The Importance Of Setting

During my clinical work with LSD, I have made numerous observations indicating clearly that the physical and interpersonal elements of the setting can also profoundly influence the nature of the LSD reaction. Most situations in which external stimuli have a strong influence on the subject and modify his or her LSD experience can eventually be understood in terms of the content of underlying dynamic governing systems and their complicated reciprocal interaction with the environmental stimuli. If the setting involves elements that characteristically occur as components of positive COEX systems or positive perinatal matrices, they tend to facilitate the emergence of pleasant or even ecstatic experiences. Since such experiences have a great healing potential and therapeutic value, this association should be systematically utilized in psychedelic sessions and as many elements as possible that are related to positive systems should be incorporated into the treatment setting. The importance of this principle was empirically discovered and is utilized by psychedelic therapists.

The treatment room should be quiet, comfortable, tastefully decorated, and furnished in a homelike fashion. Much attention should be paid to the choice of fabrics, pictures, and flower arrangements. Beautiful natural scenery or certain objects that reflect nature's creativity usually have a very positive influence on the LSD experience. This can be understood from the fact that visions of beautiful landscapes occur in the context of BPM I as part of the intrinsic symbolism of this matrix. Similarly, memories of excursions to or stays in beautiful and nourishing natural settings constitute important layers of some positive COEX systems. There exists sufficient empirical evidence that the ideal location for psychedelic facilities of the future would be in a natural environment such as by mountain lakes, on ocean beaches, on little islands, in deserts, in wooded areas, or in old parks. Clean water in any form seems to have a particularly powerful impact on LSD subjects; a swim, shower, or bath can frequently dispel negative experiences and facilitate an ecstatic reentry. One of the most significant factors of the setting is good stereophonic music of high aesthetic quality.

In contrast, elements that are usually associated with negative COEX systems tend to precipitate unpleasant LSD experiences when they are part of the setting or occur as accidental stimuli. An extreme example of this would be a small, ugly, claustrophobic and tastelessly furnished treatment room, with a window overlooking unpleasant scenery such as industrial areas with factories, junkyards, high smokestacks, and an atmosphere of chemical pollution. Loud human voices, unpleasant music, the noises of machinery, and sounds of sirens, ambulances, fire-engines and jets, exemplify the interferences that can have a very disturbing influence on a psychedelic experience. For the same reason, the setting of the sessions should not remind the subject of a hospital, doctor's office, or laboratory. As a result of COEX and BPM dynamics, medical elements such as white tiles, medicine cabinets, white coats, syringes, vials with pills, and generally sterile surroundings tend to facilitate experiences related to diseases, operations, accidents, pain, agony, and death. For obvious reasons, the traditional atmosphere of psychiatric facilities can, in addition, facilitate experiences related to prisons, concentration camps, or military barracks.

Similar relations exist in regard to the elements of the interpersonal setting of the sessions, In this sense, the optimal arrangement seems to be the presence of a few well-known persons whom the subject trusts; this generally has a very favorable influence on the course of the session. As will be discussed later, a therapeutic dyad that combines the male and the female element in an atmosphere of trust seems to be the ideal solution. Negative consequences can be expected from frequent changes in the interpersonal situation, where many persons unknown to the subject appear and disappear in an unpredictable way. This is the case with LSD experiences in party settings or even for some sessions in university hospitals where medical students occasionally drop by, observe the subject for a short time, make jokes or inappropriate comments, and leave. The same is true for experimental settings in which the subject is sent from one testing situation to another, is wired up and attached to various gadgets, has to undergo strange laboratory examinations, and is asked to urinate into containers and give samples of blood every hour on the hour.

It has already been mentioned that certain physical stimuli from the environment can change the session in a very dramatic way if they happen to be similar to or identical with the elements of a COEX system or a perinatal matrix which is activated at that time. This may be observed in connection with certain accidental sounds; thus barking of a dog, sound of a jet, explosions of fireworks, factory or ambulance sirens, or a particular tune may have a specific biographical meaning that can elicit quite unexpected responses from the subject. Sometimes the general character of the treatment room, specific pieces of furniture and trivial objects, or certain aspects of the view from the window can function as powerful selective triggers of experiences.

The same mechanism can be observed in regard to the people the subject sees during the session. Various persons tend to evoke quite specific and differentiated responses. We have observed numerous situations in which dramatic reactions occurred every time certain nurses entered the treatment room. The manifestations triggered in this seemingly innocent way covered a rather wide range and involved such diverse reactions as violent shaking, nausea with vomiting, intense headache, disappearance of colors from the vision, and hallucinations of a particular color. Conversely, we have also noticed sudden experiences of light, ecstatic feelings, a sense of tranquility, or feelings of emotional nourishment. Occasionally the entire character of the session changed in a specific way with the change from the day shift to the night shift, when a new team of nurses entered the patient's experiential field. With some of the nurses the patients felt safe and protected and had predominantly positive experiences; with others, the same subjects on the same session day became anxious, hostile, or suspicious. These differences were to a great extent individual and were mostly biographically determined. We did not find that some nurses always had with absolute constancy and just because of their personalities, a positive or negative influence 011 all the subjects.

Subsequent analysis usually provided an explanation of these idiosyn crasies in terms of the personal history of the subject and his or her interaction with a particular nurse. In some instances the clue seemed to be physical resemblance of the nurse to a relevant figure in the subject's past; in others, similarity of behavior patterns, habits, or approach to the subject. Sometimes the patients' reactions could be explained by the fact that they put the nurse into an interpersonal category toward which they had either a particularly good or a conflict-laden attitude, for example, a possible sexual partner, dangerous seductress, erotic rival, competitor, maternal woman, understanding person, domineering type, authority figure, or personified superego.

Successful therapy with LSD requires intimate understanding of the significance of set and setting, so that these factors become powerful tools in the therapeutic process instead of operating in an elemental fashion and presenting unpredictable problems and complications.

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