ResearchOnline@JCU This file is part of the following reference: O’Shaughnessy, David Michael (2017) Takiwasi: Addiction Treatment in the “Singing House”. PhD thesis, James Cook University. Access to this file is available from: http://researchonline.jcu.edu.au/51692/ The author has certified to JCU that they have made a reasonable effort to gain permission and acknowledge the owner of any third party copyright material included in this document. If you believe that this is not the case, please contact [email protected] and quote http://researchonline.jcu.edu.au/51692/ TAKIWASI: ADDICTION TREATMENT IN THE “SINGING HOUSE” by David M. O’Shaughnessy BSc(SoftEng) ECowan, GDipPsych Adelaide, BHlthSc(Hons) Adelaide A Thesis Submitted in Partial Fulfilment of the Requirements for the Degree of Doctor of Philosophy JAMES COOK UNIVERSITY College of Medicine and Dentistry August 2017 ACKNOWLEDGEMENTS The work that has been condensed into this thesis could not have been realized without the assistance of numerous organizations and individuals. To begin with, the entire fieldwork and data collection process would have been impossible without the financial support that I received from the Australian Government. In this regard I also owe thanks to James Cook University and the College of Medicine and Dentistry, and especially to Professor Frances Quirk who generously provided financial assistance in order to bring the project to fruition. Over the course of my doctoral candidature, I have had the good fortune of working with a wonderfully diverse supervisory team: Spanning neuroscience to psychology and anthropology, Professor Zoltán Sarnyai, Professor Frances Quirk, and Doctor Robin Rodd have allowed me the freedom to pursue a unique path whilst still providing guidance and support according to their areas of expertise. The methodological enquiry that underpins this tripartite biopsychosocial thesis can be traced back to their collective influence, and such intellectual diversity has made for a far richer thesis than I could have conceived of at the outset. I also consider myself lucky to have been able to conduct my fieldwork at the Takiwasi Centre in Peru. Yet it seems to me that the work in this thesis, as detailed as I have tried to make it, merely scratches the surface of the possibilities that Takiwasi presents to the researcher. I thank Doctor Jacques Mabit and Jaime Torres for opening Takiwasi’s doors to me, and in particular Doctor Fernando Mendive for his ongoing research support as scientific coordinator at Takiwasi. I must also thank Doctor Ilana Berlowitz, whose support increased my understanding of Takiwasi immensely. At Cayetano Heredia University in Lima, I thank Doctor Michel Sauvain and Denis Helan Castillo Pareja for assisting with the biological part of the project. Outside of Takiwasi, I want to thank my friends at the Huascar; in particular Tony, Katy, and William. Apart from all the great discussions and insights into Peruvian life, you quickly made Tarapoto feel like home. Here in Australia I also thank my family for their good humour, spirit, and support of my direction. Of course, I am indebted to my partner Lidia, who travelled with me always and whose support would fill more than this page on its own if it were to be detailed! Perhaps most importantly, I wish to thank the Takiwasi patients for sharing their stories with me. Their help and trust enlivened not only this work, but my own experience in Peru. Lastly, special mention must be made for Doctor Robin Rodd and the particularly instructive and thorough chapter reviews that he provided over the entire period of writing this thesis—the final manuscript stands vastly improved as a result. i STATEMENT OF CONTRIBUTION OF OTHERS The following list details the contribution of others to the project: • Intellectual Support – Initial research design: Zoltán Sarnyai (biological), Frances Quirk (psychological), and Robin Rodd (anthropological). – Design modifications: Fernando Mendive and Ilana Berlowitz trans- lated the Craving Experience Questionnaire to Spanish, and are re- sponsible for its subsequent inclusion in the project. Both also con- tributed ongoing discussion regarding logistics and design feasibility in the Takiwasi context. – Data analysis: Michel Sauvain and Denis Helan Castillo Pareja carried out the laboratory analyses of salivary cortisol levels at Cayetano Heredia University, Lima, Peru. Zoltán Sarnyai contributed analytical ideas, discussion, and guidance. – Statistical support: Rhondda Jones provided advice and code review concerning mixed-effects modelling in R. – Writing support: Robin Rodd supplied ongoing written feedback and opportunities for discussion and reflection. • Financial Support – Scholarship: Daily living expenses were covered by an Australian Postgraduate Award from the Australian Government. – Project funding: Research materials, training, and travel costs were paid for by James Cook University’s College of Medicine and Den- tistry. – Additional project funding: Frances Quirk contributed extra funding for project equipment, and also a post-scholarship writing stipend. • Data Collection – Psychological testing: Ilana Berlowitz administered a portion of the Craving Experience Questionnaire tests. Homero Saavedra Flores administered a number of psychological tests on my behalf after I had left the field. ii ABSTRACT Takiwasi is an addiction treatment centre located in Peru that fuses traditional Amazonian medicine (including the use of psychoactive plants, such as aya- huasca) with Western medicine and psychotherapeutic techniques. Anecdotal and indirect evidence suggests that the treatment could be highly effective for certain individuals, yet rigorous studies have been rare. Given the centre’s medical pluralism, I develop and utilize a research approach based on a reappraisal of George Engel’s biopsychosocial model; that is, a biopsychosocial model founded on critical pragmatism. The basic relationship between stress, addiction, andthe environment is represented in a new model of addiction, which is then elaborated upon in terms of critical psychosocial theory. Such an approach draws on biology, psychology, anthropology, and sociology in an attempt to understand not only Takiwasi, but the phenomenon of addiction itself in relation to the modern world. Results from the study of Takiwasi patients undergoing treatment (with methods including ethnographic fieldwork, psychological testing, and salivary cortisol measurement) indicate not only an absence of harm, but also the presence of clinically positive change for the majority of patients. Within the treatment context, it seems likely that profound (yet poorly understood) biological and psychological mechanisms are associated with these changes, although the na- ture of the treatment also leads to discussion of alternate healing mechanisms which exceed current Western medical rationality. Contextualizing these results within a critical biopsychosocial model of addiction challenges the adequacy of the biomedical “brain disease” paradigm, and also demonstrates the logical deficiency (and potential danger) of asocial and ahistorical theories of addiction. Finally, addiction is considered from the perspective of classical critical theory, with Takiwasi demonstrating a potentially resistive process against a dangerous tendency embedded in the project of modernity. iii Dedicated to the patients of Takiwasi CONTENTS Acknowledgements i Statement of Contribution of Others ii Abstract iii Contents v List of Tables ix List of Figures x 1 Introduction 1 1.1 Thesis Outline ............................ 1 Part I — Theory and conceptual framework ............ 1 Part II — Takiwasi ......................... 2 Part III — Synthesis ........................ 3 1.2 Methodological Summary ..................... 3 Social methods ........................... 3 Psychological methods ....................... 4 Biological methods ......................... 5 Field site limitations (Takiwasi) .................. 5 1.3 Brief Note on Style ......................... 6 I Theory and Conceptual Framework 7 2 Addiction: Revisiting the Biopsychosocial Model 8 2.1 Defining Addiction ......................... 9 2.2 The Biopsychosocial Model ..................... 10 History and analysis ......................... 10 Essential elements of a biopsychosocial theory . 11 Stress and drug addiction: An empirical example . 12 Expanding the “social” in biopsychosocial . 15 2.3 Critical Biopsychosocial Theory: Addiction and Stress . 16 Biological theory .......................... 16 Psychological theory ........................ 19 Sociocultural ............................ 23 v CONTENTS vi Cultural theory ........................... 23 Sociological theory ......................... 26 Summary: Critical biopsychosocial addiction theory . 31 2.4 Conclusion ............................. 32 II Takiwasi 34 3 Cross-Cultural Medicine: Interdisciplinary Views 35 3.1 Traditional Amazonian Medicine . 36 The traditional uses of ayahuasca . 37 Vegetalismo and globalization ................... 39 Takiwasi, tourism, and neo-shamanism . 43 The legitimacy of curanderismo . 46 3.2 Altered States of Consciousness: Therapeutic Use . 48 The politics of terminology ..................... 48 The rise, fall, and rebirth of psychedelic science . 49 Ayahuasca as therapeutic agent ................... 51 3.3 Conclusion ............................. 58 4 Concepts of Health and Illness in Takiwasi 60 4.1 Theoretical Domains of Health and Illness . 62