At about the time the article on !Kung healing was being written for this website, Michael Winkelman was publishing a book entitled Shamanism: a Biopsychosocial Paradigm of Consciousness and Healing. Noted researchers in this field, Adam Rock and Stanley Krippner, refer to this book as “the current major academic source book on the topic of shamanism”. Although difficult to penetrate because of its dense use of technical terms, it is a brilliant, overarching treatment of the subject. Winkelman has put together vast information from anthropology, evolutionary biology and the neurosciences to create a fresh, beautiful and common sense insight into the nature of shamanism. The core framework presented in this book is presented below as understood by someone not in the field and hopefully it is not oversimplified to the point of distorting Winkelman’s paradigm.
The Paradigm
Our brains can be described as having anatomic structures that correspond to functional levels. These structures that function at different levels first appeared at various times in our evolution. Thus, we share with reptiles and all other mammals the brainstem, the most ancient level of the brain, which connects the rest of the brain with the spinal cold and the cranial nerves. All sensory information comes through the spinal cord or cranial nerves and passes through the brainstem. However, most of this information is edited out before it reaches consciousness. Winkelman and others refer to the brainstem as the “reptilian brain” because it is present in reptiles as well as more recently evolved life forms. It is involved in regulating our physiology. For instance, it regulates breathing, heart rate, bowel activity, blood pressure and many reflex behaviors. Examples of reptilian brain reflexes include temperature regulation, constriction of the pupils in bright light, blink reflex and coughing. Connected to the reptilian brain is the midbrain, a complex structure that we share with all mammals but is not developed in reptiles. The midbrain is often called the “mammalian paleocortex” – “paleo” meaning ancient. A major function of this part of the brain is to generate emotions. It also has major functions in memory and creation of a mental map of our environment. At a higher level, wrapped around the mammalian midbrain is the “neocortex – “neo” for new. In humans, it is more highly developed than in any of our evolutionary predecessors or in relatives such as the chimpanzee, bonobo and gorilla. The neocortex is ordinarily the seat of most of our conscious activity. It is where we compare things, work out strategies, decide what is important, keep track of time, form speech, conceptualize, think and fantasize.
Before any creature had such a large neocortex, animals did a good job of surviving and even in humans, information from the reptilian brain and the paleomammalian cortex is important for our adaptation. However, we tend to live in the higher level environment of the neocortex, partly out of touch with the picture of reality arising in the lower brain structures. This information exists in a raw and unprocessed state without language or systematic symbols. It can be difficult for humans to access. Our vast moment-to-moment sensory experience is mostly edited out before it reaches awareness. Important memories are sometimes there but not accessible. We may be unaware of our total emotional landscape when we are making important decisions. It would seem obvious that making more of this information available could lead to a kind of wisdom and to better decisions. Because the information in the deeper parts of the brain may in some ways conflict with information in the cortex, the process of developing this wisdom may be difficult. For instance, it is common for people to harbor fear, anger or even love without being aware of it because it would be inconvenient given the narrative going on in the neocortex.
Winkelman’s fundamental point is that as we evolved, despite any difficulties involved, it was advantageous for humans to stay in touch with the information from the lower levels of the brain as our awareness became based more and more in the neocortex. For this reason, we evolved with an ability to integrate this information through our original, natural religiosity as universally expressed in traditional nomadic hunter-gatherer societies. This ability can be called the “integrative mode of consciousness” (IMC) because it integrates information in the various levels of the nervous system as it integrates our total experience. This term describes a special mode of consciousness that is different from conventional waking consciousness, deep sleep or REM sleep (when dreams usually occur). Like these other three modes of consciousness, IMC is characterized by its own characteristic EEG patterns. People particularly adept at using IMC in hunter-gatherer societies are referred to as shamans. They are known for their psychodynamic maturity, strong intuition, altruism and ability to help people experiencing problems in life, including illness. The main point of their shamanistic practice is to access information that helps people. Because their practices disrupt habitual thought patterns, they also may find unconventional or creative solutions to problems.
Accessing IMC
IMC can take several forms – shamanism as practiced in nomadic hunter-gatherer cultures, possession rituals, meditation practice and use of hallucinogenic drugs, called “psychointegrators” by some. It seems likely to be less integrating to take psychointegrators outside the context of practicing shamanism and without having an appropriate teacher. Also, it is presently illegal and research on these drugs effectively stopped after the 1960’s. Therefore, I will not discuss psychointegrators separately.
Classic Shamanism
Classical hunter-gatherer shamanic trance has an extraordinarily long history and appears to have biological roots. Anthropologists infer that it has biological roots because it is universal in nomadic hunter-gatherer cultures the world over. Some aspects of chimpanzee behavior also suggest an ancient biological basis for basic human religiosity taking this form. However, though IMC may be a biological function, it also requires training. Shamans generally went through apprenticeships that lasted for years. Classical shamans used various methods to enter trance including sleep deprivation, extreme and prolonged physical activity, fasting, sexual abstinence, song and rhythm and use of psychedelic drugs. According to the anthropological record, use of psychedelics has been very common. In hunter-gatherer societies, classical shamanic trance manifests as out-of-body visual experiences in which the practitioner experiences being in places other than where his body is located and communicates with beings such as animals and gods. The practitioner may experience himself taking the form of an animal. The most likely explanation for these phenomena is that, as mentioned above, information in the reptilian brain and paleomammalian cortex is nonverbal and does not have systematic symbolism. It presents itself as these dream-like experiences. Even so, emotional and intuitive information taking these forms gives the shaman an opportunity to work with it and let it help shape decisions.
Possession by Mediums
When conditions led hunter-gatherers to become sedentary, many aspects of culture changed in a reproducible way. Egalitarian mores were supplanted by emergence of a “big man”, who concentrated political power and restricted the autonomy of those around him. Probably because shamans had been influential, they were widely suppressed. In agricultural societies, classical shamans as found in nomadic hunter-gatherer societies are essentially non-existent. This predominantly male role was replaced by mostly women entering possession trance as “mediums” for the benefit of themselves and others during rituals. Extensive field data indicate that a shift from shamans to mediums was widespread throughout the world as hunter-gatherers became sedentary and transitioned to villages. Among other things, it seems likely that unapparent aspects of themselves that such mediums accessed through spirit possession were often aspects that had been suppressed in highly male dominated societies. However, that was not always the case. Throughout Africa, embodiment of a universal spirit rather than a spirit with a limited personality is a common practice today.
Meditation
The third form of IMC may have evolved directly from shamanism by a path different from that of mediums. The exact origins of the Eastern meditative traditions will probably never be certain. Winkelman suggests that over 5,000 years ago the practices of the original hunter-gatherers of the Indian subcontinent persisted in the background as the state-supported Vedic religion emerged. Possibly because the usual drumming and chanting of shamanism brought unwanted attention and suppression, the ancient shamans there transformed into silent yogans and developed new approaches. Linguistic elements within the vocabulary of yoga and Buddhism seem to support this version of events. Classical yoga, Buddhism and some practices in Hinduism represent the transmission of these practices through the ensuing millennia and the practices have fertilized other world religions as well. These traditions imply or explicitly state that they offer a potential to see through thoughts, language, emotions and conceptualization to access underlying awareness that is not normally accessible. Practitioners usually intend to alter their understanding of self and to experience their universe of sensory and emotional experience more directly, even bypassing visions and spirits. The writer’s experience as a modern provider taking this path to IMC is described elsewhere on this web site (“Integrating Medicine’s Missing Dimension – A Zen Perspective”).
Death and Rebirth
In a section of his book, under the heading “Death and Rebirth as Self-Development”, Winkelman, I believe, describes a core aspect of these practices. He states that some version of the death-rebirth experience appears to be universally associated with classical shamanism. These experiences may take culturally prescribed forms that involve out-of-body experiences and magical thinking. But at its heart, this kind of experience shares with possession experiences and meditation practice “the death of one identity in development of another. As a consequence of the inability of the existing psychological structures to manage the stress, the organization of the psyche – identity, beliefs, habits and conditioning – collapses, resulting in a period of introversion and reduction of intentionality…Following the collapse of the psyche…a psychological reorganization follows, guided by an archetypal drive toward holism…” In this case, the stress would be powerful, normally inaccessible memories and the influx of information from the reptilian brain and paleomammalian cortex. Significant new information of this type can strongly and suddenly contradict who we think we are and what we think is going on in this world. These difficult experiences tend to happen early in shamanic or meditation practice. Speaking again of shamans specifically, Winkelman adds, “As one becomes more accustomed to the experiences and as they are associated with symbols associated with positive affect, they lose their terrifying nature as representatives of death and become objects of exploration. The progressive development of the shaman requires that the ego have sufficient strength to reciprocally assimilate conflicting structures through transformations that can resolve the discrepant internal models…Resolution of these experiences leads the shaman to transcendence, a new level of identity….This reflects the integration of the individual sense of self and experience within neurognostic structures of the organism (memories and aspects of the self that are mediated by ancient parts of the brain – added by KW). ”
In other words, IMC tends to make people aware of sensations pouring through them, memories they might rather not recall, an archetypal sense of being after all an animal, feelings of vastness and not being separate from the objects of perception, fear of dissolution, greed yet compassion, not really being totally masculine or totally feminine, timelessness, unrecognized aggressiveness or sexuality... Also, IMC is likely to lead a person to a place where he/she sees that all the ways we look at things, all our words and concepts are just artificial structures we superimpose on a huge and intricate reality we can never really understand with the usual approaches with which we identify. Yet even with our limited nervous system we can touch that reality more directly than you would imagine and it can give quite a jolt. I would say that different traditions handle adapting to these kinds of awakenings quite differently. The shaman resolves the deep paradoxes of being human and the disorientation from seeing our vastness by going outside of rational thought through personal relationships with worlds, spirits and animals, often in out-of-body experiences. The shaman can then work with these worlds, spirits and animals, which represent aspects of the self, including raw emotions and sensory experience. The adept meditator works with new awareness by modifying understandings, by developing wisdom outside of discursive thought (intuition) and by intentionally seeing through the self and letting many of its aspects drop away or lose their force so they do not so strongly conflict with a deeper nature. This nature includes what is embedded in most humans, the drive for compassion. Indeed, classical shamans, too, do not go through death and rebirth just for themselves; their role is to help other people and they are actually known for being altruistic.
Implications About Human Religiosity
Two aspects of IMC as the original expression of human religiosity have struck me repeatedly in my reading. First, religiosity originally did not have much to do with a firm belief system. The hunter-gatherer shamans had very flexible views about who the gods were and what they were like. Indeed, to serve the functions described above, concepts of gods and spirits had to be flexible. Second, unlike many religious figures in all sedentary cultures, those practicing IMC in nomadic bands did not use these practices to support the power of big men or the state. Although shamans were influential within their social groups before there were big men and states, they were held to the same standard of equality and sharing as everyone else. This nonalignment of IMC with power can be seen even in early agricultural societies, where mediums who practiced IMC were marginalized as far as political influence went, while official priests held political power. These priests generally worked with unchanging gods and a firm belief system that justified unequal status and unequal distribution of goods within the group. We see the same phenomenon today. Billy Graham has had political power as a religious figure, while Brother David and Thomas Merton have not despite their obvious deeper and more flexible understanding of Christianity. Thus, if a health care provider wants to pursue IMC to gain influence, he will be disappointed. It has not worked that way for 10,000 years.
Why Should Health Care Providers Take the Red Pill?
In the movie The Matrix, Morpheus offers Neo, the protagonist, a blue pill or a red pill. If he takes the blue pill, life will go on as if nothing happened. If he takes the red pill, he will be cast outside of his delusional existence and enter life as it really is. Of course, he takes the red pill despite the uncertainties or there would have been no story to tell. But in our lives outside the movies, why would we take the red pill by engaging in some form of IMC?
Unlike Neo, we will not be regarded as heroes or be given special powers to influence people and the course of events. To the contrary, we may lose our desire for such things and really be marginalized in the power politics going on around us. We are likely to suffer through death and rebirth in one of its various forms, maybe repeatedly. If anything, going through such an experience is likely to bring someone strongly back into touch with original human values of generosity, egalitarianism, fairness and valuing the earth and all its life forms. If one still wanted to get involved with power politics, it would probably be as a person in opposition to those who exert the power. Consider, for instance, the case of Jesus Christ. I emphasize this point because I think many people want to take the red pill because it will give them some special status or power. Most people will not notice or care if you have truly gotten real and some might even think it a little strange. But your patients will notice and appreciate it very much. This is because many of them have been forcibly caste outside of the world of hierarchy, TV, the news, clever (or not so clever) extroverted banter, sports events, wearing the right clothes, knowing the right stuff. They have been thrown from the world of cultural conditioning into the world of life and death or they have been reminded of this world by being in the health care setting. They are glad to have someone able to enter their world with them.
Aside from wanting a provider with technical expertise, most patients appreciate a provider who has some depth, who is psychodynamically mature. A psychiatrist friend of mine from China once told me that she felt many people who emigrate from that country to the US are emotionally immature because they have had to work so hard to get here and they did not take the time to engage in their emotional lives. The same could be said of physicians. Our medical schools select for the students who have applied themselves the most intensely to reading, figuring out intellectual problems and memorizing over the previous 8 years, then medical school does not give them a chance to breathe for another 4 years. The medical graduates then go on to work harder than ever in house staff training for another 3 to 8 years. The medical school then selects some of the most intense workers whose sense of worth is now tightly caught up in how well they perform intellectual tasks and keeps us on as teachers to serve as role models. It is little surprise that patients sometimes go outside of the standard medical care system for help. An acquaintance of mine who is a neoshaman in Winston Salem, NC, once told me that her role was to help people go through difficult transitions in life when they got sick. Of course, her training had made her familiar with difficult transitions. Occasionally cures happened, but this was not her main focus. She had no shortage of patients.
At this point I would like to make a disclaimer. I would not claim to be a particularly psychodynamically mature person. My wife could certainly set the record straight on that count. However, I would say that 12 years of Zen practice have helped me to become probably about as mature as the average 64 year old patient of mine not in prison. It also forced me to face the connection between my emotional immaturity, my lifestyle over the years of training and medical practice, and my productivity as an academic. I don’t think there is much doubt that the most productive people tend to be neurotic, so encouraging emotional maturity would probably lead to decreased productivity in medicine. It is a trade-off, and what we are trading is a part of our humanity.
Another reason to take the red pill is that it will give you better access to compassion. I realize that many people in medicine today feel skeptical about compassion when so often medicine is about how productive and smart you are. I have heard some of my colleagues say really negative things about compassion as if it were a figment of the imagination or in reality counterproductive (which in the business sense it may be). Some seem to feel social pressure to say such things sometimes. However, compassion is very real. If someone dances all night long into a state of exhaustion and collapses in a trance where emotional turmoil is played out in a journey experienced outside of the body and unknown strong emotions are appearing as spirits and animals in strange places, he will find not just fear but compassion. If someone sits facing a wall for a week dropping thoughts as they come up and faces the relativity of the self and the smallness of everything it thinks, he will find not just fear but compassion. Keeping it alive may be a different issue, but at least there will no longer be any doubt that it is a strong force. Really, somehow compassion is an ultimate solution to our human predicament. Also, if you have faced the places that scare you or make you uncomfortable, you will be better able to help other people who are doing the same. If you have faced and adapted to everything within you whether you initially liked it or not, you will find that there are fewer patients for whom it is difficult to feel compassion and pleasure at seeing.
Finally, if you want to really enjoy being a healer, do it as a healer who knows IMC well. It is the dimension of healing that is missing from medicine today. Engaging this basic biological capacity will not only enhance our healing presence from the point of view of the patients, it will enrich our experience as health care providers. We do not have to stop striving for technical and organizational excellence in order to engage IMC. We just have to stop treating such striving as the only dimension that matters as if it were a war or a race on which our lives depended. Western health care will become a rich experience for all when its healers engage their full human capacity to heal.
Acknowledgement: I thank David Guy for reviewing this manuscript and for offering encouragement.