How to prevent sudden cardiac death and relieve fundamental fears: lessons learned from the Iboga initiation ceremony in Gabon

Uwe Mass and Suster Strubelt

Despite of client selection, extensive monitoring and resuscitation facilities, the risk of cardiac death after intake of Ibogaine still has to be considered. Surprisingly, most fatalities occurred following the intake of small doses or several days after ingestion.

Gabonian healers who are using Iboga in initiation ceremonies “to die and be reborn” are aware that there is a danger to life. Their tool to prevent death is the ritual framework. But what is essential within this framework?

In occidental medicine, there is no conclusive explanation at the present time for the sometimes fatal outcome of Ibogaine-intake. Comparing studies on pharmacologic effects of Ibogaine with the physiology of near-death states, we hypothesize, that these deaths may be a result of cardiac arrhythmias, caused by a dysregulation of the autonomic nervous system.

Iboga impacts the fastigial nucleus the same way ischemia does. This is a phylogentic old cerebellar part, involved in coordination of the autonomic nervous system, especially the dominance of the sympathetic system (flight and fight reaction) or the vagal system (feigned death). The special stimulation of the fastigial nucleus seems to enable an extraordinary situation of simultaneous vagal and sympathetic activity that could be responsible for the exceptional experience, but might also be dangerous:

High sympathetic stimulation or coincidence of a high parasympathetic tonus and a left-sided sympathetic stimulation increase the risk of fatal cardiac arrhythmias. This could occur under influence of small doses of Ibogaine and also at times of exhaustion, some hours after Ibogaine-intake when vagal tonus is high. In this situation sudden sympathetic reactions (like fear) could cause a critical left-sided sympathetic stimulation.

The statement of Gabonian healers, that fatalities during the initiation ceremony have spiritual causes fits with this hypothesis. They avoid strong emotional reactions by isolating their patients from normal life and by induction of a hypnotic trance-state with right-hemispheric and vagal dominance which prevents sudden fear-reactions. For this purpose, they are using sophisticated auditory, visual, body perceptional and social elements: distorted sounds, polyrhythms inducing cerebral theta- and delta-waves, musical repetitions with minimal changes, unusual patterns and objects like painted mirrors to learn to change the focus, tactile stimulation and dancing in different bodily states, social escorting, reframing and integration of the experience.

In the context of addiction treatment, the ritual concept offers more than a safe method to manage a deep trance state:

Extraordinary experiences lead to extraordinary ways of thinking. The initiation should be considered as a method to train new conscious, subconscious, and spiritual abilities, allowing to see the world with different eyes and to resolve problems in a new and better way. The initiated knows that his normal ways of thinking and feeling, his surroundings and his body perception, even his idea of being a single soul are not hard facts, but just temporary states. The relationship of equality with the spirits is relieving fundamental fears.

Audio: (To download, right click this link and select “Save File As…”) [audio:http://www.puzzlepiece.org/ibogaine/gita_conference_2012/uwe_mass.mp3]


Uwe Mass is a clinical pediatrician and neonatologist with training in systemic family therapy, as well as a Violonist in different settings (classic and folk-jazz). He has completed five years of working, fiddling and studying traditional medical concepts in the South (Bangladesh, Gabon, Zimbabwe, Mozambique, Rwanda). He has made several visits to Lambaréné, Gabon lead to the development of friendships with traditional Mitsogho healers. In 2001 his interest in their practices lead him to the decision to receive initiation into the Missoko men cult. Board member of ICEERS.

After completing her studies in sociology and psychology Süster Strubelt worked for four years as a journalist in Central America and afterwards for a radio station and at the information resource center ”Third World” in Dortmund, Germany. Training in systemic family therapy was followed by employment as a psychologist at a children’s home and different children’s hospitals. Five years of work in development cooperation and studying traditional medical concepts in the South (Gabon, Zimbabwe, Mozambique, Rwanda). Dissertation submitted for master of public health on the topic of the Iboga-healing ceremonies in Gabon. In 2003 she was initiated into the Mabandji women`s cult of the Mitsogho.

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