Tehseen Noorani

ABSTRACT:While the literature on psychedelic medicine emphasizes the importance of set and setting alongside the quality of subjective drug effects for therapeutic efficacy, few scholars have explored the therapeutic frameworks that are used alongside psychedelics in the lab or in the clinic. Based on a narrative analysis of the treatment manual and post-session experience reports from a pilot study of psilocybin-assisted treatment for tobacco smoking cessation, this article examines how therapeutic frameworks interact with the psychedelic substance in ways that can rapidly reshape participants' identity and sense of self. We identified multiple domains relating to identity shift that appear to serve as smoking cessation mechanisms during psilocybin sessions, each of which had an identifiable presence in the manualized treatment. As psychedelic medicine becomes mainstream, consensual and evidence-based approaches to psychedelic-assisted identity shift that respect patient autonomy and encourage empowerment should become areas of focus in the emergent field of psychedelic bioethics.

I am grateful to the authors for their comments, and for the opportunity to respond. To clarify my approach, I sought to discuss the centrality of ‘set and setting’ at descriptive and normative levels in the Psychedelic Renaissance by focusing on the language of containment prevalent during my ethnographic research. Inspired by the study of material culture, I took up certain questions that can be asked of any container—how they are constructed and maintained, how leaks and overflows are dealt with, the work done by their boundaries, and relationship of these containers to their contents. There are undoubtedly more questions but these are the ones I found fruitful to think with. My goal was to explore how the...

We argue that successful participatory mental health organisations should be seen as ‘engines of alternative objectivity’ rather than as the subjective ‘other’ to objective science. With the term ‘alternative objectivity’, we point to collectivisations of experience that are different to biomedical science but are nonetheless forms of objectivity. Taking inspiration from feminist theory, science studies and sociology of culture, we argue that participatory mental health organisations generate their own forms of objectivity through novel modes of collectivising experience. Through two case studies, the Hearing Voices Movement and Stepping Out Theatre Company, we demonstrate how successful participatory organisations can be seen as ‘engines of alternative objectivity’ rather than as the subjective other to objective, biomedical science. The Hearing Voices Movement cultivates an ‘activist science’ that generates an alternative objective knowledge through a commitment to experimentation, controlling, testing, recording and sharing experience. Stepping Out distinguishes itself from drama therapy by cultivating an alternative objective culture through its embrace of high production values, material culture, aesthetic standards and critical review processes. A crucial aspect of participatory practice is overcoming alienation, enabling people to get outside of themselves, encounter material worlds and join forces with others.

We argue that successful participatory mental health organisations should be seen as ‘engines of alternative objectivity’ rather than as the subjective ‘other’ to objective science. With the term ‘alternative objectivity’, we point to collectivisations of experience that are different to biomedical science but are nonetheless forms of objectivity. Taking inspiration from feminist theory, science studies and sociology of culture, we argue that participatory mental health organisations generate their own forms of objectivity through novel modes of collectivising experience. Through two case studies, the Hearing Voices Movement and Stepping Out Theatre Company, we demonstrate how successful participatory organisations can be seen as ‘engines of alternative objectivity’ rather than as the subjective other to objective, biomedical science. The Hearing Voices Movement cultivates an ‘activist science’ that generates an alternative objective knowledge through a commitment to experimentation, controlling, testing, recording and sharing experience. Stepping Out distinguishes itself from drama therapy by cultivating an alternative objective culture through its embrace of high production values, material culture, aesthetic standards and critical review processes. A crucial aspect of participatory practice is overcoming alienation, enabling people to get outside of themselves, encounter material worlds and join forces with others.