The Taíno believed it was possible to travel to the supernatural realm during cohoba-induced trances. One of the strongest psychoactive substances used in the pre-Columbian world, cohoba is still taken by shamans in the Amazon Basin of South America. The effects of cohoba make the user see the world in an inverted way: people, animals, and objects appear upside down; movements and gestures are reversed; and perceptions are marked by constantly shifting shapes and kaleidoscopic colors. Everything is the opposite and the inverse of the here and now, intensely colored, and completely mutable. Many Taíno works associated with the cohoba ceremony, especially the vomiting spatulas, are exquisitely carved with fierce animals, upside-down images, and skeletal figures from the otherworld. Thus spatulas are unique in the corpus of pre-Columbian art.
Ceramic figures on duhos illustrate stages of the cohoba ritual, from the initial use of the spatula to the aftermath of stupor, fatigue, and spiritual exhaustion. Once the hallucinogen was inhaled through snuffers, the cacique or shaman would sit on his duho, elbows resting on knees, body hunched forward, lost in the thoughts and images that would result from cohoba's swift effect. In this position, caciques and shamans communicated with spirits and ancestors. The duhos themselves probably had inherent supernatural power, which "centered" the user in the fifth directionin the center of the cosmosa concept important to pre-Columbian societies.