The Control of Drugs and Drug Users

Reason or Reaction?

Ross Coomber

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9781000162127
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Informed debate on how, why, or even if, drugs and those that use them should be controlled needs an insight into the background of such controls, how effective they have been and what reasonable alternatives there may be. This book seeks to provide such an insight. Reviewing important aspects of past and current drug control policies in Britain and America, the international compliment of expert contributors seek to explore the rationality of the reasoning which produced the initial controls, the continuing relevance of those currently employed, and provide alternative scenarios for future policy.

PART ONE
THE EMERGENCE OF DRUG CONTROLS

CHAPTER 1

Pathologising the Soul: The Construction of a 19th
Century Analysis of Opiate Addiction

Geoffrey Harding

Opium has been consumed wholesale, largely with equanimity, in Britain for centuries. In broad historical terms however, it is only relatively recently that the use of opium (and latterly opiates such as morphine) and it’s attendant addictive properties emerged as a public health issue of concern, and became the subject of widespread vigorous debate. This debate originally resulted in compulsive opiate use being re-defined from mere bad habit, to that of a moral disease or “disease of the will”, and latterly as a medically defined condition. Combined with other negative perspectives on drug use and drug users, this resulted in opiates being subject to increasing controls from the mid to late nineteenth century.

The aim of this chapter is to supplement existing accounts of the nineteenth century responses to unregulated opium use by approaching this development from a perspective derived from the work of the philosopher, Michel Foucault. This perspective is elaborated in Foucault’s The Archaeology of Knowledge and is essentially a methodological treatise which attempts to provide a novel means of analysing historical knowledge. In applying it to the development of institutionalised responses to opiate use this analysis aims to explore the conditions in which compulsive opiate use could be know as addiction, and be spoken of as a particular type of problem.

As with all Foucaudian analyses, this analysis of historical responses to opiate use involves a rejection of objective concepts of knowledge and truth. Hence it is not assumed that addiction exists as an objectively given, self evident state which was simply discovered. Rather, the analysis is premised on the assumption that what constitutes addiction is a social construction. What distinguishes this approach from previous articulations of a social constructivist perspective is the claim that objects are constructed through what Foucault terms “discourses” and networks of “discursive practices” (Foucault, 1974).

It is through analysing discourses that we can move towards an understanding of how we know what we know — specifically, how the contours defining addiction could be known. The term discourse, in the Foucaudian sense, however is not equated simply with language. An analysis of discourse does not involve simply what was said, but rather how it was possible for what was historically documented to have been recorded. Discourses are not treated simply as if they were a descriptive record of an objective world, but are the embodiment of what are termed discursive practices. The concern is not with who said what, but rather the conditions under which those sentences of the discourse are capable of being uttered and have a truth value. Thus,

… the familiar objects of the social world … are not “things” set apart from and independent of discourse but are realised only in and through the discursive elements which surround the objects in question. Things then, are made visible and palpable through the existence of discursive practices … (Prior, 1989:3)

These discursive elements include the authority and status of statements which describe and refer to these objects, the concepts which formulate the object, and the theoretical viewpoint from which they are developed. This chapter then, examines the discursive elements which formed the conditions in which it was possible for opiate addiction to spoken of as a precise object during the late 19th century and be rendered susceptible to particular types of power and control.

A MORAL PATHOLOGY OF ADDICTION

From the stand point of conventional histories of the social response to opiate use in 19th century Britain, it may be considered as curious that this analysis starts several decades after the initial expressions of concern over opiate use were first articulated. The reason for this is that the task is not to re-establish that point in time when addiction first emerged as an issue of concern, but to establish how it was possible that opiate addiction could be analysed and understood in terms of a model which explained addiction as a result of an impaired moral faculty. This model, which was successfully promulgated within 19th century Britain, although premised on the concept of the individual addict’s pathology, was not formulated within a bio-medical conceptual framework, although it could be, and was subscribed to within medicine as a legitimate analysis of addiction. Rather it resulted primarily from the analytic endeavours of a 19th century anti-opium movement: the Society for the Suppression of the Opium Trade.

In order to place this study into a wider context it is useful to briefly consider the social circumstances within which opiate addiction was understood and articulated within terms other than of the addict’s underlying pathology. There are a number of accounts documenting the use of opiates in nineteenth century England. Of these the pioneering contribution by the social historian Virginia Berridge is particularly notable (Berridge, 1977a, 1977b, 1977c, 1977d, 1978a, 1978b, 1978c, 1978d, 1978e, 1982, Berridge & Lawson, 1979, Berridge & Edwards, 1981).

Berridge has observed that in England during the first half of the nineteenth century opium dependence was popularly known as a ‘habit’ rather than ‘addiction’. Opium and opium based preparations such as laudanum — a mixture of raw opium, distilled water and alcohol — were cheap, widely available, and could be bought without restriction from pharmacists and general grocers. In the main they were consumed in quantity by the working classes as a culturally sanctioned practice restricted largely to self-medication. Consequently many people developed a dependence syndrome; but they remained unaware of the fact until their regular supply was interrupted or restricted. When their ‘habit’ was recognised it constituted nothing more than an unfortunate side effect of the drug or a concomitant of their poor social conditions (Berridge & Edwards, 1981).

The essentially relaxed attitude to opium consumption and acceptance of its use for non-medical purposes is illustrated in the response (or rather lack of response) invoked by a rash of scandalous confessions among the literary middle classes, of opium use, most notably those of Thomas DeQuincey. In 1822 DeQuincey’s revelations were published under the title of ‘Confessions of an Opium Eater’, a development which marked the beginning of an awareness of the stimulant properties of opium. DeQuincey’s ‘Confessions’ met with mild protestations over his ‘recreational’ use of the drug — purportedly to induce a creative imagination conducive to writing — but overall the reaction remained merely one of mild curiosity. (Berridge, 1982)

However, after the mildness of public reaction to these scandalous confessions, the first significant development in response to opiate use was not concerned with whether it was consumed merely as a stimulant, but rather with the effects, if any, this practice had on life expectancy (Berridge, 1977b). Medical inquiries into the effects of opium grew apace during the 1820s. These led Robert Christison, Professor of Medical Jurisprudence at Edinburgh University, to judge that neither opiates themselves, nor their sustained consumption, produced any directly damaging condition. For the most part of the early nineteenth century regulation of the drug’s use remained embedded in the culture of urban and rural working class communities (Berridge & Edwards, 1981).

By 1840 however, opium consumption, which earlier was an issue only in so far as its effects on longevity were concerned, had evolved a number of other facets. For example, a Dr Thompson (Thompson, 1840) writing in the Medical Times of the same year, was given to opine that opium when consumed as a ‘stimulant’ — i.e. for no recognisable medical complaint, — “… affected all that was good and virtuous in women, it acted as an aphrodisiac and subverted all morality”. Responses provoked by opium consumption could also vary in accordance with the consumer’s class. While middle class usage could be held to result from pressure from severe ‘mental distress’ (Medicus, 1851), working class ‘stimulant’ consumption was popularly attributed to poor housing conditions and the prevalence of fever (Parliamentary Papers, 1844).

The elevation of unrestricted opium use as a public health issue was resultant on developing class tensions. These tensions were evident in the nineteenth century Public Health campaign’s enquiries into the consequence of unrestricted availability of opium. An image of working class use of opiates consumed gratuitously, as a cheaper alternative to alcohol, was fabricated by these enquiries. Fuelling the rising concern over the open availability of opium was the development of the medical and pharmaceutical professions in the mid-nineteenth century. Working class practices of self medication were diametrically opposed to the aspirations of the middle class medical and allied professions — to tighten their control over all forms of medical treatment. It was therefore in the interests of these professions to exaggerate the dangers of uncontrolled distribution and access of opium when called to give evidence to the various public health commissions (Berridge & Edwards, 1981). Support for initial regulatory control over the distribution and access to opiates then rested largely on a perception of who was using them and how they were being used.

Nonetheless, what ever the explanations for compulsive opiate consumption it was conceptualised as the product of an intrinsic pharmacological property of opium. People, therefore, did not addict themselves to opium; but rather it was opium’s imputed pharmacological properties (as yet little explained and even less understood) that were thought to be responsible. Whatever the reason for taking opium — whether it was as a ‘stimulant’ consumed as a luxury, or for the relief of pain — in those cases where addiction ensued, it was perceived to result primarily from opium’s properties and not from qualities inherent in the addict. Though the upper classes disapproved of opium consumption by the lower social strata, and made exaggerated claims of it’s “stimulant” use among the labouring classes amidst emerging concerns over assumed links between opiate use and race (see Berridge & Edwards, 1981, Chapters 14, 15) to justify its control (while regarding such use among the upper social echelons as considerably less problematic) it was the drug’s mode of use then — as a purported stimulant — that was the issue of concern, rather than a perceived state of addiction itself.

The anti-opium lobby therefore agitated for a response directed not at the addict but the addict’s supply. The first legislative measure designed to regulate opium’s availability followed, with the passage of the 1868 Pharmacy Act which allowed only registered pharmacists to sell opiates. Until addiction itself could be conceptualised, made visible and analysed as a pathological deviation from the normal — as an example of abnormality — the addict could not be responded to with either blame, moral indignation or medical treatment. Subsequent to the Act, however, a distinct model of addiction was evident, and by the turn of the century the addict could be cast, not as a victim of opium, but as an irresponsible individual wilfully adopting a course of self-destruction — fully aware of the probable consequences but unable to resist the drug induced craving. In other words, the addict was cast as a ‘willing victim’ whose condition was a symptom of a pathological breakdown or impairment of normal moral functioning, resulting in the addict irresponsibly denying his own morality: a moral pathology of addiction. Describing the moral-pathological model, however, does not explain how such a model came to be spoken of and invested with a truth value. To do so, the analysis now turns to the status and position of those who were authorised to articulate this model as an object of discourse.

THE SOCIETY FOR THE SUPPRESSION OF THE OPIUM TRADE

This model owes its existence primarily to discursive practices surrounding the founders of an anti-opium movement: the Society for the Suppression of the Opium Trade (SSOT). The Society is of particular significance not least because it was the most prominent organisation in the Victorian anti-opium movement, giving an organisational focus to the hitherto sporadic protests by the movement as a whole. Since its inception it had waged, for nearly fifty years, an unremitting and ultimately successful campaign against the British controlled Indo-Chinese opium trade. The Society’s Quaker founders were strong moral enforcers, committed to using political practices to change what they perceived as social wrong-doings. Along with other moral reformers of the day they regarded the exploitative practices endorsed by British colonial policies as distasteful, and particularly abhorred the use of force to export opium to China. Their objection to the trade lay in the belief that opium, when consumed for non-medical purposes — i.e. gratuitously and not for a specific ailment — was evil; and that the Chinese government, recognising this, had a right to block its importation on moral grounds. Despite Chinese protestations the British opium trade continued. During the course of the Society’s campaign it had sought to persuade the British public that consuming opium for other than medically defined ailments was in every form and every instance evil in the fullest religious sense.

The Society for the Suppression of the Opium Trade was founded in 1874 by Edward Pease — a wealthy northern industrialist and Quaker. Its impetus derived from a public meeting, held in the same year in Birmingham, organised by a local Quaker, Thomas Reynolds, with the intention of drawing public attention to a trade which hitherto had not aroused widespread public concern. The meeting resolved to form an anti-opium committee; and from it, in November, the London based Society for the Suppression of the Opium Trade was formed.

The Society gathered momentum in early 1875, the bulk of its initial funding coming from the Pease’s Quaker family. The Society’s forty-six man General Council, presided over by the Earl of Shaftsbury, included seventeen members of Parliament, eighteen ecclesiastical ministers and several other distinguished members: Thomas Barnardo, the London philanthropist; Edward Bains, the educational reformer; and Thomas Hughes, Liberal MP and author of Tom Brown’s Schooldays.

In March 1875, the Society published the first issue of its monthly journal ‘Friend of China’ whose masthead carried the epigraph ‘Righteousness exalteth a nation, but sin is a reproach to any people.’ The Society published in the first issue its major lines of attack against the trade, claiming that (a) Britain forced opium on China, (b) Revenue was the sole reason for continuing the trade, (c) Prohibition except for medical pur...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• Preface
• Foreword
• Contributors
• Part One: The Emergence of Drug Controls
• Part Two: The Current Control Context
• Part Three: Current Trends and Possibilities for the Future
• Index