soundtracktotodaysentryisamievil
Last night: "Am I Normal?", where a clinical psychologist1 looked at "addiction"; is it a disease or syndrome? Is it behavioural? Or is it just a medical label for bad behavioural traits?
The latter position was taken by a Dr Jeffrey Shayler, whose position is that addiction has no medical reality and is a sop given to people who are unwilling to control their own behaviour. "All behaviour is a choice", said Shayler. "That's just common sense."
The words "common sense" have a long history in science. It was "common sense" to believe that everything revolved around the Earth pre-Copernicus. It's "common sense" that allows everyone from the Flat Earth Society to those who claim the death penalty reduces murders to get away with flying in the face of all evidence.
I think it was Einstein who said something like; "common sense is just a set of prejudices acquired before the age of eighteen." Anyone with any rational scientific understanding shivers whenever they hear the phrase.
His application of "common sense" can be neatly carved up by his following statement; "All behaviour is voluntary." – him meaning that addicts are making rational choices to shove crap in their system. O rly? All behaviour is voluntary, huh? So, if one happened to take Dr Shayler, tie him to a railway line, and drive the 14:25 Intercity London to Norwich train at him, it'd be a purely "voluntary" act when he shits his pants?
Happily, the programme then turned away from him, and into some real science. Brain scans of addicts were analyzed, showing how not just substances, but thoughts of substances, triggered dopamine areas of the brain, and providing a direct insight into how "addiction" has a real, tangible impact upon brain chemistry.
The programme moved on from there to the next question; although substance addiction is accepted by all but the psychologist equivalent of creationist frogheads, does behavioural addiction come under the same category? Can one be as addicted to activities as one can to smack?
Cut to a woman playing a computer game, and lo and behold; it's World Of War-Crack. A pr0n addict was also interviewed. Brain scans of these behavioural addicts seemed to show that the same processes were at work; although the environmental factors for their getting into their addictive behaviour seemed stronger than the "substance" addicts. Certainly when these behavioural addicts were put in groups for substance addicts, the latter recognized and were able to empathize with large parts of the behaviour patterns involved.
The last part of the programme dealt with therapies to "treat" addiction. Most of them seemed to prey on rich addicts' desparation – "thought field therapy" being something particularly barmy, with no proof of efficacy above placebo.
An interesting one was equine therapy – a hardened smackhead was interviewed about how she re-learned about relationships and trust by befriending a pack of ponies. Not something I'd ever consider2, but I started considering it in Rogerian3 terms; if the "enabling relationship" is the key to therapy, and an "unconditional positive regard" the goal, and you've got someone who doesn't trust other people, does it matter if such a relationship and such regard comes from a horse?
Finally, we had Shayler back to argue that because 60-70% of addicts "recover" with no "intervention" or treatment4, it proves that addiction has no medical basis. More bollocks. 99% of people recover from the common cold with no "intervention" – does that mean everyone just imagines the snot pouring out of their nose?
He quotes how some 80-something percent of American soldiers in Vietnam were addicted to substances, but the vast majority of them returned home and were able to give up their addictions without "intervention". He fails to recognize that, in behavioural and mental health, change of this magnitude, going from combat to home, is an "intervention" all by itself. The stress of "change" – even positive change – knocks the brain out of its static patterns as much as a baseball bat does.
My social work guru, JH, used to semi-joke that instead of spending lots of money on expensive drugs for my client group, it'd be cheaper to take people accompanied out to Barbados for two weeks; although some wouldn't survive the trauma of change, it'd be worth it for the amount of people who would find it breaks their circles of suffering.
Anyway, back to the central question of the programme; is the medical label of "addiction" useful?
My answer, and I think the programme's answer overall, is that yes, it is: it allows a person to recognize their behaviour patterns as addictive, and start to work to change. Like it or not, it does describe real changes in brain chemistry. Of course, environmental, cultural and behavioural factors play a big part in the process – we live in a culture where addiction to alcohol is still often hidden under people's self-labelling as "sociable" or "party-loving"5 – but there's much more at work here than just people's "bad" moral choices.
And for those who deny that in the face of evidence, perhaps that railway line isn't such a bad idea….
footfetishnotes:
1 Of course, this being television, she happened to be the most conventionally-attractive female clinical psychologist I've ever seen.
2 Reasons for which I explained in this post. For those of you who do like horses, see here.
3 From Carl Rogers, a hero of mine, who postulated that any therapy which truly has the two qualities mentioned must work, whatever the "methods" used.
4 I am in this category; my initial "recovery" from alcohol had no clinical intervention. Doesn't mean it was froggin' easy, though…
5 See sites like OKCupid: you can tell the piss-artists a mile off…
