The Whole Picture

Changing the paradigm is about obtaining a global framework for how things work.

This involves a new set of terms, terms that might not make sense under the old paradigm. We use words like 'set', 'setting', and even 'psychedelics'. Under the old paradigm we see terms like 'context of use' and 'hallucinogens'.

New paradigms emerge when the previous paradigm fails to account for several novelties or inconsistencies. To that end, a new paradigm is an adaptive tool. We have to zoom out and re-write the rules of the game a bit.

Once the new 'rules' are established, we can continue to operate as normal, but a massive shift takes place in deciding to up-end the system that we previously relied on.

The new paradigm involves a broader understanding. We have to account for as much anomaly as we can muster. This means an understanding of the positives, the negatives, and everything in-between.

A clear understanding of what might cause things to go wrong can allow us to avoid getting into situations where things go wrong unintentionally.

Perhaps 'bad trips' are consequence of improper 'set' and 'setting'. What does that really mean?

To unpack that, we must deeply understand these terms - what are set and setting? Then, how do we optimize them?

It is very broad language to talk about set. It’s a further challenge?to be able to optimize it. The user's mind-set going in is certainly important, but what constitutes a proper 'set' and an 'improper' set? If the user is afraid of what might emerge and fails to surrender to the experience, we might call that an improper set. But, what other factors play a role? What about the 'set' of the facilitator, or even the business owner or researcher who is providing the experience? What if they are nefarious, or have unintegrated shadows, and the person taking the psychedelic picks up on that, becomes scared, recognizing that they are vulnerable? This is rife for a bad trip.

We could also consider cases that involve the user taking psychedelics with friends, for recreation, and undergoing some sort of cataclysmic shift. What if the friends are improperly set-up to support that individual, and then are upset with the user for having such a deep experience when they just want to have fun? Then, the user, needing support, recognizes that they aren't really with true friends, but are, instead, surrounded by a group of self-interested people who aren't really looking out for each others' needs? This, too, is scary, and will not allow the experience to properly unfold.

Additionally, when considering 'setting', we must look into the myriad layers of what constitutes setting. Are you in a hut, in the jungle, in a war-torn country? Or, are you in a hut, in the jungle, in a well-adapted country? Are you in the home of a dear friend of 20-years, or in a hotel of someone you met off of Reddit? What is the political state of affairs governing your relationship to the substance? Is the CIA giving you these drugs to see if they can pry the truth from your brain against your will? Is a researcher systematically breaking down your ego and sense of self while under the influence of a mind-altering drug (looking at the Unabomber's case here...)

I'm not saying that I understand the exact nuance of set and setting, or that those alone are the critical factors that determine the outcome of a user's experience. I am saying that so much is involved in how a user's experience goes that we really don't understand. Critics will argue, "No, we do understand, you just described it."

There is a very, very big difference between understanding at the level of direct interaction and understanding things from a methodologically determined process.

The scientific method is specifically set-up to minimize bias an multiple levels. Interdisciplinary teams are required to submit their proposals to ethics committees to ensure no harm is done. If their proposal is accepted, and they get funding (not easy to do), they can run their experiment. They must adhere to standards of quality, such as placebo-controlling experiments. These experiments are incredibly costly (hundreds of thousands, often millions of dollars), paying highly-trained and highly-competent researchers for their time and energy. Projects take years to obtain specific data, analyses are ran, and, even then, a board of highly-qualified reviewers must pour over the manuscript and critique it with fine-grained analysis before it can be shared with scientific community. After that, the scientific community may still shred it apart, criticizing failure to account for certain limitations: failing to account for covariates (other variables that may influence the outcome), failing to include a properly diverse sample, using a poor metric that doesn't have high levels of reliability and validity, etc.

Multiple such studies are ran, and, eventually, meta-analyses and systematic reviews that are able to compile the results of several studies and run a global analysis provide fairly comprehensive understanding of what exactly we are looking at. Such results are further bolstered by qualitative analysis, where individual users' experiences can be recorded, transcribed, and coded for common themes.

This is the kind of level of detail that we need to really start to formulate the new paradigm of psychedelic-assisted therapy. My concern is that people throw out 'bad trips', or fail to account for them, because they are afraid that we are swinging the narrative back to the total prohibition era days by talking about them.

I think that's the wrong way of thinking about it. I think having a clear picture (research-based) of both the risks and the benefits will allow us to move forward with expanding access to these critically in-need treatments. Silencing the risks and harms that absolutely do occur only leads to a fear and speculation-based narrative that gets us no further and will only continue to perpetuate bias and misunderstanding.