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DRUG USE AND DRUG USERS PDF Print E-mail
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Books - Drugs & The Public
Written by Norman Zinberg   

DRUG USE

Three factors determine how one reacts to a drug: the pharmacological action of the drug itself (what a pharmacological text says it should do); the set, which is the individual's expectation of what i the drug will do to him, his personality and personality reaction; finally, the setting (the total physical and social environment in which a drug is taken).

It is possible and even likely that the combined effects of set and setting will overshadow completely the pharmacological action of a drug. For this reason it is difficult to predict how a drug will affect certain individuals when it is taken at different times and in different social situations. The vaguer and less predictable the pharmacological effects of the drug (and marijuana, the drug causing most concern today, is extremely unpredictable), the greater the influence of set and setting. For example, the barbiturates are characteristically used as sedatives, and their pharmacological action is considered to be more consistent than that of marijuana; yet they are also stimulants when taken in certain circumstances. Cocaine, usually a stimulant, can sometimes have powerful sedative effects.

Theories of pharmacological action of a drug established in experiments with laboratory animals in a laboratory setting are often almost entirely irrelevant to the short-term or long-term effects of the same drug in our complex human environment. But most attempts to describe and categorize the effects of drug use began with the pharmacological effects, and experimental laboratory information was used to establish the effect of specific dosage.1 The essence of the experimental method is the manipulation of the environment so that an observed effect may be ascribed with confidence to a known cause. Opiates can have reasonably consistent effects under laboratory conditions, so when in 1902 Charles Towne, a New York physician, described the addictive triad—increased dosage, craving for more drugs, and withdrawal syndrome when the drug is removed—he could support it with the results of laboratory experiments with animals.

The categorization of drugs was largely based on whether or not they were physiologically addictive, and this method of categorizadon predominated for many years, despite the severe limitations of laboratory-gained information. The result was that the physiological effect of the drug was taken to be the crucial factor in drug use, and although it was admitted that individual reactions varied, this was regarded as unimportant. Even today the common differentiation of drugs into "hard" and "soft" vaguely refers to whether the drug is physiologically addicting. This leads to confusing, contradictory situations: opiate derivatives are always considered "hard" —which in the public mind tends to mean "dangerous"—while LSD, a strong drug producing intense physiological and psychological responses, is "soft."

By 1925 observers2 were noticing that drugs such as phenobarbital or bromides, which did not produce a consistent physiological addictive syndrome in animals, caused intense attachments in people, raising the question of "psychological habituation," so named because the problem lay less in the power of the particular drug to cause a physiological addiction than in the weakness of the user. The set—what the person brought with him to the drug experience—was recognized as a critical variable, but a basic differentiation was made, like that between hard and soft drugs, between drugs that caused addiction and those that caused habituation.

Slowly, reports3 appeared showing that this differentiation was meaningless except in laboratory animals. Drugs such as the barbiturates, bromides, or nicotine, which were thought to be "psychologically habituating" rather than "physiologically addicting," caused pernicious and dangerous withdrawal symptoms in some individuals, while some opiate users did not develop either tolerance or withdrawal syndrome even after continued heavy use. But the question of drug use was complicated by so many political, legal, moral, psychological, and social concerns that this new understanding did not lead to research and clarification; it merely added semantic confusion.

In 1963, the World Health Organization's committee' on drugs capable of producing addiction attempted to clear the air by a classification according to the characteristic syndromes produced by heavy use. Thus, the sedative or stimulating capacity of a drug, and the incidence of a withdrawal syndrome after heavy use, became merely some of the properties of each drug. When one spoke of dependency of the amphetamine type, the basic characteristics of the response were clear to everybody.

This method of categorization based on dependency used the drug effect itself as a take-off point, and by laying less emphasis on the user's physiological responses made it easier to differentiate with greater subtlety among the potency, differential sensitivities, the behavior arising from the use of particular drugs, and—this only by implication—the various pleasures to be derived from them. The concept of dependency per se in the WHO categorization includes the psychological response to any extensive drug use and raises set to an equivalent position with the pharmacological effects. People who are dependency-prone, it implies, become dependent more readily than people who are not, and strong drugs spell quick trouble for the former, though weaker drugs are less dangerous. "Independent" people, by implication, can withstand a mild drug for a long time and have a fighting chance even with a strong one. The WHO position, in which strength and weakness could be considered moral properties, has puritanical overtones. Addiction is defined as a "state of periodic or chronic intoxication detrimental to the individual and to society," without any attempt to explain what "detrimental" means. The WHO classification in fact perpetuates the medical tradition of presuming that people caught up with drugs suffer, except in unusual circumstances, from personality defects.°

Before the drug explosion of the 1960s, much of what was written about drug use by psychiatrists, and particularly by psychoanalysts, emphasized the personality of the user. Learned articles° discussed unconscious motives rooted deeply in the user's character, often beginning with infancy and the earliest mother-child interaction. The typical drug user had a weak ego, a limited capacity to tolerate frustration, was unconsciously preoccupied with the oral development stages. These early concerns, it was thought, dominated later relationships with people, who were seen as objects, and led to an overwhelming preoccupation with a part-objectdrugs. AM, indeed, the evidence supported this view until the early 1960s. But with the increase in marijuana use the evidence no longer supports the conclusions.

The WHO categorization pays little attention to setting. Nor do the psychiatric and psychoanalytic approaches, which are concerned with demonstrating how the drug user's current choices are determined by the subtle, pervasive, unconscious influences of his past.

Sociologists categorize drug use according to the background of the user, and end up using the past in the same way: the son of immigrant parents from southern Europe, Puerto Rico, or the Deep South is shown to be more likely to use heroin than a child from "middle-class" groups.

The attitude of the WHO and the psychoanalytic and sociological approaches all emphasized susceptibility, and took heavy use for granted. Little attention was paid to the occasional user. Until the enormous change in drug use of the past few years, he scarcely mattered. But with the explosion of marijuana use and the hysterical public response things have changed. The vast majority of those who use marijuana are, in the old terms, occasional users, and it is important to distinguish them from heavy users, particularly of such drugs as heroin. But usually, the public and opinion-forming bodies make no distinctions. Some writers, such as KenistonT and Geber,8 noticed this glaring mistake and tried to make the necessary distinctions. To someone who uses marijuana occasionally, and under certain social conditions, drug use is essentially peripheral; Keniston calls him a "taster": he smokes pot a few times a year at certain social events. Regular or chronic users are called heads, and cannabis smoking is central to their lifestyle.

The emphasis on the life-style of the user attaches importance to the social setting in which drug use occurs. The differentiating factor is how often the drug is used, and the personality of the user is examined only in order to determine what importance he attaches to drug use—whether it is central or peripheral to his life. Of course, this describes rather than explains where the individual stands in relation to his drug, and takes little account of the practical problem that neither the informed, opinion-making public nor the law makes much of the difference between peripheral and central use.

DRUG USE AND DEVIANCY

In the post-Civil War period it may well have been that those who were addicted to morphine were, on the whole, susceptible and disturbed individuals, but at that period addiction was regarded as an infirmity; drugs were readily available, and the addict could expect support and encouragement from friends and family rather than reproach and condemnation. After passage of the Harrison Narcotic Act in 1914, the changed legal position of the addict shifted public concern to the moral decay of the drug user and to the evil of the drug responsible for his downfall.

Deviance has always been defined from outside; an action, violating a particular social or legal norm is considered deviant by those who do not do it. It is our intention to show that modern drug users, though they are held to be deviants, differ little from nonusers—except in their attitude toward drug use. Their drug use is only an auxiliary trait for them, but society perceives it as a master trait. We discuss principally marijuana users, and we believe that their decision to try this drug (and even some others) is influenced more by social pressure than by personality factors. We submit that after some time attitudes toward marijuana use held by the general public, by the user's family and friends, and by the law can have a pronounced effect on his values, standards and, in the end, his personality. As we shall show, it is valid to view a young marijuana user's continuing use of drugs as a response to the social forces that have labeled him deviant.

DRUG USERS

During part of our study° we gathered data from a sample of English students and apprentices. About 15 percent of both groups turned out to be drug users; the vast majority had used marijuana between one and one hundred times, while a small percentage occasionally used amphetamines. The users and nonusers in this study were progressing in their careers at virtually equal rates. The groups differed little on other levels. Political opinions, for instance, varied according to class rather than drug use, and the political radicals came from the student group and not from among the apprentices. In the English apprentice group both users and nonusers tended to be more conservative than the student group; in both groups the users tended to be somewhat more liberal toward abortion, homosexuality, the abolition of capital punishment, and other controversial social issues. Nonusers and users differed greatly as to how they preferred to spend their leisure time. The users tended to be more experimental, were more interested in pop music, art movies, and so on. Nonusers drank more on social occasions, dated less, and enjoyed more conventional forms of entertainment; they also tended to be more satisfied with their jobs than the users. But the two groups did not differ obviously on how much they enjoyed their work, on the quality of imagination they brought to it, or on questions about working per se. The only basic differences the study revealed were in their attitudes toward drug use and their knowledge of the effects of drugs. The nonusers tended to see the users as untidy, antisocial, irresponsible, and potentially difficult members of the social group. The users did not share this opinion, though they were aware that this was how others saw them. They regarded themselves as socially freer and more interested in social change. They defined the nonusers just as the nonusers defined themselves—more cautious, more accepted by society at large, and more law-abiding. This indicated the capacity of the users to make accurate and reliable social observations.

In another part of our study,' ° we questioned a group of students from liberal eastern colleges in the United States who were split fifty-fifty between users and nonusers. They volunteered for testing in answer to an advertisement calling for students to participate in a psychological experiment. They were not distinguishable on any social or psychological dimension other than drug use. Both groups came from approximately the same class background and were pursuing their careers with equal rapidity. They had similar personality structures, with a low overall incidence of neurosis, and showed little difference in their political opinions. They divided in the same way as the English group in how they spent their leisure time, the users getting more involved in experimental activities and drinking less alcohol than the nonusers. The groups in this exclusively student study did not show as sharp a differentiation in the attitude of nonusers toward drug users as the earlier study had revealed, though both groups regarded the users as less cautious and controlled and more experimental than the nonusers. However, there was a significant difference in that nonusers expressed considerable fear of any drug, of the risk that it would interfere with their capacity for work, with personality organization, initiative, and responsibility. Users did not see themselves as differing from nonusers on any of these levels as a result of their drug use, but were aware of the nonusers' views.

How does this picture square with previous investigations of drug users? Probably the most comprehensive study is The Road to H by Isadore Chein.11 This book is principally concerned with heroin use, but many of its conclusions are relevant to drug use in general. We found Chein's book particularly helpful because it describes three pressures influencing people in the direction of drug use: the desire for status, the desire for certain kinds of intense personal relationship, and rebellious feelings against existing social standards. Certainly these factors heavily influenced the users among our sample who had begun regular use before 1962 and used drugs other than marijuana. Even among those who had recently begun using only marijuana there was a small but significant group whom we described as "in-for-anything" types and fell into the same category as those described by Chein though they came from middle-class backgrounds, not immigrant-ghetto. They had many more affinities with the drug user of the 1930s—the more stereotyped delinquent deviant—than with the marijuana users of the 1960s. They form part of the first group that we describe in Chapter 1, and we suspect that it is from this group that the evidence for drug progression is gained. They are disturbed and will try anything—drugs, people, alcohol, or sex—and because of personality difficulty are much more likely to get into trouble with the law. Any study of arrests will show a much higher percentage of this group than of any other.

Chein's idea that the drug user desires status is certainly true for a minority-group youngster whose father has just migrated. The people who use drugs in his neighborhood are the big shots: they make money, wear flashy clothes, drive new cars. The boy wanting to break out of his background requires a model and longs for status; he will naturally emulate one who stands out from the gray faceless pattern of economic and social deprivation, and how his model has broken out would seem less important than that he
has.

Few of Chein's factors hold true in the same way with the modern marijuana user. We found little evidence in studies or in our own interviews that most of those who had begun to use marijuana in the past two or three years thought that it afforded them much status among their friends. It was so generally accepted that users did not feel they were associating themselves with big, brave people. In fact, one third of the users we interviewed had stopped, not because it was against the law but simply because they did not like it or because it was too much trouble; this did not represent loss of status.

The other two pressures influencing people in favor of drug use—a desire for intense personal relationships, and ambivalent feelings about contemporary society, particularly as represented by a number of our most prominent social institutions—do eventually become important factors to the marijuana user. According to Chein12 these pressures are motivating forces for heroin users, but we find that initially they are not very important to the marijuana user. Their importance does grow when the latter finds himself labeled deviant, and a direct result of this is that his psychological and social position—set and setting—change markedly.

In 1972, we have a bigger illicit-drug problem than we had when the Federal Bureau of Narcotics was founded in 1930; everybody from Timothy Leary to Spiro Agnew will grant that we must be doing something wrong. We would like to suggest a new approach, one that views the drug revolution as part of a larger social process. Specifically, we suspect that the increasing switch from alcohol-based drugs, still used by the older generation, to marijuana and psychedelic drugs, preferred by youth, could be the result of our recent and still continuing advances in electronic technology.

We are experiencing a social upheaval of which the so-called drug problem is merely the part on which many older people choose to center their fears. We may even be facing a change in the nature of consciousness, induced by our technology and brought into every house by television.

Of course, there are many factors other than technology at work in the emergence of the drug culture. But none of these other influences alone, nor many of them together, could have caused the dramatic cultural revolution of the 1960s, in which pot use, for instance, skyrocketed from a few hundred thousand to somewhere between five and twenty million, and psychedelic fallout, in the form of music, light-shows, new cinematic techniques, and other by-products, inundated our country with the mystique of the electrochemical turn-on. The very phrase "turn on" itself, in fact, indicates the primarily electronic origins of the transformation that is occurring. So does the fact that most users are under 25.

This group has also been called the television generation—and not only in the United States. Marshall McLuhan suggests that electronics creates a "global village," and indeed it is conceivable that a French youth who watches television has more in common with his contemporaries in the United States than with the older generation of his own country.

No one would deny the all-encompassing, all-enveloping nature of the television medium, and most children experience its power early in life. Mothers quickly discovered television's pacifying effect on the very young. Many children, sociologists tell us, have spent more hours in front of the set by the age of 12 than they have spent in school. Finally, hard evidence, gathered from interviews with 1,000 pot smokers, has led us to believe that electronics preceded chemistry in altering their consciousness.

Alcohol was around for centuries before the problem of alcoholism became a massive social issue. The wine and beer consumed by the Greeks, Romans, Goths, and other peoples evidently produced few hard-core drunkards until two major technological breakthroughs occurred. In mid-fifteenth-century Italy, the process of distilling alcohol was discovered. Then, early in the seventeenth century, improved agricultural methods provided a surplus of grain, and alcohol in large quantities became available. Gin, rum, and whiskey appeared in a flood, and along with them came myth and misconception. It was believed that those who could drink huge quantities were stronger than those who could not, that alcoholic drinks were aphrodisiacs and possibly even love potions, and that what was thought and said under its influence was wiser and more profound than what was thought or spoken while sober. (Note that the same old claims are now made for marijuana.) Even sobriety itself acquired the appellation "stone cold," and seemed a dismal state in comparison with the warm good-fellowship of drunkenness, just as pot smokers regard nonusers as "plastic" or relatively emotionless.

These myths and exaggerations had widespread and catastrophic repercussions; for instance, many artists of this period died of alcoholism. It was two centuries—some would say three, considering that there are still over five million alcoholics in this country alone—before a measure of social control began to reappear. And, of course, even this degree of adjustment did not occur until after the most stringent measure of political control—total prohibition—had conspicuously failed.

Similarly, the earliest writings of the Chinese, Egyptians, and Greeks indicates a comprehensive knowledge of drugs that fall more or less into the psychedelic category, including manda agora, belladonna, henbane—and marijuana. For millennia before the arrival of the white man, the Indians of both Mexico and the southern plains of the United States were using psychedelic drugs, including peyote (from which came mescaline, the chemical that much later turned on Aldous Huxley to the mind-expansion cult) and the "magic mushroom," Psilocybe mexicana (which gave Timothy Leary his first trip, before he ever heard of LSD). In the ancient Near East, there was another "magic mushroom" cult, which probably influenced the religious concepts of the Greeks, Jews, and early Christians, and which still lingers in Siberia. And yet there was never a mass-based psychedelic-drug problem until the 1960s—that is, until the first TV generation grew out of childhood.

Before centering our attention on television, however, we may avoid oversimplification by considering some of the other social factors that fed into the creation of the drug revolution.

In 1910 the Carnegie Foundation produced a vitriolic official document, the Flexner Report. This study revealed defective medical training and appalling inadequacies in basic medical research in the United States. As a result, immediate and widespread reforms occurred which revolutionized American medicine and the public image of doctors. But this also propelled the profession into a conservative and frightened position on controversial social issues, especially abortion and drug use. When the Harrison Narcotic Act was passed in 1914, doctors were glad to be free of the "dope" problem and quite willing to let the government grapple with it. The government proceeded in the only way it knew. The addict was defined as a criminal, and scientific investigations virtually stopped as drug issues became defined as police issues.

Then World War II and the GI Bill changed the concept of higher education in the United States as huge numbers of students poured into the colleges. The first wave of new students in the forties and fifties were terrorized by the uncertainties of that war and their childhood memories of the Great Depression; they accepted security and life without risk as basic values. But by the sixties students felt more removed from those catastrophes and experienced the need for different goals and meanings.

They questioned the society that had tolerated Joseph McCarthy and had,, failed to come to grips with problems of poverty and social justice. They turned to activity—racial justice in Mississippi, international cooperation in the Peace Corps, sexual freedom in the colleges. Music, clothes, and art all opposed the past.

At the same time, the good faith of the government in general was in question. From the U2 incident, the Bay of Pigs, and the Gulf of Tonkin to body counts and Spiro Agnew, young people found it hard to believe official pronouncements. Their wish for a government they could trust led to a desire for a new politics, a new morality, and a new intoxicant.

Thus by the 1960s a variety of social forces coalesced to create a climate where nonmedical drug use could flourish. The emotional responses to this climate can be heard in any discussion of drug use with young users.

One subject in our study, aged 19, said: "Sure, I use pot. It feels good. Pot slows the world down a little. I listen to myself better. Slow and hazy, but somehow clear, like a movie in slow motion or a TV show with a screen so small that it gets right into your head so you can feel what it shows on the pictures."

Another, aged 17, said: "Hell, I used grass since I was 14. This year I dropped acid and for a little while I thought it would be a bummer, but I came down and it was all right. Hell, that's enough drugs for me, although I'll try acid again. All the pictures inside my eyeballs made me think about the country and me. Music was on and I didn't really listen—it was just part of everything and I sensed everything else. I listened to people and saw they meant well but were playing games. Mostly though I thought about how I sensed them. We were all together but I watched them from here like on a TV show." Similar references to television appear again and again in our interviews.

Radio, previously one of the major influences on infants, encouraged a high degree of psychic development because the child heard people speaking on the set and this encouraged verbalization. Even musical programs, undoubtedly soothing, were interspersed with words. Probably a child learned to respond to certain words quite early in life—one could see a small child's head jerk when "Stop" came from the set. To take the next step, and to learn to understand the meaning of specific words, requires another, higher level of intellectual development, and radio made demands on the infant to attain this next level. Learning to read is also a process in which the child is rewarded for attaining higher levels of abstraction and minimizing or inhibiting feelings and sensory impressions to concentrate on a linear message.

But in the homes of the generation now reaching the age of 20, television was far more widespread than radio, and the child could participate in the experience it offered without the intellectual structures that radio demanded. The developing child's first task is to differentiate between self and the outside world. It seems possible that television permits and encourages a oneness with the screen, a sense of total participation, that does not emphasize that difference. Press the button and everything is there: turn on, tune in—and even relax and drop out for a while. The boundaries between inside and outside imperceptibly become diffuse, When a field or some other outside scene is shown on the small screen, a two-year-old tries to walk into it.

McLuhan's" concept of television as a low-definition medium means that the images, particularly in contrast to print, are sufficiently indistinct to encourage "creative" participation on the part of the watcher. This encouragement to participate, combined with the screen's insistence that you watch it—try ignoring a turned-on screen as you might a phonograph or a radio—gives rise to a situation where the viewer must use his own inner processes to complete an external situation. Rather than setting the task of separating ourselves from external reality, television insists on diminishing such boundaries.

Many of the current crop of drug users describe this melting away of boundaries between their internal and external worlds as their most important reaction to marijuana use. They insist that organizing sensory impressions is less important than being "in" them.

Again, many people have noted that we live in the movie generation; modern producers, and certain young people influenced by the cinema, have indicated that the difference between their relationship to the visual and to the printed page has been crucial in their development. They talk about movies "washing over" them to create sensations; they lose themselves in an experience without having to be able to describe or analyze it.

Those describing the effect of marijuana tend to stress the lack, or rather the irrelevance, of the analytic, penetrating, active approach with its inhibition of direct sensory experience. One is with the music, rather than bringing one's intellectual and emotional powers to bear on the music. When one is experiencing a high on marijuana, one is expected to be able to reach a state of communion with one's companions that involves understanding without the medium of discrete (verbal) ideas. The wholeness of the experience, the sensation, the understanding occur diffusely rather than in a more logical, circumscribed step-by-step fashion.

Using an analogy from physics, one might say it partakes of the field nature of magnetic action, rather than the sequential nature of mechanical processes. But in the mechanical, preelectronic age we learned to think only in step-by-step sequences and, hence, this experience appears "mystical."

Television seems like just another gadget to adults, but to a child it is as important as the refrigerator or the toilet—and psychoanalysis has shown the importance of those facilities in the development of the young.

Contemporary drug users are formed by society, and also prepare society for future developments. They have undoubtedly already influenced certain values in modern North American society. Our institutions—schools, churches, the law—reflect a social hierarchy based on the capacity to produce or achieve. The drug users, however, have begun to promulgate a participating, contemplative, and experiencing society, which is very accurately called the counterculture.

Drugs other than marijuana are involved in this emerging pattern. The birth-control pill, for example, may be as influential as cannabis in the shift toward permissiveness; and LSD and other so-called mind-expanding drugs are taken not only to enable the individual to explore his inner self but also to break down the boundaries between people. The new value consists in being in oneself and others as totally as possible rather than producing and achieving with others.

This combination of increased individualism—doing one's own thing—together with a desire for closer bonds with a group—"Do we have to live in our own skins?"—presents a paradox that has ramifications in the larger society. Our culture now presents many of its middle-class members, at least, with a new range of decisions. Previously our choices of occupation, mate, and residence were difficult indeed and, once made, tended to preclude alternatives.

Now in the United States we have arranged for the middle class a prolonged adolescence during which a vast number of options are available. The problem is less getting what we want by overcoming obstacles and inhibitions than being able to decide what to reject out of all the possibilities open to us. We can break with our parents, get an education, shift academic field at almost any age, have a variety of sexual partners, and choose from a number of jobs. We can move to many parts of the country and think in terms of what climate as well as what social milieu we prefer. As our options proliferate, role definitions of all sorts become increasingly less clear.

Obviously this range of choice is not open to some, but enough people are presented with it for LSD users to be able to ask why dropping out should not be one of the options. When the drug user wants to have it all ways, to be at one with himself and with others, is he not reflecting a society that wishes to extend all options indefinitely, that refuses to reject anything? A society that, through the wonders of an electronic miracle, transcends all physical boundaries and offers vicarious participation in every human experience? We can literally see men killed in Vietnam before the Army knows they are dead, just as we can see an astronaut hurtling into endless space the instant it occurs. And on television the event is right there inside your house; to go outside, to do something else, makes a discrete event that is separated from the rest of your life. Almost all of us can remember the first time we went to the theater; and if we try hard, we can even take a pretty good guess as to which was the first movie we saw. This separation from the rest of your life permits the event to be compartmentalized into an external experience. Such external events may be moving and, by forcing you to feel or think, may enlarge your personality, but you distinctly go to them.

On the other hand, can you imagine anyone born since television entered the home remembering his first television show? The medium is so pervasive, so much part of our most intimate environment, that when we share a live experience on television—who can forget the murder of Lee Harvey Oswald?—we participate totally. By being insistently there, in our bedrooms and kitchens, this medium prevents us from delineating it as an unusual external event. Then, by its low definition, which forces us to fill in with fantasy and sensation what is only suggested, it further floods us with intrapsychic data. That would mean that mechanically oriented people who grew up before television's impact would hardly know what the field-oriented younger generation is talking about; and the youngsters would also be baffled by their elders. Is this not exactly what is happening?

Drug users claim that the drug experience permits a controlled descent into a realm of benign chaos. They speak of "cosmic unity" and the mystic "now" in a way that often repels those of us still print-dominated, who search for semantic clarity, rules of evidence, and a reasonable objectivity. Might they not simply be trying to explain differing patterns of sensation and thought—a way of perceiving the world separate from that demanded of us before television?

Thus we do not believe that a young man or woman who uses cannabis in today's social setting is per se neurotic. Neither do we believe that the turned-on generation found their electronic babysitter so gratifying that they seek to return to that early infantile experience. On the contrary, we think of the television medium as a subtle and pervasive teacher.

There is abundant evidence that the modern child learns an enormous amount—facts, ideas, values—from his watching experience. When he starts school he knows much more than his counterpart of twenty-five years ago, but most of what is learned is chaotic and disorganized, drawn from commercials, thrillers, educational programs. When an educational program such as "Sesame Street" is written to meet the learning potential of children, one realizes with awe the organized teaching capacity of the medium.

Television's ability to effect what we dub "cognitive style" can also be demonstrated in other areas than drug use. For instance, the norm for the pretelevision child, after he became a regular reader (fifth grade and beyond), was to read one book at a time. He could be diverted by other activities but would want to finish the thread of that book before starting another. Today's child seems much more at ease reading several books at a time. Somehow he can keep the different entities all going at once.

The insistence of the pretelevision generation that psychic boundaries need to be sharp and clear indicates anxiety about what happens if they are not. McLuhan's comments," many of which were written before drug use became popular and the idea of a counterculture reached its present height, show his prescient awareness of what was to come:

Television, in a highly visual culture, drives us inward in depth into a totally nonvisual universe of involvement. It is destroying our entire political, educational, social, institutional life. Television will dissolve the entire fabric of society in a short time. If you understood its dynamics, you would choose to eliminate it as soon as possible. Television changes the sensory and the psychic life. It is an Oriental form of experience, giving people a somber, profound sense of involvement.

This whole passage, especially McLuhan's unabashed use of the strong word "destroy," sounds almost as if it came from some underground newspaper advocating the drug revolution, or some government publication deploring it, yet it does not mention chemicals at all; it deals entirely with electronics. No wonder the pretelevision generation is so confused and so frightened by what is happening. They see only the drug aspect of the revolution in consciousness, and drugs are associated in their minds with narcotics and addiction; most of them believe that Oriental and tribal modes of consciousness are in all ways inferior to the mechanical Western mentality. They can literally believe that the current shift in sensibility will "destroy" their "entire political, educational, social, institutional life."

We would prefer to use McLuhan's more neutral word "change" and quiet many fears. After all, every society we know about has a way of getting high. We know too little about different cultures' acceptance and rejection of intoxicants, but we do know something of the psychology of intoxication. Alcohol generally relaxes minor inhibitions of behavior and promotes gregariousness. A society that insists on habits of linear thought, sensory detachment, uniformity of "point of view" toward cognitive material, and repeatability requires early and powerful inhibitions against spontaneous, unregulated feelings and scattered, unorganized, sensory responses. Thus a drug that gives them the opportunity to test the boundaries of such inhibitions easily attains popularity. The average, nonneurotic individual can, with two or three martinis, reassure himself that his powerful inhibitions have not become a total psychic cage. From childhood he has watched people drink and has seen the results as not too frightening. There was no hysteria in his family about the fact that he drank, no question of sending him to a psychiatrist or of regarding him as a criminal.

Could we not look at the modern nonneurotic marijuana user in the same light? Television has taught him a style of looking at the world, first as a single, global entity, then as an environment that demands a sharpened, sensory involvement. He constantly tests the extent of his capacity to absorb new perceptions and control them harmoniously. Just as with the alcohol drinker, his drug of choice contains the counterphobic anticipation of more total dissolution, here of psychic boundaries rather than inhibitions. It is not accidental that adverse reactions to marijuana sharply diminish when the effects of the drug are thoroughly familiar to potential users. Our interviews indicate that such reactions are far more frequent among the pretelevision generation when they are talked into trying it (sometimes by their children).

Of course, one must be careful to differentiate actual changes in perception or psychological response from the ideology of a movement. Changes in reading habits or shifts in capacity to tolerate sensory impressions reflect genuine changes in the way people grow up. As a result of being raised on television, these modern youngsters may have subtly changed in their responses to the world. However, this does not mean that the particular slogans, movements, and group activities that are now popular are directly related to early experience with television. There are fads and cults today, as there always have been, and the current drug craze may just be one of them. One must look deeply to find which changes are permanent and which are merely temporary adjustments.

In the present social setting, where drug use is labeled criminal and drug users deviants, subcultural responses—such as anger, exhibitionism, alienation, anxiety, the desire to be different—are stimulated. Often it is hard to tell which is part of the new consciousness and which is in response to social persecution. All we can do is to remember that such a difference exists. Then we will not dismiss new insights because they are clothed in revolutionary rhetoric or polemic; nor will we uncritically accept loose allegations and utopian visions merely because they come from alleged spokesmen for the wave of the future.

Psychologists have long known that what we allow ourselves to perceive is simply a matter of thresholds; men with game legs notice limps which the rest of us do not. The lowering of perceptual thresholds resulting from the television experience .permits greater participation in sensory response which, in turn, leads to changes in behavior. Almost everything about those growing up will show change, including the chemical they use to get high on. Should not this awareness calm some of our fears?

Even if the hysteria subsides, we are left with the mighty task of transcending and mastering the changes brought about by modern technology. We cannot have the world as it was before television. Nor can we return to the concept of drug use that was current in the 1940s and 1950s. If we are to avoid whatever the marijuana equivalent of Hogarth's Gin Lane might be (and we should remember that New York's 15,000 saloons were replaced after Prohibition by 32,000 speakeasies), we must not spend our time decrying the young as deviants or neurotics.

We, must not, above all, fall back on cheap moralizing or simplistic arguments based on "horrible examples." There will be hard cases, and people will suffer because the process of mastering this technological miracle and learning to tolerate the social disruptions accompanying it will be long and difficult. But we must make the effort. Otherwise we will have a vast, self-fulfilling prophecy: by defining a huge number of people as antisocial (criminal), we change their motives and create hatred, disruption, and true rebellion.

SOCIAL SETTING AND PERSONALITY CHANGE

Generally, when psychiatrists examine people who have used drugs regularly for some time—marijuana, psychedelics, or other drugs —they find a fair degree of personality disorganization. This disorganization permits or encourages primitive motives, so that the drug user is described as someone with powerful passive or dependent longings leading to indolence or apathy. He is said to deal with aggressive feelings by rigid, total defenses such as reaction formation ("If you don't come out for peace, I'll kill you") and is considered to be one whose cravings are direct and powerful, with an intolerance of frustration. In such interviews psychiatrists stress the underlying personality factors that led to drug use and play down the effect of the drug and particularly the influence of social setting.

The Zinberg-Weil study15 raised the question, concerning chronic marijuana users, about what aspect of drugs, set, and setting was responsible for the observed personality factors of vague paranoia, excessive anxiety, and dependency.
The researchers wondered whether these factors preexisted in users' personalities and led them to seek out drugs before they were popular; whether (and this was the drug users' contention) the persistent hostility of the social setting had brought about defensive reactions which resulted in personality changes; or, finally, whether the personality syndrome was a direct effect of the drug.

But this study would not necessarily differentiate between changes brought about by the drug use itself and the impact on personality of hostile interpersonal and social responses. There are among drug users many disturbed people who, influenced by the vast publicity drugs receive, unhesitatingly choose them as their vehicle of expression. There is no doubt that in some cases preexisting personality disturbance is the crucial variable in a choice of drug use. But among other subjects of equivalent age and social status, one could not easily find personality differences between users and nonusers.

At first we were preoccupied in our interviews with what personality factors may have influenced some of them to become users. Principally we searched for expressions of dependency, antisocial aggressiveness, or personal isolation that may have determined the choice. It took a long time before we decided that most contemporary drug users drifted into the choice through mild peer-group pressure and chance.

If then we rule out preexisting personality disturbance, where do we look for the source of the personality changes that seem to accompany continued drug use?

The drug users blame the social setting. They are convinced that changes in attitudes, personality, and demeanor follow a growing and deepening awareness that a user is regarded as deviant in society.

In a theoretical approach to the problem, Erik Erikson16 brings intrapsychic, interpersonal, and social factors together in a total developmental scheme. He characterizes each phase of the life cycle as a specific developmental task to be solved. This solution is prepared for by previous phases and is carried further in subsequent 'phases. He assumes an inborn coordination with a predictable environment, and this idea of mutuality specifies that crucial coordination occurs between the developing individual and his human (i.e., social) environment. The caretakers are coordinated with the developing individual by their specific responsiveness to his needs and by specific needs of their own.

Sociologist Erving Goffman, on the other hand, argues that a man's attitude toward himself is formed by the particular social situation society has placed him in, and other people's response to it. In Asylum," his study of hospitalized mental patients, Goff-man describes how friends, family, and society at large see the individual as patient, and thus he becomes what he is labeled. It is a view diametrically opposite to Freud's.

In our study of attitudes toward drug use we seek a middle way by illuminating the complex hierarchy of psychological structures within the psychic apparatus. They vary from simple automatic defense to more complex attitudes, values, ideological beliefs, and identities compatible with those accepted by society. These structures require social stimuli unique to that society, not only to maintain themselves but to develop. Though Erikson accepts instinctual vicissitudes, he insists that simple psychological structures develop into complex values through current experience, and become a complementary series of experiences. The original modes of behavior (Freud associated them with specific organs—the mouth, anus, genitalia) develop into differentiated social behavior through the impact of traditions, institutions, values, and attitudes provided by the society in which the individual develops and by the social places it makes available to him

For an individual to grow up in any society, it is assumed that the internal structures and the codetermined socially provided rituals must fall into a lawful sequence of differentiation. And it is in precisely this area that Erikson's theoretical explorations add a dimension to our study of response to drug use. One must differentiate a complex sociopsychological response to a life situation from the rapidly changing social scene, which cannot remain static if it is to accommodate the cultural changes necessary to this cogwheeling process. Shifts in society that would formerly have been only quantitative now become, by their nature and their social potential, qualitative. The young person experimenting with marijuana or LSD knows that the general attitude of society toward the former, at least, is slowly changing. But given his kinship with his peer group, his use of the drug makes him deviant to the culture at large, and the result is a qualitatively different relationship to society. The change in attitude toward marijuana is not matched by the slow rate of change in public morality and the law—that is, there is no stable psychological regularity in the social organization's response to the individual.

How can one place the individual in this newly disruptive social context? He is part of a social system whose pressures form attitudes and values. These are part of his accepted self, and not "neurotic," even though his life may be inhibited. Compatible social rituals must be legitimized into a developmental scheme that accepts social change so that individual and social needs can be coordinated.

An example of how different levels of motivation function is the situation of a surgeon as seen psychoanalytically. If his motivation to become a surgeon is traced to its most primitive beginnings, we might find early sadistic tendencies in an aggressive youngster whose energies were directed against living things. Our psychoanalysis quickly shows us that it is not these early sadistic desires that make him a surgeon, although they may remain an underlying force. From early on he develops secondary derivative motives which allow him to grow up and perform an exacting, deeply humanitarian function instead of becoming a killer. His capacity to organize, his curiosity, his intelligence, and his manual dexterity are recognized by others in the society and rewarded. Over his lifespan this mutual interaction so strengthens his secondary motives that they provide the impetus for his daily actions, the basis for a self-definition known as an identity, and an absolute defense against the breakthrough of those earliest preoccupations we call primary motives.

At a certain point in the life of this surgeon, he no longer needs social reinforcement to maintain his defenses against primary motives. His desires for an ethical standard, human dignity, rational, evidence, and the like are thoroughly automatized into perceptual and discharge thresholds. But at what point does this occur? Certainly not in school or college, probably not in medical school or during the early years of surgical training. Until his identity has coalesced through experience and interaction, he is at least to some extent vulnerable. Without the consistent support of the law, his teachers, colleagues, patients, friends, and family, who not only say that he is within his rights to stick a knife into fellow humans but commend him for it, he would falter. It is unlikely that he would slip back to the pervert or killer stage, but he might easily become disorganized and apathetic, even at odds with society.

Young drug users have probably not reached the age at which their identities coalesce. They have developed complex secondary motives which have begun a cogwheeling process in this society, leading them toward specific social tasks. Most of our contemporary drug users come from backgrounds that allow them to expect social approval from a reasonable trial-and-error effort. At no point did they expect most social institutions to be arrayed against them. Their families, discovering their drug use, become hysterical, rush them to psychiatrists, and an incredible 43 percent would turn them over to the police. Their schools and colleges threaten expulsion; the law proposes penalties that classify them with murderers; and public officials, through the mass media, suggest that they undermine the foundations of society itself.

This response of the social setting not only interferes with the development of a coherent identity but weakens the secondary motivations already prominent, thus permitting the intrusion of earlier primitive motives. The personality is too well developed for such motives to enter consciousness or behavior in any direct form. Few marijuana smokers, as one comprehensive study shows, are troubled by the more or less realistic primitive illusions/delusions that plague psychotics. But with the withdrawal of external social support, psychic energy is needed to keep the repressed early ideas unconscious. The defenses are weakened and the personality organization becomes less stable. This permits ideas about magic, transcendental experience, and visceral expression, which roughly correspond to primitive impulses, to flourish while those ego interests decrease that are dependent on social nutriments such as desire for accomplishment and organized expression of thought. We find this syndrome in drug users; and if our argument holds, it occurs because of the influence of the social setting and not because of early personality disturbance or the drug itself.

There are other straws in the wind which, though not in themselves definitive evidence, offer some support for this hypothesis. Our sample included a number of regular marijuana users who began to smoke when they were over 30. A small percentage of these subjects reported having an occasional bad experience ("I get paranoid about the people with me, I am suspicious about what they are doing." "I got sick to my stomach and then my heart began to pound and it seemed that I would never be able to pull myself together." "I have lost control and been 'taken over' by an outside force or will which is evil in intent for a while"). None showed the characteristic regressive syndrome. They resented being forced into a deviant role almost as much as their younger counterparts, but were less dependent on social institutions for the support of their secondary motivations and could maintain their delineated social course despite feelings of conflict around drug use. This group with a well-defined identity could usually accept their marijuana smoking as a single, deviant activity and resist seeing themselves more completely as deviants with the accompanying urge to become what you are labeled.

Twenty-two of our subjects had used psychedelic drugs frequently (25 to 250 times) and were members of communes. During the interviews we were initially struck by the extensive presentation of the sort of regressive position previously described. They characteristically expressed vague, generalized thoughts about meditation, spiritual experience, the possibility of being in touch with a higher power, perhaps by leaving their own physical bodies, along with a loss of a sense of physical boundaries. This latter sensation seemed to be connected with a change in time sense that not only resulted in the slowed perception of external events but tended to permit the idea that time flows endlessly in a stream so that past and future are somehow magically more concrete and available. While usually these sensations are presented positively, there is frequent talk of freaking out, of losing control, and particularly of becoming paranoid. Each one of this group of subjects reported periods of intense suspicion of others which they knew was unwarranted.

As these feelings were accompanied by behavior that was specifically described as attempting to reduce individualization, such as living in a commune, it was hard for the psychiatrically oriented interviewer not to respond with automatic concern about the disintegration of ego, loss of self, and other psychopathological ideation that was being expressed. While it was obvious that these people were dealing more directly with primary primitive motivations, further reflection about the material they presented showed that there were more secondary motivations and better reality testing than had appeared at first blush. For one thing the subjects recognized the difference between many of their more unusual sensations and their desire to enter another level of consciousness. They did not completely believe their feelings but would quote some text such as The Teachings of Don Juan'8 or I Ching" to show the interviewer that it was his blindness that prevented him from understanding the subtle combination of fantasy and reality that they expressed.

For another thing, their commune offered them the opportunity not just for the gratification of primitive merging impulses but, more important, the chance to exist in a society where they could feel useful. In the commune, they were slowly redeveloping secondary motives in a social setting that accepted and rewarded them. Their devotion to this island of people stemmed in part from their awareness that this reciprocal acceptance of themselves as human beings with secondary motives for organization, for orderly sequence of activity, for affectful interactions, for communicative discourse, albeit with different standards from the larger society, only occurred in the commune. In the larger society, they were seen as hostile deviants and had accepted the role. This interaction between them and society they understood to result in more childlike thoughts, feelings, and behavior.

Further, they knew that this effort at personal development in the commune was fragile and at the mercy of just those social institutions whose hostility had proved so disorganizing. Continued discussion of the paranoid trend evident in this group and reported by Zinberg and Weil among chronic marijuana subjects presented the question of whether this trend would exist if the attitude of social institutions toward drug use were not so hostile. Although the acid heads knew that many of their suspicious responses were personal projections, they also insisted that they existed in a society hostile to them. Their specific reactions were irrational, but they felt that their overall paranoia was a valid response to external reality. They firmly placed their personality regression at the door of the social setting.

Another important social upheaval provides an example that lends weight to this argument. In 1952 Dr. Grete L. Bibring2° reported on a study of people, mostly Jews, who had survived Nazi persecution in Germany and had come to the United States. These people had existed for years under the most intolerable conditions, often living like animals and constantly hearing of the extermination of their friends and families. At the time of their arrival in the United States, most of them had bizarre psychosomatic symptoms and serious personality disturbances. Certainly they showed marked regression to primitive early preoccupations, and much suspicion, concern about being fed, and ill-controlled aggression.

Dr. Bibring was able to isolate two factors contributing to this condition which were far more specific than the general brutality of life under the Nazis. For one thing, they literally felt guilty about being the ones to survive. Why were they alive when so many other people were dead? But the other factor interests us more at the moment. They placed the beginning of their disturbance at the time before the real horrors began. Many described how unsettling it was when those individuals and social institutions that they had been brought up to trust turned against them. Neighbors, police, judges, the law itself were no longer there to protect them and support them. Instead they became pariahs, wore Yellow Stars, and could be beaten by a policeman or pseudo-soldier not for breaking a known law, but simply for existing.

These displaced people reported the confusion they felt about who was truly at fault. Their sense of justice and social regularity was so disrupted that they wondered if they were indeed criminal. And it was at that point that their regressive symptoms and ideation began. Like the drug users, they doubted society and questioned themselves. They felt disorganized, apathetic, often dissociated.

If the social setting is even in part responsible for personality changes, the situation is more hopeful. A change in the social climate about drugs, similar to what is taking place with abortion, should be easier to bring about than the stamping out of the widespread illicit use of marijuana. The first step toward such a social change is to become fully aware of the present situation and its results. As long as we think of the users in terms of being in the thrall of a powerful drug, or as a psychological weakling debilitated by mind-altering intoxicating experiences, we cannot assess collective social influence on him.

 

Our valuable member Norman Zinberg has been with us since Sunday, 19 December 2010.

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