Transpersonal Events in Childbirth, Birth-giving Trauma and Ritual Healing

by Gregg Lahood

The eminent anthropologist, Clifford Geertz, once remarked that anthropologists ran the risk of being ‘merchants of the strange’ and peddlers of the ‘exotic’. After exploring childbirth for almost 20 years (20 as a holotropic breath-worker and seven as an anthropologist) it now seems both strange and exotic to me that the non-ordinary events that many women (and men) participate in during childbirth (existential crises, encounter with death, spiritual emergency, peak states, and NDEs – near-death experiences) remain marginal in trans/personal discourses.

In America the home birth movement began in communes in San Francisco around the same time that the trans/personal psychology movement birthed itself out its humanistic parents. There is a connection: the influx of Eastern religion into the West, social upheaval, radical protest, the interest in psychedelic states (and its cross-cultural parallel ‘shamanism’) the human potential movement’s encounter groups, Neo-Reichian techniques, and the gestalt boom prepared the way for the trans/personal orientation (and the home birth movement). Yet despite transpersonal psychology’s widespread appeal, the rise of feminism and the popularity of spiritual studies in general in the Western world, women’s non-ordinary states of consciousness and trans/personal events in childbirth have not been the focus of a systematic study – at least from the humanistic and transpersonal perspectives.

This hole in the research is even more fascinating because one of the founding fathers of both humanistic psychology and transpersonal psychology, Abraham Maslow, had noted the emergence of ‘peak’ states at childbirth in his popular books on humanistic and trans/personal psychology:

The truth is that at some moments she will flip into her goddess-like aspect, most especially when she’s fulfilling those biological functions that men see as basically female: nursing, feeding, giving birth (Maslow, 1964:110).

A dissertation will soon be published which will show that out of this humanistic science, has come, I would say, one of the real childbearing improvements since Adam and Eve. It is a dissertation on peak experiences in natural childbirth. And this can be a potent source of peak experiences. We know just how to encourage peak experiences; we know the best way for women to have children in a fashion that the childbearing mother is apt to have a great mystical experience — an illumination, a revelation, an insight. That is what they call it, by the way, in the interviews (1971:169).

Two other important pioneers of transpersonal psychology Stanislav and Christina Grof both, in different ways, focused on the birthing as a primary catalyst for psycho-trauma. Stanislav Grof, as is well known, is widely regarded as the world’s foremost psychedelic researcher and one of the original founders of the transpersonal orientation. He found that adults in deep experiential psychotherapy, spiritual emergencies, and meditation can ‘relive’ aspects of their birth. Grof’s uncovering of the tabooed womb in all its multivalent and unstable glory and his integrative presentation of the ‘perinatal’ as a meeting-house for Freud’s biological psychology and Jung’s archetypal psychology has had (and will continue to have) far reaching ramifications for those interested in integrating the personal with the trans/personal.

A basic assumption of psychoanalytic theory is the notion that early childhood experiences can cause trauma and neurosis. Melanie Klein and others explored the idea further by looking at pre-oedipal states of human development. With transpersonal psychology the search for trauma and ‘self’ is pushed even further back along the ontogenetic pathway to the experience of birth and beyond (this ‘beyond’ has some parallels to the Jungian collective unconscious). Grof and others argue that an echo of these earliest states is found in adult spiritual states of consciousness but that they can also have traumatic and pathological elements to them.

However, the Grof’s groundbreaking research is not specifically focused on the transpersonal events in actual birth-giving but two related areas: birth-trauma as it is re-experienced by adults using their therapeutic method (holotropic breathwork) and in spontaneous transpersonal crises or spiritual emergencies and their relationship to what Stan Grof calls the biographical, perinatal and transpersonal realms of the human unconscious. Indeed the Grof’s therapeutic strategy or healing ritual is largely geared toward the integration of birth trauma; it’s more florid or pathological expressions, and the spiritual impulse. By providing a ritual container for these sometimes dangerous and distorted energies to emerge for conscious evaluation holotropic breathwork stands somewhere between a therapy, a meditation, a shamanistic technique, and a collaborative inquiry. Nevertheless, Dr Grof has consistently noted in general terms, in is many books and articles, how women during birth-giving can participate in trans/personal openings:

Delivering women and people participating in the delivery as assistants or observers can experience a powerful spiritual opening. This is particularly true if birth does not occur in the dehumanized context of a hospital, but under circumstances where it is possible to experience its full psychological and spiritual impact (Grof, 1998:135).

Indeed Christina Grof, the founder of the Spiritual Emergency Network and co-creator of holotropic breathwork, experienced a life-changing transpersonal crisis during childbirth:

Lying on the delivery table, I glanced up at the immense surgical lamp and the kind, curious faces of the doctor, the assisting intern and nurses, and my husband. After only a few hours of labor, my son was suddenly and rapidly making his way into the world as I enthusiastically cooperated. As the people around me encouraged me to “push…push…nice and hard, remember to breathe…,” I felt an abrupt snap somewhere inside of me as powerful and unfamiliar energies were released unexpectedly and began streaming through my body. I started to shake uncontrollably. Enormous electrical tremors coursed from my toes up my legs and spine into the top of my head. Brilliant mosaics of white light exploded in my head, and instead of continuing the Lamaze panting, I felt strange, involuntary breathing rhythms taking over.

It was as though I had just been hit by some miraculous but frightening force, and I was both excited and terrified; the shaking, the visions, and the spontaneous breathing were certainly not what I had expected after all my months of preparation. As soon as my son was delivered, I was given two shots of morphine, which stopped the whole process. Soon wonder faded and I became embarrassed and fearful. I was a restrained, well mannered woman who had a strong sense of authority over my life, and now I had completely lost control. Very quickly, I pulled myself together (Grof and Grof 1990).

The medical takeover of childbirth may well be one of the reasons that so little research has been done on transpersonal events in childbirth. Shelia Kitzinger, following Levi-Strauss, writes that “birth and death are rich with meanings which have penetrated the whole of social life. But in the West, as part of a process of ‘scientific praxis’ we have emptied birth and death of everything not corresponding to mere physiological processes (1982:195). Anthropologists have also shown that birth in most pre-industrial cultures has been a ritual event enveloped in protective rites of passage and spiritual procedures that lend emotional, ‘supernatural’ and charismatic support to birth-giving women. They argue that fertility and birth are in all cultures embedded is social, psychological, cosmological and spiritual systems (MacCormack, 1982:10).  Furthermore, the basic pattern of biological birth serves as a “model for structuring other rites of passage” (Davis-Floyd, 1994:325) and other ceremonial healing rituals. Traditional helpers at birth, midwives and shamans, operated as ‘technicians’ of the sacred (Potter, 1974; Paul and Paul, 1975).

Another reason for the gap in our understanding of the transpersonal dimensions in childbirth may be the European colonization of indigenous peoples. It has been pointed out by Thomas Buckley and Alma Gottlieb, that menstrual/birthing huts, a site of women’s spiritual power and knowledge, were also early targets for Christian and colonial missionary zeal, “Menstrual huts have widely been among the first of indigenous features to be relinquished by native peoples upon contact with outsiders from the West” (Buckley, 1988:12). They say that ethnocentric missionaries saw these sacred places, sanctuaries and shrines to women’s power and “blood magic” as evil and took pride in dismantling them (1988:12). Furthermore Buckley points out that women’s menstrual/ birthing huts are part of a wider complementary system of spiritual practice with parallels to men in their sweat-lodge “training” (hohkep) and where a woman was held to be “at the height of her spiritual powers” (1988:190).

Western biomedicine, operating on Cartesian principles and empirical science, splits the body from the mind, the mind from nature, and has tended to either demonize or pathologize unusual states of consciousness. For example, G. Frazer believed that what was called totemism in so-called ‘primitive’ religion was actually the fruit of “the sick fancies of pregnant women” (Frazer 1910: 243).  Sigmund Freud considered women in child-bed, “unborn infants”, “new-born babies”, “childbirth” as “uncanny things” that were “charged with dangerous power, which can be transferred through contact with them, almost like an infection” (Freud 1985[1913]:72-75). Unfortunately the modern Western biomedical approach to birth-giving (for all of its many advantages and successes) does not value emotional or spiritual support nor does it value visionary states (c.f. Davis-Floyd, 1992; Klassen, 2001:104; Sered 1991:15).

Moreover, in the Western world most births do not occur in domestic environments but in hospitals and many contemporary women are left traumatised by the dehumanized nature of ‘technocratic’ childbirth rituals. For all this, it has been noted that transpersonal visions may be part of a contemporary birth-giving woman’s reality and the father’s reality (Lahood 2006, 2006a, 2006b). A psychologist, who I will call Mary, told me that during the birth of her third child and in the peak of a very strong contraction:

I went to a dark place, like a vault, where a man in suit appeared before me. I couldn’t work out why it was a man, I’m a good feminist woman, I don’t have male doctor, so why was it a guy and why was he in a suit for God’s sake? I asked him if he was my dead father or my grandfather, or an angel, or God and he replied ‘No’. I asked him if he was a ‘part’ of me and he replied ‘no’. I came through the contraction and sort of back to normal consciousness. When the next contraction came I found myself in the same black space and I called out for him and he came. I questioned him a few more times about what he was doing here and eventually he said, ‘I am here to help you birth this baby’. And my baby was born as he said those words. I felt really fragmented after the birth and I thought I might have been a bit psychotic and so I didn’t tell anyone about this experience. I know it sounds a bit ‘funny’, but I thought I was so opened up that I might be possessed or something. I want to know if the experience was ‘real’ or not. I had a sense that I had gone into a higher level of consciousness to deal with the pain, you have to or you get taken over by it. But it was definitely like a religious thing, you know like a guardian angel. I suppose because I have a Catholic background I might just think like that.

A ‘Bad’ Rite of Passage: Maternity in Modernity

Robbie Davis-Floyd’s Birth as an American Rite of Passage (1992) is perhaps the most comprehensive study to date concerning ritual, cognition, and contemporary Western birth. She argues that contemporary hospital birthing can be constructed as a rite of passage operating tacitly within the medical birthing regimen. According to Davis-Floyd, in this context, the ritual process is deeply problematic because it is geared to indoctrinate women to its biomedical mythology by enacting its ‘body as machine’ system of authoritative knowledge in a ritualized technological apotheosis. From the medicalized position birth = medical/technical operation.

Renowned British anthropologist Shelia Kitzinger has also suggested that modern birthing ‘rites of passage’ do not function to provide emotional support (as traditional rites of passage would have) but rather they reinforce the established (and patriarchal) social system (1982:182). In the modern scenario women are routinely stripped of bodily knowing, authoritative knowledge, and the status and charisma associated with birth-givers. Birth-giving is treated as a routine medical crises indexed into a powerful structure of hierarchical power running on an ‘assembly-line’ system bent to capitalist clock-time (Davis-Floyd and Sergeant 1999:8-11). Its rhythms do not sway easily to the rhythms of a female birthing body. Kitzinger writes:

In achieving the depersonalization of childbirth and at the same time solving the problem of pain, our society may have lost more than it has gained. We are left with the physical husk; the transcending significance has been drained away. In doing so, we have reached the goal which is perhaps implicit in all highly developed technological cultures, mechanized control of the human body and the complete obliteration of all disturbing sensations [my emphasis](Kitzinger,1978: 133).

Using elements of biogenetic structuralism as a model (a model bound to transpersonalism e.g. Laughlin, 1988, 1994), Davis-Floyd’s analysis suggests that women birthing can engage in the same neuro-cognitive processes that produce similar states to those found among ritual participants (1992:7-19). She argues that the climaxes and peaks found in ritual and meditation (after neuro-theologist d’Aquili 1979, 1985) when neuro-physiological subsystems fire simultaneously in the autonomic nervous system, are also found among birthing women (1992:11-15). Once these ritual dynamics are catalysed and ‘kick-in’ the human cognitive system can be rendered open to gestalt perception (d’Aquili 1979:173-174), and what is called “symbolic penetration”, that is, the ingression of symbols in the environment and their meaning into the opened mind of the ritual participant (e.g. Laughlin 1994). The process moves toward a peak, climactic experience resulting in the long term memory storage of symbolic messages (Davis-Floyd 1992:15).

Davis-Floyd argues convincingly that it is the symbols of the Western technocratic medical system in all its hegemonic and patriarchal glory that are impressed into women’s minds at childbirth serving to reinforce its power and status over women. In other words; contemporary medicalized birthing rituals oppress women through the use of a series of rituals that can be thought of as a dynamic rite of passage—a conversion process—it is a compelling argument. The price Western women pay for the belief in the Western hospital system’s ability to control childbirth outcomes, its routine technological wizardry, its hierarchy of charisma, its body as a machine mythology, and its efficiency in saving lives and reducing pain; is a reduction in participation, a reduction in emotional and spiritual life, the loss of personal autonomy and authoritative knowledge, and at worst, psychological, physical, emotional, and spiritual traumatization.

I will suggest that while the technocratic birthing ritual system begets and amplifies birth-giving trauma (after Davis-Floyd, 1992) holotropic healing rituals can be used to heal the trauma associated with birth-giving (e.g. Grof, 1985; Walden, 1993). Grasp the nettle: if it is in ‘bad’ ritual where harm is caused – it may well be that it is in ‘good’ ritual where trauma could be negated and healing found. Therefore, just as the birth-giving trauma began with a whole person, bodily, social, political, psychological, sexual, existential, and trans/personal wounding—in a ritual context—healing may need to be attended to in a counter-ritual and counter symbolic/therapeutic social milieu.[1]

The Problem with Death

Another problem is that some women’s birth-giving narratives also point to a frightening encounter with death during parturition. Certainly among the women (and men) I interviewed in New Zealand this was a common factor (Lahood, 2006, 2006a, 2006b). The two following narratives disclose just how potent but also how unrecognized this feature of birthing is:

I was terrified when my daughter was born. I just knew I was going to split open and bleed to death right there on the table, but she was coming so fast, they didn’t have any time to do anything to me [my emphasis] (Davis-Floyd, 1994:331).

During the delivery process, some women were shaken to the core by feeling abandoned and alone, as illustrated by the following quote: ‘I had a major bleed and started shaking involuntarily all over. Even my jaw shook and I couldn’t stop. I heard the specialist say he was having trouble stopping the bleeding. I was very frightened, and then it hit me. I might not make it! I can still recall the sick dread of real fear. I needed urgent reassurance, but none was offered’ [my emphasis] (Beck, 2004:22).

There is a serious knowledge gap surrounding birth-giving women and the impact of the psychological encounter with death during parturition. According to some anthropologists fear of death (like the wounding of sexual abuse) plays a crucial role in reproductive crises. Carol Laderman, writes that “The prolongation of labor because of fear is associated with much higher than normal perinatal mortality rates” (Laderman, 1987:300). James McClenon notes that, “Fear results in muscle tension, which inhibits the normal dilation of the cervix” (McClenon, 2002:53). He also suggests that fear and stress can increase the likelihood of childbirth complications, psychosomatic infertility, spontaneous abortion and miscarriage, post-partum haemorrhage, and obstructed labour (2002:46-57).

It is important to note, however, that the human encounter with death, is not always necessarily a negative experience (perhaps in the same way that losing control is not always a negative experience and one often mandatory for birth giving), it can also become a part of the ritual process and a doorway into transpersonal consciousness (Grof, 1985, Lahood 2006a). For example, anthropologist Megan Biesele in her study of birth and trance dancing among the Ju/’oansi of Africa’s Kalahari Desert writes:

Daring death seems to be part of cultural maturation for the Ju/’hoansi, as it is in fact for many other groups of people. Both the men’s and the women’s daring—in trance and in giving birth—seem to function as transformational rites of passage in Ju/’hoan society (Biesele, 1997:476).

Indeed Grof and anthropologist Joan Halifax wrote that an encounter with death is at the very core of rites of passage: “profound experiences of symbolic death result not only in an overwhelming realisation of the impermanence of biological existence but also in an illuminating insight into the transcendent and eternal spiritual nature intrinsic to human consciousness” (1977:5). Women in the Kalahari have access to ritual status through the processes of transformation and self-actualization by giving birth and encountering death (Biesele, 1997). This ritual or charismatic status is denied in the Western birthing system. Good ritual, then, must be potent enough to rework the encounter with death at the somatic and symbolic level and restore ritual status and charisma to women.

Midwives and birthing women categorically encounter new life and the potential of death every time a child is born.  I would like now to introduce a story from a midwife, Ali, who has participated in a dozen holotropic rituals and who had also recently participated in the delivery of a still-born child. While I will not attempt to analyze these narratives but rather let them stand on their own merit, I would like to draw the reader’s attention to the remarkable shamanistic-like death and rebirth motifs in each story.

Breathing deep into myself another path was to be explored. As previously experienced in holotropic breathing, I fell I am often taken into the darkest aspects of my soul. I have learnt to trust this journey and surrender once again having acknowledgement from my guides.

This day I had a golden deva, of feminine form and energy from what felt to be a heavenly realm. As I was being drawn deeper into what I experienced as a dark spiralling tunnel I remember looking back, perhaps over my shoulder, and feeling the reassurance of my golden heavenly deva encouraging me forward. Breathing deeper into these dark surrounds, encapsulating me in its spiral design, fears began to rise, descending upon me rapidly, accumulating within me so quickly.

Confronting so many fears at such speed. Beginning to feel a nausea rise from within my belly, running out of breath. The taste of fear rising from out of my belly now into my throat, a few coughs to try and clear this muck, some gagging, having difficulty breathing as my body fills up with fears needing to expel somehow. Then the sense of just opening my mouth as this black dust sprayed from my mouth, a thick stream of black fear broken down into little bits exiting my body. My mouth is wide open as if in a yawn with some sound being emitted. Time was lost as my body purged this accumulation of dark fears from my body. When I was empty of the fears and darkness I find myself breathing again and still, bit only for a moment.

As I journey on to explore other aspects of myself as Midwife. I began to experience the birthing of all the Mothers and Babies I have been witness to. I began to birth them myself, I birthed them, their histories, all their ancestors and beyond. Giving birth to the earth in its entirety itself. Yet there was still more.

My physical body begins to leave behind all of its layers to expose only my skeleton self. Beginning to shake and rattle I slowly begin to crumble and disintegrate into the earth, there is nothing left of me. I have stripped myself bare to the bone and completely undone myself. Having completely lost every layer of myself I am lost in the awe of transformation as slowly I resurrect myself into physical form once more. Here I am held in a pink loving womb, rocking to and fro slowly coming into a new consciousness. Here I am, heavenly being. Here I am, alive and breathing again.

The following is from Penny, a Scottish woman who attended a workshop this year in North England. In her account she is confronting a spontaneous abortion which she felt was connected to earlier sexual abuse:

The peace of being pregnant settled within as I took every precaution to nourish my growing bundle. I sang my songs, made plans, paid close attention to the doctor’s advice and attended the scans. I smiled, seeing the fetus develop into a recognisable form my pleasure and expectation mirroring the growth.  The magical nature of the following months heightened my sensitivity to the wonder of creation. I occupied a space which held my baby and me in an inviolable bond.

Disaster struck just before my sixth month as I stood in the bathroom one morning. I blacked out. Coming round I crawled to the bedroom followed by my youngest daughter whose face was streaked with tears. Her distress was palpable and I was caught between trying to comfort her and the pain in my belly. My husband called the doctor who came sometime later. When he examined me he told me I was miscarrying. The bed was soaked with blood and the contractions strengthened doubling my body with pain, the weakened womb pacing my mounting distress joining with the stark realisation that my baby’s life was transformed into death’s dark and still hand. My son was stillborn, my grief overwhelming as I held his small, formed lifeless body, the doctor gently mouthing his sorry.  Time stood still.

Jeni’s 4th holotropic session: I remember entering the coldest blackest space I have ever encountered. My whole self shivers to the bone and beyond, as chilly fingers flex their ice laden grip stilling all hope. I curve my body as tightly as it will allow; fear transplanting the warm blood in my veins. I descend into the agony of loss, seeing my broken baby, dead in my womb. My son, his lifeless body held gently in the weakening womb, is small, formed and silent. Holding him with my mother’s love, I struggle to rise for him, for me. I am caught in a density, which threatens to overwhelm me. Pinioned by strong hands, I smell the maleness of raging desire assaulting my nostrils and stare desolation in the face [Jeni is re-experiencing a sexually abusive episode]. I flee to that place of non-identity. I know not how long I wander desolate or how I find myself again. My broken baby is no more and my womb is no longer with me.

I hear my name being called softly, it is whispering still on the wind, warming my limbs, bidding me rise. I feel a powerful presence – primal in nature. A huge yellow and black cat softly pads across my path – sinuous, lithe and, familiar. Mouth open, enormous yellow sabre teeth displayed, ears sifting meaning, tail long and gently flicking side to side. Cat stops and gazes in my direction, slanted eyes focussing. Without warning we merge and, I become Cat – savage, ancient and flushed with natural instinct. My cub has been killed and I hunt his slayer. My humanness sits inside quiescent and accepting. Tears flow inside as I roar ‘you killed my baby’. The force of my distress marked by a loss of control, warm urine rushes down my legs. I feel no shame. Our flattened tight body hugs the grass, eyes centred on my prey. A thrust of speed and claws and teeth fasten; rending, tearing, cracking muscle, sinew and bone.  Life’s blood spurts, spills, soaking fur teeth and tongue.  My hunger sated, I curl my body into contentment’s shape and rest. Fat Cat.

A huge deep orange sun hangs just above the horizon. Seven tall, tall dark men, twig thin, stand in front of this sun; their bodies glistening with effort. Startled by this image, I come to a standstill. They are moving in unison, to an internal rhythm, spears held in hands as brown as the soil they dance upon. Their heads are each decorated with four points floating just above. Fascinated by this and their primordial ways, it takes time to realise they are dancing for me, and for him – the broken woman and the broken baby. A sense of awe and a feeling of pure connection spirals within.

Holotropic ritual can break through the hegemony imposed on the psyche by a traumatic birth, reworking the traumatic event until a new sense of self is born. The ‘data’ women gather in transpersonal states of consciousness generated in holotropic ritual suggests that the frozen energy bound up in blocked emotional or psychosomatic symptoms is converted “into a stream of experience” (Grof, 1988:166) coupled with a sense of “flow” after Turner (1979:154). This ritual process has been likened to the death and rebirth mysteries of many cultures, it is a process that seems to be a universal one naturally occurring when the psyche seeks to rebalance and re-tune to its organic healthiness. The experience is also educative, after the climax of the session and the breakthrough into trans/personal consciousness, “The remainder of the session will be spent in these spaces as one’s education continues against an often ecstatic background” (Bache, 2000:13). There is a feeling of community and cooperative endeavour that pervades the ritual process, which when heightened to its zenith, bears fruit as communitas – a sense of deep psycho-spiritual bonding with the universe and its particulars beyond all hierarchies. It is in the state of communitas where further transpersonal potentials open and flower.

A final world on women’s transpersonal knowing in childbirth and the knowledge gap in transpersonal studies: until very recently the major world religions have been male dominant or patriarchal, some would say, for many thousands of years. Thus many of the spiritual ideas and beliefs we inherit are steeped in a subtle but pervasive gender bias. This can lead to the habitual marginalizing or even the mis-recognition of our bodies own ‘homegrown’ spiritual events in favor of those outlined by idealized sages, gurus, paths, ways, texts, traditions, places, and so-called masters. We may defer from our own knowing in favor of more fashionable transpersonal objects such as ‘non-dualism’ which masquerade as the ultimate spiritual authority in every direction (Heron 1998).

Eastern mystical traditions (among others) dominate by ranking their own aspired states over others (e.g. Winkleman, 1993:5) and many in the trans/personal movement, in the wider ‘New Age’ proliferation, and among Western spiritual seekers in general  may have introjected such ideas.  However, a growing interest in embodied spirituality and the sensitivities of the human body and environment as the locus of spiritual knowledge, following the feminist affirmation of sensuality and the erotic, confound the notion that Eastern ‘enlightenment’ precepts are paradigmatic for all spiritual endeavours.

Transpersonal theory has, perhaps understandably, been tilted in this gendered direction because it has largely studied the predominant ultimate states and peak experiences associated with patriarchal religious endeavors. Yet as Grof has maintained for over forty years: “For women, situations associated with motherhood can become another significant source of unitive experiences. By conceiving, carrying, and delivering a child, women directly participate in the process of cosmic creation. Under favourable circumstances, the sacred nature of these situations becomes apparent and is consciously experienced” (1998). The point here is that women’s transpersonal sensitivities in childbirth may be strongly divergent from men’s displaying, disclosing and enacting universes hitherto unknown to masculine religious sensitivities. After all, no male religious hero, neither, Buddha, Jesus or Mohamed has given birth to child.

Gregg Lahood will be in Ireland to give a holotropic workshop mid August. To find out more contact Markus Hohmann  at or email Gregg at


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[1] According to Hollan, recent anthropological inquiry into spirit-possession rituals show that possession idioms are a means “by which otherwise unknowable, suppressed or repressed knowledge … is directly or indirectly expressed” (2000, p. 539). Which is similar to Lévi-Strauss’s argument that the Cuna shaman in their childbirth ritual was expressing ‘otherwise inexpressible psychic states’ (Levi-Strauss, 1963).