Harry G. Levine
http://www.hereinstead.com/sys-tmpl/htmlpage14/The following letter is a reply to the long-time editor in chief of the most eminent alcohol and drug abuse journal in the world today. He was putting together a book of the journal's interviews with prominent addiction specialists. The book was to be divided into sections with a brief introduction by an appropriate outside expert. Dr. A (for Anonymous) wanted me to introduce a section called "USA Treatment: Not by Doctors"
He sent me only the last names of two interviewees. I did not immediately recognize either name, but I tracked down one of the printed interviews. The fellow turned out to be a major figure in the Therapeutic Community movement, and I found his views as expressed in the interview appalling. So I wrote back to the good doctor and editor to explain my problem with his assignment.
This was a professional correspondence and until now I have kept my letter private. But I think that drug courts, drug treatment, and therapeutic communities are becoming increasingly important political topics, at least in New York. And since September 11, 2001, it seems important to me to discuss things like this more openly. -- HGL, October 2001
--------------------------------------------------------------------------------
Harry G. Levine
Department of Sociology,
Queens College and the Graduate Center
City University of New York
Flushing, New York 11367
718-997-2800
______________________________________________________________________
January 10, 2001
Dr. A
Editor-in-Chief
(Journal Name Omitted Because It Is Not Relevant)
London, UK.
Dear Dr. A:
You occasionally make seemingly simple requests that, when scrutinized closely, turn out to involve very difficult issues. If I quickly agree to do the task, I immediately find myself in a thicket of sticky, complicated questions, and I'm forced to learn and think about a whole lot of things I had in no intention of getting involved with. However, if I closely scrutinize the proposal before accepting, then I am still confronted with the thicket of complicated questions, and I'm forced to learn and think about a whole lot of things that I had no intention of getting involved with. All as a result of a seemingly simple request.
You asked me to comment on "USA Treatment: Not By Doctors" with two names listed. David Deitch is not on the tip of my tongue, especially in the "Deitch" only version, and I still don't know who "McDermott" is. But your publisher was willing to sell me an electronic copy of Deitch's interview through the web for an absolutely exorbitant sum -- which I was very happy to pay because I wanted to see the mine field you were offering me a chance to run through.
David Deitch, as they say in America, is "a piece of work" -- or to translate into another American slang expression: he is "sumpthin' else." That he is, as you properly understand, an American temperance character is only part of the story. He is a temperance character as pictured by Mark Twain, especially in Huckleberry Finn. He is the con man, chiseler, thief, hypocrite, ne'er do-well and do-gooder, adventurer and jolly companion, all rolled into one. He cheerful embraced shaved heads and busting people as good for them, and he opposed methadone maintenance as close to the devil's work. Then he more or less cheerfully abandoned those views eventually becoming an administrator of, yes, methadone programs.
Dr. Deitch claims to have played an important role in calling the lock-em up and bust-em down approach to curing drug addiction a "therapeutic community." But in his interview Deitch reveals that he is unhappy with the name therapeutic community. He regrets not using the term "humanizing community" to characterize these punitive, moralistic, authoritarian, infantilizing institutions. I believe that earnestly using the opposite term to name something is properly called "Orwellian." Since the fifteenth century, "humanism" has been about respect for human freedom, creativity and autonomy. Most American TCs push pretty much in the opposite direction. And Deitch hasn't a clue to the ironies and contradictions in his ideology.
I've never seen Deitch, but in the late 1980s I did meet George DeLeon (who is a more serious thinker than Deitch). I had an extended conversation with George about what he believed. I was fairly astonished to discover that, deep in his heart, this gentle, nice man passionately believed in keeping drug addicts (but, conveniently, not alcoholics) in what to his dismay I insisted on calling "pink padded prisons."
Unlike the nineteenth century temperance speakers, who just spread the message of their personal reformation, Deitch's project (like Synanon's) has a more punitive and sadistic edge. And this preference became even more pronounced as Deitch became more professionally successful. It does not seem surprising, therefore, that after a while Deitch's work emphasized the institution TCs most resemble: prisons. Especially prisons in "Malaysia, Thailand, Sri Lanka," and "Latin America." It takes someone later than Twain, Graham Greene perhaps, to invent a character who proudly reports in his interview that
"some of the best staff I ever trained were in the Malaysia prison system. They now have four therapeutic communities in Malaysia in the prisons run entirely by uniformed personnel. Thailand has 54 prisons using therapeutic communities."
I'll bet they do. Yet even Deitch doesn't tell us in which Latin American countries he trained prison personnel. Argentina under the Generals? Pinochet's Chile? Cuba? Does anyone doubt that if Kim Il Song invited Deitch to set up "humanizing communities" in the prisons of North Korea, that David would not leap at the chance. He might even get to dig out the old Ché poster that he reminisces about.
East Germany, by the end, was filled with characters like David Deitch, George DeLeon and Mitchell Rosenthal [the director of Phoenix House] -- high status and successful professionals who believed they were "serving the people," doing good for ordinary folks by humiliating them, coercing them, depriving them, punishing them, and lying to them, for their own good.
I know a couple of knowledgeable observers who say that just about the only careers that successful graduates of American drug treatment TCs have is working for a TC. If so, David Deitch is emblematic of that pattern. No matter how many twists and turns his life took, or that the drug-free therapeutic community movement took, Deitch stayed onboard. Maybe he's the most successful TC graduate of all time, the greatest one of all. And now he trains prison personnel in how to reform inmates in countries whose prisons are nightmares, including those of the state of California.
The problem, Dr. A, is that these kinds of comments are not appropriate for your purposes.
The legitimacy of TC's in the U.S. is a big problem, and not to my mind an accomplishment. Most of them probably have made things worse for hard-core drug addicts, for people with drug problems, and even for non-problematic drug users.
I offer one personal anecdote. About a year ago, my then 18 year old son brought home a friend of his to talk with me. Jeffrey smoked marijuana a few times a week, most often perhaps before going home to his often feuding parents. He was a bit goofy but sweet, and my son had worked on an after school project with him for two years and knew him quite well. Jeffrey had never been a great student, but he was doing better academically than ever before. He had a girl friend at another elite school, he'd been accepted at a decent university. He was happy,18, and in his last semester of high school. He and another dopey friend got arrested by undercover police for smoking a joint in Central Park, near their homes. Mayor Giuliani has increased marijuana arrests from about a thousand or so a year to forty thousand a year. Mainly teenagers and young adults get caught, including lots of middle class kids like Jeffrey. What happens? No one knows for sure, but this story may not be that unusual.
When Jeffrey's parents were told to come to the police station and get him out, they became very upset and worried. They sought out a competent professional to examine Jeffery, and were given the name of a top doctor. His name happened to be Dr. "E" (as in Addiction Expert). As you no doubt know, he is a professor at a prominent medical school and a long-time member of the American Society of Addiction Medicine.
Dr. E did not want to see Jeffrey, but only his parents. He listened to them and may have said that Jeffrey was in serious danger. In any event, he firmly told the parents that they and Jeffrey should all go to Phoenix House. When the three of them arrived at Phoenix House, the parents and Jeffrey were separated. The Phoenix House staff told the parents that they had seen many cases like this. They said that Jeffrey was in very serious trouble, he was on the way to becoming a drug addict, his life was in danger. They said that Jeffrey must immediately enter a Phoenix House program, and the parents could attend a group too, so as to better help their son. Jeffrey's parents told him that, given all these professionals' advice and experience, he had no choice: he was to begin treatment at Phoenix House in few days. During that time my son brought Jeffrey to me.
When Jeffrey came to my house a Dutch psychiatrist who specialized in drug cases happened to be there. This good doctor listened to the whole story along with me and was flabbergasted to hear that an eminent physician and medical professor had recommended Phoenix House for someone he=d never met. Jeffrey himself was most upset that almost overnight his parents had become deeply fearful and distrustful of him: they fully accepted the idea that he was in immediate danger of becoming a drug addict and destroying his whole life. He found this prognosis amazing, especially considering that he had never done any other drugs, and he didn't even like alcohol.
I then brought Jeffrey to another drug expert physician who interviewed him at length. He told Jeffrey that, in his opinion, Phoenix House would not be the best place for him, and that if Jeffrey wanted counseling or psychotherapy there were a number of alternatives to consider. The physician also said that, unlike private counseling or psychotherapy, Jeffrey's treatment by Phoenix House for drug abuse might well become part of his permanent medical and health insurance records -- with serious implications for career, reputation, and future health insurance. The physician also said he would say all this to Jeffrey's parents if he wished.
Jeffrey thought it all over that evening, and then bravely told his parents that he did not want to go to Phoenix House, and he wanted to consider other treatments. His parents went ballistic, and fought with each other and him. They then called Dr. E to ask him what to do. Dr. E said that now he did want to see Jeffrey. However, before, going to meet Dr. E, Jeffrey was directed to meet a girl, about his age, who had been in Phoenix House for a couple of years. She told him what a great place it was and how he could meet interesting people there. Jeffrey said she was also pretty good looking.
Jeffrey and his parents then went to Dr. E's office where it was announced that Jeffrey would be interviewed by another doctor -- who just happened to be Dr. E's wife. Jeffrey talked with her for quite a while. Then she came out and reported to the parents and Dr. E that Jeffrey certainly did not need to go to Phoenix house, but instead would be in treatment with ... her.
The story goes on, but that's enough. Now I know the world is full of crazy people, but it is also full of crazy institutions -- and American drug treatment therapeutic communities are disproportionately of that class. In the U.S., TCs have enormous credibility, and prominent addiction physicians work closely with them. It's my sense that the majority of TCs -- or at least the ones like Phoenix house -- probably should be regarded as "treatment" in much the same way that, 200 years ago, Benjamin Rush's ice baths and preference for locking patients in closets were treatment.
Unfortunately, the machine that caught Jeffrey and his family rolls on. Jeffrey's experience has produced no new collective knowledge. He's now far away in college and doing very well -- more sober-minded, in fact, than the heavy-drinking dormitory mates he finds all around him. For understandable reasons he hasn't told many people, and his parents don't want anyone to know what happened. I tried to get a New York Times reporter interested, but unless the family was willing to go on the record there was no story, and no one wants this said about them in the papers.
So this year, when the thousands (perhaps tens of thousands) of New York City high school students, younger perhaps than Jeffrey (17, 16, 15, or 14 years old) get caught smoking marijuana by Mayor Giuliani's police, some of them will get referred to expert physicians who will send them and their families to a TC. There, these mostly innocent (in the fullest sense) people will meet experienced, compassionate professionals and treatment personnel who will say and truly believe that the teenager must, of course, come only here, immediately. And some of those many thousands will enter treatment.
What would David Deitch say about all this? He would likely say what a great place Phoenix House is and that he helped out the young "Mitch" Rosenthal early in his career. He might say that perhaps a few inappropriate referrals are made, but not many, and besides, just smoking marijuana is a danger sign. He might also say that TCs are, after all, very beneficial institutions, even for people without drug problems. For Dr. Deitch, with the right approach, even horrific third world prisons can be "humanizing communities."
Now, who was that other guy you wanted me to comment on? And what can I possibly say about him or Deitch that would be appropriate for your volume? Of course these are all important issues that should be discussed, but not I suspect in the 1200 word introduction to two interviews in a book of interviews.
But I may misunderstand the situation, so please advise.
Cheers,
Harry G. Levine