Medical tensions & Cannabis: Uncertainty in the
Netherlands
An anthropological investigation into cannabis’ medical effects
Medical tensions & Cannabis: Uncertainty in the Netherlands
An anthropological investigation into cannabis’ medical effects
Lucrezio Ciotti- 10882383
Lucrezio_ciotti@hotmail.com
Master Social and Cultural Anthropology
Universiteit van Amsterdam
Academic year 2015-2016
30
thJune 2016
Word count: 25, 959
Supervisor:
Dr. A. Aalten
Readers:
Dr. Y.M. van Ede
Plagiarism Declaration
I have read and understood the University of Amsterdam plagiarism policy [published on http://www.student.uva.nl/fraude-plagiaat/voorkomen.cfm]. I declare that this assignment is
entirely my own work, all sources have been properly acknowledged, and that I have not previously submitted this work, or any version of it, for assessment in any other paper
Acknowledgements:
I wish to thank all my interlocutors for sharing their stories, perspectives, and insights, upon which I built this thesis. Many of their stories did not make it into this final draft but where nevertheless an essential part of it. For the interlocutors who did feature, I hope to have done justice to their profound stories, and to have successfully maintained anonymity where necessary. I hope that cannabis can continue to improve the various lives which I
encountered, and many more which I did not. Cannabis and its medical potential will undoubtedly become an increasing global, and local concern, and hopefully in ways which can give credence to the voices of persons who benefit from it in unquantifiable ways. Thank you to all of those individuals who helped me shed some light on this particular process.
I would also like to significantly thank my thesis supervisor, Dr. Anna Aalten. This substantial piece of work would not have been possible without her unwavering support and help. Following my progress and assisting me out of various difficulties over about a year, her supervision has been of inestimable help. Through thick and thin I constantly had Dr. Aalten on my side rather than against me, something that I am deeply grateful for. Thank you so very much Anna.
Finally, my gratitude goes out also to my loving family. Although geographically distant, their love and support remained very near throughout my long endeavor. I am truly grateful for how fortunate I am to have such support, encouragement, and motivation. Grazie Papà, Mamma, Costa, e Mimi.
Table of Contents
• Summary……….……….……5
• Introductory chapter………...………...……...…...6
a. Introduction………...…..…………6
b. Theory & research question……….………7
c. Methodological reflections……….….11
• Chapter 1: Historical conditions of possibility for cannabis’ medicalness..…14
• Chapter2: Mediating the self-managing reflexive individual through cannabis
products: Menzo’s story………...………...17
• Chapter 3: Cannabis for body-persons: Jackie’s lived case and the gap between
pharmaceutical standards……….…...24
• Chapter 4: ‘Natural’ Cannabis products for individuals amongst legal and
chemical distinctions: Jerry’s oils ………..………….31
• Chapter 5: The ‘ghost of the hippy’, validating cannabis’ medicalness against
symbolic associations and medical uncertainty: Marian the patient..………38
• Chapter 6: Merging interests in cannabis’ medicalness: the problematic
reproduction of objective knowledgeable arbiters………...46
• Conclusion.………..57
Summary
Medical uses of cannabis are internationally pushing for questions on cannabis’ ‘real’ medical effects in light of a history of symbolic and political contestation. Meanwhile, various medical users benefit from cannabis in unquantifiable ways and vouch for its fundamentally medical effects. From various angles and actors, there appears to be an understanding of cannabis that locate its medical qualities within the substance itself, and away from subjective claims. Ethnographically grounded in the perspective and accounts of various actors in the Netherlands with a stake in cannabis’ medical potential, I investigate why this is occurring. I question why medical users, recreational and medical activists, producers of medical cannabis oils, coffeeshops, recreational cannabis social clubs, and the Netherlands’ official producer of pharmaceutical cannabis, essentialize a medical potential in the substance itself and downplay the ‘meaning response’. The effects of substances has anthropologically been considered in relation to potent symbolism and social relations that deeply impact the physiological action of substances. These aspects are often actively excluded, and I investigate what this does for medical and knowledge relations in the Netherlands. In a context of stratified claims to truth, and the authority of biomedicine, cannabis’ lack of linear cause-and-effect intersects with pervasive assumptions and symbolisms producing a particularly tense situation. Searching for the ‘truth’ on cannabis, and assuming such a thing, has the paradoxical effect of reinforcing certain knowledge and medical authorities, at the cost of persons’ individualized medical needs and uses. These relations pose a tension between the benefits and problems of a well-known and regulated cannabis, against a flexible and vague sort. Cannabis grants the
possibility for persons to treat self-defined ailments that might be unreachable by the linearity that characterizes biomedicine; whilst at the same time posing issues in the proliferation of various products that pose a potential health risk. The medical use of cannabis highlights the problems that the standardization of biomedicine has in attending to the needs of individuals within a late-modern process of self-management and reflexive appraisal of authoritative claims. In the particular context of the Netherlands, I show how a search for linearity has the potential of reinforcing deeply rooted dichotomies at the possible cost of persons’ wellbeings.
Introduction
In recent years, cannabis has been increasingly visible in the international spotlight, with pressing questions about its medical qualities. A polarizing substance, with different claims and takes as to what it does and how to govern it, claims of its medical potential are pushing for specific sorts of questions. “What’s going on inside the plant? How does marijuana really affect our bodies and brains? Could those chemicals lead us to beneficial new
pharmaceuticals”1 seem be the pressing concerns, evidenced by the dedicated issue by the
highly visible National Geographic magazine. At the same time, international laws on drugs are largely being rethought in light of the failures of drug prohibition programs, and the harms that emerged from harm reduction policies (Csete et al. 2016), whilst the United Nations recently had a general assembly in regards to international drug problems (the UNGASS 2016). The resulting resolution suggesting “we reiterate our strong commitment to improving access to controlled substances for medical and scientific purposes”2. It generally
seems that reported medical benefits and attempts at reducing harm and fostering health, are pushing for a discovery of what cannabis ‘really’ is and does. A discovery that takes on a specific form of inquiry and answers.
On the other hand, a growing number of persons who consume cannabis for reasons that are beyond recreation swear by the medical benefits of cannabis and many products made from it. ‘It doesn’t matter how you look at it, it is medical’ one of my interlocutors once told me. With strong symbolic associations regarding cannabis’ effects and a long history of it being predominantly treated as a harmful drug, various medical users locate an essential medical potential in cannabis itself and away from their own subjective claims. It appears that from various sides questions and assumptions about the medical benefits of cannabis are placing its healthful properties within the substance itself: an objective medical potential to be known through objective scientific means.
This search for certainty markedly contrasts the highly uncertain situation in the Netherlands, where cannabis has a unique history characterized by gray areas and ambiguous policies of Gedoogbeleid (tolerance). The recreational and the medical aspects of cannabis have long been intermeshed in one of the few countries to have a medical cannabis program that emerged from the liberalization of recreational consumption. This messy setting is an ideal location to bring the discussion of cannabis’ medical potential of out of cannabis itself: to consider
1 Sides, H. (2015) ‘ Science seeks to unlock marijuana secrets’. National Geographic. June 2015.
2 UN Commission on Narcotic Drugs. (2016: 8) Report on the fifty-ninth session (11 December 2015 and 14-22 March
2016). (E/CN.7/2016/16) Available at:
https://www.unodc.org/documents/commissions/CND/CND_Sessions/CND_59/E2016_28_Advance_unedite d_19042016.pdf
it within various relations, and to critically examine what social impacts this understanding and search for medical objectivity has.
Cannabis, and the claims and enquiries of its medical qualities, are good to think with as they highlight the tensions between the making of dominant forms of medical knowledge, and the diversification of persons and health practices in a state of late-modernity. It raises the opportunity to study the friction between individualized emic notions of wellbeing and the standardization of substances’ cause-and-effect within the dominance of biomedicine. Questions of cannabis’ ‘real’ medical effects are further highlighting the differences in hierarchical forms of knowledge, their deep embeddedness within Western modernity and culture, and how these are challenged or reproduced in seemingly innocuous ways.
Theory & Research Question
:In current times health is something to be achieved on an individual basis as a broader social imperative, resulting in challenges towards definitions on how to achieve it. Foucault famously outlined his notions of governmentality and subsequently of biopower, suggesting the ways in which power exerts itself in diffuse and intimate ways through the definition and achievement of health (Foucault 2008, Lupton 1995). As a conduct of conducts, and an economic3 means to foster of the vital forces of a population, governmentality and
biopower lead to individualized necessities for managing one’s own health and wellbeing. Nichter and Thompson’s (2006) case of dietary supplements provides helpful parallels as they show how various substances that are not formally defined as medicines are put to use in achieving these broader mandates of self-management that take on individualized definitions. How might cannabis be put to independently-defined medical uses and serve these broader mandates? What they effectively point towards is the reflexivity that ensues from a demand to individually self manage, and thus the emically-medical use of substances. In maximizing control over one’s own wellbeing, the definition of wellbeing becomes more varied, a sense of selfhood is heightened, and dominant definitions and ways to achieve health are critically scrutinized. This process of reflexive self-management has been contextualized both within neo-liberalism (Muehlebach 2009), and within the notion of late-modernity (Giddens 1991, Williams & Calnan 1996), which seems more applicable to my case. Considered in terms of the reflexive challenge towards the institutions that characterize modernity, late-modernity
suggests a process whereby centralized4 institutions such as biomedicine are increasingly
distanced from the diversity of the present era. The use of substances for the goal of wellbeing, particularly those not clearly defined as medicines, are well to be considered within this broader context of the need to self-manage, the heightened level of individualism that ensues, and the challenge towards authoritative institutions on the basis of ‘what works for me’.
The dominant form of medicine in Western society- that is at times reflexively
challenged due to its centrality- has been theorized in relation to the diversification of persons. Lock and Nguyen’s (2010) enquiry into biomedicine with an anthropological focus on the role of the body as both a site of experience and power further helps explain its critical appraisal, and the use of alternative treatments in relation to individualized health-management. They suggest that a characteristic feature of biomedicine is that it works upon an assumed ““body proper” given wholly by nature” (Lock, Nguyen 2010:61): a reductionistic universal body decontextualized from the persons that inhabit them. This partly helps explain the
disillusionment towards standardized treatments that do not take into account the heightened importance of individual experience regarding wellbeing. By trying to provide scientific and objective facts as the measure of things, biomedicine works with a standardized body that poses a distance to persons’ lived experience of illness.
Importantly, it is helpful to follow Good’s (1994) critical historical tracing of the notion of the objectivity of biomedicine, which situates it in a western cultural context and the rise of reason. The idea of objectivity, and its dichotomous difference to subjectivity, is in itself a western notion with deep roots in the Enlightenment’s positivism and a humanist search for the facts of the world, with particular implications. That there is a fundamental reality ‘out there’ to be known, in contrast to subjective beliefs and experiences of it, also plays out within biomedicine as a form of power relation. Doctors and experts are seen as providing facts on disease, whereas persons merely subjectively experience illness, providing authority to the former at the cost of the latter. This powerful dichotomy can however be obscured and further strengthened by the seeming obviousness of the evidence that underpins biomedicine. Goldenberg’s (2006) theoretical feminist reflections on how the obviousness of ‘evidence’ within the dominant paradigm of Evidence Based Medicine (EBM) obscures particular social aspects is further helpful. She suggests that hierarchical divisions of medical evidence
depoliticize the knowledge they produce, positing it as the seeming natural order of things whilst reproducing this powerful dichotomy. In practice, biomedicine is indeed not as objective as we might often imagine it to be. Rather, it includes aspects of magic and religion as Van der Geest (2005) identifies in a Dutch hospital setting. He shows how biomedical
4 I do not mean centralized in terms of the institutions that are centrally embedded within the state, but central in being a point of reference. Such as how biomedicine is a reference to other approaches to health: the central measure of things, against which other things are evaluated and considered.
practices also produce and work upon features of hope, of ritualistically controlling the unknown forces of nature, and as a cultural site where persons “express and recreate their belief in the canons of ultimate truth (i.e. science and biomedicine)” (ibid: 145). The notion that biomedicine and its scientific underpinning is objective, rid of cultural bias and able to describe reality, is a cultural notion with deep roots in Western modernity. It is by working according to this notion that biomedicine disvalues subjective experiences and claims, and delegates other medical treatments and practices as alternative and complementary.
Literature on Complementary and Alternative Medicine (CAM) further provides useful theoretical material to consider the medical use of substances in relation to other treatments. There is a lively debate regarding the definition of biomedicine and CAM with various theoretical conclusions (Coulter, Willis 2007; Evans 2008; Hess 2004; Micozzi 2002). What emerges as a useful notion is to consider this relation in terms of boundary-making rather than content: to take CAM not to necessarily be characterized as a medical system by a specific epistemology or tradition, but rather as the treatments, substances, and practices that do not fall within the dominant biomedical standards of linear effects and ‘objective’ evidence. The increase use of CAM has indeed also been attributed to a late-modern diversification of definitions of wellbeing and dissatisfaction with standardized biomedical procedures (Fries 2008). Furthermore, it is important to contextualize these uses within broader social processes to move away from considering its users as mere ‘dupes’ retreating from ‘proper science’ and medicine, or as just a matter of enacting an identity through consumption (Macartney, Wahlberg 2014). Considering the use of CAM, or cannabis, as pragmatic thus suggests looking at the ways that it allows persons to mediate the shortcomings of biomedicine, but with a looming tension. By not working within standardized confines, various alternative treatments grant persons a more individualized remedy where healing is not just a linear bodily process, and thus persons can attend to their necessity to self-manage and self-defined ‘subjective’ ailments.
This ‘more’ that goes into healing, beyond5 the physiological effects of substances, can
be thought through Whyte et al. (2002) notions of the ‘charm’ of medicines. Substances that travel and are exchanged through various contexts carry symbolic traces of their previous ‘social life’. These traces allow the perceived benefits of the previous contexts to be unleashed at a distance, such as the scientific production of pharmaceuticals, the expertise of a doctor. This suggests that the efficacy of substances emerges within a process of movement and symbolic associations, and for persons embedded in rich social and symbolic worlds rather than upon bodies. Moerman et al. (2002) makes a similar argument in regards to the placebo, where its effectiveness derives from the perceived expertise of the medical administrators: the
5 This is not to say that they are apart from physiological effects, as the ‘more’ can have clear physiological effects. Take for example the loss of hair from stress.
social relations within which a substance is consumed, will have potent symbolic effects that will shape the ‘total drug effect’. Because of this ‘charm’, medicines have been theorized to have an inherent tension in the democratization of health (Van der Geest 2010). Persons can achieve wellbeing through medicines at a distance from medical expertise by unleashing their ‘charm’, but therefore also remaining partially connected to such expertise. Most importantly this means that to think of the medical benefits of cannabis it must be considered in terms of where and from who it comes from, in relation to other medical options, and in the local context different associations shape the meanings of these contexts. For example, the ‘charm’ of pharmaceutical cannabis needs to be understood in terms of what a high tech
pharmaceutical context of production might mean for individuals in the Netherlands. Because of these considerations of the extra-material6 effects of substances, and the emic definitions
and uses of medicines and wellbeing, I use the term medicalness throughout my thesis. This is to allow me to consider and discuss the medical potential of cannabis as an emic aspect, as an adjective projected onto cannabis by persons, thus grant persons their own definitions and understandings without juxtaposing them to biomedical ‘facts’.
Medical options that are alternative can at times be appealing due to their perceived ‘naturalness’. The ‘naturalness’ of particular substances and remedies is one way of reflexively mitigating the increasing amount of risk, something which is capitalized upon by economic interests and marketing (Nichter, Vuckovic 1999). Nichter and Vuckovic’s concept of the paradox of the ‘double think’ touches upon the ways that persons can have a paradoxical desire for the traditional- or natural- and the technological in terms of health-substances, and suggest looking at the power of medical advertisements. Yet, on the other hand, the notion that the ‘natural’ and cultural/technological are paradoxically opposed, might itself be a situated understanding. Strathern (1980:177) thus suggests considering what ‘nature’ might mean in a Western setting as a “matrix of contrasts” rather than a totalizing dichotomy. Cannabis is seen as natural and thus beneficial by many, yet how its naturalness is defined and attains meaning should be seen in light of the local circumstances and the multiple contrasts that persons make.
How might cannabis’ medical alternativeness and the dichotomy between
subject/object that disvalues subjective medical accounts intersect with particular symbols and meanings? Cannabis’ history as a harmful drug might impact the present situation, persons’ endeavors to consume and validate it, and its medicalness. In discussing the (recreational) consumption of cannabis in Norway, Sandberg (2012) points to the potent and persisting meanings that revolve around cannabis. He interestingly identifies a process of stability rather than change, where symbols such as the stoned disillusioned hippy, persist even as they are challenged. Particular associations remain even in their absence and thus pose enduring
difficulties for some individuals. Cannabis’ medical alternativeness on the basis that it is not linearly effective7, risks intersecting with the notion that people will have instrumental aims to
their medical claims, and that persons’ claims and ailments are merely ‘subjective’ and less valid. Moore’s (2004) concept of ‘drugality’ sheds further light on this process. She suggests that the dominant meanings attributed to a drug, the ‘personality’ it achieves, must be considered in relation to a drug’s physiological effects. However, when the medical effects of cannabis are uncertain, this uncertainty itself might intersect with cannabis’ history as a drug and the cultural distinction between subject/object that also play out within biomedicine. For the local Dutch setting, given the heightened call to science, this speaks to the ways that persons must validate cannabis in light of its ‘gray’ past and medical uncertainty, and not only for medical purposes.
This literature is useful to make sense of the current Dutch situation where various actors are locating cannabis’ medicalness within the substance itself rather than in relations that emphasize extra-material effects. It is useful to explain why this is occurring and to consider the implications this has upon knowledge and medical relations. It is helpful in answering my research question:
Why do different actors locate cannabis’ medicalness inherently within the substance itself, and how does this impact knowledge and medical relations?
Methodological Reflections:
To consider why different actors locate cannabis’ medicalness within the substance itself, and the implications this has, I followed cannabis and several of its derivative products to various interlocutors, sites, and situations. Nevertheless, due to legal aspects8 I did not trace
its social life from production to consumption, but to interconnected actors. By starting from specific intuitions and foundations, online forums and Facebook groups, and personal acquaintances, I found several interlocutors through a ‘snowballing’9 effect throughout the
Netherlands. Although this was not as successful as I had initially hoped, it brought me into contact with multiple relevant stories, and provided a chance for reflection. Why I was unable
7Again, the fact that the physiological effects of cannabis are not, very linear due to the variety of cannabis types, the variety of uses, and the relations between chemicals
8 It was not possible for me to follow cannabis’ movements since production is largely illegal, or ambiguously tolerated, thus all of my interlocutors were unwilling or unable to bring me to the source of their product. 9 When one interlocutor leads to the next. Something particularly necessary considering the uncertainty between legal and illegal doings under tolerance policies and therefore the apprehension of sharing information with strangers.
to reach some persons, or attain useful snowballing contacts, sheds some light on the local context and persons’ take on cannabis’ medicalness. This is something I reflect upon in the following chapters. I began researching solely from the perspective of medical users, but then broadened to include other relevant actors who also have a stake in cannabis’ medical potential. This led me to medical users, but also medical foundations, cannabis activists, Amsterdam’s cannabis social club, producers of medical cannabis products, a biomedical researcher, among others.
To remain as open as possible to unexpected accounts I opted for a methodology of unstructured interviews. Nevertheless I would follow certain thematic patterns that emerged and that were previously of little relevance, such as the appeal of ‘nature’, the inextricability of the political situation from peoples’ medical narratives, and the importance placed upon individualism. My questions to my interlocutors therefore sharpened throughout the research as I tried reacting to what the field was throwing at me. This proved to be very fruitful. Not recording interviews, and leaving room for interlocutors to bring up aspects that were relevant to them, led me to further entanglements and the emergence of relevant themes I had not expected. Reponses with strong emotions, disagreements or connections between
interlocutors, the borderline-illegal practices of some, were partly a result of keeping a broad stance towards my interlocutors and their stories. Because of some of these delicate aspects, some of the names in this thesis have been changed in order to keep particular interlocutors’ anonymity. I did however take written notes during my interviews, to be able to directly quote my interlocutors10. Furthermore, having stayed in Amsterdam throughout this research also
allowed me to observe, engage, and at times participate in different sites and occasions where cannabis’ medicalness is of relevance, such as Amsterdam’s cannabis social club. After three months of fieldwork I was able to notice and immerse myself in an emergent network of actors, some of who are key local and international players in the broad process of medicalizing cannabis.
Throughout this research and in this thesis, my own position played a relevant role. Undoubtedly my own prior knowledge regarding cannabis was helpful in not having to start from scratch, and thus useful in discussing with my interlocutors. Being a student, a
researcher, and an individual with a non-aversive relation to cannabis further impacted my research in multiple ways that speak of the ‘field’ and the local situation. At times an
intrusively interested nuisance to individuals’ serious health concerns, an academic resource to bring out the truth, a fellow activist also implicated in hoping for and producing change- my position as a researcher was fluid and shifting in the eyes of my interlocutors. These are aspects which I reflect on further down. Not being able to speak the local language was also a
decisive constraint, limiting the persons I could reach and my ability to read into official policies, laws, and documents. Nevertheless this presented an opportunity to understand policies as they play out in practice and in the lives of my interlocutors. Because of the situated nature of my research and data, I take my thesis to be a performance, an enactment of sorts, rather than a representation of what is ‘objectively’ going on ‘out there’ (Law & Urry 2004).
This is a particular story grounded in specific interactions, and situated within the knowledge produced between my research, the literature I use, and my interlocutors11, which
is geared towards understanding and problematizing this process of locating cannabis’
medicalness in the substance itself. Thus, I emphasize particular aspects at the cost of others, and therefore chose to predominantly tell in-depth stories of individual interlocutors. The accounts of several interlocutors did not make it into this thesis, but undoubtedly shaped my findings and argument. I sought to make individual accounts speak to the case at hand, as persons’ stories were rich with ethnographic depth and often speak for themselves. By
foregrounding individuals through apposite chapters, I perform a way of thinking of cannabis’ medicalness that seems rather alternative to what is largely occurring in the field: one that deals with persons rather than bodies. In doing so I try show how this emphasis on certainty regarding cannabis’ medical effects, from the heights of the United Nations to the messy embodied lives of my interlocutors, might actually sideline particular realities where the medicalness of cannabis is not directly located in chemicals themselves- and does not function upon decontextualized bodies- but within various relations. Grounded in the stories of interlocutors with different positions and interests in cannabis’ medicalness, I explain why such a process is occurring, and highlight the implications it has for medical and knowledge relations, and the wellbeing of persons caught in a pragmatic process of managing their health.
11 This is why I prefer to use the term interlocutor rather than informant or respondent. It is to remind and emphasize how my data was a product of our interaction, rather than a representation of already-complete information, accounts, or opinions that I merely extracted from persons.
Chapter 1: Historical conditions of possibility for
cannabis’ medicalness
Cannabis has a very particular history in the Netherlands. The relevant story begins in 1976, when in an amendment to the Dutch 1928 Opiumwet (Opium act) cannabis became decriminalized for an effort to separate schedule II and schedule I drugs12. Offenses were also
differentiated, and the consumption of cannabis became legal, whilst possession remained illegal yet tolerated for personal use and punishable and enforced for purposes of dealing. This policy of Gedoogbeleid (tolerance), of extreme importance to the historical developments and the current situation, can be described succinctly as “no prosecution, unless…” (Korf 2008:141): technically illegal yet not necessarily prosecuted. This is well exemplified in the case of growing cannabis for personal use: tolerated up to 5 plants, but to the digression of local13
authorities according to aspects such as fire hazards and nuisance to neighbors.
The idea was that the already large number of consumers would ideally not have to mingle and come into contact with drugs considered more of a risk, and would not be legally punished. This policy softened the regulations on cannabis consumption and sale, with the aim of reducing harm, and which consequently and indirectly gave rise to the coffeeshops14.
Keen entrepreneurs seized the opportunity with this new legal distinction between drugs, and began setting up businesses to sell decriminalized products, again under a condition of tolerance. With slight changes over time, the sales of coffeeshops remained technically illegal but tolerated, given that certain rules were followed, such as no sales to minors, restrictions on amounts sold to individuals per day, restrictions on the amount of cannabis within the
coffeshops at any given time. This indirectly led to what is known as the ‘backdoor problem’, where the consumers’ side of coffeeshops is (semi)legal yet the production and circulation of the very same product remained illegal: ‘legal milk, but illegal cows’ as one of my interlocutors put it. Ever since, these policies push the earlier ‘social life’ of cannabis into illegal and
untraceable territory.
However, the Netherlands’ membership in the European Union and United Nations limited the options for a national policy on drugs. Dutch laws and approaches to drugs were challenged and shaped by other EU member states, as the Netherlands was imagined15 to be
supplying drugs to neighboring countries, and challenged the validity other member states’
13Indeed the vagueness of ‘tolerance’ leads to differential policing according to provinces, as well as according to individual officers, when no strict guidelines exist- as I learnt from my interlocutors.
14 I use the term ‘coffeeshops’ rather than ‘coffee shops’ to distinguish the establishments that sell cannabis to those that do not.
15The international flow of cannabis is the very different than as it has been imagined by bordering countries. According to multiple interlocutors more cannabis enters the Netherlands than it exists.
more repressive policies (Van Solinge 1999). Meanwhile, the 1972 U.N. Single Convention on Narcotic Drugs restricted the Netherlands’ leeway for national policy, whilst granting specific exemptions on the basis of ‘medical’ and ‘scientific’ use and research16.
Then, in January 2001 health minister Els Borst acknowledged that a significant amount of persons in the Netherlands were indeed consuming cannabis from coffeeshops for medical purposes. Importantly, this occurred a few years after the discovery, and amidst studies, of the human endocannabinoid system17 that further heightened questions of
Cannabis’ medical potential on an international scale (De Petrocellis et al. 2004). The sheer availability of cannabis in the Netherlands afforded people the possibility to easily obtain it, and therefore experiment and mobilize it for a variety of uses beyond just recreation. Yet, the unregulated and unofficial status of cannabis sold in coffeeshops made it impossible to standardize and provide guarantees of safety and quality for persons seeking medication, and has been found to potentially contain harmful molds, bacteria, and pesticides (Hazekamp 2006). Concurrently, the complex relation between cannabinoids and the variety of difference in cannabis products18 complicated linear accounts of physiological action (Russo, McPartland
2003). This significantly complicates the position of cannabis as a ‘proper’ medicine. With various sorts of cannabis types and products, and with complicated relations of chemicals, it problematizes a search for linear objective accounts of what it ‘actually’ Thus in 2003 cannabis was made available to pharmacies throughout the Netherlands on a
prescription basis, and with the founding of an apposite government bureau- as dictated by the UN’s single convention- in charge of centrally overseeing it all. To this day, dried cannabis flowers exclusively produced by Bedrocan supply pharmacies with a few selected and
controlled types of cannabis, and under contract with the Dutch Ministry of Health. The six strains19 that are now available, are produced to the rigorous standards of other
pharmaceutical products, “that means [they are] produced according to pharmaceutical regulations: each strain has a standardized profile of Active Pharmaceutical Ingredients (APIs) and levels of contaminants (such as mold, bacteria or other) that are safe for inhalation into lungs” 20.
This history of regulation, based on pragmatic harm reduction and to structurally implement a medical cannabis program, resulted in a resounding emphasis on the ‘parts’ of
16Article 4 General Obligations, Single Convention on Narcotic Drugs, 1961, as amended by the 1972 Protocol Amending the
Single Convention on Narcotic Drugs, New York: United Nations, available at
https://www.unodc.org/documents/commissions/CND/Int_Drug_ Control_Conventions/Ebook/ The_International_Drug_Control_Conventions_E.pdf
17The innate human receptors and producers of cannabinoids.
18Differences in strains, in growing methods, in storing, etc. all factors that contribute to uncertainty and non-linearity of cannabis’ material action.
19 ‘Strains’ can be comparable to dog ‘breeds’. They are varieties of the same taxonomical plant, that have been crossed and bred into distinct new ‘types’.
cannabis: the Active Pharmaceutical Ingredients. In 2011 a controversial policy was
attempted but significantly failed due to various impracticalities (Rolles 2014). Attempts were made to distinguish sorts of cannabis according to their level of Tetrahydrocannabinol (THC), the chemical attributed to cannabis’ psychotropic effects. A percentage higher than 15% would classify any cannabis-product as a Schedule I drug. This had the unintended
consequence of performing THC as an undesirable chemical, in its association with cannabis’ ‘high’ and its possible consequences on public health. Consequently, the other active
ingredients, namely Cannabidiol (CBD), were enacted as harmless. Although a failed policy, this reflected and exacerbated the differentiation between active chemicals with ‘bad’ and ‘good’, ‘drugful’ and ‘healthful’ distinctions, with strong symbolic and practical implications. Importantly, this chemical form of intelligibility for the governance of cannabis has led cannabis extracts and oils containing THC to be a Schedule I substance, whilst extracts containing only CBD to have similar legal status to health-supplements21.
The very chemicals of cannabis became matters of governmental concern, in a situation where international ‘scientific’ and ‘medical’ exemptions are heightened by medical uses and attempt to foster health whilst pragmatically reducing harm. The decriminalization, emergence of coffeeshops and recreational uses, set the conditions of possibility for the medicalness of cannabis to arise from the bottom-up. International laws on drugs further required a national bureau and a centralized producer as actors that permit cannabis to be pharmaceutically available. Ideas about the effects of cannabis, and the uncertainty its materiality poses for linear biomedical accounts have solidified through policies, producing symbolic and practical distinctions on what is inside cannabis and what its ‘parts’ do. Furthermore, the authoritative position of science in western thought and the ethical
importance of health, emphasize science and medical applications as ways to liberate cannabis from the shady unknown territory of historical uncertainty. This has direct implications upon the uses and relations that revolve around cannabis’ medicalness in the Netherlands. This historical setting significantly shapes how the medicalness of cannabis is thought and practiced, playing into the ambiguities of late-modernity and the messy entanglements that cannabis locally exists in.
21 This means they can legally be sold, yet without any claims of what it will do, but only what it might be helpful for.
Chapter 2: Mediating the self-managing reflexive
individual through cannabis products: Menzo’s story
This chapter looks into the story of one specific consumer, to consider why cannabis and cannabis-products might be used medically, and how this speaks to broader processes of late-modernity and the local historical developments. Menzo’s22 self-medication presents a
case where the demands on the self-management of health, and the subsequent reflexivity and understanding of selfhood that emerge pose a distance to biomedical practice and
epistemology. Menzo was able to mediate his position as an individual body-person through cannabis oils that emphasize his individuality in his treatment. Thus I mobilize theoretical concepts from a Foucauldian tradition that consider how the demands on health, and the power that lies within, lead to the emergence of particular identities which can stand at odds with authoritative definitions of health. Nichter and Thompson’s (2006) discussion on supplement use is a particularly important one, as they connect the use of various liminal substances to increasing demands on health, and how these can be put to use in creative ways to attend to individualized needs. In consuming cannabis oils as an alternative to other remedies, and in contrast to biomedical procedures, MacArtney and Wahlberg (2014) paper on CAM further explains the pragmatic dimension of Menzo’s reflexive use of cannabis oils. This is a use that speaks to broader sociocultural trends and the shortcoming of biomedical epistemology rather than an identity Menzo enacts, or his misunderstanding of ‘real’ science. Lock and Nguyen’s (2010) theorization on the standardized body that biomedicine works upon additionally explains the biomedical shortcomings and the gap they pose to Menzo’s situated life as a body-person. The appeal to cannabis oils as an alternative in relation to his understanding of selfhood and that of biomedicine, is further explicated through the notion of the ‘charm’ of medicines (Whyte et al. 2003). By obtaining his oils through individual
producers, their care is imbued in the oils, granting a potent symbolic alternative to Menzo’s previous medical encounters, and allowing him to better place his selfhood in his treatment process. Through the use of cannabis oils and the alternative caring ‘charm’ they carry, Menzo was able to mediate his relations to medical expertise and consequently his position as a late-modern individual engaged in the artful and pragmatic process of wellbeing.
After being put in contact from a previous interlocutor, I had the opportunity to visit Menzo in his home to chat about his experience using cannabis oils medically. Greeting me with his friendly old dog, and wearing comfortable clothes for the house, signs of illness and medical struggles marked Menzo’s figure. With a missing eye and discolored skin, he calmly
gave me an account of how he came to use cannabis oils- a story that speaks of his marks, and his past medical experiences.
Twenty-two years ago, following a pancreas and kidney transplant’s therapy, Menzo developed cancer on one of his eyes. Yet, the confirmation of cancer came too late and at a grievous expense. He explained that prior to that discovery, Menzo visited a doctor for a fear that a small a small lump on his eye would turn out to be cancer. This fear was not shared by his doctor, who insisted it was not cancer, and refused to remove the small lump. Whether a mistake or carelessness, Menzo ended up having his entire left eye removed from the cancer that indeed developed. This was a long time ago, but Menzo’s medical complications did not end there. The subsequent chemotherapy did not fare well for him. ‘I wasn’t’ myself’ he explained, recalling the days he would have to spend on the couch suffering, unable to live the life he had previously conducted. The nausea and stomach pains left him weak and miserable, barely able to take his dog on walks. The large amount of pills he had to keep on consuming brought on devastating side effects, not only was he physically ill but also unable to be himself. As he comfortably sat crossed-legged on his couch, Menzo further explained his story. An unusually youthful and slouched sitting pose for a man his age, I thought at the time. But it was clear that Menzo’s world had significantly shrunk due to his illness: the amount of time he has spent lonely at home was visible in just how used he was to sitting on that couch in his home-wear. There, on a coffee table just in front of what must have been his usual sitting spot, was his laptop.
As he continued, Menzo explained another of his negative medical encounters, recalling an occasion when his dermatologist gave him a cream to simply apply to sores on his skin. After noticing the unexpected potency and side effects of said cream, Menzo confronted his dermatologist about it, who only then told him it was a form of chemotherapy. Certainly, his dermatologist was not happy when Menzo told her he stopped her remedy for his own, and she could not account for the improvements that Menzo reported. Regardless of this terrible encounter, he explained how he still needs to visit her, as she is the one who sends him to surgery- a procedure which he does not allude to be replaceable with cannabis oils.
Searching for remedies to his eye’s chemotherapy’s side effects on the Internet, Menzo came across cannabis oils as a potential medicine. This was no easy task however. The sheer amount and variety of information that he was faced with left him having to make up his own mind. All those people ‘yelling’ at each other, with different ‘loud claims’ about what cannabis oils, and THC and CBD did, was suspicious for Menzo. Many of these accounts, and publicities for various cannabis products, struck him as mere business. He did not want to smoke cannabis, and therefore received little information from the national bureau when he sought answers.
What Menzo’s case reflects is the medical reflexivity that several authors have
discussed and attributed to broader condition of neoliberalism and late-modernity (Fries 2008, Hardey 1999, Nichter, Thompson 2006,). This notion builds from a Foucauldian perspective on the individualization of health, the techniques used for achieving authoritatively-defined conditions of wellbeing, and the subsequent sorts of subjects that emerge. Fostering the health and vital forces of a healthy body politik – the population as a recourse, and the raison d’etre of the modern state23- is made economic by delegating the requirements to achieve wellbeing
to individuals (Foucault 1984, 2008). Yet, inherent in this diffused and intimate power to normalize and to make a docile population is the resistance to normalizing and totalizing discourses. The imperatives to self-management and the rise of the individualized subject lead to a disillusionment towards authoritative and generalized accounts of what health is and how to achieve it. Persons are made to take care of themselves and therefore distrust ‘what they say works for me’ and seek to “maximize control over their health” (Nichter, Thompson 2006: 186). Neoliberalism connects this process to the dwindling social care services and
intensification of capitalist relations (Muehlebach 2009). Whilst I prefer the use the notion of late-modernity as it suggests gradual challenges and changes, without assuming a clear historical break, to the foundational institutions of modernity such as science and biomedicine (Giddens 1991). Williams and Calnan (1996: 1612) concisely refer to reflexivity as a process of “chronic revision in the light of new information and knowledge”, a process that is
significantly intensified by the Internet (Hardey 1999). The necessity to self-manage one’s health subsequently leads to a particular understanding of selfhood and on the role and importance of the individual; biopower and the imperatives to health are indeed embodying24,
they do not just dominate subjectivity but grant its existence.
We see how Menzo was extremely reflexive in making his mind in light of the necessity for self-management and a sense of selfhood, a variety of accounts, and negative medical encounters. In his two medical encounters (his undiagnosed eye cancer, and the sneaky chemotherapy cream) Menzo was not treated like an individual person, but rather a body in need of medical expertise and bodily improvement. He was confronted with authoritative stances that took little account of his ‘belief’ (that cost him his eye), and that provided potent25 remedies for his body. By dealing with a standardized “body-proper” (Lock,
Nguyen 2010) biomedical expertise significantly contrasts Menzo’s lived experience of having, but also being a body, where his crucial selfhood is left out of the equation in his medical encounters. Both in diagnosis, and in treatment, Menzo was excluded as a body-person. From
23 The population rather than an territory being the object of modern stategovernance
24 They are not just disembodying. They do not simply produce the body as an object of power and social control, but lead to particular senses and notions of selfhood.
25 This is by no means to say that chemotherapy is an extension of pastoral power. But rather that chemotherapy aggressively targets bodily conditions as a ‘magic bullet’ of linear action at the cost of a Menzo’s sense of self.
the severe ailments brought on by his medical treatment, he lost his sense of self, as the medicines that aggressively work upon his material bodily existence complicate and
significantly reduce his life as a person, to the point he where he would not recognize, and be ‘himself’. Menzo reflexively sought other treatments out of the heightened need to maximize control over his health, but also due to the shortcomings of biomedicine that struggles to account for his late-modern selfhood.
As we shall see, this leads individuals like Menzo to consequently seek their treatments elsewhere, away from institutionalized standards and control on quality and safety. The Netherlands’ history of decriminalized commercial and recreational cannabis adds to the uncertainty for Menzo, where economic interests are pervasive and not always clearly visible or separable from medical products and claims. He was able to treat himself also partly thanks to the Internet, forcing further reflexivity in presenting a broad variety of ‘lay’ voices and claims (Hardey 1999). It allowed him to challenge medical expertise’s treatment, and make his mind against a lack of expert information on cannabis from the national cannabis bureau.
Furthermore the legal status of the oils he consumed, and the lack of linear and unanimous accounts, leads to further experimentation and self-treatment. The legal status of oils containing CBD as against the illegality of THC oils, interestingly matches Nichter and Thompson (2006: 177) discussion on food supplements. In legally regulating the advertised claims of substances and differentiating them from ‘real’ medical claims on what a substance will do, can lead many “users to reinterpret labels and experiment with products in the effort to address perceived needs”. Without any clear claims or indications of what CBD does Menzo was able to distinguish its use from THC oils, applying CBD oil to specific perceived needs, to interpret and make up his own mind as to what and how it benefitted him.
In seeking an alternative treatment, I side with MacArtney and Wahlberg’s (2014) explanation in not accounting for Menzo’s use on a psychological level, assuming he is a ‘dupe’ misunderstanding science, or that he has ideological motives. Also, similarly to Raffaeta’s findings (2013), Menzo does not envision a clear-cut distinction between medical ‘systems’, he did not opt for an alternative remedy for alternativeness’ sake. Rather, his search for an alternative treatment emerged from the very epistemological shortcomings of his medical encounters, and the distance they presented to his own importance and
understanding of him as an individual- as ‘himself’. It was not a matter of embodying and enacting a particular (counter-) cultural identity as the use of substances has at times been attributed to (i.e. Whyte 2009), but a pragmatic quest for wellbeing that lead him to look elsewhere. Menzo did not allude to being able to replace particular procedures with his alternative treatment. His use of cannabis oils speaks more of the medical shortcomings and the broader necessities of self-management than of Menzo himself.
Eventually, Menzo managed to come across someone who saw and did it differently. He found Robin’s website, where he provides consultations about the medical benefits of cannabis and cannabis oils from a spiritual perspective. This attracted Menzo, not only because he and his wife had had spiritual inclinations in the past, but also because Robin did not make ‘loud claims’. Thus he began purchasing the first of two cannabis oils he would end up using, made by Robin himself, and ingesting it on a regular basis. That the oil contained THC was not too much of an issue for Menzo, even though he had no intention of getting ‘high’, and it provided him with much relief. Even though Menzo did not, and could not, know for sure what was inside that oil, he trusted it since he trusted Robin. ‘He speaks from experience’, he explained, and he doesn’t give clear answers to how to consume it or what it will do. Among the uncertainty that Menzo was faced with, with the numerous competing claims and accounts of what cannabis and its chemicals ‘really’ do, this seemed like an attractive and nuanced option for him. Learning about Robin, and for Robin to learn about Menzo and his ailments during their (telephone) consultation, was very important for Menzo. He was only given suggestions about what it might help with, and to find the right dosage for himself. This was very different from those loud online voices trying to make a sale, or that doctor who just wouldn’t listen to him. ‘We are not machines’, cannabis does not work in the exact same way on everyone, and it was important to have his individual circumstance catered to, he explained.
Although he did not give much weight to a distinction between chemicals, and consumed on the basis that it worked regardless of what was in it, Menzo started to purchase CBD oil after reading that it would be better for nerve pain than THC oils were. He would subsequently start purchasing CBD oil from an individual who makes it and had his loving wife carefully massage it onto his skin in the evenings. Again, this new supplier was someone who did not ‘yell’ their claims. They also took the time to hear Menzo’s story over the phone, and he trusted that they did not have the same financial interest as others might.
Menzo’s subsequent improvements led him to share his insight, directing others to the same oil, and even discussing his improvements with his radiologist. Some of his friends’ opinions on cannabis also changed after seeing his visible improvements, from the negative stereotypes that they may have socially learned, to seeing the medical potential, Menzo explained. He knew that the oils improved his condition. Regardless that he had no concrete evidence from a doctor, Menzo would be able to walk his dog again.
Through the use of cannabis oils, Menzo was able to mitigate his relation with doctors, and bringing his treatment into different social relations. The provenance and ‘charm’ (Van der Geest, Whyte 1989; Whyte et al. 2003) of these substances allowed a particular medical potential to be activated at a distance from the biomedical relations that proved negative in Menzo’s case, and within different ones. His oils carried a symbolic
potency from the previous context and hands it they came from. They materialized a form of care and ‘working-with’ of the individuals who learned about Menzo’s situation, which significantly contrasted the disembodying and authoritative ‘working-upon’ of his other medications. For Menzo, this experiential form of ‘soft’ knowledge marks a powerful contrast to the authoritative sort he encountered, and to the loud and instrumental online claims. This association is also contextual to the governance of cannabis. Loud claims are associated with loud political voices that do not speak from experience on cannabis’ potential, and that lead to persons learning that cannabis is harmful, as Menzo explained. Using oils at home with his caring wife, allowed the imbued healing potential to be activated in relations where he was present as a person, thus being able to treat himself away from the medical relations that proved unsuccessful and unappealing. For Menzo this proved highly successful, and
undoubtedly he healed from more than the oils themselves. The efficacy of his oils emerged out of a particular process where the movement of cannabis, his attributed meanings, and the relations within which this occurred, had a strong impact on Menzo’s wellbeing.
Perhaps in treating himself, through the ‘charmed’ substance, Menzo was also able to negotiate social pressures and processes of individualism: the biopolitical subject in charge of self-managing, but also the ‘mindful’ (Scheper-Hughes, Lock 1997) body-person that he is, which is accentuated by the very need to care for himself. The demands that push individuals to maximize control over their own wellbeing, and thus judge for themselves can lead to a “somatic re-education” (Nichter, Thompson 2006:202). This is a concept that points to how persons pay closer attention to their bodily experience in personally evaluating the effects of substances. Consequently in a shift in understanding his body, and through the use of substances also a mediation of the understanding of selfhood can occur (Hardon, Moyer 2014).
Thus, by self-managing, Menzo’s treatment brought his embodied sense of selfhood to the fore. It was through his necessary treatment with oils that not being a ‘machine’ was emphasized, as a unique person who’s bodily ailments reduce the ability to be and feel an individual, and who requires healing and not just medication. In treating a person, who does not react mechanically to substances and requires care to cater to his individual personhood, we also see how other relevant actors and healers emerge, and how the positive effects of cannabis products shapes cannabis’ symbolic associations26.
Yet this self-treatment was not merely out of social demands, but also necessarily because of the medical shortcomings he encountered, and with particular effects. By being able to target aspects not reachable by biomedicine- such as catering to his selfhood- his treatment might help validate the very ailments that other treatments and procedures could not. The subjective aliments and the sensation of ‘not being myself’ are aspects that were
validated by the very alternativeness of his treatment with cannabis oils, the very aspects that were previously excluded. “Therapeutic substances invite the concretization of ill-being” (Van der Geest, Whyte 1989:356), and his oils concretized the abstract and ‘non medical’ ailments Menzo experienced. In this sense, the alternativeness materialized in cannabis oils and the caring charm held within, were sources of efficacy and wellbeing: Menzo found a treatment for a very abstract experience of illness. Nevertheless, In a bid to treat himself, Menzo
paradoxically placed the medicalness of cannabis within the oils themselves: without too much distinction between chemicals it was cannabis oil in general that helped heal him, partly reducing the effects to the substance and downplaying the social and symbolic element.
Chapter 3: Cannabis for body-persons: Jackie’s lived case and
the gap between pharmaceutical standards
After Menzo’s story as a medical user, I present a very different case with some striking similarities. A long-time medical user and home-grower of cannabis, Jackie’s story emphasizes a particular gap between her lived experience of medicating with cannabis and its pharmaceutical version produced by Bedrocan. By following Whyte et al.’s (2002)
enlightening account of the procedural and extra-somatic aspects of the efficacy of substances I show how these might be discounted by pharmaceutical standards, along with Hess (2004) and Evans’ (2008) discussion on them. Substances do not merely impact bodies as
standardized and static entities, but much more goes into the ‘total drug effect’ when dealing with persons; whilst pharmaceutical standards lead to the development of what Micozzi (2002) refers to as ‘magic bullets’. Pharmacological standards, and a search for a linear cause-and-effect of substances can stand at odds with persons’ ongoing therapeutic requirements. However, also these supposed disembodying substances and epistemology are not devoid of symbolism, as Van der Geest (2005) suggest. Yet, as Jackie’s story highlights, local
developments lead Bedrocan’s high-tech context of production to carry a negative sort of ‘charm’. By trying to provide standardized cannabis, Bedrocan makes its products from the inside-out, on the basis of its chemical compounds rather than how it will embed into persons’ lives. This, and other aspects such as coffeeshop’s financial interests, leave Jackie disillusioned with what she considers a lack of proper attention and implementation for a substance that for her is inherently medical, but that is not treated as such. Thus for Jackie her home-grown cannabis provides a wholesome and ‘natural’ option in its contrast to other versions and interests. Quite paradoxically this leads her to also locate the medical benefits she experiences fundamentally within cannabis: a real medical potential that is not being fostered by Bedrocan and other actors. Situated within the current local Dutch context, Jackie’s case highlights the possible shortcomings of well-regulated and standardized cannabis that actively seeks to downplay extra-somatic effects, at the possible cost of its healing potency for persons.
After briefly having had the chance to meet her at a public event, I was finally able to sit down and have a conversation with Jackie. Seated in a busy coffeeshop in Amsterdam drinking various juices and consuming amounts of cannabis that would floor most persons, Jackie recounted her medical consumption of cannabis.
Having developed Crohn’s disease27 25 year ago, with eight operations that left her
without much of her bowels, further complicated by her opioid allergy, Jackie is now in a constant fight to stay alive and well. She explained how severely underweight and weak she has become, something that was personally visible in how she took about two weeks longer than I did to recover from the same flu we both contracted from our first public encounter. Now Jackie must carefully monitor and forcefully consume an above-average caloric amount. She must manage her ailments daily, including drinking five liters of coconut water a day; not an easy task when her appetite dwindles, eating physically hurts, and it has become a dreary activity. Without this regiment she risks having her nutrition delivered through blood infusions, ‘the end’ as she saw it. Cannabis entered her life as a possible treatment for these complications several years ago. Widowed at 32 year of age, and with a young son to care for, she recalled how she necessarily had to ‘be self-helpful’. Fast-forwards to now, she explains just how effective cannabis has been for her: ‘it kept me alive’ she told me in all seriousness and solemnity. Her appetite and ability to eat significantly improved, but her world remained very small, and very entangled with cannabis.
An expert grower by now, Jackie only consumes cannabis she grows herself, and various products and extracts she makes with it. As I continued interviewing her amongst plumes of her stickily smoke, Jackie gradually warmed up to my open ears28 I came to learn
about her intense disdain for Bedrocan, and her long ongoing struggle to keep herself alive and well. She explained that since 2010 she is one of only two persons in the Netherlands to receive governmental subsidies to legally grow her own cannabis for medicinal purposes. She explained this in a way that carried strong hints of pride but also bitterness. It was no easy task, and much work was required involving lawyers, yearly appeals, long documentations: it was a true achievement obtaining the exemption against many odds. This ongoing endeavor is further problematic since she lives in constant fear of loosing her medication and the home she is able to grow it in29. Not only does she constantly have to medicate by consuming
cannabis, but her life is an ongoing process of being able to obtain and use it, something which she makes very clear in her narrative and demeanor. A struggle so real that it brought Jackie to genuine tears more than once.
From this position as a user but also a grower, Jackie significantly distrusts the pharmaceutical version of cannabis. She had tried Bedrocan’s varieties but with extreme
27 This is a sort of inflammatory bowel disease which affects any part of the gastrointestinal tract.
28 And probably to my lack of audio recording. Pursuing a methodology of unstructured interviews allowed me to contextualize my questions to my specific interlocutors’ cases, and taking notes rather than recording audio granted my interlocutors more room to openly discuss. I strongly believe that the accounts I received from Jackie would have been very different, and likely less honest and heartfelt, if I would have recorded her word by word. By trying to ‘chat’ rather than subject my interlocutors to linear questions, my position as a researcher was perhaps taken with more openness.
29 Even though home-cultivation is tolerated up to three plants for personal use, this does not guarantee a tenant will not be evicted by a landlord or housing agency. A mere complaint by neighbors, even regarding an unwanted odor from the plants, can be enough premise for an eviction.
disappointment, to the point of making YouTube videos criticizing them. In our chat, she focused on what was the epitome of a particular pharmaceutical take on cannabis: Bedrocan’s granulates30. With clear disgust she explained how terrible it was that ground up granules of
cannabis were being pushed as medical: full of un-smokable bits, extremely unappealing to consume, and highly ineffective. The high-tech laboratories that Bedrocan grows its cannabis in are far detached from her own practice of growing and experience as a consumer.
Bedrocan’s was contrasted to the cannabis Jackie grew herself, ‘happy plants’ that she follows and tends to from seed to joint. Answering what she thought of the cannabis in coffeeshops, Jackie explained how she would prefer it to Bedrocan, but nonetheless considers it a result of the liberalization of recreational consumption and therefore the economic interests therein. She mentioned she is able to tell that the cannabis found in coffeeshops is given exotic names to sell, whilst being grown quickly and ineffectively, and often crossed with hemp31 for
CBD-heavy varieties: cannabis that is not medically very effective and that is lied about. In contrast to these two options ‘cannabis simplex’ is superior, the ‘whole cannabis’ plant with its natural balances of chemicals, that can also be extracted into smokable products. In her growing practice she therefore tries to mimic nature, as one ‘can never beat mother nature’.
In a different way to Menzo, Jackie’s reflexivity shines through from her laborious process of obtaining what she was certain was a medication. She necessarily had to take control over her own health by taking charge of her own medicine, not only because of her son to care for, but because of the legal and historical barriers in place. The semi-legality of personal production was simply too uncertain for Jackie’s case, who requires more cannabis than can legally be grown, and for whom Bedrocan was not an option. The long and ongoing legal processes coupled with her weakened physical state, required impressive amount of work she had to carry out herself.
Her evident disdain for Bedrocan is particularly interesting considering her position as a consumer and grower also. The previous contexts that Bedrocan travels from- the high tech growing facility- carried a ‘charm’ that was not a source of perceived safety, efficacy, and appeal as might be the case with other substances (Whyte et al 2003, Van der Geest, Whyte 1989). Rather it was a source of distrust due to the standards Bedrocan necessarily adheres to, to particular local symbolic associations, and Jackie’s own relation with cannabis. The case of Bedrocan’s granulates, and Jackie’s reaction reflect Hess’ (2004) Evans’ (2008:2105) discussion on the standards that problematize CAM:
“EBM [evidence based medicine] encourages the development of herbal knowledge based on products made from plants rather than the plants themselves. The use of
30 Ground up dried bits/ ‘granules’ of mixed cannabis flower.
31 Hemp is the industrial variety of the cannabis plant, generally not consumed recreationally, and namely used making for textiles.
manufactured herbal products distances us, rather than connects us, with the plant in their raw, or natural, state … Evidence-based medicine and science become the points of reference in resolving disputes over how medicine is to be integrated” Among academic debates and various takes on the relationship between CAM and
biomedicine, what these authors point to is the empirical standards according to which certain remedies and practices are provincialized and others attain validity. The forms of positive evidence that Bedrocan must necessarily adhere to in their production of ‘pharmaceutical-grade’ cannabis therefore lead to a product that might not take into account the ‘meaning response’ (Moerman et al. 2002) and symbolic associations that significantly play into the ‘total drug’ effect. It is cannabis that is developed from the inside out, according to its chemical medical compounds rather than the ways consumer use and relate to it. Much can be lost in standardizing cannabis within dominant accounts of evidence. Not least because a substance that is unappealing will not be consumed, thus not live out its social life as a medicine whatsoever. If we follow Whyte et al’s (2002) notion that substances’ efficacies are procedural- contingent upon the meaningful movements, the processes and rituals of obtaining, preparing, consuming that shape the final outcome- a sort of ‘magic bullet’ will not be very effective in this case. Micozzi (2002) suggests that therapeutic aspects can indeed be difficult to target from a position where standardization and linear cause-and-effect are sought, hence a ‘magic bullet’ of linear pharmacological action will necessarily be blind to the ongoing healing that persons, rather than bodies, desire and require. Bedrocan naturally does not have the same emic sensibility as Whyte et al. in considering how substances act and affect persons. Rather, by trying to provide a sterile and standardized product, it leads to a focus on how chemicals will impact a static and standard body rather than how persons will relate to a highly contested and symbolic substance in their ongoing situated lives.
This suggests a vivid tension. Having biomedical and pharmaceutical standards that focus upon the ‘hard stuff’ of medicines- the chemical location of physiological effects- might be problematic for cannabis due the deep symbolic associations, and contrast its
embeddedness in some person’s lives. Jackie’s case exemplifies a gap between such pharmaceutical standards and the lived experience of wellbeing and of using cannabis to achieve this. It reflects the procedural efficacy of substances in persons’ lives as opposed to its (supposed) linear effects in laboratories. For Jackie, a state of ‘being’, of being alive, and of being well as a person, is an ongoing and painstaking process. It is a constant process of ‘becoming’, where her ‘beingness’ is in a constant forwards motion, and not on her own. She is becoming-with her medicine, allowing her to maintain the process of living as a body and as a person. Cannabis is not an external force that momentarily impacts her life, but a central aspect of it. Her life is formed around cannabis through her constant use that ‘keeps her alive’, and through the ongoing endeavor and efforts to secure it as a medicine. Her very existence as a body, and
