Book Review: Drug Effects: Khat in Biocultural and Socioeconomic Perspective

Drug Effects: Khat in Biocultural and Socioeconomic Perspective. Lisa L. Gezon, Walnut Creek, CA: Left Coast Press, Inc., 2012, 263 pp.

Khat (Catha edulis) is a relatively little-known psychoactive plant. In her book Drug Effects: Khat in Biocultural and Socioeconomic Perspective, Lisa Gezon shows that khat’s marginal position is a good entry point to address broader and often opposing stances in public health and anthropological literature about the harms and benefits of psychoactive drugs. By using “khat effects” as a lens, Gezon critically examines contemporary drug politics in Madagascar and beyond, presenting evidence from nearly 10 years of ethnographic fieldwork in northern Madagascar, particularly from the city of Diego Suarez.

The book’s main thesis is that “khat (or any drug for that matter), in itself, is neither good nor bad” (p. 29). This challenges polarizing arguments about the dangers of drugs for health, social well-being, and economic advancement. Gezon shows that while many Malagasy khat producers and sellers benefit from the drug’s local and recently growing market, consumers must cope with the financial and health pressures that khat consumption creates. Furthermore, she recognizes that northern Malagasy people are active participants in the creation of a local khat economy as part of a global modernity, which challenges theories of global homogenization of cultural and economic forms.

Specifically, Gezon argues that the production and trade of khat in Madagascar has developed within “the cracks” of neoliberal political economic reforms—because of rather than in spite of these reforms. Thus, for Gezon, the khat economy plays a part in multiplying forms of modernity and is more a positive development than a powerless struggle of the subjugated. As a local commodity, khat generates economic activity, indicating real and possible ways to reduce overall levels of poverty and thus to improve nutrition and access to health care.

Gezon’s first two chapters generously reference available literature on khat and provide an extensive outline of khat’s psychoactive properties and overall health and social effects. She addresses issues around khat classification and presents evidence on addiction and consumption. The core chapters contain an analysis of the effects of khat on Malagasy households, on gender and ethnic identities, and on food security and environmental sustainability. In her conclusion, Gezon reviews Madagascar’s informal khat economy in the context of state interests and the globalized war on drugs discourse.

Central to the book is consideration of the problem of understanding khat’s drug qualities—both social and physical—and its quasi-legal status in Madagascar. Research shows that the effects of khat on health are benign, yet it has been prohibited in many countries, most recently the United Kingdom in 2014. Given this, Gezon observes that in Yemen and East Africa, the regions of production where khat is legal, it is treated by “state silence,” despite its significance for local economies. She asks why this is so and what implications this has for Malagasy people.

While structural support of the khat economy could improve Malagasy livelihoods, the state is under international pressure to choose either not to draw attention to khat or to tackle it as a harmful drug with potential need for prohibition. State silence on khat has many repercussions. On the one hand, silence perpetuates reduced public health awareness and the lack of subsidies for khat farmers; on the other, local people are relatively free to engage in khat production and trade as means of adapting to the effects of poverty and global economy. In turn, Madagascar’s khat commodity chain affects food security and environmental sustainability. Gezon suggests that khat farming, with appropriate state support, can improve local ecology and food security, especially given that people are well aware of the need to diversify their crops.

Gezon shows that as a marker and attribute of identity, khat use and production mediates ethnic and gender relations. Young urban consumers, known as koroko and jaoambilo, take up khat as their identity marker along with Western pop-cultural artefacts. As an entheogen, khat is important for certain Islamic practices, which makes its use politically sensitive in Madagascar as elsewhere. In contrast to overall state silence, Gezon aptly demonstrates how khat is invoked in political rhetoric by local people and politicians. For example, she notes that association of khat use with laziness is not uncommon in Madagascar, as it is in Uganda, Kenya, and Somalia.

One of Gezon’s most engaging discussions explores Malagasy “affairs of the heart” as gendered and affective social structures that govern the khat economy at the level of interpersonal relations. Informed by feminist studies of economic activity as interrelated with affect and emotions, she analyzes how Malagasy cultural notions of marriage, romantic love, and extra-marital partnerships shape khat production and consumption. Gezon argues that many Malagasy women find autonomy and empowerment through their participation in the khat economy. This discussion has great comparative value, because Malagasy women’s entrepreneurship is a counterexample to analyses of drug use contexts, especially in other khat localities, like Uganda and Somalia, where women are usually disadvantaged.

Drawing on critical medical anthropology and political ecology, Gezon also investigates khat as an object whose very materiality determines its meaning in social dynamics and its impact on the physical environment. Her argument that the effects of khat on health are mediated through these conditions rather than solely by its psychoactive properties or its mere status as a drug draws the book close to an exploration of the social and environmental determinants of health. This leaves her overall analysis of khat in Madagascar more pronouncedly at the level of structural conditions. Readers who are primarily interested in experiential and subjective aspects of Malagasy khat use and its micro-level details of production and consumption and health and recreational effects might find themselves wishing for more ethnographic detail, for example, on urban youth socialization and consumer–producer household differences.

The evaluative content of the main argument, that khat is neither good nor bad, does not address the subject in terms of Malagasy morality. Gezon interprets value in terms of khat’s cultural, economic, and political significance. Yet important for her argument is a notion of morality that emerges early in the book: “Perceptions of health (and what is “good for you” and “bad for you”) exist in a field of competing ideologies, where the ones held by those with power are more influential than others and will more likely be translated into action” (p. 24). It would be interesting to learn more about how khat is interpreted in terms of Malagasy morality, which appears to underlie attitudes to local and global moralizing drug ideologies. For instance, description of such affective and symbolic institution as affairs of the heart implies strong moral experience and action.

The book goes a long way to introduce khat to readers who might be hearing about it for the first time. It will be an accessible source for undergraduate anthropology students who are interested in social studies of psychoactive substances and critiques of structural health conditions. The discussion of globalization as the framework of Madagascar’s khat economy also makes it relevant to global health studies. More advanced readers will find Gezon’s attention to environmental sustainability issues and the influence of development initiatives as perspective broadening. The book will also appeal to anthropologists who are interested in East African drug use and the repercussions of the war on drugs in the region.

Detailed explorations to build a strong evidence base of the effects of drugs is much needed. Gezon calls for a greater sensitivity toward psychoactive substance production and use, particularly in the context of the need to refine drug scheduling. With an upcoming UN General Assembly Special Session on drugs in 2016—which is set to seek a balanced strategy for drug control—Gezon’s book is very timely.

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