America’s relationship with drugs is riddled with contradictions. One the one hand we love to demonize and stigmatize drugs even though pretty much all of us do them in one form or another. We are ruthlessly authoritarian in how we treat illegal drug users, recreational or otherwise, and small-scale producers and traffickers, and yet we arm Mexican drug cartels with the weapons we manufacture, or collaborate with and protect regional drug lords in Afghanistan. We imprison more nonviolent drug offenders than any other country, but we allow powerful corporate pharmaceutical monopolies to openly sell dangerous drugs to consumers, buy unfettered access to our media and advertising mediums, bribe elected officials and professional medical associations, write our heath care legislation, and profit off of the proliferation of diagnosable diseases. We relentlessly tell our kids to “say no” to drugs, but we are the most medicated society on Earth, diagnosing 3-year old children with ADHD or bipolar disorder and sedating their undeveloped brains with powerful antipsychotics.
The reality of drugs in America has long since been muddled by decades of prohibitionist hysteria, the War on Drugs, Big Pharma propaganda, scientific officialdom, and the incantations of rightwing culture warriors. Drugs are at the same time highly taboo and widely available around every corner, in various forms, some legal and others not. Contradictions aside, it is undeniable that we have turned to drugs to cure our existential angst and cultural melancholy. Drugs rear their mysterious head at every level of our society, from the shadowy underground to the halls of official power, from the inner city street corner to the suburban doctor’s office, at the grocery store and gas station, in our homes, schools and workplaces, from the ghetto to the board room, drugs are everywhere. In an attempt to have a sane, reasoned discussion on the role of drugs in our society, which necessarily leads into a wider discussion of health care, public policy, and the medical establishment, I sought the counsel of esteemed author and physician Gabor Mate.
Gabor Mate is a prolific author, physician, and social critic. A renowned speaker and public intellectual, his most recent book is In the Realm of Hungry Ghosts: Close Encounters with Addiction.
Collin Harris: There seems to be two underlying realities to the issue of drugs in our society. One is the highly suspect world of recreational and abusive illegal drug use and the global drug trade, the War on Drugs, the criminal justice system, and the prison-industrial complex. The other is the more polished, legitimate world of deregulated drug monopolies, PHARMA, industry control over national health policy, relentless advertising and mass marketing of pharmaceuticals, a corrupt medical establishment, and skyrocketing rates of prescription drug use. What’s happened in these two worlds over the past forty years?
Gabor Mate: On the one hand a relentless persecution of drug users has been mounted in the past several decades, with the result that the U.S. has the highest per capita and even absolute numbers of incarcerated citizens of any country in the world. Lives are blighted, families destroyed, prisons overcrowded, the apparatus of repression empowered and emboldened. All this, while programs are not developed and supported that could effectively prevent and reduce drug use, reduce harm from drug use, and rehabilitate people. In the meantime, the pharmacological industry–the real big time drug pushers–dominate research and medical practice, sell billions of dollars worth of drugs that feed addiction. They also, with impunity, market drugs that often harm people, without in any way having to prove efficacy–see for example the shameless purveying of anti-pscyhotic drugs for use in controlling children’s behavior, a completely untested indication with often severe side effects. So harm, great harm, is being caused both by the useless attempts to control addiction by legal means and, on the other hand, by the lack of government control over the actions of the pharmaceutical companies.
CH: What’s the historical significance of the emergence of the War on Drugs in 1971? What has been its fundamental social function over the past four decades?
GM: The elite that dominates U.S. policy, foreign and domestic, always needs an enemy as a way of marshaling popular support for the military-police-industrial complex and as a way of diverting people’s anxieties in directions away from the real sources of their problems. The “junkie” and the “dealer” are the domestic versions of the “Communist” and the “terrorist.” The so-called War on Drugs justifies the apparatus of repression, especially against minority populations.
CH: Should we really be thinking of the War on Drugs in terms of a “failure”? Is it really accurate to say that the War on Drugs is a policy mistake? Is this like saying the wars in Iraq or Afghanistan are mistakes? By framing it this way, don’t we obscure the real causes of the problem (and therefore possible solutions) by ignoring the matrix of overlapping interests–state, corporate, professional, criminal–that benefit from what is a disaster for everyone else? What’s a more useful way to think and talk about the issue?
GM: First, let’s get it clear is that there is no “War on Drugs.” You cannot make war on inanimate objects, only on people. What we are witnessing is a war on drug users, particularly poor and minority drug users. This so-called war is a failure only if one accepts it on its own terms–that is, if one believes that its real purpose is to interdict the supply of illegal substances and to prevent drug use. On that level it’s a colossal failure of historic proportions. However, from the perspective of justifying repression–of justifying the continued funding of highly armed police forces, of validating the existence of the legal machinery of what is called the “justice” system, and of channeling profits into the owners of private prisons and the many industries that supply prisons–the war is a major success. To which benefits we can add the political value of fear mongering and offering to be “tough on crime” to political opportunists vying for the support of a frightened, credulous and uninformed public.
CH: What would be the role of America’s criminal justice system–the DEA, police, courts, prisons, etc–if the War on Drugs ended? How would these institutions be affected by progressive drug policy?
GM: What would happen to McDonald’s if people stopped eating junk food? Either it would have to provide real value or go out of business.
CH: Today high-profile critiques of the War on Drugs are becoming more commonplace. Is the tide of elite opinion beginning to turn? What’s the significance of the recent report by the Global Commission on Drug Policy?
GM: Many people are now recognizing the futility of the War on Drugs and the damage wrought by it, and such a perspective is increasingly articulated by people in high places, such as the recent report from the GCDP. However, as with the report, these sane and evidence-based opinions are often stated by people after they have left their powerful positions in policy-making circles. They dared not speak it while still in a position to make an immediate difference and, for all we know, there are many in positions of influence now, who still dare not speak out. Nevertheless, it’s heartening to see the truth being spoken by such figures as former presidents of countries, leaders of the financial world, and cultural heavy weights.
CH: What is the relationship between the economic, political, and cultural crises of American society and lifestyle and the radical proliferation of preventable disease, mental health problems, and prescription drug use? Is this the stress-disease connection?
GM: The research on addiction clearly shows that stress is one of the major causes of addictive substance use. As I show in my book, When The Body Says No, stress is also the major contributing factor to the onset of all manner of chronic disease, from cancer to autoimmune conditions to neurological illness. Stress, and specifically childhood trauma, is also the leading cause of mental illness. Since human beings are very much affected by their psychological and social environment, we cannot understand addiction, mental illness, or physical disease without looking at the broader social and economic and cultural landscape.
CH: What are the consequences, at the individual and social levels, of the hegemony of the bio-genetic framework for how we understand, diagnose, and treat physical and psychological illness? Has the Western medical establishment stripped the human being from its social and environmental context? If so, why? Can you talk about the social origins of addiction or mental health problems? Does it let us off the hook as a society to say that addiction or mental illness is rooted in biology and genetics?
GM: Precisely because illness, mental and physical, is rooted in people’s life experience–and, hence, also in social, economic and cultural circumstances–it is useful, from the perspective of the status quo, to promulgate an ideology that takes attention off such factors and focuses, instead, on so-called genetic causation. As I show in my books, and as even a cursory look at the science of genetics demonstrates, the idea that genes “cause” illnesses is, with a few notable but rare exceptions, completely untenable. It ignores the fact that genes, even when present, are modulated–turned on and off–by the environment. But the separation of mind and body endemic in Western culture and the ideological benefit of genetic fundamentalism to the status quo create a stubborn attachment to the unscientific theories of genetic dominance. To see otherwise is necessarily to question how society is organized and how people are compelled to live.
CH: Why is the wealthiest society in the world also the most medicated? Is this the bitter, ironic fruit of Western values, lifestyles, and priorities?
GM: For all the reasons mentioned above and many others: the stress and insecurity endemic in our socio-economic system, the separation of mind and body on the part of the medical profession, the profit motive of the drug companies, the complicity of politicians, to mention only a few.
CH: When individuals go through what I claim American society has been going through for the past forty years, psychiatrists may diagnose them with Seasonal Affective Disorder, the tendency for seasonally-induced depression, and write them a prescription. Allegorically, if you were to diagnosis America with a 40-year case of Seasonal Affective Disorder, to make the argument that America has been trapped in a long, dreary winter of cultural decline for the last forty years–courted by popular cynicism, despair, and passivity–what would you recommend for finding a way out?
GM: Only when people seek and glimpse the truth can they find their own way out of the morass. People need to question and re-question the assumptions which govern their lives, the nostrums offered by political leaders and the mainstream media, and by the scientific “truths” uttered by experts who, though highly educated and highly adept in ways unimaginable not too long ago, are operating within the limits of narrow ideology that serves mostly to maintain a system that serves the few and deprives the many.