Learning to Discern the Voices of Gods, Spirits, Tulpas, and the Dead.

There are communities in which hearing voices frequently is common and expected, and in which participants are not expected to have a need for care. This paper compares the ideas and practices of these communities. We observe that these communities utilize cultural models to identify and to explain voice-like events-and that there are some common features to these models across communities. All communities teach participants to "discern," or identify accurately, the legitimate voice of the spirit or being who speaks. We also observe that there are roughly two methods taught to participants to enable them to experience spirits (or other invisible beings): trained attention to inner experience, and repeated speech to the invisible other. We also observe that all of these communities model a learning process in which the ability to hear spirit (or invisible others) becomes more skilled with practice, and in which what they hear becomes clearer over time. Practice-including the practice of discernment-is presumed to change experience. We also note that despite these shared cultural ideas and practices, there is considerable individual variation in experience-some of which may reflect psychotic process, and some perhaps not. We suggest that voice-like events in this context may be shaped by cognitive expectation and trained practice as well as an experiential pathway. We also suggest that researchers could explore these common features both as a way to help those struggling with psychosis, and to consider the possibility that expectations and practice may affect the voice-hearing experience.

The socialization of hallucinations: Cultural priors, social interactions, and contextual factors in the use of psychedelics.

The effects of so-called "psychedelic" or "hallucinogenic" substances are known for their strong conditionality on context. While the so-called culturalist approach to the study of hallucinations has won the favor of anthropologists, the vectors by which the features of visual and auditory imagery are structured by social context have been so far little explored. Using ethnographic data collected in a shamanic center of the Peruvian Amazon and an anthropological approach dialoguing with phenomenology and recent models of social cognition of Bayesian inspiration, I aim to shed light on the nature of these dynamics through an approach I call the "socialization of hallucinations." Distinguishing two levels of socialization of hallucinations, I argue that cultural background and social interactions organize the relationship not only to the hallucinogenic experience, but also to its very phenomenological content. I account for the underpinnings of the socialization of hallucinations proposing such candidate factors as the education of attention, the categorization of perceptions, and the shaping of emotions and expectations. Considering psychedelic experiences in the light of their noetic properties and cognitive penetrability debates, I show that they are powerful vectors of cultural transmission. I question the ethical stakes of this claim, at a time when the use of psychedelics is becoming increasingly popular in the global North. I finally emphasize the importance of better understanding the extrapharmacological factors of the psychedelic experience and its subjective implications, and sketch out the basis for an interdisciplinary methodology in order to do so.

Culture, context, and ethics in the therapeutic use of hallucinogens: Psychedelics as active super-placebos?

Following decades of prohibition and widespread concern about their mind-altering properties, there is increasing public, scholarly, and clinical interest in the therapeutic potential of psychedelic substances. Serotonergic substances in particular (DMT, psilocybin, and LSD) are now being tested as treatments for such ailments as depression, anxiety, and substance use disorder. This thematic issue of Transcultural Psychiatry presents articles that investigate the cultural assumptions, political dimensions, and clinical and ethical implications that arise from this renewed interest. After reviewing ongoing debates on therapeutic mechanisms of action and the importance of context, we argue that psychedelics can be conceptualized as "active super-placebos"-that is, substances that enhance ritual, symbolic, and interpersonal therapeutic processes by increasing suggestibility and the influence of extra-pharmacological, "non-specific" factors. Rather than simply freeing up habitual constraints on perception, the articles in this issue support the claim that psychedelic encounters typically entail processes of sense-making, crystallization of meaning, and enculturation into contextually mediated assumptive worlds (or ideologies) and behaviours that necessarily install novel constraints with potentially maladaptive consequences. We highlight the importance of clinical and epistemic integrity in the framing of psychedelic therapies. The importance of structuring and providing oversight for the therapeutic context raises difficult questions about the search for appropriate forms of epistemic authority that are at once respectful of the plural cultural origins of psychedelic rituals and mindful of best practices and standards in clinical care.

Towards psychedelic apprenticeship: Developing a gentle touch for the mediation and validation of psychedelic-induced insights and revelations.

A striking feature of psychedelics is their ability to increase attribution of truth and meaningfulness to specific contents and ideas experienced, which may persist long after psychedelic effects have subsided. We propose that processes underlying conferral of meaning and truth in psychedelic experiences may act as a double-edged sword: while these may drive important therapeutic benefits, they also raise important considerations regarding the validation and mediation of knowledge gained during these experiences. Specifically, the ability of psychedelics to induce noetic feelings of revelation may enhance the significance and attribution of reality to specific beliefs, worldviews, and apparent memories which might exacerbate the risk of iatrogenic complications that other psychotherapeutic approaches have historically faced, such as false memory syndrome. These considerations are timely, as the use of psychedelics is becoming increasingly mainstream, in an environment marked by the emergence of strong commercial interest for psychedelic therapy. We elaborate on these ethical challenges via three examples illustrating issues of validation and mediation in therapeutic, neo-shamanic and research contexts involving psychedelic use. Finally, we propose a pragmatic framework to attend to these challenges based on an ethical approach which considers the embeddedness of psychedelic experiences within larger historical and cultural contexts, their intersubjective character and the use of practices which we conceptualise here as forms of psychedelic apprenticeship. This notion of apprenticeship goes beyond current approaches of preparation and integration by stressing the central importance of validation practices based on empathic resonance by an experienced therapist or guide.

Historical Osteopathic Principles and Practices in Contemporary Care: An Anthropological Perspective to Foster Evidence-Informed and Culturally Sensitive Patient-Centered Care: A Commentary.

Historical osteopathic principles and practices (OPP)-considering the patient as a dynamic interaction of the body, mind, and spirit and incorporating the body's self-healing ability into care-are inherited from traditional/complementary and alternative (CAM) principles. Both concepts are familiar to contemporary osteopathic practitioners, but their incorporation into healthcare for evidence-informed, patient-centered care (PCC) remains unclear. Further, a polarity exists in the osteopathic profession between a 'traditional-minded' group following historical OPP despite evidence against those models and an 'evidence-minded' group following the current available evidence for common patient complaints. By shifting professional practices towards evidence-based practices for manual therapy in line with the Western dominant biomedical paradigm, the latter group is challenging the osteopathic professional identity. To alleviate this polarity, we would like to refocus on patient values and expectations, highlighting cultural diversity from an anthropological perspective. Increasing an awareness of diverse sociocultural health assumptions may foster culturally sensitive PCC, especially when including non-Western sociocultural belief systems of health into that person-centered care. Therefore, the current medical anthropological perspective on the legacy of traditional/CAM principles in historical OPP is offered to advance the osteopathic profession by promoting ethical, culturally sensitive, and evidence-informed PCC in a Western secular environment. Such inclusive approaches are likely to meet patients' values and expectations, whether informed by Western or non-Western sociocultural beliefs, and improve their satisfaction and clinical outcomes.

Psychedelics as Tools for Belief Transmission. Set, Setting, Suggestibility, and Persuasion in the Ritual Use of Hallucinogens.

The use of psychedelics in the collective rituals of numerous indigenous groups suggests that these substances are powerful catalysts of social affiliation, enculturation, and belief transmission. This feature has recently been highlighted as part of the renewed interest in psychedelics in Euro-American societies, and seen as a previously underestimated vector of their therapeutic properties. The property of psychedelics to increase feelings of collective belonging and transmission of specific cultural values or beliefs raise, however, complex ethical questions in the context of the globalization of these substances. In the past decades, this property has been perceived as problematic by anticult movements and public authorities of some European countries, claiming that these substances could be used for "mental manipulation." Despite the fact that this notion has been widely criticized by the scientific community, alternative perspectives on how psychedelic experience supports enculturation and social affiliation have been yet little explored. Beyond the political issues that underlie it, the re-emergence of the concept of "psychedelic brainwashing" can then be read as the consequence of the fact that the dynamic through which psychedelic experience supports persuasion is still poorly understood. Beyond the unscientific and politically controversed notion of brainwashing, how to think the role of psychedelics in the dynamics of transmission of belief and its ethical stakes? Drawing on data collected in a shamanic center in the Peruvian Amazon, this article addresses this question through an ethnographic case-study. Proposing the state of hypersuggestibility induced by psychedelics as the main factor making the substances powerful tools for belief transmission, I show that it is also paradoxically in its capacity to produce doubt, ambivalence, and reflexivity that psychedelics support enculturation. I argue that, far from the brainwashing model, this dynamic is giving a central place to the agency of the recipient, showing that it is ultimately on the recipient's efforts to test the object of belief through an experiential verification process that the dynamic of psychedelic enculturation relies on. Finally, I explore the permanence and the conditions of sustainability of the social affiliation emerging from these practices and outline the ethical stakes of these observations.

Hallucinations Under Psychedelics and in the Schizophrenia Spectrum: An Interdisciplinary and Multiscale Comparison.

The recent renaissance of psychedelic science has reignited interest in the similarity of drug-induced experiences to those more commonly observed in psychiatric contexts such as the schizophrenia-spectrum. This report from a multidisciplinary working group of the International Consortium on Hallucinations Research (ICHR) addresses this issue, putting special emphasis on hallucinatory experiences. We review evidence collected at different scales of understanding, from pharmacology to brain-imaging, phenomenology and anthropology, highlighting similarities and differences between hallucinations under psychedelics and in the schizophrenia-spectrum disorders. Finally, we attempt to integrate these findings using computational approaches and conclude with recommendations for future research.

[Practices in search of legitimacy: the contemporary use of ayahuasca, between religious and therapeutic vindications]. / Prácticas en búsqueda de legitimidad: el uso contemporáneo de la ayahuasca, entre reivindicaciones terapéuticas y religiosas.

In recent decades, the growing interest of Westerners in the psychotropic brew ayahuasca and the participation in exotic rituals has led to the multiplication of "shamanic centers" in the Peruvian Amazon. Among these, Takiwasi is a therapeutic community that welcomes hundreds of national and foreign clients every year. This institution, created by a French physician in 1992, was originally intended to propose a therapeutic alternative for the treatment of addiction, characterized by the use of tools of Peruvian mestizo shamanism, biomedicine and clinical psychology. The diachronic evolution of the institution is however marked by the growing use of elements of the Catholic tradition. In this article, I will examine the hypothesis that these transformations can be interpreted as the effects of the globalization of the use of ayahuasca and its legal and political consequences. Thus, the case of Takiwasi underlines the role played by religious traditions and the medical field in the construction, legitimization and maintenance of new and hybrid practices that are multiplying around the use of ayahuasca.

El creciente interés de los occidentales por la bebida psicotrópica ayahuasca y la participacion en rituales exóticos ha llevado en las últimas décadas a la multiplicación de los "centros chamánicos" en la Amazonía peruana. Entre estos, el centro Takiwasi es una comunidad terapéutica que acoge cada año a cientos de clientes nacionales y extranjeros. Esta institución, creada por un médico francés en 1992, fue originalmente destinada a proponer una alternativa terapéutica para el tratamiento de la adicción, y se caracterizaba por el uso de ciertas herramientas del chamanismo mestizo peruano articuladas con la biomedicina y la psicología clínica. La evolución diacrónica de la institución está, sin embargo, marcada por la creciente utilización de elementos de la tradición católica. Examino aquí la hipótesis de que estas transformaciones pueden ser interpretadas como los efectos de la globalización del uso de la ayahuasca y sus consecuencias jurídicas y políticas. De este modo, el caso de Takiwasi subraya el papel jugado por las tradiciones religiosas y el campo médico en la construcción, la legitimación y el mantenimiento de las prácticas nuevas e híbridas que se multiplican alrededor del uso de la ayahuasca.

Prácticas en búsqueda de legitimidad: el uso contemporáneo de la ayahuasca, entre reivindicaciones terapéuticas y religiosas / Practices in search of legitimacy: the contemporary use of ayahuasca, between religious and therapeutic vindications

RESUMEN El creciente interés de los occidentales por la bebida psicotrópica ayahuasca y la participacion en rituales exóticos ha llevado en las últimas décadas a la multiplicación de los "centros chamánicos" en la Amazonía peruana. Entre estos, el centro Takiwasi es una comunidad terapéutica que acoge cada año a cientos de clientes nacionales y extranjeros. Esta institución, creada por un médico francés en 1992, fue originalmente destinada a proponer una alternativa terapéutica para el tratamiento de la adicción, y se caracterizaba por el uso de ciertas herramientas del chamanismo mestizo peruano articuladas con la biomedicina y la psicología clínica. La evolución diacrónica de la institución está, sin embargo, marcada por la creciente utilización de elementos de la tradición católica. Examino aquí la hipótesis de que estas transformaciones pueden ser interpretadas como los efectos de la globalización del uso de la ayahuasca y sus consecuencias jurídicas y políticas. De este modo, el caso de Takiwasi subraya el papel jugado por las tradiciones religiosas y el campo médico en la construcción, la legitimación y el mantenimiento de las prácticas nuevas e híbridas que se multiplican alrededor del uso de la ayahuasca.

ABSTRACT In recent decades, the growing interest of Westerners in the psychotropic brew ayahuasca and the participation in exotic rituals has led to the multiplication of "shamanic centers" in the Peruvian Amazon. Among these, Takiwasi is a therapeutic community that welcomes hundreds of national and foreign clients every year. This institution, created by a French physician in 1992, was originally intended to propose a therapeutic alternative for the treatment of addiction, characterized by the use of tools of Peruvian mestizo shamanism, biomedicine and clinical psychology. The diachronic evolution of the institution is however marked by the growing use of elements of the Catholic tradition. In this article, I will examine the hypothesis that these transformations can be interpreted as the effects of the globalization of the use of ayahuasca and its legal and political consequences. Thus, the case of Takiwasi underlines the role played by religious traditions and the medical field in the construction, legitimization and maintenance of new and hybrid practices that are multiplying around the use of ayahuasca.

Children's Sensitivity to Cost and Reward in Decision Making Across Distinct Domains of Probability, Effort, and Delay.

Many behavioral paradigms used to study individuals' decision making tendencies do not capture the decision components that contribute to behavioral outcomes, such as differentiating decisions driven toward a reward from decisions driven away from a cost. This study tested a novel decision making task in a sample of 403 children (age 9 years) enrolled in an ongoing longitudinal study. The task consisted of 3 blocks representing distinct cost domains (delay, probability, effort) wherein children were presented with a deck of cards, each of which consisted of a reward and a cost. Children elected whether to accept or skip the card at each trial. Reward-cost pairs were selected using an adaptive algorithm to strategically sample the decision space in the fewest number of trials. Using person-specific regression models, decision preferences were quantified for each cost domain with respect to general tolerance (intercept), as well as parameters estimating the effect of incremental increases in reward or cost on the probability of accepting a card. Results support the relative independence of decision making tendencies across cost domains, with moderate correlations observed between tolerance for delay and effort. Specific decision parameters showed unique associations with cognitive and behavioral measures including executive function, academic motivation, anxiety, and hyperactivity. Evidence indicates that sensitivity to reward is an important factor in incentivizing decisions to work harder or wait longer. Dissociating the relative contributions of reward and cost sensitivity in multiple domains may facilitate the identification of heterogeneity in sub-optimal decision making.

How does reactivity to frustrative non-reward increase risk for externalizing symptoms?

Frustration is a normative affective response with an adaptive value in motivating behavior. However, excessive anger in response to frustration characterizes multiple forms of externalizing psychopathology. How a given trait subserves both normative and pathological behavioral profiles is not entirely clear. One hypothesis is that the magnitude of response to frustration differentiates normative versus maladaptive reactivity. Disproportionate increases in arousal in response to frustration may exceed normal regulatory capacity, thus precipitating aggressive or antisocial responses. Alternatively, pathology may arise when reactivity to frustration interferes with other cognitive systems, impairing the individual's ability to respond to frustration adaptively. In this paper we examine these two hypotheses in a sample of kindergarten children. First we examine whether children with conduct problems (CP; n=105) are differentiated from comparison children (n=135) with regard to magnitude of autonomic reactivity (cardiac and electrodermal) across a task that includes a frustrative non-reward block flanked by two reward blocks. Second we examine whether cognitive processing, as reflected by magnitude of the P3b brain response, is disrupted in the context of frustrative non-reward. Results indicate no differences in skin conductance, but a greater increase in heart rate during the frustration block among children in the CP group. Additionally, the CP group was characterized by a pronounced decrement in P3b amplitude during the frustration condition compared with both reward conditions. No interaction between cardiac and P3b measures was observed, suggesting that each system independently reflects a greater sensitivity to frustration in association with externalizing symptom severity.

Implications of ongoing neural development for the measurement of the error-related negativity in childhood.

Event-related potentials (ERPs) have been proposed as biomarkers capable of reflecting individual differences in neural processing not necessarily detectable at the behavioral level. However, the role of ERPs in developmental research could be hampered by current methodological approaches to quantification. ERPs are extracted as an average waveform over many trials; however, actual amplitudes would be misrepresented by an average if there was high trial-to-trial variability in signal latency. Low signal temporal consistency is thought to be a characteristic of immature neural systems, although consistency is not routinely measured in ERP research. The present study examined the differential contributions of signal strength and temporal consistency across trials in the error-related negativity (ERN) in 6-year-old children, as well as the developmental changes that occur in these measures. The 234 children were assessed annually in kindergarten, 1st, and 2nd grade. At all assessments signal strength and temporal consistency were highly correlated with the average ERN amplitude, and were not correlated with each other. Consistent with previous findings, ERN deflections in the averaged waveform increased with age. This was found to be a function of developmental increases in signal temporal consistency, whereas signal strength showed a significant decline across this time period. In addition, average ERN amplitudes showed low-to-moderate stability across the three assessments whereas signal strength was highly stable. In contrast, signal temporal consistency did not evidence rank-order stability across these ages. Signal strength appears to reflect a stable individual trait whereas developmental changes in temporal consistency may be experientially influenced.