Pubdate: Sat, 22 Nov 2008 Source: Vancouver Sun (CN BC) Copyright: 2008 The Vancouver Sun Contact: http://www.canada.com/vancouversun/letters.html Website: http://www.canada.com/vancouversun/ Details: http://www.mapinc.org/media/477 Author: Peter McKnight, Staff Writer ADDICTS AND HOMELESS PERCEIVED AS OBJECTS Not Surprisingly, There Isn't Much Help For Them Last summer, Stephen Hwang of the University of Toronto and St. Michael's Hospital wrote a commentary, endorsed by more than 130 other scientists and health professionals, which began by asking the reader to consider the following hypothetical scenario: "An innovative new intervention for people with diabetes is developed. Health Canada provides funding to a highly accomplished group of academic health scientists, who have no financial conflicts of interest with respect to the new intervention, to conduct research on its effectiveness. "Their work shows that the new intervention significantly reduces the incidence of a variety of diabetic complications. Despite a careful search for possible adverse effects of the intervention, none are detected. Over a three-year period, the group's research findings are published in leading medical journals, including the New England Journal of Medicine, The Lancet and BMJ [British Medical Journal]. "In response, the federal government calls the research inconclusive and states its position that the only acceptable therapies for diabetes are those that either prevent or completely cure this condition. Two national organizations state their opposition to the intervention because they fear that the availability of an intervention that reduces the risk of diabetic complications will cause people with diabetes to eat more food and become more obese. "The government indicates that, unless additional research can address its concerns within a year, it will likely move to ban the new intervention. Meanwhile, institutions other than the one at which the research was initially conducted are forbidden to provide the intervention." With developments over the last year, we can now update this scenario by adding the following: The government did move to ban the intervention, and decided to spend millions of dollars appealing a court decision that prevented it from doing so. And it continued its attacks on the intervention, and on physicians who provide it, despite recent evidence that it is not only effective, but cost-effective. Hwang's thought experiment was, of course, intended to highlight the disconnect between the way the government addresses drug addiction and the way it treats other medical problems. For as Hwang says, the scenario "becomes true to life if one substitutes 'drug addiction' for 'diabetes,' 'drug-related harms' for 'diabetic complications,' and 'supervised injection facility for injection drug users' for 'new intervention.' " This disconnect has led many people in the health care professions, including Hwang, to charge that the government's position is driven by ideology rather than evidence. But thanks to a commentary in the current issue of the Canadian Medical Association Journal, a much more disturbing hypothesis now presents itself. And as disturbing as it is, it is a hypothesis for which there is substantial evidence. In commenting on a study in the CMAJ which suggested that Insite might lead to a cost savings of $14-20 million over a decade, New York researchers Don Des Jarlais, Kamyar Arasteh and Holly Hagan state that "humanity and the right to optimal health for all [should] be the framework for assessing the effectiveness of public health interventions." But in an effort to explain why this is not the framework used by the Canadian government, at least when it comes to drug addiction, the author suggest that ideology might be the least of our problems. Rather, it is how we view -- or fail to view -- drug addicts that leads to our willingness to withdraw from them a potentially lifesaving intervention. Des Jarlais, Arasteh and Hagan point to a study titled Dehumanizing the Lowest of the Low by Lasana Harris and Susan Fiske of the Center for the Study of Mind, Brain and Behaviour at Princeton University. Harris and Fiske presented subjects with pictures of a wide variety of people, including wealthy individuals, those from the middle class, those with disabilities and drug addicts and homeless people. While these pictures can provoke different reactions -- shots of wealthy people, for example, often produce emotions of envy while those of the middle class produce feelings of pride -- Harris and Fiske were interested specifically in what was occurring in the brains of subjects while they viewed the photographs. The researchers therefore scanned the brains of the subjects, and noticed that photos of almost anyone -- rich or poor, able-bodied or disabled, young or old, men or women, black or white -- resulted in activation of the medial prefrontal cortex (mPFC) of the brain. Activation of the mPFC occurs during social cognition, when people are thinking about humans, either themselves or others. On the other hand, when people are shown pictures of objects -- cars, statues, buildings -- the mPFC is not activated. And in addition to objects, a few other pictures were not processed through the mPFC: specifically, pictures of drug addicts and homeless people. This means that subjects were literally objectifying addicts and homeless people -- member of these "extreme out-groups" were perceived as objects, as non-humans, as non-persons. Even worse, the areas of the brain that were activated were the insula and the amygdala, which are commonly associated with disgust and fear, and are also activated upon seeing disgusting pictures such as photos of vomit and overflowing toilets. These results, while disturbing, are tremendously important because they provide us with a picture of how many people view the most marginalized members of our society. Until the advent of such neural imaging, psychologists had to rely on people's self-reports, which are always unreliable since few people are willing to admit that they see addicts and homeless people as objects equivalent to backed-up commodes. And even fewer governments are willing to admit as much, though their actions often give them away. The Conservatives, for example, talk frequently about providing treatment, but did almost nothing on that front until recently, and even with recent injections of cash for treatment, at least two-thirds of federal anti-drug money goes toward law enforcement. Further, mandatory sentencing legislation the Conservatives hope to pass will see more addicts sent to jail, and will disproportionately affect the lowest functioning addicts -- the lowest of the low. This reliance on imprisoning addicts, on removing them from our sight, is entirely consistent with perceiving them as objects of disgust. As University of Chicago law and philosophy professor Martha Nussbaum, who literally wrote the book on disgust -- Hiding from Humanity -- has said, disgust "expresses a wish to separate oneself from a source of pollution." And on this point, let us not forget the Conservatives' taxpayer-funded campaign flyers -- which they insisted were not campaign flyers -- sent around the country in August. The flyers told us that "junkies and drug pushers don't belong near our children," and that the Conservatives will "keep junkies in rehab and off the streets." For all the Conservatives' sanctimonious talk about treatment, the intent here is clearly not to help people with substance abuse problems. It is, rather, to further dehumanize addicts -- referring to them as junkies is like calling mentally ill people crazies -- and to play on the public's fear and disgust of people experiencing drug addiction, by assuring "children and families" that the Conservatives will remove addicts from their sight -- will, as it were, separate the public from this source of pollution. And this is all the more troubling, since the Conservatives have never explained how they will get the most marginalized people -- the lowest of the low -- into rehab, especially when they seek to remove the primary point of first contact (Insite) for addicts seeking help. But the intent of such material is not to provide coherent policy -- it is to perpetuate the dehumanization of the lowest of the low. And it works, unfortunately. This is why the work of Harris and Fiske is so important: It can alert us -- all of us -- to the fact that, whether we know it or not, we might well perceive certain groups as less than human, and might therefore be susceptible to government propaganda. And we know all too well what happens when otherwise well-meaning people dehumanize their fellow human beings at the behest of unscrupulous governments. - --- MAP posted-by: Larry Seguin