Medicine, religion and ayahuasca in Catalonia. Considering ayahuasca networks from a medical anthropology perspective

The paper is theoretical-empirical, grounded in critical medical anthropology and conducted through ethnographic fieldwork undertaken by the authors' Medical Anthropology Research Center (MARC, Universitat Rovira i Virgili). Methodologically, the work synthesises literature on ayahuasca and psychedelics, historical tracing of cultural diffusion, legal and policy analysis of international conventions and national cases, and qualitative field data consisting of participant narratives and group observations. The authors draw on case examples and vignettes from interviews and participant observation to illustrate therapeutic itineraries and the organisational forms of groups in Catalonia. The extracted text does not provide precise methodological details such as the number of interviews, sampling strategy, fieldwork dates, or analytic procedures (for example, coding or thematic analysis). Nonetheless, it is clear that the empirical basis includes ethnographic examples (several named pseudonyms are used) and institutional/legal document analysis. The authors also integrate broader secondary-source evidence on clinical and epidemiological studies of ayahuasca where relevant.

Apud and Romaní first elaborate conceptual findings: medicine is framed as a universal human activity, and the authors use the concept of medical pluralism to argue that biomedicine achieved hegemonic status through a process of medicalization, which delegitimised other care forms. Medicalisation is defined as the historical expansion of biomedical authority and state-backed surveillance that marginalises competing healing practices; medical pluralism denotes the coexistence of multiple therapeutic subsystems with differing legitimacy. Historically, the authors identify three broad moments in ayahuasca’s circulation. The first is traditional indigenous and vegetalista use across Amazonian groups. The second is the emergence of syncretic Brazilian churches (notably Santo Daime, Barquinha and União do Vegetal), which institutionalised ritual uses in impoverished rubber-producing regions. The third is the recent transnationalisation since the 1990s—New Age and therapeutic networks, international branches of Brazilian churches, and specialised treatment centres combining traditional and western approaches (examples noted include Runawasi, Takiwasi and the now-closed IDEAA). Focusing on Spain and Catalonia, the authors report heterogeneous forms of practice. They identify 17 ayahuasca groups in Catalonia spanning shamanic ceremonies, Brazilian church rituals, holistic centres linked to alternative psychologies (Gestalt, transpersonal), and sessions oriented to addiction treatment by Latin American healers or western guides. User demographics mirror broader complementary medicine trends in Spain: studies cited in the text report a predominantly female clientele (between 60% and 90% in Catalan studies). Founders and leaders vary and include academic professionals (psychologists, psychiatrists, anthropologists), spiritual seekers who re-import ritual forms, and 'wounded healers' who convert personal therapeutic experiences into offerings for others. Empirical vignettes illustrate typical therapeutic itineraries. Many participants come to ayahuasca after prolonged and unsuccessful engagement with conventional treatments. The paper gives several life-story examples (presented under pseudonyms). One user, Jaime, reports years of failed addiction treatments and describes ayahuasca as a last resort that offered an "intense, powerful introspective experience" that helped him recognise personal patterns. Another, Antonio, describes a 'biographical review'—an ability to observe his life from outside—experienced as therapeutically useful. A third, Hernan, attributes spiritual beliefs to direct experiences rather than inherited doctrine. Across narratives the authors emphasise the prominence of strong introspection, 'insights' and autobiographical review as central therapeutic effects reported by Western participants. On the legal and policy front, the authors document ambiguity and heterogeneity. Internationally, DMT (the principal active alkaloid in Psychotria viridis) is listed under the 1971 Convention, but international bodies such as the INCB do not consider ayahuasca itself to be uniformly controlled; this creates a legal grey area that allows divergent national responses. European examples reported include the Netherlands recognising sacramental use, France and Italy treating ayahuasca as a derivative of non-controlled natural products, and Germany prohibiting it on public health grounds because of DMT content. In Spain, the Santo Daime church faced seizures and litigation around 2000 but ultimately secured registration as a religious organisation; another high-profile case involved the 2008 arrest of Alberto Varela, who was later absolved. The legal instability is linked to closures of some initiatives (IDEAA among them) and a general cautious operating stance among groups. Finally, the authors summarise evidence on health effects. They note literature reporting positive effects of ayahuasca on adult mental health, adolescent populations, depression and addictions, while also acknowledging reports of adverse effects and contraindications—cardiac risks, potential pregnancy toxicity, and dangerous interactions with antidepressants and other psychoactive medications. The extracted text emphasises the need for further research to delineate benefits and risks and for strategies that maximise therapeutic potential while minimising harm.

Apud and Romaní interpret their findings to argue that ayahuasca-related networks function as informal medical systems embedded within broader medical pluralism. They contend that the intellectual separation between religion and medicine is largely a product of medicalization and biomedicine's claim to hegemony; in practice the boundary is porous, especially in mental health where ritual and therapeutic language commonly intermingle. The authors stress that participants and group founders frequently translate indigenous cosmologies into psychological and New Age idioms—a process they describe as 'cultural translation' and 'ritual redesign'—which adapts ceremony and discourse for Western therapeutic expectations. The paper positions legal and policy tensions as arising at the intersection of three contested categories: drugs, public health and religious freedom. Court decisions and human rights arguments (notably religious freedom claims) have influenced outcomes in some countries, yet recognition of ritual use often stops short of accepting therapeutic claims. The authors highlight contradictions in international drug treaties, national sovereignty in enforcement, and the uneven European landscape as factors that produce instability for ayahuasca groups. Limitations and uncertainties acknowledged in the text include the heterogeneity of ayahuasca practices, which resists neat categorisation, and the legal ambiguity surrounding plant-based preparations containing scheduled substances. The authors also recognise both positive and negative clinical reports in the literature and therefore call for balanced evaluation: they do not seek to privilege one medical system over another but argue for rigorous assessment to protect participants and consumers while respecting cultural and religious practices. In terms of implications, the authors recommend further empirical research into the therapeutic and adverse effects of ayahuasca, the development of harm-reduction and risk-management strategies within ritual settings, and a critical re-examination of drug policies that take into account medical pluralism and human rights claims. They suggest that medical anthropology can contribute by revealing the power relations, legitimation processes and social factors that shape policy and practice.

The authors conclude that ayahuasca practices in Spain and Catalonia should be understood as part of plural medical systems in which religious, spiritual and psychotherapeutic elements coexist and overlap. Their fieldwork shows diverse group types, recurring processes of cultural translation, and common therapeutic themes—most notably intense introspection and autobiographical insight. Legal and policy frameworks created by medicalization and international drug treaties produce tensions between public health concerns and religious freedom; these tensions have real consequences for groups and individuals, including legal uncertainty and closure of initiatives. The authors advocate for respectful, evidence-informed evaluations of ayahuasca practices that aim to maximise benefits and reduce harms without dismissing the cultural and spiritual dimensions of participants' experiences.