The Power of Social Attribution: Perspectives on the Healing Efficacy of Ayahuasca

Gearin frames ayahuasca use as occurring in three overlapping social spheres: traditional Indigenous and Mestizo communities, neo-shamanic and recreational contexts largely outside the Amazon, and Western clinical/therapeutic settings. The paper situates recent popular and scientific interest in ayahuasca within a history of shifting meanings, arguing that contemporary accounts often import and reconfigure Indigenous ideas about the substance in ways that reflect colonial power relations and cultural appropriation. The author highlights a tension between two dominant explanatory models: an Indigenous animist logic that locates efficacy in relations with non-human beings mediated by specialists, and a Western naturalist-medical logic that treats the brew’s neuropharmacology as the principal mechanism of therapeutic effect. The perspective sets out to compare these three modes of use and to analyse how "social attributions"—the discourses and beliefs ascribed to ayahuasca—shape perceptions of its healing efficacy. Gearin aims to show that differing ontologies underlie Indigenous, neo-shamanic, and clinical practices, that contemporary therapeutic and recreational uses draw heavily on constructed images of Indigeneity and ritual, and that these processes often go unexamined in scientific research and popular accounts. The paper therefore seeks both to map these differences and to urge that medical research explicitly account for contextual and attributional factors.

Gearin presents ethnographic material from fieldwork among Shipibo-Konibo healers to exemplify Indigenous conceptions of ayahuasca. Apprentices undergo lengthy "diets" that involve abstentions and ingestion of other plants to establish reciprocal relations with plant or spirit "owners"; these diets may precede or follow healing work and are central to acquiring songs and powers. In this model, efficacy is rooted in the healer’s accumulated powers, social relations with non-human allies, and mastery of melodic, linguistic and metaphorical techniques. Ayahuasca itself is optional and often restricted to trained specialists; patients do not generally ingest the brew. High-intensity hallucinations are deliberately avoided, doses tend to be low so the healer can maintain control, and vomiting was not observed in around 100 traditional sessions Gearin witnessed. A quoted practitioner encapsulates the social restriction: "why should I drink this, I am not a healer!" By contrast, neo-shamanic and recreational uses invert key Indigenous practices: clients commonly ingest ayahuasca themselves, ceremonies are exported and reimagined for foreign audiences, and the brew is frequently sacralised as "mother," "teacher," or "master." Diets are variously omitted, temporally displaced, or mixed with ayahuasca ingestion; ritual elements are exoticised and "white-washed" to present a uniformly positive, non-sorcerous practice. Gearin reports that many non-Indigenous practitioners and apprentices lack the social stability traditionally required of healers, and that ceremony-goers tend to be seekers or people with psychological, spiritual, ecological, or socio-economic discontent. Intense physical reactions—vomiting, harrowing visions—are often interpreted in these contexts as necessary catharsis and markers of healing, shifting attribution of efficacy toward the substance and associated ritual aesthetics. Turning to Western therapeutic and clinical uses, the paper acknowledges accumulating evidence that psychedelic compounds, including ayahuasca, can have beneficial effects for certain non-psychotic mental health conditions, with the strongest support reported for addiction treatments. However, Gearin emphasises methodological and interpretive limitations in much of the literature: many studies are conducted "in the wild" within retreat settings, recruit self-selected participants already committed to ayahuasca groups, or involve investigators who hold pro-ayahuasca beliefs. These factors introduce expectation and selection biases that often go unexamined. Adverse events are acknowledged: acute intoxication crises reported to poison control centres, a small number of fatalities, documented psychotic episodes in some cases, and possible exacerbation of personality disorders such as narcissism. The therapeutic model in clinical practice typically has the patient ingest the brew while the therapist remains sober, reversing the Indigenous specialist-patient dynamic. Gearin argues that few clinical studies adequately account for the power of social attributions—beliefs about the brew’s spirituality, authenticity, or naturalness—which can shape experiences and outcomes. In an Outlook that serves as the paper’s concluding discussion, Gearin interprets these observations through an ontological lens: the three modes of ayahuasca use presuppose different worldviews (animist, neo-indigenous/colonial, naturalist) and thus produce distinct forms of efficacy. The author stresses that beliefs and rituals create feedback loops in which social expectations shape experience, which then reinforces cultural narratives about ayahuasca’s powers. Gearin calls for clearer separation between Indigenous concepts and scientific research designs, critiques the field’s frequent unacknowledged ideological commitments, and urges recognition of the colonial dimensions of ayahuasca appropriation. Practical implications discussed include the need for anti-colonial strategies for fair use and benefit-sharing, and sensitivity to the fact that many ayahuasca-origin regions have been disproportionately harmed by crises such as COVID-19. Gearin notes the difficulty of disentangling pharmacology from context given researchers’ and participants’ investments in particular discourses, and recommends that future medical studies explicitly consider contextual, ritual and belief-related factors when evaluating therapeutic efficacy.