IDEOLOGIES AND DEVELOPMENTS IN PRACTICAL DEALINGS WITH ADDICTION

Morten Nissen, PhD

Paper to the 4.th International Kongress of Critical Psychology, Berlin 1997

In the knowledge and practice field of drug addiction, the famous WHO conception of health, a state of well-being, proves a less than perfect ideal, even if it does point relevantly to the intersection of mental, physical and social phenomena. The idea itself seems to suggest either just the kind of static hedonism, or just the objectifying gaze from the outside which for so long have blocked the efforts of the addicts and their healers. It makes more sense to found a general notion of health on the concept of action potency as developed in critical psychology. Elsewhere(1), Hysse Forchhammer and I have suggested that any understanding of health that does not wish to contradict the specific, psychic and societal aspects of human life, must reflect a practice that deals with the reproduction of the individual in a general sense, and in which this same individual takes part. Key concepts in this thinking are the contrast of restricted and generalized action potency, the dual possibility in individuals' life situations and the societal thought forms with which they can be articulated. Thus, practical dealings with addiction and other health matters are by no means neutral humanitary services. They are intimately connected to a partiality, Parteilichkeit, right in the interactions of partial and common interests and right in the struggle between ideology and development. However, such health practices, and their ideological problems, even if they 'are about' individuals, cannot be adequately understood with a theory that leaves individual subjects alone faced with societal conditions and thought forms. We must be able also to reflect how the very issue of the reproduction of the individual is constructed and changed in the flow of situated social practice. This is one question where the recent Danish attempts to develop a theory of situated practice in action contexts on the basis of critical psychology become relevant(2).

Linda's perspective

To demonstrate the approach I shall begin with a small excerpt from an interview I made with a young woman I shall call Linda. Linda takes part in Sjakket, a grass root mutual help organization that is funded by the Danish state as a development project for the so-called "street kids", the very marginalized young in Copenhagen, which I have been hired to evaluate. Linda is 18 years old. For the past months, her life has been dominated by being a member of Sjakket. Before that, she was very isolated and had many conflicts in her middle class Copenhagen family. Now, she has become one of a clique that some in Sjakket call the 'hash-heads' for their consuming habits. I have taken her to a nearby café for an interview. For nearly an hour, she talks about how wonderful Sjakket is. When I insist that she also points to problems, this is what she, reluctantly, comes up with: Now, in my evaluation of the development projects the Danish Ministry for Social Affairs want me to take the users' perspective. This coincides well with methodological principles of critical psychology, basing empirical research on the perpective of the subject, or the first person perspective. So I try to understand Sjakket through the eyes of Linda herself.

That presupposes, first, that Linda has her own good reasons to take part in our interview. Indeed, she states herself that she really wants to do something for Sjakket, she wants to praise the organization to me because of what the evaluation is likely to mean to it. But she also wants to define Sjakket in a certain way: Sjakket is, or should be, a grass-root, mutual help organization, and not the more traditional sort of institution that she fears Sjakket is becoming lately. Recognition and money from state agencies effect the advent of evaluators, but apparently, it also means that some participants have developed into semi-professional counselors who pick on girls like Linda, just like the social workers or pedagogues would do in ordinary youth clubs or institutions. Sarcastically, Linda calls them petty pedagogues. This conflict is where our projects meet, this is where we can form an alliance, a cooperation, since in my evaluation, I am very interested in how the participants define Sjakket. But there is a problem: It is not altogether clear that she is right. She doesn’t really go into the problem of smoking hash. Maybe the person who picks on her is right about it: Maybe Linda is simply a weak and self-uncertain girl under the influence of the group, the hash-heads? This problem reflects the second precondition for taking the perspective of the subject, the requirement that we do not simply take the words of Linda - or anyone - at face value, but approach them warily with what Markard (1984) has called a 'Suspicion of Ideology' (Ideologie-Verdacht). Not merely that the formulation of the problem is itself part of the problem (as any psychotherapist since Freud would agree), but also the fact that we can only talk with words that have meaning - precisely the meanings filled with ideological distortions which should themselves be overcome in the re-interpretative work of critical research. So we do need to find out at a more general level what we think about the problems that Linda mentions - what do we think about smoking hash like that? Clearly, in our everyday experience, smoking hash daily, even if it isn’t 7 grams a day, can be very problematic. But does that mean we are dealing with a case of drug abuse or addiction?

The Myth of Addiction

In the medical and psychological literature, patterns of compulsive dependence behavior are well-known. Even in the tradition of critical psychology, we can find confirmations of this view - for example Norbert Schultze (1980) who stated that 'addiction' is a form of repression (Abwehrmechanismus). But there is also an alternative view on the matter. There is abundant documentation that drug use is an integral feature of all cultures, including what we consider to be normal, and there is no sober evidence that illegal drugs are more dangerous or addictive than the tobacco, the alcohol and the sleeping pills most people more or less believe to be controllable. The Danish sociologist Winsløw (1984,1991) has thoroughly documented how, beginning in the mid 60'ies, a curious but also dubious object emerged, constructed by politicians, sociologists, doctors and pedagogues: The drug addict. As with madness some two hundred years earlier, what was once a tendency or vice in the life of all has become an object of expert intervention in the guise of a disease or pattern of behavior which wholly absorbs individuals endowed with certain personality traits or social characteristics. With the words of the American philosopher Fred Newman (1991), we can say that addiction is a myth. That does not mean to say, however, that it does not exist. As Bruno Latour (1996) so vividly puts it, we should not, with our work of critique, think that we can pump it out of real existence and into the minds of people by calling it a 'mere belief'. It does exist and it is very powerful: The social construction of 'the addict' serves to exclude people and then de-humanize the socially excluded by way of personalization of the social problems they represent. Such ideological dynamics are nothing like mere tricks of the mind. They are social organizations of meaning, that is, they function to organize a real practice with real objects, including the craving experienced by the addict and the psychopathy or borderline psychosis diagnosed by the professional. Even so, using the term 'myth' signifies the possibility of an alternative understanding, an alternative organization of practice, which is somehow more general, more relevant to our critical purposes.

To find a way toward such an alternative view we may revisit some of the studies done 30 years ago when drug use was still largely considered a cultural phenomenon connected with youth, even with revolt. One representative is Paul Willis of the Birmingham Centre of Contemporary Cultural Studies. Investigating "the cultural meaning of drug use" among hippies in the early 70'ies, Willis found that "Drugs importantly mediated many areas of the hippies’ life, including the group’s relation to music" (Hall & Jefferson (eds), p. 106) Willis even suggested a 'sub-cultural pharmacology' , in which, following Becker (1963), the specific meaning, including toxical effect, of using drugs such as marihuana is sought, not in physiological mechanisms, but in the nexus of cultural meaning systems that must be learned by the user as well as the ethnographer. At this point, we run into a different kind of problem: It is clear that there is a critical political edge, a Parteilichkeit, in de-constructing the myth of addiction and the associated politics of the socially excluded, well-meaning or not. But it is not so clear what is to be gained in under-standing drug use as a cultural phenomenon instead. It seems that tends to imply a denial of the problem altogether. As Linda says, she wants to decide for herself what she wants to do - and with such a culturalization of the problem, we seem to have to leave her to it even when we join her in it(3). And so, we wind up pretty close to where Linda is already: Right in the middle of the struggle between the petty pedagogues and the hash heads. Regarding Linda's problem, there isn’t much perspective in any Parteilichkeit here: Either way she goes, we can criticize Linda’s self-understanding as a form of restricted action potency, and either way, we fail to reach a level of understanding where we take the side of Linda, the first person perspective. Theoretically, we seem to reduce Linda’s actions to be expressions of thought forms or discourses - when she smokes hash, she is either captured in a compulsive pattern of behavior that makes it reasonable to intervene by picking on her, or she is just living out a cultural pattern that is in itself meaningful and therefore 'un-touch-able' simply because it is culture.

Positioning in the action context: The User

But this is where we might learn from a slightly more concrete, localized view of culture and society as social and societal practices among people, in this case, what goes on in Sjakket. We may begin by looking more closely at what Linda actually does with her words, here in the interview, when she says: 'The problem was, she didn’t know I had reduced my consumption so much'. She states a kind of a compromise: Allright, maybe smoking hash all the time is problematic, but compared to what it was, it is OK, and the meaning of Sjakket is that I do what I want. Now, one of Sjakket’s working principles is to meet the young, the street kids, where they are, on their own terms. Thus, something which is in itself wrong or bad may be just fine if it means a movement from something worse. In this narrative, Linda pictures herself as a user who must be acknowledged the way she is, someone who decides for herself what she wants to do.

The concept of the 'user' may be considered one key concept in a modern discourse on social work and health politics(4). The 'user' combines the privacy of the consumer with the privacy of the client in a rather self-contradictory manner. Users are independent individuals who relate to a finite service with regard to a daily life which is separate from this service. As we shall see below, this does not match very well with Linda's overall relation to Sjakket - or, to be more precise, it emphasizes one aspect and neglects others. But this is one aspect which is very much implied in our conversation being a 'user perspective interview'. And the overall project with the street kids, that I evaluate, is actually about the sanctioning, the recognition (Anerkennung), of subjectivity, in four ways:

· As users, as we have seen

· As young, that is, not yet adults, but also no longer children, in this way forming part of a long-term movement towards the societal establishment of a developmental phase characterized by individual generalized qualification and self-determination

· As persons who 'do what they want' instead of being punished, cured or segregated for deviant behavior, thus drawing the boundaries and conditions of legitimate well-fare state citizenship in new ways suited to 'post-Fordist' society

· As informers of research, co-researchers - perhaps as 'subjects' in the abstract sense, each recruited to a leading rôle in the etherical Aufklärung of rationalist discourse, or perhaps, more pragmatically, to play dummies in the hands of the blind oracle of evaluation, inciting progressive social and health workers towards a practice 'on the terms of the users'

Apparently, Linda employs this discourse to defend herself - and in general, to achieve empowerment: Being a 'user' she has privileged access to research as well as to the regulation of Sjakket. The participants in Sjakket pay much attention to the wishes and requirements of their users. Theoretically, this analysis sees Linda as not 'structured by' discourse, but also not standing outside it with a pre-given natural subjectivity in an equally natural 'life-world': Linda, the first person perspective user, is emerging right here in front of us. With a word I have borroughed from Rom Harré(5), she is positioning herself while also producing discourse - she uses and produces discourse, and discourse provides her with position. The below graphic model of the action context may be helpful in understanding the theoretical approach here.

 

What is important is to realize the fluctuating inter-dependence of the concepts involved. Even if the analytic unit in this 'activity theory', following Leontjew, is formed around an object, it is in a constructive sense, viewed as a process of objectification (Vergegenständlichung). And even if practice is fundamentally subjective, as critical psychology has unfolded from the philosophy of Marx, essentialist misreadings of what can be meant by 'the subject' are sought overcome by focusing on how subject positions are concretely developed and changed in the process of positioning, not in abstract claims of identity, but through participation in a local practice.

Local Ideology

But Linda doesn’t just provide herself with a position: She also defines what Sjakket is all about. This way, the 'we' of our interview, which in itself seems organized in the discourse of the user perspective, aquires new meaning as it is linked to the 'we' of Sjakket, the local community which she, in turn, hopes to influence by endowing it with something even more general, something transcendental, a 'meaning'. This could be one way to understand ideology - as a form of 'participatory Parteilichkeit': The defensive construction of the common or general (Allgemeine) from the perspective of the special (Besondere). Or, to be more precise, the reproduction of partial interest by constructing and reproducing one version of the general, the common interest, referring to what is universal. In a general sense, ideology mobilizes discourse to reproduce a given constellation of subjects(6). At a closer look, 3 levels of subjectivity can be identified in the logic of ideology: The action context, the participants, and the general societal production/reproduction process(7).

Ideology focuses on the aspect of reproduction which is always implied in subjectivity. It is important to notice that subjectivity in general must exist precisely in the tension between reproduction and development. Without reproduction there may be change and generalization, but there is no subject. This means that in a sense, we must acknowledge ideology, partial interest and power if we wish to acknowledge subjectivity. The aim, thus, is not to deny or destroy ideology, but to find ways to what might be called an extended reproduction, a generalization that includes reproduction of partiality(8) .

Linda’s account, then, may be seen as ideological in this sense: She reproduces her own position by reproducing one version of what Sjakket is all about. Even if it is self-contradictory: Smoking hash may be a problem, but Sjakket is all about her doing what she wants to do. The contradiction is, for now, resolved by means of the movement: 'I have reduced my smoking'.

But there is more confusion still to come. We cannot decide whether she tells the truth or not. Perhaps she didn’t really smoke the incredible amount of hash - 7 grams a day. Perhaps she is really just a frail little girl under the influence of the hash-head boys, even too weak to face the 'petty pedagogues' and the evaluator who may suspect that in fact she is increasing her consumption. But then again, perhaps she’s right - we do not know.

This split is itself a classical form of knowledge in traditional social work institutions: The recurring emergence of antagonistic versions of events, motives and objects, typically associated with equally fixed positions of clients and professionals. Do we believe her or don’t we - either way, I contend, the basic institutional form is reproduced, and with it, the identity of the deviant as well as that of the professional, in a world where social work is about helping addicts, and should be on the premises of the addict.

Interestingly, drug treatment institutions have been among the first to develop the principle of ideological institutions which has become possible in the wake of the de- and re-institutionalization and the crisis of expertise in the field of psychiatry(9). More or less total institutions in Goffman's sense offer interpretations of life in the world and form therapies based on holistic views on persons - in a variety of different ways. And user involvement in local ideology replaces the ideology of professionalized welfare state consensus. Typically, these ideologies are not very comprehensive in relation to the premises of the participants. They work by a logic of exclusion that blocks any accumulation and generalization of experience. Inconsistencies of one lead to declaring another in an endless process of starting all over. Each institution/ project/ alternative must grow from its own experience and reproduce its own system of blind spots, from which opposite versions of institutional life proliferate anew. In this case, it may be argued, Linda excludes her real self under the surface of self-determination when she claims the position of the user in the ideology of Sjakket as a user oriented institution. Either way, she is threatened - if she admits the hash problem, she is thrown into the arms of the petty pedagogues, if she denies it, she capitulates to the hash-heads.

Denouncing Sjakket as an ideological institution like this leaves Linda with no choice, just as it leaves the reader and myself with nothing constructive apart from theoretical conside-rations that do not really require her assistance. Partly contrary to Markard (this volume), I contend that any analysis that unveils ideology and outlines restricted action potency but ignores the other side of the coin, the developing or generalizing action possibility in relation to which alone any subject science effort may be relevant, becomes one-sided and, what is worse, neglects the theoretical reflection of its own ends and means. Our hypotheses on ways to go from here should be stated - not in spite of, but because of the fact that they are likely to be the next to be unveiled as restricted and ideological.

Local Culture

I think it is rather typical when I suggest that here, if we want to find the generalizing alternative, we must parenthesize the hash smoking, not because it is not a problem, but because we need to find a basis, a language, a common denominator, in terms of which we may approach it without splitting it up. This common denominator or common basis cannot be Linda’s identity as a user, taking part in a 'user perspective evaluation', since it is precisely this autonomy which is at stake here. So, we must see if Linda’s participation, in Sjakket and in the interview, can be understood in any broader sense as developing or generalizing. When Linda talks about what Sjakket is all about, she is not merely reproducing a convenient individualistic ideology to defend her position. She is also talking on the background of her describing an impressing variety of cultural and political activities that she is taking part in. Among many other things, she is one of the founders of a local radio station, she is establishing a project to cooperate with street kids in Rumania, and she is trying to engage criminal young people in various activities, she herself becoming, in these activities, one of the 'petty pedagogues' so to speak. Viewed on this background, Sjakket's 'being all about her deciding for herself what she wants to do' is by no means any simple individualism. Much sooner, it can be considered an expression of the organizational form through which Sjak-ket can be said to deal collectively with individualized social problems such as drugs, violence, racism etc. Structurally, Sjakket's seemingly liberalist flexibility towards its members' conduct facilitates participation on a very broad diversity of different kinds of premises. In some ways, it resembles Narcotics Anonymous, therapeutic movements etc., organizations who paradoxically form communities on the basis of the interpretation of individualized problems such as addiction. But in other ways, Sjakket is more than that. Linda lives her whole life here in Sjakket. Sjakket as an organization is a local form of daily life in which social and psychological problems are dealt with in the 'first person perspective', precisely not in the form of the traditional help to self-help split, but also not simply in the form of a self-help in which individualized problems are interpreted on the premises of unchallenged life conditions and adaptation thereby facilitated. We are not merely considering varieties of Lebensführung here(10). Rather, we are dealing with an organization that to a relevant extent aquires the power to define its own specific kind of societal positions, i.e. overall relations between individual contributions to society and individual reproduction (gesellschaftliche Positionen in the terminology of Holzkamp's Grundlegung). I have called this a local culture, using a materialistic concept of culture derived from my health research group collegue Højrup(11): A meaningful organization of daily life practice, notably the ends and means structuring the reproduction of societal position, which presupposes certain conditions specifiable under a certain mode of production and a certain form of state. The life conditions of this local culture - if it is to defend itself, reproduce its power and thereby make any empowerment of girls like Linda possible - is constantly achieved in a political struggle, so long as it cannot survive commercially. The economic support from state agencies is a resource - even a vital resource - but also a problem: The resources themselves make it possible for semi-professional counselors to emerge, because Sjakket partly think of themselves in terms of the modern individualist on-the-terms-of-the-users ideology. An ideology that may effect an ability to gain financial support, but which may also obscure reflection on developmental possibilities, even if it is, for some of Sjakket's most politically trained members, more or less feigned to secure a workable alignment of such diverse allies as the street kids, young politically active, state funding, city counsel officials, and local institutions and organizations. When I evaluate Sjakket, one main point is to see what financial support and close cooperation with state agencies (in the form of what is known in the EU as a social partnership) does to a local culture like Sjakket. One would perhaps expect the emergence of semi-professionals and the ensuing 'institutionalization' of the 'social movement'. But one could also say that it is precisely through this interface, this confrontation and cooperation, this democratic battlefield, that the general welfare state aspects of Sjakket's social work are developed, since this does not take place in the traditional interplay of professions, sciences, and state bureaucracies. It is largely in this interface that Sjakket's political reproduction of power to maintain and develop a local culture is at stake. And in this interplay of agents and considerations one can discern dual possibilities and clusters of alliances that can be judged to either further or discourage social development. The evaluator takes part in these movements, alliances, and developments. When I emphasize the political aspects of Sjakket’s local culture identity and practice, it is one form of my Parteilichkeit . The point is not that in this issue I agree with Linda and many of her fellow street kid participants. The point is I contribute to the ideological legitimacy of Sjakket - even apologetic, acknowledging it's subjectivity by allowing for the percieved necessity of it's reproduction - but by trying to achieve recognition, not of hash-heads or petty pedagogues, not of users or semi-professionals working on the premises of the user, and neither of help nor of self-help: But recognition of this local cultural organization, thus pointing to the needs of political reproduction, which, in a sense, amounts to saying that it will only survive so long as it swims upstream.

Notes

1. Forchhammer, H.  & Nissen, M. 1994.

2. See, among others, Dreier, 1994, 1995, 1996, Nissen, 1994, in press, Axel, 1997

3. Much of critical Danish social policy is currently caught in this dichotomy on the issue of drugs: Between a social indignation that confirms paternalism or even the law-and-order-policy of the right, and a liberal culturalization to which social distress becomes invisible

4. 'Discourse' here signifying not just how it is talked about, but also how it is organized in practice. This presupposes a materialist reading of Foucault and the tradition of discourse analysis, which in my view is justifiable, in particular when referring to Foucault (1977) and (1978). It is not implied that practice equals ideas. Rather, it is meant to grasp the extent to which all practices, including those dealing with symbols, are organized in structures of meaning.

5. See Davies & Harré, 1996. To them, conversation seems to literallly exhaust the meaning of 'practice' or even life. But the process of positioning is also implied in any materialist version of situated action that wishes to  avoid alienation of social relations into 'role structures' or the like.

6. Cf. Billig, 1991, Whetherell & Potter, 1992

7. What is new here, relative to critical psychology, is the level of the action context. More generally speaking, the definite (bestimmte) constellation of subjects forming itself a 'societal subject'; this could be a nation state, an organization, or any social agent in sociological terms. To me, this appears a fruitful way to develop a notion of ideology in critical psychology, since it may point to alternatives to the structuralist or socialization theory implications that  tend to follow too easily from abstract notions of 'bourgeois society' as a systemic whole of the overall societal reproduction (as in Holzkamp, 1983), or from unclear 'above/below'-metaphors, such as in PIT's concept of 'socialization from above' (Vergesellschaftung von Oben, see Haug, 1979).

8. Of course, certain constellations of subjects can or should be dissolved. What results, however, is not the end of definite societal subjects, but the forming of new. The Russian revolution was the formation of the Soviet State.

9. Cf. Castel, Castel & Lovell, 1982

10. This is not to imply that the theme of Lebensführung is unimportant. But it does suggest that we should not abstract the theme too much from the societal organization of positions.

11. Højrup, 1983, 1989. A recommendable introduction in German may be Schriewer, 1993. It should be added that Højrup is not responsable for the idea of local cultures as presented here.
 

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