A Misplaced Focus: Harmful Drinking Patterns in South Africa

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Notes

¹ The reader is asked to consider that the recent medicalizing and pathologizing of a range of human behaviors, include categories of substance use, misuse, “abuse, addiction, dependency, habituation, hazardous drinking, etc., is, at best a consensualizing labeling process and not a diagnostic process. Such labeling is based upon the labelers’ criteria whose validity not based upon empirical generalizability. “Alcoholism,” however, defined, was associated for millennia with sin as its etiology. A usable diagnosis, based upon a process of gathering valid, relevant information and accurately interpreting and understanding such “data” (knowledge) in order to make a needed decision needs to supply a minimum of three types of information: etiology, process, and prognosis. A contemporary flaw in this process is associated, most generally, with the reported “explanation” about any type of substance misuse as being a unidimensional, linear either/or description which does not adequately distinguish between initial use, or nonuse, ongoing use, or nonuse, changes in use (patterns, manner of use, meanings, functions of the use, sites of use, frequencies of use, etc.) cessation of use, beginning again which can result in our “knowing” without adequately understanding a phenomenon which is dynamic, nonlinear, complex and not simply complicated, multidimensional, level-phase structured, and bounded (time, place, selected demographics, etc.). This is not a semantic issue. Editor's note.

² The reader is asked to consider that concepts and processes such as “risk” and “protective” factors are often noted in the literature, without adequately delineating their dimensions (linear, nonlinear, rates of development, sustainability, decay and cessation, etc.), their “demands,” the critical necessary conditions (endogenously as well as exogenously; micro- to macrolevels) which are necessary for them to operate (begin, continue, become anchored and integrated, change as de facto realities change, cease, etc.) or not to operate, and whether their underpinnings are theory-driven, empirically based, individual and/or systemic stake holder- bound, historically bound, based upon “principles of faith” or what. This is necessary to clarify, if possible, if these terms and their all-too-often stigmatizing labels and implications are not to remain as yet additional shibboleths in a field of many stereotypes and flaws. Editor's note.

³ The reader is referred to Tilly, Charles (2006). Why. Princeton Univ. Press. Princeton, NJ for a stimulating analysis about generic “causative” reasons given in the West, and to Tilly, Charles (2008). Credit and Blame Princeton Univ. Press. Princeton, NJ for an important analysis about “blame.” Editor's note.

⁴ The interested reader is referred to the following thought provoking works which challenge current contemporary flawed conceptualizations. The cyberneticist Heinz Von Foerster who posited that there are two types of questions; legitimate and illegitimate ones. The former are those for which the answer is not known and is, perhaps, even unknowable during a given state of knowledge and technology-–the effective control of man's “appetite” for a range of psychoactive substances, whatever their legal status. An illegitimate question is one for which the answer is known, or, at the very least consensualized. An illegitimate question is one for which the answer is known, or, at the very least is consensualized enabling the creation of a state of temporary or more permanent query-closure. The quest within a question becomes guaranteed. The asking of illegitimate questions has been, and remains, by and large, the acculturated norm. Heinz Von Foerster, Patricia M. Mora, and Lawrence W. Amiot, “Doomsday; Friday, 13 November, A.D, 2026,” Science, 132, 1960. pp. 1291–1295. The reader is referred to Pablo Neruda's The Book of Questions for a poetic exploration of legitimate questions. Rittel and Webber suggested that problems can and should be usefully categorized into two types: “tame problems” and “wicked problems.” The former are solved in a linear, traditional known and tried “water fall paradigm”; gather data, analyze data, formulate solution, implement solution. The latter “wicked problems” can only be responded to individually, each time anew, with no ultimate, repeatable solution. The range of “problem drinking,” which is a socially constructed concept, is usefully considered from their thesis as being “wicked problems.” Rittel, Horst, and Melvin Webber, (1973). Dilemmas in a General Theory of Planning.” Policy Sciences, Vol. 4, pp 155–169.

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Notes on contributors

Arvin Bhana

Arvin Bhana, PhD, (South Africa), currently Honorary Associate Professor of Psychology at the University of KwaZulu-Natal, obtained his PhD in Clinical and Community Psychology at the University of Illinois, Urbana-Champaign. He is a registered clinical psychologist with the Health Professions Council of South Africa. His current research is focused on understanding the developmental precursors to mental ill health and personal and contextual aspects that contribute to well-being and resilience. He also has a strong interest in promoting public health interventions for adolescent alcohol abuse.