Constructing drug effects : A history of set and setting
Drug Science, Policy and Law, 2017, 3, (0) 1–17
Doi : 10.1177/2050324516683325
Set and setting is a term which refers to the psychological, social, and cultural parameters which shape the response to psychedelic drugs. The concept is considered fundamental to psychedelic research and has also been used to describe nonpharmacological factors which shape the effects of other agents such as alcohol, heroin, amphetamines, or cocaine. This paper reviews the history and evolution of the concept of set and setting from the 19th-century Parisian Club des Hashischins, through to 1950s psychotomimetic research on nondrug determinants of psychopharmacology, the use of extra-drug techniques by psychedelic therapists of the 1950s, and the invention of the concept of set and setting by Leary. Later developments and expansions on the concept of set and setting are discussed, and the term of collective set and setting is suggested as a theoretical tool to describe the social forces which shape individual set and setting situations.
The concept of set and setting, it is argued, is crucial not only for psychedelic research but also for advancing drug research and developing more effective drug policy.
Keywords : drug policy, hallucinogens, non-drug factors, psychedelics, psychopharmacology, set and setting
To what extent are the effects of psychoactive drugs fixed and predictable, and to what extent are they a
construction produced by society and culture? The question of ‘‘nondrug parameters of psycho-pharmacology,’’ as it was sometimes called in the 1960s (Feldman, 1963), has been debated extensively over the past century, yet it has still not been answered in full. We know about the significant role played by the placebo effect (Brown, 2012; Moerman, 2002), and we know that the effects of drugs can vary significantly between users across societies, cultures, and subcultures (Wallace, 1959), yet we are still lacking a solid working theory as to how and why that happens.
In a world which is growing increasingly skeptical of a long and failed war on drugs, and which is seeking alternatives in decriminalization, legalization, and a host of other approaches to drug reform (Boggs, 2015; Golub et al., 2015; Hari, 2015), the question of extra-pharmacological variables is becoming increasingly urgent. Studying the ways in which drug effects are shaped by social and cultural parameters is essential to developing effective strategies for harm reduction, and a more effective drug policy which would reduce drug harms and allow the emergence of more beneficial patterns of drug use.
A key concept in the field of drug research that offers a testable, applicable, and a potentially fruitful approach to studying the role of extra-pharmacological parameters on drug effects is the concept of set and setting, which emerged within the field of 1960s psychedelic (1) drug research and has since become accepted both within the drug research community as well as in extra-academic discourse. The set and setting hypothesis basically holds that the effects of psychedelic drugs are dependent first and foremost upon set (personality, preparation, expectation, and intention of the person having the experience) and setting (the physical, social, and cultural environment in which the experience takes place) (Hartogsohn, 2015). While the concept of set and setting was born out of psychedelic research, and though it seems to be of special applicability in that domain, it has also been proven useful for researchers who have studied the effects of various stimulants, depressants, and antipsychotics such as alcohol, heroin, methyl-phenidate (Ritalin), methamphetamine, cocaine, and crack cocaine (Cohen, 1990; Ditman et al., 1969;
Dwyer and Moore, 2013; Hart, 2013; Zinberg, 1984). In actuality, current research suggests that non-pharmacological effects are responsible for a major part, if not a majority, of therapeutic benefits in a variety of accepted drug treatments (Brown, 2012; Kirsch and Sapirstein, 1998; Moerman, 2002).
Issues of set and setting play an important role in both popular and scholarly accounts of mid-20th century psychedelic research, part of an extended discussion which has been going on since the 1960s
about why experimental results varied so wildly at the time (Dyck, 2008; Lattin, 2011; Lee and Shlain, 1992). Indeed, Langlitz’s Neuropsychedelia, the most comprehensive investigation of the current wave of psychedelic research, points to the fact that set and setting continues to complicate and shape investigations in the field even today (Langlitz, 2012). In a time when psychedelic research is being resumed and performed in an increasing variety of set and setting conditions such as psychotherapy research (Griffiths et al., 2006), psychotomimetic research (Vollenweider et al., 1998), and MRI research (Carhart-Harris et al., 2011), the issue merits further consideration and thorough integration into the discussion. This paper wishes to contribute to the discourse on the ways in which set and setting
shaped hallucinogenic research in the past, and the ways in which they continue to do so today.
Set and setting, it is important to note, is critical not only to experimental results obtained in labs but also to the ways drug experiences play out in the field. Indeed, if one lends an ear to what drug users themselves have to say, the ubiquity of issues of set and setting within their discourse points to the matter being much more than a mere academic pursuit. Drug users are often surprisingly occupied with considerations of set and setting and credit such conditions both for negative as well as safe and positive drug experiences (McElrath and McEvoy, 2002; Shewan et al., 2000). Thus, studying set and setting and educating citizens about their importance seems essential to the success of any drug education program working both within the framework supplied by current drug policies as well as in a potential
Yet despite its popularity and applicability, the concept of set and setting has never been integrated into the study of psychopharmacology. Integrating variables of set and setting into clinical drug research would entail great complications for a pharmaceutical industry bent on randomized controlled trials (RCTs) and with limited patience for injecting fuzzy social and cultural elements into its considerations. This is lamentable because a better understanding of set and setting can often serve to reduce drug harm and increase potential drug benefit more efficiently than seeking new molecules or banning drugs altogether. In a pharmaceutical culture set on developing magic bullets and eliminating extra-drug parameters from drug research, set and setting serves as a reminder that extra-drug parameters cannot be eliminated from actual drug use, and point the way toward a more comprehensive conceptualization
of drug effects.
Partly, this neglect might be due to the fact that the discourse on set and setting has remained largely
underdeveloped over the years. The abandonment of the mid-20th clinical psychedelic research has, as a side effect, led to the marginalization of the concept of set and setting. The literature on drugs effects still
lacks an account of the history and evolution of the concept of set and setting. Such an account would be
valuable not just as a matter of historical curiosity, but because by tracing the genealogy of set and setting we can better understand it: how it evolved, how to make sense of it, and how it can be relevant for a variety of clinical and extra-clinical situations. Indeed, in a period when psychedelic research is reemerging and governments worldwide are considering drug policy reforms, such an account would seem timely and essential.
In this paper, I wish to present a preliminary history of the concept of set and setting and its evolution, as well as suggest some ways in which a better understanding of set and setting can prove useful to advancing current research as well as to reducing drug harms and fostering safer patterns of drug use.(2)
The origins of set and setting
The coining of the concept of set and setting is commonly credited to Timothy Leary, the controversial
Harvard psychologist who played a crucial role in introducing psychedelics into the cultural discourse of 1960s America. According to Horowitz et al. (1988: 103) the term has first been published in a paper presented at the annual meeting of the American Psychological Association on 9 September 1961 (Leary, 1961).
Leary and his group would publish a number of formulations of the set and setting hypothesis during the 1960s decade (Leary et al., 1963, 1964; Metzner and Leary, 1967). While some of these early formulations
differ in their emphases, together they make the claim that the set and setting is the most important determinant of the contents of psychedelic experiences. Set is understood as anything related to the internal state of a person, including personality, preparation for the experience, intention, as well as ‘‘mood, expectations, fears, wishes’’ (Metzner and Leary, 1967: 5). Setting is understood as anything related to the environment in which the experience takes place, including the physical environment, the emotional/social environment, and finally the cultural environment—the ideas and beliefs which are prevalent in the society regarding drug effects and the world in general.