On Thursday, the small Appalachian city of East Liverpool, Ohio, posted photographs on Facebook of a man and woman apparently passed out from an opioid overdose. The two adults sit slumped in the front and passenger seats of a car. A small boy looks out from the back. The city warned that the photos might shock and outrage, but that was its goal: "It is time that the non drug using [sic] public sees what we are now dealing with on a daily basis," the city administration wrote in the post. "We feel we need to be a voice for the children caught up in this horrible mess."
The post attracted more than 4,000 comments on Facebook, and was quickly picked up by the news media. Some compared it to the recent photograph of the Syrian boy in the orange chair that drew attention to the country’s ongoing civil war. But many have condemned it as a public shaming of people struggling with drug addiction.
"We would never do anything like that to somebody who just had a heart attack, or somebody who just had a suicide attempt, or any other medical condition," says Maia Szalavitz, a neuroscience journalist and author of Unbroken Brain, a book about addiction.
not going to RT that photo of people w/adxn OD'd w/their child. we don't do this w/any other health condition. fails as prevention, too.— Maia Szalavitz (@maiasz) September 9, 2016
In East Liverpool, Ohio, the city’s service-safety director Brian Allen said that the intention was to inspire people to seek help, and to raise awareness about the opioid epidemic devastating Ohio. Last year, accidental opioid poisonings killed over 3,000 people in Ohio — the highest number on record — up from 2,531 in 2014.
"I had a man thank me for doing what we did," Allen says of a father whose son died of an overdose three months ago. "And not because it would have shamed his son, but his son would have sought help."
"It touches everybody."
The city was particularly criticized for not obscuring the adults’ or the child’s faces before posting the photos. The faces weren't obscured because the photos are part of the court documents on public record, which the city administration can’t edit, Allen says. The city didn’t want to shame anyone, he says. "Locally, we don’t attach a stigma to it, it’s every walk of life, every race, every income level," Allen says. "It touches everybody." (Both adults survived the overdose after being treated with the opioid antidote Narcan. The man pled guilty to child endangerment and driving while intoxicated, while the woman — the child’s mother — pled not guilty and is awaiting trial. The child has been removed from her custody.)
Some, however, saw the photos as a scare tactic — the desperate response of a town coping with the devastating and far reaching effects of addiction. Taking an aggressive position against addiction can make you feel like you are doing something, Carrie Wilkens, co-founder and clinical director of the Center for Motivation and Change, a drug use recovery program, wrote in an email. And that feels better than helplessness, or fear.
The reality is, though, that scare tactics aren’t a good strategy when it comes to drug addiction, Szalavitz says. Addiction is a compulsive behavior that by definition continues despite the negative consequences — getting arrested, hurting families, wasting money, even possibly dying. Showing people who struggle with drug addiction photos of someone overdosing with a child in the back of the car isn’t going to keep a drug addict from using drugs.
"I think part of the thinking is that this’ll scare people straight," says June Tangney, a clinical psychologist studying moral emotions at George Mason University. "There’s no evidence that that really works, either. People use drugs for a lot of reasons. Probably if they had a choice — if it were really a choice — they would not choose that lifestyle."
"It’s a very outrageous and awful thing to do."
The photos are particularly damaging, Szalavitz says, because they not only shame the two adults, but also the four-year-old child in the back of the car. It makes a traumatic situation even more traumatic. "It’s a very outrageous and awful thing to do," Szalavitz says. "If we want to fight addiction, we need to treat people with dignity, compassion, and respect."
Public shaming has been a punishment tool for centuries: brandings, or forcing criminals to sit in wooden stocks for the whole town to see. That’s not a thing of the past, either: in 2014, a Cleveland man was sentenced to hold a sign that said "I am a bully. I pick on children that are disabled" for five hours.
In this case — when dealing with addicts — one of the main problems of this style of punishment is that it can make addiction worse. Shame is particularly harmful to people who struggle with drug addiction because it sends this message that the person is worthless; it cuts the social support drug users need to recover and stay clean. "Shame is basically social rejection," Szalavitz says. "It says you’re bad and you’re incorrigible. You’re useless."
What’s more, shame discourages people from seeking treatment: people who want to avoid the stigmatizing label of junkie might avoid facilities where care is available. That’s because of the misconception — spawned by prejudice — that only junkies need treatment for drug addiction.
"Research has shown us time and again that shame and addiction are a potentially lethal combination," Wilkens.
Shame makes people want to run away and hide
That’s because shame makes people want to run away and hide, says Jessica Tracy, a psychologist at the University of British Columbia. And drugs and alcohol can feel like an escape route — which can fuel a spiral into increasing substance abuse. Her research found that feelings of shame made people with alcoholism more likely to relapse, because those feelings pull people into a vicious cycle: feel shame, drink to escape, feel more shame about the drinking, drink again. (That’s different from feeling guilt, she points out, which is more about the bad action, than the bad actor. "It motivates people to take positive steps towards change," Tracy says.)
"The amount of shame people feel about their addiction directly predicts their ability to get over it," she says.
Other research confirms Tracy’s findings. In a 2007 study, for example, scientists reviewed the use of "confrontation" — shaming and humiliation — in addiction treatment. They found it was not effective. "Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling," they concluded, "whereas a number have documented harmful effects."
"Our intent here was to try and help."
The city of East Liverpool stresses that they didn’t want to disrespect anyone. "Our intent here was to try and help," Allen says. "To help everybody that’s facing this epidemic. Everybody in this country knows someone who uses heroin. We’ve got to help those people." And no one denies that. But posting graphic photos on Facebook wasn’t the way to do it.