- Some Aspects of Containment Matter
Tehseen noorani’s article “Containment Matters: Set and Setting in Contemporary Psychedelic Psychiatry” presents a comprehensive, deeply researched ethnographic perspective on current research practices in psychedelic-assisted therapy. This is rapidly evolving terrain scientifically, clinically, legally, and socially. Noorani’s on-the-ground observations from within the Johns Hopkins research program are fascinating and timely given the numerous challenges faced in investigating and developing this emerging mode of psychiatric treatment as well as the complex history psychedelics represent. The level of detail afforded by Noorani’s embedded work between 2015 and 2019 in characterizing the complexities of this landscape offers a unique opportunity for anticipating future challenges the field will inevitably encounter, including challenges that have the potential to bury this line of investigation for decades to come, as has been the case for most of the last fifty years.
Noorani centers his argument around the concepts of ‘set and setting’ in psychedelic therapy to argue that this emphasis—vaguely characterized as it is—articulates not only therapeutic imperatives but a set of social, political, and economic imperatives. This central claim is supported by two lines of argument: a) problematization of the notion of ‘containment’ and its implications, and b) interrogation of the consequences of a certain quality of reflexivity whereby psychedelics, through alterations of the sense of self that are subject to the vicissitudes of set and setting variabilities, alter those very conceptions and the social and political environments they arise from. Although there are very good reasons to tread carefully in these waters, and to be attentive to the range of factors implicated in Noorani’s arguments, at several points Noorani’s analysis of the complex sociocultural interpretations of the psychedelic researchers’ behavior can seemingly elide more practical, and obvious, explanations.
Noorani explores a complex set of motivations behind the purported current emphasis on ‘containment’ as it relates to set and setting of psychedelic use and discovers intentions that if not frankly sinister, are presented as manipulative or—at the very least—an imbrication of complex, if unconscious, social and economic pressures. For Noorani, ‘living room settings’ used in current psychedelic research implicate loosening Victorian norms in a uniquely American bourgeois history, gesture grimly towards ‘death rooms’, and suggest porous boundaries and potential associated perils with mention of Bill Richard’s personally chosen artwork on display. No doubt there is a rich social history behind the concept of the ‘living room’, however there are also simple, pragmatic empirical questions that arise in designing a space to administer an extremely powerful psychoactive agent to a diverse group of participants in a safe and therapeutic fashion. There are also associated empirical facts to be discovered as to psychological changes these participants can mount when these [End Page 223] set and setting dials are turned: while initial design may be motivated by a host of tacit assumptions, these are all up for empirical testing. Similarly, wall-mounted CCTV cameras here suggest if not a frankly Orwellian impulse, at least some elaborate performance of medical and scientific legitimacy: “they reveal the nestedness of the session room within a broader scientific-bureaucratic container, shaping participants’ own experiences through symbols of safety, accountability and rigor.” Let’s imagine the set of conversations at Johns Hopkins that led to this decision: were Rolland Griffiths and his team interested in an elaborate machination to situate and contain the psychedelic experience and all of its associated inchoate phenomenology within the medicoscientific paradigm? Motivated to ‘police’ where and when psychedelics can and should be used? To demarcate their scientific enterprise from the broader (and it seems at least somewhat overlapping) underground community? Or were they motivated to a) document and record data for scientific investigation and b) protect themselves medicolegally within a field that has encountered florid boundary violations that would threaten to undo years of research and set the field back decades—an unfortunate outcome with robust historical precedent? The claim that recording of video footage shapes participants’ experiences is also an empirical claim, and no doubt one that would be of interest to the researchers involved. The fact that this reflexive effect has not arisen within this...