From Madness to Mental Illness: Legality, Legitimacy and Morality in the Psychotropic Drugs Market

Morality has always been an integral part of sociological explanations. Sociologists have always considered that the market is affected by the moral conduct of agents. Two other concepts, legitimacy and legality, also appear intrinsically linked to markets because economists see them as components of the institutional environment that allow markets to function. However, the relation between these three concepts is not clear. Very often they are used in conjunction, or one is used to define another, which may hinder understanding in the blurred areas of the moral-immoral, legal-illegal and legitimate-illegitimate markets as well as those markets which move from one form of activity to another, e.g. from legal to illegal. This paper aims to deepen the theoretical discussion of the concepts of morality, legality and legitimacy and their implications for the market. Beyond that, it presents the empirical case of the psychotropic drugs market in Brazil to illustrate the theoretical framework.

To define these concepts, we will start with the more objective of them which is legality. Something is legal if it is in conformity with the law, otherwise it is illegal. A market can be illegal if:  (1) the product or service transacted is illegal; or (2) the product is legal but the transaction of it, is not; (3) the production is illegal even though the product per se is not, for example, a stolen good; or (4) it violates legal regulation in another part of the chain production, for example, untaxed cigarettes. For legitimacy, we will use Max Weber’s definition: legitimacy is a belief in the binding and exemplary of an order. This belief can have different bases, as in the case of the three types of domination presented by Weber. In our argument, a market is legitimate if its participants have the subjective belief in its exemplary and binding nature. Then, a market can be illegal but it may exist because it has legitimacy among its participants.

The definition of Moral and Morality needs a more deeply discussion due to its evolution in  sociological studies. References of the concept in sociology have been declining, but there is no reason to believe that it is less important now then it was for founders like Weber or Durkheim. To keep up coherently, we use a Weberian perspective on Morality in which individuals have subjective beliefs about what it is right or wrong. These moral beliefs are not ultimate universal values, they are relational, which means that something is right or wrong related to the subjective beliefs used to make this judgment. Moral convictions are empirical phenomena to be explained.

Legitimacy and morality are related, but are not the same. One of the bases of legitimacy can be morality, but not any legitimate action can be considered a moral based action. Legitimacy can have different grounds, for example, formal procedure legitimacy instead of moral legitimacy. For example, an action that follows formal procedures requirements is considered legitimate, but it can still be consider immoral when it is judged by moral assumptions.

In our proposal, the shadow grey areas, the blurry boundaries, come to exist in the intersections among these concepts, legality, legitimacy and morality. For example, in the intersection between legality-legitimacy, when you have the legitimacy of the law being called into question, it creates a shadow area that opens up room for the existence of illegal markets or it can enhance conflicts and disputes about legality and legitimacy of the market at stake. The intersection legality-morality can have interesting effects on markets. For example, in the case of blood donation, when an exchange (donation of blood) becomes legally a trade (blood is allowed to be sold), the morality of the exchange, that now has become a trade in market, can be at risk. It is moral to donate blood, but it may not be moral (people do not believe it is right) to sell it.

The empirical case of psychotropic drugs market in Brazil can help us to disentangle the hindered understanding of the relations among legality, legitimacy and morality. Psychotropic drugs are psychoactive substances which manufacture, prescription and disposal are subject to the psychotropic substances protocol of the International Narcotics Control Board (INCB), of which Brazil is a signatory, and which seeks to control the use and abuse of these substances aiming to the health and well-being of humanity. This is a billion (dollar) growing market all over the word for pharmaceutical companies. In Brazil, it is subject of intense government and institutional regulation. At the same time, disputes are intense about which professionals should be allowed to diagnose and treat mental disorder diseases and prescribe psychotropic drugs. Discussion about morality is fundamental in this market due to the change of the concept of mental health.

The concept of mental health varies widely throughout history.  Initially, witch doctors were sought after to cure the suffering that men could not distinguish.  Healers and religious figures performed treatments with herbs, rituals and prayers, seeking to ward off negative spirits or entities that were causing the patient to deviate from their “normal” personality. As the years went by and medicine evolved, these patients began to be treated through medical science, with admissions into asylums, and through chemical drugs and electroshock therapy. From being a taboo disease, that ought to be hidden from society, to becoming a social elite infirmity, with TV shows and advertisements of treatments on television, mental health disorder is subject of an exemplary transformation of morality in society.