Pubdate: May 1999
Source: Harper's Magazine (US)
Copyright: 1999 Harper's Magazine Foundation
Contact:  666 Broadway, New York, New York, 10012
Fax: : (212) 228-5889
Website: http://www.harpers.org/
Contact:  Joshua Wolf Shenk
Note:  Joshua Wolf Shenk is a former editor of The Washington Monthly who
writes frequently on drug policy, pharmacology, and mental illness. He lives
in New York City.

Introduction, and Part I

AMERICA'S ALTERED STATES

When does legal relief of pain become illegal pursuit of pleasure?

My soul was a burden, bruised and bleeding.  It was tired of the man who
carried it, but I found no place to set it down to rest.  Neither the charm
of the countryside nor the sweet scents of a garden could soothe it.  It
found no peace in song or laughter, none in the company of friends at table
or in the pleasures of love, none even in books or poetry.... Where could my
heart find refuge from itself? Where could I go, yet leave myself
behind? -St. Augustine

To suffer and long for relief is a central experience of humanity. But the
absence of pain or discomfort or what Pablo Neruda called "the infinite
ache" is never enough.  Relief is bound up with satisfaction, pleasure,
happiness-the pursuit of which is declared a right in the manifesto of our
republic.  I sit here with two agents of that pursuit: on my right, a bottle
from Duane Reade pharmacy; on my left, a bag of plant matter, bought last
night for about the same sum in an East Village bar from a group of men who
would have sold me different kinds of contraband if they hadn't sniffed cop
in my curiosity and eagerness.  This being Rudy Giuliani's New York, I had
feared they were undercover.  But my worst case scenario was a night or two
in jail and theirs a fifteen-year minimum.  As I exited the bar, I saw an
empty police van idling, waiting to be filled with people like me but,
mostly, people like them, who are there only because I am.

Fear and suspicion, secrecy and shame, the yearning for pleasure, and the
wish to avoid men in blue uniforms.  This is (in rough, incomplete terms) an
emotional report from the front.  The drug wars-which, having spanned more
than eight decades, require the plural-are palpable in New York City.  The
mayor blends propaganda, brute force, and guerrilla tactics, dispatching
undercover cops to call "smoke, smoke" and "bud, bud"-and to arrest those
who answer.  In Washington Square Park, he erected ten video cameras that
sweep the environs twenty-four hours a day.  Surveillance is a larger theme
of these wars, as is the notion that cherished freedoms are incidental.  But
it is telling that such an extreme manifestation of these ideas appears in a
public park, one of the very few common spaces in this city not controlled
by, and an altar to corporate commerce.

Several times a month, I walk through that park to the pharmacy, where a
doctor's slip is my passport to another world.  Here, altering the mind and
body with powders and plants is not only legal but even patriotic.  Among
the souls wandering these aisles, I feel I have kin. But I am equally at
home, and equally ill at ease, among the outlaws. I cross back and forth
with wide eyes.

What I see is this: From 1970 to 1998, the inflation-adjusted revenue of
major pharmaceutical companies more than quadrupled to $81 billion, 24
percent of that from drugs affecting the central nervous system and sense
organs.  Sales of herbal medicines now exceed $4 billion a year. Meanwhile,
the war on Other drugs escalated dramatically.  Since 1970 the federal
antidrug budget has risen 3,700 percent and now exceeds $17 billion.  More
than one and a half million people are arrested on drug charges each year,
and 400,000 are now in prison.  These numbers are just a window onto an
obvious truth: We take more drugs and reward those who supply them.

We punish more people for taking drugs and especially punish those who
supply them.  On the surface, there is no conflict.  One kind of drugs is
medicine, righting wrongs, restoring the ill to a proper, natural state.
These drugs have the sheen of corporate logos and men in white coats.  They
are kept in the room where we wash grime from our skin and do the same with
our souls.  Our conception of illegal drugs is a warped reflection of this
picture.  Offered up from the dirty underworld, they are hedonistic, not
curative.  They induce artificial pleasure, not health.  They harm rather
than help, enslave rather than liberate.

There is some truth in each of these extreme pictures.  But with my dual
citizenship, consciousness split and altered many times over, I come to say
this: The drug wars and the drug boom are interrelated, of the same body.
The hostility and veneration, the punishment and profits, these come from
the same beliefs and the same mistakes.

I

Before marijuana, cocaine, or "Ecstasy," Before nitrous oxide or magic
mushrooms, before I had tried any of these, I poked through the foil
enclosing a single capsule of fluoxetine hydrochloride.  My drug story
begins at this point, at the end of a devastating first year of college. For
years, I had wrapped myself in an illusion that my lifelong troubles-intense
despair, loneliness, anxiety, a relentless inner soundtrack of
self-criticism-would dissolve if I could only please the gatekeepers of the
Ivy League.  By the spring of freshman year, I had been skinned of this
illusion and plunged into a deep darkness.  From a phone booth in a library
basement, I resumed contact with a psychiatrist I'd begun seeing in high
school.

I told him how awful I felt, and, after a few sessions, he suggested I
consider medication.  By now our exchange is a familiar one.  This was 1990,
three years after Prozac introduced the country to a new class of
antidepressants, called selective serotonin reuptake inhibitors. SSRIs were
an impressive innovation chemically but a stunning innovation for the
market, because, while no more effective than previous generations of
antidepressants, SSRIs had fewer side effects and thus could be given to a
much broader range of people. (At last count, 22 million Americans have used
Prozac alone.) When my doctor suggested I take Prozac, it was with a casual
tone.  Although the idea of "altering my brain chemistry" unsettled me at
first, I soon absorbed his attitude.  When I returned home that summer, I
asked him how such drugs worked.  He drew a crude map of a synapse, or the
junction between nerve cells.  There is a neurotransmitter called serotonin,
he told me, that is ordinarily released at one end of the synapse and, at
the other end, absorbed by a sort of molecular pump. Prozac inhibits this
pumping process and therefore increases serotonin's presence in the brain.
"What we don't understand," he said, looking up from his pad, "is why
increased levels of serotonin alleviate depression.  But that's what seems
to happen." I didn't understand the importance of this moment until years
later, after I had noticed many more sentences in which the distance between
the name of a drug-Prozac, heroin, Ritalin, crack cocaine-and its effects
had collapsed.  For example, the phrase "Prozac eases depression," properly
unpacked, actually represents this more complicated thought: "Prozac
influences the serotonin patterns in the brain, which for some unknown
reason is found to alleviate, more often than would a placebo, a collection
of symptoms referred to as depression." What gets lost in abbreviation
Prozac cures! Heroin kills! -- is that drugs work because the human body
works, and they fail or hurt us because the body and spirit are vulnerable.

When drugs spark miracles-prolonging the lives of those with HIV, say, or
dulling the edges of a potentially deadly manic depression-we should be
thankful. (1) I But many of these processes are mysteries that might never
yield to science.  The psychiatric establishment, for example, still does
not understand why serotonin affects mood. According to Michael Montagne of
the Massachusetts College of Pharmacy, 42 percent of marketed drugs likewise
have no proven mechanism of action.  In Listening to Prozac, Peter Kramer
quotes a pharmacologist explaining the problem this way: "If the human brain
were simple enough for us to understand, we would be too simple to
understand it." Yet pharmaceutical companies exude certainty.  "Smooth and
powerful depression relief," reads an ad for Effexor in a recent issue of
The American Journal of Psychiatry.  "Antidepressant efficacy that brings
your patients back." In case this message is too subtle, the ad shows an
ecstatic mother and child playing together, with a note written in crayon:
"I got my mommy back."

The irony is that our faith in pharmaceuticals is based on a model of
consciousness that science is slowly displacing.  "Throughout history,"
chemist and religious scholar Daniel Perrine writes in The Chemistry of
Mind-Altering Drugs, "the power that many psychoactive drugs have exerted
over the behavior of human beings has been variously ascribed to gods or
demons." In a sense, that continues. "We ascribe magical powers to
substances," says Perrine, "as if the joy is inside the bottle.  Our culture
has no sacred realm, so we've assigned a sacred power to these drugs.  This
is what [Alfred North] Whitehead would call the 'fallacy of misplaced
concreteness.' We say, 'The good is in that Prozac powder,' or 'The evil is
in that cocaine powder.' But evil and good are not attributes of molecules."

This is a hard lesson to learn.  In my gut, where it matters, I still
haven't learned it.  Back in 1990, 1 took the Prozac and, eventually, more
than two dozen other medications: antidepressants, antipsychotics,
antianxiety agents, and so on.  The sample pills would be elegantly wrapped.
Handing them to me, the doctors would explain the desired effect: this drug
might quiet the voices in my head; this one might make me less depressed and
less anxious; this combination might help my concentration and ease my
repetitive, obsessive thoughts.  Each time I swelled with hope.  I've spent
many years in therapy and have looked for redemption in literature, work,
love.  But nothing quite matches the expectancy of putting a capsule on my
tongue and waiting to be remade.

But I was not remade.  None of the promised benefits of the drugs came, and
I suffered still.  In 1993, 1 went to see Donald Klein, one of the top
psychopharmacologists in the country.  Klein's prestige, underscored by his
precipitous fees, again set me off into fantasies of health.  He peppered me
with questions, listened thoughtfully. After an hour, he pushed his reading
glasses onto his forehead and said, "Well, this is what I think you have."
He opened the standard psychiatric reference text to a chapter on
"disassociative disorders" and pointed to a sublisting called
depersonalization disorder, "characterized by a persistent or recurrent
feeling of being detached from one's mental processes or body."

I'm still not certain that this illness best describes my experience. I
can't even describe myself as "clinically ill," because clinicians don't
know what the hell to do with me.  But Klein gave me an entirely new way of
thinking about my problems, and a grim message. "Depersonalization is very
difficult to treat," he said.  So I was back where I started, with one
exception.  During our session, Klein had asked if I used marijuana.  Once,
I told him, but it didn't do much.  After he had given me his diagnosis, he
told me the reason he had asked: "A lot of people with depersonalization say
they get relief from marijuana." At that time, I happened, for the first
time in my life, to be surrounded by friends who liked to smoke pot.  So in
addition to taking drugs alone and waiting for a miracle, I looked for
solace in my own small drug culture.  And for a time, I got some.  The basic
function of antidepressants is to help people with battered inner lives
participate in the world around them.  This is what pot did for me.  It
helped me spend time with others, something I have yearned for but also
feared; it sparked an eagerness to write and conjure ideas -- some of which
I found the morning after to be dreamy or naive, but some of which were the
germ of something valuable. While high, I could enjoy life's simple
pleasures in a way that I hadn't ever been able to and still find
maddeningly difficult.  Some might see this (and people watching me surely
did) as silly and immature.  But it's also a reason to keep living.

Sad to say, I quickly found pot's limitations.  When my spirits are lifted,
pot can help punctuate that.  If I smoke while on a downward slope or while
idling, I usually experience more depression or anxiety.  Salvation, for me
at least, is not within that smoked plant, or the granules of a pill, or any
other substance.  Like I said, it's a hard lesson to learn.

To the more sober-minded among us, it is a source of much consternation that
drugs, alcohol, and cigarettes are so central to our collective social
lives.  It is hard, in fact, to think of a single social ritual that does
not revolve around some consciousness-altering substance. ("Should we get
together for coffee or drinks?") But drugs are much more than a social
lubricant; they are also the centerpiece of many individual lives.  When it
comes to alcohol, or cigarettes, or any illicit substance, this is seen as a
problem.  With pharmaceuticals, it is usually considered healthy.  Yet the
dynamic is often the same.

It begins with a drug that satisfies a particular need or desire-maybe known
to us, maybe not.  So we have drinks, or a smoke, or swallow a few pills.
And we get something from this, a whole lot or maybe just a bit.  But we
often don't realize that the feeling is inside, perhaps something that, with
effort, could be experienced without the drugs or perhaps, as in the
psychiatric equivalent of diabetes, something we will always need help with.
Yet all too often we project upon the drug a power that resides elsewhere.
Many believe this to be a failure of character.  If so, it is a failure the
whole culture is implicated in. A recent example came with the phrase "pure
theatrical Viagra," widely used to describe a Broadway production starring
Nicole Kidman. Notice what's happening: Sildenafil citrate is a substance
that increases blood circulation and has the side effect of producing
erections in men.  As a medicine, it is intended to be used as an adjunct to
sexual stimulation.  As received by our culture, though, the drug becomes
the desired effect, the "real thing" to which a naked woman onstage is
compared.

Such exaltation of drugs is reinforced by the torrent of pharmaceutical ads
that now stuff magazines and blanket the airwaves. Since 1994, drugmakers
have increased their direct-to-consumer advertising budget sevenfold, to
$1.2 billion last year.  Take the ad for Meridia, a weight-loss drug.
Compared with other drug ads ("We're going to change lives," says a doctor
pitching acne cream.  "We're going to make a lot of people happy"), it is
the essence of restraint. "You do your part," it says in an allusion to
exercise and diet. "We'll do ours." The specific intent here is to convince
people who are overweight (or believe themselves to be) that they should ask
their doctor for Meridia. (2) Like the pitch for Baby Gap that announces
"INSTANT KARMA" over a child wrapped in a $44 velvet jacket, drug ads
suggest or explicitly say-that we can solve our problems through
magic-bullet consumption.  As the old saying goes, "Better living through
chemistry."

It's the job of advertisers to try every trick to sell their products. But
that's the point: drugs are a commodity designed for profit and not
necessarily the best route to health and happiness.  The "self help" shelves
at pharmacies, the "expert only" section behind the counter, these are
promised to contain remedies for all ills.  But the wizards behind the
curtain are fallible human beings, just like us. Professor Montagne says
that despite obvious financial incentives, "there really is an overwhelming
belief among pharmacists that the last thing you should do for many problems
is take a drug.  They'll recommend something when you ask, but there's a
good chance that when you're walking out the door they'll be saying, 'Aw,
that guy doesn't need a laxative every day.  He just needs to eat right.
They don't need Tagamet.  They just need to cut back on the spicy food."' It
is hard to get worked up about these examples, but they point to the broader
pattern of drug worship.  With illegal drugs, we see the same pattern, again
through that warped mirror or long after his second inauguration, President
Clinton signed a bill earmarking $195 million for an antidrug ad
campaign-the first installment of a $1 billion pledge.  The ads, which began
running last summer, all end with the words "Partnership for a Drug Free
America" and "Office of National Drug Control Policy." It is fitting that
the two entities are officially joined.  The Partnership emerged in 1986,
the year basketball star Len Bias died with cocaine in his system and
President Reagan signed a bill creating, among many other new penalties,
mandatory federal prison terms for possession of an illegal substance. This
was the birth of the drug wars' latest phase, in which any drug use at
all-not abuse or addiction or "drug related crime"-became the enemy. (3)
Soon the words "drug-free America" began to show up regularly, in the name
of a White House conference as well as in legislation that declared it the
"policy of the United States Government to create a Drug-Free America by
1995."

Although the work of the Partnership is spread over hundreds of ad firms,
the driving force behind the organization is a man named James Burke-and he
is a peculiar spokesman for a "drug free" philosophy. Burke is the former
CEO of Johnson & Johnson, the maker of Tylenol and other pain-relief
products; Nicotrol, a nicotine-delivery device; Pepcid AC, an antacid; and
various prescription medications.  When he came to the Partnership, he
brought with him a crucial grant of $3 million from the Robert Wood Johnson
Foundation, a philanthropy tied to Johnson & Johnson stock.  Having granted
$24 million over the last ten years, RWJ is the Partnership's single largest
funder, but the philanthropic arms of Merck, Bristol-Myers Squibb, and
Hoffman-La Roche have also made sizable donations.

I resist the urge to use the word "hypocrisy," from the Greek hyp6krisis,
"acting of a part on the stage." I don't believe James Burke is acting.
Rather, he embodies a contradiction so common that few people even notice
it-the idea that altering the body and mind is morally wrong when done with
some substances and salutary when done with others.

This contradiction, on close examination, resolves into coherence. Before
the Partnership, Burke was in the business of burnishing the myth of the
ciber-drug, doing his best-as all marketers do-to make some external object
the center of existence, displacing the complications of family, community,
inner lives.  Now, drawing on the same admakers, he does the same in
reverse. (These admakers are happy to work pro bono, having been made rich
by ads for pharmaceuticals, cigarettes, and alcohol.  Until a few years ago,
the Partnership also took money from these latter two industries.) The
Partnership formula is to present a problem urban violence, date rape,
juvenile delinquency-and lay it at the feet of drugs.  "Marijuana," says a
remorseful-looking kid, "cost me a lot of things.  I used to be a straight-A
student, you know.  I was liked by all the neighbors. Never really caused
any trouble.  I was always a good kid growing up. Before I knew it, I was
getting thrown out of my house."

This kid looks to be around seventeen.  The Partnership couldn't tell me his
real name or anything about him except that he was interviewed through a New
York drug-treatment facility.  I wanted to talk to him, because I wanted to
ask: "Was it marijuana that cost you these things? Or was it your behavior
while using marijuana? Was that behavior caused by, or did it merely
coincide with, your marijuana use?"

These kinds of subtleties are crucial, but it isn't a mystery why they are
usually glossed over.  In Texas, federal prosecutors are seeking life
sentences for dealers who supplied heroin to teenagers who subsequently died
 of overdose.  Parents praised the authorities.  "We just don't want other
people to die," said one, who suggested drug tests for fourth-graders on up.
Another said, "I kind of wish all this had happened a year ago so whoever
was able to supply Jay that night was already in jail." The desire for
justice, and to protect future generations, is certainly understandable. But
it is striking to note how rarely, in a story of an overdose, the survivors
ask the most important question.  It is not: How do we rid illegal drugs
from the earth? (4) Despite eighty years of criminal sanctions, stiffened to
the point just short of summary executions, markets in this contraband
flourish because supply meets demand.  Had jay's dealer been in jail that
night, Jay surely would have been able to find someone else-and if not that
night, then soon thereafter.

The real question-why do kids like Jay want to take heroin in the first
place?-is consistently, aggressively avoided.  Senator Orrin Hatch recently
declared that "people who are pushing drugs on our kids ... I think we ought
to lock them up and throw away the keys." Implicit in this remark is the
idea that kids only alter their consciousness because it is pushed upon
them.

Blaming the alien invader-the dealer, the drug-provides some structure to
chaos.  Let's say you are a teenager and, in the course of establishing your
own identity or quelling inner conflicts, you start smoking a lot of pot.
You start running around with a "bad crowd." Your grades suffer.  Friction
with your parents crescendos, and they throw you out of the house.  Later,
you regret what you've done-and you're offered a magic button, a way to
condense and displace all your misdeeds.  So, naturally, you blame
everything on the drug.  Something maddeningly complicated now has a single
name.  Psychologist Bruce Alexander points out that the same tendency exists
among the seriously addicted.  "If your life is really fucked up, you can
get into heroin, and that's kind of a way of coping," he says.  "You'll have
friends to share something with.  You'll have an identity.  You'll have an
explanation for all your troubles."

What works for individuals works for a society. ("Good People Go Bad in
Iowa," read a 1996 New York Times headline, "And a Drug Is Being Blamed.")
Why is the wealthiest society in history also one of the most fearful and
cynical? What root of unhappiness and discontent spurs thousands of college
students to join cults, millions of Americans to seek therapists, gurus, and
spiritual advisers? Why has the rate of suicide for people fifteen to
twenty-four tripled since 1960? Why would an eleven- and a thirteen-year-old
take three rifles and seven handguns to their school, trigger the fire
alarm, and shower gunfire on their schoolmates and teachers? Stop searching
for an answer.  Drug Watch International, a drug "think tank" that regularly
consults with drug czar Barry McCaffrey and testifies before Congress,
answered the question in an April 1998 press release: "MARIJUANA USED BY
JONESBORO KILLERS." (5)

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