A brief critical look at
Cannabis psychosis has been the subject of a great deal of interest by drug researcher, yet it is almost completely disregarded by millions who use drug regularly. Amit Basu offers a fresh look at the subject
'Psychology can never tell the truth about madness because it is madness that holds the truth of psychology.' Michel Foucault
The question of psychosis or 'madness' related to cannabis use is still being asked. The notion of 'cannabis psychosis' - the subject of voluminous works since its conception never ceases to make researchers inquisitive. In a recent study, Negrete has argued that the cannabis issue needs a high level of social and scientific interest. He also gives a brief account of the scientific writings on the subject:
'There were only eleven entries under the heading "Cannabis" in the 1966 edition of the Cummulate Index Medicus; but the numbers increased markedly in each subsequent year, to reach a peak of 386 publications in 1976. From 1977 onwards, however, the figures have been consistently lower, and the 1986 issue of the index contains 207 references. Just 132 of these are found in the 'Cannabis/Cannabinoid' sections, the remaining 75 having entered under the heading, Tetrahydrocannabinol. The latter heading . . . seldom addresses matters of public controversy, as they tend not to involve human subjects and are not based upon naturalistic observations.'
Though cannabis is the most widely used illegal drug throughout the world, the postfix 'psychosis' has made it somehow different from others. In other words it can be said that one of the major negative attributions to cannabis is the chance of 'becoming mad'.
My intention is not to redefine 'cannabis psychosis' or to update the recent biological research profile. Rather, I am inclined to explore the issue of cannabis use from the historical viewpoint to trace the construction of this 'psychosis' arising from the effects of this age-old herb. With the development of power in the structure of psychiatry, the special scrutiny given to cannabis use came into being by assimilating the phenomenon of cannabis use as a psychological disorder. What was folly or a recreational or religious practice, which society had once tolerated benignly, could no longer remain so under the scrutiny of the powerful psychiatric gaze. The creation of nosological categories provided a special compartment for cannabis. This development was not immediate; it closely followed the development of the definition of unreason through the power of reason. Thus unreason became the 'other', the threatening gesture to the order of reason (Sheridan, 1990).
THE HISTORIOGRAPHY OF CANNABIS
'The entire universe is fixed upon your essence, on the eternal ocean, on the heart, on the number of life breaths,
May we master your wave made of honey which was brought to the place where Soma is mixed with water in the presence of God!'
Tracing the literature on cannabis back to the Vedic times, we find copious hymns eulogising the use of Soma. The ingredients of Soma, according to some researchers, is something very close to cannabis. Indologist A.L. Basham has noted that:
'Soma was a divinity of special character. Soma was originally a plant, not certainly identified, from which a potent drink was produced, which was drunk only at sacrifices, and which caused the most invigorating effects. The Zoroastrians of Persia had a similar drink, which was called 'Haoma', the same word as 'Soma' in its Iranian form; the plant identified by the modern Parsis is a bitter herb which has no special inebriating qualities and which cannot have been the Soma of the Veda. The drink prepared from the plant can scarcely have been alcoholic, for it was made with great ceremony in the course of sacrifices, when the herb was pressed between stones, mixed with milk, strained and drunk the same day. Sugar and honey which produce fermentation, were not usually mixed with it, and the brief period between its brewing and consumption cannot have been long enough for the generation of alcohol in any appreciable quantity. The effects of Soma, with vivid hallucinations and the sense of expanding to enormous proportions, are rather like those attributed to such drugs as hashish.'
Similar mention of Soma is also found in a work completed 10 years after Basham's research (O'Flaherty, 1971), and the archaeological findings of remnants of cannabis from prehistoric times have also been documented (Reininger,1946), as well as ample documentation of the social, cultural, religious and medicinal use of the drug, from ancient times onwards (Aitken and Mikuriya,1980).
The psychological effects of the drug, as eulogised in the Veda, are also echoed in the literature of the ancient Greeks, Scythians and Iranians, some dating back as far as 515 BC. Also, there are numerous traditional tales, including the famous Arabian Nights, which describe the effects of cannabis, often from a humorous viewpoint, or one that incorporates the folk-wisdom of the day (Andrews and Vinkenoog, 1967).
These historical accounts show that until the nineteenth century, the psychological effects of cannabis were not considered particularly detrimental to mental health. In fact, the therapeutic qualities of the drug have been stressed from time to time (Aitken and Mikuriya, 1980).
Therapeutic application of cannabis in Western medicine lasted for a century, from the 1840s to the 1940s. The drug was used to treat a wide variety of diseases. It was introduced to Western medicine by W.B. O'Shaughnessy, a young medical graduate from Edinburgh employed by the East India Company, who published his monograph, 'On the preparation of the Indian Hemp, or Gunjah' (Mikuriya,1973).
As far as the history of psychiatry goes, the dividing line between the sane and the insane was completed by the birth of the 'Age of Reason', the middle of the seventeenth century.
'This exclusion of madness from the centre of intellectual life, its demotion to the purely negative, dependent status of Unreason is paralleled by changes in the institutional treatment of madness in the life of society. A single symbolic event marks the beginning of the classical experience of madness, the founding of the Hospital General. But this event, and the legal and institutional reforms of which it all forms a part, did not concern the insane as such, at all. What their measures amounted to was a policy for dealing with the unproductive poor.... They were interned not because they were mad, but because they were useless [author's emphasis].' Sheridan, 1990
In his famous work, Folie et deraison: historie de lafolie a I'age classique (published in Britain as Madness and Civilization) one of the most eminent thinkers of our time, Michel Foucault, comments:
'If we wanted to analyse the profound structures of objectivity in the knowledge and practice of nineteenth century psychiatry from Pinel to Freud, we would have to show in fact that such objectivity was, from the start, a reification of a magical kind, which would only be accomplished with the complicity of the patient himself, and on the basis of an initially transparent moral practice, gradually forgotten as positivism imposed its myths of scientific objectivity; a practice forgotten in its origins and meanings, but always used and always present. What we call psychiatric practice is a certain moral tactic contemporary with the end of the eighteenth century, presumed in the rites of asylum life and overlaid with the myths of positivism [author's emphasis].',
So no wonder that by the end of the nineteenth century, the gaze of 'scientific objectivity' which had been turned towards madness would begin to incorporate the otherwise 'unreasoned' behaviour that was thought to result from the use of cannabis.
In a voluminous study by the British Colonial Government of India in 1893-94 (The Indian Hemp Drugs Commission, 1895), the deleterious effects of cannabis were scrutinised from all possible viewpoints available to a ruling body. Of some 1140 witnesses who were commissioned to give evidence (excluding Burma),328 fell into the category of medical personnel. Of those 328, 209 said that the moderate use of cannabis was deleterious to health; 289 claimed that excessive use of cannabis was deleterious. Conspicuously, only 76 of the medical witnesses claimed that moderate use of the drug was not deleterious, with only one among them who considered that the excessive use of ganga was not deleterious (Indian Hemp Drugs Commission,1895).
As a consequence of this new construct, brought about by the thought processes of the psychiatric discipline, a cause of insanity became readily available to the colonial administrators of asylums in Bengal:
'The number (of cases) attributed to ganga is 169 out of 230 admissions in which a cause was known, but it may be that it has become the habit to attribute insanity to ganga [author's emphasis].'
Although investigators were uncertain about the validity of 'ganga insanity', they were quite conscious of the power of scientific reason, as opposed to the native 'unreason'.
'I would like to point out some of the difficulties under which all Superintendants of asylums have suffered with regard to patients admitted for 'Ganga Insanity'. The patients nearly always belong to the lower and grossly ignorant classes, to whose minds the relations of cause and effect, except in very ordinary affairs of life, are more or less unknown, and everything outside their ken (sic) is generally given up as unknowable. When pressed for reason, the given such are foolish or wilfully untrue [author's emphasis].' Walsh,1894 t
QUESTIONS FOR OUR TIME
In an editorial comment, Negrete has rightfully argued that research on cannabis 'often follows a course outlined by political priorities, and that these in turn are determined by the strength of social expectations and the magnitude of the interests at play' (Negrete, 198'3). As a member of the scientific research community, he proposes more research to 'represent genuine knew knowledge' to find out the harmful consequences of cannabis from the viewpoint of public health. But the statement begs a number of questions. What is this 'genuine' and 'new' knowledge? Is it to the body of knowledge that is bounded by 'scientism' that he wishes to refer? Is it only 'new' from the viewpoint of 'hard core objective data' collected, or is it genuinely ready to question its own political-ideological paradigm?
Even if we have a brief browse through the current research on cannabis psychosis, we find the same uneasy gesture in response to so many unanswered questions (Negrete, 1988). Whereas one researcher sees cannabis as resulting in schizophrenia-like symptoms (Negrete 1989), another is recording symptoms of mania (Chaudry et al., 1991). In a study of 908 cannabis users admitted for acute psychiatric care, researchers commented about the difficulties conducting an experiment that could definitively demonstrate that the correlation that they discovered had any relation to causation (Mathers et al., 1991) Interestingly, the conclusion echoes that of the comments made by the Lunatic Asylum Superintendants to the Indian Hemp Drug Commission almost 100 years ago.
Returning to the point that Negrete raised, I want to stress that no exercise in epistemology is devoid of the exercise of power, and therefore has political implications. It is inevitably a reflection of the polemics between governmental political priorities, and those of the scientific institutions.
So how far can we explore the process of the construction of the notion of 'cannabis psychosis' from the viewpoint of a dominant ideological structure? With the incisive line between reason and unreason drawn some three centuries ago, how did cannabis use become included in that barbed area of unreason? If reason is truth with perceivable objectivity, surely the other half of that truth remains in the domain of unreason, in our subjectivity. The history of cannabis psychosis should be rewritten, exploring the world of those people who wilfully occupy the category of 'folly'.
- Amit R. Basu, Antara Psychiatric Centre, West Bengal
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