process severe trauma as it
is happening. The internal split was actually a survival mechanism.
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As a way to maintain a sense of control over her life, she secretly went to the roof of her house every day for years
with the intention of jumping off, but she never followed through. Not jumping served as proof of her agency. She
had no recollection of experiencing any pain. She had ’just wanted to die for no apparent reason’.
Dissociative symptoms started with intentional and conscious daydreaming as a form of escapism, but eventually
transformed into an uncontrollable and unconscious automatic response. The child’s visions of imaginary friends and
mythical creatures, which were initially created to create a safe and controllable personal world, took on a life of
their own and led to severe dissociation and derealization. She felt like she was not in the present, but she didn’t
know where she was.
She started to ’shift between worlds’. This shifting was accompanied by a physical sensation in her stomach. When
she dissociated, she seemed to exist in multiple states of consciousness at the same time, partly in the present moment
as if she were having an out-of-body experience, and partly in a dimension without time where she felt like she was
simultaneously in the present, past, and future. There was also a dimension without causality, where her perceptions
and actions seemed disconnected from each other.
She felt that everything she saw around her was ’created by her and also parts of her’. Boundaries between inner and
outer dissolved into ’oneness’. When ’everything coexisted in timelessness’, social interaction was difficult. Words
could turn into units of time, or into ’souls who found their vibrational matches in their surroundings’. To ’bring
herself back’, she applied obsessive-compulsive methods: repetitive sounds and rituals, ’to keep her grounded before
she got completely lost in the other worlds’.
When her parents finally found out about her habit, they closed all access to the rooftop. Subsequently, she began
to feel the pain. She described that ’it broke my heart that I felt I was being taken even this control and freedom.
Standing on the edge every day had been my secret. I felt like my choice of not jumping had made me a good girl,
and after the lockdown, that choice was no longer mine’. Subsequently, she began sleepwalking, playing with knives
and blades, cutting herself, and swallowing pharmaceuticals and detergents. Once she stood on a tramline when a
tram was coming, but a neighbor pushed her away from the tracks. She remembered being pushed away, but not
how she had ended up standing there.
Her suicidality originated from ’not being seen: likely the most common and influential trauma on the societal scale’.
According to her, a lot of people actually did not want to live but remained largely unaware of this tendency. The
lack of overt suicidality did not imply the absence of an unconscious wish to die. Such unwillingness was ’the biggest
conflict one could have’. In an organism with a fundamental survival instinct, it sent a ’completely wrong signal’. A
healthy individual fought to remain alive. An internally conflicted individual might have lost this objective.
In her case, the abuse had been ’more dramatic, and thus had more dramatic effects’ but an ’unseen’ hypersensitive
child could become traumatized in the absence of dramatic events, through neglect alone. The underlying mechanism
was the same: not being seen led to not being protected. It was interpreted as not being important enough to be
protected, which led to low self-esteem and efforts to compensate by performing at school and work.
Every time a child is beaten by his parents, he gets the message that he is not worthy of not being beaten.
If he goes the extra length, like many do, he will translate that into: I’m not worthy of being here, not
worthy of being loved, not worthy of anything. I suffer, but it remains unseen and therefore unvalidated.
The subconscious message is that I deserve that suffering because nobody saved me. The logical conclusion
will naturally be that I’m not worthy of being here, and since being here brings only suffering, why should
I be here?
At the age of thirteen, she developed ’a firm irrational belief’ that she had terminal cancer. Yearly health checks
made her ’hysterical’, yet when the results came back completely normal, it only strengthened her belief that her
illness had become ’so much worse’. She believed that she knew the exact type and location of the tumor and was
trying to prepare her mother for her death, praying that her mother would stop loving her in order to not be hurt
by her death. In retrospect, she described that the belief had ’no grounds in reality’ and that ’the fact that I was
perfectly healthy all those years was in no way connected in my head to the possibility that I didn’t have cancer’.
For seven years, she was convinced that she would die in a month at the latest. In her diary, she organized her
funeral and wrote letters to her mother, telling how happy she had been during her life, asking her mother not to
be sad. Her heart was breaking because of the pain her mother would feel. She cried ’every night without exception
from 10 p.m. to 3 or 4 a.m.’ She cried ’so hard she couldn’t breathe’ and begged God to forgive her for dying and
causing so much pain for her mother.
Despite these issues, she was ’an A-grade student all the way, winning first place every year at every contest or
competition’. She said that ’absolutely no-one knew’ about her suicidality. A few times, she attempted suicide
because she ’could not stand to look at all the suffering that was waiting in my near future because of this imaginary
cancer’.
Around the age of 20, the belief about having cancer was replaced with a different belief: delusional parasitosis. She
became convinced that inside her body were unique species of bugs that were multiplying faster and faster because
8

her body was feeding them. She saw bugs all around her body: they were moving under the skin of her arms, on
her head, and inside her brain. Describing her question as ’curiosity’ unrelated to herself, she asked a medical doctor
whether such a phenomenon was possible. The doctor ’explained to me why that couldn’t happen, and I understood
the explanation perfectly, but it made no difference: I knew the bugs were there. I was seeing and feeling them, and
every time I looked in the mirror, I had to throw up due to disgust about the bugs’. She had always hated bugs and
still did.
Psychosis could be due to trauma or extreme sensitivity. Her mind was hypersensitive, extremely flexible, and ’allowed
to travel to very unusual places’. It ’lacked a kind of identity’, i.e., points of reference. Hypersensitivity in itself was
not a problem, but the inability to ground this hypersensitivity on anything ejected her ’into outer space’. Her mind
’flowed like a wave’, yet when it attached to something, it became rigid ’in a nanosecond’. Everyday beliefs and
opinions were formed gradually, but in psychosis, an impression instantly transformed into an unchangeable belief.
The belief transformed into ’a black hole sucking everything in’, and her whole life was subsequently subordinated
to that belief.
For example, when I saw that bug near me, I immediately stated: ’It’s from me’. I don’t know why. It
just happened. After that, any sensation confirmed that idea. If I felt itchy or saw a leaf moving in the
wind, it was because of the bugs. My mind went to great lengths to fabricate stories to sustain the thought.
I started creating.
Creating is the essence of psychosis, and its connection to the spiritual realm. We create our reality and
manifest externally what is inside us. Psychosis is an extreme example of creating your own reality: you
shape everything around you to fit your beliefs. My mind got very imaginative. Every thought, every
move, the way clothes fit on me, and how I felt after eating supported that belief. If there was a wrinkle
in my pants, it was because there was a bug under the fabric. If I felt better or worse after eating, it was
because the bugs liked or disliked that food.
In retrospect, it is interesting to look back and see what a very playful mind was capable of inventing. It
was like an improvisation exercise: how can I link everything in my world to a single belief? When you
already understand that the belief was untrue, it appears funny.
It appeared that building a better world, or ’choosing to see it’, was central to maintaining individual agency. Lysaker
et al. noted that recovery from mental illness involved recapturing a sense of agency (Lysaker and Leonhardt, 2012).
Creating also aligned with the concept of psychosis as a survival strategy in severe stress (Bergstr¨om et al., 2022;
Seikkula, 2019), as well as with the concept of psychosis as a massive defense system (Fisher, 1970, 1997; Walsh and
Grob, 2005).
After contemplating the parasite issue for two weeks, she ingested rat poison, assuming that it would kill the bugs
but not her. However, as she began to feel ill, she realized she had poisoned herself and called the ambulance. At
the hospital, she described the situation and was referred to a psychiatrist, who mentioned that she might have
’latent schizophrenia’, adding that she would need to go through a formal evaluation to establish a formal diagnosis.
She refused both the suggestion and the evaluation, commenting that she was ’refusing to have this illness’. The
psychiatrist appeared to feel pity for her and commented that it was not her choice: no-one decided whether they
had the condition or not. She repeated that she had the choice and that she ’decided to not have it or be that’.
Regardless, she accepted the prescribed antipsychotic medication, and promised to start a therapy program but never
did. The medications she took occasionally.
According to her, anti-psychotic medications ’did not necessarily make a person worse, although they could’, but
primarily they just ’completely hid the causes of the disease’. She considered them not medicines but anesthetics,
which suppressed symptoms instead of addressing the root causes. The causes of disorders were not ’psychiatric’ but
’spiritual’, and needed to be handled as such.
In this context, ’psychiatric’ referred to the view that psychosis was due to biological predispositions (genetic variance)
leading to a ’failure state’ that was to be corrected with medication to allow a return to a state of normalcy. ’Spiritual’,
in turn, referred to a holistic view according to which psychosis was due to the loss of individual agency: the loss of
one’s ’spirit’, as a result of a process sometimes referred to as ’soul loss’. She was not against antipsychotic medication
but considered it very important to mix both approaches and ’avoid the extremes’. She proposed a dialog between
these approaches in order to improve the treatment of serious conditions.
In psychosis, the mind becomes rigid or calcified around an idea, losing all flexibility. It resembles a
very tight muscle. A person blinded by such a rigid belief needs help. It is impossible to work with
someone who has not slept for four nights. First, she needs to relax. Antipsychotics can function as
’muscle relaxants’. Afterwards, she can be approached by a doctor, a friend, or even herself. In my
case, the person approaching was usually myself. Upon noticing that I had lost connection with myself,
I temporarily used whatever was necessary to unblind me, after which I did whatever else was necessary.
My work was very personal; no one taught me how to do it. It was step-by-step intuition. The essentiality
9

of inspecting one’s beliefs is a general rule that applies to everyone: don’t hold rigid beliefs or slip into
fanaticism. Opinions can and should always be combined.
She began educating herself on ’what schizophrenia meant and how to make sure she didn’t have it’. She described
that when the antipsychotics (aripiprazole, 15 mg) worked as intended, she ’recognized the unnaturally rigid and
inflexible nature of her beliefs, which were always in complete contradiction with any kind of rational reality’. For
this reason, she admitted to herself that her mind was not functioning properly. She described having gone through
’uncountable rituals all day’: counting various things or saying specific words in certain fixed sequences. The rationale
for this was ’to ascertain that a major disaster, such as a fatal accident to someone I loved, or a fatal earthquake,
would not happen during the next half hour’.
She described how, upon reading about schizophrenia, she ’slowly began to understand that this was not normal’. In
order to resolve the situation, she initiated ’a program for learning the proper way of thinking, in the same manner
as someone would re-learn to walk or speak, or how autistic children learn about feelings’. She learned to discern
how ’the type, density, or energy’ of her psychotic beliefs, sounds, presences, or voices differed from ’the real, healthy
ones’. She became her ’toughest and most unforgiving trainer’, constantly checking whether what she saw, heard,
felt, and thought was similar to the perceptions, feelings, and thoughts of others. When she observed differences,
she either adopted the ways of the others, or buried her idea or habit altogether. Her method proved successful, and
after some time she was ’doing it almost automatically, like fixing an engine in motion piece by piece, an engine that
was constantly working erroneously’.
In the presence of fear or paranoia, she experienced a partial dissolution of boundaries: an external object was ’from
her or in her’. There was no full identification: she was not one with the object. The experience resembled a type of
paranoid projection in the presence of partial boundlessness. To overcome such projection, she developed a technique
for differentiating paranoid ideas from the non-paranoid ones.
I began questioning everything in this way: ’Does this thought or idea originate from fear or love?’ The
ideas ’I am the bug’ and ’I am the universe’ originated from love. Such good, functional ideas brought
me further. On the other hand, the idea that inside me were bugs that were attacking me originated from
fear. It was a sort of metaphor for the underlying trauma: you’re a victim with no control over what
happens to you, to your body. Psychosis is always a metaphor.
The differentiating factors were her emotional state and the degree of identification with the object. In the presence
of love, one could fully identify with the world and its parts (perhaps ’surrender’ to it): she experienced ’oneness’.
In the presence of fear, one experienced the world as consisting of separate, threatening parts, and needed to defend
oneself against them.
She felt that she was feeding the attacker simply by being alive. The bug appeared to be a representation or a
metaphor of the abuser. Her brain tried to convince her that, in order to stop being attacked, she needed to die.
While, from a purely factual perspective, death would have been one solution to the problem, it also conflicted with
the two most fundamental intentions or ’drives’: survival and reproduction.
The brain is extremely smart in this way, actually. The fact that you’re alive feeds your attacker. That
was the message that my brain was trying to send me: ’You feel attacked, and what do I want you to do:
I want you to die. That is your role. How do I get you to die?’ So I created this story: ’The fact that
I’m alive is keeping the bug alive. So what do I have to do?’ You see: it’s a kind of a puzzle, a trick of
the brain, that will always give you the same answer. That’s what the mind does: it loops. You will have
to die, and how do I get you to do that? I convince you that you have a disease, I convince you that you
are being attacked. In various ways, the mind will try to convince you to do the same thing: to die.
In her words, her ’life force was feeding the position of being a victim’. On the other hand, ’being a victim was feeding
the bug’, which could be interpreted as follows: the attacker was receiving energy from the abuse, or in other words,
her suffering was promoting the well-being of the attacker. In the ayahuasca context, this phenomenon is typically
referred to as ’energy exchange’. Regardless of the metaphoric details, the essence was about her vulnerability, her
’core feeling’, originating from personal and transgenerational trauma. She was ’certain that there could exist genetic
information telling you that you are vulnerable, which could manifest as metaphors’ (see e.g., (Dias and Ressler,
2013; Morin et al., 2021; Wolynn, 2016)).
Regardless of her relative success in correcting her biases, she commented that ’I was never a whole: there were just
pieces that I had made functional’. Still, her only reason for staying alive was the fear of hurting her mother and her
family with her death. Like in her teens, she remained very high-functioning professionally in her twenties, acquiring
a PhD and starting a family of her own. Successfully keeping her symptoms a secret, she only presented with ’brief
but frequent moments when my friends would see a glitch and a crisis would emerge’. She described that everyone
had regarded her as ’very atypical, explosive, and unpredictable, but otherwise fun and a good friend’.
However, after a couple of years, she ’could no longer hold her emotions in check’, and was beginning to act ’more
and more impulsive, dangerous, and unstable’. She ’bursted in fits of uncontrollable anger, violence, and self-harm’.
10

Frequently, she was ’watching powerlessly how someone else was in control’, someone who was destroying her life,
relationships, and family.
Her husband, not knowing that she had seen a psychiatrist before, convinced her to see one. The second psychiatrist
performed an EEG, which he said was showing a ’classic bipolar pattern with abnormal activity all around’. He
therefore diagnosed her as bipolar, prescribing a mood stabilizer (sodium valproate, 1000 mg) and an anti-epileptic
(clonazepam, 0.5 mg). She told her husband about being prescribed some medication but not about the diagnosis.
After having taken the new medications for a short while, she decided that she would not accept the diagnosis of
bipolar disorder either. Overcoming bipolar features was more difficult because they were ’more about emotions’
which she described as her ’soft spot’. Her thoughts were easier to control than her emotions. At the time of the
interview, she said this issue was ’not yet completely healed but much easier than before’ and that she could manage
it. She linked schizophrenia to cognitive biases and delusions, and bipolar disorder to emotional instability.
Due to medical reasons, she had to terminate a pregnancy. After that, she had another pregnancy with a high risk
of death for both herself and the child. Her husband was aware of the risk but not the severity of it until the very
end of the pregnancy. Her grief over the loss of the first child, and the fear of losing the second one made her more
unstable than before. Her husband again asked her to see another psychiatrist, who added a diagnosis of borderline
personality disorder. She remained uncertain whether this diagnosis was intended to replace or complement the
diagnosis of bipolar disorder, but ’they seemed quite similar anyway’.
Once again, she began studying her newly acquired diagnosis, working on understanding it and gathering skills to
handle it. However, this time she was ’too tired’. She described having been ’completely exhausted and feeling the
cosmic pain that my children would eventually lose their mother because not even my children, whom I loved beyond
what was possible, were enough for me to actually want to live, or like it here’. Adding to the exhaustion, she had
’another traumatic sexual experience’ (undisclosed, but assumedly a rape), which led to yet another suicide attempt
involving a car crash.
By then, although she could recognize in herself many of the features associated with the diagnosis of bipolar disorder,
she became convinced that she had ’never actually been either schizophrenic or bipolar’. She identified more with
the borderline criteria, which she said also explained her history of psychosis. She ’gave up all three diagnoses’ and
the related prescription medications. Regardless, she was ’not coping well’.
The memory of the diagnoses ’continued to scare’ her, keeping her ’maybe even overly aware of any irregular state
of mind’. She described that her sense of personal identity or trust in her thoughts or feelings had been ’completely
lacking’. After years of ’forming herself based on other people’s patterns’, she had ended up with ’no idea’ of what
she liked or who she actually was (an ’adverse effect’ of her training method, perhaps). She was also ’terrified of
someone seeing through my well-organized composure’. This was not because of the fear of abandonment but mostly
because ’I knew that if someone would regard me as crazy, I would have no tools against seeing myself instantly in
the same way and eventually end up being exactly that—if there was anything to save me from being that, I was my
secrecy and my decision that I was neither of those diagnoses’.
In this situation, ayahuasca had been her ’last shot’. She said that, although up to that point in her life she had also
experienced ’many happy moments’ and ’sincerely enjoyed life often’, only her first experience with ayahuasca had
transcended her life story into ’a story of light’.
The first thing I experienced during the ceremony was the emotional storm that I had trained to control for
years. Following that, I felt the familiar energy, high density, and the unescapable isolation of psychosis.
Only at that time, these feelings were fleeting, and they always ended in an unimaginable ocean of love
and support, coming from both inside and outside of me. It was a degree of support I had never felt before,
and most importantly, I experienced it in a state in which I had absolutely no way of hiding anything.
For me, in that moment, there were no more secrets.
I was shocked by two things. First, about the enormity of pain and terror living inside me, which I saw so
clearly that I could not believe I had ever managed to survive it. Second, about receiving so much support
and trust even though this pain had surfaced and was visible. I realized that I had treated this pain as
a disease, as my fault, and as my greatest shame. I could feel nothing but compassion and amazement
about how I had managed to live for so long with that, with what I felt were many generations of grief,
loneliness, and pure sadness. For the first time, I felt genuinely proud that I was alive.
Subsequent ayahuasca ceremonies shifted her away from having a self-image of being ’mentally broken’. She gained
’an understanding of the massive split and fragmentation that had been created in me’. Her former challenges had
been about unbiasing her thoughts (cognitive or ’schizophrenic’ aspects), and bypassing or controlling her emotions
(emotional or ’bipolar’ aspects). Her new challenge became ’how to hold in so much love, so many supportive
presences, and the entire understanding of the dimensions of the soul’ (connecting with the Self, perhaps). She
described that ’the opening of so many more levels of consciousness finally created a space in which I as a whole
made sense’.
11

Once I visited a psychotherapist who asked about my childhood. I said I had a perfect childhood. It was
perfect. And in that exact moment when you say it, your inner child, who was hurt and not seen, kind of
splits from you. This was exactly what half of my latest ayahuasca journey was about. I saw a girl who
told me: ’Every time you repeated this lie, you denied me completely’.
Ayahuasca ceremony facilitators trained in accordance with traditional indigenous guidelines often mention that in
ceremonies, they have the ability to access participants’ visions. Interestingly, the interviewee described possessing
the same skill: in a ceremony, she saw the vision of another participant; this was confirmed in a discussion afterwards.
In a sharing after another ceremony, participants realized that a group of participants had shared a vision of having
been in a burning medieval town, some as attackers, some as victims.
As described, her childhood symptoms had included violent raging, sleepwalking, suicidal behavior and self-harm,
and actual suicide attempts. Her mother continued to deny the existence of these events or interpret them as
inconsequential or harmless. The interviewee had eventually admitted her parents’ wrongdoing: ’Allowing myself to
accuse my parents of wrongdoing was a big thing for me. It was essential because the validation of myself as a whole
became possible only after I admitted that it was not ok, instead of telling myself all my life that it was ok’.
Before the first interview, she had attended ten ayahuasca ceremonies. For the last ceremony, she had two intentions:
first, to see whether unresolved trauma existed (it had appeared as if nothing significant remained); second, to find
out whether ayahuasca was safe for psychotic people. To her, this was significant because she ’cared so much and
believed with all her heart in this medicine’. She was going to dedicate as much of herself as she could ’to bring it
to the people who need it’. She felt that it would break her heart if she felt that ayahuasca would hurt the people
she wanted to help.
The result of this inquiry was that ayahuasca ’could not hurt anyone, at least not on its own’. According to her,
all ayahuasca did was ’purge’. She described that while ayahuasca often caused vomiting, ’the purge’ was to be
understood as a metaphor, as a purging of unwanted elements from the body. In a similar way, psychosis or mania
was to be conceptualized as ’vomiting of the mind’.
While her first ceremony had been explicitly about her personal early trauma, in the subsequent ones she was forced to
adopt the role of a therapist for lost souls or ’spirits’ who needed to be seen. This otherworldly social service function
paralleled her own trauma of not having been seen. For years, she had learned various ways of conceptualizing
psychological phenomena, and could choose a point of view: ’spirits’ could be hallucinations, exiled parts she could
not integrate, or representations of transgenerational trauma. But was such theorizing helpful, or did it only make
her worse? By choosing a point of view, she could choose her reality.
In this way, we create our own reality. Rules that are pragmatic for you might not be pragmatic for me.
That is why a person should primarily trust their own intuition. When you see spirits coming, you can
ask: ’Do they make you feel bad? Are they intrusive?’ Such questions actually matter. I found that for
me, the spirits are actually vibrational matches. I have always been a very empathic person. I feel the
emotions of others around me, as well as my own, very intensely. I often felt clear presences around me.
I didn’t see them or hear them, only felt their presence. I always had the same relationship with them: I
needed to tell them that they were fine.
I could call it transgenerational trauma, but I didn’t think about it like that. I felt them coming to me all
the time, to show me the dead in their families. I didn’t see them visually: they only existed in my mind’s
eye, as if I were imagining them. They could come with a dead child in their arms and say: ’Look what
happened! No one knew about this.’
It was breaking my heart. I had moments during which I could not go on with my tasks. This was the
most difficult thing for me. I don’t know whether this specific aspect should be called psychosis. A doctor
might say: ’Yes, because it disrupts your actions’. I would go erratic and stop what I was doing. I would
feel that I was breaking. I had moments during which I cried as if my entire family would have been dead.
Later, I learned to manage it to a degree.
Each time I asked them: ’What do you expect me to do? I feel you, I see you, and I’m really sorry for
you. You see that I am breaking, but I don’t know what to do with you, yet you keep coming’. Their
message was always the same: ’We just want someone to see us’. After fighting with it, I eventually
accepted the situation, saying: ’You know what? Maybe I simply am the kind of person who needs to see
the dead people or whatever, the suffering that needs to be seen’.
My first ayahuasca ceremony was about my personal trauma and the purging of that. Right after that,
spirits started arriving in droves, and my ceremonies transformed into this kind of collective work. I begun
to see them visually, in person. They could look like ordinary people or like bodies of light. Each time, it
was perfectly clear to me why they came to see me. It was no longer about me. I was only holding space
for these spirits.
Initially, it felt like I was dying for real. The cosmic pain was of such intensity that I felt unable to contain
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it all. I was hopelessly restless. Eventual ly, I learned that the proper way to hold space was to allow their
emotions to pass through me. It was an important lesson in opening myself up. I relaxed. They embodied
my body for a few seconds, and then went their ways. Their energy simply needed to flow through me to
be released. They were energy stuck in the universe because they had never been seen or validated. The
energy just needed to pass through something, like when you are mad and need to go to the garden just to
smash something.
When I got the idea and accepted my role, things got easier. Currently, this work happens not only in
ceremonies, but all the time. Maybe this doesn’t really make my case that I’m no longer psychotic. I
mentioned to my friends that now I actually see the spirits visually and communicate with them. They
likely thought I was still psychotic. But as long as you’re functional, and as long as the process feels
fulfilling for you, it is a non-issue.
Eventually, I found out that, in the same way that they need me, I need them. I am not only doing
charity work for the spirits. Because they are my vibrational matches, and the fact that I needed my pain
to be seen attracts similar vibrations from all the layers of reality around me. It is like coming together.
We think that our soul has a human experience in our body, but maybe my soul is comprised of all these
external parts and fragments that are coming together.
Ever since I was a child, I had the organic possibility to see such things. It was not because I was taught
to see them. I was taught differently. But this was how I felt inside since I was three or four years old. In
the ceremonies, others around me shared the same experience, which I had thought was only my psychosis.
I used the complete emotional instability and intensity of the psychotic experience as a bridge to connect
deeply with those around me, as well as with my soul as a whole in all its past charge. I recognized
that because of my unusual traits, I was able to connect to a greater wisdom, to higher self, and to feel
unconditional and absolute love. I begun to consider these traits a privilege.
In guidelines for ayahuasca ceremony participants and psychedelic therapy in general, participants are typically
instructed to ’surrender’ or ’let go’ of resisting their emotions. The described process largely mirrored these instruc-
tions. The idea of emotional energy being released through experiencing it was also described in another case study
concerning psychedelic therapy (Turkia, 2022a). A conventional interpretation might consider her holding space for
the spirits as indirect processing of either transgenerational or personal trauma. The increased visibility of the spirits
could be interpreted, for example, as a strengthening of connections between exiled parts and the Self.
It was essential to belong to a group where one felt accepted instead of being ’a freak left alone’. Her previous
attempts to belong had been based on conformance, mimicry, and pretending that she was like the others and
believed in the same things. This resembled society ’putting beliefs in her head’ when these beliefs did not fit her.
Subsequently, she believed that there was something wrong with her.
In the ceremonies, she discovered that other participants experienced the same ’dimensions’ through ayahuasca.
Being able to share her internal experience connected her to others, dissolving her feeling of complete isolation:
’Overcoming this isolation for the first time in my life was the reason for my ayahuasca experiences being such a big
relief for me’. Instead of being ’crazy’, she was ’awakened’. Despite this, she could only connect with a small group
of people who shared her experience, rather than the entire society.
She also realized that she ’needed to choose what is practical’. The idea of her creating everything around her was
impractical in everyday life. Among the infinite alternative worlds, the most practical solution was to choose a point
of view. Existing in all dimensions made daily life impossible and equaled to psychosis. An inability to choose a
point of view appeared to equal to a lack of identity.
Psychosis was partly ’a sort of enlightenment’: a process of receiving a lot of relevant information. It only became
a problem when one did not understand the information, could not process it, or choose a point of view, and
subsequently got confused. Other people could provide points of reference, to discern between ’true’ and ’false’,
practical and impractical. Although she considered many common concepts (such as, at the time of the first interview,
the idea of external objects not being created by her) arbitrary and fundamentally untrue, she had ’chosen to play
by the rules, to play the social game’ (e.g., believe that external objects were ’real’). This acceptance had been ’her
key to professional success’.
Another essential concept had been ’radical acceptance’ originating from Zen Buddhism and dialectical behavior
therapy (Linehan and Wilks, 2015). Her acceptance of the usefulness of radical acceptance was based on its pragmatic
value in everyday life. Its essence was that there was no good or bad, and one believed that everything was necessary.
By eliminating resistance, fighting, and the associated negative emotions, acceptance set an order to life: one just
’needed to play along’.
Despite having presented with ’all contraindications’ to the use of psychedelics as well as contraindications to at-
tending most ayahuasca retreats, her ceremonies had been unproblematic and productive. In her view, the purpose
of contraindications was to protect weekend retreat organizers who could not provide extensive in-ceremony sup-
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port and/or follow-up after ceremonies. These contraindications were understandable but, in the broader view,
counterproductive.
The most difficult patients were ’usually stuck in all kinds of therapies or medications that functioned as anesthet-
ics, only hiding their problems’. In order to optimize the cost-effectiveness of mental health services, these more
challenging patients should have been prioritized over the ’easier ones’. The scarce resource of ayahuasca ceremonies
should have been used for the ones who had not been helped by other means, as well as for the ones who caused the
most harm to themselves, others and society by remaining untreated. Ceremonies should have been augmented with
proper aftercare (’psychedelic integration’); what was important was what one did after the ceremony. She planned
on providing these services herself in the future.
With regard to ’adverse effects’ during the ceremony, she commented that ’if something unwanted happened, it was
because one’s soul chose that as its method to heal itself’. Adverse events occasionally occurred: a bipolar woman
became manic after a ceremony. According to the interviewee, this was because the woman ’lacked any insight into
her issues, as well as any skills for handling her particular brain chemistry’. Therefore, she had also been vulnerable
to various everyday environmental triggers.
Adverse events functioned as a diagnostic filter. Instead of the patients’ issues remaining ’blind spots’ and these
patients refusing to admit the existence and/or severity of their issues, the so-called ’adverse events’ made them
attentive to their issues, giving them a chance to learn how to handle them. The purpose of psychedelics was to
reveal such unprocessed issues, to ’bring into light what remained unseen’. Allowing that to happen was ’very
necessary’. Rather than depriving such patients of treatment, a more comprehensive approach was required.
Attitudes were also essential. An indigenous healer (met outside of the ceremony context) with a ’very gentle way
of communicating and zero judgement’ seemed to ’read her’ non-verbally, making her feel ’very seen and validated’.
His approach had been working together in order to teach her something, without putting it into words. The healer
had shown her how to navigate the ’dimensions’ without psychedelics. Psychiatric personnel, in contrast, verbalized,
labeled, and judged, as well as appeared scared and avoidant, treating symptoms as ’monsters’. Being labeled often
shocked patients, amplifying their feelings of inadequacy.
Such practices arose from and propagated ’collective trauma’. In her view, societal structures were traumatized. In
the absence of experiences with alternative ways of being, collective traumatization appeared normal. Despite such
appearances, an individual could feel the abnormality as an internal conflict, i.e., the pain and suffering ingrained in
structures. Such causal relationships remained largely unrecognized. Some people could remain open to perceiving
this state of affairs. Psychoses could result from collective trauma. Failure to find explanations in individual life
histories could lead to patients being handled as mechanistic systems that could be ’adjusted with buttons: anger
down, pain down, joy up’. In the extreme case, collective trauma could lead to an unrecognized, subconscious
unwillingness to live, resulting in society-scale failure to thrive, or inadequate or delayed responses, ’collective freeze
reactions’, in the face of threats such as climate change. Societies typically wanted to further repress collective
trauma instead of ’sitting with it in order to transcend to higher levels of consciousness’.
On the individual level, chronic stress from collective trauma could manifest either as psychiatric or somatic issues
such as immune system disorders or cancer. The exact phenotype was determined by how much of the trauma an
individual could accept, i.e. process, and release, or ’pass through’. The remainder of the ’stagnated energy’ remained
in the body, causing disease.
With regard to her childhood psychosis, she commented that she had ’chosen not to include myself in the world
because I was not ready to acknowledge all that darkness, and also because I was basing my so-called modesty on
the fact that I was still alive and others were not’. Also, getting confused was due to the simultaneous experiencing
of several ’states of consciousness’ or ’dimensions’, some of which lacked the concepts of time and causality, as well
as involuntary switching between such states.
Diagnostic practices she considered inappropriate. Schizophrenia was mentioned once in an emergency room, and
never again by any doctor. Bipolar disorder was diagnosed after a short appointment with a psychiatrist, based on
an EEG. She considered herself ’a victim of superficial labeling’. While some people could be ’actually bipolar’ or
’schizophrenic’, she considered herself different due to her high performance in her working life, which would have
been impossible if she was actually bipolar or schizophrenic. She ’exhibited some unusual traits’ but predominantly
identified herself with a borderline condition. Therefore, she did not want to see herself as someone who had been
healed from bipolar disorder and/or schizophrenia.
According to her, the root cause of schizophrenia was currently considered to be trauma combined with hiding it.
Her psychotherapist friends working with schizophrenic patients considered ’stopping their patients from hiding’ their
primary method. A person could only heal by feeling safe and stopping hiding. They could first experience it in
therapy sessions, and later in real life; in contrast, ’taking sedatives and becoming compliant’ did not heal.
The outcomes of first psychoses were determined by how cultures conceptualized psychoses. She learned about the
concept of psychoses as ’awakenings’ from TED Talk video presentations, which mentioned that in many indigenous
cultures, if a child hallucinated, she was instantly separated from her peers, carefully nurtured, regarded as a carrier
14

of special skills, and later trained as a healer (Borges, 2021; Som´e, 1997). Individuals with hypersensitivity to
interpersonal issues were identified by asking whether they had experienced near-death experiences or psychotic
episodes. They were open to receiving an unusually large amount of information in interpersonal situations, but
if they lacked the skill to organize and process such information, they would become dysfunctional. They could
only become healers, leaders, or prophets by learning to process the information. Indigenous approaches to first
psychoses aimed at initially calming these individuals down by explaining that nothing was actually wrong (Som´e,
1997). Subsequently, they were taught the required skills, and later assigned a role in their society as a solver of
complex interpersonal/psychiatric, and/or medical issues.
This information is mixed up and very irrational. But if you regard it like: ’Oh, how interesting! You’re
psychotic, maybe you have a gift, maybe you have a special ability, let’s see what we can do with that’,
then you completely shift the perspective, prioritize that person, make him accept himself, maybe even be
proud of himself: ’Oh, look: I am special, I have this kind of thing’. That’s why they say that the psychotic
ones are future shamans.
Her struggles had largely been the result of being overloaded with information. Conventionally, the source might be
considered to be the subconscious or exiled parts. She was ’not yet perfectly healthy, and there was still processing to
be done’. The abused girl part remained dissociated: she could not feel anything when talking about it, and talking
about it triggered escapist reactions.
I still can’t connect to it in any way. The previous time, when we talked about the abuse, I could not feel
anything. I was completely blank. I could not handle the situation. I felt that if I connected, I would
get completely depressed. Afterwards, I chose to numb everything with alcohol and cocaine, and I partied
for three nights. Party drugs and alcohol, in contrast to plant medicines, completely isolate you from
yourself and the world around you—from everything. They function exactly like psychiatric drugs, which
are artificial and toxic. I knew very well what I was doing, and did it on purpose. It was a trauma
response to do the exact opposite. This is how people become alcoholics or drug addicts.
I still possess these ingrained, dissociative patterns that affect my memory. Even when I don’t drink or
take drugs, when I go out with friends and drink only tea, the next day I only remember arriving at the
bar and being at home in the morning. It is freaky. Usually, there was a trigger: something hurtful that
caused me to lose touch with myself. Yet my friends did not notice anything. Later, when I asked, they
said that I had acted completely normal. Regardless, none of it was stored in my memory.
As another example, people often tell me that I met with them yesterday, and I am like: Oh yes, we met
yesterday, of course, I know that. And I do know that, but I only remember one sentence from a one-hour
meeting. Such situations are extremely difficult: I have to pretend that I remember everything or else I
will appear insane. Such situations perpetuate a vicious circle: by pretending that I remember, I deny the
hurt part that caused me to forget what happened. I fail to validate that part. It creates yet another split.
Ideally, I would simply tell them: ’My memory fails because I am very traumatized’. But I cannot say
that.
Some of her close friends, whom she had told about this issue, could ’watch for her’, i.e., occasionally notice changes
in her behavior, and subsequently assume a protective role by ’not leaving her side from that moment on’.
I often see myself from the outside, say, ordering ten tequilas in a bar. I would be completely out of myself,
observing the situation and saying: ’I do not want to do this, please stop, you’ll get drunk’. I am certain
that I don’t want to get drunk, but I am looking at this person from above: looking at something that I
cannot influence or stop. I need to have friends with me who say: ’Stop it!’ Currently, this happens less
often than before, maybe once every two or three times I attend social events. I call it ’my feet slipping’.
My friend then tells me: ’You’re acting irrationally, you’re crazy, stop it!’ And I do. I am very complacent
in such situations, even if I sometimes don’t understand what they are saying. I might ask: ’What?’ and
they would tell me something that completely contradicts my own idea of my behavior. It might resemble
descriptions of bipolar disorder. I could buy whatever people want from the bar, for a lot of people, for
people I don’t know, feeling like I actually know them very well, as if they were all my friends. An actual
friend of mine might then interfere, saying: ’You don’t know these people!’ I would realize that she is
right: I don’t know them. But in a way, I feel that we are friends. Sometimes I need help with such
things.
She also consulted her friends about work-related projects. External feedback and validation provided her with ’a
lot of safety’. Regardless, she was trying to find a balance between external support and trusting herself, ’because
you have to trust yourself’.
After her first ayahuasca session, in which she first experienced the possibility of not having to hide, she participated
in IFS therapy sessions. The therapist asked her to pay careful attention to dissociative traits. In some sessions, he
asked if he could talk to ’the other her’, and ’yet another her’. According to the psychiatrist, her parts possessed
different voices, moved differently, and related to people differently. She was aware of the issue herself, and mentioned
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that these traits also originated from her childhood traumas, and that switching between these parts was caused by
trauma triggers.
She chose to tell her story ’because it was not only her story’. She felt survivor’s guilt about ending up as one of those
who did not jump off the roof, although she believed the selection was ’random’. This ’complete randomness’ had been
the most difficult lesson of her survival. She considered herself lucky because her problems had been severe enough
to ’push her into a clear awareness of the underlying causes’. People with less severe issues could remain unable to
identify the underlying causes, and remain indefinitely confused and chronically depressed. People who were ’only
neglected’, regardless ’got the message that they were not survivable material and didn’t matter’. Like a sick puppy
ignored by its mother, they gave up trying. In such cases, ’soul retrieval’, or a guided reliving of a traumatic event in
a safe setting, accompanied by ’rewriting’ the trauma memory in such a way that personal agency is reestablished,
could be indicated (this mechanism may be considered the core essence shared by all psychotherapies).
Eventually, your soul breaks. In such cases, if we get more spiritual, ’soul retrieval’ could be helpful. It
is a metaphor, a meditation upon your wholeness: going back to the scene of the traumatic event, and
taking back something that was left behind, because that is what trauma does: it breaks you and leaves a
part of you at the scene.
A thorough review of the previous discussions in a follow-up interview two and a half years later revealed that, after
two years, not all she had said before reflected her current views. The main difference was that she now recognized the
validity of her bipolar disorder (officially, bipolar type II disorder, ICD-11 6A61; with rapid cycling, 6A80.5). Based
on the case description, it could be said that before her first ayahuasca ceremony, she presented with severe (suicidal)
depressive episodes with psychotic symptoms. After the first ceremonies, severe episodes no longer emerged. During
the first interview, she might have been slightly manic. She was taking mood stabilizers (lamotrigine, 200 mg/day)
but also continuing regular plant medicine work with ayahuasca. According to her, mood stabilizers did not interfere
with the plant medicine work. With regard to dissociative symptoms, she mentioned that they had largely been
resolved.
She believed that her early trauma was solely responsible for the onset of her bipolar disorder, which was an adaptation
to trauma, and the core of her early trauma remained largely unresolved. She needed more C-PTSD-focused therapy
and somatic work to overcome the remaining toxic shame and coping mechanisms, which included self-harm. Through
constant plant medicine practice paralleled with trauma therapy, she was making slow progress with these issues,
however.
She still occasionally struggled with bipolar symptoms, and while plant medicine brought ’immense gifts to her life on
a daily basis’, the years had brought a clear awareness that it had not cured her bipolar disorder. She was therefore
’more moderate and humble’ in how she talked about plant medicines. Plant medicine or psychedelics, in any case,
’opened the door to integrating the fragmented parts from trauma, which automatically helped to resolve the bipolar
mechanisms’.
She held that a history of psychotic disorders was not a contraindication to psychedelic therapy. She had been
involved with plant medicine and trauma work for the whole time, and observed, in detail and for long periods of
time, several people diagnosed with bipolar disorder or psychotic episodes. She was using her expertise to train
psychotherapists in plant medicine work.
She considered schizophrenia to be outside the scope of her expertise. She ’did not want to risk anyone’ by saying
that plant medicine could cure psychosis, schizophrenia, or dissociative identity disorder. Her suffering did not match
’the really deep suffering’ of people with schizophrenia. Her own diagnosis of schizophrenia she saw as a mistake: it
was ’just a word someone threw once’, not something she had to deal with. Instead, practically all her challenges
were due to bipolar disorder. Ayahuasca had helped her a lot with that, as well as with suicidality, and she had
observed the same positive effects in others.
The abuser’s perspective
In contrast to most cases of early childhood sexual abuse, in the present case, the abuser later admitted the issue,
validating the victim’s memories. This recognition was a consequence of him attending an ayahuasca ceremony.
About my early trauma, I can talk in general terms: it was sexual abuse that went on for some years.
Then I forgot about it. Such amnesia is typical. It is called dissociative memory: you kind of forget these
things. And because it is a kind of Stockholm syndrome, you begin to repeat the same pattern. You get
attracted to the same kind of people, because that is how you understand that you are valued.
One day, I remembered the abuse. Regardless, I always doubted whether those memories were real. There
was always at least a grain of doubt: What if I am not right? What if I am only imagining it? I doubted
my memories because they had been forgotten for so many years. This is very typical for victims, especially
for victims of early childhood trauma. When you eventually remember, it is of course shocking, and you
feel hurt. At the same time, you also feel that maybe you are crazy, or that you have invented it all. You
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don’t have the luxury of an ordinary person beaten up on the street. He will not question himself or the
fact that he was beaten up. Therefore, he will allow himself to grieve and feel angry at his abuser.
In contrast, if you have carried a dissociated memory with you for years or decades, and suddenly remember
what happened, unless you get a chance to really put the issue on the table, it will always be unclear to you
whether the event you remembered really happened in the first place. Many people do not have the chance
to speak to the abuser afterwards to say: ’Hey, did this really happen?’ Some people do that. They have the
courage. I didn’t have the courage to open that discussion. But many do. Of course, typically, the abuser
will then lie and say that the abuse did not happen. The victim will end up even more confused, no longer
knowing what is right or wrong. I think that in time, such a response can actually cause schizophrenia. It
is a split: a part of you is hurt and knows it, while another part of you is accusing the hurt part of being
wrong.
I, too, carried this conflict until recently. Then I found out that all of it was actually true, although a part
of me already knew that it was true. Nonetheless, receiving confirmation was a relief. But I didn’t have
the courage to open this discussion. The other person did.
Interestingly, the abuser eventually took up the issue as a result of also attending an ayahuasca retreat, although
not immediately after it. She assumed that the ceremony had ’opened up something in him’. In addition, during
the preceding years, the abuser had pursued ’self-development’, realizing that he was also traumatized. According
to her, they were both victims. His trauma was also an early childhood issue: the divorce of his parents. After the
divorce, his parents did not get along. Because the abuser did not get along with his stepfather, i.e., the girl’s father,
the situation may have included an element of vengeance: abusing the girl to exact revenge on the stepfather.
People think psychosis only means having visual or auditory delusions, but it is not only that. It can also
be a belief that you have. In my case, my therapist always said that if you don’t talk to your abuser, if
you don’t tell him that you know what happened, you’ll never be fully healed. You need to hear how the
abuser reacts, in order to bridge your reality and the abuser’s reality. Despite everything, I stayed in close
contact with the abuser. We spent a lot of time together, but that reality did not link in any way to the
reality of my childhood. They existed as two completely separate worlds.
Later, I recognized the same phenomenon in others. A child lives between the two incompatible realities
of the mother and the father, each of whom accuses the other parent. At the father’s house, he has to act
like his mama is horrible. Regardless, she is still his mother, and he loves her. This situation induces
trauma, b