Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
Narcotics research, rehabilitation, and treatment. Hearings, Ninety ... Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
I316Casriel, who is medical-psychiatric superintendent of Daytop Village. "For thefirst time, an addict upon entering Daytop sees 100 people who were alsoaddicted but who are living happily and functioning without drugs or the preoccupationwith the thought of drugs."Daytop A'illage has been in existence for 6 months. It is an outgrowth of DaytopLodge, established under a 5-year National Institutes of Mental Health projectto compare the results of several alternative probation arrangements forfelons of the Second Judicial District, New York Supreme Court, and initiallylimited to 25 probationers.,"People live in Daytop in a pleasant, paternalistic, tribelike, family environment,"Dr. Casriel said, paraphrasing his book on Synanon, "So Fair A House."The members think of Daytop neither as a hospital, a prison, nor a halfway house,but as a family-type club or home—a fraternity of people living together andhelping each other to get well * * *. The members are neither patients nor inmates;they are free to leave any time they wish."OXCE BELIEVED THEKE WAS NO HOPEHe said that he himself had once believed there was virtually no hope fordrug addicts "Ten years of contact through community psychiatry with the:problem of drug addiction had left me deeply pessimistic * * *. My observationshad almost brought me to the conclusion that, once addiction was established incertain predisposed but undefined personalitie.s. a basic metabolic change ordeficiency was produced in the a,ddict, manifesting itself in" a craving that onlythe opiate could relieve." .'n.:-. ."That was my position imtil I discovered Synanon 3 years ago," he said, callingDaytop "the amalgamation of the best that was Synanon and the best of theprofessional understanding and knowhow."Citing the relative lack of success of psychiatry in the treatment of characterdisorders, he said that "the question I kept asking myself was, 'Why were nonprofessionalsable to stumble upon a rehabilitation and cure of the drug addict,whereas professionals, as a general rule, were completely unsuccessful?' At lastI feel I've discovered why."After working intensively learning the process of treatment of the drug addictspecifically and the character disorder in general, I was finally able to traceit back and evolve a psychodynamic theory which to me explains why the processworks."The theory, he said, was a modification of the psychocultural views developedby the Columbia School of Adaptational Psychodynamics."A major defect in the adaptational psychodynamic theory," as.serted Dr.Casriel, "was its lack of awareness that there are three major methods of copingwith pain or stress. * * * They accounted for two of these ways by the mechanismsof defense called flight or fight, using the emotions of fear or rage. Whatthey failed to bring into focus is that there is a majoi:, perhaps more primarymechanism in which one avoids danger or pain. * * * it uses neither the emotionsof fear nor rage and may be called isolation or encapsulation. * * * Somepeople withdraw from the pain of awareness, the pain of reality, what theyexperience as the pain of everyday functioning, by withdrawing unto themselves."It was bis observation, he said, "that those people whose primary mechanismof defense is withdrawal are those who fit into the psychiatric classification ofcharacter disorder."Once this "intrapsychic world without tension" has been evolved, he continued,"the individual will overtly or covertly fight anyone who attempts toremove him from his prison-fortress. * * * Once the adaptational mechanism ofisolation is evolved and becomes a primary mechanism, the standard psychoanalytictechniques using introspections and observation are useless. The individualpatient, though he hears, cannot be reached."shbh:,!.must be removedTo treat such patients, Dr. Casriel said, "One must first remove the shell andprevent the individual from acquiring or running into any other kind of shell."Then he must be taught how to grow uj) emotionally, socially, culturally, sexually,vocationally, and educationally.'•!/,!•.
317other shells under which to hide." Only one reaction to his stress is left open tothe Daytop member—fear. He can leave Daytop if unable to cope with his fears.However, said Dr. Casriel, "We anticipate that at least 80 percent of those whoenter Daytop will sooner or later remain to get well."If he stays, the member is given two prescriptions—go through the motionsand act as if. The first means to abide by the rules and follow instructions, like itor not. If a member complains that he doesn't linow exactly how to do as he istold, he is instructed to act as if * * * you knew what to do * * * you had theexperience * * * you are mature * * * it is going to be successful * * * you aregoing to grow up and get well * * * you are already well and adult."When people go through the motions of acting as if," Dr. Casriel said, "theystart thinking as if and finally feeling as if." At the beginning of this process,there is a crucial 90-day hump during which painful underlying feelings come tothe surface, he said, but the support of others at Daytop helps the new member.COMMUNICATION IS TREATMENTTreatment through communication then helps the member to understand thatthe undifferentiated somatic painful feelings that he has experienced on a visceraland emotional level * * * are nothing more than fear, anger, guilt, and depression,emotions experienced by all humanity * * * are not exclusive to what hefelt was the mystical parahuman called the drug addict.Tools of communications used at Daytop are a form of group therapy calledthe encounter, seminars, public speaking, psychodynamic interviews, lectures,and community relations. There are also rituals and rites of passage, includingthe intake and indoctrination processes, entrance into regular membership aftera month's probation, a birthday after a year, and primitive rituals to maintaindiscipline, called the haircut and the general assembly.[Exhilnt Xo.14ff)]The Family Physician and the Narcotics Addict(By Daniel H. Casriel, M.D.^)(From the Sandoz Panorama, February 1970)Because of my work in rehabilitation of drug addicts, I am often called uponfor help by family doctors faced with this problem in their practices. The followingis basically a summary of the answers I have given to their questions.People seeking relief from their emotional problems have always been amongus. Drugs are not a specific maladaptive resolution of an emotional need, butour present culture is drug oriented. Most of us have not the slightest hesitationin taking aspirin at the first twinge of a headache or a sleeping pill for a restlessnight or two. The underpinnings of this drug orientation are widespread andculturally accepted. One has only to turn on the nearest radio or television setto be cajoled, pleaded with, even intimidated into buying any of the medicinalremedies for a wide variety of common conditions. The easj' availability ofmedicines through comercial production, widespread distribution, and multiplesources of supply, makes the awarweness, acquisition, and use of all kinds ofdrugs so easy as hardly to be given a second thought. In this way the ground isprepared for the specific use of narcotic drugs, and the resulting addiction tothem by the emotionally troubled.Availability is a prime factor; it is, indeed, a fact that those sections of thecountry which are closest to sources of supply have the greatest problem in thisfield. One obviously cannot be a heroin addict without access to heroin. A housewifein the black ghetto of Harlem, might be (one could even dare to say, wouldprobably be) addicted to heroin and in close contact with her pusher : whereas ahousewife in Iowa might be habituated, if not addicted to some barbiturate, tranquilizer,or stimulant, while maintaining a very close relationship with herdoctor-supplier.Anyone who is not functioning, or who is under achieving in a responsible task,is potentially susceptible to drugs, and a certain percentage of these people will1 Dr. Casriel Is well known for his snccessfiil rehabilitation of narcotics addicts. He hasbeen medical director of the Daytop therapeutic community, and its affiliates, for many vears.He also has a private psychiatric practice in New Yorls City.
- Page 278 and 279: —:266Mr. HoRAN. We don't support
- Page 280 and 281: 268Mr. Horan, let's back up a littl
- Page 282 and 283: 270It is not up to heroin or morphi
- Page 284 and 285: 272nesses yesterday who brought out
- Page 286 and 287: 274;Mr. Perito. It is my understand
- Page 288 and 289: 276So that at the end of the week t
- Page 290 and 291: 278steroid he lias in him we might
- Page 292 and 293: 280Mr. Perito. You are referriii"'
- Page 294 and 295: 282not drug free. I can say approxi
- Page 296 and 297: 28 A$2-a-day habit these individual
- Page 298 and 299: •As286I got to the point once in
- Page 300 and 301: 288Mr. Steiger. You mentioned anoxi
- Page 302 and 303: 290Mr. Eangel. I could see then tha
- Page 304 and 305: 292Dr. Casriel. Mr. Keating, I have
- Page 306 and 307: j294What period of time are ^ve tal
- Page 308 and 309: 296was March of 1970—he was admit
- Page 310 and 311: 298"The paper by Dole and Nyswander
- Page 312 and 313: :300vent them from coming to New Yo
- Page 314 and 315: 302[Exhibit No.14(b)]Casriel Instit
- Page 316 and 317: 304to result from the insuflScient
- Page 318 and 319: 306It is this role of the intervent
- Page 320 and 321: 308EESULTSStudies concerning tlie p
- Page 322 and 323: 310The method derives from a specia
- Page 324 and 325: 312Why is this happening? What need
- Page 326 and 327: m)effective with uncured alcoholics
- Page 330 and 331: 318resort to heroin. One must not f
- Page 332 and 333: .320in Permanent Cure of Narcotic A
- Page 334 and 335: 322!(4) '-Modification of Adaptatio
- Page 336 and 337: 324sections of the country, all sor
- Page 338 and 339: ;Mr.Pertto.niuch,I?,Mr. Peritq. Tha
- Page 340 and 341: 328Chairman Pepper. Mr. Steiger.Mr.
- Page 342 and 343: , Mr., In''wMr, WiNx.nltiiink tlie
- Page 344 and 345: :332"Stomach cramps" were found to
- Page 346 and 347: 'i.We334'""^li'anTOanl^ETPPEiL That
- Page 348 and 349: :))))336would be deprived of any cl
- Page 350 and 351: 338less abuse liability than agents
- Page 353 and 354: NARCOTICS RESEARCH, REHABILITATION,
- Page 355 and 356: CONTENTSApril 26 1April 27 77April
- Page 357 and 358: :•vEXHIBIT NO. 4 (a) AND (b)Eddy,
- Page 359: :lovernor,vnEXHIBIT NO. 21 (a) and
- Page 362 and 363: 342have no desire to preempt the au
- Page 364 and 365: 344We hope these hearings will prov
- Page 366 and 367: 346tons in 1962 and to 155 tons in
- Page 368 and 369: 348SOUTHEAST ASIAAs you know also,
- Page 370 and 371: 350I would also point out as I did
- Page 372 and 373: 352their farmers who have been grow
- Page 374 and 375: 354told that much of the insurgency
- Page 376 and 377: 356Mr. IxGERSOLL. Well, again, Mr.
317other shells under which to hide." Only one reaction to his stress is left open tothe Daytop member—fear. He can leave Daytop if unable to cope with his fears.However, said Dr. Casriel, "We anticipate that at least 80 percent of those whoenter Daytop will sooner or later remain to get well."If he stays, the member is given two prescriptions—go through the motions<strong>and</strong> act as if. The first means to abide by the rules <strong>and</strong> follow instructions, like itor not. If a member complains that he doesn't linow exactly how to do as he istold, he is instructed to act as if * * * you knew what to do * * * you had theexperience * * * you are mature * * * it is going to be successful * * * you aregoing to grow up <strong>and</strong> get well * * * you are already well <strong>and</strong> adult."When people go through the motions of acting as if," Dr. Casriel said, "theystart thinking as if <strong>and</strong> finally feeling as if." At the beginning of this process,there is a crucial 90-day hump during which painful underlying feelings come tothe surface, he said, but the support of others at Daytop helps the new member.COMMUNICATION IS TREATMENTTreatment through communication then helps the member to underst<strong>and</strong> thatthe undifferentiated somatic painful feelings that he has experienced on a visceral<strong>and</strong> emotional level * * * are nothing more than fear, anger, guilt, <strong>and</strong> depression,emotions experienced by all humanity * * * are not exclusive to what hefelt was the mystical parahuman called the drug addict.Tools of communications used at Daytop are a form of group therapy calledthe encounter, seminars, public speaking, psychodynamic interviews, lectures,<strong>and</strong> community relations. There are also rituals <strong>and</strong> rites of passage, includingthe intake <strong>and</strong> indoctrination processes, entrance into regular membership aftera month's probation, a birthday after a year, <strong>and</strong> primitive rituals to maintaindiscipline, called the haircut <strong>and</strong> the general assembly.[Exhilnt Xo.14ff)]The Family Physician <strong>and</strong> the <strong>Narcotics</strong> Addict(By Daniel H. Casriel, M.D.^)(From the S<strong>and</strong>oz Panorama, February 1970)Because of my work in <strong>rehabilitation</strong> of drug addicts, I am often called uponfor help by family doctors faced with this problem in their practices. The followingis basically a summary of the answers I have given to their questions.People seeking relief from their emotional problems have always been amongus. Drugs are not a specific maladaptive resolution of an emotional need, butour present culture is drug oriented. Most of us have not the slightest hesitationin taking aspirin at the first twinge of a headache or a sleeping pill for a restlessnight or two. The underpinnings of this drug orientation are widespread <strong>and</strong>culturally accepted. One has only to turn on the nearest radio or television setto be cajoled, pleaded with, even intimidated into buying any of the medicinalremedies for a wide variety of common conditions. The easj' availability ofmedicines through comercial production, widespread distribution, <strong>and</strong> multiplesources of supply, makes the awarweness, acquisition, <strong>and</strong> use of all kinds ofdrugs so easy as hardly to be given a second thought. In this way the ground isprepared for the specific use of narcotic drugs, <strong>and</strong> the resulting addiction tothem by the emotionally troubled.Availability is a prime factor; it is, indeed, a fact that those sections of thecountry which are closest to sources of supply have the greatest problem in thisfield. One obviously cannot be a heroin addict without access to heroin. A housewifein the black ghetto of Harlem, might be (one could even dare to say, wouldprobably be) addicted to heroin <strong>and</strong> in close contact with her pusher : whereas ahousewife in Iowa might be habituated, if not addicted to some barbiturate, tranquilizer,or stimulant, while maintaining a very close relationship with herdoctor-supplier.Anyone who is not functioning, or who is under achieving in a responsible task,is potentially susceptible to drugs, <strong>and</strong> a certain percentage of these people will1 Dr. Casriel Is well known for his snccessfiil <strong>rehabilitation</strong> of narcotics addicts. He hasbeen medical director of the Daytop therapeutic community, <strong>and</strong> its affiliates, for many vears.He also has a private psychiatric practice in New Yorls City.