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This is an invited commentary on Noorani, T. (2021). Containment matters: set and setting in contemporary psychedelic psychiatry. Philosophy, Psychiatry, & Psychology, forthcoming.
© 2021 by Johns Hopkins University Press 217
Culture, Context,
and Community
in Contemporary
Brian D. Earp & David B. Yaden
Psychedelics require cross-cultural,
interdisciplinary study, and we were happy
to see a contribution from the field of medi-
cal anthropology. Such a study holds the promise
of characterizing the ways in which psychedelics
are situated in contemporary societies, both within
and beyond research and clinical contexts. Here,
we offer some friendly criticism of the target article
by Noorani (2021) while also highlighting various
points of agreement and looking ahead to future
research in this field.
Noorani’s article is structured around an orga-
nizing theme of “containment.” The term is not
formally defined, but functions more as a poetic
metaphor, allowing the author to explore various
ways in which psychedelics challenge conventional
boundary-drawing: treatment versus enhancement
(Earp, 2018; Earp & Savulescu, 2020b), medical
versus recreational, scientific versus “spiritual”
(Cole-Turner, 2015; Smith, 1964), and so forth.
Noorani is right to call attention to, among other
things, the therapeutic setting—understood here
as a kind of ‘container’ for psychedelic experi-
ences—while also casting a critical eye over the
background conditions within which those experi-
ences take place.
One relevant set of background conditions
concerns the psychedelic research community
itself: that is, the clinical scientists, therapists, and
(other) academics who are often seen as driving
the so-called Psychedelic Renaissance (Puente,
2020; Sessa, 2013). Amidst calls for vigilance in
maintaining rigorous standards in research and
caution in clinical applications (Yaden, Yaden,
& Griffiths, 2020), analysis of the wider social
context of this research is imperative. Science,
including psychedelic science, is not conducted
in a cultural vacuum, but is rather shaped and
informed by the often-implicit values and assump-
tions of the scientists themselves, as well as the in-
stitutions within which they conduct their research
(Douglas, 2009). Just as importantly, it is shaped
by omission: the voices, perspectives, experiences,
and contributions that are ignored or suppressed
or left out (often those of women and people
color) (George et al., 2020; Williams, Bartlett, et
al., 2020). Noorani tackles both issues, at least
in part: he tries to tell an untold story by giving
a “behind the scenes” look at the contemporary
psychedelic research community, albeit one that
is focused primarily on some of that community’s
more prominent members.
218 PPP / Vol. 28, No. 3 / September 2021
To make sense of this research community,
Noorani draws on his experience as a trainee
in Public Health at Johns Hopkins University,
the institution where most of the recent wave of
experiment-based psychedelic studies has been
conducted. The author supplements this experi-
ence with an ethnography involving interviews
with, and personal observations of, members of
what he terms “the psychedelic community.” But
the community invoked here is broader than the
“research community” of scientists and clinicians
we have just described. For Noorani, it seems to
refer to really anyone with an interest in psychedel-
ics or MDMA, whether privately or professionally,
who may or may not know each other person-
ally, and whose values and priorities may not be,
and often are not, aligned. So, for example, in
characterizing the “the psychedelic community,”
Noorani lumps together research scientists, aca-
demics, and therapists with, among others, those
whom he describes as “neo-shamanic healers,”
“hippies,” “Yippies,” “New Agers,” “amateur
botanists,” and “party-goers.” The extent to
which members of these different groups can be
said to form a coherent “community” (as opposed
to, say, sometimes attending similar workshops or
conferences) is tenuous.
In fact, there are two senses of community that
seem to be invoked in the target article. The first
refers to a group of people who have a shared set
of characteristic values or social norms: their his-
tory, formative experiences, self-understandings,
or socio-political positioning typically tie them
together in an organic fashion, often resulting in
a collective identity or sense of purpose. The latter
sense is conceptually weaker: it refers to a theoreti-
cal assemblage of individuals, possibly clustered
into different factions, who may, in practice, have
little in common apart from a selected high-level
property (e.g., having an interest in psychedelics).
The author, at times, seems to slip between these
two different senses to imply that the “psychedelic
research community”—as we have understood
that term—is surreptitiously or in some other way
unduly connected with “the psychedelic commu-
nity” broadly construed.
For example, Noorani claims that his research
collaborators at Johns Hopkins misrepresented the
way in which they sourced participants for some
of their studies. The author writes: “Despite pos-
turing to the contrary, the clinical research team
was not separate from underground communities
of psychonauts.” These “extra-clinical” connec-
tions are not at that point concretely described,
but rather are loosely characterized as “leaks and
overflows from the constraint of particular set
and settings” (which we understand to mean the
physical and institutional setting of the clinical
research carried out at Johns Hopkins). Because
Noorani uses metaphorical language, both here
and throughout the article, the intended implica-
tion is not entirely clear. However, we propose that
the multifaceted relationship between the Johns
Hopkins scientists and their study participants is
less conspiratorial than what seems to be implied.
Here is a more straightforward way of char-
acterizing this relationship. Some research stud-
ies seek psychedelic naïve participants (people
who have never used these substances), in which
case recruitment for volunteers can draw on any
number of available populations. However, some
studies seek participants who are experienced users
of psychedelics. In these types of studies, partici-
pants who fit this criterion are asked to “spread
the word” within their real-life social networks
(known as snowball sampling) to recruit more
eligible participants. Over time, researchers come
to engage to some extent with network members
as such.
The practice is standard across many drug
studies, not just those involving psychedelics.
In fact, it is standard across studies in general
that seek to involve a special population. In all
such cases, complex ethical and methodological
questions arise as to the appropriate relationship
between researchers and participants, both as oc-
cupiers of relatively well-defined social roles (e.g.,
scientist, study volunteer), and as members of a
local community. Anthropologists, in particular,
have developed a range of theoretical perspec-
tives on how best to negotiate such relationships
(e.g., Paris & Winn, 2014; Simpson, 2007). A key
theme in this literature is the need to be mindful
of potential power asymmetries and competing
interests between researchers and (other) com-
munity members whose lives and experiences are
made the subject of research.
Earp & Yaden / Culture, Context, and Community in Contemporary Psychedelic Research 219
In a recent consensus statement, a large group
of bioethicists and allied professionals argued that
drug users, community members, and other diverse
stakeholders should be, if anything, even more
closely involved in research and policymaking:
for example, by acting as consultants on ethical
research design or helping develop community
impact statements (Earp et al., 2021). Psychedelic
research should be no exception. As Jamilah R.
George and colleagues have argued, the “lack
of diverse expertise informing study designs and
therapy models can result in narrow frameworks
that unnecessarily limit the generalizability [of]
findings” (George et al., 2020) (p. 11). For ex-
ample—as Noorani highlights—in the context
of studies on psychedelic-assisted therapy for
post-traumatic stress disorder, the overwhelming
majority of both researcher/therapists and study
participants have been (relatively) economically
privileged White people (Michaels et al., 2018).
Accordingly, the particular forms of racialized
trauma often faced by people of color have not
yet been thoroughly considered (Williams, Da-
vis, et al., 2020). To be generalizable, “we must
demonstrate that these therapies are applicable to
different types of people; otherwise, we are merely
testing a highly specific therapy on an exclusive
subpopulation under narrow conditions (George
et al., 2020) (p. 11).
Noorani touches on some of these issues, in-
cluding the concern about “narrow conditions” in
which psychedelic research takes place. In particu-
lar, he flags the potential for unrecognized cultural
biases: not only in the abstract design of research
studies (in terms of the sorts of questions asked,
variables measured, and so forth), but also in the
physical design of the therapy settings.
For example, Noorani notes that, in research
contexts, psychedelics are often administered in
what has come to be characterized as a “living
room-like setting.” To unpack the implicit values
that may be baked into the design of such a set-
ting, Noorani devotes a section of the manuscript
to describing how the very notion of a “living
room” arises from “American bourgeois history.”
He states that, until the end the nineteenth century,
the front room of the family home was known as
the “death room,” until a change in nomenclature
was first proposed by “the esteemed Ladies Home
Journal in 1910.”
We have not been able to find a primary source
for this claim, and neither does Noorani cite one.
Nevertheless, Noorani relates that Victorian-era
conformity in the realm of interior design ultimate-
ly gave way to the idea that living rooms should
reflect the unique personalities of their designers.
This claim is then leveraged to imply that the
idiosyncratic design preferences of a single Johns
Hopkins therapist may have served as a model
for the living room-like setting used more gener-
ally in psychedelic research. This setting includes
a “couch, comfortable chairs for the therapists,
and soft lighting—all without sharp corners or
breakable glass.”
We agree with Noorani that it is crucial to de-
velop an awareness of the cultural, historical, and
perhaps even personal contingencies behind the
design of psychedelic studies, down to the physi-
cal details of the environment. It is also tempting
to speculate about the ways in which particular
values associated with “American bourgeois his-
tory” may be inadvertently shaping the experi-
ences of psychedelic research participants. But
we think that other factors are likely to be much
more salient. A medical exam room is not typically
an agreeable place to spend several hours in an
altered state of consciousness. The main reason
to add softer lighting, cozy chairs, and a couch to
such a room is simply to help participants feel a
little bit more comfortable.
Indeed, the very experience of being in a clini-
cal environment—however well-disguised with
furniture, etc.—can be incredibly unnerving for
some participants. Consider the experience of one
woman, herself a therapist, about to undergo an
MDMA-enhanced therapy session:
I was so scared. As a Black woman who grew
up watching my communities torn apart at the
hands of gang violence, the street drug market,
mass incarceration, murder, etc., drugs were not
a friend of mine. Not to mention the legacy and
lasting impact of the War on Drugs in the Black
community, along with the over-policing and
history of unethical medical practice on Black
bodies. I was petrified. I thought to myself,
“You mean to tell me, they want to bring me,
a Black female, into a clinical setting to receive
220 PPP / Vol. 28, No. 3 / September 2021
a psychedelic substance?” It felt like a set-up.
Were the police hiding out somewhere? Would
they bother me (while doing absolutely nothing
wrong, like so many others), find MDMA still
in my system, and take me to jail? I didn’t know.
I just knew that because of the society in which
we live, I did not (and still do not) feel safe. The
concept was inconceivable. (Williams, Reed, et
al., 2020) (p. 131).
Stories like this reinforce the need, raised earlier,
to include diverse stakeholders in all aspects of
psychedelic research, so that culturally compe-
tent therapy becomes the default, rather than the
exception. For many individuals contemplating
psychedelic-assisted therapy, especially those from
groups that have been, and continue to be, subject
to institutionalized mistreatment, any implicit
bourgeois values of the kind that Noorani suggests
may be encoded in therapy settings are likely to
be the least of their concerns.
Noorani mentions but does not expand on the
need for cross-cultural psychedelic research. Such
research is important ethically but can also shed
light on scientific questions about the role that
cultural expectations play in psychedelic experi-
ences. Additionally, the impact of such experi-
ences on close personal relationships—and vice
versa—in different cultural environments needs
to receive more attention (Earp et al., 2020; Earp
& Savulescu, 2020a). This seems to us a research
project for which anthropologists would be par-
ticularly well-suited to constructively collaborate
with other scientists.
We hope to see cross-cultural psychedelic
research done by interdisciplinary teams of re-
searchers and scholars informed by, and involv-
ing, relevant communities. In short, to move this
field forward, we need to integrate medical and
neuroscientific perspectives with a much deeper
awareness of the context—cultural, historical,
political, and interpersonal—in which psychedelic
studies and experiences take place.
Acknowledgements Thank you to Adam Gilbert-
son for feedback on an earlier draft.
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Background: Despite renewed interest in studying the safety and efficacy of psychedelic-assisted psychotherapy for the treatment of psychological disorders, the enrollment of racially diverse participants and the unique presentation of psychopathology in this population has not been a focus of this potentially ground-breaking area of research. In 1993, the United States National Institutes of Health issued a mandate that funded research must include participants of color and proposals must include methods for achieving diverse samples. Methods: A methodological search of psychedelic studies from 1993 to 2017 was conducted to evaluate ethnoracial differences in inclusion and effective methods of recruiting peopple of color. Results: Of the 18 studies that met full criteria (n = 282 participants), 82.3% of the participants were non-Hispanic White, 2.5% were African-American, 2.1% were of Latino origin, 1.8% were of Asian origin, 4.6% were of indigenous origin, 4.6% were of mixed race, 1.8% identified their race as "other," and the ethnicity of 8.2% of participants was unknown. There were no significant differences in recruitment methodologies between those studies that had higher (> 20%) rates of inclusion. Conclusions: As minorities are greatly underrepresented in psychedelic medicine studies, reported treatment outcomes may not generalize to all ethnic and cultural groups. Inclusion of minorities in futures studies and improved recruitment strategies are necessary to better understand the efficacy of psychedelic-assisted psychotherapy in people of color and provide all with equal opportunities for involvement in this potentially promising treatment paradigm.