The Norm Chronicles (14 page)

Source: Health Protection Agency, 2012

Again, these risks vary according to such factors as the strength of the virus in the infected person’s bloodstream. For gonorrhoea, see
Figure 13
, the risk of infection has been reported as up to nearly 1 in 2 for heterosexual partners.
¹⁰

And then we must remember that sex can be energetic, which itself carries a risk. It’s been recently estimated that 1 in every 45 heart attacks is triggered by sexual activity.
¹¹
Luminaries such as Nelson Rockefeller, Errol Flynn, President Felix Faure of France and at least two Popes are said to have succumbed this way. Solo sexual activity used to be associated with blindness and stunted growth, for which let’s say there is a limited evidence base, but if it involves asphyxiation it is not recommended for the cautious. Numerous fatalities have been recorded,
including David Carradine, Michael Hutchence and a British MP. A study recorded 117 deaths from just two states in Canada.
¹²

Finally, sex has to be the moment we mention optimism. Kelvin isn’t the sexually careful type (see the Fray Bentos metaphor/image). No surprises there. A variety of attitudes can complicate sex and risk, and he has plenty, not least a heroic lack of self-control (see eating Kath’s flake).

The first of these attitudes is wish-fulfilment, behaving as if what you wish to be true, will be true, as in ‘It’ll all be all right’. This is funny to watch in young children – ‘Can I drive the car, daddy? I won’t crash.’ – less so in adults, but still common. The puzzle is that we know we do it, and we still do it. As the Buddy DeSylva song ‘Wishing Will Make it So’ (from the film
Love Affair
) says: ‘Wishing will make it so/Just keep on wishing and care will go.’ This also goes by the glorious academic name of ‘desired end-state’ bias, in which you calculate that the risks are lower for no better reason than you would like them to be lower. ‘You won’t get pregnant. It’ll be fine.’ People are similarly reported to underestimate the chances of divorce or losing their job – because they don’t want it to happen.

Call this positive thinking, but bear in mind the following examples, useful because they quantify the ‘it’ll be all right’ tendency. First, the ‘demonstrated, systematic tendency for project appraisers to be overly optimistic’ during building projects. What could possibly go wrong with a building project? Plenty, as we all know. Project appraisers know this too. But still they tend to underestimate the risks – so much so that the UK Treasury forces them to make a formal adjustment for over-optimism.
¹³
So for capital spending on developing new equipment, even when you think you’ve thought of everything that could reasonably go wrong, add between 10 per cent and an astonishing 200 per cent for all that probably will. For the time it takes, add between 10 per cent and 54 per cent. Even for standard buildings, add up to 24 per cent to the projected bill; for non-standard civil engineering add up to 44 per cent to your best estimate of the cost.

A related problem is known as the planning fallacy, most famously demonstrated by 37 psychology students whose average estimate of the time it would take to finish their thesis was 33.9 days, or 48.6 days if
everything went as badly as it possibly could. In the event, the average time was a whole week longer than that.

It’s been suggested that we are ‘hard-wired for hope’,
¹⁴
since hope for a better future might encourage us to strive for it. If this is true, evolutionary fortune favours the optimistic. This is also a conjecture. For though it might be true that over-optimism helps Kelvin’s genes spread far and wide, that’s not what he’s striving for. His is the wrong kind of optimism.

Another explanation for over-optimism is that you know yourself better than you know others. Asked to think about the risk that someone else will be accidentally knocked up and, lacking stats about average behaviour, we might try to picture a typical case, but really invent a crude caricature. Who is she, this slapper who typically gets pregnant? ‘Well, she’s drunk, she gets around, she just doesn’t care, she’s almost asking for it.’ In other words, if we think about the risk of getting pregnant, we tend not to think of statistical averages, we tend once again to conjure up images of extreme cases. Then if we compare ourselves to these extremes, we might say: ‘That’s who it happens to, and I’m not like that, so I’ll be all right.’

The moral of this? That given sufficient motivation – and sex is often a powerful one – risk is easily confused with morality, hope and even convenience, especially in the stories we tell ourselves.

9
DRUGS

P
RUDENCE DRAINED HER COCKTAIL
of butanol, iso amyl alcohol, hexanol, phenyl ethanol, tannin, benzyl alcohol, caffeine, geraniol, quercetin, 3-galloyl epicatchin and 3-galloyl epigallocatchin.

She felt the dark brown liquid flow around her mouth, sucked it down, swallowed, eagerly, gratefully. The chemical concoction seeped into her body, the liquid radiated warm, sedative comfort. She knew the effects; in her short life she had already come to depend on them. Her eyelids fell, she leaned back in her chair and let out a long, tranquillised sigh as her arm fell to the table with the empty cup.

‘More tea, Pru?’ said Norm.

A grey afternoon. And Kelvin had never felt greyer, or sicker. All colour gone, from him, from the parade of shops he walked past, traffic it hurt his head to look at as he crossed the road, mad visions of even his blood’s redness leaching away.

Sensation gone too, except pain. Pain that began hours ago between his shoulder blades, spread through his ribs into a 10-tonne, coat-of-lead ache with every step. Moaning for relief through the metal taste in his mouth, the insomnia-lethargy, nausea, dehydration, irritability, anxiety, tearfulness and shot concentration, he needed another hit, now, to ease the pain, but he was all out. ‘Now’ was all he could think of. Another, now.

Kelvin spent his entire youth seeking instant gratification. At 18, he’d done enough mandy to ski in – bombing a half gram of powder at 5 a.m. at a festival one day and after that hooked, the mad looking-and-not-seeing and then seeing it all different and weird in the street lights. He loved it. He didn’t stop until several years later, when his heart felt different, pumped different, the twitching hands and feet, and aches. So he quit pure, powdered MDMA, took something for the aches it bequeathed him, which became pains, took some more and now craved that instead.

He knew where to go and knew the routine. Be there, just before 6, with the money. So here he was, carrying his coat of pain, sweating. He ducked inside. The man he knew only as ‘the man’ was there, sure enough. Always the same man, same coat, same place, lurking in the back. They nodded. Kelvin walked over. The man had it. Kelvin handed him the cash.

Then the man said what he always said, the same taunt every time, knowing Kelvin would be back: ‘Shall I put the repeat prescription and the receipt in the bag for you, sir?’ he said.

‘Please,’ said Kelvin. And he left, cradling his Vicodin like a baby, fumbling at the foil inside the bag to pop some before he was even outside the chemists.

‘And you took it why?’ said Prudence on another occasion.

‘Ah, well, you see … balance of probabilities weighted by risk perception …,’ said Norm.

‘Oh God,’ she said.

It turned out that Kelvin had been goading Norm again, this time by saying Norm’s idea of the wild side was two cups of tea.

‘So the question was how to experience a risk sensation with modest objective risk,’ Norm said. And after refining the options – how to maximise
frisson
per MicroMort, etc. – it came down to horse-riding … or Ecstasy.

‘Am I really hearing this?’

‘Death is possible in either case, naturally, but the point is to stick to practical calculations on an objective basis.’

‘Is it really?’

‘Of course, procuring a tablet was going to be an issue, so I approached a man outside the Big Lurrve Club who was suspicious but helpful, picked up a Lucozade and
Horse and Rider
at Smith’s and studied the form, so to speak.’

‘And?’

‘Well, do you see a horse? Serious adverse event every 350 exposures! Obviously, logically, I dosed up and blissed out,’ said Norm.

‘And did you have to play
Happy Hardcore Mix
quite so loud?’

PEOPLE HAVE TAKEN
mood-altering substances ever since they had moods. Remains of opium poppy husks have been found in Neolithic settlements in Europe; natives of South America have long chewed coca leaves as a mild stimulant or to suppress pain; almost everything edible has been fermented to make alcohol.

There are many drugs, and about every drug’s risks and benefits there are many opinions. In this chapter we’ll sample that opinion, one of the widest, wildest and most diverse spreads of opinion about any risk,
*
to see how diversity squares with numbers.

The arguments have been around long enough. Opium in the 18th and 19th centuries was variously described as an inspiration, a medicine and the devil. Some writers romanticised it. Samuel Taylor Coleridge took laudanum (from Latin
laudare
, ‘to praise’), a tincture of 10 per cent opium in alcohol, before writing the poem
Kubla Khan
(1797), ‘composed … in a sort of Reverie brought on by two grains of Opium taken to check a dysentery’ – until famously interrupted by a person from Porlock.

By contrast, John Jasper in
The Mystery of Edwin Drood
(1870), by Charles Dickens, awakes in a squalid opium den alongside a drooling Lascar, a haggard woman and a Chinaman convulsed by gods or devils. Jasper is a choirmaster, but in Dickens’s hands opium betrays his degeneracy.
²
In Oscar Wilde’s
The Picture of Dorian Gray
(1890) ‘There were opium dens where one could buy oblivion, dens of horror where the
memory of old sins could be destroyed by the madness of sins that were new.’

In politics and business too fashions changed, and not just towards prohibition or censure.
*
Drug production went from cottage industry to industry proper, beginning in about 1827 with Heinrich Merck’s commercialisation of morphine, an extract of opium, laying the foundation of the Merck pharmaceutical company. Britain, as now, had a trade imbalance with China, and whereas today Britain exports malt whisky to the Chinese, in the 19th century the East India Company fought two wars for the right to ship them opium.

Heroin, also known as diamorphine, was first derived from morphine in St Mary’s Medical School in London in 1874, but was rediscovered by the Bayer pharmaceutical company in 1897 and marketed as a non-addictive painkiller and cough medicine. Meanwhile cocaine was extracted from coca leaves. ‘Cocaine toothache drops – Instantaneous cure!’ was one product for children. Sigmund Freud was one of many cocaine enthusiasts, as was Sherlock Holmes, to Dr Watson’s disgust:

‘Which is it to-day?’ I asked, ‘morphine or cocaine?’ He raised his eyes languidly from the old black-letter volume which he had opened. ‘It is cocaine,’ he said, ‘a seven-per-cent solution. Would you care to try it?’ ‘No, indeed,’ I answered, brusquely.
³

Today a modern Holmes equivalent, Dr Gregory House in the medical TV drama
House
, can use and abuse Vicodin, a painkiller and opiate, just like Kelvin, even as politicians speak of a war on drugs. Romance and heroism still sit side-by-side with the end of civilisation, amid the stars and in the gutter.

Compare the following edited extract, from the oral testimony at a meeting of Narcotics Anonymous of a man who lost his daughter and
brother to drug abuse, in which drugs are the mark of a life almost born to ruin –

Because me dad was always kicking fuck out of me mother and there’d be blood on me and blood on me brother an that and I’d be hiding me brother under the bed. And so I got out when I could. And what me dad done is he said I’d never be anything and he put all his hang-ups and all his issues and all his negative perceptions on me. And the way I coped with that is I became very paranoid and very angry with anyone who slighted me and I learnt how to be violent and how to get amongst people and hide really well. I started using when I was eight. Robbing Diconal off the prostitutes … And so when I was 20 I finished up doing 13 years in high security and I didn’t know who I was so anyone who had any identity I mixed with them. I was hangin’ out with the Palestinians and the Moslems and I grew a beard. I was just taking on anyone’s grievance as my own. And what me mum said about that she said, ‘Better bring him some gear, straighten him out.’ (laughter)

– with this, from Hunter S. Thompson, drug glutton and author of
Fear and Loathing in Las Vegas
, who had a journalistic style once described as extreme participatory fieldwork –

I like to just gobble the stuff right out in the street and see what happens, take my chances, just stomp on my own accelerator. It’s like getting on a racing bike and all of a sudden you’re doing 120 miles per hour into a curve that has sand all over it and you think ‘Holy Jesus, here we go,’ and you lay it over till the pegs hit the street and metal starts to spark. If you’re good enough, you can pull it out, but sometimes you end up in the emergency room with some bastard in a white suit sewing your scalp back on.
⁴

The point again is the variety of view – from deadly to life-affirming. Ideas of what it is that’s at risk have also shifted: it’s not just health at
stake now but relationships, employment, crime, rainforests cut down to farm coca – far away from the drug-taker.

To many, drug abuse is used needles, squalor and everything the film
Trainspotting
is about. To others, it comes with a corporate logo. Some addictive drugs – painkillers like Codeine, for example – are available over the counter; others – alcohol at the pub – may be woven into a way of life. Cathryn Kemp ‘used to think a drug addict was someone who lived on the far edges of society. Wild-eyed, shaven-headed and living in a filthy squat,’ until she become one.
⁵
What began as a legitimate need for pain relief and a painkiller called Fentanyl became a comfort as she consumed it the way she’d take a glass of wine to unwind at the end of the day, then moved to dependency, then to about ten times the maximum recommended dose, then to thinking only of the next hit, living only for the drugs, raging at her family, finally accepting that she was an addict and a brutal rehab, all via nice packaging and clean suppliers at local chemists, much like Kelvin.