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Ceremonial Chemistry (1974)

Ceremonial Chemistry is about drugs, drug users, addiction, and all the various psychiatric, legal, and criminal measures and problems that are generated by the drug problem.

Szasz begins by wondering what the concept of addiction actually means. In former times it referred to a strong, morally neutral tendency towards a certain behavior. Later it became a bad, morally objectionable habit. In 1934 the American Psychiatric Association adopted a resolution that “alcoholics are valid patients,” which marks the beginning of the official medicalization of addiction. At that moment addiction became a medical problem. The official Standard Classified Nomenclature of Diseases published by the American Psychiatric Association first listed “drug addiction” as a category of diagnosis in 1934. Nowadays the word refers to just about anything that is illegal, immoral, or undesirable regarding some (but not other) drugs.

Then Szasz explores in which conceptual framework and in which logical class of concepts the word addition belongs. He denounces the custom of ascribing addictive properties to certain drugs because that would evoke the illusion that the problem is pharmacological. Addiction is not about a pharmacological substance, but about a certain way people deal with it. As such the study of addiction belongs in the humanities, alongside anthropology, sociology, law, and ethics. Addiction belongs in a category of concepts that include ritual, ceremony, and religious and symbolic actions, rather than pharmacology’s scientific and technical category of concepts. A chapter on addiction in a manual of pharmacology is comparable to a chapter on prostitution in a manual of gynecology, a chapter on perversion in a manual of physiology, a chapter on the racial inferiority of Jews and Negroes in a manual of genetics, and a chapter on sun-worship in a manual of astronomy.

Inasmuch as drugs can help in dealing with life’s difficulties and disappointments, drug dealers are comparable to the white witches of the middle ages. They, too, offered substances for the relief of pains and cares. They, too, were persecuted and severely punished.

The role of medicine in the drugs problem does not confine itself to the examination and treatment of ill people, but is strongly associated with controlling human behavior. Physicians have often served political regimes that requested their assistance. In the current war on drugs, physicians take the lead by denouncing the use of drugs and lobbying for their restriction and prohibition. Szasz describes how physicians are poised to become victims of their own opposition to drugs. He cites examples of doctors who were visited by agents of the “Bureau of Narcotics and Dangerous Drugs.” These agents posed as patients with certain complaints. If the duped physicians prescribed “prohibited” medicines, the agents charged them. Noting that one reaps what one sows, Szasz concludes, “However, my adaptation, to the requirements of the contemporary drug scene, of a time-honored wisdom from the Gospels makes a fitting epitaph for the headstone of a Medicine devoted to curing the sick but murdered by a brother devoted to controlling the sinful.” (p. 142)

To Szasz the essence of the drug problem is the notion that drugs form a temptation for man, one that he can or cannot resist through moderation or abstinence. These concepts used to be key concepts in our Christian culture. As religion gradually gives way to medicine as a religion, they are replaced with the more “scientific” terms impulse and satisfaction. In other words, whereas man used to be considered exposed to all sorts of temptations which he was supposed to resist through self-restraint, now he is seen as helpless in the face of impulses for which he seeks satisfaction, and from which he must be restrained by external controls. Man has been converted from a tempted individual to an organism in need of protection. This implies that external controls are gaining in emphasis. Any external controls will evoke resistance, so ironically, the use of illegal drugs is promoted by their prohibition.

External control means that the satisfaction of certain impulses is encouraged, for instance heterosexual impulses towards one’s own spouse, masturbation, and the use of some drugs like tobacco and alcohol. Satisfaction of other impulses, such as homosexuality, pedophilia, and the use of other drugs, is made impossible by social controls. The extent to which man is viewed as a defenseless victim of his impulses is illustrated by the growing tendency to exonerate the user (the “victim”), and punish the tempter (the drug dealer, prostitute, and such). Szasz sees a similar development regarding jealousy. In former times, jealousy was a vice. Nowadays the person who gives the other reason to be jealous is denounced. Undoubtedly this shift places a premium on dependency, helplessness, and civil heteronomy.

By replacing self-restraint with external controls, by unleashing an attitude of lynch towards drugs and all that is related to them, and by constantly drawing attention to the problem, it is clear that “our present war on drug abuse encourages precisely the sort of behavior which its stupid or sadistic supporters claim they want to discourage.” (p. 163) In this book, the “Therapeutic State” (see Chapter III, 2.4) is turned into a “Pharmacracy,” a characteristic technical form in which we are ruled by the control of drugs.

Szasz’s conclusion is that respect for citizens’ autonomy requires that all drugs and medicines be freely available, at least to adults. Whoever cannot deal with that can ask for assistance if he wishes. It is not the government’s job to determine what somebody may eat, drink, inhale, or inject.
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