Is there Harm in Harm Reduction - Part 3

The watering down of language When I was a medical resident in Kingston Ontario in the late 90’s, we would sometimes receive patients from the Rideau Regional Centre. This was a residential facility or “Institution” between Kingston and Ottawa that at its peak in the mid-50’s housed over 2500 mentally handicapped people. Back then in the 90’s, the government was in the last stages of phasing out these larger centres in favour of “small options homes” and “community care” for the handicapped. Whether this is an improvement is a debate I won’t step into here, except to say “it’s complicated”.Some of these residents had been admitted to the centre when they were very young, and many were old by the time I cared for them. They would arrive with their original paper charts, some of which had admission data from the 1940’s, 50’s or 60’s. Admission notes included diagnoses such as “Low-Grade Idiot”, or “High-Grade Imbecile”. Back then, these were technical terms. “Idiot” meant someone with an IQ of 0-25, an “Imbecile” between 25 and 50, and a “moron” between 50 and 70. As I don’t have to point out to you, these terms were co-opted from being technical and medical to being terms of insult and derision. Their use in medicine was abandoned. Numerous iterations have followed. “Retarded”, which etymologically means “slow” followed, but also became a term of derision. So then we used the word “slow”. “Mentally handicapped” followed. “Delayed” or “developmentally-delayed”. “Differently-abled”. Or now I have heard the term “Multiple Learning Disabilities” to describe someone who in 1950 would have been a “High-Grade Moron”. The peak of “euphemizing” about mental handicaps hit a few decades ago. I remember listening to the news and hearing about the “Association for Community Living”. What was this new organization? Did they help seniors remain in their homes? Or provide affordable housing? A church organization? Were they a swinger’s group? No, this was the new name for the Association for the Mentally Retarded (it is VERY hard to find traces on the internet, as record of its existence now seems to be memory holed). The Association for Community Living supports mentally handicapped people, but there is no longer any trace of that apparent in their name. It has been euphemized to the point of being completely devoid of meaning. This process has been called the “euphemism treadmill”. Euphemizing can lead to normalizing We have followed a similar process with the word “addict”. Many euphemisms have been used. “Drug abuser”, “substance abuser”, “person living with addiction” (as Lionel Shriver says, a description which makes it sound like they took in a roommate), a “person who abuses substances”. We seem to have somewhat settled on “a person with an SUD” (substance use disorder). Recently the term “a person who uses substances” has come into common usage. The problem with that is that we all “use substances”. I drink coffee most mornings. I bet many of you have taken Advil for a headache. Some might have a drink of wine on Saturday evenings. Cheerios are a “substance”. The term “a person who uses substances” does not differentiate the average person from someone who has emptied his wife’s bank account to supply his drug habit, wrecked his marriage, impoverished his family, and is living under a bridge. (Could living under a bridge be called “Community Living”?) It’s not what you say, it’s what you do that matters Our society tends to develop euphemisms for issues which are uncomfortable or difficult to discuss. But it seems to me that the term you use to describe someone is not nearly as important as the respect and compassion that you actually show that person. I’ll never forget when one of those handicapped patients from the Rideau Regional centre died, watching 2 of his caregivers completely overcome with tears. The fact that his record indicated that he was officially a “moron” hadn’t stopped them from loving and caring for him over several decades. They wept for him as if he were a brother. On the other hand (if you’ll recall back in part 2), Bonnie Henry is very careful to use the term “people who use substances” instead of “addicts”. But then she says they have a “brain disease” and that they can never get better. Is that respectful? Is it compassionate? We can run on the euphemism treadmill but go nowhere. When we water down a word, we lose something. There is still some stigma about being an “addict”. It is normal to be a “person who uses substances”. Perhaps this is why I meet lots of people who self-describe as “addicts” or “alcoholics”, many of whom haven’t used or touch a drop in decades, whereas I’ve yet to have met someone who describes himself, or is described by his family, as “a person who uses substances” who has kicked his addiction. The first step to a cure is a proper diagnosis We need straight talk. Many media reports muddy the issue of addiction and homelessness, referring to them as “intertwined”. It is suggested - or sometimes said directly - that some people become addicted because they are homeless. Yet in all my years in medicine I have never once met someone with this story. In 2024 nearly every homeless person in Canada is addicted, which suggests the arrow points in one direction, from addiction to homelessness, but not in the other. If your brother, cousin, or friend called you some frigid winter evening and said that he was down on his luck and needed a place to stay for a while, how many people would tell him to go fly a kite? Not many. I sure wouldn’t. Now picture if you knew that person was addicted, injecting drugs regularly, stealing to support his habit, and had stolen or got in fights at the last few places where he stayed? Would that change your answer? Non-addicts rarely end up homeless, or if they do it’s not for long. Getting stigma right, not getting rid of it Julie and I sometimes joke that we need to start a “Restigmatization” movement to counterbalance the destigmatization movement. Why? Shame is normal and necessary. There are whole books written on this subject. Shaming those who engage in personally and/or societally destructive behaviour is not only reasonable, it’s necessary. Shame helps hold societies together. We could probably steal our neighbour’s bicycle and sell it for money and get away with it, but that would be shameful. We could knock down a little old lady and take her purse, but that would be shameful. The vast majority of us don’t do these things, not because the police are watching us every minute (at least not yet), but because we would bring shame on ourselves and our families. We know certain actions are wrong - there is stigma attached to them. The only way to never feel shame is to not have a conscience. As we destigmatize drug use, we can unintentional cross a line into normalizing and condoning it. We need to remember that it SHOULD be shameful to be an addict. It is bad for your family, for your community, and for you personally. If there is no stigma, there is less impetus to change. What is the right amount of stigma? If there is too much stigma and shame, a person can feel beyond redemption, and give up on himself. An addict should not be made out to be hopeless or evil. But they are not just fine like they are. It’s important to stigmatize the BEHAVIOUR and not the PERSON. An addict is not worthless or irredeemable or forever lost, despite what Bonnie Henry says. But the behaviour is destructive, costly, and socially irresponsible. Hate the sin, love the sinner. Get full access to Pairodocs’ Collection of Heresy at pairodocs.substack.com/subscribe