Over the coming days there will be a lot written about Channel 4’s ‘Drugs Live: The Ecstasy Trial’ and much of it will be better informed, and better written, than anything I have to say.
One important ‘read’ to better understand the first programme was written three and a half years ago. I’ll explain.
Though not under the same strictures regarding ‘balance’ as the BBC, Channel 4 knew that it had to include voices opposed to this trial of MDMA. Since the emphasis of the programmes is on science, it decided it would not be appropriate to bring in the ‘usual suspects’ to provide the ‘anti’ voice and turned, instead, to Professor Andy Parrott from Swansea University. Professor Parrott is a prohibitionist who claims the science shows that MDMA is a dangerous substance. This article by the BBC’s Mark Easton gives a clear identification of the way Prof. Parrott cherry picks his data to support his point.
But my reason for writing, today, is to do with ‘set and setting’; the notion that the state of mind of a drug user, pre-use, and the circumstances of use have an impact on the effects of the substance.
It has to be remembered that the purpose of this trial was to obtain images of the activity in the brain under the influence of MDMA rather than attempt to mirror the experience of recreational users. For all the subjects, the ‘setting’ was, therefore, totally unlike the stereotypical club environment where ecstasy is perceived to be taken. (I make the point about a ‘stereotypical’ environment because many of the deaths attributed to ecstasy occur in men at home alone taking a cocktail of drugs and not solely ecstasy.)
Nonetheless, even without the setting of a club full of people looking for a good night out, all but one of the subjects who participated in the first programme said they found the experience enjoyable and felt well-disposed toward other people as a result.
The one exception was the former SAS soldier whose ‘set’ was very different from the others. Though he said he had agreed to participate in the trial because of the suggestion that MDMA might be a useful treatment for sufferers, including soldiers, of post-traumatic stress disorder (PTSD), the ex-sergeant seemed to go in with the attitude that he was going to demonstrate that he could defeat the drug’s attempts to change his mood.
As a result, his experience of the trial was that it produced anger and frustration that he was having to mentally battle to resist the effects of the MDMA. Interviewed, he made some comment about ingrained training to combat torture but I don’t think there was anything subconscious about his response. I believe he was determined, consciously, not to let the MDMA affect him. As a result, I’m not sure his contribution to the trial has much value when it comes to the possibility of using MDMA for people desperate for help in overcoming PTSD.
I’ve come across this stubborn resistance to help before. When I worked at the Alnwick Garden, the Duchess of Northumberland went to see a hypnotherapist to see if her tobacco addiction could be broken. Though she realised there was something perverse about attending meetings to discuss how to discourage young people from taking drugs and excusing herself to go outside for a cigarette, I think it was family pressure that led her to go. Certainly, she sounded quite proud of herself when she told me how the hypnotherapist had not been able to exert any influence over her thinking and she continued to smoke. If you don’t have the right ‘set’ you cannot expect the ‘right’ results.
There are many examples of the importance of ‘set and setting’. I want to focus on two of them.
The first concerns a plant that will be back in the news shortly when the Advisory Council on the Misuse of Drugs (ACMD) issues its report to government later this year; Catha edulis, khat. The effects of chewing the leaves are described variously as no different than having a strong cup of coffee or being highly addictive and dominating the lives of users. Some of that spread of outcomes may be the result of differences in the strength of the particular plant being chewed but, I believe, a lot has to do with ‘set and setting’.
The earliest descriptions of khat use are mostly from western travellers to Yemen and north-east Africa and are based on observation of khat users or discussions with them. In 1917, however, Charles Moser, a former American consul in Aden, wrote an article for the National Geographic Magazine detailing his own experience of trying it. In spite of chewing ‘a huge supply of leaves’ for two hours he felt no effects. That night, however, he found he could not sleep. Most khatting sessions are based on users bringing their own supply but, occasionally, a generous host will offer his khat to visitors. Descriptions suggest that this khat always produces stronger effects. This may be because the host is wealthy and can afford better quality (though the wealthy are thought to favour younger, softer leaves that have a lower content of the active ingredients) but it may also be the unconscious desire not to give offence to the host.
This notion of not offending a superior brings me to the other example of the importance of ‘set and setting’. The Koryak people of the extreme north are thought to have been the first to discover that the urine of someone who had eaten the Amanita muscaria, fly agaric, mushroom had similar hallucinogenic properties to the mushroom itself.
The mushroom was used in tribal rituals with the headman or religious leader eating fresh mushroom and passing his urine to the next in line to drink. The second man, in turn, would offer his urine to the third and so on through the whole group. It is said that the effects of the drug persisted all the way to the lowliest in the group though this has never, to my knowledge, been tested. I suspect recruiting trial subjects might prove difficult.
Clearly, not experiencing hallucinations after drinking a superior’s urine would be a grave insult so it is likely that ‘set and setting’ played a very important part in the effects seen.
One thing missing from last night’s programme was any information on the experience of subjects given a placebo. We know that a quite a lot of the pills sold to clubbers as ecstasy contain little or no MDMA yet they seem to have the desired effect. I’d be interested to find out whether, absent the club ‘setting’, subjects receiving the placebo felt any effects at all.
Perhaps, we’ll find out when the second programme airs tonight.
If you’re reading this later than today, follow the link above and you should be able to watch both programmes on Channel 4’s ‘On Demand’ service.
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