Abstract
Dr. Livingston makes the very important point that no deaths have occurred in sweat lodge ceremonies being conducted by traditional elders in the prescribed ceremonial manner. The only reported deaths occurred in “New Age” sweats conducted by non-Native people and not performed in the prescribed manner that has been practiced for as long as oral history and ethnographies can confirm. He appropriately describe the lengthy training that prepares people to lead the sweat lodge ceremony, which is not separate from training that also eventually qualifies them to be recognized as a healer by their community. This training take years, and those who do lead sweat lodge ceremonies take the well-being of their participants very seriously. Dr. Livingston makes reference to these leaders modifying their technique to fit the health needs of their participants and being quite aware of important modifications that must be made for people who have just come out of detoxification programs for alcohol or drugs, for people with diabetes, for people with heart disease, and for people with other illnesses. I had the privilege of being one of the reviewers for this article and of helping Dr. Livingston to shape it toward its current state. During those discussions, we likened the sweat lodge to a scalpel. In this metaphor, the sweat lodge is to the traditional healer like the scalpel is to the surgeon: tools for healing. A surgeon can use a scalpel in many different ways and for many different levels of procedures, from removing superficial skin tags to heart transplantation. Similarly, a traditional healer can use the sweat lodge in many different ways, from preparing healthy young men for vision quests to blessing and sanctifying people who are well advanced in the process of dying of cancer. Traditional healers practice the same wisdom in knowing how to use their tools that a surgeon practices in applying the scalpel. Unfortunately, not all “New Age” people or “wannabe” Natives have this wisdom.
Dr. Livingston describes the almost universal presence of sweat lodge ceremonies of one kind or another across North America, but also Europe, Russia, and Mongolia. Recently, on a trip to Australia, I discovered that the Maori have sweats and were doing them in Australian prisons. The Australian aboriginals have a kind of sweat in which the person is placed in a pit in the ground with the hot stones on the bottom covered with mats and grasses. Apparently this practice of sweating for health exists worldwide.
I emphasize Dr. Livingston's points that we must pay attention to the training that leads a person to become a leader of sweat lodges and of the overall context of this ceremony in their lives. As these ceremonies become more popular in mental health and addiction treatment programs, we physicians need to interact with the traditional healers, but from a position of respect, dialoguing with them about our patients and their illnesses and medications, trusting that the elders will take what we say into consideration as they design the ceremony for more vulnerable populations.
As a Native person (Cherokee–Lakota), I began attending sweat lodge ceremonies in 1972. I described my experience in the first chapter of Coyote Medicine. 2 I trained for 10 years as a fire keeper/stone carrier. In general, I suspect we graduate when our teacher dies. In my case, I began leading sweat lodges when no one else more qualified was available, beginning in about 1989. I have averaged attending one sweat lodge per week since 1972, which is about 2000 lodges. I know many people who lead sweat lodges. None of us ever heard of anyone dying or even experiencing a serious adverse event. In each of the lodges that I have attended or led, there have averaged 12 people, which amounts to 24,000 people-lodge exposures.
Dr. Livingston makes the point that those of us who are traditionally trained understand the lodge ceremony (inipi or “breath of life” in Lakota) as a sacred undertaking for the benefit of the people. We understand that our role is to bring the people to a point of suffering that is helpful for clearing the mind, but never taking them beyond what they can handle. My teacher said, “If you chase the people out of the lodge, what good is that? No prayers take place.” My training was to sense the level of comfort or discomfort of every person present and to take that into continual account. In the way that I was taught, I feel the suffering in my own body and cannot drive them further than they can go.
In lodges I have done for people who are in recovery, detoxifying from drugs, or for people who have serious medical conditions such as diabetes or heart disease, I learned to pace the lodge to what was safe and acceptable for them. I would add that I have diagnosed diabetes through noticing people who could not handle the routine heat and sweating of the lodge. I have encouraged them to leave and have then strongly requested blood glucose determinations. Uncontrolled diabetes is incompatible with being able to tolerate the sweat lodge ceremony.
The sweat lodge ceremony is a curative, healing technique that aims to strengthen people and not destroy them. The traditional leaders of sweat lodges care greatly about the people who attend and would suffer intensely if anyone came to harm in a lodge they were leading. When we pour water for a lodge, we are responsible for the well-being of the people who come. This was drummed into me for years. Bucko 3 has written extensively about the Lakota style sweat lodge and its many variations among families.
I trained in the Black Elk family style. My teacher learned from Wallace Black Elk, who learned from his lineage of Black Elks, well past the Black Elk popularized by Niebuhr. In this style of lodge, there are four rounds. A round lasts from the close of the door to the opening of the door. We do not leave the lodge between doors, but remain inside. The first door is for the West, dedicated to wicasa wan sabiciya, or the Guardian of the West, the man wearing black. Four songs are sung during this round, all oriented toward alerting the Four Directions and their guardians that we are doing something worthy of notice. In my lodges, I usually sing a Four Directions Song, then a song that honors the Guardians of the Four Directions (in Lakota, the four sons of Tate, the Wind), then a march without words (only vocables) that sings the spirits into the lodge as they proceed down a spiral from the heavens into the lodge and down into the firepit, passing through each person as they descend. Then I have a choice of many songs, often choosing one that will honor the Bear Nation.
In the second round, we sing “the song they sing before the people pray.” This song honors the spirits overseeing the prayers—the sky spirits (wakantankan), the Creator (Daku Skan Skan, or that which moves everything that moves), Wohpe, the White Buffalo Calf Woman, the ancestral spirits, or the Tunkashila, and a variety of other beings. We go around the circle of people, each one praying in the way that they were taught, to the name of Creator that is most comfortable to them. After the second round, water in the form of medicine enters the lodge. This water often has herbs inside and has been made sacred by the prayers of the people. A song is sung to honor the water as the people drink. Then we send more water around to quench the people's thirst.
In the third round, we listen for the good guidance and direction of the spirits. Four songs are sung, the last one of which is often a chant to support the people to hear and see their vision. Then, when we open the door, the pipe enters the lodge. We smoke it, passing it around the circle to symbolize our prayers being answered. In the fourth round, we begin with a thank-you song. Then we proceed around the circle again, with each person having an opportunity to pray for someone forgotten, to tell a story, tell a joke, sing a song, or simply talk to us. When all are done, after an exit song, we leave the lodge.
Thus, the sweat lodge is a spiritually powerful ceremony designed for the benefit of the people and never for their detriment. It is physically challenging, but never more than we can handle. We need this challenge, to help us to enter an altered state of consciousness and to rise above ordinary reality, but never to suffer harm. I trust that Dr. Livingston's article will begin a process of discussion within medical and academic circles about sacred ceremony and its role in healing and curing the people that has never occurred before. I am grateful to be a part of that dialogue.