BEYOND psychedelic SUBSTANCES: WHEN CULTURE enters THE LAB
Brendan Borrell’s recently published New York Times article The Psychedelic Evangelist, about Johns Hopkins University’s late pioneering researcher Roland Griffiths, joins a series of blog posts, news articles and academic papers discussing problematic aspects of psychedelic science. Some of these concern personal misconduct, but others are rooted much deeper. Psychedelics bring together human psychology and chemical compounds, science, metaphysics and cultures. They are explored by pharmacologists and philosophers, anthropologists and psychiatrists, all trying to study what’s in a psychedelic, each with their own vocabulary and worldview. Some of the problems which arise from psychedelic research represent old schisms between the sciences and the humanities, and questions about knowledge as a whole. Here too, psychedelics seem to have a revealing effect, exposing our own thinking mechanisms.
Mystical science
The concept of “mystical experiences” has been one of these subjects of ongoing discussion. According to the Cartesian view, the spiritual and the experiential are in principle beyond the bounds of science, as they can neither be confirmed nor refuted. Thus uncomfortable feelings around their appearance in scientific articles can be easily understood. In The Language of Metaphysical Experience, Alan Watts relates to a similar problem encountered by physics in relation to unknown fundamental entities. While these cannot be explained and remain mysterious, they can be related to in quantitative terms for prediction purposes. For example, we can say that “dark matter makes up 30.1 percent of the matter-energy composition of the universe“ without knowing what ‘dark matter’ is. In the same way, we can put ‘mystical experiences’ on a scale, and measure how many subjects experienced them, their level of intensity and so forth. Even if such information enables prediction, ontologically such statements remain meaningless, or as Alan Watts puts it: “By admitting a few numbers, even ‘Jabberwocky’ may become scientific”.
‘Mystical’ is surely an eye-catcher, but psychedelic literature is abundant with what Bateson called “heuristic concepts”: concepts which bring to the table more fog than clarity. Consider for example ‘connectedness’, ‘awe’, ‘oneness’, ‘ego-death’, ‘oceanic boundlessness’, or even basic terms like ‘mind’ and ‘consciousness’. Do we really know what they mean? Humanities scholars thoroughly discuss and contextualize such terms, like the mystical in religion studies or awe in art and philosophy. As they travel to the hard sciences and find themselves in quantitative questionnaires, they can become inaccurate and biased.
These are differences within disciplines in our own culture; stepping outside reveals a deeper abyss, but it could also help in bridging gaps. In the same essay, Watts elaborates on differences between Western and Asian conceptualizations of metaphysics and their purposes. In the West we see metaphysical statements as conveying positive information about Reality. In Asia they are treated as remedies to frustrating human psychological ‘unreal’ problems, while Reality itself is ineffable. There is indeed something paradoxical about using objective terms and methods like observation to understand a subjective phenomenon like the psychedelic experience. There is a constant need to find less subjective terms: from ‘bad trip’ to ‘negative’, ‘adverse’, ‘challenging’ experience. The latter may sound more scientific than hippy, but aren’t they all personal value judgements of subjective experiences? Do they tell us anything objective at all? Another example is the quest to compile THE playlist for psychedelic interventions. Can there be one or even multiple recommended playlists? Is music not a matter of personal taste, memories and associations, of cultural references and education?
Experiencing objectivity
Some of the challenges are anchored in psychedelics’ legal status as schedule I drugs and the wish to develop them into treatments for medical conditions. Here too, our web of ontological assumptions and scientific methods keeps getting entangled, sometimes creating dangerous traps. Trying to stay as objective as possible, we wish to minimize the “human element” in order to properly assess the efficacy of substances. We use blinding and placebo-controlled trials, but this very practice sometimes leads to a nocebo effect (worsening of symptoms due to not getting the treatment) and even death, as described in the New York Times’s article. In many cases, practices applied to enhance objectivity are reinterpreted by participants as cold or unempathetic, and thus end up influencing results. For example, in order to minimize bias, the FDA recommends that a trial’s in-session monitor would not be involved in post-session psychotherapy. The assumption is that a therapist may be biased, in the sense that they know what happened during the psychedelic session and may use this information later. For participants, this means there is no continuity between the psychedelic session and the integration part (if there is one). This, in turn, creates trust issues and makes it difficult for participants to let go and to share their experiences. Since the therapy element is so determinate and hard to measure, psychotherapy and psychological support are often minimized in trials (also due to financial reasons), raising ethical concerns and undermining potential benefits. So some of the measures taken to accurately determine the safety and efficacy of psychedelics are in themselves a detriment to the safety and effectiveness of trials.
Medicalization as a goal has received much critique. Different approaches, as manifested by indigenous cultures or even by counterculture are often regarded as less or not at all valid. But even within mainstream culture, and within medicine and psychiatry, psychedelics raise some thoughts about the very definitions of mental illness, health and well-being. Here are a few: how come psychedelics seem to work for so many different mental disorders? Could it be that the terms “placebo” and “inner healing” refer to the same thing? If placebo works so well, why do we focus on external solutions which would prove better, instead of trying to enhance placebo? Some say that psychedelic research is leading to a full-blown paradigm shift in psychiatry, integrating social and cultural factors into conceptualizations of mental disorders and to transformation as the new basis for psychiatry.
Wired by culture
Known since the beginning of the 1960’s, ‘Set and Setting’ is the main mechanism through which subjectivity and culture enter the psychedelic experience. Indeed, many academic papers include an apologetic paragraph acknowledging the importance of these two illusive and immeasurable components, before embarking on a futile battle to neutralize them.
Originally referring to a person’s mind-set and environment during a trip, set and setting bring into the psychedelic experience a complex web of one’s personal history, tendencies, mood, culture, environment and education. And all of these together influence participants’ interpretations, the meanings they give to their own experiences. In 1997, Betty Eisner added the Matrix component, one’s broader cultural frame. Then, in American Trip, Ido Hartogsohn expanded it to a Collective Set and Setting of a nation with its particular history and sociocultural context. Our Collective Set and Setting influences not only participants, but researchers and therapists as well. It can include, for example, the infamous hype of the psychedelic renaissance, articles we’ve read, films and documentaries we watched, stories and images from the 1960’s counterculture and echoes from the “War on drugs”. Back in 1959, Anthony F.C. Wallace already attributed the discrepancy seen between reactions to mescaline of Westerners and indigenous people to their cultural beliefs. While white subjects reported ‘going mad’ (e.g. mood swings, losing touch with reality, forsaking social inhibitors, etc.), such phenomena were not felt by the indigenous group, who remained generally stable and positive. Wallace concluded that the differences stemmed from the cultural conceptualization of hallucinations. In Western psychiatry, hallucinations are perceived as signs of mental illness, while in the indigenous culture, they are considered normal and even desirable.
Several elements in the setting of Griffiths’ lab were deemed problematic by Dr. Richards. It is easy to see how participants’ interpretations and experiences may be affected by a Buddha sculpture. But in fact, a ‘neutral’ setting does not exist. A hospital building carries its own associations, the outside and inside appearance of clinics also matters. According to Art literature, even white walls are not neutral. Music, smells… There is no way out; everything matters, from the size of the room and type of furniture through the number and gender of people present, to perceptions and beliefs of researchers, therapists and participants about psychedelics, people and the world. Moreover, not only do they affect trial results, but also their design, our research questions and our approach to the process. For example, a study aimed at minimizing nausea during consumption of Ayahuasca treats it as an undesired side effect, while another can regard it as an act of cleansing conducive to positive changes in well-being. Simply put, Set and Setting cannot be kept away from the lab.
Psychedelic research is full of contradictions, paradoxes and absurdities. We strive for total control and meticulous procedures to study substances which make one lose control and reflect on your own processes. We wish to eliminate anything weird or mysterious, but also dream of discovering a “magic pill”. As meanings, chemicals, cultures and personal tendencies collide, interdisciplinary research can supply the necessary means – perhaps not to overcome all contradictions – but at least to understand them better and to live with them as best as we can.