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Summer 2014
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Theodore Dalrymple
The Government Made Me Do It « Back to Story

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Wow...addiction not a disease? visit kevin malculey on youtube. Or "pleasure unwoven". There is a compeling reason addiction IS a disease.
' Surely not a sufficient basis for a culture's aspirations. I have just discovered and bookmarked Theodore Dalyrmple, a voice of common sense and wry humor who eloquently describes how unprincipled mediocrity is the ticket into the ruling class.'

Although that could be a kind of defence mechanism on his part: public employee for the whole of his working life. Never mind, though, it's the mediocre who really make it.
With refined sensibilities and high culture out of fashion, the measure of man is now the measure of the common man . . . Surely not a sufficient basis for a culture's aspirations. I have just discovered and bookmarked Theodore Dalyrmple, a voice of common sense and wry humor who eloquently describes how unprincipled mediocrity is the ticket into the ruling class.
Daily Mail Special Investigation:
http://www.dailymail.co.uk/news/article-1277955/Special-Investigation-Why-ARE-doctors-addicted-drink-drugs.html

Any ideas?
Once, before I knew his character, I referred a young female patient to him because she had an abnormality on her chest x-ray, When her notes returned with her from Dr Pascal, they bore a detailed account, scrawled across several pages in writing that clearly betrayed loss of control, of something more closely resembling a sexual assault than a medical examination. Fortunately for Dr Pascal, the patient was too deranged either to appreciate what had been done to her or to give sufficiently coherent evidence to be believed. Being a coward and reluctant to act as an informer of any kind, I kept silent; but like everyone else, I thenceforth refrained from referring patients to him, sending them instead to other hospitals in our group.

Fool or Physician: Anthony Daniels, 2011   First published in 1987 by John Murray
The number one killer disease in the west is heart disease and the primary cause of heart disease is unhealthy and lazy nutritional choices. Is it a disease then? Alcoholism is caused by a disfunction of the liver that creates an extra chemical called THIQ (tetrahydroisoquinoline). This chemical causes a malfunction of the normal working of brain neurotransmitters. Alcoholism=disease. Heart disease=disease?..not so much.
Why did Thomas Harris make his psychopathic anti-hero DOCTOR Hannibal Lecter a psychiatrist, as opposed to a neurologist, an oncologist or even a...social worker?

and now, it seems, they run in packs.
"Oddly enough, the more therapists there are, the more people are discovered to need therapy to solve the problems of daily living. This is an instance of the law first enunciated by my psychiatrist colleague, Dr Colin Brewer: misery increases to meet the means available for its alleviation. The alleviation, is of course, bogus."

The alleviation (psychiatry) is, of course, bogus. Very true. Which begs the question: why choose psychiatry as your medical specialism? Because you didn't have a choice. This is not the fault of your former patients.
He may have talked the talk but he didn't walk the walk.

As I said he was a 'publicly funded psychiatrist'.

And I think you missed the point of my modest proposal.
Hi Rosalie, I didn't mean to imply Mr. Dalrymple is a Szaszian (I used the name for myself). He has certainly flirted heavily with Szasz' ideas in other columns I've read over this past year, though I'm not too familiar with all his previous writings to know whether he's done this for a long time.

In your scenario, by the way, the denominated patient showed up voluntarily seeking help, rather than having been civilly committed. So I think Szasz would have been fine with it.
Dalrymple is not a 'Szaszian'. He was a *government employed, publicly funded, biopsychiatrist. Pro coercive and very statist. Szasz would have despised him.

Maybe the doc has something like this in mind: patient turns up on psych ward claiming to be 'depressed'. Patient is then left in a room on the top floor of the hospital, windows left wide open. If the patient jumps then he is clearly depressed and if he doesn't then he a fake and then you can push them out of the window.

It's a method based on 'the ducking stool'.
Great column up to this: "Genuine mental illness exists, but it takes severe judgment to distinguish it from that which is merely reflexive in nature".

Mr. Dalrymple, you are surely familiar with Szasz' objection that there's no diagnostic test for mental illness. What kind of "severe judgment" could you possibly have in mind? Either you have a diagnostic test for it, or you don't.
"'This, of course, is what some politicians hanker for'

No, it's what psychiatrists hanker for. What the doc just did there: it's called projection.
"is to infantilize them" and "This, of course, is what some politicians hanker for, a people without powers of decision for themselves, a people without resilience: for then, they need the politicians to save them" make me think of the adult male in pajamas with hot chocolate in the Obamacare ads.
What is your source for addicts quitting? I've never known anybody addicted to cigarettes or opiates to quit, ever, and the only meth addict I ever knew who quit got, and continues to get, heavy pharmacological treatment for mental illness. I've known casual users of cigarettes to quit, but I'd never have called them addicted, and I've known marijuana users to quit, but that's not supposed to be physically addicting. So what's the data? There's no cite of any kind in your post.

Who is Terry Eckersley ?
visit: www.terryeckersley.co.uk

Terry lives in the north of the UK. He is blissfully married to Jill an accomplished stylist, recording artist & worship leader and they have known each other 20 years and been married 5. Terry became a Christian in 1992 after a powerful conversion from a cycle of brokenness, drugs, crime & prison, this then led to healing & total redemption into extraordinary success. Then serving his way to CEO in Christian Charity & media helping people all around the world documented in his prolific autobiography "Born Ready ". Terry has been described as a tonic, humorous, high energy, yet vulnerable and relational. He has a strong gift of encouragement & shares the full Gospel message that has so radically changed him. Terry Eckersley is a creative communicator with an instant appeal that transcends all cultures, people groups & denominations. His much-appreciated art of motivational faith, with deep insight helps people to discover spiritual vitality in a humorous, friendly & powerful way that brings life and healing. A graduate of 2 Bible Colleges including Hillsong Leadership College.
To date, he has completed many speaking, media, radio & TV engagements at Churches, conferences, towns, cities and Prisons in many countries & on 3 continents. Terry has published books, songs & music all around the world, on many platforms & mediums. An ambassador for Compassion UK & associate evangelist with JJohn & The Philo Trust.
Never mind addictions. I had whiplash once, and it hurt like hell. It took several physical therapy sessions to make it better, and I have a few lingering effects two decades later. I didn't sue.
Great insight! I hate that they try and brain wash us into believing addiction is a disease... I personaly have an addictive personality, and have been using opiates for over eight years. From the begining to the present day, I have always felt that it's a choice. My choice. Everyones individual choice to use drugs or not to use drugs. Yeah, you can get to a point where you'll feel incredibly sick from not using, but its still a choice. You choose to either get high to numb the pain, or you choose to deal with the pain and agony of sobering up. After that, it's more choices. Use again, or not.
The Good Doctor seems to have derived a great deal of satisfaction from this procedure:

You mean something like this?

'Meanwhile, down in casualty a young lady in a red bandana was spraying everyone in sight with shaving foam. She had bought it, apparently,, as protection from the demons which she had recently taken to seeing and hearing everywhere, rather as nervous ladies in violent cities carry tear-gas around in their handbags.

'I had my revenge, however: I ordered her to be held down and injected in the buttock..'
I definitely think that Theodore Dalrymple, movie critic extraordinaire and the leader of the fight against graffiti, knows more about addiction than the scientists at the National Institute on Drug Abuse.
Remember: there are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.
You know, there's a theory that psychotic experiences are glimpses into other dimensions. Or maybe demonic possession. Cool, huh?

Or even witchcraft.

Come back, Matthew Hopkins. We have need of thee.
33 years sober in AA here.

From the book Alcoholics Anonymous: "Our description of the alcoholic, our chapter to the agnostic, and our personal adventures both before and after make clear three pertinent ideas:
a) That we were powerless over alcohol, and that our lives had become unmanageable;
b) That probably no human power could relieve our alcoholism;
c) That God could and would, if he were sought."

Re alcoholism as a disease -- I agree that it's not a disease like the flu or cancer. But it is known that ~10% of the population is strangely vulnerable to this condition; that it strongly runs in families (and twin-adoption studies bear this out); that alcoholics, once we're addicted, pursue the booze to the gates of insanity and even death: that signifies that booze has, For The Alcoholic, no ordinary "bad habit" hold.

Same for cigarettes: anyone who's seen people smoke in their sickbed through a tracheostomy hole in their throat has to admit, if they have an ounce of compassion, that Something major has a grip on these people.

Also: alcoholism is something each of us IS responsible for getting help to kick.

Re the science: I read many years ago that alcoholics don't metabolize alcohol like normal drinkers do -- our bodies turn it into a chemical analogue of morphine. So yeah, we get a MUCH better high than you do, which is intensely addictive.

Here's more on the science. I met this gal at Brookhaven Laboratories in the 1990s; she's brilliant and a real livewire. She has done many studies of addicts' brains using positron emission tomography (PET) scans. If you're interested, click through: http://www.mc.vanderbilt.edu/lens/article/?id=129&pg=999

She also says that there is a definite biological basis for addiction, AND that the addict is responsible for getting the help to quit.

And, as we say in AA, it's "an inside job." The do-gooders just tick addicts off: only when the drunk or druggie realizes for himself that he has to quit, does he have a fighting chance. And that, for booze at least, is only if he turns to a power greater than himself.

That's my experience, and the experience of all of us sober in AA. (No, I don't speak for the fellowship; just my two cents!)

Merry Christmas, all.
Absolutely! Anybody can quit drinking, anytime.

I mean, look at me: I've quit thousands of times.

(Honestly, I wish everybody had something like A.A. It's a fantastic program, and can produce stunning results when people use the steps as a foundation for living.)
Rep Tim Murphy (R. PA) introduced a bill to end mission creep within mental health spending and return the funds to providing treatment to the most seriously ill, rather than using them to serve the largest number of highest functioning. It's a smart proposal, I wrote on it here http://www.nationalreview.com/article/358796/save-hospitals-d-j-jaffe
DJ Jaffe
Exec. Dir.
Mental Illness Policy Org
http://mentalillnesspolicy.org
ADDICTION IS THE ONLY DISEASE YOU CAN BUY: oh really.. you can't buy cigarettes? you can't buy a horrible diet which most Americans have CHOSEN--which creates the so called "genuine diseases" of heart attacks, heart disease, et al ??
I witnessed ruined lives and death when not treated as a disease. I witnessed recovery when treated as a disease.
I understand the frustration with categorizing a choice-based malady with other conditions that seem to occur for now reason. But as a doctor, I see lots of people with diabetes, hypertension, or cancer that was caused by their choices. Drug abuse and addiction are simply on the continuum of diseases, whether self-induced or otherwise. True, rheumatoid arthritis is good old-fashioned all-American disease, but drug abuse, while less pure, still encompasses all the standard attributes of disease. The issue is that due to neurochemical changes caused by the initial exposure to, say, methamphetamine, the victim may lose the ability for further decision making. Thus they induced an essentially incurable disease state in themselves. Calling it a disease helps when it comes to the science of studying it and trying to provide the afflicted with better tools to fight it.
oh reallhy so smoking cigarettes isn't self inflicted? eating too much junk food and not exercising etc is not self inflicted--all these and more lead to heart disease, cancer etc you are drawing the line just at a different place
If Addiction is a Disease, it's the only disease you can buy.
Where did you get your medical degree? Addiction is a certified diagnois in the DSM-5. People like you get people killed with your irrelevant ignorance.

I have 29 years of continuous sobrienty,and have seenthe "Disease" of alcoholism destroy and devastate people and families.
Even if it were somewhat disease-like, telling an addict that it's just like having diabetes, or whatever, is a counterproductive tactic. I was able to stop drinking in a 12-step program 27 years ago, and I still recall the constantly reiterated catechism that "alcoholism IS a disease". However, that was anything but an invitation to disclaim responsibility for the affliction, as it served to introduce and emphasize the credo that "You are not a drunk because of 'persons, places or things', you are a drunk because you buy the booze, you open the bottle, you fill the glass, and you drink it down". A year after putting the cork in the bottle, I managed to give up cigarettes, and that was really tough. It is, IMHO, just as cruel and misdirected to suggest to a person that they have no ability to control a dangerous behavioral trait, as to suggest they are responsible for getting a chronic disease like MS. The Serenity Prayer may be a cliche, but it's a cliche because it makes an timelessly valid point: failure to recognize the circumstances of your life that ARE within your control, whether from fear, embarrassment or just downright laziness, is a recipe for a very bleak--and possibly short--existence.
Spot on. Here's an interesting one from Peter Hitchens who is also exceedingly sceptical about "addition"

http://hitchensblog.mailonsunday.co.uk/2013/12/reflections-intranquillity-on-the-matthew-perry-encounter-.html#comments

Sorry, forgot link
Spot on. Here's an interesting one from Peter Hitchens who is also exceedingly sceptical about "addition"
Agnosticus

But occupying that role clearly did something for you.

This is a quote from Martha Stout's 'The Sociopath Next Door':

'Why would she direct her skills against psychiatric inpatients? They have nothing she wants. They are disenfranchised by the world, and she can feel powerful merely by sitting in a room with them.'

Picking on easy targets is cowardly.
I retired after spending 25 years counseling alcoholics and drug addicts. IMHO, advances in neuroscience show that there is definitely a physiological component to substance abuse. There are some people who just like doing drugs and alcohol and have no desire to quit, but they are a definite minority. There is a another definite minority who do quit and make it stick, they do not relapse. Then there is the large majority who want to quit but keep relapsing. Some of that may be that they are too lazy to follow a treatment regimen, but for most of these people the problem is that they come from family and social backgrounds that are not supportive of their efforts to stay clean and sober. And no medical intervention can cure laziness or a dysfunctional family/social environment. So government efforts to treat addiction like a physical disease are doomed to failure. But this will only be apparent much useless expenditure of the taxpayers' hard earned money.
'There is incentive for a government making "war on drugs" to emphasise addiction.'

It also enables Baby Boomers to pretend that they participated in a war like their predecessors: The Greatest Generation.
"The Government Made Me Do It."

Is that a confession, Dr. Dalrymple?
There is incentive for a government making "war on drugs" to emphasise addiction. It not only justifie that war (the drugs cause a "disease") but can be used to scare people away from trying drugs. As always with government incentives though there are unintended consequences, and people on drugs assume they are addicted, so act like addicts are thought to act just as kids who drink alcohol-free beer they are told is alcoholic will act drunk.
According to DrugAbuse.gov, the website of the National Institute of Drug Abuse, "When relapse occurs, many deem treatment a failure. This is not the case. Successful treatment for addiction typically requires continual evaluation and modification as appropriate, similar to the approach taken for other chronic diseases...For the addicted individual, lapses to drug abuse do not indicate failure. Rather, they signify that treatment needs to be reinstated or adjusted or that alternate treatment is needed." They compare drug addiction to chronic diseases like diabetes and hypertension. They argue that just as you can never be really cured of hypertension since symptoms return when treatment is withdrawn, it's unreasonable to expect drug rehab to cure you permanently of drug addiction. It's a flawed argument because it fails to account for the difference between the addicts who do abandon drug abuse permanently and those who relapse. If there were a population of diabetics who ceased to be diabetics while others remain so, wouldn't science demand an explanation of the difference?
Two different anecdotes:

One friend smoked cigars. He enjoyed them greatly and smoked 10-20 a day, I think he told me. He was a banker, it was long enough ago it was socially acceptable and legal in his office, etc. Then he had to have bypass surgery. He had his last cigar in the taxi on the way to the hospital for his surgery. When he got out of the hospital, he just didn't smoke cigars (or anything else for that matter) any more.

A friend of my wife's husband was a life-long smoker. He had a heart attack. Ambulance was called, he was rushed to the hospital emergency room. The doctor there asked him if he smoked. Answer: no. Doctor asked if he ever had smoked. Answer: yes. Doctor asked when he quit. Answer: 20 minutes ago.
'Genuine mental illness exists, but it takes severe judgment to distinguish it from that which is merely reflexive in nature, such as whiplash injury, which scarcely exists in countries whose legal systems allow no compensation for it.'

The main difference between physical versus mental disorders is that patients can reject or accept treatment for the former whereas psychiatrists reserve the right to impose coercive treatment methods on the latter. Some of them even get a sadistic thrill out of it.

You seem to have declared war on your former patients, Doctor Daniels. Why is that?
Having given up smoking, I know how hard it was, but I never felt I had a disease, nor did I consider asking for medical advice. I knew that cigarettes would kill me if I continued, but it still took me several years to actually make the decision to quit. At that point I did get some pills that helped to reduce the craving for nicotine, but that was after the decision. Addiction is a huge problem, but it's not a disease, and is not curable by medical intervention.
When there is a personal financial cost, one is much more likely to have the will to stick with the program. When it -- drug/alcohol treatment, education, health care, food, housing, a cell phone -- costs nothing, there is no appreciation as there is no consequence for lack of completion or care. If my health insurance company told me I had to lose X pounds or pay $1000 more per year, you can be darn sure I would lose X pounds.
When alcoholics in Amsterdam were hired to clean the streets and paid in beer, The New York Times got letters insisting that an addiction was being exploited. I suppose you'd call that a consequence of the "medicalization" of mental illness and addiction. Why not call it an effective treatment? The alcoholics are doing better remaining upright all day, purposefully occupied, before succumbing to the inevitable. To medicalize is not necessarily to take the route to infantilizing the mentally ill and addicted. In this case, the beer was part of the treatment.
http://www.thecriticalmom.com
From what I have read; Some smokers are told that they have lung cancer, they quit immediately, even though it's too late.
I take your point TD but can you not allow for special consideration of the neuro-biological (intended to encompass the effect of the chemical) changes that may have been rubbed in over time especially when confirming activity was pursued either because it was not a high cost "choice" at the time and/or because circumstances (not within the ready control of the addict) made it difficult to resist, of which the weariness of of the mother coping with many young children would be about as innocent an example as you could get?

Sure, anyone can choose to get really fit and run a marathon (I did 34 years ago) but there are degrees of difficulty. On a scale of 1 to 10 my degree of difficulty (almost entirely that nature meant me to be a good sprinter only) was about 2. If I had started very unfit and somewhat overweight while pursuing a 70 hour a week professional career conscientiously and taking my children Saturday football practice I would have liked at least a personal coaches help and encouragement to get over my degree of difficulty 8. So, too much black and white perhaps Dr. D??
The template is obvious: We’re all born addicted; some remain so, we’re all born bullies; some remain so, we’re all born gay; some remain so.
Dr. Dalrymple. I"ve read most of your books and many of you articles, and I agree with all of them except this one. When you see the destructive power of addiction among both rich and poor, educated and uneducated, and the powerlessness of otherwise intelligent people, it's hard for me to understand how you view this as essentially a "will power" issue. You're wildly off base. I'm very disappointed. This is a wholly unsupported thesis. No facts or numbers to justify your rash claim. Highly unusual for you.
One of the most common statements about quitting drinking is "you gotta wanna." If one doesn't want to, one doesn't; simple as that.

Yes, I've quit both alcohol and tobacco, and it's true: I had to want to, and all the "medical expertise" was ineffective before I quit, and unnecessary afterwards.
No kidding. If the author did not have evidence enough, consider this: tobacco is generally recognized as being among the most addictive of substances.

And yet---my father just quit. No Nicoderm, no nothing. Not that it was easy for him; my mother said he found its pull exceedingly strong. My wife's parents also both just quit. They---made a decision.

Now decisions is what brains are made to make. It's a rare person who just flat cannot make a decision, not even when there are very good reasons to go ahead and decide.

But this law, and the trends behind it, are designed (or might as well be designed) to yank the rug out from under the reasons that normally impel people to quit bad habits.