Greetings. It seems that somebody’s passing is the only thing that will stir me sufficiently to write about what’s going on in this benighted country.
I had anticipated writing this a week or two ago but I got sidetracked. It’s certainly not too late, since Hoffman’s death by heroin overdose is still being discussed in the media and by folks I run into. Yes, I know, he only died 5 weeks ago – February 2, to be precise – but our attention spans tend to be not too long.
Hoffman’s death was dramatic – found dead with a needle stuck in his arm with bags of heroin strewn nearby, a famous actor at the top of his craft with artistic heights still to climb. His death has been portrayed as a benchmark event and has drawn attention to the opioid abuse and addiction that has seemed to sweep the country. If it can happen to a man with everything to live for, it can happen to anyone in Vermont and Staten Island, to name two locales portrayed in two recent New York Times articles.
I never got to meet Hoffman, and I saw him in person on only two occasions: at the Public Theater’s production of Idiot Savant, starring Willem Dafoe, in December, 2009; and on Broadway in Death of a Salesman, in April, 2012. At the Public, he came in alone, no entourage, just another, non-descript member of a typical New York Sunday matinee audience. Yet everyone knew who he was, and we all probably figured he had come to see Dafoe. For us, Hoffman was, like Dafoe, a New York actor, not a celebrity. In Death of a Salesman, different story – you couldn’t take your eyes off him when he was onstage. He made Willie Loman real today, another middle-aged working stiff betrayed and humiliated by the corporate bosses to whom he had been loyal his entire working life. He reminded me and my wife and anybody paying attention why Miller’s play is still America’s greatest.
I knew nothing of Hoffman’s private life until I read Anthony Lane’s beautiful tribute to him in The New Yorker (“Postscript,” Feb. 17 & 24, 2014). I learned he was a family man, living with his partner, Mimi O’Donnell, and their three kids – boy, 10; two girls, 7 and 5 — in the West Village, often seen there when not working strolling the streets with them or running errands. He was only 46 when he died; and I was struck by the absence of speculation about the role his break-up with O’Donnell a few months prior might have played in his relapse and eventual overdose. How respectful of the media, I thought; or how dumb.
I was much more disappointed by the immediate zoom-in on Hoffman’s heroin addiction and the immediate and zealous search for villains, for the evil dealer. Soon enough, he and his compatriots had been arrested and their stash seized. How simplistic, but since when do the media and the general public want complexity? Those of us who have at least a rudimentary appreciation of human behavior know that addictions just don’t happen. Something must have occurred in Hoffman’s life that contributed to his relapse after twenty-plus years of sobriety – we might never know. We can speculate that his relapse led to his and O’Donnell’s break-up; again, we might never know whether other factors were involved. We do know, as Hoffman, himself, seems to have known, that once drug addiction takes hold of your body and your life, it can kill you.
The focus on heroin served to avoid consideration of these issues. It also diverted attention from oxycodone, the increasingly notorious pain-killing opioid, that re-opened the door for Hoffman and pushed him down the stairs. Reports in the media, particularly The Times (3/1/14), noted that Hoffman had begun using oxycodone several months earlier. The toxicology report completed after his death led the New York City medical examiner to conclude that he had been “killed by a poisonous mix of drugs that included … heroin … cocaine, amphetamines and sedatives…”
Yet, no outcry against Big Pharma for producing these drugs – the amphetamines, sedatives and the oxycodone – in the first place. Against the FDA for allowing them willy-nilly in the marketplace with little regulation. Nor against the GP’s who dispense these drugs like M&Ms.
Readers of the recent series of articles published by The Times since Hoffman died (2/11; 2/16; 3/6/14), can only conclude that oxycodone is the new “gateway” drug; that millions of Americans have been prescribed it and become addicted; or have raided Aunt Sylvia’s medicine cabinet and discovered the soothing effects of an opioid. Once hooked, oxycodone can become expensive, particularly if you can’t wangle a prescription from some indifferent medico. In New York State, individual prescribers’ scrips are tracked, particularly when addictive substances – the benzos and opioids – are prescribed. It’s not clear whether the new state regulations are deterring the facile prescription of these meds or whether they’ll eventually become a bureaucratic “feel-good” for the state’s politicians. And not all states – for example, neighboring New Jersey – are even doing that much.
Heroin is the next step for oxycodone abusers because it’s cheap — $4 a bag in Staten Island, New York City’s southernmost borough and the 19th century abode of Walt Whitman. Surprisingly, given the media hype, heroin is much less deadly than oxycodone. National statistics reported in one of The Times articles (2/11/14) showed that, in 2010, more than 19,000 persons suffered opioid-related drug deaths, 3,000 of which were from heroin. Oxycodone by a 5 to 1 margin. Given that more than half of those who died were younger than 34 and almost one-fifth were between the ages of 15 and 24, that margin could well shift. So long as heroin stays cheap and oxycodone so readily available, the number of deaths from heroin and from all opioids is certain to rise. At present, approximately 6 million Americans are believed to be opioid-addicted.
Of course, no one’s thought to ask, at least not in the media, why so many folks, particularly young “selfies”, are “tuning out and turning on.”
An old phrase, to be sure, and one which dates the writer, but unfortunately apt once again. It’s beginning to remind me of what happened in the latter half of the Vietnam War, when American draftees got strung out on the heroin they injected while on “r & r” in Bangkok and the U.S. Army began falling apart. That was the “smack” manufactured in the nearby “Golden Triangle” – Burma (Mynamar), Cambodia and Thailand – by the remnants of Chiang Kai Chek’s Nationalist Chinese army, those that didn’t make it to Taiwan, whose drug manufacture and smuggling was aided and abetted by the CIA and those conservative die-hards who still believed we could “save” China. Bangkok might have been the first stop for their “product;” Harlem and other black communities in the U.S. were the next. Don’t take my word for it. Read Peter Dale Scott’s several books on the subject (1991, 1998, 2003, 2009, 2010); and take a look at Ridley Scott’s American Gangster (2007), starring Denzel Washington and Russell Crowe, which nicely depicts what I just wrote.
So what do you do when you’re disillusioned from fighting — or opposing — a futile war? Why not drugs when you can’t find a decent paying job and can’t support yourself or your family? Is the situation any different now than it was forty years ago? Nixon, of course, isn’t around. But his legacy remains: the “War on Drugs (1971); the end of the military draft (1973); and welfare reform (1972). The first two initiatives were designed to strengthen the National Security State; the third, with all categorical income maintenance programs for the elderly and the disabled consolidated into SSI, became another brick in the foundation of what has now become known as the Therapeutic State.
Kirk, Gomori and Cohen provide a thorough description of the Therapeutic State in Mad Science … (2013). It’s the public mental health system writ large – the “Bigs”: Big Government, Big Pharma, Big University, Big Insurance; the acronyms: NIH, NIMH, APA, DSM, NAMI; the professionals: who earn their living there; the users of service: who get their treatment, i.e., meds, there. Follow the money – the pharmaceutical research funding; SSI, SSD, Medicaid, Medicare – and you’ll see that the Federal Government, with its “big” and “alphabet” partners, pretty much controls everything. The Therapeutic State.
Originally designed as an adjunct to the National Security State – c.f., Jonathan Metzl’s The Protest Psychosis … (2009) – the Therapeutic State has grown into its own entity within the national security apparatus. Its principal task, particularly since the advent of the DSM-III in 1980, has been to promote a neurobiological explanation of human behavior.
No job or prospects of one; beaten up by your partner; feeling down, despondent, maybe suicidal. You’re depressed; your brain is messed up – take a pill, preferably an SSRI.
Yes, its complementary task is to sell the psychoactive solution. Any evidence to support the theory and its remedies? No, but take your pill anyway and keep quiet. And get yourself on SSI.
Bottom line, the Therapeutic State is peddling what Kirk, et al, call “mad” science. I call it “faux” or “phony” science. Either way, it’s just one big shell game. What brought that home to me was when Obama, in the wake of the Newtown massacre and his failure to get any gun control measures through Congress, suddenly fastened on to the explanation proffered by the NRA — Adam Lanza (Newtown), James Holmes (Aurora) and Jared Loughner (Tucson) were simply crazy and E. Fuller Torrey had the answer. Psychoactive medication. Without it, persons diagnosed with serious mental illnesses, particularly schizophrenia were dangerous and capable of murder. Again, there’s no data to support this contention, but those in authority, starting with Obama, grabbed hold. Easier than butting heads with the NRA. So did the Congress. Increased funding for mental health services was the only gun control-related legislation enacted by Congress during 2013.
Same deal with the use of the heroin card in reporting Philip Seymour Hoffman’s death – another diversion in the shell game. Don’t ask about oxycodone. More importantly, don’t ask what difference actually exists between heroin and oxycodone. After all, both are opioid-based; both relieve pain; both are psychoactive medications that scramble your brains. The big difference, of course, is that heroin is illegal, another target of the “War on Drugs.” All profits go the Mexican cartels. As for oxycodone – no easy answer. One minute, provided you have a prescription for it, it’s legal, with profits to the Big Pharma company that holds the patent. The next, no prescription, buy it on the streets, provided you can afford it, profits to the dealer who sold it and his/her suppliers.
Marijuana’s getting even more complicated. Increasingly legal, for personal use – Colorado and Washington – or medicinal purposes – 20 states and growing, the DEA doesn’t know whom to arrest any more. The line between legal and illegal, “good” and “bad”, keeps on moving, confusing the hell out of the DEA and the FDA. What’s the solution? Continue the woeful “War on Drugs”, keep the DEA occupied, the prisons full and the proprietors of the for-profit “prison-industrial complex” in business? Or legalize everything and double or triple the size and responsibilities of the FDA? Just imagine – Big Pharma growing weed in its own aquaponic nurseries, investing in the Afghan poppy market; the Mexican cartels and California pot growers incorporating and going public on Wall Street.
Fun, even funny to think of, but actually just a much larger shell game. If we get caught up in such a debate or find ourselves obliged to bear witness to it, what of the poverty, the racism and the exploitation and misery that cause some folks to seek psychoactive escapes, whether illegal or not, and force others, even more vulnerable, into psychoactive shackles? I’m reasonably certain that Philip Seymour Hoffman and his family and friends do not want him and his death to be dragged into the middle of such a debate, to be used as a symbol to characterize the mad or phony choices I depicted above. He was a man whose time to die had simply come. As the Zen Buddhists are wont to say, “The world is perfect as it is.”
I’ll remember him as a great New York actor, who was able to bring to life on stage and screen men very much like me and others – honest and deceitful; happy and unhappy; brave and frightened; in love and in pain.
I’ll miss him.
As consolation, remember the spirit of Joe Hill is always available to us. Just conjure him up, continue to struggle, and organize.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.