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The Marijuana Smokers
Erich Goode
Chapter 5 - Physicians on Marijuana Use
Introductory Remarks
A sociologist of knowledge seeks to explicate whether and to what
extent man's social surroundings influence his intellectual efforts.
Adopting this perspective toward the sentiments of the various
disputants in the marijuana controversy, we are alerted to the
possibility that attitudes about, and orientations toward, the
use of marijuana, as well as what effects it has, and whether
these effects are good or bad, may be at least in part traceable
to a specific kind of role one plays, or status one has, in society.
It would seem highly peculiar if, somehow, doctors were exempt
from the generalization that ideas have a powerful existential
referent, that individuals are compellingly influenced by their
social locations and interactions. We expect, therefore, that
the ideas of physicians in the sphere of marijuana use are influenced
by, and can be traced partly to, their social contexts. (This
is a testable proposition, not an axiom beyond the reach of empirical
investigation.) The question which remains, therefore, is what
is the nature of the social expectations, demands, and sentiments
related to the position of physician in American society, and
what is their articulation with regard to marijuana use.
Physicians act not only as individuals; they also act as representatives.
Unlike intellectuals, writers, and professors, their clients comprise
everyone, all classes and groups in society. In their hands is
entrusted the health of the social body. They are burdened (or
blessed, depending on one's point of view) with the responsibility
of protecting the well-being of society at large, and therefore
are under a pressure to act in a manner that society defines as
responsible and mature. The physician knows that when he speaks,
many listen. His favored position disinclines him to a radical
direction.[1] His prestige
and power are a mixed blessing, because whatever he says will
be taken seriously. He is highly visible, and he is expected to
make sober and responsible pronouncements. The physician and the
intellectual, although equally well educated, informed, and occupying
roughly the same social class position, differ markedly in their
accountability to a constituency, and thus usually differ radically
on crucial issues. The question, therefore, becomes not so much:
"What is the opinion of the medical profession, trained in
the scientific technique and objective about anything affecting
the human body, on the dangers of this drug, marijuana?"
It is, rather: "What sorts of responses toward marijuana
use might be expected from a group of individuals who are highly
respected and affluent members of their community, geared to social
functions of a distinctly protective nature, and responsible to
a public?" I would predict that the responses of doctors
regarding marijuana use would not be much different from individuals
in positions much like theirs: bankers, politicians, attorneys,
executives, judges. Their attitudes, I maintain, stem less from
their medical knowledge than from their social position in society.
The position of medical men is a conservative posture, if we understand
that as having the implication of "conserving" the status
quo—protecting society from any possible danger. The basic thrust
of such a position is that any substance has potential dangers
that have to be thoroughly examined before it can be released
to the unsuspecting public. It is far better, this line of reasoning
goes, to restrict access to an innocuous drug than to permit access
to one which is truly dangerous. The parallel between marijuana
and thalidomide—inadequately tested and prematurely marketed—is
obvious and sobering. The physician's stance, then, is paternalistic;
certain decisions have to be made for the public, who, without
expertise, cannot possibly decide on the danger or safety of a
drug, unaided by those whose responsibility it is to perform that
very task. As Henry Brill, physician, professor of medicine and
hospital director, wrote: "All drugs are guilty until proven
innocent."[2]
A guiding principle in this analysis is the specialness of the
physician's orientation toward marijuana and its use.[3] I
intend "specialness" to bear two distinct but interrelated
meanings. First, that physicians' attitudes toward marijuana,
as with everyone else, are largely "nonrational," not
simply untrue or false in a scientific sense, but that their stance
is a possible one out of several competing versions, and that
all of these versions "surpass experience," that is,
are based on attitudes that are sentiments and values which cannot
be either supported or refuted scientifically. It follows from
these expectations of society that the physician will act in a
manner society defines as "responsible," that is, he
will make essentially protective pronouncements.
Let us assume something true that is false, namely that it has
been established scientifically that the statistical chance of
experiencing a "psychotic episode" while under the influence
of marijuana is one in a thousand—or even one in a million.
This is, we will assume, a fact on which all observers agree.
(It is not, of course.) The manner in which the physician makes
his decision, that is, to be "responsible," will lead
him to decide that this is too great a price for society to pay
for the luxury of allowing a small freedom, and therefore marijuana
use ought to be prohibited. Someone with a different set of values
would make the decision in a very different way. The civil libertarian
would say that the incidence of danger is sufficiently small to
offset the larger threat to society's freedom to smoke marijuana.
Both may agree on the facts, but it is the sentiments, even among
the physicians, that ultimately decide.
The ideas of physicians are "special" in a second sense
as well: doctors have been successful in defining the nature of
reality for the rest of society in a vast number of areas. They
have been successful in claiming that they alone are competent
to interpret the reality of marijuana, and that their version
of the drug's actions is the only legitimate, valid, and objective
one. They have managed, that is, to establish epistemological
hegemony. Their position enables their special version of the
nature of the drug and its use to be regarded by others as neutral,
impartial, and objectively true, and all other versions to be
biased and based on special interest pleading. The physician is
seen as transcending the accidental and irrational prejudices
that blind others. In the area of drug use, physicians are "instant
experts," knowledgeable and unbiased.
Since most members of society are not aware of professional and
scientific distinctions, they will make little effort to seek
out the word of those physicians who are most qualified to
speak and write on marijuana, that is, those physicians who
have actually done studies themselves, or who have closely read
such studies. In fact, it might very well be disadvantageous to
publicize the views of those physicians who are best-informed
on the effects of marijuana, because they will present a more
complex view, one which does not square with official morality.
The contrary, in fact, will be true: the public will encourage
those physicians whose views are most hostile to marijuana use
which, almost inevitably, will be those physicians who are least
informed on the subject. As a general rule, doctors whose
writings on marijuana indicate dubiousness concerning its
dangers are more likely to have done original research. Those
physicians who are most stalwartly against its use, and whose
writings indicate a strong feeling that clear dangers attend its
use, are more likely to be without any systematic research experience
on the drug's use, have no real contact at all with users, or
be acquainted with them only as patients. (Patients who smoke
pot and who visit doctors, especially psychiatrists, in connection
with their drug use are, as we might expect, radically different
from the average user—as are individuals who visit psychiatrists
for any reason.)
It is not only the characteristics of the physician that would
enable us to predict the role he would take vis-à-vis marijuana
use. We must also look to the tie-in between the doctor's role
and the cultural values of American society that generate his
concern. It has become a cliché that American civilization
still retains many strong traces of a Puritan ethic. Not all clichés
are completely wrong; this one has at least a grain of truth.
One axiom in the Puritan ideology is that pleasure must not be
achieved without suffering. In fact, much of the machinery of
Calvinist culture was devoted to making that axiom a self-fulfilling
prophecy. Through guilt, ridicule, and punishment, the pleasure-seeker
was made to suffer. We consider our age more enlightened.
We have lost faith in many of the stigmata that once indicated
sin. We no longer believe that it is possible, by outward sign,
to "tell" if a girl has been deflowered, and we no longer
counsel the adolescent boy against masturbation for fear of insanity
or pimples. Yet we have not entirely moved away from this form
of reasoning. With regard to marijuana use, we still take seriously
the notion that the user must pay for his evil deed. No one is
permitted to experience great pleasure without suffering a corresponding
pain—a kind of moral Newton's Third Law. This is one of the
reasons why alcohol is such a perfect American intoxicating beverage:
getting drunk has its price. (There are, of course, historical
reasons as well for liquor's acceptance.) It is, however, puzzling
to the American cultural mainstream that anyone could enjoy cannabis
without suffering any misery. It is necessary, therefore, for
the cultural apparatus to construct a pathology explanation
on marijuana use. A search must be made for signs of mental and
bodily suffering that the marijuana smoker experiences as a consequence
of his use. In the vastness and diversity of the many experiences
that users have, at least some pathological traces may be dredged
up. By searching for and emphasizing these traces, we have satisfied
our need for discrediting marijuana use, and have done so in a
manner that specifically calls forth the efforts of physicians
to verify our cultural sentiments.
It follows that marijuana use will be viewed as a medical matter.
And that it is a matter for physicians' attention. It might be
presumed that physicians' word is sought on marijuana use because
it is a medical matter. The sociologist looks at the issue differently.
That marijuana use is a medical matter is an imputation, not a
fact. It is because society has already adopted the pathology
or "disease" model on marijuana use that it seems reasonable
to infer that marijuana use, therefore, is a medical matter. But
the prior imputation was necessary to see it that way in the first
place.
The central point of this book, explained in detail in the chapter
on "the politics of reality," is that we all view reality
selectively. We notice that which verifies our own point of view,
and ignore that which does not. We accept a "world taken
for granted," and an exposure to contrary worlds does little
to shake our faith in our own. Moreover, when our version of what
is real and true is threatened, we marshall pseudoevidence to
support this version. Facts used in arguments are rhetorical
rather than experimental. Societies whose values do or would
oppose a given activity face a tactical problem: how to make a
condemnation of that activity seem reasonable and rational? A
rationale must be provided, and a personnel whose word is respected
must provide that rationale. Thus, by generating statements from
physicians, society is utilizing a valuable ideological resource.
The antimarijuana lobby will therefore court and win the sympathies
of doctors whose word on cannabis is largely negative. Society
is searching for verification of an already held ideological position,
not for some abstract notion which idealistic philosophers once
called "truth." (We all assume that we have truth
on our side.) So that the pathology position will be crystallized
out of the magma of society's needs and expectations, out of the
social and cultural position of physicians, their self-conception
—partly growing out of society's conception of them—as preservers
of society's psychic and bodily equilibrium, and as experts on
anything having to do with what is defined as a health matter.
It is these pressures that generate the concern of physicians
regarding marijuana, and not any particular expertise they might
have.[4]
In lieu of actually doing a survey, it is necessary to examine
the writings of physicians on marijuana. However, to use these
written statements to characterize the dominant medical view on
cannabis use it would be necessary to resolve at least one difficulty
first. There is the question of the typicality of published and
widely disseminated statements, as opposed to the actual sentiments
and actions of the vast bulk of doctors who do not write on marijuana.
Those who wish to spread their views by publishing them might,
for instance, be those who feel most strongly involved—both
for and against; they might be "moral entrepreneurs,"
to use Howard Becker's phrase. Yet, in spite of the possibly nonrandom
sentiment expressed in physicians' printed statements on marijuana,
we must also remember that these are the views that tend to have
the greatest impact. The American Medical Association makes an
official pronouncement, reported by major newspapers and magazines,
which means that a position is congealed and more easily utilized
in the continuing debate. Published statements take on a life
of their own. Although the question of whether or not physicians'
published statements are typical is an empirical question, and
not one on which we have an answer, nonetheless, the basic thrust
of these statements is overwhelmingly negative, largely cast in
the form of a pathology model,[5] and
used by the antipot lobby to verify its own position. Thus, although
we will encounter some diversity of orientations regarding drug
and drug use, it is possible to discern a relatively consistent
ideology, both in "official" and in working day-to-day
terms. In the remainder of this chapter I intend to elaborate
on the mainstream medical position on marijuana use. This position
is made up of a number of separate elements. Let us examine each
element.
Drug Abuse
In the typical medical view, marijuana use is by definition "abuse."
Drugs are taken for therapeutic purposes, to alleviate pain, to
aid adjustment, to cure a disease, and must be prescribed by a
physician. Marijuana has no known or recognized, professionally
legitimated role whatsoever. The human body operates best, in
the absence of a pathology, without drugs. Drugs are unnecessary
without illness. The purpose of getting high is seen by this view
as illegitimate. All use of marijuana is abuse; all use
of drugs outside of a medical context is in and of itself the
misuse of the purposes for which drugs were designed. The AMA
writes: "... drug abuse [is] taking drugs without professional
advice or direction."[6]
Marijuana is hallucinogenic and has no medical use or
indication.... Feelings of being "high" or "down"
may be experienced. Thought processes may be disturbed. Time,
space, distance and sound may be distorted. Confusion and disorientation
can result from its use. Reflexes are slowed. Marijuana does not
produce physical addiction, but it does produce significant dependence.
And it has been known to produce psychosis. With this description
of the effects of its use and the total lack of any medical indication
for its use, medically it must be stated that any use of marijuana
is the misuse of a drug.[7]
The damning constituent of marijuana, like all "recreational"
drugs, is that it is used to get high; the normal state is seen
as desirable—the state of intoxication, pathological. The use
of a drug to get high is abuse of that drug: "There is no
such thing as use without abuse in intoxicating substances."[8]
In an essay in what is widely considered the bible of clinical
pharmacology, the following is a definition of drug abuse (of
which marijuana abuse is discussed as an instance; a distinction
is made between obsolete "Therapeutic Uses" and current
"Patterns of Abuse"):
In this chapter, the term "drug abuse" will be used
in its broadest sense, to refer to use, usually by self-administration,
of any drug in a manner that deviates from the approved medical
or social patterns within a given culture. So defined, the term
rightfully includes the "misuse" of a wide spectrum
of drugs.... However, attention will be directed to the abuse
of drugs that produce changes in mood and behavior.[9]
Etiology of Drug Use
In terms of the etiology of marijuana use, physicians may generally
be found within the orbit of the personality theory of causality.
Now, no psychologist or psychiatrist would dispute the contention
that sociological factors play a decisive role in marijuana use.
Clearly, a milieu wherein marijuana is totally lacking, or in
which its use is savagely condemned, is not likely to generate
many marijuana smokers, regardless of the psychological predisposition
of the individuals within that ambiance. Yet, at the same time,
a theory of marijuana use set forth by a psychologist, psychiatrist,
or physician, will look and sound very different from one delineated
by a sociologist. Doctors will tend to emphasize individual and
motivational factors in the etiology of marijuana use. It is necessary,
therefore, according to this perspective, to understand the individual's
life history, particularly his early family relations, if we are
to understand why an individual does as he does, particularly
if he challenges the established social order—as, to some degree,
his use of marijuana does. An individual of a certain family background
will be predisposed to specific certain kinds of behavior.
More than merely being generated to a considerable degree by personality
factors, physicians (following psychologists and psychiatrists)
often see marijuana use as being at least to some degree generated
by pathological or abnormal motives. Sometimes this is seen as
a general process; marijuana use, like all illicit, deviant, and
illegal drug use, represents a form of neurosis, however mild:
"The willingness of a person to take drugs may represent
a defect of a superego functioning in itself."[10]
It is, of course, necessary to specify the
degree of drug involvement. Most physicians will not view occasional
or experimental use in the same light as frequent, habitual, or
"chronic" marijuana use. Probably we can make a safe
generalization about the relative role of the factors we are discussing:
the heavier and the more frequent the use of marijuana, the greater
the likelihood that most doctors (as well as psychiatrists and
personality oriented psychologists) will view its etiology as
personality-based, as well as pathological in nature, and its
user to some degree neurotic; the less frequent and regular the
use of marijuana, the greater the likelihood that the cause will
be located in accidental and sociological factors, and the lower
the likelihood of being able to draw any inferences about
the functioning of the user's psyche. This qualification is essential.
Probably the commonest view of marijuana use within the medical
profession is that it is a clumsy and misplaced effort to cope
with many of one's most pressing and seemingly insoluble problems.
Drug use is not, of course, logically or meaningfully related
to the problem, but is, rather, a kind of symbolic buffer serving
to mitigate it by avoiding it, or by substituting new and sometimes
more serious ones. Feelings of inadequacy, for instance, are said
to be powerful forces in precipitating drug use.
An individual who feels inadequate or perhaps perverted sees in
drugs a way out of himself and into a totally new body and mind.
For some a drug does give temporary surcease from feelings of
inferiority, but for most it provides only numbness and moderate
relief from anxiety, with no true or constant feeling of strength
or superiority. Often this search for a new self is what leads
to escalation and a frantic search for new drugs which may lead
to addiction.[11]
Occasionally, this notion of inadequacy is further pinpointed
to sexual inadequacy. One prominent physician, analyzing a case
history, writes: "Tom began to smoke marijuana and to gamble.
He also suffered from impotence. Tom's need for marijuana and
gambling was to help him overcompensate for his physical and mental
inferiorities. He was underweight, had only a grade school education
and suffered from the fear of organ-inferiority, called a 'small
penis complex.'"[12] Another
physician concurs: "I know of several cases where males would
use marijuana to overcome feelings of sexual inadequacy. Their
marijuana use ceased after psychiatric treatment."[13]
Sexual failure may be seen as a manifestation of a general inadequacy;
marijuana use is seen as a kind of smoke-screen for the real issues.
It becomes a means of avoiding responsibility, of concealing one's
failures and inadequacies, of "copping out" of life:
Individuals who have a significant dependency on marijuana and
use it chronically report a decrease of sexual drive and interest.
A reduction in frequency of intercourse and increased difficulty
becoming sexually aroused occurs with the chronic user. However,
there is usually a concomitant decrease in aggressive strivings
and motivation and an impoverishment of emotional involvement.
These changes are generally true for the chronic alcoholic, the
chronic amphetamine or barbiturate user. Marijuana dependency
is a symptom and the person who avoids experiencing parts of himself
through the chronic use of drugs, is usually lonely and frightened
of impersonal contact prior to drug use. Some of the diminished
sexual activity of the marijuana dependent individual is part
of his general withdrawal from emotional contacts with other human
beings. The temporary gratification of drug-induced feelings are
preferred to the gratification of interpersonal closeness which
involves the risks and vicissitudes of real emotional intimacy.[14]
Rebellion is another common component in many medical conceptions
of marijuana use, especially as applied to high school and college
students. Some doctors feel that the use of the drug represents
a symbolic rejection of parental values, a desire to shock one's
elders, to aggress against them for real or imagined hurts, to
use the drug as a weapon in the parent-child struggle:
The reason why drugs have so strong an appeal to the adolescent
are several. The reason most commonly cited is rebellion, and
this probably is a factor of importance in most instances. Children
begin at fourteen to gain satisfaction from doing the opposite
of what is expected. This is a way of retaliating against parents
for years of what is now felt to have been unjustified subjugation....
Anything that is disapproved of by adults begins to have a certain
allure.... Drugs are clearly beyond the pale in the eyes of both
parents and legal authorities, and thus have a particularly strong
appeal. A lot of the mystique that is part of the drug taking
experience is directly related to the satisfaction the participants
gain from realizing how horrified their parents would be to know
what was going on. The secrecy surrounding meetings, the colorful
slang words, the underworld affiliations make it all seem very
naughty.[15]
The intrinsic appeals of the drug itself, its specific effects,
the nature of the marijuana high, are overshadowed by its symbolic
appeal as both indication of and further cause of rebellion:
Smoking marijuana has become almost an emblem of alienation. The
alienated student realizes that the use of "pot" mortifies
his parents and enrages authorities....[Marijuana] has become
a rallying cause for students, a challenge to adults and a potent
catalyst for widening the gap between generations.[16]
Marijuana as a Dangerous Drug
The doctors feel that the drug is prohibited for a reason.
It is a dangerous drug, and because it is a dangerous drug,
it is (and should be) prohibited: "Certain drugs because
of known characteristics are classified as dangerous drugs."[17]
They take, in other words, a "rationalist"
position that men who make such decisions for society respond
rationally and logically to a real and present danger. Medical
bodies (like the legal structure of societies as a whole) do not
authorize marijuana use; they disapprove of its use because there
is enough evidence to be able to decide on the drug's dangers—or
there is enough indication that it might be thought of as dangerous.
"... those of us who oppose legalization are... implacable
in insisting that all cannabis preparations are potentially dangerous.
The potential dangers, to our minds, are severe."[18]
As a result, "... there is overwhelming
consensus that this drug [marijuana] should not be legalized,
and no responsible medical body in the world supports such action."[19]
Marijuana, then, according to the medical profession, is a "dangerous
drug." The question, therefore, is: In what specific ways
does the medical profession see its use as dangerous? Opinion
is not unanimous on the questions of what, precisely, the effects
are whether certain effects represent, in fact, a clear danger,
and to what extent the danger appears. Nonetheless, the differences
within the profession should not be exaggerated.
PSYCHOLOGICAL DEPENDENCY
Without question the danger most commonly seen by physicians
and psychiatrists in marijuana is its power to engender a kind
of psychological dependence in the user. No observer of the drug
scene attributes to marijuana the power of physiological addiction;
instead, psychological dependence is imputed. "Drug dependence
is a state of psychic dependence or physical dependence, or both,
on a drug, arising in a person following administration of that
drug on a periodic or continued basis."[20]
Each drug has its characteristic syndrome,
and each must be designated with its own specific title; we
are interested in "drug dependence of the cannabis type."
Marijuana, then, produces a psychic dependency in the user
which impels him to the continued and frequent use of that
specific drug—a dependency that is similar in important respects
to actual physical addiction.
Marijuana smokers hold the lack of physiological addiction of
their drug of choice to be a powerful scoring point in its favor;
many physicians, on the other hand, see this point as trivial
in view of the parallels between addiction and dependency. The
dimension of interest to us is not whether the impelling force
is chemical or psychological, but whether the user persists in
his use of a substance which physicians have defined as noxious,
whose use constitutes "abuse." Thus, a person is defined
as being dependent on the basis of whether use of a drug is continued
over a period of time, and is ruled undesirable by drug experts.
The imputation of undesirability is necessary to the definition,
since the repeated administration of crepe suzette[21]
is not labeled "dependency"—even
though it can occur with the same frequency and with the same
degree of disruption in one's life. The fact that a withdrawal
syndrome does not appear upon abstinence is outside the focus
of this definition; the telling point is that the drug is capable
of producing dependency.
It has... been customary to distinguish between drugs that
are habit-forming and drugs that are addicting... the present
writer, however, fails to perceive any value at all in this distinction....
Hence, it would be quite correct to use the terms habit-forming
and addicting synonymously and to refer to common habit-forming
drugs as addictive in nature.[22]
The troika of abuse, pathological etiology, and dependence combine
forces to pull in the same direction. He who tries marijuana is
impelled by the same motivational syndrome which may lead to abuse
and, ultimately, dependence; the three concepts are seen as part
of the same pattern.
The chronic user develops a psychological dependence which in
view of today's knowledge, is the prime detrimental factor. This
dependence soon causes him to lose control of his use of the drug
because the psychological factors which drew him to try it in
the first place now precipitate a pattern of chronic, compulsive
abuse. At this point the user is just as "hooked" as
are the persons we used to call addicts.[23]
The fact that, supposedly, marijuana use enlarges the sphere of
one's freedom, by broadening the field of the choice of one's
actions, can, ironically, have the opposite long-range effect,
according to dominant medical views. Dependency limits one's possibilities
for acting; by being dependent on a drug, one has severely limited
his freedom, although to have taken that drug in the first place
meant greater freedom. No physician has presented this dilemma
more strikingly than a nonphysician, Seymour Fiddle, a social
worker who coined the term "existentialist drugs" to
capture this contradiction. Existentialist drugs are those a man
takes to enact his fullest human potential, to test the limits
of his ability to act, just to see how much he can do and be and
still retain his essential humanness—but ends by so severely
shrinking his possibilities that he is able ultimately to act
out only a single role, virtually identical for everyone: that
of street junkie.[24] Thus,
we chance upon a paradox: man takes drugs to be free, only to
discover that he is enslaved by them. The Fiddle argument, then,
would hold the freedom issue to be irrelevant, since drugs are
a dead-end trap which ultimately kill off all freedom of action.
Drugs produce, in the end, even more narrowly restricted one-dimensional
men. As to whether marijuana properly belongs in this category
is an empirical question, and cannot be assumed in the first place,
but the fact that physicians commonly hold it to be a drug of
dependence demonstrates that they do believe that it can in fact
act in this manner.
PANIC STATES AND PSYCHOTIC EPISODES
Cannabis opponents consider the psychotomimetic quality of
the drug another potential danger. Physicians and psychiatrists,
especially, feel that marijuana is capable of precipitating powerful,
though temporary, psychotic episodes—or, more generally, disturbing
psychic adverse reactions. There are, of course, problems with
this view; to mention only three: (1) What constitutes such a
reaction and how do we define an "adverse effect" of
marijuana? (2) How extensively does it occur? (3) Under what conditions
does it occur?
The smoker, under the influence of the drug, is held to be subject
at times to confusion, panic, disorientation, fear, and hallucinations
—a schizophrenic break with reality. This point of view holds
that this state—ranging from a simple amused befuddlement all
the way to a full-blown outbreak of transient psychosis—"can"
happen and "does" happen. The fact that it has occurred
with at least some modest degree of frequency is, in the eyes
of many health figures, powerful damaging evidence that the drug
is, or can be, dangerous and harmful.
While physicians are adamant about the existence of these episodes
and their attendant dangers, smokers are equally as vociferous
in denying to the drug such diabolical powers. Donald Louria writes:
"The evidence on panic seems so clear that to deny its existence
indicates either abysmal ignorance of the facts or intentional
intellectual dishonesty."[25] Yet,
writers supporting use of the weed minimize and often dismiss
outright its madness-inducing potential. Their claim is that if
marijuana can induce psychosis, then the causal sequence posited
has nothing intrinsically to do with the effects of the drug itself.
Rosevear, for instance, writes: "... a broken shoelace
may also be used as a parallel for precipitating psychosis."[26]
Those who seek psychiatric and medical help as a result of an
untoward reaction to marijuana are far from typical of potheads,
or the mental state of the characteristic marijuana intoxication.
The average smoker has probably never seen any evidence of an
untoward reaction of any seriousness—so that he denies its existence
completely It is difficult to deny that marijuana can potentiate
panic or a psychotomimetic experience, given the "right"
person and setting. To assert, however, that such reactions are
typical, widespread, common, or even more than merely occasional
is, I think, entirely incorrect, since, by all accounts, extreme
psychosis-like reactions to the drug are extremely rare. Even
the staunchest opponents of the drug are careful to point out
that they are of relatively infrequent occurrence. The Medical
Society of the County of New York informs us that cannabis "is
an unpredictable drug and is potentially harmful even in its mildest
form. Even occasional use can produce (although rarely) acute
panic, severe intoxication, or an acute toxic psychosis."[27]
A pair of physicians, reporting on panic
reactions in Vietnam, inform us that at the extreme of the continuum,
cannabis is capable of touching off in some individuals "a
frank schizophrenic-like psychosis," but, at the same time,
are careful to point out that "smoking marijuana for most
persons is a pleasant, nonthreatening, and ego-syntonic experience."[28]
Work by physicians on cannabis psychosis breaks down into clinical[29]
and laboratory[30]
research. In general, clinical work must,
of necessity, be unsystematic since it is impossible to detect
the degree to which the patients who come to a physician for problems
connected (or unconnected) with their drug use are in any way
representative of users in general. It is impossible to know just
what it means when a number of marijuana-using patients show up
in a physician's office. How typical are their experiences? What
universe of individuals are they supposed to represent? How widespread
are their complaints? What role does marijuana play in their problems?
Clinical work can answer none of these troublesome but central
questions. But clinical reports do have the advantage that they
describe people in real-life situations. Laboratory work suffers
from the opposite problem. Although it is systematic, the laboratory
situation is artificial and outside the marijuana-using situation
in which the smoker actually conducts his activities. Although
this qualification in no way invalidates either form of research,
it should be kept in mind when generalizations from clinical and
laboratory situations are made to the use-patterns of the typical
marijuana smoker in real-life situations.
The complexity of the issue increases when we consider the relative
potency of the various cannabis preparations. Hashish, as we know,
is more powerful than the varieties of marijuana commonly available
in the United States. Although heavily used in the Orient, it
is less commonly, but increasingly, consumed in America.[31]
Many of the differences between the gloominess
of the findings of many studies conducted on hashish and charas
users in North Africa, the Middle East, India, and Greece, and
the relative lack of mental pathology associated with use in the
United States, can be attributed to the strength of the drugs
available. Marijuana grown in the United States is weak; and even
Mexican varieties generally lack the strength of their Oriental
sisters. The fear, therefore, is that were marijuana to be legalized,
it would be impossible and irrational to disallow hashish. "If
all controls on marijuana were eliminated, potent preparations
probably would dominate the legal market, even as they are now
beginning to appear on the illicit market. If the potency of the
drug were legally controlled, predictably there would be a market
for the more powerful illegal forms."[32]
Thus, could it be that hashish, were it freely
available to Americans, would produce many of the symptoms described
in the Eastern studies?
... no amount of qualification can obscure the fact that marijuana
can produce psychotic reactions (this is a simple medical fact)
and that a psychotic state can release violence and precipitate
criminal behavior. This is not to say that it will in every case
but that it can and has. Because of the relative mildness of Mexican
and American varieties of cannabis we have seen very little of
this kind of cannabis-induced reaction. But with the coming of
hashish, we can look for more instances of psychosis and violence
as a result of a cannabis use.[33]
MOTOR INCOORDINATION
A third reason why physicians consider marijuana dangerous
and not to be legalized or made freely available is that it supposedly
deteriorates one's motor coordination, rendering the handling
of a machine, particularly an automobile, hazardous. The fear
is that the current slaughter on the highways of America—partly
due to drunken driving—will increase dramatically with the increase
in marijuana use. The assumptions underlying this supposition
are that marijuana use characteristically leads to intoxication;
that intoxicated marijuana smokers are likely to drive; and that
one's ability to drive is, in fact, impaired by the use of marijuana.
These are all, of course, empirically verifiable (or refutable)
propositions, and cannot be assumed. But whether true or false,
this line of reasoning will be encountered frequently in antimarijuana
arguments: "The muscular incoordination and the distortion
of space and time perception commonly associated with marijuana
use are potentially hazardous since the drug adversely affects
one's ability to drive an automobile or perform other skilled
tasks."[34] More
dramatically, the marijuana smoker, intoxicated, "may enter
a motor vehicle and with "teashades (dark glasses worn because
of the dilated pupils) over his handicapped eyes and with impaired
reflexes he may plow through a crowd of pedestrians."[35]
Not only is there the fear that widespread use of cannabis will
increase the highway death toll, but since there is no reliable
or valid test at the moment for determining whether the driver
is high on marijuana, there are, therefore, no possible social
control mechanisms for preventing an accident before it happens.
Since effective tests exist for alcohol, physicians hold that
this makes marijuana a more dangerous drug than liquor, at least
in this respect. "With marijuana, there are currently no
adequate methods for measuring the drug either in the blood or
urine.... Under such conditions, the thought of legalizing the
drug and inflicting marijuana-intoxicated drivers on the public
seems abhorrent."[36]
LOSS OF AMBITION AND PRODUCTIVITY
A common concern among members of the medical profession is that
marijuana—particularly at the heavier levels of use—will produce
lethargy, leading to a loss of goals and a draining off of potential
adolescent talent into frivolous and shiftless activities. One
physician speculates whether marijuana might be America's "new
brain drain."[37] The
AMA states that frequent use "has a marked effect of reducing
the social productivity of a significant number of persons,"[38]
and that as use increases, "nonproductivity"
becomes "more pronounced and widespread."[39]
As the abuse pattern grows, the chronic user develops inertia,
lethargy and indifference. Even if he does not have psychotic
or pseudopsychotic episodes or begin a criminal or violent existence,
he becomes a blight to society. He "indulges" in self-neglect.
And even though he may give the excuse that he uses the drug because
it enlarges his understanding of himself, it is the drug experience,
not his personal development, which is his principal interest.[40]
Physicians with academic responsibilities particularly see a negative
impact of marijuana use on achievement and motivation. Dana Farnsworth,
director of Harvard's health services, writes: "... the
use of marijuana does entail risk. In fact, we find it to be harmful
in many ways and to lack counterbalancing beneficial effects.
Many students continue to think it is beneficial even when their
grades go down and while other signs of decrease in responsible
and effective behavior become apparent."[41]
Harvard's class of 1970 was issued a leaflet
which contained a warning by the Dean of the College, which read,
in part: "... if a student is stupid enough to misuse his
time here fooling around with illegal and dangerous drugs, our
view is that he should leave college and make room for people
prepared to take good advantage of the college opportunity."[42]
The message was that learning and drug use
are incompatible. However, the amount of marijuana smoking and
the degree of involvement with the marijuana subculture are not
specified. Since possibly close to a majority of all individuals
who have smoked marijuana at least once do so no more than a dozen
times in all there is no reason to suppose that marijuana smoking
should have any effect on the ambition of the average smoker.
The problem, as the doctors realize, is with the frequent user.
It is entirely possible that heavy involvement in marijuana
use (as with nearly any nonacademic activity, from heroin addiction
to athletics) leads to academic nonproductivity. It is difficult
to say whether or not this is due directly to the action
of the drug itself. Involvement with a subculture whose values
include a disdain for work probably contributes more to the putative
"nonproductivity" than the soporific effect of the drug.
THE EFFECT ON THE ADOLESCENT PERSONALITY
It would be naive of marijuana legalization enthusiasts to think
that the average age of first smoking the weed would not drop
if their demands were somehow realized, in spite of any potential
age restrictions—think of the facility with which adolescents
obtain cigarettes and liquor. I suspect that if the antimarijuana
arguments carry any weight at all, the noxious effects of the
drug will be aggravated among the very young. And even if the
promarijuana arguments turn out to substantially sound, that is,
that the effects on a well-integrated, fully developed adult personality
are either beneficial (within agreed-upon definitions) or negligible,
the impact on adolescent and pre-adolescent children (taking eighteen
as a rough demarcation line) is a matter to be investigated separately.
It is a legitimate question to raise as to the influence of marijuana
on the young. The following questions might present themselves
as heretofore unanswered requests for much-needed information:
- Are adolescents able to assimilate and integrate the insights
of a novel and offbeat perspective into a rewarding day-to-day
existence in society?
- Will they be able to avoid making the drug the focus of their
lives, a complete raison d'être?
- How aware will adolescents be of the distinction between situations
in which marijuana is relatively harmless (such as with friends,
or watching a film), and those where it may be dangerous (such
as, perhaps, in stressful situations )?
Physicians are acutely aware of the potential damaging effects
of the drug on the adolescent personality. (In fact, even many
nonmedical observers who take a relatively tolerant view of marijuana
use in general are concerned about its possible impact on the
young.)[43] The Director
of the National Institute of Mental Health, a physician, writes:
One needs to be particularly concerned about the potential effect
of a reality distorting agent on the future psychological development
of the adolescent user. We know that normal adolescence is a time
of great psychological turmoil. Patterns of coping with reality
developed during the teenage period are significant in determining
adult behavior. Persistent use of an agent which serves to ward
off reality during this critical development period is likely
to compromise seriously the future ability of the individual to
make an adequate adjustment to a complex society.[44]
THE USE OF MORE POTENT DRUGS
Finally, some physicians oppose marijuana use on the sequential
grounds that it leads to the use of more powerful, truly dangerous
and addicting drugs. At one time, heroin was the primary concern
of society, but within the past six years, it has had to share
society's concern with LSD. Physicians have absorbed a good deal
of sociological thinking and generally deny that there is an actual
pharmacological link between marijuana use and the use of LSD
and heroin. Being high does not make one crave another, progressively
more potent, drug. As Dr. Brill says, there is no connection between
marijuana and other drugs "in the laboratory," but the
association "in the street" is undoubtedly marked.[45]
The pusher line of reasoning as to progressive
drug use is sometimes cited: "... marijuana is frequently
the precursor to the taking of truly addictive drugs. Those who
traffic in it often push other more dangerous substances."[46]
Another argument is that the reason for the progression from
marijuana to either heroin or LSD is experiential: marijuana use
leads one into patterns of behavior which make more serious involvement
likely. The less potent drug acts as a kind of "decompression
chamber" gradually allowing the user to get used to increasingly
more serious drug use, getting used to it bit by bit.
There is nothing about marijuana which compels an individual to
become involved with other more potent drugs. Marijuana use, however,
is often an individual's initiation into the world of illicit
drug use. Having entered that world—having broken the law—he
may become immersed in the drug subculture and in sequential form
progress to abuse of a variety of other drugs, including amphetamines
LSD, amphetamines, and heroin.... Marijuana does not in any
way mandate use of other drugs, but it may be the beginning of
the road at the end of which lies either LSD or heroin.... [If]
certain individuals... did not begin with marijuana, they would
never get around to using the more potent and dangerous drugs.[47]
THE ALCOHOL-MARIJUANA COMPARISON
As we stated earlier, marijuana's supporters take seriously
the argument concerning the relative dangers inherent in marijuana
and alcohol usage; physicians, on the whole, are not so impressed,
and tend to dismiss it as irrelevant.
As we said in the last chapter, potheads draw the conclusion
from a comparison of marijuana with alcohol that marijuana is
unfairly discriminated against; the laws represent a double standard,
just as if there were laws permitting one social group to do something
and prohibiting another from doing the same thing. If alcohol
(which is toxic, lethal, and dangerous) is legal—then why not
pot? Marijuana is certainly no more dangerous than alcohol. Why
aren't both allowed?
The medical answer to this argument is basically that it is
irrelevant. Physicians rarely attribute marijuana with a more
dangerous temperament than alcohol. The disagreement is far less
on the facts than on the conclusion to be drawn from the facts.
Potheads will say that alcohol is far more dangerous than pot,
which is relatively innocuous, while doctors will say that pot
is no more dangerous than alcohol—both of which are dangerous
drugs. Yet this is a matter of emphasis only. Even were marijuana
smokers to grant the medical argument, the disagreement concerning
the implications of this position would still be rampant. Dr.
Bloomquist, author of an antimarijuana book, in testimony before
the California Senate Public Health and Safety Committee, when
asked a question on the relative dangers of the two drugs, replied:
"I would almost have to equate the two of them."[48]
And Donald Louria wrote: "Surely alcohol
itself is a dangerous drug. Indeed, marijuana's dangers... seem
no greater than the documented deleterious effects of alcohol.
If the question before us were a national referendum to decide
whether we would use... either alcohol or marijuana, I might
personally vote for marijuana—but that is not the question"[49]
Physicians say that the damage to society
following the legalization and widespread usage of marijuana
would only be additive to the harm inflicted by alcohol. Whatever
thousand deaths traceable to alcohol we actually experience now
would be increased by a considerable number if marijuana restrictions
were removed.
... the existence of alcoholism and skid rows is not an argument
in favor of cannabis but one against it. If alcohol has ruined
six million lives in this country, how can it possibly be an argument
for permitting cannabis to do the same, or worse? Logic compels
those who argue against alcohol to excuse cannabis to take another
stand: they should be arguing for the control of alcohol and the
elimination of its evils, not for the extension of those or similar
evils to a wider segment of society.
The attack on alcohol implicitly acknowledges the evils of cannabis
and goes on to urge that we let two wrongs make a right.... legalization
of cannabis will in no way alleviate the problems of alcoholism
but is very likely to add problems of another sort.... one drug
is as socially and personally disruptive as the other.
The question is whether we, as a nation, can afford a second drug
catastrophe.[50]
A Minority Opinion
Although mainstream medical opinion holds marijuana to be damaging,
potentially dangerous and, on the whole undesirable, a minority
of doctors demure. We have claimed that the dominant view of physicians
is that marijuana is a dangerous drug, capable of causing adverse
psychic reactions and psychotic episodes. Yet David E. Smith,
physician, toxicologist, pharmacologist, and director of the Haight-Ashbury
Medical Clinic in the midst of a heavy drug-using population,
writes that he has never seen a "primary psychosis"
among his 30,ooo patients, and, outside the clinic, he says that
he has witnessed only three cases of marijuana-induced psychosis—"extreme
paranoid reactions characterized by fear of arrest and discovery."[51]
I have stated that most physicians dismiss the pothead's point
that marijuana is less dangerous than alcohol as irrelevant. Yet,
Joel Fort, a physician, claims that alcohol is the most dangerous
of all drugs currently available in America, whether legally or
illegally. He has developed a scheme characterizing dimensions
of drug "hardness," i.e., dangerousness. Fort's feeling
is that any impartial observer will arrive at least the following
list of dimensions of hardness: addiction (or psychic dependency),
insanity, tissue damage, violence, and death. Thus, some drugs
may be hard in one way, but not in other ways. Fort claims
that alcohol scores high on all of these dimensions; barbiturates
and the amphetamines are also extremely hard as well. Marijuana,
says Fort, is probably the least hard of the drugs available in
today's pharmacopoeia. The fact that a truly dangerous drug (alcohol)
is legal and freely available, while the possession of a far less
dangerous drug (marijuana) is severely penalized, is patently
absurd, according to Fort.[52]
Andrew T. Weil and Norman E. Zinberg, both physicians, after detailed
controlled tests on subjects high on marijuana, concluded that
the drug is relatively safe, and its effects, mild.[53]
James M. Dille and Martin D. Haykin—pharmacologist
and psychiatrist respectively, and both physicians—along with
several nonphysicians, minimize the drug's deleterious effects
on simulated driving performance.[54] And
Tod H. Mikuriya, director of the San Francisco Psychiatric Medical
Clinic, in a pamphlet entitled "Thinking About Using Pot,"
refuses to persuade readers not to use marijuana; he rejects the
contention that marijuana leads to heroin and states, with regard
to psychosis, that "marijuana is exceedingly safe."[55]
His advice to those who "choose to turn
on" concerns understanding how to use marijuana wisely. What
is more, Mikuriya employs marijuana in his therapy. In treating
alcoholics, one of his recommendations is that they give up alcohol,
in his view the more destructive drug, for pot, which is far less
damaging. It is obvious that this doctor disagrees with the majority
view on at least two points: (1) marijuana no longer has any therapeutic
value, and its use constitutes "abuse," and (2) it is
a dangerous drug whose use should be avoided.
Another medical figure, Dr. Eugene Schoenfeld, writes a column
syndicated by a number of "underground" (and invariably
pro-pot) newspapers, such as The East Village Other. His
stance is usually skeptical concerning the putative dangers of
marijuana. One piece attacked the AMA's June 1968 statements condemning
marijuana use, "Marihuana and Society." The critique
is replete with such phrases as "the AMA... has chosen
... to ignore... ," "casting itself into the role
of prophet the Council demonstrates its lack of familiarity with
the current American marihuana situation by the following statement
... ," "contrary to all known evidence, the AMA statement
denies...." The review concludes with the claims: ".
.. the scientific judgment of the AMA will now be looked upon
with some suspicion by the millions of American marijuana users
... the AMA would certainly be surprised by the great numbers
of medical students and young residents who chronically use marijuana
with no observable detriment to their physical or mental well-being."[56]
It is clear, then, that some physicians do not accept the
dominant current medical views concerning marijuana. They underplay
its dangers and hold that smoking pot is less a medical matter
than a social and political question. Medically, they say, there
is relatively little problem with marijuana. It is important to
recognize that this is a minority opinion. Yet it is also interesting
to speculate on some of the roots of this "different drummer"
opinion. Probably the safest bet on the characteristics of the
minority physicians has to do with age: the younger the doctor,
the greater the likelihood that he will minimize its dangers;
the older the doctor, the more danger he will see in pot smoking.
Because of this generational difference, it is entirely possible
that a tolerant attitude in the medical profession toward cannabis
use will become increasingly common and may, in time, become the
reigning sentiment. That day, in any case, will be a long time
in coming.
It is also possible that doctors engaged in research will be more
tolerant than those who have more extensive patient responsibilities.
Issues of welfare and security will become predominant when others
are in one's care, and decisions will be inclined in a conservative
and protective direction. Risk will be minimized. Moreover, when
one's actions and decisions are constantly scrutinized by one's
clients, one feels pressure to conform to the stereotype of the
responsible, judicious, reliable physician. The greater the accountability
to a public, the more that the physician will perceive dangers
in marijuana. (It may also be that doctors who decide to do client-oriented
work are more conservative and cautious to begin with than the
research-oriented physician.) The more independent the physician
is—"safe" from retaliation and free of accountability—the
less danger he will see in marijuana use.
Third, the possibility exists that the positive correlation between
the quality of one's college and tolerance for marijuana use also
applies to medical schools. We found this relationship with students
in general; it seems natural to assume that it would hold up for
physicians specifically. What is distinctive about the more highly
rated schools, whether medical or otherwise, is that the student
lives in an ambiance of experimentation, of greater tolerance
for diversity and deviance and ambiguity. The better schools offer
a richer, more complex view of the universe. It is not that better
medical schools offer a more advanced technical training. It is
that the more highly rated the school, the more daring the intellectual
environment, the greater the willingness to diverge from conventional
opinion, the more attuned both faculty and students will be to
avant-garde cultural themes which presage later dominant modes
of thinking and acting. Whatever the virtues or drawbacks of marijuana,
it is clear that it shares a place with other developments which
are thought to be fashionable among those who consider themselves
(and who are also so considered by others),[57]
progressive, knowledgeable, and ahead of
their time. This is, in any case, speculation. Yet is capable
of being tested empirically. Anyone interested in the appeal of
marijuana has to consider this side of its attraction.
As a qualification, it must be stated that the attitudes of many
physicians are in flux, in large part moving in the direction
of a decreased severity of criticism of marijuana. Many doctors
are becoming aware of the vastness of the phenomenon of use, as
well as the predominance of relatively infrequent users in the
ranks of potsmokers. Data on the effects of use are beginning
to refute many of the classic antimarijuana arguments, and physicians
sufficiently respect the empirical tradition to be influenced
by this. Many influential medical figures have shifted their position
from the "pathology" model outlined in this chapter
to one which minimizes pot's actual or potential danger. Dr. Stanley
Yolles, for instance, Director of the National Institute of Mental
Health, cited earlier in this chapter as typifying some aspects
of the antipot pathology argument, has made recent statements
to the Senate Judiciary Subcommittee on Juvenile Delinquency which
minimized marijuana's medical dangers; his statements were summarized
in an article written by himself entitled: "Pot Is Painted
Too Black."[58] It
may very well be, then, that the medical profession is moving
in the direction of a more "soft" stand on the dangers
represented by marijuana.
If polled, the vast majority of physicians in America would certainly
oppose the relegalization of marijuana possession.[59]
However, nearly all medical commentators
admit that the marijuana laws are unnecessarily harsh. Very few
will support the present legal structure. Although nonmedical
figures who do—principally the police—invoke medical opinion
on pot to shore up their own position, utilizing the pathology
argument in regard to use, they do not mention the doctors' opposition
to the laws as they are presently written. Their conclusions on
the justness of the present legal structure is made contrary to
medical opposition to it.
N O T E S
n
1. The prestige of physicians is higher than that of any other
widely held occupation. See Robert W. Hodge, Paul M. Seigel, and
Peter H. Rossi, "Occupational Prestige in the United States,"
in Reinhard Bendix and Seymour Martin Lipset, eds., Class,
Status and Power, 2nd ed. (New York: Free Press, 1966), pp.
322-334. (back)
2. Henry Brill, "Drugs and Drug Users: Some Perspectives,"
in Drugs on the Campus: An Assessment, The Saratoga Springs
Conference of Colleges and Universities of New York State (Sponsored
by the New York State Narcotics Addiction Control Commission,
Saratoga Springs, New York, October 25 to 27, 1967), p. 49. (back)
3. The literature on the "specialness" of the medical
view of reality—as the term is defined here—particularly regarding
psychosis, is among the most impressive and exciting in the entire
field of sociology. For examples of sociological lines of attack
on the medical view see Thomas Scheff, Being Mentally Ill (Chicago:
Aldine, 1966); R. D. Laing, The Politics of Experience (New
York: Ballantine, 1968); Thomas Szasz, The Myth of Mental Illness
(London: Secker and Warburg, 1962). (It should be noted that
both Laing and Szasz are themselves physicians.) For the process
of the dynamics of constructing this reality in the patient relationship,
see Thomas Scheff, "Negotiating Reality: Notes on Power in
the Assessment of Responsibility," Social Problems 16
(Summer 1968): 3-17. (back)
4. The sword cuts two ways, however. Physicians who have conducted
research on marijuana use may also be employed as rhetorical devices
by the pro-pot lobby. In fact the scientific method may be employed
as a rhetorical device for the purpose of convincing the opposition.
As many of the arguments of the antimarijuana side fail to be
substantiated empirically, the scientific rhetoric will tend to
be invoked correspondingly less, but will become increasingly
emphasized by the opposition. (back)
5. This concept of the disease or pathology model is precisely
equivalent to what Dr. Norman Zinberg independently calls a "medical
model" on marijuana use. (back)
6. American Medical Association, Committee on Alcoholism and Drug
Dependence Council on Mental Health, "The Crutch That Cripples:
Drug Dependence," pamphlet (Chicago: AMA, 1968), p. 2. For
some reason, a small but vigorous contingent of marijuana supporters
maintain that the drug may actually be therapeutic. For instance,
in the vast and decidedly promarijuana anthology, The Marihuana
Papers, edited by David Solomon, several articles were included
which dealt specifically with marijuana's healing powers in some
regard or another. A physician-psychiatrist, Harry Chramoy Hermon,
is licensed to employ cannabis in his therapy. See Hermon, "Preliminary
Observations on the Use of Marihuana in Psychotherapy," The
Marijuana Review , no. 3 (June-August 1969), 14-17. (back)
7. E. D. Mattmiller, "Social Values, American Youth, and
Drug Use" (Paper presented to COTA, January 22, 1968), p.
5 (my emphasis, in part). (back)
8. Brill, op. cit., p. 52. (back)
9. Jerome H. Jaffe, "Drug Addiction and Drug Abuse,"
in Louis S. Goodman and Alfred Gilman, eds. The Pharmacological
Basis of Therapeutics, 3rd ed. (New York: Macmillan, 1965),
p. 285. (back)
10. Paul Jay Fink Morris J. Goldman, and Irwin Lyons, Recent Trends
in Substance Abuse," The international Journal of the
Addictions, 2 (Spring 1967): 150. (back)
11. Graham B. Blaine, Jr., Youth and the Hazards of Affluence
(New York: Harper Colophon, 1967), p. 68. (back)
12. Frank S. Caprio, Variations in Lovemaking (New York:
Richlee Publications, 68), p. 166. (back)
13. Duke Fisher, "Marijuana and Sex" (Paper presented
to the National Symposium on Psychedelic Drugs and Marijuana,
April 1l, 1968), p. 3. (back)
14. Ibid. (back)
15. Blaine, op. cit., pp. 67-68. Blaine qualifies his assertion
by distinguishing the "hard core" user, who would be
impelled to drugs in the absence of the rebellion motive, and
the "experimenter," for whom parental rejection is a
strong impetus to sporadic and eventually discontinued use of
drugs. (back)
16. Seymour L. Halleck, "Psychiatric Treatment of the Alienated
College Student," American Journal of Psychiatry 124 (November
1967): 642-650. (back)
17. Mattmiller, op. cit. (back)
18. Donald B. Louria, The Drug Scene (New York: McGraw-Hill,
1968), p. 101. (back)
19. Henry Brill, "Why Not Pot Now? Some Questions and Answers
About Marijuana," Psychiatric Opinion 5, no. 5 (October
1968): 19. (back)
20. Nathan B. Eddy et al., "Drug Dependence: Its Significance
and Characteristics," Bulletin of the World Health Organization
32 (1965): 721. (back)
21. The parallel with agents of which society approves was made
by Eliot Freidson, in "Ending Campus Incidents," Letter
to the Editor, Trans-action 5, no. 8 (July-August 1968):
75. Freidson writes, with regard to the terms psychic addiction
and habituation: "What does this term mean? It means that
the drug is pleasurable, as is wine, smoked sturgeon poetry, comfortable
chairs, and Trans-action. Once people use it and like it,
they will tend to continue to do so if they can. But they
can get along without it if they must, which is why it cannot
be called physically addictive." (back)
22. David Ausubel, Drug Addiction (New York: Random House,
1958), pp. 9-10. (back)
23. Edward R. Bloomquist, "Marijuana: Social Benefit or Social
Detriment?" California Medicine 106 (May 1967): 352.
(back)
24. Seymour Fiddle, Portraits From a Shooting Gallery (New
York: Harper & Row, 67), pp. 3-20. (back)
25. Louria, op. cit., p. 103. (back)
26. John Rosevear, Pot: A Handbook of Marihuana (New Hyde
Park, N. Y.: University Books, 1967), p. 90. (back)
27. The Medical Society of the County of New York, "The Dangerous
Drug Problem—II," New York Medicine 24 (January
1968), p. 4 (my emphasis). (back)
28. John A. Talbott and James W. Teague, "Marihuana Psychosis:
Acute Toxic Psychosis Associated with Cannabis Derivatives,"
The Journal of the American Medical Association 210 (October
13, 1969): 299. (back)
29. For some representative clinical work by physicians on the
use of marijuana, see Martin H. Keeler, "Adverse Reaction
to Marihuana," The American Journal of Psychiatry 124
(November 1967): 674-677; Doris H. Milman, "The Role of Marihuana
in Patterns of Drug Abuse by Adolescents," The Journal
of Pediatrics 74 (February 1969): 283-29c, Aaron H. Esman
et al., "Drug Use by Adolescents: Some Valuative and Technical
Implications," The Psychoanalytic Forum 2 (Winter
1967): 339 353, Leon Wurmser, Leon Levin, and Arlene Lewis, "Chronic
Paranoid Symptoms and Thought Disorders in Users of Marihuana
and LSD as Observed in Psychotherapy," unpublished manuscript
(Baltimore: Sinai Hospital 1969). (back)
30. The most well-known of the cannabis laboratory experiments
are those conducted in the Addiction Research Center in Lexington,
Kentucky. (Actually, THC is used, not natural marijuana.) See
Harris Isbell et al., "Effects of (-)A9-Trans-Tetrahydrocannabinol
in Man," Psychopharmacologia 1l (1967): 184-188, and
Harris Isbell and D. R. Jasinski, "A Comparison of LSD-25
with (-)A9-Trans-Tetrahydrocannabinol (THC) and Attempted Cross
Tolerance between LSD and THC," Psychopharmacologia 14
(1969): 115-123. See also Reese T. Jones and George C. Stone,
"Psychological Studies of Marijuana and Alcohol in Man"
(Paper presented at the 125th Annual Meeting of the American Psychiatric
Association, Bal Harbour, Fla., May 1969). (back)
31. The use of hashish in America is, as we stated earlier, increasing
rapidly certainly much faster than the use of the less potent
cannabis preparations. As a rough indication of this trend, consider
the fact that more hashish was seized by the United States Customs
in the year 1967-1968 than in the previous twenty years
combined. See The New York Times, September 19, 1968: The
California police in 1968 seized over seven thousand grams of
hashish, whereas none was recorded as having been seized in 1967.
(In neither year was a category for hashish provided on the official
police forms.) See State of California, Department of Justice,
Bureau of Criminal Statistics, Drug Arrests and Dispositions
in California, 1968 (Sacramento, 1969), pp. 40-41. In 1969,
this tendency was further accelerated by the "Great Marijuana
Drought" caused by increased federal vigilance in reducing
the quantity of Mexican marijuana entering the country. Thus,
hashish, which comes from Asia, was more in demand and imported
in far greater volume than previously. And, of course, used with
greater frequency. (back)
32. American Medical Association, Council on Mental Health, "Marihuana
and Society," The Journal of the American Medical
Association 204, no. 13 (June 24, 1968): 1181. (back)
33. Edward R. Bloomquist, Marijuana (Beverly Hills, Calif.:
Glencoe Press, 1968) p. 102. For some of the Oriental studies
on marijuana use referred to, see Ahmed Benabud, "Psycho-Pathological
Aspects of the Cannabis Situation in Morocco: Statistical Data
for 1956," United Nations Bulletin on Narcotics 9, no.
4 (October-December 1957): 1-16; Ram Nath Chopra, Gurbakhsh Singh
Chopra, and Ismir C. Chopra "Cannabis Sativa in Relation
to Mental Diseases and Crime in India," Indian Journal
of Medical Research 30 (January 1942): 155-171; Ram
Nath Chopra and Gurbakhsh Singh Chopra, The Present Position
of Hemp-Drug Addiction in India, Indian research Memoirs,
no. 31 (July 1939); Constandinos J. Miras, "Report of the
U. C. L. A. Seminar," in Kenneth Eells, ed., Pot (Pasadena,
Calif.: California Institute of Technology, October 1968), pp.
69-77
It should be made clear that the validity of many of these studies
has been severely called into question. For instance, in the Leis-Weiss
trials in Boston during 1967, conducted by Joseph Oteri, it was
revealed that the Benabud data were collected at a time when there
was not a single certified psychiatrist in the entire nation of
Morocco, the admitting diagnosis cards were filled out by French
clerks, who recorded the opinions of the police who brought in
the suspect. The transcript of the court proceedings in which
Oteri reveals these facts is to be published in book form by Bobbs-Merrill.
(back)
34. Stanley F. Yolles, "Recent Research on LSD, Marihuana
and Other Dangerous Drugs" (Statement Before the Subcommittee
on Juvenile Delinquency of the Committee on the Judiciary, United
States Senate, March 6, 1968). Statement published in pamphlet
form by the National Clearinghouse for Mental Health Information,
United States Department of Health, Education and Welfare, National
Institute of Mental Health. (back)
35. Bloomquist, "Marijuana: Social Benefit or Social Detriment?"
p. 348. It should be noted that dark glasses may be worn because
the user thinks that his pupils are dilated, but not "because
of the dilated pupils," because, as we shall see in the chapter
on the effects of marijuana, the pupils do not become dilated.
(back)
36. Louria, op. cit., pp. 107, 108. (back)
37. Brill, "Why Not Pot Now?" p. 21. (back)
38. American Medical Association, "Marihuana and Society,"
p. 1181. (back)
39. AMA, "Marihuana Thing," Editorial, Journal of
the American Medical Association 204, no. 13 (June 24,
1968). (back)
40. Bloomquist, "Marijuana: Social Benefit or Social Detriment?"
p. 352. (back)
41. Dana Farnsworth, "The Drug Problem Among Young People,"
The West Virginia Medical Journal 63 (December 1967): 434.
(back)
42. J. U. Monro, unpublished memorandum to the Harvard class of
1970 April 13, 1967. (back)
43. William Simon and John H. Gagnon, "Children of the Drug
Age," Saturday Review, September 21, 1968, pp. 76-78.
(back)
44. Yolles, op. cit. (back)
45. Brill, "Why Not Pot Now?" and "Drugs and Drug
Users." (back)
46. Blaine, op. cit., p. 74. (back)
47. Louria, op. cit., pp. 110-111. (back)
48. Edward R. Bloomquist, Testimony, in Hearings on Marijuana
Laws Before the California Public Health and Safety Committee
(Los Angeles, October 18, 1967, afternoon session), transcript,
p.43. (back)
49 Louria op. cit., p. 115. (back)
50. Actually, Bloomquist misses the point here somewhat. Potheads
do not say that marijuana is as dangerous as alcohol—and
that both are dangerous—and therefore marijuana ought to be
legalized. They say that alcohol is dangerous and legal, while
pot is not dangerous, but illegal, and legalizing marijuana
would reduce the seriousness of the drug problem, because
more pot and less alcohol would be consumed. See Bloomquist Marijuana,
pp. 85, 86. (back)
51. David E. Smith, "Acute and Chronic Toxicity of Marijuana,"
Journal of Psychedelic Drugs 2, no. 1 (Fall 1968): 41.
(back)
52. Of Fort's many publications, perhaps the most relevant to
these points is "A World View of Marijuana: Has the World
Gone to Pot?" Journal of Psychedelic Drugs 2, no.
1 (Fall 1968): 1-14. See also "Pot: A Rational Approach,"
Playboy, October 1969, pp. 131, 154, 216, et seq., in which
Fort argues for the legalization of marijuana. See also The
Pleasure Seekers (Indianapolis: Bobbs-Merrill, 1969). (back)
53. Andrew T. Weil, Norman E. Zinberg, and Judith M. Nelsen, "Clinical
and Psychological Effects of Marihuana in Man," Science
162, no. 3859 (December 13, 1968): 1234-1242; Zinberg and
Weil, "Cannabis: The First Controlled Experiment," New
Society/ (January 19, 1969): 84-86; Zinberg and Weil, "The
Effects of Marijuana on Human Beings," The New York Times
Magazine, May 11, 1969, pp. 28-29, 79, et seq.; Weil, "Marihuana,"
Letter to the Editor, Science 163, no. 3872 (March 14,
1969): 5 (back)
54. Alfred Crancer, Jr., James M. Dille, Jack Delay, Tean E. Wallace,
and Martin D. Haykin, "A Comparison of the Effects of Marihuana
and Alcohol on Simulated Driving Performance," Science
164, no. 3881 (May 16, 1969): 851-854. (back)
55. Tod H. Mikuriya and Kathleen E. Goss, "Thinking About
Using Pot" (San Francisco: The San Francisco Psychiatric
Mental Clinic, 1969), p. 24. (back)
56. Eugene Schoenfeld, "Hip-pocrates," The East Village
Other 3, no. 36 (August 9, 68): pp. 6, 16. (back)
57. I am not making the claim that marijuana is inherently
part of an intellectual avant-garde movement. At certain times
and places, it may be looked upon as reactionary. It is just that
today, in America, it is so considered. We also do not say that
it is only among those who consider themselves in the historical
vanguard that marijuana will appeal; it is just that those who
do think this way will be more likely to try marijuana
than those who do not. (back)
58. Stanley F. Yolles, "Pot Is Painted too Black," The
Washington Post, September 21, 1969, p. C4. Compare this later
statement with those made in the National Clearinghouse for Mental
Health Information, NIMH pamphlet, published in part in the March
7, 1968 issue of The New York Times, p. 26, and the article
"Before Your Kid Tries Drugs," The New York Times
Magazine, November 17, 1968, pp. 124, et seq. (back)
59. In an actual mail-in questionnaire study by a physician of
the attitudes of psychiatrists and physicians in the New York
area on the legalization of marijuana, it was found that the large
majority (about 60 percent) said that they were against legalization.
Only a quarter were for it. See Wolfram Keup, "The Legal
Status of Marihuana (A Psychiatric Poll)," Diseases of
the Nervous System 30 (August 1969): 517-523. (Another way
of looking at these figures, however, is that there is far from
unanimous agreement within the medical and psychiatric professions
on the status of marijuana.) (back)
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