Imagine an experienced healer  somewhere in the Peruvian Amazon beginning a month-long dieta on your behalf. You have never met this person, and yet, as they follow this strict protocol of abstinence and isolation, they begin to feel things that aren’t theirs: grief, rage, shame, or even a pain that they have never felt before. Another skilled maestro moves between you and the other healer in the astral realm, tracing the contours of what needs to be healed. Under the maestro’s instruction, with only your name, birthdate, and a photograph to serve as a guide, healing work is performed through a healer you’ve never met before as a kind of living conduit.

This is what the Shipibo call sustituto or surrogate healing, sitting at the far edge of what most people in the Global North imagine what psychedelic healing can look like. In the Shipibo tradition, healing is carried out by the Onaya, or master healers, who work through the ikaros they sing. Received over years of intensive dieta and training, the ikaros are sacred medicine chants channeled directly from the plant spirits, and it is through these chants, more than the ayahuasca brew itself, that healing takes place.

Matthew Watherston, the founder of the Temple of the Way of Light, a traditional plant medicine and ayahuasca healing center near Iquitos, Peru, and longtime apprentice of Shipibo curanderismo, describes surrogate healing as typically involving three people: the participant receiving healing from a distance and two healers, one of which acts as a “surrogate” for the participant.

The participant receiving healing does not need to be physically present, nor do they drink the brew themselves. Instead, the surrogate follows a strict dieta lasting from anywhere between four to six weeks, abstaining from alcohol, sexual activity, most foods, social interaction, conflict or negative thinking, and much more. It’s through this process that a healer assumes an energetic imprint of the participant. 

“A process is begun whereby the maestro examines the participant in the astral or energetic realm, recruiting allied spirits that agree to support the healing of the participant through the surrogate,” says Watherston. “The surrogate takes on physical, emotional, psychological, and energetic experience on behalf of the participant. For example, they might experience a pain, negative emotion or mental challenge that correlates with that of the participant.”

Maestro José López Sánchez, a Shipibo curandero who runs his own dieta healing center, Shipibo Rao, and occasionally works at Temple of the Way of Light, explains that in the past many people were afraid to approach healers directly, with their relatives often coming in on their behalf to plea for healing. “A mother or a wife would come to a healer. ‘My husband doesn't believe in this, but I see him so sick, so lost,’ she would say. Or, ‘My son is suffering, but he won't accept it.’” 

“The maestro would do the work from a distance, only asking for the name of the person, when they were born, and how they were doing,” he says. “In the world of ayahuasca, [the maestro] would call on their spirit and see [the other person’s] energy — what the problem is, where it sits, why they are suffering. In ]the maestro’s ceremonies], he would begin singing to them. After a while, once [the person in need of healing was] calmer, they would come to ceremonies themselves, with a lot of trust. And when a person feels that trust, believing the plants can heal them, it is easier to work on them.”

Surrogate dietas are an ancient practice that has been largely lost in the modern Shipibo healing tradition. Genuine distance work of this kind requires high-level healers, who are increasingly hard to find, and there are growing numbers of offerings made by practitioners without the training to carry it out successfully.

Watherston hypothesizes that it may have developed in part as a way to treat family members separated by large stretches of forest. “Imagine a person who is unwell and stuck four days upriver,” he says. Maestro José saw renewed relevance for the practice during the pandemic, when people were not able to travel.

Assuming the energetic imprint of the participant, the surrogate helps them identify and clear bultos, a term that roughly translates to “packages” or “burdens,” referring to deep blockages and misalignments carried down through one’s ancestral lineage. In the Shipibo tradition, there is this concept of “cleaning” ancestral lines to heal familial trauma which gets passed on through generations and compounded over time, creating energetic blocks and illness in the mind, body, and spirit.

“Let’s say that your great grandfather was in the war and killed people in active combat, going on to experience a sense of deep shame and guilt,” Watherston said. “Those feelings can get passed on, and manifest in your own difficulties in your life.” 

Simon Ruffell, psychiatrist, student of curanderismo, and co-founder of Onaya Science, a non-profit using biomedical research to bring greater recognition to Amazonian healing traditions in collaboration with traditional healers, shared his firsthand experience doing this work. 

“I come from a military background on both sides of my family, so there is naturally a lot of trauma related to war,” he says. “Eventually, it started to come through in my ceremonies. I could quite literally feel the grief and heartbreak of my grandmother losing her fiancé in the second World War. To process that was such a release.”

Initially, Ruffell began to do this work drinking ayahuasca himself in the company of a traditional healer. Eventually, however, he had to return home. Having worked through only one side of his family lineage, the curandero he had been working with offered to continue the work remotely on his behalf. But instead of healing someone who is alive, the curandero worked to heal Ruffell’s deceased grandmother.

“[The healer] was remotely healing my deceased ancestors so that the trauma would stop flowing down that line and into me,” said Ruffell. “As he was working on it independently, I would receive dreams about it.”

During surrogate dietas, participants might experience vivid dreams and other internal processes, though these can be very subtle. As the diet moves toward completion, they typically begin to slowly feel better and more at peace on an energetic, mental, and emotional level. 

Ruffell’s case differs from the sustituto healing because there was no third-party surrogate processing his experiences. Rather, the curandero worked directly and remotely on Ruffell’s behalf, tending to his ancestral line without an intermediary body to carry the work. Even so, both cases share a defining feature involving healing that unfolds over a distance, outside the physical presence of the person being healed. 

Surrogate diets are generally recommended for those who cannot do the work themselves, whether because they are unable to travel to the jungle, are carrying high amounts of trauma, or are in a difficult mental, emotional, or physical state. 

For example, a surrogate diet might be a good option for people with substance addictions who are unable to adhere to a dieta, preventing them from drinking ayahuasca. Additionally, individuals with severe levels of trauma such as war vets or survivors of sexual assault might be advised to work with a surrogate or attend ceremonies without drinking the brew themselves in order to clear some of the more heavy or dense energies. “Mostly it is for people who are too loaded, who are not ready for ayahuasca or to go straight into a diet,” says López Sánchez.

Once a surrogate diet — typically lasting four to six weeks — is completed, the participant receiving healing at a distance is often invited to sit in an ayahuasca ceremony themselves. “The surrogate diet prepares them, discharging everything that needs cleaning. Semi-clean, they enter an ayahuasca ceremony, then eventually they enter into a diet themselves.”

This groundwork of cleaning and discharging negative, heavy energies supports curanderos in their healing work, making it easier to help participants move toward long-term change. “A doctor cannot operate on you if you are inflamed,” says López Sánchez. “You come with your liver, your gallbladder, your kidneys all inflamed, no matter how experienced or scientific the doctor is, he cannot operate. He has to bring the inflammation down first, and that takes time.”

In certain ayahuasca lineages including the Shipibo, healers traditionally drank ayahuasca on behalf of their patients, both as a diagnostic tool and to mediate the patient’s psychospiritual world. “In the old days, ayahuasca was highly respected, and the maestro was careful in determining who would be able to drink it,” says López Sánchez.

DoubleBlind spoke with an anonymous source who underwent an extensive surrogate dieta and later sat in an ayahuasca ceremony. “In one of my visions, I saw a little boy who was crying with his chin wobbling, experiencing the deepest sense of shame and wrongdoing, and then something opened up where there was a recognition.”

They understood the little boy to be an ancestor in their lineage who had been sexually abused, how far back they were uncertain. “[I felt] in myself what I knew to be the psychological and emotional experience of deep abuse, although I had never had that experience myself,” they said. “All I knew, deep down, was that little boy was abused generations ago, and that experience of abuse produced a challenging relationship towards sexuality in myself that I also saw existing in my father, and probably my grandfather before him, and so forth.”

Following that experience, their life slowly began to change. Their difficult relationship with sexuality began to ease, and their bond with their father improved.

The concept of ancestral trauma, or the idea that the psychological and physical wounds of earlier generations can be passed down and felt by descendants, has begun to find support in Western science, with some data showing that a parent’s trauma can leave epigenetic traces in their children. Epigenetics, put simply, refers to changes in gene expression that don’t alter the underlying DNA sequence itself: how genes are switched on or off, rather than what the genes are. For example, studies of the adult children of Holocaust survivors found they presented low cortisol levels, mirroring those of their parents.

The field of epigenetics needs more research. But a 2021 study co-authored by Ruffell and colleagues from Imperial College London, found preliminary evidence of epigenetic changes in a stress-sensitive gene linked to trauma processing and memory in participants attending ayahuasca retreats in the Peruvian Amazon. The most significant shifts occurred in participants who had experienced greater childhood trauma.

Even with these parallels, such experiences are almost ineffable, let alone difficult to  measure in that they constitute inner, subjective spiritual experiences. “We don't have the measurements or the technology to even begin to understand what a true Onaya is doing, but fundamentally it's about energy,” says Watherston. “In the Shipibo tradition, the patient didn’t drink the brew in the past, instead being healed through the ikaros of the Onaya. Westerners can't get their head around the notion that a song can heal. It's all vibration, energy, consciousness.”

“When trying to grasp Indigenous concepts in psychedelic science, we tend to try to explain things through refined commonalities. And there are some commonalities — when Indigenous medicine talks about negative energy or bad spirits, you could very loosely map that onto, for example, depression,” says Ruffell. “Or healing ancestral lines onto epigenetic change. Even so, it’s still extremely reductionist and risks reducing the experience to biological mechanisms, stripping away the cultural, spiritual, and relational dimensions that give it much of its meaning.”

“When you take what Indigenous peoples are saying seriously…the reality is that Indigenous people aren't just describing the same thing in a different way,” he continued. “What they're actually saying is that there are spirits and entities that exist outside of our physical understanding of the world, and that traditional healers — shamans — are the middlemen between those worlds. They have relationships with those spirits, and they call on them to heal on their behalf.”

Foundational to Western thought is the separation of humans from the land, and nature from culture, a legacy of the Cartesian view that mind and matter are fundamentally distinct. This same logic tends to separate us from one another, and estrange us from time itself, treating past, present, and future as a straight line. Healing, within this framework, becomes an individual project, confined to a single body, mind, and lifetime.

Most Indigenous cultures hold an entirely different orientation, however. For example, the Lakota, a Native American nation, have a saying: “Mitakuye Oyasin.” It loosely translates to “we are all related,” a reminder that humans are not separate from the web of life but embedded within it, alongside plants, animals, and nonmaterial beings. Time, in many traditions, is not linear but cyclical. The ancestors are not gone, nor are future generations absent, instead they are right here. From this perspective of interconnection, it then makes sense that healing benefits might not be confined to a specific body, or a singular timeline.

“We’re in this mutuality with everything and it's not a concept or a philosophy, rather it's a lived experience,” says Watherston. “It starts with our individual healing, but the irony is that it's not actually about our individual healing, as our individual trauma most often is a reconstitution of unresolved trauma of our ancestors.”

Glauber Loures de Assis, sociologist and co-founder of the Psychedelic Parenthood Community, reflects on the limitations of Western science in understanding these types of phenomena.

“Western academic science is extraordinary at reproducibility, falsifiability, and the patient work of mapping biological and neurological mechanisms — work that produces medicines, treatments, and regulatory pathways,” he says. “But it runs into clear limits when the questions shift. When we speak of collective healing, of meaning, of belonging, of what is possible for a human life, Indigenous cosmologies already hold extraordinary, time-tested knowledge. Knowledge accumulated across generations, not across grant cycles.”

He argues that we need to dismantle the hierarchy between these knowledge systems, calling for what he refers to as a “confluence” or “cosmic diplomacy,” a dialogue between knowledge systems that respects epistemological difference, taking other cosmologies seriously on their own terms.

“There are ceremonies, across different traditions, in which the person who is to be healed does not participate at all,” says Loures de Assis. “Others drink the medicine on their behalf. I have lived through many striking experiences of this kind, across families, across generations, and through healers carrying the work for someone who was not physically present.”

What is certain is that these experiences often resist description, with our current research methods and psychotherapeutic containers not equipped to fully grasp their numinous quality. Even so, many of those in proximity with Indigenous ontologies and ceremonial spaces, recognize them to be commonplace occurrences, gently eroding our understanding about where we end and others begin.

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