“Life as we find it is too hard for us; it entails too much pain, too many disappointments, impossible tasks. We cannot do without palliative remedies. There are perhaps three of these means: Powerful diversions of interest, which lead us to care little about our misery; substitutive gratifications, which lessen it; and intoxicating substances, which make us insensitive to it. Something of this kind is indispensable.”
Sigmund Freud
The news media suggest that America has become a nation of “lotus eaters” in search of a painless world. And, predictably, the U. S. military services have not escaped the fire. The press describes sailors dropping acid and “tripping” over the side to be lost at sea; and it has been alleged that the average patrol in Vietnam generates more pot smoke than gunsmoke.
It would seem, then, that the use of hard narcotics is a major problem within the military as it is within the nation. But, consider this: during the period from July 1968 to July 1969, the Bureau of Medicine and Surgery encountered only two cases involving addiction to hard narcotics, namely heroin. In both cases the addiction had been firmly established prior to enlistment and the victims had joined the Navy hoping to have their addiction cured. A number of other patients who were admitted to naval hospitals with alleged heroin addiction failed to manifest withdrawal symptoms or other clinical signs of hard narcotics addiction. Although even a single case represents a personal tragedy, these data justify the conclusion that the increase of hard narcotics addiction in the Navy is not yet a significant problem.
On the other hand, drug abuse in the Navy is definitely on the rise.
The types of drugs that people generally abuse depend largely on what is fashionable and readily available. The drugs that were abused in the late 1950s and early 1960s were Miltown, Darvon, barbiturates and APCs. In the middle and late 1960s there was a shift to marijuana, LSD, Speed, and other amphetamines.
Although the amount of scientific data concerning the hallucinogens is far from abundant, almost all of the experts seem to agree that these drugs, including marijuana, are mood-altering and mind-affecting chemicals. Exactly how these drugs alter one’s mental functions is not clearly understood. The matter becomes even less clear if one considers some of the vagaries of pharmaceutics.
Generally speaking, the effect which any drug, including aspirin, will have on the user depends on many variables, such as who made the drug, the impurities it contained, the expectation of the provider, the expectation of the user, the physical surroundings of the user, the actual dosage absorbed, the emotional and physiological state of the user, and most unfortunate of all, the life-style and inherent mental functioning of the user. Also, “paradoxical effects” (i.e., effects contrary to those that pharmacology predicts) of even the best known drugs are something to bear in mind. Thus, some people become sleepy on amphetamines and others become excited on sedatives.
Figure 1
Calendar year | Number of Administrative |
1963 | 30 |
1964 | 42 |
1965 | 90 |
1966 | 170 |
1967 | 611 |
1968 | 2,374 |
1969 | 3,808 |
But, in spite of all the possible variables, it can be stated unequivocally that of all the drugs routinely prescribed by Navy physicians, no effects will spontaneously recur weeks or months after a single dose consumption. Even in the case of the most widely used drug of all, namely alcohol (which can cause one drunk to be convivial and another murderous), no detectable effects are experienced several days later. On the other hand, the drugs that are currently in vogue (hallucinogens and “mind expanders”) are likely to produce flashbacks (a recurrence of perceptual distortions experienced at the time of the initial consumption) weeks and even months later when the user encounters some unpredictable or unavoidable stress. The “stress” can often be something as mundane as a cold, an auto accident or a “Dear John Letter.”
Additionally, a number of people have, in connection with hallucinogen use, committed horrible crimes, or activated a previously latent psychosis which has subsequently remained irreversible. The fact that this seems to happen to “susceptible” or “previously disturbed” people provides no real comfort or assurance, for even between you and me, we are really sure about only one of us—or are we?
Thus, it is impossible to predict the effect of a drug that was made by unscrupulous opportunists, altered and sold by illicit peddlers, with promises wild and exotic, to a deluded or gullible youth, who, by consuming the drug in a circle of peers with spirits low, resentments high or minds unhinged, hopes, for example, to blot out a jilted love. The prospects are even more dismal when one considers the possible, and yet unknown, long term-effects of genetic changes, flashbacks, or irreversible psychosis.
The only thing certain, thus far, is that with the best of luck, and under the most ideal circumstances, the drug user may be able to giggle and “groove” for awhile. But, on Monday morning, both he and the alcoholic establishmentarian (whom he detests so much—and resembles so much) will inevitably face the same old problems, hopefully without now also being confronted by a felony or lunacy charge to boot.
The issue of drug abuse within the Navy, as within the nation, is usually debated by two factions. One believes that all drugs are evil, while the other argues—and has every reason to pray—that drug abuse is harmless. Thus, while some among us frantically man the pumps and others gleefully fan the flames, shall you and I try to catch a glimpse of the man who is making all the smoke—the drug abuser himself?
The typical drug abuser in the Navy is unmarried, non-rated, and between 18 and 23 years of age. His IQ may range from the lowest acceptable for naval service to superior, and he may come from any level of society.
From the standpoint of clinical psychiatry, the drug abuser in the Navy can be placed into one of three general categories:
► Borderline psychotics and those with obvious character or behavior disorders.
► Antisocial or sociopathic personalities.
► Experimenters or those in adolescent turmoil.
Patients in the first category are unfortunates whose lives are characterized by poor socio-economic beginnings from broken homes or emotionally fragmented families. Such an environment frequently leads to poor identity formation and emotional disturbances in childhood. By the time this “loser” enters the Navy he has usually quit schools, friendships, fraternal organizations church affiliations, jobs, and a marriage or two. He feels cheated by life, is plagued not only by low-grade depression and suspiciousness, but by an intolerable discomfort in interpersonal relationships. He may transient or permanent psychotic symptoms which went undetected during his enlistment physical examinant because he concealed them at the time in order to escape into the Navy from some other intolerable situation To his command he is often known as a marginal sailor, the recipient of frequent non-judicial punishments. Inept, he exhibits puzzling or procrastinating inefficiency, surliness, aggressiveness, and destructiveness When this fellow learns about mood-altering drugs he often takes them in the desperate hope of altering his miserable world. Unfortunately, when he is under the influences of chemicals that alter his thinking, he is most apt to become paranoid, panicky, maniacal, or even clinically psychotic. Inasmuch as he is then a danger to himself or others, he usually ends up in a psychiatric ward. With supportive care his toxic psychosis usually subsides in a few days. Although from a medico-sociologic viewpoint this episode represents merely another tragic milestone in a tragic life, it also means from a logistics standpoint that his pre-existing unsuitability for naval service is now manifest and he is, in due course, discharged back into the civilian world. If he used LSD or marijuana he has usually incurred his ire of the “lifers” or “squares” in his command because of the emotional attitude which the mere mention these drugs arouses in the older generation. Actually he is psychiatrically no different from his predecessors who in the 1950s took less exotic drugs for the same reason.
The second category—the antisocial personalities is comprised of people who are characterized by their low degree of social conscience or “super ego.” This loner lacks commitment to any cause, be it religion, patriotism, mom or apple pie. If that most lovable of national symbols—Abraham Lincoln’s doctor’s little girl’s dog—were to be reincarnated, this fellow would probably kick it. He usually does not become psychotic but he is often a “walk-in” to the doctor’s or chaplain’s office where he spontaneously admits to drug abuse. Since he is really trying to obtain an immediate discharge from the Navy, he often “confesses” to having abused a long list of drugs. If his listener doesn’t look alarmed, the patient might pull out all stops and state that he has even experienced flashbacks.
In response to a “no-nonsense” approach, the patient often admits to minimal actual drug experience. If at this point the patient feels pressured or becomes impatient, his attitude might shift to defiance or contempt before he admits to having reliable underground newspaper information which states that he can get a discharge from the Navy “if I admit to being a drug user.”
A few months before, this same youth may have been enthusiastic about joining the Navy—but now he wants out. Since he has no conscience, he experiences no discomfort at being labeled a drug abuser. He is also not bothered by the stigma of an undesirable discharge. He is much like his counterpart of a few years ago who either feigned homosexuality, willfully urinated in his bed to document his enuresis, or insisted that he was a sleepwalker. Indeed, the rate of discharges for homosexuality has markedly declined over the same period of time that the rate of discharges for drug abuse has increased. He may also present himself as a “conscientious objector.” At any rate, he now operates by the motto: “LSD and a BCD (Bad Conduct Discharge) will set me free.” Because he has found an easy way to avoid his Navy obligation, his command might be tempted to “force” him to return to duty. Actually, his potential for useful service is as poor as that of the bed-wetter who won’t sleep in anything but the top bunk.
While the individuals described in the first two categories have always been vulnerable to drug abuse in one form or another, they are not salvageable, at least within the Armed Forces. It is an altogether different matter when we consider the man in the third category, namely the experimenter, or the youth with delayed adolescent turmoil. He is both vulnerable and salvageable. He is not mentally ill and not a social misfit. Unlike the personality types described thus far he does not have a character disorder. Instead, he is often struggling with an identity crisis and is trying to cope with vague, but powerfully disturbing physiologic urges in his maturing body. Like our teenage sons, he is impressionable, suggestible, and trying to find his place in the world. He may be struggling with sexual inadequacies, philosophic uncertainties and the problem of developing an appropriate stance toward authority. He experiences wide mood swings and he changes his ideologies almost as often as he does his skivvies. Although seeming to strive brashly for nonconformity, he wants more than anything else “to belong.”
Service life abruptly throws him into intimate contact with people whose backgrounds and values are terribly at variance with his own. He tries to hide his turmoil and loneliness behind a facade of boredom and indifference. Thus, he is literally a drug abuse case waiting to be “turned on.” When he goes on liberty, he might find himself in a situation where he will reluctantly participate in drug experimentation because he feels himself backed into a psychological corner.
When he is apprehended and sent to the psychiatrist, he usually is remorseful and hopes desperately that his family won’t find out. He does not want a discharge from the Navy. In response to a dispassionate, “What do you think caused you to get involved?” he might confess to having been “bored” or “curious.” There are other, by now standard, replies he might use: “It seemed like the thing to do.” “To fathom the meaning of life.” “To intensify my creative potential.” “I would have been the only one in the crowd who didn’t.” “They would have thought I was chicken.”
He might indicate that his drug experience happened months ago, that the sensation was not what it was cracked up to be, and that he had no intention or need to try it again. He may have tried marijuana two or three more times and then quit because he realized that the real world of his problems was not altered one iota by his temporarily altered mood or perceptions. He may feel privately gleeful for having indulged in some relatively guiltless law-breaking, much as his grandfathers did when they stole melons or smoked com silk behind the barn. Since he has at least a modicum of the built-in policeman in his unconscious, he will often be content with this token defiance. (Indeed, he may never come to our attention unless he is caught.) And since his is basically a solid character, he will be able to turn to sublimations, substitutions or other mental mechanisms as he resolves his emotional turmoil.
These, then, are our drug abusers—human beings all.
Thus, it seems both humane and eminently sensible to consider drug abuse in the Navy, not as a taboo subject but, rather as an indicator of motivation, suitability, and fitness for service. Men with borderline psychoses, severe character disorders or lack of social conscience have been poor team members throughout history. The same can be said of today’s subscriber to the motto “relief is just a swallow away,” regardless of what the sought-after substance may be.
Since it has on active duty only 160 of the nation’s 20,000 psychiatrists, the Navy is patently unable to do anything more than to discharge those who were previously unfit or unsuitable back to civilian life after appropriate interim treatment. The only possible constructive efforts should be expended on the experimenters who are struggling with identity problems. Out such positive step might be an education program—using pamphlets, movies, lectures, and leadership-type of counselling—for the delayed adolescent in uniform. Ours should be a rational, factual, and above all, dispassionate, “cool” approach designed to make inroads into the deluded permissiveness pandered by a sensation-seeking press and the underground news media.
Administrative moves, such as probation for the “casual” or “one-time offender” should also be considered. This approach should be rehabilitation-oriented and based on the notion that anybody can make a mistake, but that a maladaptive life-style will not be endorsed. Who should merit probation? That should be a decision of Command, derived from information such as the man’s performance on duty and impressions of his superiors along with a psychiatric consultation which should elucidate his personality structure, current mental functioning, and prognosis for future satisfactory service.
In the final analysis, our youth will have to learn how to enjoy, and endure, and mature without the chronic use of mind-numbing, reality-distorting substances. While it may seem fatuous to say that there will never be a painless world, there is really nothing else that can honestly be said. Freud was right: life will always entail “too much pain, too many disappointments, impossible tasks.” The aims of an educational and leadership program, for those who are emotionally stable enough to respond to it, should be to point out and provide “powerful diversions of interest” and “substitutive gratifications,” and to point out rationally the dangers and fallacies of “intoxicating substances.”
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Doctor Pursch did his pre-medical work at Wayne State University and graduated from Indiana University School of Medicine in 1959. After internship and Navy flight surgeon training, he served as Senior Air Group Flight Surgeon with Carrier Air Group 8 in the USS Forrestal (CVA-59) until 1963. After three years of specialty training in neuropsychiatry at Bethesda Naval Hospital, he served on the staff of the Naval Aerospace Medical Institute, Pensacola, Florida, as a lecturer in aviation psychiatry and as a member of the Special Board of Flight Surgeons. Since August 1968, he has been Chief of Neuropsychiatry, Naval Dispensary, Navy Department, Washington, D C, and the psychiatric member of the SecNav Clemency Parole Board, and the BuMed representative of the CNO’s Drug Abuse Team. He has traveled extensively with this team to speak to Navy personnel and has published numerous articles, mostly on aviation medicine.