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.
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.
