Set and Setting at Scale: Institutional Containers and the Governance of Psychedelic Therapy

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 16. The State, Legal System, and Healthcare Policy

Abstract

Renewed interest in psychedelic substances in Canada has generated multiple regulatory pathways, including randomized clinical trials, medical exemptions for end-of-life distress, and legally protected religious use. Although psychedelics are widely described as sensitive to “set and setting,” sociological research has paid limited attention to how institutional settings themselves shape what a psychedelic becomes. This paper analyzes three paradigmatic regulatory “containers” to show how background assumptions, incentive structures, and epistemic commitments within each domain actively constitute psychedelic experience.

Drawing on policy documents and a critical review of the scientific and sociological literature, the paper examines how each pathway structures who may access psychedelics, who is authorized to administer them, what substances and practices are legitimized, and which outcomes are prioritized. Clinical trials privilege standardization, reproducibility, and measurable symptom reduction. End-of-life pathways create space for existential and spiritual distress yet remain tethered to individualized medical models of care. Religious frameworks foreground transcendence and collective meaning-making while downplaying biomedical metrics of efficacy. Across cases, psychedelics appear malleable, yet this plasticity is structured by regulatory form rather than pharmacological properties alone.

Sociologically, the paper advances a framework for analyzing how therapeutic technologies are constituted through governance rather than merely regulated after innovation. Rather than assuming that medicalization consolidates authority under a single epistemic framework, it demonstrates how plural institutional logics coexist and selectively authorize different forms of expertise, suffering, and transformation. Institutional containers thus actively produce definitions of therapy, legitimacy, risk, and appropriate outcomes. Psychedelics offer a strategic case through which to examine how health governance shapes the boundaries of legitimate healing in contemporary health care.

Authors

• Sarah Badr, McGill University

• Phoebe Friesen, McGill University