The following essay appeared in the March 1998 issue of Reason magazine as one of several essays debating the medical use of marijuana.
The Washington State "Drug Medicalization and Prevention Act of 1997" asserts that "we need to...recognize that drug abuse and addiction are public health problems that should be treated as diseases." The merits of this claim cannot be intelligently debated without agreeing on the use of the terms drug abuse, addiction, treatment, and disease, and on the kinds of personal conduct that justify coercive state control by means of public health measures.
From ancient times until recent years, the term public health, as distinguished from private health, was used to denote activities undertaken by a government to protect individuals from disease-causing agents or conditions in the environment, both physical and human. The principal public health measures have been sanitation and the control of infectious diseases, aimed at protecting the community from microbial diseases such as cholera and typhoid. In this connection, the control of venereal diseases illustrates an important consideration: The prostitute's behavior, exposing her client to the risk of venereal disease, was and is viewed as a public health problem, justifying the coercive control of her conduct, whereas the behavior of her client, exposing himself to the risk of venereal infection, was and is viewed as a private health problem, not justifying the coercive control of his conduct. By defining the behavior of the individual who exposes himself to the risk of "addiction" as a public health problem, we radically expand the range of legitimate state coercion in the name of health.
Public health measures play a crucial, but neglected, role in modern political philosophy. Interventions justified in the name of health --defined as therapeutic, not punitive-- fall outside the scope of the criminal law and are therefore exempt from constitutional restraints on state coercion. On the contrary, such measures --promoted as protecting the best interests of "sick patients"-- are viewed as valuable "services" provided by the Therapeutic State (the polity uniting medicine and state, much as church and state formerly were united). Presciently, John Stuart Mill anticipated this insidious tactic: "The preventive function of government," he warned, "is far more liable to be abused, to the prejudice of liberty, than the punitory function; for there is hardly any part of the legitimate freedom of action of a human being which would not admit of being represented, and fairly too, as increasing the facilities for some form or other of delinquency."
Mill could not have put it better had he been addressing present-day American drug policy. It is self-evident that free access to a particular drug, like free access to any object, increases our opportunities for using and abusing it: Freedom of action means the opportunity to act wisely or unwisely, to help or harm ourselves. It is also self-evident that, since "no man is an island," any private act may be viewed as affecting the economic, existential, or medical well-being of others, and hence be deemed to pose a "public health problem"; and that if protecting people from themselves falls within the sphere of public health, then no private behavior is exempt from being categorized as a public health problem, subject to control by means of medical sanctions.
It is ironic that, in 1997, Americans should recommend "drug medicalization" as a cure for America's drug problem: It was the "drug medicalization" act of 1914 --better known as the Harrison Narcotic Act-- that transformed widely used analgesics and sedatives into dangerous "narcotics," specially monitored by the federal government, available only by a physician's prescription. Horribile dictu, isn't it possible that defiance of such controls is not a disease, and that coercive state interference with the free market in drugs --like similar interference with the availability of other goods-- may be the root cause of the problem we now try to solve by still further "medicalization"? Aren't we fools if we fail to ask, cui bono?: Who benefited from drug medicalization in the past and who benefits from it today?
The die is now cast: Misbehaviors of all sorts are (defined as) medical problems. Unwanted behavior, exemplified by the use of illegal drugs, is, by fiat, a disease. The concepts of disease and treatment have thus become politicized. The World Health Organization's definition of drug abuse as the "use of a drug that is not approved by a society or a group within that society" is illustrative. Thus, doctors, judges, journalists, civil libertarians, everyone accepts--or pretends to accept--that self-administering heroin is a disease and that a state agent administering methadone to an "addict" is a treatment.
Some see the Therapeutic State as an instrument of compassion and science in the service of "moral progress" and accordingly support "medicalization" in all its many guises. Others see the Therapeutic State as an instrument of cruelty and pseudoscience in the service of a new form of statism and accordingly oppose "medicalization."
Contributing Editor Thomas Szasz, professor of psychiatry emeritus at the SUNY Health Science Center in Syracuse, is author of many books, including Our Right to Drugs: The Case for a Free Market (Praeger).
For more information about Dr. Szasz visit the Thomas S. Szasz Cybercenter for Liberty and Responsibility.
Reprinted with permission, from the March 1998 issue of Reason Magazine. Copyright 1998 by the Reason Foundation, 3415 S. Sepulveda Blvd., Suite 400, Los Angeles, CA 90034. www.reason.com.
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