War on Stigma
As I walk through a crowd of people, I can feel the stress begin to settle in the pit of my stomach; it’s sharp, and strains each breath. I try to distract myself, but uncertainty and doubt consume me; fear. My thoughts accelerate. Worry rushes through my veins. My vision blurs. The world is closing in. I feel crowded; cornered. My nerves unhinge – I’m about to lose it. My heartbeat is getting louder; echoing in my chest – the pounding labors me beyond my years. My skin is trembling; crawling with unease. I can’t focus or sit still. I need a distraction – fast; now. My mind is scrambling. I have to get away from wherever I am and these people I’m around. I feel displaced; inferior; weak. I don’t fit in – even when I’m alone. But it’s all in my head; just a feeling, however real, so I fight back; react with rage, but bursts of frustration and anger at my loss of control are no match; only a feeble defense to an unstoppable force – storming me at the whim of a mood.
When my social anxiety is at its worst, I feel a bit like Howard Hughes – minus the fame and fortune. However, there is little mystery behind my madness. Thanks to modern medicine, social phobia is harmoniously defined, classified, and diagnosed as a psychiatric disorder. The National Institutes of Health (NIH) defines it as something like a “persistent and irrational fear of situations that may involve scrutiny or judgment by others, such as parties and other social events.” The International Statistical Classification of Diseases and Related Health Problems (ICD-10) clearly classifies it as a disorder, and the Diagnostic and Statistical Manual (DSM-IV), which is used to diagnose psychiatric disorders, agrees.
But stigma surrounding mental health disorders doesn’t die. Even with definitive information, there is still widespread stigma plaguing those suffering from mental health disorders. For example, we hear about the role of the media and comedians in perpetuating these myths and negative stereotypes; we hear about how sufferers are marginalized by society and can’t get jobs because of prejudicial misconceptions; and we still hear about the numbers of vets who have difficult transitions back to their normal lives while fighting depression or PTSD, yet have difficulties getting the treatment they need. According to the Department of Health and Human Services, mental illness affects 45 million Americans. To help erase the stigma surrounding mental health disorders, a number of campaigns and organizations have popped up to fight back to transform myths and misconceptions into social equality for mental health sufferers. A quick Google search of “mental health stigma” finds dozens of organizations tackling the stigma surrounding PTSD, schizoaffective disorder, and bipolar disorder, to name only a few. Like social phobia, the medicine is on their side – and they still have an uphill battle. The task is daunting, but no less needed. Even with definitive information, erasing stigma is a tall order.
In the realm of addiction, however, despite a lack of definitive information, recently, a small army of non-profits and government agencies have declared what seems to be an all out War on Stigma surrounding addiction. They differ by name, but their message is largely the same, which is the claim that addiction is a chronic brain disease, not a moral failing. Our very own Vice President, Joe Biden the apparent addiction specialist (and teetolar), even recently chimed in on the matter by introducing legislation to officially recognize addiction as a disease, and commanded the public to do the same. We hear about how addiction is not a lack of discipline; how addiction is involuntary. We hear about how addiction is not a bad lifestyle choice, and we hear about how addiction is a life-long incurable disease.
In my humble opinion, advocates for addicts and alcoholics have an even more arduous task than advocates for mental health sufferers. Working against them are shows such as Celebrity Rehab, Intervention, or My Strange Addiction, to name only a few, souring public perception even further by exploiting addiction for entertainment and profits under the guise of some misplaced sense of advocacy. We see celebrities using the involuntary disease concept of addiction as a washing machine for their public image. We see infomercials selling cures like used cars. By the end of each day, the public has been exhausted of addiction. Addiction. ADDICTION.
Now, don’t get me wrong, addicts and alcoholics face challenges in their everyday life. I can personally attest to that, being sober for 10 years. It can be difficult to get a job, find a place to live, or date even. It’s great that so many organizations are dedicated to helping those in need. Addicts and alcoholics are often the people most in need of advocates – as they can be homeless, poor, or not have much family. We all should work to erase negative stereotypes, myths, and misconceptions, and we all should advocate for change where change is needed. But there seems to be a giant, smelly white-elephant in the room, and it’s hiding in plain sight: their message doesn’t match the medicine because the medicine is still struggling to define the complicated physiological and environmental causes of addiction.
The term “addiction” is a house of cards; an emperor without any clothes. It’s a public relations tool, which carries no diagnostic credibility because there is no diagnosis for addiction – nor is addiction listed anywhere in the ICD-10 as a disease. The term “addiction” doesn’t exist in clinical diagnoses– except when we’re being told it’s a disease. Rather, the terms used by mental health professionals are substance abuse and substance dependence – both of which, like social phobia, are classified as disorders, not diseases. In other words, changing public perception is going to be tough without any definitive information to back up the claim that addiction is a disease because, in the words of the late Christopher Hitchens, what can be asserted without evidence can just as easily be dismissed without evidence.
But the advocacy doesn’t waver. We still hear about how addiction is a disease just like, for example, cancer or diabetes. But addiction is not the same as cancer or diabetes. Diagnosing a disease such as cancer or diabetes involves locating a concrete verifiable pathology inside the body or brain. For example, diagnosing cancer involves locating the cancer cells via brain or body scans or blood tests. Diagnosing diabetes involves verifying the high levels of sugar in the blood via urine analysis, and blood tests such as the Hemoglobin A1C test and the oral glucose tolerance test. Diagnosing addiction involves none of this. There are no blood tests. There are no brain or body scans (except in research). There are no specialized tests to pinpoint the exact neurobiological causes of the abuse or dependence to evaluate the intensity or severity or damage. There is no standardized method of determining the best course of treatment based upon diagnoses. Rather, addiction is commonly self-diagnosed (no doctor even needed). While research has identified how drug use may cause neurochemical changes in the brain, causing compulsion, craving, and drug seeking behavior, medical science has stopped short of describing this phenomenon as a disease, since in some people, this effect wears off once the drugs are out of the user’s system.
Treatment is different, too. Medical treatment for diseases such as cancer and diabetes are more scientific, whereas treatment for addiction is, well, hardly classified as “medical.” Treatment for cancer involves chemotherapy. Treatment for diabetes involves stabilizing blood sugar levels. However, the most prominent method of treatment for addiction, the 12 Step model, primarily involves praying to a god. While there are more modern methods gaining prominence, your insurance company probably wouldn’t cover prayer as the primary method of treatment for cancer or diabetes.
Whether the difference in treatment is because addiction is a “spiritual disease”, as professionals and support group-goers alike sometimes call it, isn’t the issue, nor my concern. As far as medical science is concerned, a “diseased spirit” seems more suited for a ouija board than anything people would willingly pay a small fortune to get medically treated. But I’m not criticizing faith nor a belief in a higher power, nor am I minimizing the importance of studying addiction. I’m not ignoring the fact that medical science has made remarkable progress, either, and continues to do so at an impressive pace. I’m just pointing out that as far as modern medicine is concerned, when compared to cancer or diabetes, the most widespread form of treatment for addiction is clearly less advanced. Scientifically speaking, it seems more similar to an outdated Hail Mary thrown at the end of a football game in hopes of scoring a touchdown than the modern-day treatment of other diseases.
Whether addiction is an actual disease, disorder, choice, or simply the hard-to-break momentum of human conditioning, I don’t know. I’m not an authority on the matter, nor do I have a stake in it any which way. I’m just the public perception, and I see inconsistencies. But calling addiction a substance abuse or dependence disorder, as it’s currently classified, like social phobia, certainly doesn’t minimize or cheapen its debilitating effect (I certainly don’t feel that I need to call social phobia a disease just to reflect its destructive nature.) Advocating that addiction is a life-long incurable chronic brain disease when there’s not even a classification nor diagnosis for it seems to foster more public suspicion rather than elicit credibility. But that’s because advocacy of this ilk that doesn’t align with the medicine doesn’t really seem like advocacy. Whether it’s well-intentioned or not, true or not, it smells like something else, like the unreliable and volatile voice of personal opinion rather than fact, which has been hastily generalized to fit the masses. And the public isn’t easily swayed when it comes to advocacy. Even with more definitive information, like campaigns to remove the stigma surrounding mental health disorders, the task of changing public perception is beyond difficult. Until there’s an official diagnosis and classification for addiction as a disease, along with sufficient medical science to back it up, how does the War on Stigma expect to get people to clearly understand a problem that science and medicine has not clearly defined when it appears that the War on Stigma itself doesn’t understand it either?
This entry was posted in Editorials.