Set, setting, and clinical trials: colonial technologies and psychedelics

This chapter brings together ethnographic work on technologies of healing, pharmaceutical and psychedelic clinical trials, and ceremonial uses of the Amazonian herbal brew ayahuasca. Building on a review of anthropological work on clinical trials, we argue that randomised controlled trials (RCTs), even psychedelic ones, have been captured by the pharmaceutical industry in its quest to grow profits rather than reduce illness. We track the role that the category of technology plays in continued industrialised, colonial, genocidal, and dispossessive violence. This includes institutions of intellectual property, evidence-based medicine, RCTs, pharmaceuticals, drugs, active ingredients, industrial medicine, diagnostic standards, investment capital, and treatment sovereignty. Using the idea of container technologies, we discuss how psychedelic clinical trials attempt to expand the magic bullet experimentally, to reveal set and setting. We contrast this with arguments by Indigenous scholars that ayahuasca is not a psychedelic, and that ceremonial work cannot be separated from ongoing colonial violence. Holding space for ceremonial work means refusing to know what the problem is ahead of the encounter with the plant spirit. Such settings are explicitly anti-causal, unpredictable, and deeply paradoxical, allowing something to happen that is not reducible to action, intention, or the act of containing.