Drugs as instruments – for anpang?

Drugs as instruments - for anpang?

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Critical remarks on the proposal to use drugs to achieve objectives

It was a summery April day in 2018, as people hunted through downtown Erlangen, looking for the next ice cream parlor or a cool spot in the shade. We inside were at the conference "Altered States" which accompanied the exhibition of the same name at the Kunstpalais.

Christian Muller, professor of psychiatry at Erlangen University Hospital and a specialist in drug addiction, spoke before me. After his lecture on "Drugs as instruments" I was going to present that the distinction between stimulants, drugs and medicines is not so much based on the substances as on the way we think about them. The category "drug" is a socio-political construct.

The day before, legal scholar Jan Fahrmann had already presented how our thinking about drugs changed over time, both politically and socially. I had already heard that colonial powers such as Great Britain and France had once been the biggest drug dealers and had even fought two wars against China (1839-1842; 1856-1860) when the country banned the import of opium.

However, I was so surprised by the extent to which drug policy was actually used to make social and migration policy, and is still being used today, that I later interviewed Fahrmann (Drug policy is used to make social and migration policy).

A menu card for drugs?

Now we will talk about Professor Muller. His lecture increasingly took on the form of a menu card, an impression that I was not alone in having. A menu card for certain mental states that can be achieved with this or that drug love. His theses caused so much discussion that my lecture started a bit late afterwards.

Today I have his thoughts on "The drug as an instrument" in writing; and I noticed that he had already published the approach once in 2011 in the scientific journal "Behavioral and Brain Sciences" presented. There was also a lively discussion, which I will briefly discuss later.

The most important statements for my commentary are summarized here once again: The vast majority of people would handle alcohol responsibly. Only 15 percent of alcohol consumers were considered addicted. For illicit drugs, the ratio is still about two-thirds to one-third. Even for those people who have problematic drug use, it usually starts with a reasonable mab to achieve certain purposes.

Nine purposes

The psychiatrist divides these purposes that the drug instrument can serve into nine categories, namely: (1) improvement of social interactions; (2) facilitation of sexual behavior; (3) improvement of cognitive performance or reduction of fatigue; (4) improvement of recovery or processing of stress; (5) self-medication of mental disorders; (6) expansion of consciousness; (7) experience of a high or euphoria; (8) improvement of physical attractiveness; and finally (9) improvement of spiritual or religious experiences.

I won’t go into Muller’s explanation of the neurobiological mechanisms of action of the substances here. He knows much more about it than I do anyway. Sometimes, however, the exports seemed very optimistic to me. In research practice many questions are still open, even with an old acquaintance like amphetamine ("Speed").

We learn now in "The drugs as an instrument", that people are very busy nowadays. In addition, he must adhere to professional standards in the work environment. Being too nice or too personal does not fit into this. And especially the initiation of sexual contacts does not belong there.

It is about work ethics

Interestingly, Muller did not mention drugs as a tool to achieve professionalism in the workplace. Thus this state appears as a kind of standard mode of the psyche. According to field reports, I have come to suspect that a drug from the class of stimulants without hallucinogenic effects, especially methylphenidate/Ritalin or amphetamine/speed, helps some people focus on work and makes them less susceptible to distractions, be they from colleagues or from news sites and social media.

I experience a gross difference in whether I take the pills or not. The amount of work I can get done and how I feel overall… It’s funny. I simply sit down and do whatever I need to do, and I won’t feel okay until I’m done with it.

A college student without a psychiatric diagnosis on her use of a typical ADHD drug according to research by Scott Vrecko, 2013; dt. translation S. Mucus

The trade name of the drug used by this student, by the way, is Adderall, an amphetamine product. The name was chosen by the inventor in reference to "ADD All" made up: everyone should get an ADD diagnosis. similarly bizarrely, the Ritalin inventor named the drug after his wife Rita. Steinreich made it both pharmacologists. ADD is an old name for the attention deficit disorder ADHD, which is abbreviated to ADHD (30 years of attention deficit disorder ADHD).

Alcohol performs well

But let us stay with Muller’s essay. We learn there, "that alcohol in low to medium doses has relaxing effects". This will help us to move more quickly from the professional mode of work to the more basic readiness for social interactions. It is only logical that the substance is also used as a tool for social interactions "facilitated sexual behavior" is mentioned. And this is simply necessary, according to the psychiatrist, "to ensure our reproduction".

Alcohol is mentioned a third time, where it is about the improvement of recovery or stress management. And Germans actually experience more and more stress (Germans want less stress – but like?). For the fourth time out of the total of nine differentiated targets, the drug finally appears as a self-medication of mild anxiety or mood lows.

In the meantime, those who have already taken a beer from the fridge or poured themselves a glass of wine should not drink up too quickly: the psychiatrist cites 100 ml of wine per day as an example of unproblematic alcohol consumption. In many wine regions this does not even correspond to half a glass, which one can order in the Straubwirtschaft or in the beer garden. More than a small glass of beer (250-330ml) was also not allowed. Then order a Kolsch?

It depends on the dose

Muller emphasizes that the optimal instrumental effect of all drugs applies only up to a certain consumption quantity. After that the problems became predominant. That is probably the crux of the thought of "The drugs as an instrument". But it already makes clear how short-sighted the new puritanism is, which demands a stronger regulation of alcohol (Do we need an alcohol ban?).

Then the people concerned had to look for other means to achieve comparable effects. Whether they were all healthier is another matter. Have to do "Means" By the way, it does not have to be substances. You can also think of other physical or psychological tools – exercise, sports, meditation, yoga, good conversation, and so on. Apart from that, we have known for a long time that prohibition hardly works here (Why repressive drug policies do not work).

The psychiatry professor discusses analogous to the alcohol example the instrumental use of substances like amphetamine/speed, cannabis/marijuana, MDMA/ecstasy, mescaline, methylphenidate/Ritalin, caffeine, cocaine, nicotine, psilocybin, LSD and others more. The details can be read at his site and I do not need to repeat them here. Where the openness of Muller’s approach shocked me at first glance, I welcome it as an invitation to reflection at second glance.

Because it cannot be denied that many people use drugs. Why? Precisely to achieve certain purposes, which the psychiatrist has divided into nine categories here. But now there is the social – or perhaps I should say political – level, which damonizes and prohibits certain means, i.e. punishes the production and possession of as well as the trade in certain drugs.

Regulation or double standards?

The (Western) states, which, as we have read, used to be the biggest drug dealers themselves, have in the course of the 20th century become the biggest drug dealers in the world. In the early twentieth century, drugs were criminalized, especially under U.S. leadership (drug policy is used to make social and migration policy). And as we know today "War on Drugs", the so-called war on drugs, a gross debacle. Even in Afghanistan, occupied by Western powers, the opium trade bleeds more than ever.

I also find the handling of substances in our society to be double-bottomed, to say the least: If, for example, people use amphetamine/speed at parties in order to party longer and feel better, then in extreme cases the public prosecutor’s office is called into action. If, on the other hand, stimulating means are used to make schoolchildren and students cram better, then even good-burger professors with demands from the Federal Ministry of Education and Research find that acceptable.

Or let’s think of sports: millions enjoy top performances on the screen or in the stadiums. The athletes get attention, glorious titles and million-dollar contracts with advertising partners. But anyone caught doping is booed and disqualified. With appropriate medical diagnosis, we think once again of ADHS, Amphetamin/Speed or Methylphenidat/Ritalin may be consumed on prescription then nevertheless.

For a recent example from the National Football League, I refer you to the Netflix documentary "Take Your Pills". Analogously, this also applies to schoolchildren and students who consume popular ADHD medications. I remind you once again that there are still no objective criteria for psychiatric diagnoses (ADHD and the search for the Holy Grail).

Wish-fulfilling medicine

I want to come now to the last part of my essay and to mention some essential ethical as well as psychosocial aspects, which in my opinion cannot be ignored when speaking about drugs as instruments:

First of all, we must realize that we are talking about a different kind of medicine: A medicine that does not primarily cure diseases, but fulfills desires. This is what is called in the professional discussion also "wish-fulfilling medicine".

Do we want that? In plastic surgery – as an extended arm of the cosmetic industry, so to speak – this is naturally a flourishing market, in which many women participate and more and more men follow suit. I doubt that this really makes people happier, when I look at the diagnosis figures for anxiety disorders, burn-out or depression, but that is another discussion (diagnoses of mental disorders are rising sharply).

Example birth control pill

But one can also think of the contraceptive pill: apart from a small minority of women who have really severe menstrual problems, the drug is prescribed for wish fulfillment and then, under certain circumstances, even paid for by the health insurances. The desires – or, in other words, purposes – at stake here are, for example, the prevention of pregnancy, but also better appearance or more efficient functioning at work.

The social scientist Katrin Wegner has described this in her book "The Pill and Me: From Symbol of Sexual Liberation to Lifestyle Drug" or rather, in her documentation, in interviews with over 300 women from three generations in both East and West Germany, very already pointed out.

Despite the cries of the second to third wave of feminists that the pill promotes sexual exploitation, girls and women of all walks of life take the drug for clearer skin, shinier hair, coarser breasts (this is probably a fallacy), or to avoid being disturbed by menstruation while studying or working. The book even quotes a girl who took the pill to improve her appearance but, according to Wegner, didn’t even know it was a contraceptive.

Cosmetic psychiatry?

Wish-fulfilling medicine is therefore not new. But this does not make the practice unproblematic. And, as already mentioned, we may doubt whether the fulfillment of such wishes really makes people happier.

In a scenario based on Christian Muller’s approach, however, patients – or then perhaps better clients – could probably go to a psychiatrist to obtain certain psychosocial experiences and services, just as people go to a cosmetic surgeon today. As far as I know, it was the U.S. neurology professor Anjan Chatterjee from the University of Pennsylvania who first coined the term of a "cosmetic neurology" pragte. The traditional competitive relationship between neurologists and psychiatrists – in former times there was still the "Neurologist" as an intermediate category – I will not go into more detail here.

The most important point for me, however, when talking about drugs as instruments, is autonomy. In other words: We can achieve certain purposes with certain substances. But who or what gives these purposes?

In Muller’s essay, I am struck by the fact that he uses the term "Time" respectively the "Free time" . For example, we had to change from the professional mode of work to the more social mode. But there is a lack of time. Therefore, alcohol, amphetamine/speed, cannabis/marijuana, MDMA/ecstasy, methylphenidate/Ritalin or caffeine would work better, i.e. faster.

Time and Acceleration

So the world that the psychiatry professor is aming is one in which the resource "Time" is very scarce. I immediately believe this of someone who has made a career as both a scientist and a physician. But is this a world as it should be, or is this not rather the real problem??

As mentioned, more and more Germans already feel stressed anyway (Germans want less stress – but how?), mental disorders are diagnosed more and more frequently (diagnoses of mental disorders are rising sharply) and the general level of sickness is also increasing (Germans are sicker than ever). And these developments are taking place, although today many times more psychotropic drugs and other medications are prescribed, more and more people make use of coaching or psychotherapy and engage in almost endless self-optimization (the price of "perfect lives").

Such remarks are quickly dismissed, especially from the Gutburger side, as "cultural pessimism" dismissed. But this does not change the reality of these data. And in the meantime, even theoretical physicists such as Claudio Gros from the University of Frankfurt confirm that political and cultural phenomena are becoming increasingly fast-moving, from the numerous publications of the Jenens sociologist Hartmut Rosa (e.g "Acceleration – The change of time structures in the modern age") not to mention acceleration in the modern age.

Endless growth

Of course, it is mainly our economic system that needs endless growth. Not only because the owners or shareholders expect dividends and price gains under the competitive conditions of the market, but also because financial speculators continuously make bets on the future, the status quo is never enough. "Standstill is death! Go ahead, everything remains different", sang Gronemeyer already in 1998. Standstill means crash and economic depression in the market.

Cultural pessimism or not – it is simply about the prevailing zeitgeist. I think it is obvious that man, after his hundreds of thousands of years of biological evolution, cannot arbitrarily keep up with the ever-growing demands of industrialization and capitalism of the last 300 years.

The fact that nature does not have the resources for perpetual growth has been discussed since the 1970s; however, the implications of this economic activity for the psyche of people are hardly considered. Thereby we see already now the failure symptoms to be expected, for example in the mentioned examples from the health service.

Eckhard Hoffner described here only recently from an economic point of view that also the ecosystem earth since the 1970s can no longer keep up with the profit expectations (The tragedy of the prosperity of nations). The bill for economic growth presents the climate change. This is how it works in capitalism: profits are privatized, costs are externalized.

Where is the autonomy??

Given this framework, the question must be asked about the central value of autonomy on which both our moral philosophy and legal philosophy are built. To what extent can people today still determine the purposes/goals of their own lives?? Or to what extent are they dictated by auben – in technical language: heteronomous?? And how does the balance shift over time?

To return to Christian Muller’s "Drug as an instrument" to go back to Christian Muller: For me the problem is not that people use drugs (or other means) to achieve certain goals. The problem for me is that these goals are dictated by pigeons. And the prere to conform due to societal structures (law and morality) is considerable.

We have already seen that the success of cosmetic surgery does not really seem to make people happier, except perhaps for the profiting surgeons. In recent science news, a survey of over 600 heterosexual, bi-sexual and homosexual women by Alina Henn and colleagues at the University of Osnabruck just came to my attention.

Example of body image

Many women have problems with the fact that they think their body does not correspond to the ideal conceptions. This is heteronomy. Consequences are dissatisfaction and sometimes eating disorders, which were hardly of clinical importance before 1900. Interestingly, according to the researchers’ data, lesbian women in particular are more satisfied with their bodies because they experience more acceptance in their environment and pay homage to a more normal body image.

A new study by Camilla Matera and colleagues from the University of Florence, who surveyed nearly 400 heterosexual and homosexual men, paints an opposite picture here: according to them, gay men are particularly demanding when it comes to building muscle, and they are then on average less satisfied with their bodies.

These are only isolated findings. But the general picture is that even in 2019 we depend to a greater extent on external factors than the philosophers of the Enlightenment could have imagined. And in this context one can now ask what drugs as widespread instruments will do in society.

How to talk about the problem

In this context, I would like to remind you once again that the recent discussion about the improvement of the human being (new German: Enhancement) was from the beginning placed by leading ethicists under the sign of adapting the individual to the characteristics of the environment. A prime example is the definition of the Oxford ethicist Julian Savulescu and his colleagues, who describe enhancement as:

… a change in a person’s biology or psychology that increases his or her chances of living a good life under the relevant set of circumstances.

"Enhancing Human Capacities", S. 7

Exactly in this notch now strikes Christian Muller’s approach with the "Drug as instrument", Whether intentional or not, it is about the biopsychological transformation of people so that they can achieve their goals and live happier lives. But in this way the whole psychosocial level falls out. Or put another way: The individual is variable, the environment is predetermined. That is in the last consequence also the end of the policy, in which it is to go straight around the organization of the society.

Who sets the goals?

I am not against using drugs, medications or other means instrumentally, i.e. to achieve certain goals. I give blob to consider: pay attention to who sets the goals, who sets the purposes!

As I wrote it many years ago in the neuroenhancement discussion, I consider the approach anyway fur "self-defeating", self-refuting (Why not boost your brain with medications and drugs??Mind-doping for all?). Man is a social being and not alone in the world. In other words, if I use these means to work more efficiently, even if it is only because I relax more efficiently, or to initiate social contacts more efficiently, then this also radiates to other people and thus ultimately has an effect on me.

Thus, the spread of drugs as tools wherever there is competition for limited resources is expected to be driven by a Enabling on a compulsion run out. From a world where I use the means can, then becomes a world in which I can do it more or less must, simply to keep up with the others.

Economically this functions naturally outstanding, as we see already at the example of cosmetic industry and surgery, where a billion market for the Anpang of humans developed. If I were simply interested in profits, I would immediately buy shares in the first cosmetic psychiatry companies.

Voices from science

As I mentioned earlier, Christian Muller’s approach was discussed in the scientific community as early as 2011, when he published an article on it. As an example, I would like to mention two reactions from a psychologist, who thinks this does not go far enough, and a psychiatrist, who is very critical of the proposal.

Psychologist Geoffrey F. Miller, of the University of New Mexico, praised the idea of drugs as tools. Specifically, he wrote:

…drug use could be one of the major ways in which people try to overcome the discrepancy between evolutionary human nature and the particular demands of modern society…While the criminal justice system sought to eliminate the harm caused by a small proportion of people who use too many drugs, a utility maximization approach suggests otherwise: namely, that most people have not tried enough drugs and do not arrange their drug use in ways that would be optimal. That is, we generally use too few drugs and in the wrong way, not too much… In view of the heartbreaking discrepancy between evolutionary human nature and the demands of modern society, we need all the help that psychoactive substances can give us to learn, work, socialize, partner, raise children, enjoy life, and explore human consciousness more effectively.

Behavioral and Brain Sciences, 2011; dt. translation S. Mucus

Miller, like Muller, takes society or the environment as a given and then argues in favor of using drugs to adapt optimally to these requirements. This is also reminiscent of Karl Lagerfeld’s fatalism that it is pointless to resist the zeitgeist of consumerism and capitalism.

Drugs and the entrepreneurial self

However, psychiatrist Kevin Chien-Chang Wu of National Taiwan University criticized the prere to conform and related Muller’s proposal to the neoliberal mindset:

While harm reduction practices [in drug use] gained prominence, drug users were portrayed as entrepreneurial selves who ran their lives by making decisions based on information about the risks of drugs…. Not surprisingly, the drug policy approach proposed here, with its emphasis on individual brain plasticity, fits well with the neoliberal idea of individual self-direction; at present, the neuroscientific description of the brain reflects neoliberal thought…When substances, both legal and illegal, find their way into people’s lives, the poor seem to be most affected by them. Therefore…individuals could not be the best level of intervention as suggested by the present approach.

Behavioral and Brain Sciences, 2001; Eng. S. Slime

Kevin Chien-Chang Wu makes clear here how even in academia, descriptions are guided by prevailing policies. And he draws attention to the problem that people are also affected differently by the drug problem depending on their social class. This perspective was in fact completely missing from Muller’s approach.

Examples from the past

Last but not least, I would like to remind you that in the past we already had a social field test for "The drug as a tool" had. From the 1930s until its demonization in the late 1960s, amphetamine/speed was popular among many social classes. In Militar (book tip: Norman Ohler, "Total intoxication: drugs in the Third Reich") as in civilian life (book tips: Nicolas Rasmussen, "On Speed: From Benzedrine to Adderall" and Hans-Christian Dany, "Speed: A Society on Drugs") it was used instrumentally, see also advertisements from that period.

An interjection on my own behalf: A colleague from pharmacopsychology and I have been trying to point out for years that instrumental drug use is not new, but has existed at least since the 1930s. The ethicists in the neuroenhancement debate in the early 2000s simply succeeded in presenting the old problem as new and increasingly. In any case, this has brought them innumerable research projects, worldwide. This enhancement discussion, if we are right, is not new at all, but just a variant of old drug and health policies.

How the field experiment of the 1930s to the 1960s would have turned out if Richard Nixon had not become president and become the "War on Drugs" had blown is open. The drug was popular not only among the lower classes, but also among government officials. But after the drug-induced high comes the fall (book/film tip: Hubert Selby, Jr. "Requiem for a Dream"). In our time it happens again that successful politicians stumble over their drug use, let’s think of methamphetamine/crystal meth, a particularly strong variant of amphetamine/speed.

Therefore, I would like to see Christian Muller give concrete answers to the questions of how drugs should be regulated as instruments and how the problem of addiction should be dealt with. Even if the vast majority of people are good with substances, there are still millions at stake if 15 to 33 percent become addicted, to quote the psychiatrist’s numbers again. And above all, how do we deal with the prere or even coercion that then arises on non-consumers?

Deprivation for society

Personally, I do not find the approach promising. If the rest of the world doesn’t change, we’ll have the same problems with more and more drugs, or newer and newer drugs, but at 105 or 110 percent efficiency levels instead of 100 percent. And perhaps then the problems will become even more disproportionately gross, as the health care data already suggest.

Above all, I don’t want to patronize anyone and instead see Muller’s approach as an opportunity to denounce the irrational and double-bottomed status quo of our drug and medication policies. Instead of prescribing more and more drugs, it seems to me that a collective withdrawal is necessary for a society that is already so addicted to consumption and money, where stress is omnipresent and there is always a lack of time.

This article also appears in the blog "Images of People" of the author.

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