“I’m going to get some medicine,” the youth said out loud to us. We were standing in a homeless shelter in America, and the guy was saying he meant to go buy some narcotics on the street and use them.
“Hmm,” my co-worker said carefully to the kid. “What do you do to keep yourself safe while you do that?” I listened quietly, trying to keep my facial expression neutral. It was hard. I hate drugs.
The shelter ran on a philosophy called “harm reduction.” The strategy, which is nearly universal in American social service agencies, said that the best way to address unsafe behaviour was to overlook its morally objectionable nature and focus on pragmatic aspects of safety. For drug addicts, that included access to our homeless shelter, sobriety not required. The approach could be tough to implement – but it had major benefits. The perspective is so useful, in fact, that it can help Bangladesh’s political process right now.
Harm reduction thinking is certainly novel in South Asia. When I was helping teach a public health course in Dhaka, one assignment involved coming up with a method to address addiction. “Tell them no,” one student said. Tell addicts that people don’t like their addiction, he advised, and then ban all drugs.
How simplistic, I thought. Banning drugs has already happened worldwide – but has never succeeded at making drugs less available. It may have even changed international markets to make drugs more prevalent. Nor do addicts get addicted because they’re mistakenly convinced that everyone approves of drugs. A simply ban is not enough.
At first, I thought this intelligent student simply didn’t know much about drugs (why would he, in a country with so few users?). But over time, I noticed how many people shared his thinking in many other settings. Recently, an op-ed called out Bangladeshis for intolerance and a desire to ban, banish, or hang anything or anyone that offends. It seemed spot-on. The urge to hold a journalist in contempt of court just for questioning an official truth is another example. The insistence on hanging every single war criminal and banning their party is rather the same.
The thinking behind harm reduction is nearly opposite to this urge. Instead of moralising or taking offense at a troubling phenomenon, it looks at objectionable behaviour and asks how to avoid the harm that might arise from it. In the process, it often requires asking why people are motivated to do what they do. Rather than threatening others to force them to meet our standards, harm reduction operates under the slogan any positive change. The idea is to establish trust as a part of helping people make steady improvements at a manageable pace. Evidence said it worked better at getting drug users to quit than simply “telling them no.”
It’s not all that necessary for addiction in Bangladesh, if only because the country has so few addicts compared to other nations. But Bangladesh has plenty of mistrustful people – including some who engage in very troubling behaviour. Jamaatis who hold endless hartals, attack Hindus, and sometimes kill people, come to mind. To manage this threat, harm reduction might be relevant.
To do this would be incredibly hard at times, as I know from my experience with individual clients I worked with in the homeless shelter. It is even tougher – and yet even more important — to use the technique for large-scale social change.
It’s incredibly challenging to use it on Jamaat, who have been the source of such intense trauma for people in Bangladesh and who remain so arrogant today. Yet banning Islamists is as useless as banning drugs, which remain a major force in the world economy no matter which side of the law they are on. People who adhere to Islamic fundamentalist beliefs aren’t going to simply disappear because we say no. The only choice one has is reducing the harm they do, talking them out of their dangerous beliefs and habits. Instead of seeking their annihilation, the realistic goal is any positive change– towards a goal of huge positive change– incrementally, with slow persuasion to the most peaceful path.
Back when I worked at the shelter, I’d do an overnight shift each Thursday, chatting with people about what they did to stay safe when they went out scoring heroin. In the morning, I’d lock up the shelter and head to a masjid, where I’d sit in the women’s section, with head covered, and listen to the Friday prayers.
The masjid was a moderate place. Located in the middle of downtown Chicago, and it served every kind of Muslim – male and female, Arab, Asian, white and black, from janitors in dirty uniforms, to judges in bespoke suits. But in Chicago, as in many other places, people were concerned about Islamic fundamentalism. For me, there was no debate: I hate fundamentalism as much as I hate drugs.
But sitting in the mellow space, I realized that the Prophet’s first and most important innovation in the seventh century Arabian Peninsula was to stop a long-standing pattern of internecine warfare. The first point of Islam was to turn fractured, conflict-ridden groups into one large peaceful society, emphasising moderate and peaceful methods. I thought of how ironic that was, given the tremendous amount of counterproductive, confused, and wasteful violence between fundamentalists and their opponents in the world in this century.
And as I sat in the masjid, I would reflect on the harm reduction work I had just done. A question often came into my mind: if you can slowly talk someone out of slamming heroin, how come we can’t talk people out of Islamic fundamentalism?
I’ve never found anything that shows we can’t.
Sophia Newman, MPH, is a freelance writer. She completed a Fulbright fellowship in Bangladesh in 2013, and is currently reporting in Africa.