ABSTRACT

Expressions of “mind, body, and soil” have taken center stage in the field of Social Medicine with the 2022 release of The Bloomsbury Handbook to the Medical-Environmental Humanities.1 This comprehensive 30-chapter journal has opened dialogue around two seemingly disparate but parallel fields driven by the current global poly-crisis of interconnected climate, social, economic, and public health emergencies. Through autoethnography, poetry, prose, citizen science, and policy recommendations readers are invited to support indigenous approaches to global and community health in Western biomedicine. Expounding upon Lock and Scheper-Hughes’ 1987 anthropological framework2 which connects bodies through individual experiences, social relationships, political and institutional regulation, and ecological dimensions, the study of biosocial medicine has enabled researchers to gain nuanced insight into the cultural elements contributing to perceptions of wellbeing. Ana Flecha, a PhD candidate and Professor of “Dancing the Americas” within UCSC’s Latin American & Latino Studies Department, furthers this - noting the complex interplay of physical, mental, and spiritual health through her critical performance studies of Brazil’s Santo Daime church.3 Her research highlights practitioners’ use of the psychoactive Ayahuasca tea, recently popularized in clinical trials for treating both physiological and psychiatric disorders.4 Furthermore, the concept of “Arts in Medicine” reveals itself as a nexus of inquiry for delivery of culturally competent care; which Flecha’s work approaches by examining the Santo Daime bailado - a series of dance interventions accompanying the tea ceremony. This interview highlights the bailado as a novel form of complementary and alternative medicine (CAM) with transformative potential for choreographed healing.

INTRODUCTION: BETWEEN BIOMEDICINE AND CULTURALLY COMPETENT CARE

Culturally competent care is integral to the field of biomedicine. It creates opportunities for medical professionals to acknowledge patient backgrounds, value systems, and mutual expectations leading to increased trust. Effective diagnosis, treatment adherence, and patient satisfaction requires providers to understand subtleties in communication and personal preference, most notably among historically marginalized populations with experienced histories of structural violence. Despite sector-wide ethical imperatives, these communities often face distinct barriers to self-determination that are notoriously overlooked in medical environments, leading to subpar treatment outcomes. The use of social prescribing is a powerful method of bypassing this, providing tailored forms of community-driven care that has increasingly connected patients to non-medical support services addressing socio-emotional, physical and even spiritual needs.

Social prescribing is one approach that prioritizes patient narratives to best offer customized solutions. It acknowledges both social and structural determinants of health including but not limited to economic status, cultural factors, political systems, and environmental conditions existing beyond the scope of routine medical interventions. Incorporated into treatment delivery protocols, it complements both Western biomedical and holistic practices, reduces costs, increases accessibility, and can minimize isolation through direct engagement with affinity groups. Through unique interventions such as health education, nature-based and cultural activities, such prescriptions bridge gaps through creative strategies leveraging the compounded resources of entire communities to heal the individual. Despite social prescription’s success throughout history, it still struggles to be integrated into biomedicine’s purview. However, in this postmodern era of Dr. Rupa Marya’s call to action for a Deep Medicine approach 5 to addressing disparities and the promotion of health equity, there is room for divergence from outdated notions of illness to more contemporary understandings of multidirectional healing.

Columbia University founding chair of the Department of Medical Humanities, Rita Charon, coined the term “narrative medicine” in 20007- calling for medical professionals to explore the cultural stories embedded within patient-provider relationships. From the close reading of patients’ interpretations of symptoms, to their perceptions of time - narrative medicine plays a direct role in influencing how care is navigated. Temporalities within the practice span biological vs. psychosocial dimensions around diagnosis, treatment, and recovery lengths; acute vs. chronic dimensions; symptom cyclicality; and future orientations - especially within the context of complex trauma and end-of-life care. Renowned Stanford artist-ethnographer S. Lochlann Jain famously wrote in their narrative of breast cancer and grief, “prognosis affects every dimension of time, not just the future, the past becomes equally mysterious and unknowable.”8 Patient understandings of time dramatically relate to the ways they self-identify, build and develop relationships, understand the severity of their condition, manage the mechanisms creating pain, and share decision making in the development of treatment strategies - ultimately impacting their quality of life. As such, it acts as a gateway for thoughtful prescriptions to foreground healing, as in experiences with Santo Daime ceremonies and their accompanying bailado.

ANA FLECHA AND THE SANTO DAIME BAILADO

Temporality acts as an agent of change in Ana Flecha’s work with Ayahuasca within the transnational Santo Daime community. Rooted in transcorporeality, the bailado’s prescribed rocking movements are performed to the church’s traditional rhythms (march, waltz, and mazurka); allowing for interconnectedness of physical boundaries, geographies, and spiritual realms that challenge Descartes’ dualistic theory of the separation between body and spirit. Descartes’ position heavily influences Western medicine to this day, however in the realm of cross-cultural healing spaces the body is believed to behave as a conduit for ecstatic experiences that blur such boundaries. Within the Santo Daime community, participants access altered states of consciousness and expression after initial consumption of the Ayahuasca beverage, enjoying social bonding through circular dancing and the singing of hymns. Flecha describes in her writings the ephemeral current of healing energies present within these community containers;3 a dramatic difference from the hegemonic trend of isolating patients for individual recovery.

As corporeal knowledge, Flecha analyzes the pedagogy and choreography of the bailado, investigating the experiences of daimistas (medicine workers) who practice the dance through participant observation, as well as personal journal entries as a daimista herself. She shared “accessing different relationships with temporality [together] can feel very healing...time changes the significance of whatever is going on [medically].” Flecha’s 20 years of participation and 6 years of formal research of 35 practitioners approach nonlinear narratives of wellness, tapping into the durational performance of each ceremony with the “vine of the spirits” which boasts an onset of 20-60 minutes and healing works sometimes lasting upwards of 12 hours. Ursula Heise explains in her relevant text Chronoschisms: Time, Narrative, and Postmodernism that the radical transformation of society’s perceptions of time has and will continue to lead to the emergence of new cultures of time in Western societies. As with the recent COVID-19 timeline, temporal horizons were drastically elongated or foreshortened for people experiencing quarantine and extended hospital stays - affecting narrative identities by “breaking up plot into a spectrum of contradictory story lines. The coexistence of these competing experiences of time allows new conceptions of history and post-history to emerge, and opens up comparison with recent scientific approaches to temporality” 6 she continues. Central to this work is a field-wide acknowledgement of competing portrayals from biomedical and traditional medicine communities. Despite its associations with deviance among Western medical practitioners due to classification as a Schedule 1 substance illegal under federal law, Ayahuasca is less regulated in Brazil where the practice of brewing decoctions from its plant-matter not only harnesses the positive impacts of its notable chemical components (serotonin-influencing dimethyltryptamine, harmine and harmaline) but is also accompanied by the transformative potential of a choreographed healing; inviting participants into embodied understanding through meditation, energy work, spiritual mediumship, rhythmic bailado, and repetitive call/response hymns. As practitioners entrench themselves in dialogue with their individual bodies, social bodies, and the natural world they are empowered to address symptoms of PTSD, addiction, trauma, and end of life anxiety among other afflictions. Flecha shared “there’s something about going through the work for that long and ending as the sun comes up that is a healing rite of passage...” A vast number of peer-reviewed studies on the medicine has focused solely on the biochemistry of the tea. However, with the approach integrating elements of dance, music, and ecstatic expression through mediated miração (roughly translated as “visions”) there is invaluable transformation in the integration of physical healing, emotional processing, and mind-body mastery. Trauma-informed Ayahuasca healing facilities can now be found across the globe, akin to clinics specializing in other entheogenic treatments such as ketamine or psilocybin; Neither of which, however, incorporate the use of dance-movement therapy as a central part of their offerings as with the Santo Daime community.

CROSS-CULTURAL PERSPECTIVES ON HEALING

Social Medicine emphasizes the removal of barriers to care access through collaborations between communities, healthcare workers, policymakers, and stakeholders. The practices rooted within traditional cultural knowledge systems as seen with Traditional Chinese Medicine (TCM), Indigenous healing, Ayurveda, Unani and more provide a road map contextualizing the ways ecological identities, spirituality, community ceremony, and plant-based healing has - and continues to- shape global wellness perspectives. Cultural exchange, adaptation, and innovation has driven these overlapping communities from 1930 to present day. The Santo Daime bailado’s blend of Indigenous, African, and Popular Brazilian movement vocabularies crafts a chain of connectivity between those dancing the medicine in a circle, honoring lineages of health justice and resilience as also seen within agrarian jíbaro dances such as Bomba, Bámbula, and Séis Corrido. Similar to these dance traditions across the Caribbean, choreography functions as cartography, mapping routes of resilience in the face of displacement, crumbling economic infrastructures, food insecurity, varying literacies, and epigenetic inheritances. Asked about her reflections on the practice as a transpersonal site of health within the Santo Daime community, Flecha remarked:

“There is no separation between therapy and religion, it’s all lifestyle. It is

important to recognize the limitations surrounding not seeing the cultural and

historical contexts around how the medicine is coming to us...It’s not just a drug

that you take for healing, but a being you step into a reciprocal relationship with.

[The] models of working with psychoactive medicines and how integrated they

are into lifestyles which brings us back to dance. It’s not just the dance, it’s a

whole knowledge system and way of relating to each other. It’s a big part of their

lives. It’s extractive to look at the medicines without considering the cultural

contexts they come from.”

Not an uncommon sentiment in the global South, Indigenous communities have derived and defined knowledge from the land since time immemorial. The caboclo knowledge of the forest informing the Santo Daime healing work, hymns, and bailado is but one example within a pantheon including the Qollahuayas of Bolivia who understand the body in terms of the health and structure of the mountain they reside on;9 and the Zinacanteco whos agro-rituals and expansive pharmacopeia of natural medicines facilitate recoveries for susto (“soul loss”) and other physical ailments.10 In these sectors healing is an intergenerational, interdependent, and liberatory praxis. Such practices are often responses to inaccessible Western curative care, relying instead on ancestral lineages heralding preventative lifestyle medicine.

BEYOND AYAHUASCA: REDEFINING HEALING THROUGH ECO-EMBODIMENT

Nodding to systems theorist Fritjof Capra and his Systems View of Life,10 the Santo Daime tradition moves beyond the simple administering of a drug via liquid, capsules, miel, or gel by daimistas in spiritual-clinical contexts; Instead employing a unifying framework that reflects principles from ecology, complexity science, and Eastern philosophies noting interdependencies inherent in all living things. While there is the potential for Ayahuasca’s exploitation within medical capitalism, the possibilities of Santo Daime healing exist beyond the plant decoction itself. The bailado’s importance as a non-pharmaceutical intervention has the potential to prompt responsible approaches to consumption and cultural stewardship. Instead, using the tea as a metaphor, with its significant fructose value11 poetically mimics the performance of photosynthesis allowing plants to distend time by converting light into chemical energy with sugars. This biological dance to circadian rhythm scaffolds metabolic works through the dark when photosynthesis is an impossibility. Could it be that the same function providing Nature with the ability to adapt to unforeseen change is also what gives Santo Daime practitioners the fortitude to navigate life’s thorns? This intricate mechanism of regulation for survival might make for a beautiful coupling, if so. At the very least, such a narrative may have proved hopeful at the height of COVID-19. The integration of a prescribed bailado might align well with more familiar complementary and alternative medicines (CAM) such as Yoga, acupuncture, Tai Chi or biofield modalities. Modern integrative clinics may consider the employment of culture bearers who can effectively incorporate culturally specific approaches to this method of somatic ecology into therapeutic programming. Flecha posits that “dance and critical studies of dance can be a force to break through dualistic thinking and boundaries around what’s legitimate knowledge and behavior. The practice is very much an integrative social work.”