“Life’s just much too hard today…the pursuits of happiness just seem to bore.” --Rolling Stones, “Mother’s Little Helper” (1966) https://www.youtube.com/watch?v=tfGYSHy1jQs
Philip Alcabes (at The American Scholar) has written a lengthy article titled “Medication Nation”. It’s one of the best and most important essays I’ve read in some time—but at the same time, I have the uneasy feeling that Alcabes isn’t saying anything that the Rolling Stones didn’t already tell us way back in 1966 (in two minutes and forty-five seconds!) on “Mother’s Little Helper”.
Fifty years later, Alcabes reports:
Americans like drugs. We like a great many drugs. And for the most part, we do not turn to drugs for a cleansing of the doors of perception, as William Blake put it. Perhaps we should. But typically we use drugs—legally or not—for more worldly reasons.
According to the Kaiser Family Foundation, Americans filled more than four billion prescriptions in 2014. On average, about half of all Americans use at least one prescription medication in any given month. The U.S. Food and Drug Administration reports that more than 300,000 legal nonprescription (over-the-counter, OTC) medications are also available. Eighty percent of us use OTC drugs as the first response to minor ailments…
We have good reasons, of course, for all this drug use, and Alcabes notes our many perfectly understandable motives:
Pain is a main motive in our use of drugs of all sorts. In addition to $3.9 billion for aspirin, acetaminophen, and the like, Americans spend about $9 billion on prescription opioids each year. More than 200 million prescriptions for opioid pain relievers are filled each year, some of which find their way to the four million Americans who use opioids for pain relief without a prescription.
In a culture attuned to gain and loss, the most potent inducers of discomfort are those that make us less productive: anxiety, sleeplessness, and lethargy. The grave psychic stress they bring is evident in how much medication we use to lessen them.
Pain is both a physical and a psychological phenomenon: who is to say which variety of pain is harder to bear? Moreover, who can measure someone else’s pain or someone else’s tolerance for it? In that sense, pain (and how we deal with it) is paradigmatic of modernity, being entirely subjective and entirely relative. When it comes to someone else’s pain, who are we to judge?
Philosophical musings aside, Alcabes observes:
America is awash in drugs. Many public drinking-water supply systems contain measurable amounts of pharmaceuticals, presumably because people dispose of unused medication down the sink or toilet, or in regular trash that goes into landfills from which the pharmaceuticals leach out into groundwater. And we’re awash in the sense that it is easy to find drugs of some kind almost anywhere.
Perhaps, then, our use of drugs has gone too far? Maybe we should do something about the situation? Philip Alcabes reminds us that we have for decades attempted, on the one hand, to control the use of certain drugs, while on the other hand undermining our efforts with brazen if unacknowledged hypocrisy:
We have seen nearly 45 years of the War on Drugs, the country’s longest-lasting campaign. We have heard ever-louder outcries about the safety of our children and accompanying uproars about nicotine in e-cigarettes, caffeine in energy drinks, “synthetic marijuana,” and heroin. We have new stimulants for attention deficit hyperactivity disorder (ADHD), new sleep aids, the very popular serotonin-activating SSRIs and SNRIs for depression. We have club drugs, designer drugs, experimental drugs, homemade methamphetamine, and those synthetic cannabinoids. We have pharmaceutical commercials on TV, many of the advertised products transparently having to do more with enhancing erotic pleasure than with curing illness—to the point that any thinking person would be forgiven for questioning the distinction between recreational drugs and prescription medication.
All this drug use has consequences, and Alcabes documents them—addiction, ruined lives, overdoses, deaths—before adding:
Beyond the statistics and outside the emergency room, many Americans—the number is simply impossible to estimate—are dependent on psychoactive drugs in ways that make it hard for them to make the best use of their innate capabilities. Drugs are often part of the story when we find ourselves unable to live the enriching life that the country’s wealth and know-how ought, somehow, to permit. It’s a tragedy of modernity.
To paraphrase the Rolling Stones, what a drag it is being free! As Alcabes explains:
We have better chemicals, but we’re not sure we have better lives. The old days of simple contrasts between the Mad Men with their martinis and the working class with their beer, of prescribed medications and illegal narcotics that get you hooked—that era now seems quaint. In a more complicated time, we seem to flounder, looking for a way to think about the life we have made with psychoactive drugs, both the medical ones and those that are illicit. It’s hard for us to recognize how firmly drugs are fixed in our collective sense of what it means to be American. Perhaps it’s even harder for us to feel sympathy for the neediness that these drugs answer.
The “neediness” is real and even urgent, or we wouldn’t take the drugs in the first place:
Unmentioned in our zeal to depict drug dependence as a matter of either impropriety or brain disease is users’ desperation, whether it’s prescription medication or illicit drugs that they are taking. The despair of the chronic depressive, about which Andrew Solomon has written movingly in The Noonday Demon, seems far more central to the human experience than the fact of needing Paxil to get out the door in the morning. And yet it’s the dependence that our drug conversation fixes on, not the despair…
I will bet you dollars to Zoloft that the average person would much rather voice an opinion—usually critical and condescending—about drug use and drug dependency than spend a single minute talking or even thinking about despair. And yet, Alcabes insists:
If we want to understand how intrinsic drugs are to the American way of life, we have to give voice to the reasons why we use them. We need to talk about how we experience living in America today, and especially about pain. So many people are in so much pain.1 No doubt, of the more than 16,000 Americans who die by overdosing on opioid painkillers, many are in unremitting physical pain (the Institute of Medicine counted about 100 million such sufferers in 2011). But something deeper is going on. Modernity brings us so much—so much information, so much stuff. But sometimes we can’t support the weight of our own lonesomeness.
To his credit, Philip Alcabes does not blame our drug problem on greedy pharmaceutical companies—those companies are greedy, no doubt about it; but they only exploit our desperation, they do not create it.
Meanwhile, when our physical and psychic desperation encounters our moral censoriousness and our pragmatic concerns about addiction, abuse, and dependency, the results are, well, complicated:
Our American experience, more and more, is mediated by some chemical. What we think about psychoactive drugs comes not from sterile knowledge, but from using the drugs, or seeing others use them. We feel we know the dangers that drugs can bring, and the pleasures. Either way, we seek to manage them: we want dosages that will help us and not kill us; we want those who need psychoactive drugs for medical reasons to have them; we want to keep them from those who don’t need them; we want parents to have some control over their children; we want children to have a chance at lives that aren’t in the sway of some chemical dependence. But however much these risk-management systems assign dosages, toxicities, prescribing rules, or prison sentences, what remains is our ambivalence.
In our haste to condemn others (it’s always “others” who are at fault) for their irresponsible use of drugs, Alcabes reminds us not to forget one salient fact—drugs work:
Anxiolytics…got me through chemistry class, Adderall gets a medical student through an exam, SSRIs keep a depressed man from jumping off a bridge. Those might be grounds for deploring American culture, if that’s your bent. A more generous view would be that our enormous capacity for using medications of all kinds, and the uncertain relationship we have with them, is an essential aspect of being American. Our feelings about drug use express both the value we put on personal experience and the coloring of experience by the effect of the medications that shape it.
Moreover, even if and when drugs don’t work, they are only one of myriad ways in which human beings, perversely clever creatures that they are, sabotage their own lives:
We all know people whose lives were ruined once they started using psychoactive medications habitually, but we count even more those whose problems started with legal psychoactives like alcohol. And still more, it’s fair to say, upend their lives with money, or out of love. We are boundlessly capable of making our own lives difficult, and those of us who are harmed by psychoactive drugs were almost always suffering to begin with. The overdoses, the destitution, the divorces, and all the untoward effects of drug use might have been avoided if someone had been able to help earlier on. Almost always, it’s something deeper than the drugs. As Saul Bellow’s scientist Benn Crader acknowledges in his 1987 novel, More Die of Heartbreak, what we know from science about the troubles modernity has brought to the world must be taken seriously. “But,” Crader says, “I think more die of heartbreak.” 2
Where does all this leave us? What is the solution? Surely Philip Alcabes wouldn’t diagnosis our condition if he didn’t have a cure to offer? 3
Well: are “compassion” and “mercy” solutions? Because they’re what Alcabes recommends:
What should we do about psychoactive drugs? I have no neat prescription. Seemingly, we can’t trust individuals not to overmedicate themselves, doctors not to overprescribe, pharmaceutical companies not to advertise misleadingly, and law enforcement not to lump harmless enjoyment with intent to do harm to others. The products of nature will relentlessly be turned into further products of industry, and the persistent and wholly American tendency to use them ever more to make life better, longer, and more comfortable won’t go away. As Internet pharmaceutical trading and made-to-order molecules render drug purchasing both easier and more individualized, the collisions between our experience-driven fears and our experience-tinged aspirations will be vexatious: our demands for control always bump up against desires for liberty. Meanwhile, the pain, discomfort, and just plain yearning that make people reach for medications—those never leave us. The deep question is whether we can look at our drug use with compassion, and infuse its management with mercy.
To go beyond the scope of Philip Alcabes’ essay: it might even be suggested, tentatively, that “compassion” and “mercy” are in fact the balm (I won’t say “cure”) for every single one of our human ills. In the end, they are the best tools we have for coping with ourselves, with each other, and with the difficult world in which we exist.
Now if only we could figure out why mercy and compassion, unlike drugs, seem to be in such perpetually short supply.
1 What a simple but heartbreaking observation: “So many people are in so much pain.” I am reminded of Leszek Kolakowski’s essay “Is God Happy?” Mr. Kolawkowski argued that the personal and relational God in whom Jews and Christians believe could not possibly be happy in the face of so much human suffering; according to Kolakowski, in order to affirm that God is happy we would have to redefine either “God” or “happy” or both. “So many people are in so much pain”: and this in the most affluent, prosperous, advanced nation on earth.
2 “More die of heartbreak”: another simple, profound, and moving observation.
3 Famously, the mid-1960s Alka-Seltzer commercial about “the blahs”: “We wouldn’t have invented a disease if we didn’t have something you could take for it.”