Interview by Nell Whittaker
Portrait by Drew Adler

NW In the US, you’ve been speaking about this book for a while. Has its reception surprised you?

PM When I first started writing it, there was a lot of pushback against the idea that mental health might have more to do with our external surroundings than our internal chemical imbalances. It seemed relatively obvious to me that our depression and anxiety would be affected by our material worlds, and I was always confused by how vociferously people grabbed onto the idea that poor mental health was only due to a chemical imbalance in the brain. There’s still disagreement, but the world has gotten so bad that it’s more obvious that there’s no way to live without periods of feeling despondent, anxious or depressed. We’ve passed the peak of people gaslighting themselves into thinking it’s all in their heads. 

NW You refer to that phenomenon as the “broken leg model” of mental health provision: “You wouldn’t refuse treatment for a broken leg, so you shouldn’t feel ashamed about taking antidepressants.”

PM Those analogies work to a certain extent. I’ve been helped by certain medications and not others. But if someone keeps smashing your leg with a hammer, you don’t keep putting it in a cast and ignore the person doing it.

NW The basic premise of the book is that there isn’t a significant difference in the way people take prescription drugs and non-prescription drugs – that in both instances they’re seeking regulatory or deregulatory effects. They can help to make life more predictable or less predictable – and both can be useful. 

PM Obviously there’s a difference between taking an antidepressant and shooting up fentanyl, but still, both users are trying to ameliorate their legitimate pain caused by capitalism. It is the same if you’re a mom in the suburbs of Chicago as it is if you’re someone who’s been forced to live on the street of any city across the world: the circumstances are different, but the uniting force is that people have been left to manage their own mental anguish without sufficient support. Drugs become ways to process that pain, whether it’s a legal medication or an illicit drug. There’s a quote in the book from Vince Tao, an activist in Vancouver, where there is a lot of heroin and fentanyl use. He says that what we’re seeing is not a crisis of drugs, but a crisis of insufficient and unequal pain management. Drugs are the symptom, not the cause. 

NW  When we tell stories about drug users, they tend to be either about decline or miraculous recovery. Your relationship to narrative in the book is more ambivalent. The opening trauma about being in the crowd at Charlottesville in 2017 [when a white supremacist rammed it with a car] provides you with an experience of being “out of narrative”, a fallout, as you describe it. But that experience forms the narrative of the book – the catastrophe that creates the plot. How do you feel about the function of narrative when it comes to discussions about drugs, violence and pain?

PM We live based on some narrative structure. Going to therapy, in many ways, is about crafting a narrative. If you were abused, experienced a horrible medical problem or lost someone, you attempt to find meaning where there isn’t one. Things like therapy are tools of narrative creation. Yet, we have the opportunity to get weirder with it than we allow ourselves to. Often, we’re told to shunt ourselves back into these narratives before these traumas, which relates to types of therapies these days. CBT, for example, is about managing the symptoms of your distress, as opposed to unravelling why you feel that distress and how that relates to the world around you. What I discovered in my journey of trauma recovery is that I learned to view my trauma as a painting that you can glean meaning from. There’s much more beauty and possibility in that to me. I feel more empathy and relate to people more now that I’ve gone through that journey, because it wasn’t just about healing myself back into an old form that wasn’t really working for me. There should be more opportunity to process how society is affecting you, your relationships, and how one moves through the world. As the philosophers Gilles Deleuze and Félix Guattari hint, there’s a reason that people are not given that opportunity – if people were allowed to explore what they desire, to acknowledge how isolated and crazed the world is making them, it would be a dangerous thing for the order as it exists. If people were given that space on a mass level, it has revolutionary potential that can be set off like a bomb.

NW I liked the chapter on the DULF, or Drug User Liberation Front, a group that hands out pure drugs for free, as well as clean syringes. They talk about themselves in terms of harm reduction. What would the world look like if drugs were high-quality, freely available and taking them was unstigmatised? 

PM I don’t think the government should be handing out fentanyl, but if our options are either to have people dying from it or to have a regulated supply of it, then the latter would be better. No one wants to be doing fentanyl, it exists because of prohibition, because people got addicted to things like OxyContin and other prescription opioids and then heroin was so prohibited that it made it much easier for drug trafficking cartels to smuggle it in much smaller packages. If you talk to most fentanyl users, they would rather get heroin but it is basically impossible to get at this point. Harm reduction doesn’t go far enough, and is one side of the coin. No one who’s not in an immense amount of pain is searching for these potent drugs like fentanyl or meth. Harm reduction gets shunted into this very small, policy-driven conversation about how we prevent people from overdosing on these drugs. But the much larger question is, why are people seeking out these drugs in the first place? That question is much scarier to answer. .