Drug Addicts in the Hellenic Armed Forces. a Ground-Breaking Study by Professor Demetrios Kouretas in 1930

WWW.HSJ.GR – HEALTH SCIENCE JOURNAL ® VOLUME 3, ISSUE 4 (2009)

Drug Addicts in the hellenic armed forces. A ground-breaking study by Professor Demetrios Kouretas in 1930.

Lazaros Vladimiros 1, Aristidis Diamantis 1,2, Apostolos Beloukas 2, Emmanouil Magiorkinis 1,2.

1. Department of History of Medicine, Faculty of Medicine, Athens University 2. Office for the Study of History of Hellenic Naval Medicine, Naval Hospital of Athens, Greece

Abstract

The aim of this study was to elevate from obscurity the results of Demetrios Kouretas’ research on the drug addicts in the Hellenic Armed forces during the mid-war period. Demetrios Kouretas, gifted with exceptional discernment, undertook a pioneering study regarding the use of addictive substances in the Greek Armed forces. Kouretas did not stick to the epidemiological parameters of the use of narcotics, but also tried to look into the reasons that led to drug addiction and to give an outline of the mental outlook of the drug addicts. Demetrios Kouretas brought forward the problem of drug addiction, which was considered as taboo. His study, based on a strict scientific basis, is considered a byword for the psychiatric research in Greece.

Keywords: History, Armed forces, drug addiction, Greece

Corresponding author: Emmanouil Magiorkinis, B.Sc., M.D. L. Aianteiou 3- PB 1541 18900, Salamina Greece Tel: +30-210-7486382 Fax: +30-210-7486382 e-mail: [email protected]

Introduction knew of the drug since the prehistoric and he history of drug use goes back many Minoan years 3. Opium was a basic centuries. Narcotics were known to component of an ancient greek remedy T ancient people and their civilizations called the “Thiriaki” (Θηριακή) which was not only for religious reasons but also for 1 considered as an exceptional therapeutic medical purposes . Drugs were used at the drug for more than 4,000 years 4. There is oracle of the ancient world and also during considerable evidence that opium-based initiation ceremonies. Many scholars believe medicines found use since the pre-historical the prophetic delusions of the Oracle 1 2 and Minoan times . The drug became part of “Pithia” were the result of drug use . Opium the therapeutic tools of doctors all over the is surely the most famous medicine in the world for many centuries including the 20th history of our world. The ancient Greeks century pharmaceutical companies. As Marios

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Marcellos professor of pharmacology at the Greek synonym is the word “thiriaki.” The University of Ioannina notes, many European dictionary meaning of the word is: the one doctors from the medieval ages through the who uses thiriaki, the opium-user, the one 17th century were called Doctor Opiatus, due who uses it with mania 8. to their frequent prescription of opium 5. Obviously, the drug was well known enough Cannabis is also a well-known drug for its to society and the world of science since a psychotropic qualities since the ancient word existed that described addiction to the times 6. substance. Since narcotics were in use ever since the ancient years, they played an important The use of narcotics during the beginning role in religious ceremonies, therapeutics, of the 20th century commerce and the history of civilization. Two cases exemplify the influence of drug Several high-profile cases of addiction use in the social life throughout history: The were noted among the social elite in the exclusive production of “Thiriaki” belonged early 20th century. Addiction to morphine to the Venetians because mainly of financial and ether was first observed in doctors, reasons and due to the Opium War during the nurses or people of their close environment first half of the 19th century between China 9,10,11. Addiction to cocaine was also often and England. noted in the world of arts. Opium and Many of the narcotics that currently cannabis were widely used by people of create serious social problems were legally lower income levels and the underworld. distributed in many countries for centuries. The use of narcotics gradually Their use was socially accepted with drug emerged as a serious social problem in the users facing no social exclusion or out 20th century. Toward the end of the 1920s casting. Scientists, artists and writers used and early 1930s, drug use, addiction and various narcotics for their psychotropic toxicomania in Greece emerged as not just qualities. Whereas the use of narcotics in the as an individual problem restricted to Exotic East was exceptionally widespread, on socially excluded users or between people of the other hand, all kind of narcotics have a small group, but as a problem for the also met their days of glory in the Western entire society. civilizations. In mid-19th century Paris, artists Historic medical records strongly note and scientists joined an elite club called The this change. The most widely abused drug is Hashish-Users Club 6. The French writer heroin, as opposed to hashish, the drug more Charles Pierre Baudelaire (1812-1867) wrote traditionally used by lower social levels. two works, Les Paradis Artificiels and Les Ploumpidis, professor and historian of the Fleurs du Mal, which were used as anthems Hellenic Psychiatry, based on medical for the use of narcotics7. Hashish, cocaine statistics published during the period and heroin are today considered illegal between the two World Wars, notes that substances. The use of narcotics for long between 1928 and 1930, 55 patients were periods of time lead many individuals to admitted in the Psychiatric Hospital addiction and toxicomania. And for this huge “Dromokaitio” for drug addiction therapy. Of and rather unresolved issue one should limit those 55, 40 were heroin addicts12. to mention just one example: To explain the This increase of heroin addicts during the meaning of the word “theriaklis” (excessive same time frame was also mentioned by Dr. user of something) and its similar Fokion Kopanaris (1883-1975) in 193313. “theriakliki” (excessive use of something). In While the number of heroin-addicted his dictionary, Stamatakos, professor of patients at the General Psychiatric Clinic of ancient Greek philosophy at the University of Athens was 10 in 1928, it increased to 51 in Athens (1896-1968), notes the word 1929, to 99 in 1930, and 113 by 1931. This originates from the Turkish word “tiriaki” dramatic increase of heroin use at that and the Persian word “tiriak,” while the period of time is closely connected with the

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history of this narcotic. Heroin, was initially Dr. Demetrios Kouretas (1901-1984) produced by Bayer as a non-addictive was widely considered one of the best morphine substitute and cough suppressant, military medical doctors of his time. After which could be used as a treatment for graduating from the University of Athens, he morphine addiction and was widely used studied at the famous Military Medical School between 1898 and 1910. However, it was of Lyon, France, on a military scholarship. At soon proved that it was quickly metabolized Lyon, he received many commendations for to morphine. The sale of heroin was banned his medical excellence. Many of the Greek in 1924 by the US congress, and since then military medical doctors that studied during manufacture of heroin became illegal. During that time at the Medical School in Lyon the period after the war the Italian Mafia, as helped the scientific evolution of the Greek well as the pre-communist China were nation16. Kouretas served in several actively involved in producing and selling distinguished positions including Director of heroin illegally and, therefore, the drug the Neuro-psychiatric clinic of the Military become extremely popular during the 1920’s Hospital in Thessaloniki (1927-1930), Director and 1930’s 14. of the Neuro-psychiatric clinic of the 6th Georgiadis (1876-1960), professor of Military Hospital in Athens (1931-1942), forensic medicine and toxicology at the instructor at the University of Athens (1933- University of Athens at the time, wrote that 1942), Professor of the Department of in the 1930s “dozens are the cases every Neurology and Psychiatry at the University of year at the coroners’ lab of deaths due to Thessaloniki (1942-1948). In 1964, he became drug abuse and mostly of heroin”15. He also Professor of Neurology and Psychiatry at the saw the the drug affected all classes: University of Athens where he introduced “Heroin poisoning is noted throughout all Psychoanalysis in Greece and authored social categories and ages of people, numerous scientific papers. Kouretas was unemployed and criminals, as well as one of the few people that influenced the wealthy and developed” 16. Georgiadis evolution of psychiatry in Greece. His blamed the increase of heroin-addicted numerous students founded a scientific individuals on the use of heroin as a school and many became university medicine, specifically as a therapy for professors and important members of the morphine addiction. scientific community16. As mentioned above, the lecture on Narcotics in Greece -- Demetrios Kouretas: drug addiction in the Armed Forces took a pioneer in psychiatry place in Athens in the beginning of December, when he was reassigned from The problem of narcotics - not just on Thessaloniki to Athens. Of course, the the individual level but as a major social published article that followed in 1932 was issue - appeared in Greece during the period enriched with more of his observations. of 1928-1930. In 1930, a military medical Later, he published more research papers doctor, psychiatrist Demetrios Kouretas, after studying the issue further16. To fully realized the medical, social, and military study and analyze drug addicts in the Armed importance of the problem of drug addicts in Forces, he collaborated with neurologist- the Armed Forces. On 3 December 1930, psychiatrist Dr. Skouras (1904-1953), a Kouretas gave a lecture on the dangers, to famous doctor and fellow graduate of the the officers of the Department of Medical Medical School in Lyon. Services and in the presence of the Greek A wise man is not the one who knows Prime Minister, Eleftherios Venizelos. The a lot, but the one who realizes things around lecture, “Drug addicts in the Armed Forces,” him that other people don’t “see.” The was published in a Greek medical journal in Goddess of Wisdom for the Ancient Greeks 1932 16. This study focuses on and analyzes was called “glafkopis,” meaning the owl. The this publication. word referred not to the large size of the

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eyes, but due to their quality – the bird that paradises” to deal with problems in their can see in the dark when all the other lives. External factors include depression, animals can’t see. Dr. Kouretas had the imitation, the social circle of the drug addict wisdom to see the problem in the military as and medical treatment, which implicates the well as its social aspect, when others around use of narcotic substances. For morphine he him ignored it or tried to profit from it 10. wondered that many morphine addicts begun from a single dose from a medical recipe” 16. The study by Demetrios Kouretas Dr. Kouretas strongly states his opinion, a view widely accepted today, that The 1930 lecture and the later the military environment leads itself more to publication are considered the first study in drug abuse than civilian life. He wrote: bibliography on drug addiction. The author “Military day life that claims total started his work by stressing that the issue of subjugation of individuality to obligations drug addicts in the troops needs special that arise from military discipline at all other attention by the officers for two reasons. inferiors, as well as abdication from all The first reason was the increased use of quirks and/or behaviors out of military narcotics during that period. More in detail, habits, creates opportune environment for he wrote : “ the propagation of toxic and drug use, especially to military prisons” 16. narcotic substances, for reasons of pleasure, Kouretas also describes in detail the has increased during the last few years symptoms that drug addicts of different dangerously threatening the balance of the substances show, analyzing in parallel the military troops”16. reasons for the spread of heroin, hashish and The second reason was the effect of cocaine. Kouretas notes the illegal drugs on the mental status of the soldier, production and circulation of those drugs making him incapable of adjusting to the across Europe. Heroin in Kouretas’ time and military environment and unable to perform in contrary with modern use of heroin, was his duties. Kouretas mentions that the data received through the nasal epithelium. for these observations were collected from Headache, nausea and muscle relaxation are examining patient soldiers from the Army of among the most usual symptoms that the Athens the Army of Thessaloniki, civilians, addict experiences after the first use of prisoners and patients in mental institutions. heroin, whereas after prolonged use heroin Kouretas study was not just a collection of causes constipation, anorexia and cases of addicts, but it was rather a stupefaction. Kouretas characteristically systematic, epidemiological study based on a describes heroin addicts to have an questionnaire examining all social and extremely pale face, “their head falls like psychological aspects of addiction. lead, their eyes are completely Heroin was the most commonly drug incommunicable when the addict talks or used followed by hashish, cocaine and laughs he gives the impression that he will morphine. The doctor remarked that the die soon” 16. preferences differed greatly from higher Another symptom, as Dr. Kouretas social classes. The social elite most often notes, is the lack of sexual urge in heroin used morphine and cocaine, while the lower addicts. In his study, Kouretas describes in levels preferred heroin and hashish. He also detail the need of the heroin addict to suggests different reasons that might drive gradually increase the heroin dose, as well people to the search and use of drugs. He as, the symptoms of the withdrawal separates these reasons to internal syndrome, which, according to Kouretas, can (predisposition) and external (by chance). lead to death if left untreated. Hashish as Internal factors include the psychological referred by Kouretas is being received temperament. People with a personality through smoking in the form of simple disturbance and with severe psychological cigarettes or with the use of special smoking problems usually find a haven in “artificial devices. Compared to heroin, hashish

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provokes stronger stimulation of the nervous about the `drug addiction issue in the Armed system. Symptoms caused by hashish use, Forces. according to Kouretas’ study, are cough, He set a specific dictionary with thirst, facial paleness, nausea and vomiting. words and phrases that heroin addicts used It is also notable Kouretas’ description of the such as: “junkie”, "fix”, “sniff”, “and getting symptoms of chronic use of hashish high”. For the hashish users he noted the resembling a form of ‘primitive dementia’ following phrases: “black”, “snort”, “whiff”. which include exhaustion and stupefaction, He also mentioned that the nargile used by anorexia and paranoia. Finally, cocaine hashish addicts in prison, was called by according to Kouretas’ study is not that inmates “Thanasis”, a Greek name, when the popular within the Armed forces. Dr Kouretas guards were around. Kouretas asked the characteristically states that “the victims of reader to excuse him for using “these vulgar cocaine are mainly members of and bad words,” but he intended to assist aristocracy”16. Cocaine as heroin is also medical doctors to understand the language received by the nasal epithelium, and its drug addicts used and to recognize these main symptoms include anorexia, increase of terms among the troops. The thorough muscular strength and tactile delusions. As recording of all the phrases and words used with heroin addicts, cocaine addicts by drug addicts shows how unconventional gradually increase the receiving dose in and original his work was. These drug addicts order to attain similar levels of euphoria. and military inmates must have respected Kouretas also discuss the different Dr. Kouretas greatly to share with him their ways that relatives of drug addicts in prisons problems and their language 16. have in order to pass drugs in prisons. He Dr. Kouretas mentioned the measures mentions in more detail that the relatives of (administrative and medical) that the service drug-addicted prisoners are being pressured would take during his time to deal with drug so much to provide them with narcotics that addicts in the Armed Forces. The “they become the executioners of these poor administrative measures, which he deemed creatures16. Among the various ways used to restrictive and intimidating, included various pass drugs in prisons are listed the punishments, imprisonments and relocations constructions of shoes, the use of to other units. The medical measure was neckerchiefs or bed sheets, the mix of heroin primarily a simple discharge of the military with tobacco, even the insertion of small personnel via the Board of Discharge. Until packs of heroin in private parts of female that period “the cases of drug addicts in the body. Despite 70 years of elapsed time, Armed Forces were rare” and the above- today’s prison population largely resembles mentioned administrative and medical Kouretas’ observations. Dr. Kouretas appears measures were enough to handle single despondent about the situation: “The cases. But, in the 1930’s the cases of drug descendents of cunning Odysseus do their addicts “increased and from single cases, best to spoil the reputation of this famous became an epidemic”16. The measures hero”16. described above were clearly not adequate, In his study on the drug addicts in the and he proposed the change of the Armed Forces, Dr. Kouretas does not limit corresponding article of the Military Law and himself in a couple of cases, but examines a the establishment of special military large swath of them. He “set from the treatment facility for drug addicts. He beginning a specific” questionnaire 16 . He warned that if the administrative and handled and approached the soldiers' drug medical measures did not change, then addiction problem with humanity and “there would only be a cover up of the understanding. Through this specific problem and not a solution of it” 16. questionnaire and his discussions with the military personnel he gained solid knowledge Conclusions

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The contribution of Dr. Kouretas work specialized in mental health problems focus is of great value not only to the Armed on the recognition of symptoms of drug Forces, but also to medicine and nursing in addiction and provision of, or referral to, the field of drug addiction and treatment by experts. Tertiary prevention rehabilitation. include services that are mainly associated Psychiatric and mental health nursing with severe or chronic mental illness by is an important field dealing with people preventing the complication of the illness with mental illness or distress, and, as such, and promoting rehabilitation that is directed drug addiction is an important mental toward achievement of each individual’s disorder. Nurses in this area receive maximum level of functioning. Nursing in additional training regarding psychological that level focuses on helping the drug addicts therapies, building a therapeutic alliance, to learn or re-learn socially appropriate dealing with challenging behavior and the behaviors so that they may achieve or re- administration of psychiatric medication. gain a satisfying role in the community. The Treating mental illnesses have improved role of the nurse in mental health care and dramatically over the last century. Basic goal especially in drug addiction is, therefore for psychiatry is, as Indira Ghandi outlined in unique; nurses have the ability to bridge the 1981 ‘to go home instead of large numbers gap between the hospital and the gravitating towards centralized hospitals’. community, between the psychiatrist and the Nursing interventions in hospital settings community care given, as well as, between include physical and biological interventions the public and other health care providers. (administration of medication and monitoring Kouretas study, overall, set the basis of side effects, preparation and recovery of of prevention in drug addicts care in Greece. patients from electroconvulsive therapy, Being an expert clinician, Kouretas had physical care), as well as psychosocial and already realized from the early 30s the spiritual interventions. psychological and social implications of drug However, the role of mental health addiction and the impact of this clinical nurses is equally important regarding situation in every day medical and nursing primary, secondary and tertiary intervention practice. Kouretas initially focused on in community settings, as projections based informing and educating the medical and on the basic model of Gerald Caplan. In a nursing staff of Armed Forces about the globalizing world, advanced practice nursing problem and its implications. Afterwards, need to be confined to direct individual and Kouretas published his results in a prestigious in family services, whereas the main goal is medical journal, in order to put wise the prevention. Mental health nurses in primary doctors and the nurses of the entire country prevention aim to reduce the incidence of about the arising medical problem of drug mental disorders (including addiction) within addiction in the contemporary hospitals and the general population, targeting both nursing facilities. Beyond any doubt, he was individuals and the environment. Mental a pioneer at his time and his work should still health nurses assist the individuals to be considered a reliable source of increase their ability to cope effectively with information. stress, whereas they target and diminish Finally, the study of Demetrios harmful factors that act as stressors within Kouretas poses the importance of the study the environment. In secondary prevention, of History of Medicine and Allied Sciences for mental health nurses aim to reduce the the modern nurse. The quality of the data prevalence of psychiatric illness by and the methodology that Kouretas followed shortening the course (duration) of the in his study prove the high standards of illness. Secondary prevention is mainly military medicine and nursing during his accomplished through the early and on-time time, and show the way that pioneering identification of problems and the prompt studies, which change the face of Medicine initiation of effective treatment. Nurses and Allied sciences, should be conducted.

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