The Medicalization of Marijuana: Legitimacy, Stigma and the Patient Experience. Michelle Newhart and William Dolphin, New York: Routledge, 2019, 302 pp.
In their cogent concluding chapter, Michelle Newhart and William Dolphin begin with a strident argument. “Cannabis and its use mark the most consequential case of social construction of the twentieth century” (p. 241). The claim has some credence. After all, whether as a cultural practice, a medicine, a felony, a livelihood, a political symbol, a religious sacrament, or a tool of self-making, the plant’s production and consumption has had enormous consequences for people, economies, environments, and governing systems worldwide. After reading The Medicalization of Marijuana: Legitimacy, Stigma, and the Patient Experience, one can have little doubt that cannabis is, if nothing else, one of the most instructive cases of social construction. And instruct Newhart and Dolphin do well.
While one might be familiar with the top-down constructions of cannabis as a “killer weed” or “gateway drug,” the (re-)medicalization of cannabis has been instigated from below, namely by patients acting individually and collectively outside of (and frequently against) established institutions, as they seek remedy for ailments inadequately addressed by biomedicine. Appropriately, then, Newhart and Dolphin center quotidian patient experience—and the contingent, contextual “lifeworlds” through which they cohere—in analyzing cannabis’s medicalization. Here, rather than in policy pronouncements, media discourses, or court decisions, one sees how patients grapple with, enact, and transform medicalization.
One imagines this patient-centered perspective derives not only from Newhart and Dolphin’s academic analysis but from their direct experience as political advocates who have witnessed the key role of patients in fighting for cannabis’s medicalization. This advocacy perspective informs the book and deepens the analysis, but not in ways that lead to premature or didactic conclusions. Fittingly, the book has already earned an award in applied/public medical sociology.
Cannabis, the authors argue, is caught in a suspended state of “incomplete medicalization,” as measured against Conrad and Schneider’s five-phase rubric (1998 ). Amidst tumultuous struggles over stigmas, legitimacy, medical credentials, harm/benefit profiles, and institutional orientations, patients play a critical role—a role in need of greater analysis as medical programs are eclipsed and sidelined by recreational or commercial cannabis systems. The book unfolds over 10 digestible, excerptable chapters. The first two chapters historicize medicalization within the broader War on Drugs, its research apparatus, and cannabis policy changes. Then, drawing on an interview sample under Colorado’s medical cannabis program, the ensuing seven chapters trace patients’ enactment of medicalization: becoming a patient, doctor–patient interactions, medical use practices, shifts in (self-) knowledge, and stigma navigation.
The penultimate chapter argues that patients often regard cannabis through a healthist lens—as contributing to one’s control over well-being, broadly defined. Patients contrast this healthist approach with pharmaceuticalization, which they see as mired in concerns over safety, narrowly defined ideas of health, and corporate power. The authors provocatively explore the epistemic challenges cannabis poses: If remedies are systemically, Platonically considered either cure or poison and embedded in a kind of “pharmacological Calvinism” (Chapkins and Webb 2008) that incites self-sacrifice and ascetic discipline, how do we consider a medicine that incites and heals through pleasure? Moreover, what do we do with a plant-based medicine that may be more efficacious and safe in its plant form, rather than the isolated, active-ingredient model of pharmaceuticals?
Can we create, then, a different path for medicalization that does not end in simple incorporation into existing medical institutions and epistemologies? Challenging the working idea that cannabis’s medicalization is incomplete, the authors ask us to take patient perspectives seriously in assessing whether “complete” medical institutionalization is desirable or adequate for cannabis therapeutics. The authors detail the ingenuity of patients as they created a parallel health system around cannabis—a system responsive to patient lifeworlds, rooted in collectivized care and social engagement, and containing concepts of health and well-being that diverge from biomedicine. Though this patient-focused perspective is indispensable, one wishes the authors had detailed what collective, organizational forms, and incipient policies might preserve and grow the spaces that have been so valuable to healing, community, and identity formation. Naming those aspects will be necessary to prevent the collapse of cannabis into predictable institutional routes, an outcome the authors clearly want to forestall, if not divert altogether. Whatever the way forward, the book reminds us that patients (as opposed to profits, state revenues, or other motives for cannabis liberalization) must be at the center of societal considerations. This intervention is not just political or ethical—it may hold lessons for reworking the shortcomings of our current medical–pharmaceutical system.
The book is grounded in the accessible voices and narratives drawn from 40 patient interviewees. This interview sample, which is mostly White and middle aged (30–65 years old), is a clear limitation for the book’s analytic purchase, which the authors adequately explore. This limitation is also a potential strength, though, and the authors might have gone further in explaining their study specifically as a study of White, middle-aged patients. In recent years, this cohort has seen a significant increase in mortality, affected as they are by opioids, alcohol, and suicide, particularly when they have less education and medical access and live in rural areas. As an effective palliative for pain and other chronic conditions, cannabis use might be regarded as a bottom-up response by this cohort to a broader crisis of health and health care. It also might be seen as a significant, massive dissent from dominant medical–pharmaceutical systems. That this dissent emanates from those who are key targets of the pharmaceutical age—White, middle-aged people—makes the critiques that much more damning. This book, then, offers a good platform from which to explore the intersection of age, race, medicine, and politics.
The appendices on research methods may be useful for teachers and students. Similarly useful is the author’s discussion of terminology (i.e., cannabis, marijuana, hemp), which itself serves as a study in social construction. Though the book’s title suggests they embrace the term “marijuana,” they actually argue that “cannabis” is a more prudent term, considering the racialized deployment of the term marijuana over the past century. While this argument is valid, it sidesteps thorny issues involved with the term cannabis—namely, that it can perform a kind of science-washing by invoking medical–scientific authority to achieve the effect of purging the plant’s racial history. Language in itself, of course, cannot undo the racial legacy of prohibition but it can advance superficial and depoliticizing attempts to cleanse cannabis of its complicated history. Moreover, the term marijuana did not begin and end with prohibitionists but has a much longer history that ties it to cultural heritages that may now be erased with the term cannabis.
Overall, this book is eminently teachable, well organized, conceptually clear, and a solid exploration of pivotal concepts in medical anthropology. Indeed, cannabis’s exclusion from (and troubled engagement with) formal medical systems offers an important perspective from which to consider health and medicine. As cannabis, medical and otherwise, is elevated to the national stage, it is easy to forget or occlude the patients who have motored this medical–political process. It was people dealing with physical ailments, the shortcomings of biomedicine, and the pressures of the drug war, who advanced cannabis’s medicalization. As engaged scholars, Newhart and Dolphin are well aware of this, offering us an insightful, instructive exploration of one of the more dynamic social issues of our time.
Chapkis, W., and R. Webb. 2008. Dying to Get High: Marijuana as Medicine. New York: NYU Press. Conrad, P., and J. Schneider. 1998 . Deviance and Medicalization: From Badness to Sickness. Philadelphia: Temple University Press.