Theodore Dalrymple on heroin

Theodore Dalrymple is a former prison psychiatrist—he also writes about his time as a psychiatrist. He sometimes writes about men who are on heroin. He says that if you no longer use the drug the withdrawal symptoms you experience are no worse than flu—so that it is not so difficult to leave heroin alone if you decide to.

He also says that under Mao, when Mao first took power, that all heroin use stopped because Mao had people who took heroin shot. Hence it is not hard to give up heroin if you are presented with the right incentives.

The general implication is that the whole “addiction narrative” is not true—and that people who take heroin do not need some special consideration or to be nursed through it like an illness; and that the cosseted approach taken to people who use heroin is based on a false premise and just allows them to carry on more or less as before.

While I do not think “addiction” is real, being a modern concept, Dalrymple is suspect in both respects.

He says that to withdraw from heroin is “no worse than the flu”. Yet how does he know? He has watched people come off heroin, but he has not come off heroin himself. This is not scientific. It is more like all men will say, even if you cut their right arm off, “it’s like the flu, I’ll shrug it off in a few days”—it’s more like bravado.

In the old days, scientists used to do things like experiment with rabies vaccines on themselves, even if they got rabies and died—or do blood transfusions before blood types were known, and also die.

Dalrymple is a psychiatrist, so he is meant to study human experience in a scientific way. True scientific method: to take heroin until you find yourself compelled to take it when you try to stop—and then report your sensations in relation to experienced illnesses (e.g. pain is equivalent to flu, pain is equivalent to the time I broke my leg, pain is equivalent to a toothache etc).

The people who no longer use heroin and experience withdrawal symptoms may look like they just have the flu—but many illnesses look like each other, different illnesses can produce, for example, clammy skin.

So I think Dalrymple’s attitude is not scientific and is more empty moralism. Until you have experienced it, how do you know?

It is not the same as a broken leg, because a man who seeks to fix a broken leg doesn’t need to understand the subjective experience to fix the leg—but psychiatrists claim to understand the subjective experiences and motivations of human beings, and to be able to alter them for the better.

Hence they need to understand the experience they attempt to change.

As far as Mao goes, we will assume that it is true heroin use in China vanished “overnight”. However, this does not prove what Dalrymple claims—which is that, therefore, it is “simple” to give up heroin.

If you are in a hospital bed with a broken leg and I come in with an automatic pistol and say, “Walk to the end of the ward or I’ll kill you,” then you will find a way to walk to the end of the ward—however undignified and painful it is.

What this proves is not that “a broken leg is nothing, you’re just moaning”—it just proves that a man will do anything to avoid death.

That is not a novel observation. It is a Draconian observation, in the genuine sense—Draco was a tyrant who made almost every crime in his kingdom punishable by death (which did reduce crime, no doubt). In the end, he was overthrown because the citizens, tired of their precarious lives, and aware that they “might as well be hung for a sheep as a lamb”, saw they had nothing to lose if they overthrew the tyrant.

So, yes, doubtless all manner of crimes and activities would be “easily overcome” if the death penalty were introduced widely, but it doesn’t prove that heroin is easy to overcome—just that men will do anything to avoid death.

For sure, penalties for drug use should be harsher—up to and including the death penalty for major offences. But I do not think Dalrymple is really interested in drugs, so much as moralisation—so much as he thinks that it is positive to suffer, whereas a doctor’s duty is to cure and, secondarily, inquire into the causes of disease.

I do not think he really has an interest in how people come to be enthralled to heroin, but I think he likes the idea that they should suffer—because what he says accentuates suffering, but does not suggest a realistic cure.