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Marvin Ross


Don't Confuse Mental Health With Addictions

Posted: 01/23/2014 4:13 pm

January 28th is the annual Let's talk campaign by Bell to raise awareness about and reduce the stigma of mental illness. And, through this campaign, Bell has committed over $60 million for mental health in Canada. This is a commendable program and an example of good corporate responsibility. However, what would also be a tremendous benefit in reducing the stigma of mental illness is for governments and the health industry to end the partnership between mental illness and addictions.

The two are intertwined and treated as equals when they are not. As examples, the Mental Health Commission of Canada combines mental health and addictions, there are institutions like the Centre for Addiction and Mental Health in Ontario and of course the Substance Abuse and Mental Health Services Administration in the U.S. It may seem like I am speaking against conventional wisdom in suggesting that addictions and mental illnesses are different but I'm not.

Consider this. No one makes a decision to suddenly develop psychotic delusions or the mania of bipolar disorder or the crushing darkness of depression. These are illnesses that just happen as do other illnesses like MS or Parkinson's or rheumatoid arthritis. They are not our choice and they are not welcome but they happen and we have to contend with them as best we can.

That is not the case with addictions. No one forces anyone to take that first drink or chemical and to continue in self destructive behaviour. There is an element of free will in addictions. Peg O'Connor, who teaches philosophy at Gustavus Adolphus College in St. Peter, Minnesota, explored the issue of addiction as a disease or as choice in The Fallacy of the Hijacked Brain in the New York Times.

The term the hijacked brain, she says, is used to suggest "the addict's lack of choice in the matter. Sometimes the pleasure-reward system has been 'commandeered'. Other times it 'goes rogue'. These expressions are often accompanied by the conclusion that there are 'addicted brains'".

"In the 'hijacked' view of addiction, the brain is the innocent victim of certain substances" and "The drugs or the neurochemicals produced by the behaviors overpower and redirect the brain's normal responses, and thus take control of (hijack) it."

As the hijacker in any situation is the villain and the hijacked is the victim, is it really possible to hijack yourself? If you believe that, she says, then you would believe that it is possible to give yourself a gift when you pass money from your right hand to your left hand and then to send yourself a thank you card. That is known as a nonsense or category mistake.

If you know that taking that chemical will result in negative consequences, then you should not do so. And when you do, it was your choice. As Ms O'Connor concludes "Addicts are neither hijackers nor victims. It is time to retire this analogy."

Psychiatrist Sally Satel and psychologist Scott O. Lilienfeld also make a similar argument in their excellent book Brainwashed, The Seductive Appeal of Mindless Neuroscience. Chapter three is called Addiction and the Brain-Disease Fallacy. The impact of choice is clearly demonstrated in their recounting of heroin and opium use in Vietnam in 1970. It was estimated that nearly half of enlisted troops in Vietnam had tried opium or heroin and that between 10 and 25 per cent were addicted.

Afraid that returning addicts would join the addicted in US inner cities, compulsory drug testing was introduced and no one was permitted to return until they had passed the test. Those who failed were put into a detox program. Almost all who went through the program passed the test and returned home and only 5% of those relapsed after 10 months. Just 12% relapsed briefly after three years.

By the mid 1990s, Satel and Lilienfeld argue, the lesson of Vietnam had been lost and the concept of "once an addict, always an addict" was a truism along with the concept that addiction is a chronic brain disease. That, the authors argue is "fundamentally bad science". They go on to say that "the disruptions in neural mechanisms associated with addiction do constrain a person's capacity for choice, but they do not destroy it."

And, they say, quitting is the rule not the exception. One study they cite done in the early 1980s with 19000 people found that of those who had become drug dependent by age 24, half later had no drug related symptoms. By age 37, 75 per cent reported no drug problems. Another study involving 43,000 people between 1990 and 1992 and again between 2001 and 2003 found that 77 and 86 per cent who had initially been addicted reported no problems during the year before the survey.

Their conclusion is that:

The brain-disease narrative misappropriates language better used to describe such conditions as multiple sclerosis or schizophrenia - afflictions of the brain that are neither brought on by the sufferer nor modifiable by the desire to be well. It offers false hope that an addict's condition is completely amenable to medical cure (much as pneumonia is to antibiotics).

How often have people with serious mental illnesses been told to get over it or to smarten up? That might be appropriate to say to an addict but it is not appropriate for someone with a blameless illness. And by continuing to lump addictions in with mental illnesses we perpetuate the opinion that there is an element of choice in mental illnesses.


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  • Number of Canadians with mental illness

    20% of Canadians will personally experience a mental illness in their lifetime - Canadian Mental Health Association

  • Anxiety

    Anxiety disorders affect 5% of the household population, causing mild to severe impairment - Canadian Mental Health Association

  • Bipolar Disorder

    About 1% of Canadians will experience bipolar disorder (or “manic depression”) - Canadian Mental Health Association

  • Suicide rates

    Suicide accounts for 24% of all deaths among 15-24 year olds and 16% among 25-44 year olds - Canadian Mental Health Association

  • Men and suicide

    The mortality rate due to suicide among men is four times the rate among women - Canadian Mental Health Association

  • Major Depression

    Approximately 8% of adults will experience major depression at some time in their lives - Canadian Mental Health Association

  • Schizophrenia

    Schizophrenia affects 1% of the Canadian population - Canadian Mental Health Association

  • Youth depression

    The total number of 12-19 year olds in Canada at risk for developing depression is a staggering 3.2 million - Canadian Mental Health Association

  • Going to the doctor

    Almost one half (49%) of those who feel they have suffered from depression or anxiety have never gone to see a doctor about this problem - Canadian Mental Health Association

  • Seeking help

    Once depression is recognized, help can make a difference for 80% of people who are affected, allowing them to get back to their regular activities - Canadian Mental Health Association

  • Youth suicide rate

    Mental illness is increasingly threatening the lives of our children; with Canada’s youth suicide rate the third highest in the industrialized world - Canadian Mental Health Association

  • Percentage of Canadian youth affected by mental illness

    It is estimated that 10-20% of Canadian youth are affected by a mental illness or disorder – the single most disabling group of disorders worldwide - Canadian Mental Health Association

  • First Nations youth and suicide

    First Nations youth commit suicide about five to six times more often than non-Aboriginal youth. The suicide rates for Inuit are among the highest in the world, at 11 times the national average, and for young Inuit men the rates are 28 times higher - Mental Health Commission of Canada

  • Available mental health services in Canada

    In Canada, only 1 out of 5 children who need mental health services receives them - Canadian Mental Health Association

  • Mental illness in seniors

    Rates of mental illness for adults between the ages of 70 and 89, including but not limited to dementia, are projected to be higher than for any other age group by 2041 - Mental Health Commission of Canada

  • Mental Health and the justice system

    The vast majority of people living with mental health problems and illnesses are not involved with the criminal justice system. In fact, they are more likely to be victims of violence than perpetrators - Mental Health Commission of Canada

  • Mental illness and unemployment

    Among those with the most severe and complex mental health problems and illnesses, unemployment is estimated at between 70 and 90 per cent - Mental Health Commission of Canada

  • Cost of mental illness in Canada

    The economic cost of mental illnesses in Canada for the health care system was estimated to be at least $7.9 billion in 1998 – $4.7 billion in care, and $3.2 billion in disability and early death - Canadian Mental Health Association


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