Sociology Lens

There is something curious happening this election season, and it has nothing to do with 47% or Obamacare. Voters in three states – Washington, Oregon, and Colorado – will be casting ballots on whether or not to legalize cannabis. Whether or not these measures ultimately pass, they amount to the most direct challenge to the legitimacy of US drug policy since the War on Drugs began over 40 years ago. Of particular interest here are the similarities between the proposed measures and the varying degrees of their success thus far.

These are not the first ballot measures to legalize cannabis; that honor goes California’s Proposition 19, which failed in 2010. This time, however, the measures are currently poised to pass in 2 of the 3 states (though election day is still a few weeks away). They represent concerted and collective effort by activists, and have much in common. But it is the way in which they are framed and promoted that matter the most this election season.

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There are many lessons to take away from the New York Times article linked below that describes a rambunctious little boy whose life was nearly ruined by anti-psychotic medications. Increasing numbers of children have been prescribed this class of drugs as of late for conditions ranging from Tourette Syndrome to bipolar disorder, which psychiatrists have begun to diagnose in children at younger and younger ages. There is controversy surrounding the very ability to diagnose these conditions in young children and certainly over the utility and safety of prescribing the most potent of the psychiatric medications for this population.  The issues associated with medicating children, especially with this class of medications, as well as the dangers to them, their families and society more broadly are innumerable (even if there are benefits in some cases, which most biological psychiatrists argue there is). But for now, let’s take this as an example of the increasing diagnosis of disorders such as bipolar disorder, which is an intriguing phenomenon that needs exploration at the aggregate level.

In the debate over whether any disorders are purely biological entities, sociologists generally adhere to the argument that bipolar disorder and schizophrenia seem to be heavily rooted in biology, since the rates of these disorders are relatively stable over time and place. As opposed to depression, anxiety, substance abuse, etc., the former disorders do not seem affected by culture (though the course of the illnesses are) or the social environment more broadly. In other words, there is fairly wide agreement that bipolar disorder and schizophrenia are in fact organic conditions, not likely to be born of  social or environmental factors alone (or maybe at all). However, as these diagnoses become increasingly common (this does not yet seem to be the trend with schizophrenia but certainly is the case with bipolar disorder), what does this say about the assumption of biological etiology?

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Inquiries as to whether many of the drugs that millions of Americans take are any more effective than say, a sugar pill, or any other placebo pill used in clinical trials are on the rise. Sadly, especially with many anti-depressants, it does not seem as though there is any clear evidence that the drugs are more effective than the placebos and this may also be an issue in non-psychotropic drugs. What if a blood pressure medication wasn’t any more helpful than a sugar pill? What if the drug you take for panic attacks wasn’t really preventing them? But my purpose isn’t to ask why the medicines don’t work as well as they should and often claim to (though someone should certainly be concerned with this), but rather to describe some of the cognitive reasons that might allow us to think a drug is working to the extent that it has an actual, physical effect on the body or the mind. Why, for instance, could we feel better on anti-depressants even if the re-uptake of Serotonin or Norepinephrine is not what’s actually making us less sad? One (of many) possibilities is the power of suggestion and, perhaps, what social psychologists call normative influence.

The concept of normative influence, in its most basic form, allows us to understand why one might conform to norms in order to be accepted or praised by others. However, it might also help to explain one of the reasons why placebos make people feel better. When one is given a medicine with a particular purpose, might one not feel as though the response the researchers, doctors or pharmaceutical reps are looking for is a positive response or the dissipation of symptoms? Of course, there is range of other reasons for which one might respond to a placebo – perhaps, in the case of something like depression, the relationship between doctor and patient itself may be comforting. Perhaps when given a heart medication, a patient, realizing her own possible fate, may also begin to exercise and eat better during the drug trial yet attribute improvement to the medication. Perhaps chronic heartburn was solved by changes in diet rather than prescribed medications. These are all possibilities as are many other explanations, but it is worth considering that, when handed a prescription, especially for a psychiatric condition, the feeling that one is supposed to feel better and of wanting to “impress” or just satisfy the doctor may influence patients to unintentionally make themselves feel better. Classic social psychological studies inform us that we generally seek conformity to expectations – no one wants to be criticized. Patients, as they would in any other life situation outside the realm of medicine, likely want to please their doctors and also family members and friends who might also have high hopes for a drug. Likewise, just the power of medicine in contemporary society puts doctors and/or medical researchers in a positions where patients would assume improvement because these professionals are considered legitimate sources of information and are associated with the belief that the medicine will work and make things better. This may go beyond a mere desire to please or conform, but may further be an example which kinds of situations make us more or less likely to conform. Medicine and doctors as purveyors of drugs and medical knowledge have power and influence. We are supposed to trust them. They should know more than the patient. Therefore, the pills they prescribe should work. And we may not “want” to challenge this impression either because it is threatening to us as believers in the system or because we value and or fear the response of the doctor. In any case, the reasons for which medicines or placebos might work may have more to do with social factors than biological or chemical ones, especially in the case of psychotropic drugs, but perhaps in the case of many other medicines as well.

The Growing Power of the Sugar Pill, NPR

Normative Influence. In the Blackwell Encyclopedia of Social Psychology.

Head Case, In The New Yorker

by paulabowles

The links between illegal drug use and crime, particularly acquisitive, have long been recognised as problematic. Recent statistics published in The Independent suggest that as few as ten percent of addicts commit 75 percent of all acquisitive crime. In spite of these consistently dispiriting figures, the familiar approach is one of punishment, with some attempt at rehabilitation. Moreover, all of these programmes have at their foundations an aim to ensure their clients maintain complete desistance from drug use.

However, recent trials—first at the Maudsley Hospital in London, but later extended to Darlington and Brighton—suggest that the way to break the link between drugs and crime should be tackled in an entirely different way. The creation of so-called NHS “shooting galleries”, where long-term addicts can get a regular, monitored fix of heroin, would appear to be having success, not only in cutting crime, but also in reducing drug use. This week the UK National Treatment Agency for Substance Abuse is expected to call for a network of these clinics to be created across the country.

However, illegal drug (ab)use is often seen very emotively, and while this initiative may make good economic and indeed, medical sense, there will be many critics. First, the programme is not cheap (although cheaper than prison), second, the already over stretched budgets of the NHS, and finally, the moral dimension, as to whether those criminalised should be given free drugs, regardless of benefit to society. No doubt this debate will continue for some considerable time.

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Eric L. Jensen on Adult Drug Treatment Courts: A Review

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by paulabowles

A recent discussion between Erwin James and Jonathon Aitken draws attention once more to the apparent incompatibility between prison and rehabilitation. As both James and Aitken are former prisoners, it is perhaps understandable that they have strong feelings about imprisonment.

During their discussion James and Aitken touch on issues of honesty, recidivism, education as well as the cost of imprisonment. At the heart of their discussion is the realisation that even in the twenty first century it would seem that there is no real consensus as to what prisons are actually supposed to achieve. It appears that despite the great wealth of research carried out into imprisonment and recidivism, including such authors as Foucault, Ignatieff, Martinson, Cavadino and Dignan, the political will to rehabilitate offenders is often lacking.

What perhaps sets this particular discussion apart is its novel focus on the economics of rehabilitation. Possibly, Britain beset by recession may find a new impetus to explore rehabilitation in a more meaningful way. As Jonathon Aitken points out:

“If rehabilitation reduces reoffending, you have two bonuses: you save money and, perhaps more importantly, communities will start to feel safer.”

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Doreen Anderson-Facile on Basic Challenges to Prisoner Reentry