On epistemic injustices,biomedical research with Indigenous people,and the legal regulation of ayahuasca in Brazil: The production of new injustices?

“Overcoming Epistemic Injustices” by Schenberg and Gerber (2022) is a valuable effort to deepen a much-needed discussion in the field of biomedical research on ayahuasca, and bravely focuses on the important issue of epistemic injustices fostered by biomedical research on psychedelics in relation to Indigenous people. The article presents relevant concerns and raises important questions regarding both the nature of biomedical research and the debate on the legal regulation of ayahuasca. Epistemic injustices exist, and they need to be critically analyzed. However, further questions remain about the ways to bridge these gaps.

As a team of activist anthropologists, psychologists, biologists, and other interested parties involved in research and policy-making, we feel compelled to ask for clarifications on the kinds of methodologies and research designs proposed by the authors to address questions of epistemic injustice. First, how does a research protocol with the proposed technologies and methodology differ from previous ones, except for the fact that it takes scientific research (with its technological apparatus) to the forest? And second, is it in the best interests of Indigenous peoples to establish this partnership with neuroscientists? If so, why?

The article, in our view, fails to confront an important issue: the intrinsic connection between the production of knowledge and the power relations attached to it. Thus, despite the undeniable emphasis given by the authors on the traditional values and knowledge of Indigenous peoples, the authors’ proposal emphasizes the need for a set of experts to define and delimit the technical procedures that culminate in the new research protocols. It seems clear to us that, in the authors’ proposal, the legitimacy and authority for the definition of protocols continue to be in the hands of scientists, despite an openness toward the therapeutic practices of Indigenous peoples. In other words, to prove the therapeutic properties of ayahuasca, Schenberg and Gerber are not willing give up biomedical dispositives (Foucault, 1984) in the final production of knowledge. These include scientific procedures and protocols concerning blood samples, EEG analysis, and the recording of vital signs, including the technologies and instruments developed for such purposes.

In a sensitive debate such as this one, a clear statement of Schenberg and Gerber’s views on the place and legitimacy of Indigenous modes of knowledge production in relation to Western science would be helpful. In a similar vein, we would have welcomed a note on the authors’ positionality, along with self-reflective insights on their own involvement with Indigenous populations. For example, how does the lead author’s position as a neuroscientist (who has coordinated biomedical research with the use of psychoactive substances) inform this epistemological tension? Given Schenberg’s current involvement with the Huni Kuin of Acre, and his project to collect EEG data in what Leite (2022) has described as “controversial research,” what will a respectful engagement with and honoring of Indigenous knowledge look like in practice?

As it stands, reading Schenberg and Gerber’s article, one is left with the sense that epistemological questions continue to be asked from a strictly scientific viewpoint. The article thus falls into the very traps it aims to critique by not including Indigenous agents as part of the research team or as protagonists of the research, and by proposing alternative methods for the scientific study of ayahuasca while reaffirming biomedical science as the ultimate criterion for validating knowledge on the therapeutic potential of ayahuasca. The lack of consultation with or inclusion of the central interlocutors of the research makes it impossible to evaluate the proposal for an interethnic and intercultural protocol for research.

The text also presents some problematic comparisons that need to be better analyzed. The authors argue that therapeutic use of ayahuasca is an ancient traditional practice and claim that its therapeutic use remains an important feature in the globalization of ayahuasca. As a result, they hastily conclude that there is an epistemological bias in not regulating the therapeutic use of ayahuasca, since it can be considered an immemorial practice that is still present to this day.

Ironically, the article implicitly transforms and considers as equivalent practices the Indigenous uses of ayahuasca for health and other purposes and contemporary therapeutic use by biomedicine and psychiatry. In this sense, they create an artificial link between immemorial and ancestral uses of ayahuasca and the contemporary practice of biomedical research with psychoactive substances. After equating two distinct issues, they try to prove that, in Brazil, there was allegedly an “epistemic injustice” because, in urban settings, the religious uses of ayahuasca are permitted, but not the therapeutic ones; in sum, the non-regulation of the therapeutic use of ayahuasca in Brazil would be the result of this “epistemic injustice.” This idea will likely appeal to a Western audience of ayahuasca enthusiasts: Indigenous people have been using ayahuasca therapeutically since the beginning of time; therefore, we should be able to use ayahuasca in this way, and we should critique neuroscience’s arrogance to demand that we scientifically prove the legitimacy of the therapeutic use of the beverage. From an indigenous standpoint, however, the stakes are more complex. Paradoxically, the findings of current biomedical research that have the goal of “proving” the therapeutic potentials of ayahuasca reinforce biomedicine’s place as the scientific authority with the power to validate the practices and knowledge of traditional peoples.

This discourse once again utilizes scientific assumptions and practices to legitimize traditional knowledge, failing to recognize that the latter has a validity on its own terms. Do Indigenous people need white scientists with their EEG machinery in the forest to prove the therapeutic efficacy or dynamics of their ayahuasca practices? As pointed out by Smith et al. (in press), “epistemic justice” would imply recognizing that the biomedical research logic has as much value as the knowledge systems and practices of Indigenous peoples and traditional communities. Thus, an interethnic research proposal would entail not only initiating a dialogue with Indigenous peoples but also establishing an epistemological counterpoint between two distinct truth regimes and epistemologies. This approach requires taking seriously the notions, categories, and knowledges of the agents involved in the research; such as, for example, the perspective of the plants themselves, the postulate that plants are beings who have their own consciousness and agency, that the natural world is also cultural, and that it has subjectivity and intentionality (Albuquerque, 2009; Dev, 2018; Fotiou, 2021; Smith & Fausto, 2016).

This stance not only challenges the assumptions of scientific epistemology, but it also puts in check the anthropocentric values that guide biomedical research. Privileging Indigenous epistemologies would imply, therefore, “disrupting hegemonic knowledges” (Dev, 2018), and considering distinct notions of body, disease, and healing (Fotiou, 2021; Meneses, 2018) that question the very authority and validation criteria of neurosciences. In the author’s argument, biomedicine paradoxically becomes the ultimate criterion to give responses to the critique of biomedicine. Thus, the text does not solve the problem that it proposes to address and ends up deepening the epistemological gap by advocating new ways to validate scientific and traditional knowledge through a different set of biomedical criteria. Ultimately, the article fails to consider a possible irreconcilability between Indigenous and biomedical epistemologies; if the contrary hypothesis were to be defended, would it be up to biomedicine or neurosciences to bridge that gap? With what instruments?

It seems to us that, despite the appealing proposal of interethnic research, the authors are unwilling to cross disciplinary boundaries and to suspend their own assumptions in the name of traditional concepts and practices. There is a lack of a deeper engagement with anthropological literature on the subject or with Indigenous intellectuals and leaders. The authors tackle issues already developed by the academic literature, such as the argument that it is difficult to create placebos for psychedelics, that the brew is not the same as freeze-dried ayahuasca, that context matters, that the rituals and the setting make a difference, and that animal research does not take into account that humans vomit ayahuasca, among other issues (Gomes, 2016; Hendy, 2018; Labate, 2011b; Labate & Bouso, 2013; Labate et al., 2008).

The article also treats different schools of biomedical research quite uniformly and fails to mention that biomedical research in Brazil has been implemented in dialogue with the ayahuasca drinkers and groups. Neuroscientists and other researchers who had first-hand access to and participated in ayahuasca rituals in Brazil used different approaches from those practiced in Europe (Anderson, 2011, 2012). Thus, the article does not emphasize that, from a global point of view, there is a particular distinction attributed to Brazilian scientific research: the fact that a dialogue was established between researchers and participants in the ayahuasca religions, who are also legitimate research subjects, regardless of the fact that they are not part of Indigenous ayahuasca traditions. Hence, despite the provocative tone associated with its main hypothesis, the authors neither present a comparative analysis of the biomedical field, nor an alternative for an organic engagement between researchers and Indigenous populations.

Finally, it is worth noting that the article also presents a problematic criticism regarding Brazilian public policies on drugs by arguing that the regulation of the religious use of ayahuasca, to the detriment of therapeutic use, was an epistemic injustice. They do not consider that, in Brazil, the regulation of the use of ayahuasca for religious purposes was not the result of biomedical research, although science played a role. This move toward the current regulation originated in campaigning from ayahuasca groups with public authorities, in dialogue with researchers from various fields, such as anthropology, psychology, and psychiatry, among others. It was, therefore, a convergence of actors and specific political conjunctures that characterized a unique and innovative process (Antunes, 2019; Assis, 2017; Labate, 2011, 2014; Labate & Assis, in press; MacRae, 2010) and one that has parallels with historical processes of recognition and legitimation of a number of popular practices in the country.

Indeed, the anthropological literature has shown that the process of constitution of the Brazilian republic was marked by the combat of “witchcraft” and “curandeirismo” in the name of a new urban “public order” (Giumbelli, 1997). As Montero (2009) demonstrates, the construction of new religions in Brazil was, above all, the result of the medico-legal repression of a series of practices perceived as threats to public order, such as mediumistic trance, possession, and traditional therapeutic practices. Consequently, the production of new religions at the turn of the 19th to the 20th century was the result of a historical unfolding resulting from a broad political-scientific debate around what the Brazilian State could legitimately recognize and accept as a “religious practice.”

In this regard, the ways in which the practices regarding Umbanda, Candomblé, and Kardecist Spiritism were re-signified as “religious” are largely the result of a process of recodification, and a reaction to the growing hegemony of the biomedical discourse and the hygienist practices of the new republic. In framing the regulation of religious use of ayahuasca as an “epistemic injustice” (as opposed to therapeutic use), the authors ignore the paradox that, historically in Brazil, biomedical discourse has not only served to discredit popular therapeutic practices, but was also used as a justification for their marginalization and repression.

The article does not mention that shamanic and traditional therapeutic practices with ayahuasca are not prohibited in Brazil for Indigenous people in their own territory (transportation and circulation outside the Amazon are the problem). It also fails to explain that the use of ayahuasca for therapeutic and medicinal purposes by native peoples is not, as the article states, legally equivalent to biomedical use, nor is it equivalent to the National Council on Drug Policy’s (CONAD) definition of therapeutic use of ayahuasca, “understood as an activity or process oriented towards healing, maintenance or development of health, in consideration of ethical scientific principles” (CONAD, 2010). In sum, while these two Brazilian researchers attempt to be advocates for Indigenous people for an English-speaking audience, they lack appreciation of the three decades of anthropological public debate around regulation in Brazil, and their critique fails to understand that the therapeutic Indigenous uses of ayahuasca are not included in the official governmental classifications of what constitutes “therapeutic uses” within the scope of health and drug policy regulations.

As recognized by multiple sources in the expert literature, the regulation of the use of ayahuasca in Brazil was based on a set of initiatives and dialogues established between the 1980s and 2000s, before the entry of Indigenous people into the Brazilian urban ayahuasca circuits (Labate, 2011a; Labate & Coutinho, 2014; MacRae, 2010). In light of this, the development of public policies focused on the religious use of ayahuasca has indeed created some bureaucratic hurdles for the circulation and transportation of ayahuasca outside the Amazon by Indigenous peoples, who have had ayahuasca seized when traveling outside of the Amazon (Goulart & Labate, 2019; Labate & Assis, in press; Labate et al., in press).

This problem, however, is not due to an “epistemic injustice,” or “biomedical reductionism” by public authorities, nor to the lack of recognition of Indigenous therapeutic use, but to the specific framework applied to ayahuasca public policies around regulation from the 1980s to mid-2000s, which involved mainly the Brazilian ayahuasca religions, Santo Daime, Barquinha, and União do Vegetal, who use ayahuasca as a religious sacrament in their respective rituals. In sum, these regulatory discussions happened before the public presence of Indigenous peoples offering ayahuasca to non-Indigenous people in urban circuits and, as such, Indigenous representatives were absent from the public conversations. It is important to understand that the CONAD resolution is mainly geared towards non-Indigenous “therapeutic” uses.

Schenberg and Gerber do not acknowledge that Indigenous therapeutic use and the use of ayahuasca by non-Indigenous people in Brazil (either in the traditional religions or the neo-ayahuasquero urban modalities) are not equivalent practices, and involve different legislation, historically constituting two separate public problems that, only recently, have intersected and overlapped. There is still much to understand from a legal point of view about Indigenous peoples’ autonomy over their own practices when it involves interaction with non-Indigenous people outside their territories. What is clear in the present context, however, is that current regulations do not guarantee rights for Indigenous peoples to transport ayahuasca freely in Brazil. While we are in agreement with Schenberg and Gerber in their support of the new Indigenous political agenda calling for the right to transport and circulate with ayahuasca, we find that much remains to be done to recognize and address the particularities and controversies regarding different legislation, political agendas, and the history of regulation of the use of ayahuasca in Brazil.

To conclude, we find that, despite their commitment to “overcoming epistemic injustices,” Schenberg and Gerber not only fail to identify ways to overcome epistemic injustices, but end up committing new epistemic injustices by keeping the initiation and control of the scientific process in the hands of biomedical experts and their tools and also by excluding the Brazilian ayahuasca churches from their active role in shaping the current legislation and contributing to the biomedical science and research around ayahuasca. This regulatory framework, despite its shortcomings, has influenced legislation elsewhere and still plays an important role internationally because Brazilian scientific research, too, is having a worldwide impact. Brazil held the first clinical trial on ayahuasca and has a unique flavor, where psychedelic researchers have first-hand experience, close contact with research subjects, and are allowed a rich cultural environment, free from prohibition, in contrast to their restricted peers in the North. We hope the next decade brings direct involvement, advocacy, and agency of Indigenous representatives in the production of knowledge about ayahuasca in a way that supports their autonomy and sovereignty.