Akrasia and the Greatest Drug Worker in History

Tuesday, March 9th, 2010

Don’t blame drugs for drug addiction, says Theodore Dalrymple, in Romancing Opiates. Richard DeGrandpre makes the same point in The Cult of Pharmacology. Lee Harris offers his own perspective:

If the drug induced the moral weakness, then shouldn’t we blame the drug, as the addict asks us to? If the moral weakness was already there, before the drug use began, and if it explains the addict’s inability to control his drug use, then what sense does it make to hold the addict responsible for his moral weakness? If a person has been trained to believe that he is helpless to control his own behavior, can you alter this fact by stigmatizing him or by making him face the adverse consequences of what Dalrymple calls his “conscious choices”? It is his very moral weakness that makes him impossible to help, because that moral weakness has long convinced him that he cannot help himself.

To accept the addict’s account at face value does not require a bleeding heart. The problem of moral weakness was frankly recognized and brilliantly analyzed by the tough-minded Aristotle who put great emphasis in both his ethical and political theories on a psychological phenomenon he called akrasia. This Greek term literally means “without power,” and it refers to a lack of mastery over the self — a state of helplessness in respect to one’s appetites, passions, and impulses. It is defined in contrast to the concept of enkrateia, which represents the exact opposite kind of character — the person who has obtained mastery over himself, and who can control and regulate his passions and impulses. The dieter, for example, who follows his self-imposed regimen strictly and faithfully, is displaying enkrateia, while the dieter who goes off his diet because he cannot resist the lure of a strawberry milkshake is an example of akrasia.

According to Aristotle, not all akrasia is the same. There is weakness (astheneia) and impetuosity (propeteia). Our lapsed dieter is an example of weakness. He has thought out a plan of action that he thinks is the right thing for him to do, namely, to lose weight; he has even established a dietary routine to achieve his end. Yet he simply cannot resist the impulse to have a strawberry milkshake, in violation of the rules that he had set out for himself. He knows better, but this rational knowledge makes no difference to his actual conduct. He is too weak to control his appetites and his passions. He exists in a state of internal conflict: part of him wants to do the right thing, but that part is not strong enough to conquer the part of him that wants to do the wrong thing.

On the other hand, the impetuous person makes no attempt to curb and control his impulses and appetites. He simply acts, and does so without any internal agonizing over what choice to make, and indeed without any reflection or deliberation at all. Yet, for Aristotle, the impetuous person is capable of regretting his impulsive actions once he has committed them, though perhaps only in the way that the impulsive shoplifter regrets the fact that he has been caught red-handed. This regret, by itself, cannot bring about a change in the behavior of the impetuous person; he will continue to give in to his impulses and to be punished for them — like the criminal who, as soon as he is released from jail, returns to committing the same crimes that put him there in the first place. The impetuous person never learns.

Aristotle’s analysis is helpful in seeing where Dalrymple’s treatment of the addict falls short, since the concept of akrasia allows us to recognize that there will inevitably be large groups of human beings who will be unable to control their own lives — a group that will naturally exhibit all the signs of the impetuous personality. Large doses of testosterone coursing through the veins of young males will invariably lead to impetuous behavior, unless these boys have been subjected from a young age to a rigorous program aimed at habituating them to self-control, or enkrateia — and even then the success may be hit or miss. Kids who have been allowed to grow up feral cannot be expected to display self-control; self-mastery is a technique no one has taught them, so how could they have learned it? They will in fact lack the strength of mind to rise even to the level of Aristotle’s weak man, since they will be ignorant of what constitutes right conduct.

In Aristotle’s political theory, such human beings are classified as “natural slaves” who must be governed by others because they are completely unable to govern themselves. Today we find Aristotle’s theory objectionable, despite the fact that in even the most advanced societies many people are “enslaved” to drugs, to alcohol, to gambling, and to sex. Indeed, Aristotle could rightly point out that no society has ever existed that achieved the complete elimination of the weak-willed and the impetuous, if only because each rising generation will consist of children who, by nature, lack the self-mastery that can only be achieved by the right upbringing — if even then.

Civilizing the young is one of the first duties of any society, though it is a duty that certain cultures have discharged with vastly more success than others. If there are many people in the society whose behavior is characterized by akrasia, or moral weakness, then the society, for its own good, has a right and an obligation to keep them from dangers to which they, by nature, are especially vulnerable. The sociological motive behind such puritanism is not a hatred of pleasure as such, but only of those pleasures that weaken the will and undermine self-control. Some pleasures are wholesome and acceptable, and should be encouraged. Other pleasures challenge not just individual self-control but the collective self-control of the whole community, threatening the ethical foundation of the society; such pleasures must be curbed. Lead us not into temptation, both for our own good and the welfare of the general society.

There are, of course, people who live perfectly productive lives while addicted to drugs:

To begin with, let us examine the case of two remarkable individuals, one cited by DeGrandpre, the other by Dalrymple.

William Halsted was an American doctor whom DeGrandpre calls “one of the greatest of surgeons in American history, perhaps even the father of modern surgery.” In 1892, Halsted became the first professor of surgery at Johns Hopkins Hospital; he later introduced the use of rubber gloves when operating on patients, and went on to organize “new fields of medicine, including orthopaedics, otolaryngology, and urology.” Yet Halsted had been using morphine from the age of twenty-two, and remained a morphine user for well over the next half-century. A study made of him in 1942 reported that Halsted “found that his addiction caused him little inconvenience…. Sometimes he went for a few days, or even weeks, without the drug, but then ‘suddenly the overpowering desire would come.’”

William Wilberforce, an Englishman who lived a century before Halsted, played a pivotal role in bringing about one of the world’s greatest ethical achievements: he worked tirelessly for the emancipation of slaves, not just in British colonies, but around the world, and he was instrumental in ending the horrors of the Atlantic slave trade. His contemporaries admired his eloquence; Boswell famously described watching the diminutive Wilberforce give a speech: “I saw what seemed a mere shrimp mount upon the table; but as I listened, he grew, and grew, until the shrimp became a whale.” Thanks to his patience and persistence, the abolitionist cause eventually won out in Parliament. Yet, as Dalrymple notes, Wilberforce died an opium addict.

Halsted and Wilberforce certainly do not fit into the categories of the weak-willed or impetuous man. Can their addictions be summarily dismissed as mere self-indulgence, or do they offer evidence that certain substances possess an occult hold over even the strongest of us? When Halsted spoke of the times when he tried to quit morphine, but found himself seized by “the overpowering desire” for the drug, was he simply propagating more pharmacological lies, as De Quincey is supposed to have done, or was he genuinely possessed by a desire over which he had no control?

Earlier we discussed the case of the weak-willed fellow who set out to follow a rigorous diet plan, but found himself seduced by the temptation of a strawberry milkshake. When dealing with our lapsed dieter and his strawberry milkshake, our common sense tells us that it would be silly to blame some sinister power in the milkshake. Instead, it makes more sense to say that he lacked the strength of will; or, as Aristotle would say, that he was weak. But can the same thing be said about other substances, like opium, cocaine, or alcohol? It was the immensely strong-willed Samuel Johnson who, when asked why he never touched wine, replied: “Abstinence is as easy for me, as temperance would be difficult.” But why would temperance have been so difficult for Johnson to achieve? It makes no sense to blame it on his lack of willpower, since he was strong enough to abstain from wine completely, and, as he said, quite easily.

Johnson’s quip about abstinence and temperance makes sense when it is a question of spirituous beverages, but what about strawberry milkshakes? We can understand a man who abstains from drinking strawberry milkshakes — but what about a man who cannot drink strawberry milkshakes in moderation, and who goes on a weekend-long strawberry milkshake binge? Is such a man even imaginable? If one finds pleasure in a strawberry milkshake at all, one can find it only in moderation: drink three of them in a row as an experiment if you doubt the truth of this observation.

But the same thing cannot be said about the pleasures of alcohol, and by extension, the pleasures of opium, cocaine, crack, and methamphetamine. While it is true that some people can use these drugs moderately, the way many of Johnson’s contemporaries could drink wine moderately, the fact remains that there are many otherwise strong-willed people who begin taking alcohol and drugs and discover, too late, that they cannot control their desire to take more and more — a problem which, as we have seen, does not afflict even the most self-indulgent lover of strawberry milkshakes. In short, the chemical nature of the temptation does matter.

Harris argues in favor of useful myths:

Is it possible that one of the causes of the modern drug epidemic is that more and more people have ceased to subscribe to the idea that certain substances are inherently destructive of our strength of will, and have therefore been tempted to taste the erstwhile forbidden fruit? If scientific knowledge leads us to abandon such myths as that of Demon Rum, Demon Heroin, and Demon Cocaine, is it altogether clear that our increased sophistication will be advantageous to the welfare of both present and future generations? Some irrational fears are obviously bad; others may serve an immensely useful social purpose. Carrie Nation’s crusade against Demon Rum may raise smiles on our faces today, but have we developed a more effective technique at getting people to resist the temptation of forbidden fruit than scaring the hell out of them?

The libertarian position seems inevitable, Harris says, once we have decided that drugs are not the cause of drug addiction:

If opiate users can be divided into those who would be criminals anyway and those who end up brilliant surgeons like Halsted and eminent humanitarians like Wilberforce, then it obviously makes far more sense to lock up the criminals for their criminal behavior, and not for their heroin use. But this argument can be turned on its head: If strong and confident men like Halsted and Wilberforce can become hopelessly addicted to a drug, then might this not be an argument for doing everything possible to keep it out of the hands of adolescent boys, slum addicts, the weak-willed, the impetuous, the self-indulgent, the depressed — in short, to treat it in the same way you would treat a dangerous strain of plague that threatened to sweep through entire populations? Yes, some people will be immune to the plague, but it remains a plague all the same. The obvious fact that some people can use these substances without undermining the foundation of the open society does not mean that their widespread promiscuous use among the general population will prove equally innocuous.

Mill argued that the prohibition of opium imports into China was an “objectionable … infringement of liberty … of the buyer.” This was a straightforward, if unappetizing, application of his “simple universal principle.” But would Mill have stood by his simple principle if he had foreseen the consequences of its application in this case? By the time the Communist Party came to power in 1949, there were approximately 20 million opium addicts in China. Chairman Mao, no student of Mill, decided that the only answer to the problem was ruthlessness. As Dalrymple writes, Mao gave the Chinese opium addicts “a strong motive to give up and the rest of the population a strong motive not to start. He shot the dealers out of hand, and any such addicts who did not give up their habit. The carrot for addicts was life and the stick was death. It would not be going too far to say that, within a mere three years, Mao produced more cures than all the drug clinics in the world before or since, or indeed to come. He was the greatest drug worker in history.”

Immediately after making this observation, Dalrymple writes that “the point of this story is not to advocate a repetition of Mao’s methods on our soil, but to demonstrate that, when a motive is sufficiently strong, not merely some, but many, indeed millions, of addicted people can abandon their addiction, without the whole paraphernalia of the help that is necessary on the standard view of the problem.” But what kind of substitute for mass executions is available to the open societies of the West in dealing with our drug problems? Out of our limited box of tricks, how do we devise motives that are “sufficiently strong” to get addicts to kick their habit, but which fall short of lining them up against a wall and shooting them?

Open societies cannot be open to everything, Harris claims.

I think Harris makes an error in logic when he asks, If the moral weakness was already there, before the drug use began, and if it explains the addict’s inability to control his drug use, then what sense does it make to hold the addict responsible for his moral weakness? As Mao’s answer to the drug problem demonstrated, moral weakness is not simply present or absent; when threatened with execution, addicts quickly found the moral strength to drop their bad habit.

That’s the totalitarian answer — Communist or Fascist. The liberal answer — modern progressive or classical liberal — is to let drug-users use drugs. More specifically, the progressive answer is to let drug-users use drugs, and to effectively subsidize their bad habit through “harm reduction” measures — clean needles, free clinics, methadone and buprenorphine treatment, etc. The libertarian answer is to let drug-users use drugs, and to assume that the only damage done is to the drug-users themselves — and to emphasize how much damage is done by drug prohibition.

What rarely seems to come up is the notion of treating self-destructive drug addicts, who live off of petty crime, as distinct from productive members of society who have a vice. In Beggars & Thieves, street ethnographer Mark Fleisher emphasizes that the members of this criminal underclass don’t get better. They come from broken homes. They become addicted to illegal drugs and legal alcohol. They commit petty crimes and beg on the streets. And when they do time in a “correctional facility”, it’s a big step up in living standard for them — except that they can’t wait to get back to their booze and drugs. They never join productive society. But they do get let out of jail.

These beggars and thieves are Aristotle’s “natural slaves” — unable to govern themselves. And giving them warm blankets and clean needles doesn’t solve their problems — or our problems with them.

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