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.