Drugs and Feared Minorities
The quarantine model can also be found in American reaction to the use of drugs by feared minority groups. The United States had an almost unrestricted market in morphine, opium, cocaine, and heroin during the nineteenth century and the first decade of this century. The use of these drugs became widespread, and in the years around World War I opposition to their nonmedicinal use reached a peak. Stringent federal laws assisted a variety of partial and conflicting state statutes attempting to control the use of narcotics. Interestingly, the campaigns that led to these laws ascribed the use of certain drugs to specific feared groups. Opium was linked to Chinese immigrants; cocaine to southern blacks; and heroin to an urban, violent, and criminal underclass. In the 1930s a similar, specific assignment was made of marijuana to Mexican immigrants who had come to the agricultural regions of the nation during the booming 1920s. In the crusade to control dangerous drugs, the emotional energy released by associating drugs with feared minority groups helped pass legislation prescribing severe penalties. The contrast with drugs that might be addicting and dangerous but are commonly used by the middle class, such as barbiturates, illustrates the intense emotions that can be evoked by appealing to the kind of fears that gave rise to the immigration laws of the 1920s.[18]
By the 1960s, a time of renewed addiction problems in the United States, simply being an addict rendered a person subject to involuntary confinement for therapeutic purposes. The Supreme Court declared that "in the interest of the general health or welfare of its inhabitants," a
state "might establish a program of compulsory treatment for those addicted to narcotics. Such a program of treatment might require periods of involuntary confinement."[19] Justice William O. Douglas in his concurring opinion went so far as to add that confinement might be justified "for the protection of society" and not just for the treatment of the addict. California and New York both established sites where addicts could be committed for treatment. In 1966 the federal government made provision for civil commitment through the Narcotic Addict Rehabilitation Act. All of these programs for massive detention of addicts failed legislators' expectations: Detention proved expensive and the rehabilitation rate was quite low. For our purposes—that is, to compare these latter measures with the possibility of quarantine in response to the AIDS epidemic—it is worth emphasizing that a group without an explicit ethnic affiliation but marked by a primary, and much feared, trait—addiction—was seen to deserve confinement "for the protection of society" by no less a champion of personal liberties than Justice Douglas. We have the advantage of knowing that the programs supported by such juridical sentiment proved impracticable.
The perceived role of drugs among feared minority groups was thought to be similar to that of a virus in an otherwise fairly healthy group. Eliminate the virus and the group would not only function much more efficiently but would also cease being a source of infection to the remainder of society. In a way, however, the fear of drug contagion was a little more optimistic than the eugenicists' pessimism that ascribed an unalterable inferiority to some ethnic groups. Remove the drug, or discourage its use by punishment, and the person and the group would be more easily assimilable and certainly less dangerous. Even so, some said the Chinese, for example, had a racial weakness for opiates. Broadly speaking, however, the tangible reality of the drug encouraged the hope that its removal would make a threatening group more tractable.
Early in this century, cocaine was said to cause southern blacks' hostile attacks on whites. Fear of cocaine fed the mounting racial tensions in the southern states. Cocaine was thought to improve marksmanship, while alcohol made it worse. Believing that blacks might be high on cocaine, officers in one police department traded their guns for larger calibers because they thought a mere .32 caliber revolver could not stop a "cocaine-crazed" black.
The smoking of opium by Chinese was used as an argument against Chinese immigration. Opium was said to be the means Chinese men used to seduce white women. Heroin, on the other hand, supposedly
bolstered the courage of underworld figures before a robbery. Champions of the strictest and most punitive antinarcotics laws, such as Capt. Richmond Pearson Hobson, considered narcotics a "racial poison." Hobson warned that the United States was under bombardment by the rest of the world, which sought to undermine American values and government through addicting narcotics. Each continent sent its wicked poison: Africa, hashish; Asia, opium; South America, cocaine; Europe, heroin. Captain Hobson was a keen student of the notion of racial degeneration, and the parallel he drew with undesirable races who wished to "invade" the United States is clear. The solution was to establish a boundary no foreign contaminant could pass.[20]
Some drug experts consider quarantine a remedy because they believe the isolation of drug-users is a protection against contagion. The idea that drug abuse is contagious is not new. In 1915 a Tennessee state official responsible for control of narcotic use, Lucius P. Brown, wrote in the American Journal of Public Health that
contagion is undoubtedly a very frequent method of spread. I have met many instances in which more than one member of a family was infected, the first case acquired accidentally or through a physician, infecting the other members of the family largely through a certain tendency on the part of the addict, particularly in the early stages, to introduce others to the delights of addiction.[21]
Addiction spread through contagion, or, as it is more commonly described now, "peer pressure," has led to some forms of isolation in the United States. During the years just after World War I, for example, addicts in New York City were brought to North Brother Island in the East River. In the 1930s a federal narcotics hospital was built in the form of a prison in Lexington, Kentucky. The major reason for these isolated locations was to ensure that the patient would have no access to drugs, although treatment and imprisonment also removed "pushers" from communities.
With the second major onslaught of drug use in the United States and other nations in the 1960s, the contagion model again proved popular, both to explain the growing use of dangerous drugs and to suggest a means of control. Dr. Henry Brill, later a member of the National Commission on Marihuana and Drug Abuse (1970-1973), described in 1968 two kinds of addicts: the medical, caused by treatment for a painful disease; and the nonmedical, or "street," addicts. The former he found to be solitary users, but the latter frequently used drugs in groups, and their
primary mode of spreading addiction was through "psychic contagion," as Brill labeled it, which may assume "epidemic proportions."[22]
A prominent Swedish drug expert, Dr. Nils Bejerot, agreed that interfering with this form of spread was a key to stopping epidemics of drug abuse. In Sweden the problem in the 1960s was stimulant abuse, such as amphetamines and other "diet pills," but the principle still held, he believed, for other forms of drugs. He called this situation an "epidemic toxicomania" and recommended establishment of "treatment villages" in open locations "without the patients being able to escape at the first impulse." He favored islands or depopulated areas for the construction of treatment villages. Dr. Bejerot thought a year in a village would be the minimum required. Women would have intrauterine devices inserted to prevent pregnancies.[23] Although these villages have not been adopted in Sweden or the United States, the proposal is an interesting look at the wish to apply quarantine to a feared and massive social problem.
Quarantine boundaries are best defended if there is a clear distinction between the feared aggressors and those requiring protection. The leper had a prescribed costume and warning cry. Immigrants often looked different from settled citizenry; in the cities, the poor could be distinguished from the middle and upper classes. In the case of narcotics, Chinese, blacks, and Mexicans stood out from mainstream society; and society, threatened by their discontent and hostility, hoped to stop their use of dangerous drugs, if not to expel them and "their" drug from the nation altogether. How convenient it was to discover a contaminant among a group already held in low esteem and easily distinguishable from the majority of the population; the role that this view of addiction played in race discrimination should not be underestimated.
When such groups are quarantined, lasting psychological damage may follow. Insights into the emotional sequelae (aftereffects of disease) that would be involved in quarantining those who test positive for human immunodeficiency virus (HIV), but are otherwise unaffected by the illness may be gathered from studies of Americans of Japanese ancestry who were interned in concentration camps during World War II simply because of their lineage. About 120,000 persons—men, women, and children living in western states—were abruptly taken from their homes and settled in government camps for several years on the grounds that they presented a security risk to the United States. In recent years deep regret for this action has been expressed in Congress and by many citizens aware of what happened under the stress of war. Studies conducted
on the former detainees reveal a number of reactions including denial; loss of faith in legal protections; aggression turned inward, with consequent feelings of guilt, shame, and inferiority—and identification with the aggressor.[24] We should try to learn from that era of fear and to consider the effects of quarantine on the targets of that fear. The efficacy of the quarantine procedure itself must also be questioned.