We need an Armistice

in the War of Words

Issue 2 written 2000. W O'Mara

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Yet choice is as much deceptive and capricious as it is merely free, and it casts a very long shadow. It is interdependent, socially rooted, and it future is, at best, uncertain. Grappling with such concepts is not easy, and the human mind dislikes not being able to understand and deal with situations beyond its comprehension and experience. Unfortunately, it is then we fill the knowledge gap with our own preconceptions, limited attitudes and ideas.

So, nothing is straightforward, especially in the field of drugs and there is no better time to be asking new questions, as even a cursory enquiry into our current policies on the treatment of 'drug abuse' reveals the absolute poverty of our past methods and ideas and quickly reaches the firm conclusion that the present system of sanctions, backed up by punitive treatment regimes, is unsustainable in moral, ethical, scientific and economic terms.

It is the time to question the medical profession and its claims to authority based on rather dubious and esoteric knowledge and exclusivity. As Turner (1987) pointed out in his book Medical Power and Social Knowledge -

It has become apparent that rather than social responsibility and an ethic of service, some members of the medical profession have used their powerful position to exert inappropriate social control over areas of vulnerable peoples lives.

Treatment centres, like the NHS Drug Dependency Units, are places of reprehensible attitudes and unbridled, unregulated power for the employee - psychiatrists and psychiatric nurses - and humiliation and powerlessness for the drug users. The compulsory therapy breeches every tenet of the therapeutic relationship. The negative effects for the client of this inequity and the internalization of the perceived and felt powerlessness is psychologically well documented. There is no social or medical equality for drug users. They are forced to live within an unholy alliance, dependant on programmes that most often have little sympathy or understanding of their chemical/biological dependence and certainly it seems, very little concern for their overall health. They are never patients or clients. Only 'not to be trusted' junkies. They are the non deserving. The self inflicting.

The appalling discrepancies, the abuse of power and the lack of a firm research base exists alongside minimal accountability and negative attitudes, all hindering the prospect of developing more humane, holistic and respectful treatment and care. This is largely because we, as a society, turn our heads away. I would further suggest therefore, that where there is a drugs war, it's a war of bigotry, hypocrisy and vested interests and the casualties in that war are our children.

Oppressing people is no answer to anything and plays no role in treatments of any kind. By all means, let us examine drug use and its costs. But let us include, amongst the headings, alcohol, prescribed drugs, nicotine and so on. And then let us ask the honest questions, whilst refraining from the inflammatory, lacerative language we now use to describe the 'illicit' drug scene. If we can become less hysterical and more reflective, we may be able to analyze our own proclivities and be able to ask the question - Why as a society have we become drug dependant.

Now, it is with restrained anger and anguish that I try to help my daughter fight prejudice on all fronts. Getting through this barrier to access health care is intolerably stressful because she is seen primarily as an injecting drug user. What this obscures is a complete person - intelligent, young, often ill, trying to live courageously with HIV and HEP C. But there is little compassion. And all I can do is to be there and help her insist on her right to be treated as an individual. Fear is certainly blinding. It doesn't like reason. It doesn't like truth. It silences families who have addicted children. It prevented my daughter's partner from telling her he had HIV. It keeps us silent and promotes a dangerous ignorance. As Susan Sontag (1990) said in her essay about AIDS The way we live now -

"But how does one fight armored with silence? How does one tell others what it means to be dying of AIDS in silence? The man dying of AIDS is spoken of - he does not speak……."

Tragically, I have to add, the drug user dying of AIDS is not even spoken of.
What we now need is the courage and creativity to develop a new paradigm - one that excludes the language of prejudice, neglect and punishment and actively encourages and embraces the voices of those addicted. It is time.

Wendy O'Mara

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Pejorative language, partial facts, lies, spurious research, plus downright hypocrisy are leading us ever backwards into a war strategy and a structure of prejudice that helps to justify neglect and medical ineptitude and ignore the ever rising health problems and death toll amongst drug users.

My daughter has been using heroin for approximately 20 years. She has been Hepatitis C (HCV) positive since 1989 and was diagnosed HIV seropositive in 1995. Much of that time as a Clinical Psychologist and Lecturer, I have had to stand by and hear her (and her friends) described by my colleagues- and by the outside community- in all the derogatory terms commonly used to describe addicts. I have watched as her health issues have been misdiagnosed or ignored; watched as she has been shunted from mainstream medicine to drug dependency clinics and back again, and watched as the full impact of the unavailability, prejudice and illegality of heroin has helped destroy her health and push her to the brink of despair. Such blatant and cruel discrimination and its sad consequences continually shock and appalls me.

By corralling, labelling and punishing our young in this way, we enter into an intractable mind set which does nothing for ourselves, our society, or for our understanding of the drug issue in all its complexity. There seems no reason except fear and prejudice to keep insisting on the addicts 'differentness', on their separation, as if their label makes them one thing and as if that was all human life was about. As Edward W. Said noted in his book Culture and Imperialism (1993) ;

"Survival, in fact, is about the connection between things… .it is more rewarding and more difficult, to think concretely and sympathetically about others, than only about us. This means not trying to rule others and not trying to classify them or put them in hierarchies, otherwise we would remain committed more to the exclusions and reactions of prejudice than committed to the freedom of real knowledge".

But unfortunately, we have already created an image of heroin and drug addicts and constructed a discourse that purposely evades open analysis and in doing so have satisfied our own inadequacies and fear. We have handed concentrated, in fact supreme power to the psychiatric model of health, the Home Office, the Police, with their enforced treatments and legal sanctions and deprived drug users of all their civil liberties.
As one Home Office official said in 1982 - and it remains the same today; ' Addicts have no rights simply because they are addicts',(Trebach, The Heroin Solution, 1982).

The politicians, the hospitals, the media, the community, go on discussing 'addicts' in the same horrible and negative language used help to structure a world in which drug users are assigned to a subordinate and almost dehumanized position - a position that allows them no voice in their own treatment; no voice in policy development; no voice in how the press behave; no voice in how drug educators educate. In short, no personal narrative.

Yet heroin itself is a relatively benign drug browse through the scientific literature in a calm and rational way - especially when compared to many others. Our stubborn refusal to should be questioned. It has nowhere near the costs of socially acceptable alcohol abuse, yet the word provokes hysteria. It is reviled. Just as the people who use it are reviled. That is, the visible people who are to poor to buy it legally and end up stealing, becoming ill and are eventually seen on the streets and in our prisons.

Many drug workers, doctors and so on, advise parents to throw their children out once they have discovered they are on drugs (part of the rock bottom/tough love fallacy). For the majority, this is a callous and tragic solution that has no evidence base. It breaks down the family, drives the drug user further from the mainstream into their own cultures and deeper into their addiction. This, of course, further compounds the problem, because drug users are not a homogenous group. They come from many different backgrounds and they start taking drugs for many different reasons - some of them social (just like people begin to drink alcohol or smoke nicotine); some of them from social disaffection (homelessness and poverty); some from curiosity or availability and yes, sometimes to fill a need within themselves.

They are individuals. Individuals who made a choice, one might say. Yet I wonder how many of those young people would have knowingly chosen heroin or some other substance if they were completely cognizant of the facts or if they knew they were destined to become society's outcasts? And perhaps, worse still, if they fully realized that that same society would never allow them re-entry with their self respect and dignity intact?

Words like choice, fear, bigotry, hypocrisy, misrepresentation, all need our analysis. The dialectic between representation and reality. The politics of exclusion. Our fears about drugs; of HIV; of 'differentness'. The very middleclassness of our discourse about health. For example, let us just take the word choice - a revered hallmark of democratic consumerism. We promote it as it implies freedom; reason; having all the facts and choosing between them; knowing all the consequences of your choice.