Americans regard freedom of speech and religion as fundamental rights. Until 1914, they also regarded freedom of choosing their diets and drugs as fundamental rights. Today, however, virtually all Americans regard ingesting certain substances—prohibited by the government—as both crimes and diseases.
What is behind this fateful moral and political transformation, which has resulted in the rejection by the overwhelming majority of Americans of their right to self-control over their diets and drugs in favor of the alleged protection of their health from their own actions by a medically corrupt and corrupted State? How could it have come about in view of the obvious parallels between the freedom to put things into one's mind and its restriction by the State by means of censorship of the press, and the freedom to put things into one's body and its restriction by the State by means of drug controls?
The answer to these questions lies basically in the fact that our society is therapeutic in much the same sense in which medieval Spanish society was theocratic. Just as the men and women living in a theocratic society did not believe in the separation of church and State but, on the contrary, fervently embraced their union, so we, living in a therapeutic society, do not believe in the separation of medicine and the State but fervently embrace their union. The censorship of drugs follows from the latter ideology as inexorably as the censorship of books followed from the former. That explains why liberals and conservatives—and people in that imaginary center as well—all favor drug controls. In fact, persons of all political and religious convictions, save libertarians, now favor drug controls.
Liberals tend to be permissive toward socially disreputable psychoactive drugs, especially when they are used by young and hairy persons; so they generally favor decriminalizing marijuana and treating rather than punishing those engaged in the trade of LSD. They are not at all permissive, however, toward non-psychoactive drugs that are allegedly unsafe or worthless and thus favor banning saccharin and Laetrile. In these ways they betray their fantasy of the State—as good parent: such a State should restrain erring citizens by mild, minimal, and medical sanctions, and it should protect ignorant citizens by pharmacological censorship.
Conservatives, on the other hand, tend to be prohibitive toward socially disreputable psychoactive drugs, especially when they are used by young and hairy persons; so they generally favor criminalizing the use of marijuana and punishing rather than treating those engaged in the trade of LSD. At the same time, they are permissive toward nonpsychoactive drugs that are allegedly unsafe or worthless and thus favor free trade in saccharin and Laetrile. In these ways, they too betray their fantasy of the State—as the enforcer of the dominant ethic: such a State should punish citizens who deviate from the moral precepts of the majority and should abstain from meddling with people's self-care.
Viewed as a political issue, drugs, books, and religious practices all present the same problem to a people and its rulers. The State, as the representative of a particular class or dominant ethic, may choose to embrace some drugs, some books, and some religious practices and reject the others as dangerous, depraved, demented, or devilish. Throughout history, such an arrangement has characterized most societies. Or the State, as the representative of a constitution ceremonializing the supremacy of individual choice over collective comfort, may ensure a free trade in drugs, books, and religious practices. Such an arrangement has traditionally characterized the United States. Its Constitution explicitly guarantees the right to freedom of religion and the press and implicitly guarantees the right to freedom of self-determination with respect to what we put into our bodies.
Why did the framers of the Constitution not explicitly guarantee the right to take drugs? For two obvious reasons. First, because 200 years ago medical science was not even in its infancy; medical practice was socially unorganized and therapeutically worthless. Second, because there was then no conceivable danger of an alliance between medicine and the State. The very idea that the government should lend its police power to physicians to deprive people of their free choice to ingest certain substances would have seemed absurd to the drafters of the Bill of Rights.
This conjecture is strongly supported by a casual remark by Thomas Jefferson, clearly indicating that he regarded our freedom to put into our bodies whatever we want as essentially similar to our freedom to put into our own minds whatever we want. "Was the government to prescribe to us our medicine and diet," wrote Jefferson in 1782, "our bodies would be in such keeping as our souls are now. Thus in France the emetic was once forbidden as a medicine, the potato as an article of food."
A THERAPEUTIC STATE
Jefferson poked fun at the French for their pioneering efforts to prohibit drugs and diets. What, then, would he think of the State he himself helped to create, a State that now forbids the use of harmless sweeteners while encouraging the use of dangerous contraceptives? that labels marijuana a narcotic and prohibits it while calling tobacco an agricultural product and promoting it? and that defines the voluntary use of heroin as a disease and the legally coerced use of methadone as a treatment for it?
Freedom of religion is indeed a political idea of transcendent importance. As that idea has been understood in the United States, it does not mean that members of the traditional churches—that is, Christians, Jews, and Mohammedans—may practice their faith unmolested by the government but that others—for example, Jehovah's Witnesses—may not. American religious freedom is unconditional; it is not contingent on any particular church proving, to the satisfaction of the State, that its principles or practices possess "religious efficacy."
The requirement that the supporters of a religion establish its theological credentials in order to be tolerated is the hallmark of a theological State. In Spain, under the Inquisition, there was, in an ironic sense, religious tolerance: religion was tolerated, indeed, actively encouraged. The point is that religions other than Roman Catholicism were considered to be heresies. The same considerations now apply to drugs.
The fact that we accept the requirement that the supporters of a drug establish its therapeutic credentials before we tolerate its sale or use shows that we live in a therapeutic State. In the United States today, there is, in an ironic sense, pharmacological tolerance: approved drugs are tolerated, indeed, actively encouraged. But drugs other than those officially sanctioned as therapeutic are considered worthless or dangerous. Therein, precisely, lies the moral and political point: governments are notoriously tolerant about permitting the dissemination of ideas or drugs of which they approve. Their mettle is tested by their attitude toward the dissemination of ideas and drugs of which they disapprove.
The argument that people need the protection of the State from dangerous drugs but not from dangerous ideas is unpersuasive. No one has to ingest any drug he does not want, just as no one has to read a book he does not want. Insofar as the State assumes control over such matters, it can only be in order to subjugate its citizens—by protecting them from temptation, as befits children; and by preventing them from assuming self-determination over their lives, as befits an enslaved population.
Conventional wisdom now approves—indeed, assumes as obvious—that it is the legitimate business of the State to control certain substances we take into our bodies, especially so-called psychoactive drugs. According to this view, as the State must, for the benefit of society, control dangerous persons, so it must also control dangerous drugs. The obvious fallacy in this analogy is obscured by the riveting together of the notions of dangerous drugs and dangerous acts: as a result, people now "know" that dangerous drugs cause people to behave dangerously and that it is just as much the duty of the State to protect its citizens from dope as it is to protect them from murder and theft. The trouble is that all these supposed facts are false.
It is impossible to come to grips with the problem of drug controls unless we distinguish between things and persons. A drug, whether it be heroin or insulin, is a thing. It does not do anything to anyone unless a person ingests it or injects it into himself or administers it to another. Obviously, a drug has no biological effect on a person unless it gets into his body. The basic question—that is logically prior to whether the drug is good or bad—is, therefore: How does a drug get into the person's body? Although there are many ways that that can happen, we need to consider here only a few typical instances of it.
A person may take an accepted nonprescription drug like aspirin by way of self-medication. Or, he may be given an accepted prescription drug like penicillin by way of medication by his physician. Neither of these situations disturbs most people nowadays. What disturbs the compact majority is a person taking a drug like LSD or selling a drug like heroin to others.
The most cursory attention to how drugs get into the human body thus reveals that the moral and political crux of the problem of drug controls lies, not in the pharmacological properties of the chemicals in question, but in the character-properties of the persons who take them (and of the people who permit, prescribe, and prohibit drugs).
The true believer in conventional wisdom might wish to insist at this point—not without justification—that some drugs are more dangerous than others; that, in other words, the properties of drugs are no less relevant to understanding our present-day drug problems than are the properties of the persons. That is true. But it is important that we not let that truth divert our attention from the distinction between pharmacological facts and the social policies they supposedly justify.
Today, ordinary, "normal" people do not really want to keep an open mind about drugs and drug controls. Instead of thinking about the problem, they tend to dismiss it with some cliche such as: "Don't tell me that heroin or LSD aren't dangerous drugs?" Ergo, they imply and indeed assert: "Don't tell me that it doesn't make good sense to prohibit their production, sale, and possession!"
What is wrong with this argument? Quite simply, everything. In the first place, the proposition that heroin or LSD is dangerous must be qualified and placed in relation to the dangerousness of other drugs and other artifacts that are not drugs. Second, the social policy that heroin or LSD should be prohibited does not follow, as a matter of logic, from the proposition that they are dangerous, even if they are dangerous.
Admittedly, heroin is more dangerous than aspirin, in the sense that it gives more pleasure to its user than aspirin; heroin is therefore more likely than aspirin to be taken for the self-induction of euphoria. Heroin is also more dangerous than aspirin in the sense that it is easier to kill oneself with it; heroin is therefore more likely to be used for committing suicide.
The fact that people take heroin to make themselves feel happy or high—and use other psychoactive drugs for their mind-altering effects—raises a simple but basic issue that the drug-prohibitionists like to avoid, namely: What is wrong with people using drugs for that purpose? Why shouldn't people make themselves happy by means of self-medication? Let me say at once that I believe these are questions to which honest and reasonable men may offer different answers. Whatever the answers, however, I insist that they flow from moral rather than medical considerations.
For example, some people say that individuals should not take heroin because it diverts them from doing productive work, making those who use the drugs, as well as those economically dependent on them, burdens on society. Others say that whether individuals use, abuse, or avoid heroin is, unless they harm others, their private business. And still others opt for a compromise between the total prohibition of heroin and a free trade in it.
There is, however, more to the prohibitionist's position than his concern that hedonic drugs seduce people from hard labor to happy leisure. If prohibitionists were truly motivated by such concerns, they would advocate permission to use heroin contingent on the individual's proven ability to support himself (and perhaps others), rather than its unqualified suppression. The fact that they advocate no such thing highlights the symbolic aspects of drugs and drug controls.
DRUGS, FUN, AND SIN
The objects we now call "dangerous drugs" are metaphors for all that we consider sinful and wicked; that is why they are prohibited, rather than because they are demonstrably more harmful than countless other objects in the environment that do not now symbolize sin for us. In this connection, it is instructive to consider the cultural metamorphosis we have undergone during the past half-century, shifting our symbols of sin from sexuality to chemistry.
Our present views on drugs, especially psychoactive drugs, are strikingly similar to our former views on sex, especially masturbation. Intercourse in marriage with the aim of procreation used to be the paradigm of the proper use of one's sexual organs; whereas intercourse outside of marriage with the aim of carnal pleasure used to be the paradigm of their improper use. Until recently, masturbation—or self-abuse, as it was called—was professionally declared, and popularly accepted, as both the cause and the symptom of a variety of illnesses, especially insanity. To be sure, it is now virtually impossible to cite a contemporary medical authority to support the concept of self-abuse. Expert medical opinion now holds that there is simply no such thing: that whether a person masturbates or not is medically irrelevant, and that engaging in the practice or refraining from it is a matter of personal morals or life style.
On the other hand, it is now impossible to cite a contemporary medical authority to oppose the concept of drug abuse. Expert medical opinion now holds that drug abuse is a major medical, psychiatric, and public-health problem: that drug addiction is a disease similar to diabetes, requiring prolonged (or life-long) and medically carefully supervised treatment; and that taking or not taking drugs is primarily, if not solely, a matter of medical concern and responsibility.
Like any social policy, our drug laws may be examined from two entirely different points of view: technical and moral. Our present inclination is either to ignore the moral perspective or to mistake the technical for the moral.
A MEDICAL PROBLEM?
An example of our misplaced over-reliance on a technical approach to the so-called drug problem is the professionalized mendacity about the dangerousness of certain types of drugs. Since most propagandists against drug abuse seek to justify certain repressive policies by appeals to the alleged dangerousness of various drugs, they often falsify the facts about the true pharmacological properties of the drugs they seek to prohibit. They do so for two reasons: first, because many substances in daily use are just as harmful as the substances they want to prohibit; second, because they realize that dangerousness alone is never a sufficiently persuasive argument to justify the prohibition of any drug, substance, or artifact. Accordingly, the more they ignore the moral dimensions of the problem, the more they must escalate their fraudulent claims about the dangers of drugs.
To be sure, some drugs are more dangerous than others. It is easier to kill oneself with heroin than with aspirin. But it is also easier to kill oneself by jumping off a high building than a low one. In the case of drugs, we regard their potentiality for self-injury as justification for their prohibition; in the case of buildings, we do not. Furthermore, we systematically blur and confuse the two quite different ways in which narcotics can cause death: by a deliberate act of suicide and by accidental over-dosage.
I maintain that suicide is an act, not a disease. It is therefore a moral and not a medical problem. The fact that suicide results in death does not make it a medical problem any more than the fact that execution in the electric chair results in death makes the death penalty a medical problem. Hence, it is morally absurd—and, in a free society, politically illegitimate—to deprive an adult of a drug because he might use it to kill himself. To do so is to treat people like institutional psychiatrists treat so-called psychotics: they not only imprison such persons but take everything away from them—shoelaces, belts, razor blades, eating utensils, and so forth—until the "patients" lie naked on a mattress in a padded cell, lest they kill themselves. The result is one of the most degrading tyrannizations in the annals of human history.
Death by accidental overdose is an altogether different matter. But can anyone doubt that this danger now looms so large precisely because the sale of narcotics and many other drugs is illegal? Persons buying illicit drugs cannot be sure what they are getting or how much of it. Free trade in drugs, with governmental action limited to safeguarding the purity of the product and the veracity of labeling, would reduce the risk of accidental overdose with so-called dangerous drugs to the same levels that prevail, and that we find acceptable, with respect to other chemical agents and physical artifacts that abound in our complex technological society.
In my view, regardless of their dangerousness, all drugs should be "legalized" (a misleading term that I employ reluctantly as a concession to common usage). Although I recognize that some drugs—notably, heroin, amphetamine, and LSD among those now in vogue—may have dangerous consequences, I favor free trade in drugs for the same reason the Founding Fathers favored free trade in ideas: in a free society it is none of the government's business what ideas a man puts into his mind; likewise, it should be none of its business what drug he puts into his body.
Clearly, the argument that marijuana—or heroin, methadone, or morphine—is prohibited because it is addictive or dangerous cannot be supported by facts. For one thing, there are many drugs, from insulin to penicillin, that are neither addictive nor dangerous but are nevertheless also prohibited: they can be obtained only through a physician's prescription. For another, there are many things, from poisons to guns, that are much more dangerous than narcotics (especially to others) but are not prohibited. As everyone knows, it is still possible in the United States to walk into a store and walk out with a shotgun. We enjoy that right, not because we do not believe that guns are dangerous, but because we believe even more strongly that civil liberties are precious. At the same time, it is not possible in the United States to walk into a store and walk out with a bottle of barbiturates or codeine or, indeed, even with an empty hypodermic syringe. We are now deprived of that right because we have come to value medical paternalism more highly than the right to obtain and use drugs without recourse to medical intermediaries.
I submit, therefore, that our so-called drug-abuse problem is an integral part of our present social ethic that accepts "protections" and repressions justified by appeals to health similar to those which medieval societies accepted when they were justified by appeals to faith. Drug abuse (as we now know it) is one of the inevitable consequences of the medical monopoly over drugs—a monopoly whose value is daily acclaimed by science and law, State and church, the professions and the laity. As formerly the church regulated man's relations to God, so medicine now regulates his relations to his body. Deviation from the rules set forth by the church was then considered heresy and was punished by appropriate theological sanctions, called penance; deviation from the rules set forth by medicine is now considered drug abuse (or some sort of "mental illness") and is punished by appropriate medical sanctions, called treatment.
The problem of drug abuse will thus be with us so long as we live under medical tutelage. That is not to say that, if all access to drugs were free, some people would not medicate themselves in ways that might upset us or harm them. That, of course, is precisely what happened when religious practices became free. People proceeded to engage in all sorts of religious behaviors that true believers in traditional faiths found obnoxious and upsetting. Nevertheless, in the conflict between freedom and religion, the American political system has come down squarely for the former and against the latter.
If the grown son of a devoutly religious Jewish father has a ham sandwich for lunch, the father cannot use the police power of American society to impose his moral views on his son. But if the grown son of a devoutly alcoholic father has heroin for lunch, the father can, indeed, use the police power of American society to impose his moral views on his son. Moreover, the penalty that that father could legally visit on his son might exceed the penalty that would be imposed on the son for killing his mother. It is that moral calculus—refracted through our present differential treatment of those who literally abuse others by killing, maiming, and robbing them as against those who metaphorically abuse themselves by using illicit chemicals—which reveals the depravity into which our preoccupation with drugs and drug controls has led us.
I believe that just as we regard freedom of speech and religion as fundamental rights, so we should also regard freedom of self-medication as a fundamental right; and that, instead of mendaciously opposing or mindlessly promoting illicit drugs, we should, paraphrasing Voltaire, make this maxim our rule: "I disapprove of what you take, but I will defend to the death your right to take it!"
Sooner or later we shall have to confront the basic moral dilemma underlying the so-called drug problem: Does a person have the right to take a drug, any drug—not because he needs it to cure an illness, but because he wants to take it?
The Constitution and the Bill of Rights are silent on the subject of drugs. That would seem to imply that the adult citizen has, or ought to have, the right to medicate his own body as he sees fit. Were that not the case, why should there have been a need for a constitutional amendment to outlaw drinking? But if ingesting alcohol was, and is now again, a Constitutional right, is not ingesting opium or heroin or barbiturates or anything else also such a right?
It is a fact that we Americans have a right to read a book—any book—not because we are stupid and want to learn from it, nor because a government-supported educational authority claims that it will be good for us, but simply because we want to read it; because, that is, the government—as our servant rather than our master—hasn't the right to meddle in our private reading affairs.
I believe that we also have a right to eat, drink, or inject a substance—any substance—not because we are sick and want it to cure us, nor because a government-supported medical authority claims that it will be good for us, but simply because we want to take it; because, that is, the government—as our servant rather than master—hasn't the right to meddle in our private dietary and drug affairs.
It is also a fact, however, that Americans now go to jail for picking harmless marijuana growing wild in the fields, but not for picking poisonous mushrooms growing wild in the forests. Why? Because we, Americans, have collectively chosen to cast away our freedom to determine what we should eat, drink, or smoke. In this large and ever-expanding area of our lives, we have rejected the principle that the State is our servant rather than our master. This proposition is painfully obvious when people plaintively insist that we need the government to protect us from the hazards of "dangerous" drugs. To be sure, we need private voluntary associations—or also, some might argue, the government—to warn us of the dangers of heroin, high-tension wires, and high-fat diets.
But it is one thing for our would-be protectors to inform us of what they regard as dangerous objects in our environment. It is quite another thing for them to punish us if we disagree with them.
Dr. Szasz, a contributing editor to REASON, has written widely in books and articles on the subjects of psychiatry, involuntary mental hospitalization, drug laws, and suicide. Another version of this article appeared in Skeptic in 1977.