On April 29, 2014, marijuana activist John Payne would enter an abandoned cell with yet another tragic victim of America’s justice system. Jeff Mizanskey, a 20-year-old Missourian, was sentenced to life imprisonment in 1994 after his third non-violent offense of marijuana possession (ABC 17 News). The two men sit parallel to each other, discussing the prison system’s biased discrimination against marijuana possession, the medicinal benefits of cannabis, and wrap up with a human rights debate on the ethics of incarcerating nonviolent “criminals” (ABC 17 News).
During their discourse, Mizanskey proudly identifies with the term “law-breaker,” as he recognizes the fragility of Missouri’s laws during the time of his imprisonment (ABC 17 News). As he puts it, “just having a couple grams [of marijuana] in [his] pocket was enough to break the law” and justify stripping him of his rights to his family, society, and dominion over his daily affairs (ABC 17 News). What’s more, Mizanskey dismantles society’s unfounded bias towards marijuana possessors through an assessment of the numerous applications that marijuana has in medical affairs. He references the vast scholarly literature on marijauana’s applications in alleviating adolescent epilepsy symptoms, chemotherapy side effects, and treating visual impairments such as glaucoma - all of which are supported by contemporary medical research conducted by reputable institutions such as the American Cancer Society and The American Academy of Ophthalmology (ABC 17 News; American Cancer Society; The American Academy of Ophthalmology).
Mizankey attributes his imprisonment to society’s conceptual association of “marijuana'' with “harmful”; though he fails to properly analyze why this is so, on account of this being a colloquial conversation rather than a planned debate (ABC 17 News). However, there’s something interesting to note about the events that transpired after the release of Mizanskey’s ABC interview and assessment of America’s ill-informed prejudice against marijuana despite it’s medicinal benefits. 3 years following Mizanskey’s interview, on a November 2018 voter initiative, a whopping 65% of Missourians would vote for the legalization of medicinal cannabis, resulting in the approval of Article XIV - an amendment to Missouri’s constitution that enables doctors to prescribe medicinal cannabis to patients they feel need it (Ballotpedia).
By ‘medicinal,’ it is meant that the chemicals within the drug such as cannabidiol, a chemical used to treat epilepsy symptoms, or cannabichromene, a drug associated with a reduction in cancerous tumour size, are used treat disease and/or illness that traditional pharmaceuticals show little effect on (American Cancer Society; The American Academy of Ophthalmology). Given the relatively short time period between the interview and Article XIV, I would like to investigate the extent to which Mizanskey’s interview could have impacted Missouri’s decision to legalize medicinal cannabis. This is not to assume a relationship between correlation and causation, but rather to explore how public challenges to societal structure, such as Mizanskey’s interview, can elicit societal advancement - a lesson I feel is necessary for modern activists endeavoring to reform societal systems that have been in place for centuries.
To understand the significance of such a question, it is necessary to understand something that Mizanskey’s interview, unfortunately, leaves out, which is how marijuana criminalization historically stems from America’s history of minority oppression and xenophobia. Alex Krief, Professor of Criminology at the Arizona State University, analyzes marijuana criminalization’s history of prejudice in his book titled Marijuana Legalization, published in 2009. In it, Krief discusses America’s poorly-hidden past in masking racial spite under the guise of “law enforcement,” asserting that “many early drug laws were passed expressly for the purpose of discriminating against minority populations,” with cannabis being only one of the many drugs weaponized to suppress non-white populations (Krief, 124).
For instance, stepping outside the scope of marijuana, one such example of this was the prohibition of opium smoking in 1914, which suspiciously coincided with the assimilation period of Chinese-Americans following the California Gold Rush of the late 19th century. Chinese citizens fled their country en masse to escape the economic consequences of China’s overpopulation - taking their culture of opium smoking with them (Calisphere). Krief juxtaposes this with the analogy of marijuana criminalization in 20th century America, as he notes that support for marijuana prohibition laws rose sharply during the era of Jim Crow - where African Americans began to culturally advance in society through the arts, despite the evident increase in racial segregation (Krief, 23). He posits that the government actively took advantage of African Americans’ history with cannabis smoking to marginalize and suppress black Americans and maintain the U.S.’s ‘white tradition’ in the same way that opium criminalization was used to repress the influx of China’s foreign culture.
To individuals who are unfamiliar with America’s history in suppressing marginalized groups, this may seem to be a ridiculously sweeping claim - and yet it’s supported by evidence from a 1994 Harper Magazine Interview, where Former President Nixon’s Assistant of Domestic Affairs, John Ehrlichman, proudly proclaimed that politicians’ motives for marijuana criminalization, both at the time of the interview and in the past, was purely to disrupt the black household, stating “We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did” (Briggs, 107). Of course, there’s the question of why white Americans - notably white politicians - were so eager to repress marginalized groups to begin with - a question that is aptly answered by science reporter Brian Resnick, who theorizes that white Americans fear what he calls a “minority-majority shift,” where white Americans lose their constraint on American culture and would, instead, have to distribute political control to other populations - thereby stripping them of their majority status and consequent ability to bend the criminal justice system to their favor (Resnick).
At face value, this information doesn’t seem to relate to Mizanskey - a middle-classed caucasian who would politically benefit from the empowerment of white Americans. However, through eliciting a conversation between these sources, I’d assert that there is an inherent connection between 19th century America’s racial motives for criminalizing marijuana and America's current attitudes towards marijuana possessors in general. If America’s criminal justice system has spent centuries enforcing strict laws on drugs associated with minorities, such as opium in the 19th century and marijuana in the 20th century, then there is new variable introduced in the 21st century that would prevent modern America from upholding the same tradition of harsh drug enforcement, even if the historical reasons for this enforcement have somewhat dissipated over time. As such, through assessing how Mizanskey’s interview could have shaped something that is so deeply ingrained in historical racism and white supremacy, I believe we can apply such a formula to shape other racist aspects of societal superstructure that aren’t challenged as often by the public, such as modern opium criminalization that stems from the aforementioned xenophobia experienced by Chinese Americans in the late 18th century.
To answer the question of how Mizanskey’s interview could’ve influenced Missouri’s decision to legalize medicinal cannabis, I’d acknowledge the work of Dr. Anna Taylor, whose work surrounding the normalization process of antidepressant prescription in contemporary medicine prompts me to assert that Mizanskey’s broadcasted analysis of the medicinal benefits of marijuana may have contributed to the legalization of medicinal cannabis by increasing viewers’ understanding of its medicinal properties, prompting viewers to reconsider their stance rather than remain stagnant in their repulsion towards marijuana (Taylor et al.). I derived this conclusion from their application of a recent theory in healthcare sociology called “Normalization Process Theory” (NPT), a model developed to “identify key mechanisms that promote and inhibit the implementation, embedding and integration of new health techniques and technology” (Taylor et al.). Essentially, this model exhibits 4 requirements that must be fulfilled by medical practitioners for a new healthcare technology or technique to be integrated into modern medicine: “coherence” - the ability to think critically about the purpose and basic working of a new technology; “cognitive participation” - the ability to understand the benefits, value, and downsides of a new technique; “collective action” - the open-mindedness to engage with the technology; and “reflexing monitoring” - the ability to reflect on the utility of the healthcare technique after observing its effects.
In the context of Taylor’s work, Taylor specifically emphasizes the importance of the cognitive participation - or ‘understanding’ - element of this theory through an experiment conducted on general practitioners (GPs) at the BMC Family Practice Facility, where experimenters had GPs participate in interviews that tested their understanding of antidepressant prescription in the context of ‘psychiatric collaborative care’ - a system in which healthcare practitioners and patients collaborate with one another to assess the patients’ mental health and necessary antidepressant prescription (Taylor et al.; American Psychiatric Association). The study found that many GPs lacked fundamental knowledge on the concept of collaborative care and antidepressant prescription, with many admitting that “[they] don’t know what collaborative care is” to start with, despite being aware that one of their primary goals is to support patient mental health (Taylor et al.). What this highlights is a lack of understanding of the utility of antidepressants in contemporary medical practices, which Taylor et al. found would directly translate to “poorer mental health symptoms in their patients” (Taylor et al.). Through application of the NPT model, Taylor et al. positions the theory and the results of their experimental findings to assert that a greater understanding of collaborative care and antidepressants is vital to general practitioners applying said antidepressant techniques in their approaches to providing aid to their patients (Taylor et al.).
This element of ‘understanding’ is equally emphasized by Mizanskey - who asserts that contemporary America’s aversion to marijuana usage is entirely due to a lack of knowledge on the medicinal benefits of cannabis (ABC 17 News). In his interview, Mizanskey emphasizes the various medicinal applications of cannabis that aren’t typically recognized by society. For instance, he details how “marijuana helps in a lot of cancer treatments,” referencing the utility of cannabichromene in reducing cancerous tumour growth by 60%, how it “helps children suffering from epilepsy,” referencing how cannabidiol has been correlated with a 43.9% decrease in seizure frequency in adolescent epilepsy sufferers (National Cancer Institute; Zaheer et al.). Mizanksey posits that a lack of understanding on how these benefits can help the public results in the very marijuana-strict laws that elicited his life imprisonment in 1994 (ABC 17 News). Through comparing the information between both sources, I would assert that there is massive significance in the correlation between ‘understanding’ and the potential of normalization.
In his interview, Mizanskey provided an enriching analysis of a side of marijuana that society rarely considered at the time of his imprisonment. In the same way that Taylor posits that enriching GP’s understanding of the benefits of antidepressant prescriptions may elicit increased prescription through Normalization Process Theory, I would argue that the same logic could be applied to assert that Mizanskey’s conceptual development of this under acknowledged medicinal element to marijuana cultivated viewers’ understanding of cannabis to the point of Missouri legalizing it for medical practices.
Of course, should this assertion be correct, I would also add to it by positing that Mizanskey’s informative analysis on the medicinal aspects of marijuana was likely as effective as it was due to the media’s tendency to purposely distort or withhold such information for a particular agenda - an agenda that, unfortunately, may not have evolved as significantly as one would think since America’s history of using mass media to repress minority populations. The reason I feel there needs to be an explanation on the effectiveness of Mizanskey’s ‘informative’ analysis is because Mizanskey is an average middle-classed Missourian with no specialty in medicine or pharmaceutical science, so it's necessary to consider why the information presented in his interview would even have such a profound effect in the first place?
In answering this, I think it is necessary to refer back to the aforementioned 1994 interview with Nixon’s representative, John Ehrlichman, where he unapologetically admitted to America’s history of spreading misinformation on drugs to antagonize people of color and repress their cultural advancement in society, such as the media purposefully misrepresenting marijuana to further marginalize African Americans in the 19th century, who were culturally associated with the drug at the time (Briggs). The term coined for this is ‘media bias,’ described as “the perceived bias of journalists and news producers within mass media in the selection of events and stories that are reported, and how they are covered,” and it often influences societal perceptions of the marginalized groups being misrepresented (Aggarwal). Historical examples of these have been discussed (i.e. opium with Chinese Americans, and marijuana with African Americans), though it's equally important to recognize the more modern instances of this that have expanded past simple drug misrepresentation, such as the disproportionate portrayal of black criminal activity in comparison to white criminal activity, which various statistical analysts posit are a root cause of disproportionate sentencing (Sims). At face value, it’s difficult to pin down the motivations behind this media bias, given that such motives are not liberally advertised to viewers.
However, calling back to Resnick’s aforementioned “minority-majority” shift model, where he claims that white Americans have had a history of suppressing minorities for fear of losing political power and cultural authority, I would assert that his model can be extended from a historical analysis to a more modern analysis. By this, I am suggesting that the historical motives for the lack of fair representation of marijuana in the past is analogous to the historical motives for the lack of fair representation of marijuana today, given that we see similar patterns in the media’s behavior in regards to minority representation. Given this, I believe a further development can be made to my thesis of Mizankey’s interview influencing Missouri’s decision to legalize medicinal cannabis by enriching public knowledge of medicinal marijuana through NPT. In order for this “enrichment” to occur, there would need to be an initial lack of public knowledge on the medicinal aspects of marijuana, which historical and contemporary evidence indicates may be due to media bias in the presentation of marijuana, stemming from contemporary motives to prevent the shift of white Americans from a majority position in society to a minority position.
Yet, despite the historical and contemporary evidence supporting the plausibility of my application of NPT, there is a major flaw in NPT highlighted by David James Clarke, a Doctor of Sociology from the University of Leeds, who criticizes NPT for failing to “explicitly locate this within the organisational and relational context in which this implementation occurs” (Clarke). By this, Clarke is referring to the fact that, if a process has yet to have been implemented into modern healthcare, there is likely something in the environment that has prevented this implementation from happening, which is not accounted for in NPT. Although, initially, the significance of this is not immediately evident, Clarke claims that the link between healthcare technique implementation and the external factors working against this implementation cannot be set aside in NPT, since “NPT generative mechanisms are in dynamic interaction with these local contexts and external drivers'' (Clarke). For instance, this line of thinking can be applied to critique Taylor et al’s conclusions from their experiment with GPs. They posited the mechanism by which hospitals can enhance the mental health care provided by their general practitioners: if they better informed their GPs on the utility of antidepressants and collaborative care in treating mental illness, these GPs would be more inclined to utilize them in medical practices, thus successfully implementing antidepressant prescription into the hospital’s mental health care system.
Not only was this hypothesis never tested, but should it have been tested through experimentation, Clarke’s analysis would indicate that this experimentation may not have been very successful, since there is likely a reason that GPs aren’t as well-informed on antidepressant utility as they should be. Without intellectually grappling with the dilemma of what could be working against GP knowledge of antidepressant utility, it is precarious to assume that their proposed mechanism of enhancing antidepressant utilization would’ve been effective.
For instance, applying this to Taylor et al.’s study, one variable that may have contributed to antidepressant underprescription could’ve been the lack of respect exhibited towards the field of psychiatry within the medical community. In a cultural analysis by Dr. Anna Mead Robson, Robson asserts that “most doctors identify psychiatry as the least respected medical specialty,” which is likely due to psychiatry’s history of misdiagnosing individuals with particular diseases due to cultural and psychological biases that many, unfortunately, many psychiatrists are influenced by - one such instance being psychiatry’s early role in America’s association of African Americans with insanity due to disproportionate diagnoses of schizophrenia in the 1960s (Robson). This lack of respect towards psychiatric practices could've manifested in a decreased inclination to incorporate psychiatric practices such as antidepressant prescription into their methods, though, again, experimentation would need to be conducted to verify this. Should this be true, Clarke’s theory would assert, even if you informed GPs on the effectiveness of antidepressants in mental health, there will always be this factor of psychiatric skepticism that will limit the potential for antidepressant prescription to be completely normalized. As such, Clarke’s emphasis on the significance of addressing the external factors that could inhibit NPT is very significant and not thoroughly accounted for in Taylor et al.’s study, and it poses a powerful challenge to my application of NPT to assess how Mizanskeys’s informative interview could’ve influenced Missouri’s stance on marijuana.
Although Clarke’s theory makes a compelling case for the significance of acknowledging the environmental factors, I would argue that NPT actually manages to acknowledge these factors through its other constituent elements. Taylor et al.’s study brilliantly highlights the significance of the “cognitive participation” or ‘understanding’ element of NPT through their reasoning on how GP antidepressant prescription could be related to GPs’ knowledge of antidepressants and collaborative care, however their conclusion lacks major emphasis on the other aspects of NPT that make the theory so formidable. For instance, returning to how psychiatry’s reputation in the medical community could inhibit GP antidepressant prescription, one aspect of NPT that could be used to discuss this is the “collective action” element, which addresses the need for open-mindedness in medical practitioners to engage with new techniques and technologies, rather than remain stagnant in their thoughts towards such techniques. Additionally, the concept of “reflexive action”, being willing to assess the effects of a newly implemented technique after implementation could potentially resolve the issue of GPs fearing the negative effects of antidepressants on certain patients. Ultimately, although Taylor et al’s specific study doesn’t liberally emphasize the significance of these other elements of NPT, I would argue that these elements embedded in the theory allow NPT to accommodate for these “external factors” that Clarke highlights in his criticism of NPT (Clarke).
If we were to apply Clarke’s argument to the thesis of Mizanskey catalyzing Missouri’s decision to implement marijuana into modern healthcare through informing the public on a side of marijuana that is not typically highlighted by the media, Clarke would likely assert that there is no correlation between the public’s knowledge of medicinal marijuana and the normalization of it - as Mizanskey’s interview never really addresses the factors in Missouri’s environment that prevented the public from knowing about these medicinal benefits to begin with - media bias. Even if Mizanskey enhanced his viewers ‘understanding’ of marijuana, there always would’ve been this misrepresentation of marijuana in the media that would undo that newfound understanding, suggesting that knowledge and understanding had nothing to do with Missouri’s decision. However, an acknowledgment of other elements in NPT indicates that there is still the possibility of Mizanskey’s interview having played a significant role in Missouri’s turnover. For example, the “collective action” aspect of highlights the importance of promoting open-mindedness to a new technique, which I would argue Mizanskey elicited through inviting his viewers to “consider people who use marijuana to get off hard drugs,” “people who have been exposed to marijuana when they were young,” and other individuals whose circumstances are not often represented in the media (ABC 17 News). One could also assert the “coherence” aspect - which emphasizes understanding the purpose of a new technique - through Mizanskey highlighting the various potential uses of medicinal cannabis in healthcare. As such, although Clarke makes a compelling case for the importance of these “environmental factors,” I would respond to his argument by highlighting how NPT has multiple different aspects to it that address these environmental factors.
Ultimately, the sources discussed above provide a multidimensional answer of how Mizanskey’s interview could have shaped Missouri’s decision to legalize medicinal marijuana in 2018. There is the initial concept of NPT utilized by Taylor et. al’s study of GP collaborative care and antidepressant prescription, where I posit that the cognitive participation element of this theorem suggests that Mizanskey’s informative interview could’ve influenced Missourians through highlighting an aspect of marijuana that is typically shunned by the media (Taylor et al.). Further developing that through historical analyses of media bias and its relation to historic racism provided by Krief, Briggs, and Resnick, indicates that the reason Mizanskey’s information may have been so effective was due the media bias that has been utilized to (Krief; Briggs; Resnick) misrepresent drugs like marijuana to repress the societal advancement of people of color. However, given that the initial purpose of this research was to highlight how a small interview such as Mizanskey’s could impact such a momentous decision in Missouri, I think it's necessary to next ask the question of how modern activists, such as the activists that pushed Missouri to release Mizanskey after his interview, could spark a change contemporary America that would combat the very systemic racism and consequent media bias that led to Mizanskey’s imprisonment in the first place.
Mohamed Diagne is a 3rd Year student at the University of Virginia.
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