Timothy Leary used the phrase “set and setting” to describe the way that one’s mindset and physical setting impacts their psychedelic experience. In a recent talk titled “Beyond Set and Setting: Cultivating Mosaics of Support,” Kwasi Adusei, DNP, PMHNP-BC, clarified that set and setting refer to the extra-pharmacological influences on psychedelic experiences, including the “color palette of set” (i.e. internal elements like mood, beliefs, and attitudes) and the “crucible of setting” (i.e external elements like music, space, and people). Adusei ultimately advocated for the addition of a “mosaic of support”–meaning the collection of factors that aid in integrating a psychedelic experience–to set and setting in order to increase the benefits and reduce the risks of psychedelics.
Adusei came to the University of Wisconsin-Madison to give this talk for the next installment of the “Psychedelic, Pasts, Presents and Futures” Borghesi-Mellon workshop. In his work as a psychiatric mental health nurse practitioner, psychedelic-assisted psychotherapist, and co-founder of the Psychedelic Society of Western New York, Adusei hopes to shift the stigma around psychedelics and demonstrate that psychedelics can help people heal and remain productive members of society. The aim of such work, in Adusei’s view, is to empower people to do this work within their own communities by providing numerous resources that support them in this project.
The talk centered around the mosaic of support needed to integrate a psychedelic experience. In order to highlight the many layers of extra-pharmacological factors that influence psychedelic experiences, Adusei cited psychologist Urie Brofenbrenner’s ecological systems theory that describes five levels of factors–macro, exo, meso, micro, and individual–that impact child development. Adusei’s talk focused on the macro-level and how factors such as culture, race, and economics affect psychedelic experiences. For instance, Adusei cited an article from the Journal of Psychedelic Studies titled “Race as a Component of Set and Setting” that highlighted the influence of race on psychedelic experiences and concluded with a call for better facilitator training around race and ethnicity. Therapists, practitioners, and facilitators who do not share a racial, ethnic, or cultural identity with the patient, according to Adusei, do not often have the experience or training necessary to provide the mosaic of support that patients in this situation require and may, in fact, cause harm because of it.
When the talk drew to a close, audience members raised a number of questions to Adusei, including concerns about proper training for facilitators in cross-cultural or cross-racial psychedelic therapy settings, the role of community organizing in psychedelic risk reduction, and how to get more involved in psychedelic-assisted therapy training. As I listened to the discussion, what struck me most about Adusei’s talk were the implications of expanding the concepts of set and setting to include other macro-level factors that influence psychedelic experiences, such as the unjust drug policies of the U.S. that perpetuate harms not even associated with the pharmacology of the psychedelic drug itself. Current discourse around psychedelics, in my view, too often treats set and setting as a one-size-fits all key to a “good,” successful, or healing experience. The trouble with this narrative is that it frames the psychedelic experience as connected mainly (if not solely) to the immediate internal state and external surroundings of the individual undergoing the experience. It is not news that most people still take psychedelic drugs outside of clinical trials, which means that most use remains criminalized and illegal. Why this bears pointing out is that it highlights how an aspect on the macro-level–like punitive drug policies–can affect the psychedelic experience on an individual level–like paranoid or fearful thoughts about arrest and incarceration. Such factors exert an influence on the psychedelic experience even if they are not present in the immediate setting and, drawing on Adusei’s talk, require a mosaic of support to address and integrate.
I wonder what such an inclusion might imply about the impact of other social, cultural, and material issues on the psychedelic experience. How might, for instance, the impending (and ongoing) environmental crisis influence experiences of psychedelics? How might the matrix of patriarchy, racism, colonialism, and capitalism affect those who ingest psychedelics, particularly those who have undergone violence due to that matrix of domination? Many people who use psychedelics report feelings of interconnectedness with other humans, the world, and even the whole universe. If interconnectedness is fundamental to humanity and each human being is viewed as the embodiment of interconnected social, cultural, and material processes, then it behooves those of us who advocate for psychedelics to better attend to the macro-level aspects of society that impact the experiences of psychedelics.
Editorial Note: This post is part of the Pharmaceutical Inequalities series, funded by the Holtz Center and the Evjue Foundation.