PSYCHIATRY AND “DRUG PROHIBITION”^*

Baldomero Cáceres Santa Maria M.A.
Social Psychologist

 

“Drug Prohibition”

The policy of an international prohibition on a series of dissimilar substances, which are called “drugs” without any differentiation, now followed by the majority of states, whether or not they have signed the international conventions, constitutes a characteristic phenomenon of our time. It is not a spontaneous and coincidental political phenomenon, grown from the needs felt by diverse societies. Begun almost a century ago with the 1909 Shangai conference and continued with the so-called Opium Convention (The Hague, 1912), prohibition was at first directed against opium at the behest of diplomats from the United States, which by then had already begun to restrict the authorized use of opiates as well as cocaine domestically. (Pure Food and Drug Act, 1906).

It is important to note the effort at suppression fell initially on natural psychoactive substances that until then had been accepted by academic medicine, as Szasz (1975) pointed out. A reminder of this in the case of coca is the monumental work of Golden W. Mortimer, a New York doctor and historian, Peru, History of Coca, “The Divine Plant of the Incas,” published in 1901, a condensed version of which appeared in a French edition for doctors in 1904. It is also worth noting that despite the republication of the orginal version in 1975 and its translation into French in 1992, there still exists no Spanish language edition.

From its reading, in the first place one sees the good clinical sense of the U.S. doctors of that period, since they showed an appreciation of the virtues of coca in their professional practice while it was in style, as is shown in the questionnaires sent out by Dr. Mortimer and whose results are found in the appendix.[1] At the same time, nonetheless, as the author noted, a conspiracy that would lead to the exclusion of coca from the list of the world’s most prized crops was growing. The Hague Convention of 1912, improperly called the “Opium Convention,” also internationalized the regulation of the production and commerce in coca, upon including within it “cocaine and its salts.” The convention, agreed to by Peru in 1913, was ratified at the Treaty of Versailles. At the end of the Second World War, the United Nations assumed the task of championing the prohibitionist campaign, a task accepted by a most diverse set of governments: democracies, dictatorships and totalitarian states—fascism, nazism, and communism, all alike. The creation of the World Health Organization provided a “scientific” forum that exercised decisive power through its Expert Committee on Drugs Liable to Produce Addiction[2], which, in 1952 and 1953 ordered that traditional Andean coca use “must be” considered a form of “cocainism,” based on information provided by the Coca Leaf Study Commission of the United Nations (Report, 1950).

The Single Convention on Narcotic Drugs (New York, 1961) defined the nature of drug control, including among other objectives, the eradication within 25 years of the long-lived traditional use of coca and the coca plant itself (Erythroxylum coca, E. novogranatense)[3]. Because of pressure from the United States (Cáceres, 1977, 1989; Cotler, 1999), in 1978 Peru enacted DL 22095, known as the “Drug Law,” a law that considers traditional use of coca “a social problem.” That law remains in effect.

The economic, social, and political consequences of this policy have been profund: A vast underground economy that launders ill-gotten money through the thousand and one resources of the financial system[4]; societies divided between the conventional sectors - especially those dependent on the state apparatus, including the universities and the justice system - reinforced by the permanent presence of the campaign against “drugs” in the mass media, which broadcasts the official propaganda, and the hundreds of millions of satisfied users who must hide themselves, because there is personal stigmatization even when prohibited use is decriminalized; conformity by political actors who don’t know how to reverse this policy and because of that, downplay the importance of the business even as they are aware of the conflicts it generates, as has happened in the Andean region. Internationally, “prohibition” has been converted into a “war,” supported by the government of the United States, which has the habit of involving itself in the internal affairs of the other countries, since it seems legitimate to do so for the public health, the “reason” it cites.

It is the United States, with the permanent support of the United Kingdom, that sends and controls its “secret agents” into countries significantly involved in the production or transit of the prohibited substances, especially when it assumes those substances are destined to supply its own population. This is the case in the Andean region, where the cultivation of the coca plant, limited to traditional and industrial uses by national legislation to comply with international accords, has been at the service of the multi-million dollar cocaine business. Peru was the world’s largest producer of coca for more than a decade (1980-1994), until Colombia took the lead with its extensive and well cared for plantations, replacing the lesser cultivation in Bolivia and Peru. Although Peru’s decrease has been maintained, the recent bump up in the price of coca leaf brings with it the fear that the offensive against coca in Colombia will bring a return of the old situation and will we once again be known as a “cocaine country” (narcoestado), and once again afflicted by the violence that grows as a strategic smokescreen behind which the business prospers.

 

Prohibition as a “social fact”

The “prohibition of drugs” has been recently characterized as “a system of state power extended worldwide. Global prohibition is, in Durkheim’s terms, a ‘social fact’”[5]. It is a “social fact” that describes the situation in all its broad variety, from the extreme criminalization in the United States that holds nearly half a million prisoners for drug possession or small sales, to Holland with its pragmatic policy of decriminalizing the sale of marijuana in certain establishments (“coffee shops”), in order to prevent the worse harm of its criminalization and resulting link with the much smaller world of the so-called “hard” drugs, as heroin and cocaine are considered to be.

While Levine did not fail to ask about the reasons for the generalization of “drug prohibition” as the most widely accepted and legitimated state policy no matter what type of government, he paid little attention to the fact that every “social fact” nonetheless has its genesis. Upon asking oneself the reasons for this acceptance, while of course one accepts that in practice it is because of the diplomatic pressure of the United States, one finds that “drug prohibition” has spread because it was and is useful and functional for every government. With prohibition, the state increases its military and police powers and through the demonization of the substances themselves — achieved through the mass media — converts prohibition into a unifying social crusade, supposedly humanitarian, that demands the adherence of politicians, church men, educators, communicators and all others with a “romance with the state,” as Levine put it, with the state esteemed as the highest arbiter of service to the public welfare.

Lastly, Levine showed the instrumental role of the United Nations in the generalization of the U.S. policy. Within it, apparently, has grown an acceptance of the “harm reduction” movement, which attempts to moderate the negative effects of prohibition through tolerance and regulation, as with the distribution of needles or even the prescribed administration of injected heroin, as is done in Holland and Switzerland. In the name of “harm reduction,” for example, in the United States George Soros has led a compassionate and well thought-out campaign advocating — through the Lindesmith Center and later the Drug Policy Alliance — the use of marijuana for various illnesses with a doctor’s approval. Either because of a forced respect toward the system (the psychiatric establishment) or because of a pragmatic focus, the habitual or “recreational,” if you wish, use of marijuana is omitted. This with a plant that was so successfully grown in California in the late 1960s and then spread across the United States by the 1980s that by the turn of the millennium there was enough domestic production to supply tens of millions of cannabis aficionados who, because of the weight of the repressive laws, cannot be free citizens, if we remember that, in the words of José Martí, “freedom is the right of all men to be honorable, and to think and speak without hypocrisy.”

For Levine, as he noted later, “harm reduction” constitutes a tolerant and pragmatic approach. It assumes that prohibition is not going to disappear soon and because of that it is reasonable and responsible to try to mitigate the damage it causes.[6]

 

The Justification of Prohibition

Although Levine’s penetrating analysis points out decisive factors in the establishment and maintenance of the adopted policy, one can distinguish two intimately linked lacunae. The first is to place the policy’s beginning in the 1920s, centering it in the United States[7], and ignoring the stage of decisive change at the end of the 19th Century and the beginning of the 20th, which is considered the initial period by those who have dealt with this subject, beginning with Thomas Szasz in his “Ceremonial Chemistry” in 1975. The second, linked with the first, was to be unaware of the basis by which prohibition grounded itself in public opinion in the 20th Century, an aspect generally omitted by analysts interested in the topic. The public campaigns against “vice” carried out by the mass media were not enough, nor was the stirring of the “temperance” groups in the United States — cause commonly cited. (Musto, 1987). The necessary support came when the discrediting of alcohol, opium, cocaine, and marijuana became accepted and diffused in psychiatric works of the forerunners of what would attempt to become a medical specialty (above all Emil Kraepelin), who stigmatized their use as “drug addiction,” at the time that diverse psychological theories (Freud and followers, orthodox and heterodox) grew to explain the malaise of modern culture and grant to rationalism an interpretive faith in the avatars of life that it was lacking because of secularization.

Since then, users of “mind-altering,” “addictive” substances have been claimed as part of the clientele of psychiatry, completely ignoring their own opinions and their public image; a clear discounting of human rights. This brings with it a practical consequence: The restrictions imposed on the commercialization of such substances remain justified, just as does the imposition of forced psychiatric treatment, without taking note of the negative consequences of the stigma that sustains prohibition and fills the North American jails.

Only the recent advances in cognitive neuroscience and the modern technology for the exploration of cerebral functioning are finally orienting psychopharmacology, reducing the harm produced by traditional psychiatric practice, which for most of the last century retained its undeserved scientific prestige. But not only did it rule over its clientele, voluntary and involuntary. In the name of “mental health,” against which it worked in theory and in practice, psychiatry arrogated to itself the classificatory power that stigmatized millions of human beings and keeps them stigmatized to this day. To disqualify medicinal plants for the nervous system used by medicine throughout the 19th Century was almost a professional requisite, so to say, for the existence of psychiatry itself and of the psychotherapies created to “cure” the problems associated with the absence of such natural resources.

Prohibition, we must insist, was and is the result of psychiatric discourse placed at the service of social control by the police state and by the corresponding ideology of the 20th Century, (Szasz, 1975), that of “the philanthropic ogre” (Paz, 1979). To omit this fact, as is generally the case, impedes really restating the theoretical basis of “the drug problem”, which would involve authentic scientific knowledge based on reason and experience.[8] If that were to occur, prohibition could be restated and the change would be sudden.

 

Coca and its Condemnation

Differing from Levine, who as a sociologist limits himself to the “social fact” of “drug prohibition” without disaggregating it in any way, my argument passes from the fact of prohibition to its history, taking as the connecting thread the official stigmatization of Andean coca use after the ruling by the World Health Organization’s Committee of Experts on Drugs of Abuse, which in 1952-53 decided that it must consider the traditional habit as a form of “drug psychosis” or “addiction”, a category of phantasmagoric psychiatric psychopathology, as I discussed in a first treatment of this subject[9].

In effect, such condemnation has a perfectly reconstructible documentary history in the Report of the Study Commission on Coca Leaf (Lake Success, 1950), commissioned by the United Nations Economic and Social Council (UNESCO). With that Report, the World Health Organization, through its Committee of Experts, tried to end the review of the pertinent information. In the 28th session of the World Health Organization’s Expert Committee on Drug Dependence, a critical review of the case of coca was rejected, based on the information already gathered and the ruling already made, in spite of the revalorization coca has seen in Bolivia and Peru[10].

 

Medicine and Psychiatry

A first reading of the Report presented by the Commission shows, within the bibliography collected and annotated by Dr. P.O. Wolf, an exclusion of medical testimonies from the 19th Century that talked about the benefits derived from coca use and were gathered by Mortimer (1901). Among those ignored was the Dissertation on the Character, Cultivation, Commerce and Virtues of Peru’s Famous Plant Called Coca that Dr. Hipólito Unanue published in the Mercurio Peruano[11], a report that was widely read as much in the United States as in Europe, and whose dissemination would lend academic support to coca and would be taken advantage of for industrial uses by pharmaceutical firms (Parke, Davis and Co.; Merck) and others (Vin Mariani produced by Angelo Mariani in Paris; Coca Cola in Atlanta). Doctor Wolf took charge of discrediting the excellent compilation of medical knowledge thanks to Mortimer (1901), noting that “you can simply pass this by”[12].

The omission of Unanue’s report would also have to be later justified by Dr. Wolf, in an article he submitted to be presented in the Narcotics Bulletin[13], noting that in the works of Hermilio Valdizán[14], founding father of Peruvian psychiatry, he had written about an “agricultural study” entitled “Coca cultivation”, although Wolf had written the complete title of Unanue’s Dissertation.

The Report’s “bibliography,” on the other hand, gathered fully and uncritically all of the psychiatric work produced on the subject, making clear from the beginning through its adopted vocabulary the psychopathologizing orientation that animated it. The Andean habit was described erroneously as “chewing coca”, since coca is not chewed but exudes its juice in the side of the mouth, was called “cocaism” by P.O. Wolf, a modification and repetition of Valdizán’s sentence about “indigenous cocainism,” which began this whole absurd, Kafkian process. It isn’t enough to say that the presumed scientific investigations that supported the negative Report of the Study Commission were works driven by Kraepelian scholastic prejudice against cocaine, which its members took on faith. Erroneous conceptualizations and questionable investigative methods, which appear ridiculous today, served as the basis of the Report that led the WHO Committee of Experts to impose the sanctions it adamantly maintained in 1992.[15].

Cocaine.

Behind the judgment on coca that followed the end of the 1940s lay the presence of the previous condemnation of cocaine, which in turn is questionable even in its origin. This task has been made possible by the 1975 publication of Sigmund Freud’s Cocaine Papers, thanks to the interest of Professor Robert Byck and the authorization of Anna Freud, daughter of the creator of psychoanalysis. The story of the events that occurred in Vienna between 1884 and 1887 shows us that the stigmatization of cocaine was the result of an extrapolation by a neuropsychiatry alarmed by the sad result that Freud had had with a distinguished colleague and friend, to whom he presribed cocaine injections to liberate him from a morphine habit (Erlenmeyer, 1885). From Erlenmeyer and his reaction it has become commonplace today to call the alkaloid “a scourge”, a contention that soon after provided support for Kraepelin (1891) to refer to “cocainism” as the anxiety or desire to consume it, given its “toxic” nature.

As experimental psychology has been demonstrating, from Külpe (1904) through Bruner (1949, 1955), our attitude determines the fundamental act of perception, identification, recognition or categorization. As a function of such identification, the object is analyzed, its characteristics determined. Thus, the seductive power of prejudices, which condition our perspective. Psychiatric prejudice has since then remade itself in the public gaze.

The coca leaf, perceived as nutritional and medicinal plant until the growth of the psychiatric discourse (Mortimer, 1901), was reclassified as a dangerous drug by the “addiction” provoked by “cocaine,” contained in its leaves —“cocainism”. That would be the “active substance” named by 20th Century pharmacology as being responsible for its most notable effects: local anesthetic, and at the same time, central nervous system stimulant. We should recall that in Freud’s first essay, “Über Coca” (1884), he had assumed the same point of departure by attributing the known virtues of the leaf to the alkaloid extracted from them: “Cocaine and its salts are preparations that have all the effects, or at least the most essential, of the coca leaf.” [16]

Such initial and shared reductionism also allowed the arbitrary carry over of the condemnation of cocaine to the leaf itself, never considering that it is an organic compound. To that effect, whether by “congruence” (Osgood &Tannenbaum,1955) or “consonance” (Festinger, 1957), it was necessary to bury the earlier reports that talked of its benefits. The United Nations’ Report can, in other words, be legitimately questioned for having hidden evidence. To update the scientific evidence would imply the recuperation of such information and the gathering of recent basic researches that have not been incorporated into the United Nations’ coca archive nor taken into account by the World Health Organization.

 

The coca leaf as a nutritional supplement

Sigmund Freud thought he had found in cocaine the stupendous stimulant required: “Many doctors have thought that cocaine can occupy an important place among the series of drugs that psychiatrists administer. It is well known that they have a broad gamut of products that allow them to help their patients to reduce central nervous system excitation, but that there is nothing to augment the diminished function of those centers.” It was, in the medical language of the age, the ideal remedy for “neurasthenia” (Beard, 1868).

It is not unusual that the pharmacological reductionism adopted by Freud upon wanting to see in cocaine “the authentic agent of the coca leaf’s effects” was facilitated by the level of analysis at which chemistry had arrived, as Freud himself noted in his monograph, “Über Coca: “According to the researches of the chemists, coca leaves contain some other substances that have not yet been discovered.”

Nonetheless, little by little the organic composition of coca was analyzed, arriving at the point that in its own 1950 Report, the United Nations Economic and Social Council’s Commission of Enquiry recognized that, like any other plant, coca contained various nutrients, vitamins, and minerals, especially calcium, without taking this into account because the dominion exercised by the pharmacological-psychiatric discourse reduced coca to cocaine.

In 1965, Carlos Collazos-Chiriboga, then director of the Peruvian Ministry of Health’s Institute of Nutrition, published a report called “Coca Use and Nutrition”, which didn’t get the recognition it deserved because by then the silencing of the theme had already begun, given that coca was destined for extinction. In the absence of a critical diplomacy that would question the assumptions of the prohibitionist treaties, the Peruvian government has accepted such a measure by signing the Single Convention on Narcotic Drugs (New York, 1961).

Dr. Collazos’ decisive contribution to the consideration of the coca leaf as a food was to experimentally demonstrate the extraction, “relevant, certainly, of various important nutrients,” and especially the use of carotene, prized in blood plasma, in traditional coca use. His primary conclusion was to show that “it contains various nutritional substances, some of them in noticeable proportions,” but that “its association with cocaine is a major impediment for its use.”

The analysis of the coca leaf accomplished by Duke, Aulik and Plowman (1975) demonstrated the leaf’s great nutritional richness compared with that of the 50 most important food plants in Latin America. They found specific values that led them to emphasize its importance: One hundred grams of coca leaf would satisfy the minimum recommended daily requirements in calcium, phosphorus, vitamin A, and riboflavin, for men and women.

Neither the scientific findings already mentioned nor the critiques coming from within the United States itself (Martín R., 1970; Weil A., 1972, 1975; Grinspoon L. and Bakalar J, 1976) altered the official and psychiatric understanding of the Andean aliment, which explains the promulgation of Law 22095 (1978) — still in effect — which in its initial consideration qualified Andean coca use as a “social problem.” The academic response came without delay and made itself felt months later in América Indígena 4 (1978), the prestigious journal of the Inter-American Indigenous Institute[17]. The research undertaken in Bolivia by William Carter and Mauricio Mamani[18], gathering basic information in the universe of traditional coca users, didn’t manage to alter either the substitutionist policy imposed by the international legislation that excluded the reality of coca as a food of the Andean world or the view of the psychiatrist world, which continues considering coca “a dangerous drug.”

 

Marihuana and opium poppy

While the history of the discrediting of marihuana (Cannabis indica, sativa) and of the opium poppy (Papaver somniferum) does not include an official record from the United Nations, as was the case with the coca leaf, it would be easy to confirm the purely psychiatric origin of their discrediting through historical studies similar to those followed in the case of the Andean plant. It would be enough to move from contemporary science to its history, as Thomas Kuhn recommended in his illuminating book, The Structure of Scientific Revolutions (1964). It will be understood then how psychopathologizing prejudice, taken on officially and diffused through official propaganda, thanks to the prestige granted to psychiatry, is imposed on a medical knowledge that always considered them useful traditional medicines for the nervous system.

To confirm this, it is sufficient to review the precious information shared by Szasz in his Ceremonial Chemistry, the ritual persecution of drugs, addicts and pushers, published in 1973, a book that gained only marginal attention in the most serious journals, given the consequences that adopting his denunciation of “addiction” as a pseudo-medical diagnosis would have. As Szasz noted, in 1885 the Report of the Royal Opium Commission compared opium with liquor, and the 1894 Report of Indian Hemp Drug Commission, under the charge of the British government, concluded that “the regular, moderate use of ganja or bhang produces the same effect as regular, moderate doses of whiskey.” Indian hemp and the opiates indeed have and have had an assured place in the approved pharmacopoeia. As Thomas Szasz noted, “the mythology of psychiatry has corrupted not only our common sense and the law, but also our language and our pharmacology”. That distorts policy and misinforms public opinion, which certainly would support the modification of the laws if it recognizes prohibited plants as traditional psychoactive medicinal plants.

 

Conclusion

The review of the official information on coca leaf in the United Nations, from the Report of the Commission of Enquiry on the Coca Leaf (1950), shows the evident distortion of the of the psychiatric “gaze” that discards or ignores the validity of earlier medical reports, of which the “Annotated Bibliography” of the abovementioned Report constitutes a documentary proof. The “paradigm” of “chronic intoxication” or “addiction” established as “mental disease” deserving of treatment, helped maintain the dogmatic prohibition of the United States, converted thus into the exportable patron of its international policy (Nadelmann, 1988).

Independent of the nefarious economic, social, and political consequences of the global crusade, which are paid especially by the producing countries, they impose the questioning of the current “established disorder” strictly for health reasons. Humanity’s reappropriation of plants that have medicinal uses for the nervous system, but which have been stigmatized by psychiatric scholasticism, would allow the peaceful reordering of the producing countries and, at the same time, a true education for properly using them with trustworthy medical information. It would be the best manner of responding to the challenge of unregulated and sometimes clandestine use of legal and illegal drugs since it would address, in a natural way, the nervous system’s selective appetite for the particular nutrients provided by the plants[19].

Coming out from the shadows maintained by the discrediting psychiatric doctrine, the users of prohibited plants can demand our right to count on the regular supply of the preferred plants, on the order and magnitude of cocoa, coffee, or tea. The traditional producing countries, face to face with the developed ones, would have to back their potential agro industry to find a place in the global market for those great and precious natural resources whose use is backed by respectable ways and traditions.

 

Cartagena de las Indias, June 20, 2003

 

 

Bibliography

Bruner, J.S.& Postman L. On the perception of incongruity: a paradigm. J.Personality,1949

Bruner, J.S.& Minturn A.L. Perceptual identificaction and perceptual  organisation, J.General Psychology 53, 1955

Cáceres, B, La Coca el Mundo Andino y los Extirpadores de  idolatría del siglo XX , en América Indígena 4,  Instituto Indigenista Interamericano, México, 1978

   Historia, prejuicios y versión psiquiátrica del coqueo  andino, en Perú Indígena 28, Instituto Indigenista  Peruano, Lima, 1990.

   Informe sobre el problema de salud y "las drogas", en  Drogas y control penal en los Andes, Comisión Andina  de Juristas, Lima, 1994.

   Coca ,la legalización como alternativa”, Perú en la  aldea global, Fondo Peruano de Relaciones  Internacionales, Lima, 1994.

   Acerca del uso y abuso de sustancias psicoactivas,  Debate Agrario 22, Centro Peruanos de Ciencias  Sociales (CEPES), Lima, 1995.

Cohen, P. The drug prohibition church and the adventure of  reformation , International Journal of Drug Policy.  Vol.14,Issue 2,abril 2003

Cotler, J. Drogas y política en el Perú, la conexión norteamericana  Instituto de Edstudios Peruanos,Lima, 1999

Díaz, A Hoja, pasta, polvo y roca., Pub.Universitat  Autònoma de Barcelona, 1998.

Duke,J.A, Aulik,D, Plowman, T. Nutritional Value of Coca, Botanical Museum  Leaflets; Harvard University,24

Festinger, L A Theory of Cognitive Dissonance, Stanford,  Cal.:StanfordUniversity Press,1957.

Grinspoon L.& Bakalar J. Cocaine, a drug and its social evolution,  Basic Books, New York, 1976.

Levine, Harry G Global drug prohibition: its uses and crises. International Journal   of DrugPolicy Vol 14, Issue. 2 , April 2003, Pages 145-153 :

Martín, R. The role of Coca in history, religion and medicine of  South American Indians, Economics Botany 24, 1970

Mortimer, G. W. Peru, History of Coca , “The Divine plant of the  Incas” with...,J.H Vail &Company, New York, 1901

Musto, D., The American Disease:Origins of Narcotic Control,  Yale University Press, 1987

United Nation Report of the Commission of Enquiry on the Coca  Leaf, Special Supplement, Vol.I, Lake Success,  1950.

Nadelmann E., U.S Drug Policy: a bad export, Foreign Policy,  Spring, 1988

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   International Society. International Organization 44, 4, 1990.

Osgood, C.E &Tabbenbaum The principle of congruity ..., Psycological  Review,1955.

Paz, O. El ogro filantrópico, Seix Barral, Barcelona 1979,

Szasz, T. Ceremonial Chemistry, The Ritual persecution of Routledge & Kegan Paul , London,1974

Schaler, J. Addiction Is a Choice, 2003

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Maier’s Experience,

taken from Oléron, Pierre Les Attitudes dans les Activités Intellectuelles, Les Attitudes, Presses Universitaires de France,1961

 

Instruction

Join the 9 points by means of four straight lines drawn without lifting the pencil or going back over them. It constitutes a good illustration of what is meant by “frame of reference”.

 

 

Traslated by Phil Smith
DRCNet