As a psychiatrist at Saint-Antoine Hospital in Paris and a lecturer at Sorbonne University, Dr. Jean-Victor Blanc directs one of the few clinics specializing in chemsex. On April 3, he publishes Chemical Loves, the Scourge of Chemsex with Éditions du Seuil. In this essay, nourished by his clinical experience and research, he analyzes the social, cultural, and psychic underpinnings of the gay phenomenon, and calls for awareness both political and community-wide. Excerpt.
Silences = Deaths
After almost ten years listening to and caring for men who have lost themselves in this frenzied quest for artificial paradises, I wanted in this book to convey a realistic, humane, and clinical portrait of the chemsex epidemic. I hope it can contribute to moving this scourge away from the sensationalism of tabloid news. Their media coverage is proportional to the notoriety of those involved (Pierre Palmade, Andy Kerbrat, a French MP, or Christophe Michel, the husband of Jean-Luc Romero, who died at 31 from an overdose) or to the morbid nature of the affair (a clergyman involved, a couple died…). They are instrumentalized, in search of an audience, and often treated with sensationalism tinged with homophobia. Rarely under the angle of health or distress that chemsex engenders for the first victims: gay men. This publicity is often violent for patients. It encourages them to stay silent, to hide, even within their closest circle.
The silence has too long allowed the scourge to thrive. Combating stigma and misunderstanding around chemsex is therefore necessary. By fostering awareness, education on loss of control and risk reduction, the expansion of this practice could be stopped. This requires a real political will, indispensable to improving access to care for people who need it. Two opposing winds can explain a too-long inertia. First, political and social indifference, linked to the fact that this concerns essentially gay men. If 20% of heterosexual youth took synthetic drugs to go out every weekend, it is probable that it would be on the front pages and that measures would be announced quickly. Accompanied by resources.
In parallel with this lack of interest, it seems to me that a portion of the gay community has, unfortunately, a part of the responsibility in the code of silence that has long surrounded chemsex. A fear, understandable, existed: that a public alert about chemsex would reinforce stigma, unleashing hypersexualized homophobic stereotypes of debauchery and lust. This explains the silence on the subject within the community for a long time. About ten years ago, it was assumed that it was not a health issue, and that a psychiatrist had no job “preventing men traumatized by HIV from having fun.” Linking mental health, risky sexual practices, and homosexuality was a discourse difficult for the community to accept, largely for historical reasons. This has become audible today because it has lost enough of its members to continue to view chemsex as a solution to all its ills. It would be cruel and dangerous to deny the sanitary catastrophe that already affects far too many men, especially the most vulnerable.
The Overdose
It is not about succumbing to moral panic, pathologizing a behavior, nor promoting a castrating hygienism. This book is not a manual of solutions, but, through clinical examples, I have tried to convey part of my optimism. Care, supported by scientific research, is one of the solutions for those who are ill with chemsex. A quarter of chemsex users say they need professional help. That is already too much, as evidenced by the saturation of the few specialized services that exist in France. In Corentin Hennebert and Joseph Wolfsohn’s beautiful play, Chemical Loves, one of the protagonists rightly objects to being offered an appointment in a month while he is in distress and begins a care process. Hearing this heartbreaking cry, I was myself torn: sometimes the delays for a first appointment at Saint-Antoine are even longer. The lack of resources regularly forces us to suspend new requests for care. The difficulty of accessing chemsex care reflects a broader saturation of mental health services. And it is important to contextualize: for a child who is unwell, the wait for a first appointment in the public system is on average three months… This finding should encourage awareness of the urgency to support a sector, lest the sufferings that affect today all milieus worsen.
It would be vain to wait for the arrival of a miracle pill to resolve this complex phenomenon. Because problematic chemsex use is very different from patient to patient, with a strong bio-psycho-social entanglement. But also for a more prosaic reason: developing a drug is extraordinarily expensive. For the pharmaceutical industry, chemsex is a niche market. Without political financial incentives, there is no reason for private laboratories to embark on the costly studies necessary. There is thus currently no specific replacement medication for chemsex. This is also the case for most drugs, such as cocaine, though illicitly produced, the most consumed in France after cannabis.
Care adapted to chemsex is often necessary. While most psychiatric disorders have been described for centuries, the problematic use of chemsex stands out for its novelty and not all health professionals are trained in it. An effort must be made to integrate into the training of health professionals notions about this new way of using drugs. Without this, it is impossible for the people concerned to get help. Two-thirds of patients have already seen a mental health professional before arriving at the Saint-Antoine specialized clinic. Many have nevertheless been unable to discuss the subject with their caregivers, due to a lack of knowledge. Others have faced a trivialization of their distress. Or, sometimes, a more traumatic experience: homophobia in care. This has translated into negative attitudes when they talk about their sexuality, and even remarks by caregivers. More frequently, patients are told on the phone that “we do not do ‘that’ here” when they try to be seen in general addiction centers. This can create a vicious circle in which stigmas related to sexual orientation, chemsex practice, and related psychiatric disorders reinforce each other. A systemic approach is necessary in the management of chemsex, and specialized consultation centers reduce the apprehension of facing rejection in care situations.
The issue of stigma in psychiatry is therefore as clinical as it is political. I remain convinced that knowledge and pedagogy would eradicate most of these rejection reactions. This optimism comes from the experience of my specialized clinic within a psychiatry and addiction service at a large university hospital in Paris. At first glance, it was not predestined to provide community care. And yet, a great kindness, a supportive hierarchy, and strong team commitment to the project allowed it to exist. I wish here to pay tribute to all those who made this possible.
