Ajai R. Singh MD

Ajai R. Singh MD | Editor, Mens Sana Monographs [2003- ] | At PubMed, PMC, NLM, OCLC etc | Short Bio [For talks] | Monographs, Book and Book Chapters | Lectures, Awards, Orations | Music, 'Musical Embrace' & Ghalib | Music: About the artiste | Poetry | Life and Influences | Contact

Hedonistic Issues in Drug Dependency

Namah Vol 2, Issue 2, 21st February 1995 p57-61.

 

 

Hedonistic Issues in Drug Dependency

Dr. Ajai R. Singh

Dr. Shakuntala A. Singh

 

Editor's Note:

Hedonism is a philosophical concept that regards pleasure as the ultimate goal of life. The seeking of pleasure and avoidance of pain is the essence of hedonism. Bentham, one of the chief advocates of hedonism, propounded the theory of' hedonistic calculus' which points out that the more we seek pleasure, the less we get it. We should not therefore seek pleasure but seek objects that are pleasurable to us. The authors consider that substances (drugs) with abusive potential fulfill the criteria of such objects of pleasure. The tendency to avoid pain has resulted in an overmedicated society. The authors opine that the social consciousness is becoming more and more hedonistic. Any rehabilitation program for drug-dependents must offer alternative and integrative outlets while concomitantly trying to change the value orientations of the society with the help of relevant social collaborators.

 

It is tempting to try and lay down a simple formula which could highlight both our capability and its effectiveness in the drug1 rehabilitation programme. However, as most individuals who have to tackle the experience of social deviance sooner or later find, there is no such formula that anyone can offer in this or any other condition of this nature.

…………………………

1Unless otherwise stated, the word ‘drug’ refers to that chemical agent (usually non-therapeutic, but may also be therapeutic, though not so utilized in the particular instance where it is being ‘used’) which is ingested, in the mail, by the deviant sub-culture which can be considered to believe in ‘psychotropic hedonism’ (Klerman, 1972), to a greater or lesser degree, without any further attempts at sub-division within this group.

If such is the case, how can a proper perspective of the issue be seen? To even attempt an answer, we should, in the first instance, have adequate data about those social processes that generate, perpetuate and control the expression of socially deviant behaviour in general, of which drug depen­dence is but one manifestation. Then, we shall have to consider which of these pro­cesses is of how much importance in relation to drug dependence and rehabilitation. An understanding of these processes is germane to the issue because unless we know which social processes exist, we will not be in a position to utilise or modify any of them to suit the rehabilitation programme that we wish to carry out.

 

A few important corollaries arise from this. Firstly, it would be wise to consider drug dependence as a psycho-social malady, ex­tending the disease-label of psychiatric diag­nosis from the strict medical model to a more comprehensive psycho-social one. Secondly, the psychiatrist, in such a frame of reference, will have to consider himself as one of the social scientists (and only one of them) who, although with the training, ability and op­portunity to observe, treat, and, possibly, rehabilitate drug dependents, has much to learn from other social scientists working in this area. Thirdly, even while tackling the issue of rehabilitation of the individual drug dependent, one cannot lose sight of the broader issues of social relevance which will be involved in coming to grips with the situation. Finally - and this is the inevitable conclusion that must come out of all that has been said earlier - all processes of social change will have to move in unison. Such a harmony can only be achieved with better interaction, more communication and an interdisciplinary model for the understand­ing and constructive manipulation of social deviance in general and drug dependence in particular.

Psychiatrist's Role

The role that one can visualise for the psychiatrist in this set up is of a cog in the giant wheel, albeit an important one, hope­fully. He is constantly exposed to interactional difficulties in his patient population and carries out various procedures that manipulate their environment to make it less stressful. This gives him a unique insight into those measures which would best help them to get rehabilitated. Knowing fully well the marked amount of rejection, antagonism and distrust that this patient population of his tends to generate amongst the so-called healthy environment that surrounds them, the psychiatrist must develop the ability to make the drug dependent understand the initial inevitability of this response, which the patient must face - nay, expect and welcome, rather than deny or reject. At the same time, the psychiatrist should maneuver the social network around the patient so that it is more amenable to the acceptance of a changed individual. An individual who, although retaining some of his idiosyncrasies (and, come to think of it, who, amongst the so called normal, also doesn't?), is still a person needing an environment healthy enough to continue to offer him opportu­nities to remain drug free.

In this sphere, not only will the psychiatrist have a role to play but also the legislative and legal divisions with efficient administrative handling by the drug-control wings of the bureaucracy, the judiciary and the police. At the same time, it will involve commitment from the social thinker, the politician, the social worker, the philanthropist, the eco­nomist and even the lay citizen of this socialist democracy: a commitment to get involved in the massive movement for social change that the community has to undergo in order to both rehabilitate and prevent this deviance. No piecemeal, disjointed, solitary efforts are likely to succeed, as the law enforcing agencies have realised to their dismay. Punitive measures, again, are poor means when not combined with a reformist approach. The model will have to be more global and integrative, and involve a com­bined effort from all social welfare agencies mentioned earlier.

 

This model of change will tackle both issues of primary prevention and rehabilitation. As most of us are aware, there is conceptually not much difference in these processes. At least, there need not be. An efficient rehabi­litation programme must not only rehabilitate the individual who has become depend­ant but also take cognizance of and rectify those processes in the community which generate such difficulty in the first place.

Hedonistic Pursuit

Another point worth noting cannot be missed here. It is probably an exercise in cynicism, may be an attempt at chastisement. Whatever way it is considered, we cannot but accept that our social consciousness is be­coming more and more hedonistic. The seeking of pleasure and avoidance of pain, which has been acknowledged as motivating instinctual behaviour in man. has also come to be accepted as the guiding factor for the community at large. The seeking of pleasure as an important goal in life involves utilisa­tion of all those processes at our disposal that can possibly give this pleasure. Obviously, drugs serve this purpose for some individuals and this must be one of the reasons why it is used to such a major degree in those who either lack other means of pleasure or do not consider them worthwhile. Further, the avoidance of pain as another important goal naturally involves utilisation of means that will reduce distress to the minimum, whether the means are legitimate or not. The results are, on the one hand, an over-medicated society (Klerman, 1974) and, on the other, the rejection of 'Pharmacological Calvinism' for the more attractive 'Psychotropic Hedo­nism' (Klerman, 1972). As an over-medi­cated society, we tend to increasingly abuse chemical agents to cope with the growing number of human and personal problems (Klerman and Schechter, 1984). The games that the medical professional can inadver­tently (and, sometimes, not so inadvertently) play with the drug manufacturer, the phar­macist and other sources interested in push­ing such drugs to further 'medicalize life' (Illich, 1976), has come in for strong criticism (Lennard and Epstein et al., 1970; Muller 1972; Illich 1976). But it again reflects our obsession with the avoidance of pain and seeking of pleasure. As Carstairs (1969) says,

"Everybody nowadays expects to be happy. What is more, if anybody does feel unhappy, he immediately thinks some­thing must be wrong either with him or with the state of the world, if not both".

To which one might add that he then sets about gaining this happiness (and getting rid of unhappiness) in whatever way best suits him, which is usually either the easiest available to him or which carries the greatest appeal for him in the circumstances, what with all the avenues for the supply of psychotropic drugs readily available for manipulation.

This is as regards chemical agents with abuse and addiction potential available in the pharmacies. Those which are not - the so-called non-therapeutic drugs with abuse potential - are subjected to the trend of 'psychotropic hedonism' which, in its essen­tials, has been propagated by a contempo­rary youth culture not only as a rebellion to adult authority but also as a concept that increasingly incorporates drug-taking into its ethos and sees it as consistent with its hedonistic view of life (Lasch, 1979). This sub-group culture stresses the need for the individual to assert the right to do as he pleases with himself, including the right to use any drug that he pleases (Veatch, 1974). The obvious emphasis on hedonistic pursuits as well as 'pleasing' of self that this group seeks to emphasize further fits the conten­tion that our social consciousness is becom­ing more and more hedonistic.

 

If such is the perspective, how should any rehabilitation programme be formulated? Unless, first of all, it is able to offer alter­native outlets for this hedonistic pursuit - ­outlets in which the individual may achieve his own level of satisfaction with minimal distress to self and his environment - the programme will not even have reached first base. Which alternative pursuits can the society offer, will have to be decided by each social group according to its own social ethos; but, in general, the pursuits will have to be more integrative rather than disruptive, alienative or anomic.

Restructuring the Social Edifice

A second, and more disturbing thought, must also compel our attention here. Is our obsession with and propulsion of the society towards hedonistic ways itself generating this type of deviance as an inevitable fall-out? One hates to sit in judgment like this and act the Prophet of Doom. One also hates to consider this a logical (and, probably, also just?) reward for all the pleasure-seeking we are doing. This pessimism and cynicism may be considered uncalled for in certain quar­ters. But, probably, it is worth pondering whether this is the price we have to pay for our misdemeanors and our indulgences.

 

Not only is this thinking necessary for sound­ing a note of caution but also for its practical implications in any rehabilitation pro­gramme which we may formulate. If this thought has any appeal, even in its germ, then any such programme will not only have to be so broad-based as to involve most social welfare agencies in a combined effort di­rected towards the drug dependent, but will also have to be able to affect and, hopefully, change the essential value-orientations and beliefs of our society. This point may be stressed even to the extent of sounding moralistic, which in some quarters is imme­diately considered unrealistic (as if moral cannot be realistic).

Most social welfare agencies may tend to shy away from such an idea, perhaps considering it outside their domain. One wonders whe­ther they can justifiably do so. If deviant behaviour is a fall-out of our hedonistic pursuits, the situation must demand two approaches if it is to be absorbed into the mainstream:

i) Offer such alternative hedonistic pursuits to the deviant as will fall in the group of normal variant behaviour. This will help such a group get integrated into the social group to which it originally belonged. This thought will be acceptable to most social scientists, although that does not mean it will find favour with them, or get implemented.

 

ii) Attempt to reduce the society's hedonistic pursuit and its worth as a supreme goal. It is this that has generated deviance of some type or the other from time immemorial. Unless we agree to this as well, we will be forced to accept that one or the other deviant beha­viour will forever manifest and change established social mores. Today, it is drug dependence and AIDS, yesterday it was something else, and tomorrow it will be some other. Are we not, as social thinkers, bound to also consider the fact that unless we can, in some way, cast a spoke in this fast revolving wheel of hedonistic pursuits, what right have we to avoid facing the music of deviance that must inevitably follow? Each social welfare agency, in its own limited sphere as well as in an integrative manner with the other agen­cies around it, will have to give some serious thought to this. Otherwise all our efforts will only be directed at carrying out minor repairs to the fast crumbling mansion of our social fabric, repairs carried out after the damage is already wrought. An intelligent social consciousness must demand  much more than patchwork. It demands an ability to anticipate certain repairs before they are forced on to us. Along with the insight to be able to revamp and restructure our social edifice itself, if need be, a commitment to change essential value orientations and beliefs of society can be the first important step in restructuring our social edifice, a need which has to be earnestly experienced by all, before it is forced on us by crushing circumstances in conditions where we may not have the means necessary to carry it out.

 

In such a situation two processes must go hand-in-hand. Whilst on the one hand, efforts at rehabilitating the individual drug dependent will have to be carried out, measures by which this type of behaviour will be prevented from manifesting must also be made. To be sure, it will not be possible for every social thinker to have both dimensions in equal measure. Nor, perhaps, would it be necessary. But a commitment from thinkers and workers towards both these goals is a must. Firstly, to synthesize their own thoughts and convictions, and secondly, to work in tandem with other agencies active in this area.

 

Concluding Remarks

 

It is only then that drug dependence is likely to decrease. No deviance can easily disap­pear, howsoever much it may be the wish of the most well meaning and well-modulated programme of social change. But, if we give a thought to this conceptual framework and think of means to make it operative, then, probably, not only shall we look to the rehabilitation of the drug dependent, but, in some measure at least, we shall help rehabi­litate society itself: a society which has the notorious ability to generate and sustain this and other such maladies in the enormous proportions that it has done in the past, is doing today, and can do in the future.

 

 

 

 

 REFERENCES

 

 

 

 

1.  G.M. Carstairs. A Land of Lotus-eaters. American Journal of Psychiatry, 1969, 125, pp. 1576-80.

2.  I. lIIich. Medical Nemesis: The Expropriation of Health. New York: Pantheon, 1976.

3.  G.L. Klerman. Psychotropic Hedonism ver­sus Pharmacological Calvinism. Hastings Centre Report, 1972, 1-3.

4.  G.L. Klerman. Are we an overmedicated Society? Detroit: Annual Meeting of the American Psychiatric Association, 1974.

5.  G.L. Klerman and G. Schechter. Ethical Aspects of Drug Treatment. In 'Psychiatric Ethics', ed. S. Block and P. Chodoff. New York: Oxford University Press, 1984, 117-30.

6.  C. Lasch. The Culture of Narcissim. New York: 1979, Norton.

7.  M.L. Lennard, L.J. Epstein, A. Bernstein.

Hazards implicit in prescribing psychoactive drugs. New York: Science, 1997,169: 438-41.

8.  C. Muller. The over-medicated Society: Forces in the Market-place for Medical care. New York: Science, 1972, 176: 488-92.

 Refe      9. R.M. Veatch. Drugs and Competing Medical Ethics. Hastings Centre Report,  1974,4: 68-80.

 

………………………………………………………..

 

Ajai R.

Dr, Ajai  Ajai R.  Singh is a psychiatrist who was a Senior Research Fellow in WHO

W.H.O. Collaborating Centre in Psychopharrmacology , Bombay.

Dr. ShaShakuntala A. Singh, Ph.D., is a Fellow, ICPR; Lecturer in Philosophy, K. G. Joshi C College of Arts and N. G. Bedekar College of Commerce, Thane.

 

 

<<<Previous

Next>>>

Enter supporting content here