The Political Psychology of Drugs

Psychiatrists and psychologists are a lot like children. They exult
upon discovering the obvious, gleefully assume that nobody else ever
knew it before, construct entire worldviews based upon their unique
insights, then happily inflict them on the rest of us. Most of the
time, you just want to smile, pat them on the head and croon, "That's
nice, dear." But every so often-like children telling truths and
asking question the grownups don't want to consider-it's wise to
listen.

Forty years ago, psychiatrist Robert Jay Lifton popularized a notion
that had been around for millennia, but few had cared to study. Lifton
called it "psychic numbing." His early work with survivors of the
Hiroshima and Nagasaki atomic bombings showed him people who, after
their immersion in catastrophe, lost the normal range of emotions.
They could no longer feel. It's a condition, he later found, common to
concentration camp survivors, combat veterans, and survivors of other
traumatic situations...and the perpetrators of those situations. But
by the 1980s, he was wondering whether there was something so
inherently stressful and traumatic about simply living in modern
America, that psychic numbing, to a greater or lesser degree,
afflicted us all.

At one level, the idea's ridiculous. You think living in America is
hard? Try Zimbabwe or Afghanistan. At another level, it's obvious. Of
course, we all numb ourselves to some degree to get through the day;
as we age, we lose our youthful intensity. Such is life. But when you
think about the question a bit more deeply, in the context of how we
live today, it becomes more troubling. According to Lifton, survivors
of holocausts and trauma adopted psychic numbing unconsciously, as a
defense mechanism; there is also evidence that extreme trauma produces
long-term physical changes that affect the mind. But today, in the
United States, the most over-medicated country on earth, millions of
us choose numbness as a way of life...and our doctors, insurance
companies, and pharmaceutical manufacturers are only too happy to
oblige us.

Why? And could it be that we do to ourselves-an ugly question we'll
return to later-what Soviet psychiatrists did to dissidents and other
"undesirables"-medicate them into an impotent stupor?

And if so, why?

For many years now, doctors and others have warned us of the dangers
of medicalizing the normal human condition. But today, such
medicalization is big business. Some of it reflects pure vanity, or at
least the understandable desire to improve upon one's original
endowments. "If Nature Didn't, Warner's Will"-so ran a venerable
advertising slogan for padded bras. Today, we have implants and
various other forms of cosmetic plastic surgery, from nose jobs to
foot jobs. Cosmetic dentistry has returned serious profit-making
potential to a profession that, a couple decades ago, had virtually
been strangled by stingy dental plans. And then there's Botox (enough
said). Think of all the money that goes for all this. Then think cash,
since insurance companies rarely if ever cover such procedures.

Then think, too of all the money that goes to treat those conditions
which are the natural consequences of a poor lifestyle: smoking,
drinking, drugs, obesity, lack of exercise.

In short, we turn increasingly to medicine not only to fix our real
and imagined physical imperfections, but also to deal with maladies
that are, more often than not, our own fault. And what's true for our
bodies is, more and more, also true for our minds.

Before going any farther, a disclaimer.

I am a firm believer in science-based medicine, including medication-I
have seen lives saved by modern medicine and medications. I have seen
people get their minds back, thanks to psychoactive drugs. We should
all be incredibly grateful, or at least rationally cognizant, of the
accomplishments of the pharmaceutical industry. Nor should we ever
forget the enormous costs of developing and certifying new drugs or
begrudge them their legitimate profits. (After all, unless you're
working for your own profit, you're either a volunteer or a slave.)
But this neither explains nor excuses the pandemic of medication that
we have chosen for ourselves as a means of evading the consequences of
our own choices and the ordinary stresses and disappointments of life.

Yes, they push this stuff on us. But in the end, we choose. And more
and more, we choose psychic numbing as a way of life.

There are three major categories of drugs that concern us as citizens.
Yes: as citizens. For here we're talking less about individual
patients and choices than what it means for us, as a citizenry, to
choose to be so drugged. Put differently: our bodies and minds belong
to us as individuals, but what we do to them has enormous political
and cultural significance.

The drug categories are:

Anti-hypertensives. (Blood pressure drugs.)
Anti-hyperlipidemics. (Cholesterol-lowering drugs.)
Anti-depressants. (Plus other mind-and-mood-altering, psychoactive
drugs)

In 2005, drugs were provided, prescribed, or continued (what is known
as a drug mention) some two billion times in some 679.2 million office
visits. The most common drug mention was the anti-depressant class,
with a 5.3% share of drug mentions-107,070 thousand times. Closely
following anti-depressants were anti-hypertensive and hyperlipidemia
drugs, with a 5.2 and a 5.0% of drug mentions. These are drugs you
take when your blood pressure and cholesterol are too high from eating
too fatty a diet and not exercising enough. (National Ambulatory
Medical Care Survey, 2005 Summary, Advance Data from Health and Vital
Statistics, Centers for Disease Control, Number 387, June 29, 2007,
pp. 5, 34.)

These three categories of drugs alone are clearly a multi-billion
dollar business, but it is not so much the sums of money that should
concern us (grave though that concern ought to be), as for what the
sheer numbers of these prescriptions say about us.

With fully two thirds of Americans overweight or obese, and all that
entails, and our economy and political system in serious trouble, it
is arguable that there's a connection. But it may be a far from
obvious connection. When we speak of legal "lifestyle" drugs, we
usually think of Botox, Viagra and such. Perhaps it is time to include
these three categories as well. What does it mean, as a nation and a
civilization, when so many millions of us choose self-destructive
lifestyles and then try to medicate away the inevitable results, and
when so many of us choose to numb our minds?

The first meaning is that, when both the drug makers and the health
care providers make it so easy for us, they're not just doing
something to us. They are saying something about us.

For economic reasons, drug companies advertise these items heavily to
consumers. As with all advertising, the goal is not to induce an
immediate decision for the product, a pharmaceutical "Big Mac Attack."
The goal is to bring these drugs into the realm of the known and
therefore into the realm of the acceptable and desirable. So when the
patient sees the doctor, he or she "knows" what to ask for or about.
Sadly, these ads, the TV commercials especially, are not particularly
informative. Like all advertisers, they emphasize what they want you
to know and ignore or elide the rest ("Side effects are generally mild
and may include death, impotence and an uncontrollable desire to howl
at police cars").

Also, the average patient does not read research studies. Even if he
or she did, much pharmaceutical company data is not available to the
public (even though, in no other branch of science, is secret data
accepted as valid: you can either replicate results or you can't).
Even studies that are publicly available are written in willfully
obscure (not to say illiterate) language. Further, doctors and their
employers are afraid of being sued for not providing the proper
standard of care and practice "defensive medicine," which often means
over-treating and over-medicating their patients. Current modes of
practice also encourage prescription-writing, since most doctors do
not have the time to sit down with a patient and talk about how proper
diet and exercise can eliminate or ameliorate a lot of physical and
psychological problems. Anyway, there's no money in it.

But most of all, Americans as a citizenry have become passive and
stupid, increasingly unable to access our own brains. Let's be clear
on this. The much-lamented "Dumbing Down of America" is a producer-
driven phenomenon, the better to push their wares. Dumbing Down is not
simply a matter of no longer reading Aristotle or being unable to name
Supreme Court justices or state capitals. It is about being encouraged
to lead lives of indolence and torpor and then seek medical fixes. We
have to face this, too. There's no real money to be made by our eating
less, exercising more, and solving (or learning to live with) our
various problems and travails. No major corporation profits from our
health and self-sufficiency. And we know it.

But what do we do with this knowledge? Some of us resist, some give
in; most of us do both. But more and more of us seek fixes. This
brings us to our third category of drug: anti-depressants and all the
other mood-and-mind-altering drugs now available to those who want
them. Again, this is not a matter of medicating those whose serious
conditions warrant it. When the choices are life and death, collapse
or functionality, and medication helps, so be it. And thankfully so.
Nor is this about those who might try such medications during periods
of extreme stress, then shed them afterwards. It is about those
millions of our fellow citizens for whom drug-induced and maintained
psychic numbing is a chosen way of life. And by psychic numbing I
don't just mean inability to feel. I mean also drug-produced
artificial cheeriness and tranquillity, especially when such moods are
both practically destructive and morally wrong.

America has chosen to medicalize normal human emotions and conditions.
The Centers for Disease Control inform us with a straight face that
"In 2001-2002, an estimated 16% of noninstitutionalized adults had a
major depressive disorder at some point in their lifetime, with 7%
having had a major depressive episode during the 12 months prior to
interview. The detrimental effects of depressive symptoms on quality
of life and daily functioning have been estimated to equal or exceed
those of heart disease and exceed those of diabetes, arthritis, and
gastrointestinal disorders. Access to both accurate diagnosis and
appropriate treatment of depression is necessary to combat this
prevalent and debilitating disease." (National Center for Health
Statistics, Health, United States, 2007: With Chartbook on Trends in
the Health of Americans (Hyattsville, MD: 2007), 88.)

Are they kidding?

Thomas Szasz is an eighty-something psychiatrist who, for half a
century, has been trying to tell us that "mental illness" is both a
metaphor used to control people and, in many cases, a "game" chosen by
the "mentally ill." He once demonstrated the power of diagnosis, of
labeling, to his students by describing a person, a woman, with her
problems and troubles. Then he offered his students a choice. They
could describe her as depressed and medicate her to better conform to
social expectations. Or they could acknowledge her human unhappiness
and need for contact with other human beings. Szasz was not saying
that mental pain was not real. He was saying that mental pain-or human
depravity and cruelty-cannot be treated with drugs or medicated away.
At least, not routinely, in order to avoid deeper issues. Existential
anguish is not a broken arm or even a bad back. And if we describe the
suicidal as depressed, then it means we do not have to take seriously
the fact that suicide often looks a lot like a refusal to participate
in one's own degradation, when effective self-defense is impossible.
If we describe as mad our many homeless, we do not face the fact that
some of them have no outlet for their very real energy and creativity,
are not permitted to use their capabilities to make a living, although
we are buried in expensive garbage, be it electronic toys or
"entertainment."

Science and common sense tell us that we do not live in the abstract.
We are creatures of our time and place. As the Spanish philosopher
José Ortega y Gasset once put it, "We are what the world invites us to
be." The sad truth is that, despite all the incessant invocation of
America as the Land of Everything Good, the American Way of Life has
come to be disgusting. It invites us to be trash.

And we know it.

We the People were once citizens of a genuinely great Republic-and
were treated as such by the institutions of that Republic. In our
lifetimes, however, we have seen our nation-and the overwhelming
majority of people in this country-deliberately impoverished in
material welfare and in soul. We have come to be regarded as vehicles
for consumption and wage slaves, whether at the bottom of the pyramid
or in the middle. Whatever problems we have, the answer is always the
same. Consume something. We are encouraged thus because there is
profit in rendering us thus. Including the billions to be made
peddling psychoactive drugs.

If we have been sexually assaulted or abused, we are offered pills. If
we have participated in combat, especially in a war that makes no
strategic sense and is widely ignored by the general population, we
have other pills. If we are blindsided by a divorce or tormented by a
vicious ex, or devastated by the death of a beloved spouse, we have
pills. If our jobs have been exported or our hours cut to make rich
people richer, we also get pills: at least as long as we have health
insurance and sometimes even after because it wouldn't do to go on a
shooting spree, mostly because it's not possible to shoot the people
to blame. If we are just plain anxious about our lives in what America
today has become, because deep down we know life is not supposed to be
like this, and worried about the fate of our nation and our children,
we also have pills.

Of course, anyone who claimed to be personally depressed by the state
of our nation and asked for pills would probably be refused...at least
until he or she could come up with the standard personal reasons for
the request. Anyone who claimed that he or she was being driven crazy
by what our culture has become would also be diagnosed as suffering
from personal problems and denied help until they could come up with
the appropriate terminologies. Have we seen this before?

Yes.

In Europe and the United States, the history of psychiatry is bound up
with the life stories of women, many of them middle-class,
intelligent, educated, who were literally being driven crazy by the
strictures their societies placed upon them and their lives. Freud,
who famously redefined normality as an unattainable ideal, not a norm,
derived much of his theory from treating and studying such women. In
England and America, women who suffered under the restrictions of
custom, society and law were often diagnosed as crazy for wanting to
do such bizarre things as vote and work. Involuntary commitment and
various forms of coercive treatment were normal. And the crazy maiden
(lesbian?) aunt, living in the attic has long been a staple of comedy-
and tragedy.

But if our history reveals how psychiatry was used to keep women "in
their place," other countries have carried the practice much further.
Back before the collapse of the Soviet Union, political dissidents
were commonly referred for psychiatric observation, often-misdiagnosed
as "sluggish schizophrenics," committed and forcibly medicated and
otherwise tortured.

Much was rightly made of the cruelty of this abuse of psychiatry. What
seems to have never been really appreciated in the West was how
deviant-even when they were completely sane, and of course most were-
Soviet dissidents were, how far they transgressed the norms of
acceptable political discourse, even of simple self-preservation. Most
Americans cannot imagine the pure lunacy of the answer of Joseph
Brodsky, later America's own poet laureate, on trial for "social
parasitism", to the judge's question of What is your profession?

Translator and poet, replied Brodsky.

When the judge asked, who had recognized Brodsky as a poet and
enrolled him into the ranks of poets, Brodsky replied No one. Who
enrolled me into the ranks of the human race?

Brodsky may have been a lunatic for bringing down on himself the wrath
of the system, for not adjusting to what he knew to be abhorrent. So
were tens of thousands of others. But we do not dwell on their lunacy.
We instead salute their sanity. By our standards, they were demanding
the fundamental rights and dignities that form the moral basis of our
civilization. We salute their courage for refusing to be numbed by
what their civilization had become after World War II: a sterile,
brain-dead entity, living on inertia. Not numbed by conformity, not
numbed by vodka, not numbed by trying to live entirely private lives
of "internal exile."

So the State drugged them into numbness.

At the time-as a high school student in Quincy, Illinois, who wrote a
not exactly influential senior paper on Soviet psychiatry-I decried
what the Soviet state was doing as stupid and brutal. Brutal, yes.
Stupid, no. And not because the dissidents were popular figures likely
to lead an uprising-they weren't. What was threatening to the Soviet
state was the fierceness with which they felt. Writes Olga Berrgolts,
only a handful of whose poems have been translated into English, in
"Infidelity," a poem that is amongst the greatest in any language,

Like the master of the house, proudly you crossed
the threshold, stood there lovingly.
And I murmured: "God will rise again,"
and made the sign of the cross
over you-the unbeliever's cross, the cross
of despair, as black as pitch,
the cross that was made over each house
that winter, that winter in which
you died.

(Translated by J. R. Rowland, from Post-War Russian Poetry, edited by
Daniel Weissbort.)

Berggolts, a native of Leningrad, wrote "Infidelity" in 1946. A
civilian, she was nevertheless a veteran and survivor of the entire
900-day siege, during which her second husband died of starvation. Her
first husband had died in 1937, murdered in one of Stalin's purges,
and she herself had been imprisoned and beaten so badly that she gave
birth to a still-born child.

Every Soviet, man and woman, was, in one way or another, a Berggolts:
there was no one who had not lost family and friends in the Purges,
the famines, the forced deportations, and a war in which the
monstrosity of the enemy was often compounded by the often incompetent
callousness of the Soviet high command. There was no one who had not
also suffered personally. But many of these people had also informed
upon others, not only out of spite or for material gain, but simply to
survive, or buy the life of someone dear to them, or an end to their
own torture. And there were hundreds of thousands, if not millions,
who in addition to suffering themselves, imposed it upon others: the
true believers, the sadists, the careerists, and the tiny cogs in a
vast and monstrous machine.

Berggolts lived to be honored by the state, and she is most known for
her "patriotic" poetry. But for the Soviet state to tolerate the
intensity of feeling she expressed combined with the political non-
conformity of the dissident movement was to begin something very
dangerous. Once you allowed people to set limits of state authority,
where did it end? It was that very real question that made
Khrushchev's denunciations of Stalin so frightening. Restarting that
process during the Brezhnev era would probably have provoked
tremendous violence. Later, perestroika and glasnost led directly to
the dissolution of the Soviet Union during the 1990s, and the
suffering and violence were very real; the only reason it wasn't worse
was because so many of those who had borne and inflicted so much
suffering were either very old or dead.

For us, the stakes are more a matter of fundamental economic and
political restructuring and redistribution, rather than extreme and
widespread violence. Nevertheless, a lot of us are intensely afraid of
questioning how we have come to live and what we have come to believe
about ourselves.

So we don't force people the way the Soviets did. At least, not
anymore. What we do is in some ways worse. We persuade them to want
it. How many people, I wonder, would be politically active, were they
not off in some sort of private La La Land. How many would stand up
like Joseph Brodsky and say to the governmental/corporate imperium
that controls us, "We do not need your products. And maybe, just
maybe, we don't need you."

So was Robert Jay Lifton right? Has our civilization become so
unbearable that we must numb ourselves just to survive in it? Hard to
say. But if it is true that we as a citizenry live, increasingly, in a
state of learned helplessness, a state perpetuated and intensified by
drugs, it is legitimate to ask, what would happen if we got off it?

Some weeks ago, my husband and I were shopping at the local Safeway.
As we approached the door, we noticed two girls at a table, raising
money for DARE, the group that works to keep kids off illegal drugs.
My husband said to one, "You know, if the young people of America ever
gave up drugs, there would be a revolution." The girl stared at him
for a moment, as though he'd said something he wasn't allowed to say.
Then she got a smile on her face, a fierce and genuine smile, and gave
him a sweeping thumbs-up.

Sometimes, it's good to listen to the kids.

Posted by Erin Solaro at August 23, 2008 12:55 p.m.
http://blog.seattlepi.nwsource.com/civicfeminism/archives/146927.asp?from=blog_last3