Fighting an addiction bureaucracy
Moral offloading is as old as we are. Adam and Eve invented it ("The woman/ serpent made me do it.") Literature is loaded with more sophisticated examples: Dr Jekyll has Mr Hyde; Dorian Gray has his portrait.
Modern science has taken up the case: our genes/ libido/ social context/ family background/ made us do it. One of the most strident critics of the deconstruction of moral responsibility is British psychiatrist Theodore Dalrymple. He has insisted that "people are not billiard balls", rather they make their important choices consciously.
Dalrymple’s most recent book: Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy attacks the idea that people are driven to taking heroin by unconcious forces. He criticises an addiction bureaucracy for perpetuating this myth, for treating addiction as purely a medical problem and addicts as victims, and for allowing exaggerated perceptions of heroin withdrawal to be perpetuated. Rather, he contends, heroin use is a conscious choice, addiction is an existential problem, not a medical one, addicts are renowned self-dramatisers, and the symptoms of withdrawal are no worse than the flu.
The author spoke with MercatorNet about his book and the problem of heroin addiction.
MercatorNet: Dr. Dalrymple, your most recent book has generated some controversy amongst those concerned with drug addiction. What prompted you to write it?
Dalrymple: I wrote the book because I thought I discerned an orthodoxy -- which was mistaken in its tenets -- being imposed by political action rather than by argument.
MercatorNet: You continually emphasise personal choice and freedom in your approach to this topic. Your severest criticisms are directed towards those who deny that these free choices exist for the heroin addict. Do you think this denial exists more broadly in society?
Dalrymple: The problem is that if you continually tell people that they are helpless, and actually reward them in some way for acting as if they were, then they will act helpless. This is very gratifying to the sense of power of the helpers, no doubt, but not much good for the people they purport to help. In my work, I would accept that people were victims of circumstances -- but I would rarely accept that they were just the victims of circumstances and nothing else. If they were the latter, there was nothing they could be expected to do about anything, which is a most miserable existential position to be in, and untrue into the bargain.
As Pascal said, let us try to think clearly, for such is the beginning of morality.
MercatorNet: Returning to the topic of drug use; what do you think leads people to take heroin?
Dalrymple: No doubt people take heroin for a variety of reasons. Their lives are unsatisfactory in some sense or another, and heroin is a means by which they can experience pleasurable sensations that seem, at least temporarily, to abate their dissatisfaction.
MercatorNet: Do you see a role for programs such as methadone treatment or 'medically supervised injecting rooms' in reversing someone's addiction? What about legislation?
Dalrymple: No. I don't see how encouraging people to take heroin can "reverse someone's addiction". Legalisation is a difficult question. What exactly is meant by it? Certain forms would not get rid of the black market. The nature of the supposedly controlled market would have to be worked out.
I can see the arguments on both sides. I don't think legalisation would have much effect upon crime, because I don't see crime as the consequence of addiction. The consumption of drugs tends to be related to their price and the ease of their availability. This is so with alcohol. However my book is not primarily about this question.
MercatorNet: Australian writer Luke Davies has written about addiction in his novel Candy. He recently said that you obviously haven't experienced heroin addiction and that in your book you are "talking out of your arse." What experience do you have in this field?
Dalrymple: I have dealt with hundreds, if not thousands of addicts in the general hospital and the prison in which I worked.
MercatorNet: Luke Davis describes you elsewhere as a "pompous tosser". What would you say to the charge that your arguments lack any note of compassion or that you fail to empathise with the circumstances of the heroin addict?
Dalrymple: Mr Davis's arguments are about as crude as his language. I don't need to have cancer of the bowel or cerebral malaria to know that they are serious diseases. This is not how the seriousness of conditions is assessed.
As to empathy, there is the prevalent sentimental idea that to be kind you have to accept people at their own account of themselves, even if, in fact, they are either lying or in a state of self-deception. It is precisely my point that (in many circumstances, not all) it is not kind to reinforce lies and self-deception, nor is it any kind of service to them. It is always much easier, in the short term, to accede to people's demands than to deny them, but it is not necessarily more compassionate to do so.
In fact, I describe the circumstances of the heroin addicts whom I saw in my practice, and freely admitted that, in most cases, they were terrible. But I deny that taking heroin is a constructive response to them, and I deny that they can be made better by medicine.
Phil Elias studies Medicine at the University of New South Wales in Sydney.
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