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Wednesday, 30 December 2009 06:50

Drugs, addiction and literature

It is now common place to link drugs to the world of Arts and Literature.From the 19th century onwards, many writers have taken over the subject to describe either its psychical or physical effects. French poet Baudelaire published an essay on hashish and opium in Les Paradis artificiels (Artificial Paradises, 1860) inspired by Thomas de Quincey’s Confessions of an English Opium-Eater. In the mid-20th century, writers from the Beat Generation in the US put the use and the experimentation of drugs at the center of their works, as for example with William Burroughs’ novels Junky and The Naked Lunch. Since then, the subject has also been exploited abundantly by film directors who have adapted novels such as Requiem for a Dream realised in 2000 by Darren Aronofsky from the eponymous novel by Hubert Selby Jr. published in 1978.

It is certainly very difficult and maybe impossible to objectively assert or analyse the relation between the taking of drugs and creativity, although many writers have evoked their own use of hallucinogenous substances to stimulate their imagination. Indeed, the use of drugs is known for its power of transgression, of modifying the perceptions and also sometimes making the body and the mind more efficient and productive. Drugs could tally with the fantasy of a creator who would not need to sleep or stop in order to achieve his work. For example, Jean-Paul Sartre was reported to having used mescaline and amphetamines by his companion Simone de Beauvoir (in The prime of life); he would have injected himself with mescaline while writing L’Imaginaire because he wanted to study and observe the process of hallucinations while being himself the subject of these visions. In fact, apparently Sartre was also distinguishing different uses for different drugs: he would take mescaline when writing literary works while he would take amphetamines for philosophical works. Pascal Nouvel, the author of Histoire des amphetamines (The History of Amphetamines, 2009) recalls that Sartre would have written La critique de la raison dialectique under the influence of amphetamines as apparently, for him, philosophy was the development of an idea that he already had; then the amphetamines would help him to produce more energy in order to develop this idea when mescaline would be more reserved for the stimulation of creation. Pascal Nouvel also quotes another original use of amphetamines by science fiction author Philip K. Dick. The latter took these drugs to reach a state of paranoia (also called ‘amphetaminic psychosis’) which would inspire him to reproduce this atmosphere of fear and paranoia in his novels.


These alterations and modifications of perception once under the influence of a drug are described by Baudelaire in his essay on hashish and opium, Les Paradis artificiels. In the first part of the book entitled “le Poeme du hashish”, he relates his own experience of hashish; in the second part of the book, named “the Opium Eater”, he analyses the book written by Thomas de Quincey (1785-1859), a British writer who related his addiction to opium. Baudelaire describes precisely the different steps of his intoxication, starting with the physical symptoms and the behaviour changes which result. And Baudelaire mentions a hallucinatory phase which he himself compares to poetic analogies, when the senses seem to take a more distinct power:

“It is, in fact, at this period of the intoxication that is manifested a new delicacy, a superior sharpness in each of the senses: smell, sight, hearing, touch join equally in this onward march; the eyes behold the Infinite; the ear perceives almost inaudible sounds in the midst of the most tremendous tumult. It is then that the hallucinations begin; external objects take on wholly and successively most strange appearances; they are deformed and transformed. […]The enthusiast eye of the hashish drunkard will see strange forms, but before they were strange and monstrous these forms were simple and natural. The energy, the almost speaking liveliness of hallucination in this form of intoxication in no way invalidates this original difference: the one has root in the situation, and, at the present time, the other has not." (’The Theater of Seraphim’, Chap.3, translation by Aleister Crowley, 1895)

But the final judgment of Baudelaire is not positive: after the acme of the drug’s influence, there is the ‘comedown’ which he qualifies as “terrible”:

“But the morrow; the terrible morrow! All the organs relaxed, tired; the nerves unstretched, the teasing tendency to tears, the impossibility of applying yourself to a continuous task, teach you cruelly that you have been playing a forbidden game. Hideous nature, stripped of its illumination of the previous evening, resembles the melancholy ruins of a festival. The will, the most precious of all faculties, is above all attacked. They say, and it is nearly true, that this substance does not cause any physical ill; or at least no grave one; but can one affirm that a man incapable of action and fit only for dreaming is really in good health, even when every part of him functions perfectly?“ (’The Moral’, Chap.5)

At the end, Baudelaire condemns this drug because it forces one to abdicate their will and takes away the control of one’s thoughts. Drugs may be a way to reach a certain ideal and to increase one’s imagination but this ideal remains “artificial”, “fake” as the creator should be the master of its own creation and realisation.

Here we can suggest an approach to the definition of addiction. If drugs usage is necessarily a transformation of oneself which is not necessarily a bad experience in itself, the negative ontological effect of using drugs could rely on its potential addictive power, as addiction would be the dissociation of the subject from its autonomy through the alteration and the submission of oneself. Heir of the Beat Generation, Hubert Selby Jr. describes in a very striking way the mechanism of addiction in his novel Requiem for a Dream. The book follows the four seasons of one year to depict the relentless decay of the four main characters: Sara, the mother of Harry, his girlfriend Marion and his best friend Tyrone. The latter are all young heroin users. The addiction of Harry is evoked since the very first pages of the book: in order to get money to go buy drugs, he has established a ritual during which he takes his mother’s television set to the pawn shop where Sara has to re-buy it. It is summer; Sara is a widow who spends her days watching the same television show and eating chocolates. She receives a phone call which announces to her that she may participate in the television show. She becomes obsessed with her appearance as she wants to wear a special red dress on the day of the show and, in order to slim fast, she starts a regimen of amphetaminic diet-pills. It is probably in the middle of the book that the reader becomes conscious of Sara’s addiction when she calls her doctor’s office to complain that she doesn’t feel the effects of the pills, then after the physical addiction comes the mental one almost inevitably follows.

All characters share the same craving for an ideal of happiness which they see as attainable at first. The youngsters have entrepreneurial dreams which define their ideal of success while Sara dreams of seeing herself on television. Harry’s leitmotiv is that there is never anything to worry about: whether it’s when they do not find their dose, when they get into trouble, when he recognizes his mother’s addiction she’s unwilling to admit it etc. But their passivity is what also condemns them; all four are waiting: Sara for the confirmation letter from the television show, the three kids for the stroke of luck which will decide their future. Their will is totally annihilated by the use of drugs and their habits, the automatism of their daily lives which is symbolized by the television set. Whether it is to relax after taking drugs or to feed one’s fantasies, the television is the symbol of this artificial paradise created by addiction. Actually, the author doesn’t only relate the addiction to drugs, he tells more the story of people who have renounced their will and, somehow, their ability of living together and acting their own lives. All their addictions could be exchangeable (Sara for example exchanges her bulimia for anorexia); the drugs are the means and the symptoms of the characters’ meaningless life, which reinforce somehow the idea that anything can be an object of addiction.

So one cannot say that literature, or art, have participated in normalizing the use of drugs as one can see that drug usage and addiction, whether the actor or the object of the writings, belong first to the social sphere: literature and philosophy might be able to help put into words the ‘language of drugs and addiction’ but it is also a matter of knowing what kind of society we want, how we want to consider the margins of our society, if we want to stigmatize them or to help the distressed instead.

Read a study on cocaine (in French)



Additional information
There is no doubt that rehabs for drug addiction can help treat drug addicted people from all walks of life.
Wednesday, 30 December 2009 02:31

Striking the Balance Between Alert and Panic

Cooperation with the Mass Media

In countries with a high level of connectedness of the population, a central issue in vertical communication will be the control of the information accessible to populations. Dr KUO’s presentation, which focused on the relationship of the government with the mass media, is revealing in this regard. Policy makers and communicators in highly connected environments must make do with the instant availability of parallel communication channels and contradictory information which threaten to blur the government’s message, and impede behavioural change. Dr KUO showed a video taken from a Taiwanese show, featuring a young girl whose left arm and leg had – allegedly – been paralysed following vaccination. Such a video could potentially harm the government’s vaccination strategy, and the CDC, the agency in charge of the management of health outbreaks in Taiwan, was quick to prove the hypothesis wrong and issue a denial in the media. In order to prevent and absorb such competing claims, Dr KUO insisted on the need for policymakers to be proactive, and issue information as much as possible before the media, to be reactive, and most importantly to build trust amongst its population through early announcement, but also transparency and an ability to listen to the population.

As clearly illustrated by his finishing quote: “to declare war on the media, though tempting, is a game you will never win.”

Dr KUO’s presentation focused, quite significantly, on the importance of communication between decision makers and the media. The media is indeed one of the most institutionalised channels through which the information produced by decision makers will be passed on to the public. It is also the vector through which the state of mind of a given audience will be made visible, either indirectly, through reports and articles, or directly, through op-eds and tribunes.

A certain degree of management of the media space is therefore necessary if decision makers want to control the messages that they give out. Dr KUO advocated gaining a certain degree of control over the information produced, but also of controlling, as in “taking the temperature of”, the state of mind of the population. Thus a good timing, and transparency in the communication strategy were put forward as ways of dealing with the conflicting information that can emerge in the media – such as the story of the paralysed young girl that we mentioned earlier: produce information before the media does, be honest in communicating the amount of information that you know and that you don’t know. The perception of transparency will strengthen trust, thus making populations less vulnerable to competing claims. Dr KUO also insisted on the need for decision makers to demonstrate care. In his words, “people don’t care how much you know, they just want to know how much you care.” The projection of care is an important component of an effective communication strategy, to which we will come back to as we reflect on the final part of this session.

Dr KUO also put forward the importance of knowing how an audience reacts. It is not enough to determine “the right message and the right vector for the right audience”; one must also establish whether such a message has been heard, in the first place, and whether it is being well understood in the second. This endeavour links back to the issue of the “behavioural gap”, which we mentioned earlier on. For this purpose, interesting tools were put in place as part of Taiwan’s communication strategy, to “take the temperature” of the population during the Pandemic A/H1N1 outbreak. Reports on the pandemic in the major media channels were thus closely monitored as a way of evaluating the degree of concern within the population. A toll-free hotline was also set up, which served the dual objective of handing out information to the public and informing decision makers on the state of mind of the population: number of calls indicating the level of concern, type of questions posed indicating possible gaps in the communication campaign, etc. By closely following the “mood” of the population, decision makers can palliate the emergence of conflicting information by answering concerns and tailoring messages before the media does, and reframing an unclear message before it is contradicted, thus avoiding credibility loss and strengthening confidence.

(Summarized by E. Broughton)


Singapore’s communication strategy on the Pandemic A/H1N1 has been quite country and culture-specific. Singapore’s response system, the DORSCON (Disease Outbreak Response System), evaluated pandemic severity using a classification distinct from that of the WHO, integrating the parameters of transmissibility and virulence of a disease.

Singapore’s communication strategy was also remarkable for its directive style. In the words of Dr MENON, “soft warnings and reassurances do not work”, whilst “fear can be a constructive emotion.” Thus rather directive measures, in place of incentive ones, were communicated to the public – Home Quarantine Orders for travellers returning from Mexico and voluntary quarantine for those returning from other affected areas, travel restrictions through “strong” advise to postpone or avoid non-essential travel – travellers which had stayed at the Metropark Hotel Wanchai, in Honk-Kong, were requested to call the hotline of the Ministry of Health, deployment of thermal scanning in air, sea and land checkpoints.

Such measures, which were well accepted by the Singaporean population, could have been difficult to implement in a number of other countries. The position of the Singaporean government, which is endorsed by its population, is that “it is better to err on the side of over-reaction that under-reaction.”

Dr MENON’s presentation also illustrated the difficulties that may arise from the articulation of local and global governance levels. For instance, it would seem that Singapore, despite its independent system for evaluating the severity of the pandemic, dovetailed the progressive step-up of WHO phases, only to reverse this progression and retrograde shortly after, when it appeared that the disease was less serious than expected. This “evident confusion in the responses of Government Ministries and organisations having to amend processes mid-stream” was caused by the perceived “loophole in WHO’s pandemic alert system”, or more generally by the friction that can arise between global (WHO) and local standards.

The importance of local/national specificities in elaborating an adequate communication strategy does not preclude however the existence of a global framework actively shaping it. Dr MENON underlined that the specific content of Singapore’s management of the Pandemic A/H1N1 outbreak took place under the umbrella of the WHO. Information between both levels circulated, and was either adapted at the local/national level from the global one, or compatible with it. Specific communication styles did not send contradictory signals.

(Summarized by E. Broughton)
Download here Dr. Menon’s PPT

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A summary of proceedings after the colloquium which was held on November 28, 2009 in Taipei

After the SRAS and the H5N1 avian influenza, the outbreak of the new influenza A/H1N1 highlighted the importance of communication in pandemic preparedness and response. The uncertainties regarding the emerging disease and the difficulty in predicting its evolution made decision-making delicate. The fear of creating panic, on the one hand, and the desire to promote the necessary behavioural changes from the public, on the other, was a balance that proved at times difficult to keep. Some national authorities were accused of fear-mongering, or on the contrary of downplaying real existing risks in order to reduce anxieties. The eagerness to demonstrate political action resulted at times in unnecessary if not problematic measures being taken, on the grounds that populations needed to be reassured (closing of borders, culling of pigs). The experience of past crises also proved to be a double-edge sword: lists and routines of actions and communications existed and were ready to be used, but they simultaneously had to be adapted and changed, and such changes in turn had to be explained. A need thus emerged for “flexible, flipside communication”, or in other words a communication strategy based on the idea that “today the recommendations are such, but tomorrow they could and will certainly sound different. So keep listening”.

On the positive side, the crisis demonstrated achievements, such as a high level of transparency and efficient communication strategies by the WHO, the (US) CDC, and other actors. If a close and thorough study of the experience of the new influenza remains to be written, the A/H1N1 outbreak has raised issues and lessons that are common to any global public health crisis communication strategy.

The first lesson, which now seems to have been widely acknowledged but may not yet be fully implemented, is that communication not only matters, but is key to the successful management of any crisis.

This being acknowledged, the second lesson is that communication should be first and foremost about “horizontal communication”, i.e. about the getting together of decision-makers from different sectors and organisations to exchange information and analyses through transparent processes and to coordinate their responses to maximise impact. Within one given country, how do different ministries and agencies coordinate to respond to a public health crisis? At the global level, how does the WHO play its coordinating, and information-pooling role, how does it rationalise the global response? What options exist to improve such communication processes?

The third lesson underlines the importance of “vertical communication”, between decision-makers and the public, and “transversal communication”, amongst members of the public. Often, fear of panic and the desire to “reassure” dominate the strategies to manage public health crises. This can lead to discourses fostering anxiety or on the contrary disinterest, rather than the development of a social space nurturing behavioural change and preparation. What options can we think of to circumvent such a paradox? Could and should public health communicators rely more on bottom-up strategies (empowerment of the public) or “transversal communication”?

Finally, the rise of new media (one needs only to think of twitter) has already revolutionised public health communication. What are the innovative trends and options currently being developed to improve global public health communication? What can we learn from such experiences?


Read the complete report (pdf)




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