Freud probably never participated in a sweat lodge ceremony, or he would have had quite a bit to say about it. There was something distinctly oedipal about the medicine woman’s description of the ceremony: “The sweat lodge,” she said, “is like the womb of Mother Earth.”

Unlike the more conventional conferences I’d attended in the past, this one—for integrative medicine—was open not just to physicians, but to practitioners of all persuasion, some more esoteric than others. From Ayurveda to QiGong, to Reiki to energy healing—nothing, it seemed, was off limits. As a diversion to the conference, the organizers had arranged for a sweat lodge ceremony to be conducted at the Indian Health Center of Albuquerque. My knowl-edge of Native American culture was minimal, and I’d never read a description of a sweat lodge ceremony. I naively envisioned a relaxed evening, kicking back with a cold beer, chit-chatting, talking with interesting people from all over the country, sharing ideas and thoughts about health and medicine. A perfect antidote, I imagined, to my otherwise mundane life back in the Midwest.

My colleague Amy told me she’d been to a “sweat” years ago. “A spiritual experience,” she said. I was intrigued and asked her to tell me more about the ceremony. “Well, the brochure is pretty accurate, except, I think, the actual experience is more intense.”

I looked at the brochure closely for the first time: Native Americans hold frequent ceremonies for purification, spiritual renewal, healing, and education. These ceremonies take place in structures called sweat lodges. Rocks are heated. The people who enter into the sweat lodge spend time praying together. . . . Steam from water poured on the hot rocks causes them to sweat. . . . The mind, emotions, and spirit of the participant are purified through this ancient ritual of prayer. Sessions for men and women are held separately.

Only 5 other men had signed up, which was surprising, given that this was a conference where the attendees were more likely to be open to such relatively arcane practices. We were greeted at the door by a lady who introduced herself as Martha.

“She’s the medicine woman,” Trevor, an internist from Arizona, who’d apparently been to a sweat lodge ceremony before, informed me. She was in her mid-50s and looked like a kindly aunt. I found myself momentarily surprised to hear her speak just like any other American.

Somehow, the words “medicine woman” had conjured up a stereotypical image in my mind, a result of watching too many old Westerns. I was almost as bad as anyone who had ever said to me in wonderment, “You are from India, but your English is so good, and you don’t wear a turban!”

She explained the protocol of the ceremony. “First you make an offering to the fire, say a small prayer, and then we go into the lodge. You enter clockwise, we pray clockwise, every-thing is done in a clockwise manner. After we go inside, the firekeepers will bring in the Grandfathers.”


“The hot rocks. They are called Grandfathers,” she explained.

We followed Martha outside, as she led us to the lodge located on the far side of the health center. I was expecting a log cabin, such is my ignorance, but the “lodge” turned out to be a tent of sorts fashioned out of tarpaulin and blankets and supported, I later learned, by a frame made of willow.

Two young men, silent and strong, greeted us with a nod.

“They are the firekeepers,” Martha informed us, as she gave us each a pinch of tobacco from a pouch. “You offer this to the sacred fire, and we usually say a prayer with the offering,”

she said.

I hadn’t prayed in a long time, and I waited for everyone else to go first. Finally, I said a silent “thank you” to an amorphous higher power and threw the tobacco into the fire. Red sparks arose from the flames, and the smell of tobacco filled the air. This was the first, and probably the only, time that I would associate the smell of cigarettes with a spiritual experience. Even this most noxious and reviled plant, I realized, has a cultural significance that is lost with its use outside a ceremonial context.

We were then instructed to say, “All my relations,” a loose translation of a Pueblo prayer, and then go into the lodge. Martha was the first to enter. I waited and watched as everyone went inside, forced by the construction of the lodge to almost crawl. I understood that this was meant to be a humbling experience. Stripped down to our boxers, and now compelled to crawl into the tent, it was as if we were forsaking our roles as physicians, or nurses, or therapists. Inside that tent, as Martha said, we were all the same. I took a deep breath, said the prayer, “To all my relations,” and crawled in, not knowing what to expect.

My eyes slowly adjusted to the dark. I could see the silhouettes of the others, seated in a semicircle. Martha sat on one side of the opening to the tent, and I sat down on the other. The earth felt cold in comparison to the stifling warmth. A small pit had been dug in the center of the tent, and I was aware, as we sat there, that there was no space to sit up or even move about very much. As a child, I had traveled in crowded buses in Bangalore, in packed trains in Bombay, and yet I was uncomfortable with this much physical proximity. I wondered how the other participants, unused as they probably were to such situations, felt.

“Bring the Grandfathers in,” Martha shouted out, through the flap.

“Careful. Watch out.” Through the small opening, the firekeeper maneuvered a pitchfork with 3 large smoldering rocks into the pit. Martha placed what looked like herbs onto the rocks, and a sweetish-acrid smell filled the air.

I had read vaguely about mind-altering substances used in such rituals, and I asked, somewhat nervously, “What’s that?”

“Cedar and sage,” she replied.

I was beginning to feel apprehensive and wished that I had read more about the ceremony before participating. This was a far cry from what I expected. Where was the relaxing evening, the well-lit sauna, the cold beverage, the casual conversation?

As if sensing my discomfort, Martha asked, “Before we begin, is anyone claustrophobic?”

I have never thought of myself as claustrophobic, but now I began to wonder. “No,” I replied. Apparently nobody else felt the need to answer.

“Bring the water in,” Martha said, and a pail of water was passed to her. In the shadows, her heavy lidded eyes looked at all of us in turn. “You are healers. I honor you and respect you,” she said. “Remember, inside this tent, we are all family.” And with that, she poured water onto the rocks. Steam rose up in a hot cloud. The smell of sage and cedar and the heat filled my lungs. I swallowed, tried not to panic. And then, Martha said to the firekeeper standing outside, “Close the flap.”

I have read descriptions of hell and of torture chambers, but this was far worse. I was inside a dark, hot, smoky, sealed container. The air was hot, hotter than any sauna that I had been in, and it was so black and dark that when I looked around me and didn’t see a thing—not even the absence of a thing—the space inside seemed to expand from a few feet to an infinite and unfathomable distance.

Martha picked up a drum and began to beat it loudly. Then, she began to sing in an ululating, haunting fashion.

I had heard my patients’ descriptions of panic attacks, of unbearable anxiety, and I understood what they were talking about in an academic fashion, but for the first time, I felt the beginnings of the all-encompassing terror that they must feel. Someone began to sing as well, and then, inexplicably, screamed unintelligibly, then fell silent. Thoughts raced through my head—What if I can’t take this? What if something happens? What if I lose my mind? What if I pass out? But you’re strong. This is only a tent. You can sit it out. Just close your eyes and surrender to the moment.

But the panic worsened. My thoughts and my senses were obliterated in the heat, the noise, the smoke, the darkness. My heart pounded. I tried to breathe evenly, but the heat made me gasp. I wanted to get out. But I didn’t want to appear weak. I was hoping someone else would bolt, that I would not be the first person to leave. I closed my eyes, struggling to stay calm. I do not know how long I sat in that manner, trying to keep a lid on my anxiety, but I finally told myself that I did not have to do this.

“This is not for me,” I said, when the drumming and the singing abated. “I would like to leave,” I said in what I hoped was a level voice.

Martha immediately responded. She opened the flap, I don’t remember how, and shouted to the firekeepers, “He is coming out.”

I crawled outside, feeling relief and shame and exhaustion and, strangely enough, a mild euphoria. Later, after I had recovered a bit, I waited by the fire, loathe to go back to the waiting room or to take a cab back to the hotel. I could hear drumming and chanting now and then, and I wondered how everyone else was faring inside the tent.

The entire process seemed to be designed to penetrate defense mechanisms, perhaps even to break ego boundaries within a culturally sanctioned, controlled environment. This was as brief, and as dynamic, as therapy could get.

I watched as the firekeepers, the 2 young Pueblo men—Alex and Steve—tended to the hot rocks in a large stone fireplacelike structure.

“It’s good to know your limits,” one of them told me, when I confessed to feeling a bit silly for leaving so early. For all his youth—he must have been in his late 20s—he had the manner of a wise therapist. “There is no right or wrong. You stay as long as you want; you come out when you are ready. Now was not the right time for you. On some other day, you might have stayed there for the entire ceremony. Sometimes, you are there for only a minute. Whatever works for you is fine.”

“Whatever works for you is fine.” A cliché, but in the cool night air, after the terror inside the tent, the platitude seemed like a profound realization, an insight into the conduct of my life.

I felt strangely cleansed and relaxed, as I watched the rich amber of the rocks glowing in the fire. The sky was clear. The air smelt faintly of sage and tobacco. In the distance, the Sandia Mountains looked like a sweat lodge for the Gods themselves. I could still hear the drum beats and the chanting and the singing.

Therapy, I realized, comes in all forms.

November 24, 2018 | 10:27 am | By Dr Shyam Bhat
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