Shamanismas a healing

paradigmfor complementary
therapy
Mike Money
Any healing process ^ whether recovery frominfection, physical trauma, or psychological
distress ^ must entail the stimulation anddirection of the bodys ownrestorative functions.
In former times these functions were called the vis mediatrix naturae. Arguably best
articulated within traditional Chinese medicine (e.g. Reid1993), many complementary
therapieshaveidentif|edthisprinciple. Theimmunesystemisimplicatedinthe operationof
these healing processes, andimmune systemfunctions are modulatedby bothinternal and
external variables. External variables include the nature of the infection or trauma.
Internal variables include the meaning of the illness to the patient or the patients imagery
surrounding the illness.
It follows that any modulation of internal variables that increases immune functionwill
therefore be highly benef|cial in the healing process. Sometimes such modulation happens
spontaneously, whenit may be referredto as the placebo effect, or a goodbedside manner,
or spontaneous remission. Sometimes such modulation may be brought about
intentionally either by the patient or by a therapist or healer. One body of technique for
such modulation is shamanism, which pays particular attention to bridging the internal
worldof thepatienttothe external worldwhere theproblemoriginates. Shamanic practice
is specif|cally focused on this healing task, andhas its own toolkit of techniques for the
modif|cation of consciousness, the manipulation of imagery andmeaning, and the
generation of a healing milieu and therapeutic images fromits mythic content.
Early concerns about the mental health of shamanic practitioners are nowthoroughly
resolved (e.g. Stephen &Suryani 2000). Indeed, the relevance of shamanismto positive
mental health is currently being explored (e.g. Money1994, Singh1999). Its relevance to
social work (Voss et al. 1999) and to the near death experience (Green1998) are also
subjects of academicinquiry. The shamaniccorpus exemplif|es ahealingparadigmthat may
also be used to understand the essential elements of healing, which underpin some
establishedcomplementary therapies and some other healing modalities such as spiritual
healing,psychic healing, spontaneous remission, and the placebo effect. The
comparatively recent psychoneuroimmunological perspective appears to be congruent
with and also tovalidate ancient shamanic healing technique. Both may share essential
principles with complementary therapies andilluminate their essential healing processes.
#2001Harcourt Publishers Ltd.
INTRODUCTION
This paper aims to demonstrate the enduring
relevance of shamanic technique to understand-
ing human healing, and the way its methods may
indicate the principles of several complementary
therapies. There is, of course, more to shaman-
ism than healing, and far more to health than
immunity. However, our emerging understand-
ing of the ways in which the immune system is
aected by precisely those variables which sha-
mans have always sought to manipulate is of
considerable signicance, and serves to demon-
strate once more the ubiquity and signicance of
Mike Money
MA PhD, DipEd C Psychol,
AFBPsS, Centre for Health,
Healing and Human Devel-
opment,
Liverpool John Moores
University,
T|thebarn Building,
T|thebarn Street,
Liverpool L3 2ER, UK.
ComplementaryTherapies in Nursing & Midwifery (2001) 7, 126^131 #2001Harcourt Publishers Ltd
doi:10.1054/ctnm.2001.0546, available online at http://www.idealibrary.com on
1
shamanic practice and its potential as a para-
digm of complementary as well as some more
orthodox healing methods.
Healing can be intimately associated
with the immune system
Health and healing are contested concepts, but
the shamanic tradition has always incorporated
intervention in health and illness, whether at
individual, tribal, or ecological levels. Though
they perform many functions, shamans are,
above all, healers (Walsh 1990, p. 183). Most
healing traditions from Western biomedicine
and its Greek antecedents to acupuncture or
homeopathy emphasize that ultimately what
heals is the patients natural resistance or
recuperative powers, perhaps aided and augmen-
ted by the therapist. One contemporary expres-
sion of this understanding is psychoneuro-
immunology (PNI), which focuses on the inter-
action between the patients immune system and
those physical, social, psychological, symbolic
and spiritual factors (to name but a few) which
impact upon its function and which can be used
to modulate its eects. In taking this aspect as a
theme for exploring shamanic healing, I am not
suggesting that the immune system is some
ultimate expression of human recuperative
powers merely a particularly research-active
and dynamic context, marking as it does in
certain respects the boundary between orthodox
biomedicine and traditional healing. In this
regard, my sympathies lie with traditional
Chinese medicine (TCM), which takes the view
that:
While modern Western medicine has a rm grasp
of the essence of immunity, it has much to learn
from traditional Chinese medicine about the
energy and spirit of the human immune system,
and the sooner it does do, the better the health of
human societies will become (Reid 1993, p. 321).
Over the last 20 years, with the increasing
development and legitimation of complementary
therapies, we have seen the development of
insights into the therapeutic process which go
beyond those traditionally associated with Wes-
tern biomedicine. What has been striking is the
extent to which shamanic healing has been
progressively revealed as increasingly under-
standable and legitimate within the context of
contemporary discoveries in the elds of health
and illness.
As I have suggested, an approach which
exemplies this new paradigm is that of PNI.
PNI has reconstructed the old discipline of
immunology, which saw the immune system as
essentially passive and determinate in nature,
with a view of it as something intricately
associated with psychological and social vari-
ables. PNI understands the immune system as
adversely aected by stress, loneliness and
depression, modiable by imagery and learning,
and functioning in many ways rather like
another perceptual process. And as this insight
has emerged, the parallels between the implica-
tions of this view for healing and shamanic
healing have been and continue to be signicant,
striking, and illuminating.
The topic of imagery and health illustrates this
emerging perspective which is exemplied in the
work of Jeanne Achterberg. In a landmark book
(1985), she argued that the shaman was the
master healer of the imaginary realms. Speaking
of the links between shamanism and the immune
system, she noted (p. 166) a bibliography of 1300
scientic articles all written since 1976 which
related to the minds inuence on immunity. . .
She went on to consider cancer, spontaneous
remission, and immunocompetence from the
perspective of psychological factors.
Two years later, in an article exploring the
denition and cognitive boundaries of PNI,
Solomon (1987) armed that:
The eld reinforces the view that all disease is
multifactorial and biopsychosocial in onset and
course the result of interrelationships among
specic etiologic (e.g. bacteria, viruses,
carcinogens), genetic, endocrine, nervous, immune,
emotional, and behavioral factors.
Solomons paper contains 31 PNI hypotheses,
of which at least nine are relevant to this paper.
Summarizing, Solomon suggests that there may
be links between a persons coping style and
personality factors and the susceptibility of their
immune system to alteration by external events.
He asks whether conditioning and early experi-
ence could have immunologic consequences.
Activation of the immune system should be
correlated with altered phenomena in the central
nervous system. Behavioral interventions (such
as psychotherapy, relaxation techniques, ima-
gery, biofeedback, and hypnosis) should be able
to enhance or optimize immune function (p. 5).
In relation to this hypothesis, Solomon asks Are
happiness, security, sense of control, relaxation
and other positive emotions accompanied by
immune enhancement? and wonders whether
there might be a relationship between superior
immune function, superior psychological status,
and longevity.
Healing processes may entail
modulating immune function
It may be helpful to review the functions of the
immune system very briey. Its most general role
is to act as an organ of perception, discriminat-
ing between self and not-self materials and
destroying potentially malignant cells. This is
accomplished by a variety of specialized cells,
often referred to as B cells (originating in the
Shamanism as a healing paradigm 127
bone marrow) and T cells (maturing in the
thymus). B cells produce antibodies, which
adhere to and immobilize non-self substances
and are then removed by phagocytes. T cells act
directly on pathogens and include the so-called
natural killer or NK cells.
However, the immune system has other health-
related functions, such as assisting in the healing
of wounds and the removal of dead cells. It
interacts with all other physiological systems
such as the neuroendocrine, gastrointestinal,
respiratory, urogential, and musculoskeletal sys-
tems. The cells of the immune system are
distributed throughout every part of the body,
and indeed, many of them actively travel or
migrate around it (Staines et al. 1993, p. 5). It
is thus a complex, pervasive, and dynamic system
whose operation has implications for many
aspects of human health. The amount of
information that it can process and the dierent
responses that it can generate probably make the
immune system the most complex body system
after the CNS (Besedowsky 1992, p. 13).
The emerging discipline of PNI convincingly
demonstrates that cognitive variables such as
beliefs, values, imagery, social and individual
denition of events and circumstances, and the
fundamental attribution of meaning to situations
and circumstances, profoundly aect the func-
tioning of this complex system. Hence modica-
tion or reinforcement of appropriate aspects of
these variables has substantial implications for
health. As I shall attempt to show, shamanic
healing technique may be understood as using
precisely this methodology.
Immune system function can be eectively
modulated by psychogenic variables. Much of
the original work from which PNI was developed
(e.g. Holmes and Rahe 1967) derived from
studies of stress and ill health. Overall, unma-
nageable stress is bad for immune function. In
the context of stress and cancer, for example,
Sklar and Anisman (1981) showed that the
growth of tumours is exacerbated following
exposure to uncontrollable stress, but not to
controllable stress. They comment that . . .
cancer relapse after surgical removal of a
malignant melanoma was more frequent among
individuals who expressed diculty in adjusting
to the disease and surgery than among indivi-
duals who reported relatively less diculty in
adjustment (p. 373). Fittschen et al. (1990) have
shown that even the stress of academic examina-
tions can modify immune function; but here
again the perception of the forthcoming test as a
eustress a potentially enjoyable challenge or
as distressing was a signicant factor.
Since the development of PNI perspectives, it
has become more acceptable within mainstream
medicine to consider manipulation of the im-
mune function through imagery (e.g. Simenton
and Simenton 1981) in addition to the traditional
techniques of immunization. For example, Con-
duit (1995) considers such issues as autoimmune
disease. HIV+status, AIDS, and cancer. Fol-
lowing his overview of PNI, the author com-
ments (p. 265) Extensive pathways and
mechanisms for the inuence of psychological
processes on immune function have been identi-
ed in the above research. As Neveu pithily
summarizes:
Relationships between the central nervous system
and the immune system are mediated by hormones
from the hypothalamo-pituitary axis and by the
sympathetic nervous system which are known to
have regulatory roles on the immune response,
possibly through receptors on lymphocytes.
Healing may entail the intentional
modulation of the immune system
Any process, therefore, that resulted in stressors
being either alleviated or shifted from the
uncontrollable to the controllable category
would be benecial to the immune system and
hence contribute to an improvement in health
status. The evidence here is very suggestive. For
example, Irwin et al. (1987) showed that there
was a relationship between severity of depressive
symptoms in 37 women and a weakening of
immune functions, including an impairment of
natural killer cells, and a fall in the number of
suppressor/cytotoxic cells.
For men, on the other hand, it has been shown
that as marital discord increases, poorer immu-
nological function on two measures increases.
Kiecolt-Glaser et al. (1988) showed that 32
separated and divorced men, matched with 32
married men, reported signicantly more recent
illnesses. They were also lonelier and more
distressed. Irwin et al. (1987) showed a clear
relationship between life events, depressive
symptoms, and the immune function in 37
women. Those women who had experienced the
greater life changes had fewer natural killer (NK)
cells, and severity of depression was associated
with changes in three separate immune system
functions. Investigating the possible relationship
between examination stress and immune func-
tion, Fittschen et al. (1990) concluded that
higher cortical functions could modulate im-
mune functions that might well be important
in viral, autoimmune and malignant diseases
(p. 242).
If a shamanic intervention reduces depressive
symptoms, it may have a benevolent action upon
immune system function. If it reduces individual
distress or interpersonal conict, if it increases
feelings of personal ecacy and internal locus of
control, then it will be directly benecial to
health. It seems possible to conclude that any
intervention which reduces discord and promotes
128 ComplementaryTherapies in Nursing &Midwifery
greater harmony will therefore impact positively
on health, especially those aspects inuenced by
immune function. It has often been noted that
the role of shamanic healing ritual (e.g. among
the Navajo) has the particular purpose of
reducing discord within a family or social group.
And in the light of evidence suggesting that the
immune system not only learns, but learns in a
manner analogous to classical conditioning (e.g.
Kusnecov et al. 1989) then support is given to the
notion that shamanic healing interventions can
have a prolonged and enduring eect upon the
health of the individual. Shamanism can be
understood as a corpus of knowledge enabling
such immune system modulation. A conference
held in Montreal in 1980 explicitly considered the
relationship between shamans and endorphins
(Prince 1982). While using the term shamanism
broadly (ibid p. 301), the proceedings of this
conference are relevant here. In a nutshell, the
conference reports suggest that shamanic prac-
tice may make intentional use of methods
designed to stimulate endorphin production as
a mechanism of pain relief. This is interesting to
us, because, as was suggested above, if this eect
can in fact be demonstrated or even made
plausible, interventions that can be shown to
aect the CNS in this respect must also be
capable in principle of modifying immunological
functions.
Moreover, as Neher (1962) has pointed out,
shamanic drumming may be of particular eec-
tiveness in bringing about alterations in CNS
activity. Whereas stimuli such as clicks or single
tones may have little eect, a single drum beat
may contain several frequencies, and because of
its lower pitch has the potential to deliver far
more energy to the human sensorium as low
frequency auditory receptors are far more
resistant to damage than those for high fre-
quency. Such acoustic driving is well recognized
as a process whereby CNS functions can be
modied to produce altered states of conscious-
ness.
What does this all imply? I think it is in the
work of Jilek (1982a and b; 1992) that the
dierent threads of evidence can be woven
together satisfactorily. Jilek describes how the
Coast Salish of the Pacic Northwest (1992, pp.
8996) have reinstituted their shamanic spirit
dance in the context of a cultural renaissance.
Traditionally, the spirit dance was a combination
of vision quest and secret-society initiation, and
was often focused on the spirit sickness. Today
spirit sickness has been reconceptualized by the
Salish as a cluster of indications . . .resulting
from the negative eects of the White mans
intrusion into Amerindian society. A candidate
for dance initiation today may be suering from
chronic depression, alcohol or drug abuse, or
antisocial behaviour a wide range of symp-
toms. Initiation is conceptualized as a death and
rebirth process bringing with it new spiritual
power, a new Native American identity, and a
healthier life. The old, diseased self is symboli-
cally clubbed to death.
The processes of the spirit dance bring about
an altered state of consciousness of the sort that
Harner (1990, p. 46) has termed the shamanic
state of consciousness or SSC. Jilek (1982a)
suggests that this altered state brings with it the
potential for profound changes in brain neuro-
chemistry; implicating enkephalin, beta-endor-
phin, endogenous polypetides and others. He
cites Kline (1981) as showing the eects of beta-
endorphin as . . .antidysphoric, antidepressant,
anxiolytic, analgesic and disinhibiting. He adds
(p. 340):
The same psychotropic eects as shown in clinical
trials with beta-endorphin can also be observed in
the North American Indian ceremonials described
above. . . We may further propose that the release
of these substances could be triggered by the same
conditions known to induce altered states of
consciousness in the rituals under discussion;
notably pain, acoustic and kinetic stimulation,
hypoglycaemia, and dehydration, in combination
with physical exertion.
It may be noted, incidentally, that Jilek has
attempted to evaluate the therapeutic eective-
ness of the Spirit Dance. He obtained follow-up
reports of 24 modern spirit dancers (1982b, p.
96). Of these, 11 had previously experienced
problems with depression, anxiety, somatisa-
tion, often associated with alcohol or drug abuse
and 13 had shown behaviour problems with
aggressive or antisocial tendencies, usually asso-
ciated with alcohol and/or drug abuse. In the
rst category, three had been free of symptoms
since initiation, and a further seven had shown
improvement. In the second category, seven had
been rehabilitated and three had shown improve-
ment. While these specic results may not
themselves be mediated by any immunological
process, Jileks analysis makes it clear that the
processes involved in such ceremonies are quite
capable of producing changes in immune func-
tion.
The Salish Spirit Dance, while unique to its
indigenous context, manifests most if not all of
the elements of a shamanic healing ceremony. It
is thus reasonable, I would suggest, to take it as a
paradigm case of shamanic healing. What can we
conclude from such a paradigm case? We can
conclude that there are elements in shamanic
healing which act directly and unambiguously on
the central nervous system in such as way as to
have profound eects upon its neurochemistry.
We know from PNI that brain events have far-
reaching implications for the functions of the
immune system even such a gross variable as
laterality as revealed in hand-dominance may
Shamanism as a healing paradigm 129
aect immune system function as manifested in a
predisposition to allergic disease (Betancur et al.
1990). It is therefore reasonable to conclude that
shamanic healing may derive some of its eec-
tiveness from precisely these eects. Sometimes,
as in the Salish example, healing is focused on
cognitive or behavioural issues; sometimes on
infectious disorders; sometimes on functional
maladies. These distinctions, of course, derive
from the perspective of Western Biomedicine and
are not reected in traditional cultures and hence
not in shamanic healing. More often the inter-
vention is at the whole person level. The parallel
with the beliefs of many complementary thera-
pists is striking.
But however we attempt to conceptualize the
intervention, we can see that it is now possible to
comprehend it as acting through a number of
processes and channels directly on the central
nervous system of the patient. It may have a
number of possible eects which include pain
relief, the production of more positive states of
consciousness, a greater feeling of self-ecacy,
and a stimulation and amplication of the
functions of the immune system all with
benecent eects on the recipient of the treat-
ment, and perhaps on the onlookers as well.
Indeed, it may be possible to generalize a little
further. Healing is still a mysterious process.
Even practitioners of Western biomedicine will
admit that the action of many interventions is
not understood. As Reilly commented, The
practice of medicine is often truly unscientic
(1995, p. 66). There are many conditions, from
mental illness to leukemia, where the phenom-
enon of remission is encountered. It is sometimes
called spontaneous remission, and what it means
is that the patient got better, or improved
substantially, or became symptom-free for a
while, and nobody knows why. We refer blithely
to the bedside manner or the placebo eect, but
tend to dene it as a nuisance variable in drug
trials rather than as a powerful healing phenom-
enon in its own right. Yet as Cousins observes (in
Achterberg 1985, pp. 8687):
The next great advance in human evolution may
well be represented by the ability of humans,
working with a new understanding of brain
chemistry, to preside over their own beings.
This shamanic healing paradigm may be used
to conceptualize other healing processes and
phenomena, especially those of complementary
therapy.
Let me conclude. I have suggested that healing
may be predicated upon peoples natural healing
capacity, and that interventions of whatever sort
may be understood as initiating, facilitating or
enhancing that capacity. We have seen that the
emerging discipline of PNI describes ways in
which the events in the external world, in the
psyche of the patient, in the patients central
nervous system, and nally in his or her immune
systems operations are intimately intercon-
nected. We may therefore hypothesize that
healing can be the result of interventions which
manipulate this chain of therapeutic events, and
that such a conceptualization enables us to
incorporate spontaneous remission, placebo ef-
fects, and other phenomena which lie outside
Western biomedicine within our understanding
of the healing process. Shamanic healing uses a
variety of approaches from the botanical to the
psychological which may have this immune
activation as a consequence of its intervention.
Thus, while shamanic healing practices are not
the only ones which work, or are necessarily the
most eective in all situations, they enable us to
extrapolate a general model of healing within
which all such eective practices can be accom-
modated. There may be the potential to explore
whether and to what extent the healing methods
of complementary therapy may benet from an
analysis in terms of this suggested paradigm.
The last word should come from Thomas
Largewhiskers (in Achterberg 1985, p. 11):
. . .there is a part of the mind that we dont really
know about and that is the part that is most
important in whether we become sick or remain
well.
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Shamanism as a healing paradigm 131