"In 1976, the writer Ivan Illich warned in a book, Limits to Medicine, that 'the medical establishment has become a major threat to health'. At the time, he was dismissed as a maverick, but a quarter of a century later, even the medical establishment is prepared to admit that he may well be right. (Anthony Browne, April 14, 2002, the Observer)"
History and science have shown us that the existence of the disease of alcoholism is pure speculation. Just saying it's so, doesn't make it true.
Nevertheless, medical professionals and American culture lovingly embraced the disease concept and quickly applied it to every possible deviant behavior from alcohol abuse to compulsive lecturing.
The disease concept was a panacea for many failing medical institutions adding billions to the industry and leading to a prompt evolution of pop-psychology.
Research has shown that alcoholism is a choice, not a disease, and stripping alcohol abusers of their choice, by applying the disease concept, is a threat to the health of the individual.
In a recent Gallup poll, 90% of people surveyed believe that alcoholism is a disease. Most argue that because the American Medical Association (AMA) has proclaimed alcoholism a disease, the idea is without reproach.
But, the fact is that the AMA made this determination in the absence of empirical evidence. After reviewing the history of the decision, it would not be unreasonable to suggest that the AMA has been pursuing its own agenda in the face of evidence negating the validity of alcoholism.
While the AMA has made extraordinary contributions in the mental health field, it is not outside the box. The AMA is a part of the capitalist paradigm that is necessary for our society to function.
The promulgation of the disease concept, in conjunction with AMA approval, has created a multi-billion dollar treatment industry that contributes billions to the health care industry.
But, with their status, mistakes in classifications can and do result in disastrous consequence. While the AMA's classifications for the most part are accurate, the organization is not without error. Since its inception the AMA has made classifications of varying "deviant" behaviors without scientific research to validate its claims.
And, for whatever reason, the definition of a disease, as set forth by the AMA, is a malleable and all inclusive definition allowing for the inclusion of almost every deviant behavior. As a result, every unwanted behavior can be medicalized and medically treated thereby providing professionals with more patients and more income.
While many advocate for its benefits, the disease concept has proven to be far more damaging to the substance abuser then anyone could have predicted.
Therapists claim the disease concept helps the patient to understand the seriousness of [his/her] problems.
But in reality, this idea has backfired.
The disease concept strips the substance abuser of responsibility. A disease cannot be cured by force of will, therefore, adding the medical label transfers the responsibility from the abuser to others. Inevitably they become unwilling victims, and inevitably they take on that role.
In retrospect then, the disease concept has effectively increased alcoholism and drug abuse. Furthermore, its only benefit has been vast monetary reward for the professionals' and governmental agencies responsible for providing recovery services. Specifically, it has not offered a solution for those attempting to stop abusive alcohol and drug use.
Further, it is beyond the grasp of logic for medical professionals to prescribe meeting attendance as a remedy for an "incurable" medical ailment, not to mention a contradiction to the supposed nature of the problem.
Medical professionals are admittedly incapable of helping drug addicts and alcoholics so they pass the buck. But, because of recidivism rates and treatment failure, the buck is passed right back.
Patients in search of help, pay, on average, over $18,000 (BRI 2003) to attend programs based on principals promulgated by 12 step groups. After an array of varying forms of "therapy" the patient is released with a prescription for life long attendance to AA or NA meetings.
In treatment and 12 step groups the individual is told that they can only live "one day at a time."
Additionally, they are told that they should never be fooled into believing they can be cured, and if they don't attend meetings they will inevitably fall prey to their "disease doing push-ups in the parking lot."
The disease, as described by 12 steppers, is all powerful; it is a separate entity and without meetings it will destroy them. But, with some thought one realizes, these ideas are mutually exclusive. To point out the obvious, if someone is "powerless" they would, by definition, not be able to control themselves, not even one day at a time.
The absurdities do not stop with 12 Step groups; professionals contribute their own set of absurdities. For example, the AMA's definition of alcoholism is: "Alcoholism is an illness characterized by preoccupation with alcohol and loss of control over its consumption, such as to lead usually to intoxication if drinking; by chronicity, by progression and by a tendency toward relapse.
It is typically associated with physical disability and impaired emotional, occupational and/or social adjustments as a direct consequence of persistent excessive use (Langone 27)."
A natural assumption would be that the classification of a disease requires that characteristics and symptoms can be measured or observed.
While the majority of diseases fit this requirement, substance abuse does not.
The contradiction to these requirements lies within the defined nature of "alcoholism." This supposed disease's symptoms are only discovered after the consumption of alcohol. The health risks, dangerous behaviors and repercussions only materialize after the alcohol is consumed and not before.
In comparison, the diagnosis for cancer comes after symptoms surface or cancerous cell are discovered. There are physically visible anomalies that can be measured. This measurement does not exist with alcoholics. The majority of time, the diagnoses of alcoholism is a guess, if indeed such a diagnosis actually exists.
There is little question that a person exposed to carcinogens or radiation will eventually get cancer.
With alcohol it is questionable if a person will become a problem drinker if exposed to alcohol. While cancer is a separate entity of its own within the body that first exists without the knowledge of its host, over consumption of alcohol, a substance consumed by choice, is necessary before a diagnosis can be made.
That is to say that one must choose to create the condition before the condition can be diagnosed.
Furthermore, consider the following taken from CNE Health. "From doctors and patients to drug companies and the media, there are relentless pressures to classify any condition as a disease.
Richard Smith, the British Medical Journals editor, wrote: 'Doctors, particularly some specialists, may welcome the boost to status, influence and income that comes when new territory is defined as medical.
International pharmaceutical companies have an apparent interest in medicalising life's problems. Dr Iona Heath, head of ethics at the Royal College of General Practitioners, warns that there could also be clear downsides: 'Alternative approaches - emphasizing the self-limiting or relatively benign natural history of a problem or the importance of personal coping strategies - are played down or ignored.
The disease-mongers gnaw away at our self-confidence. Inappropriate medicalisation carries the dangers of unnecessary labeling, poor treatment decisions, economic waste, as well as the costs that result when resources are diverted from treating or preventing more serious disease. At a deeper level, it may help to feed obsessions with health."(CNE Health)
Then there is the DSM IV criterion for diagnosing alcohol abuse. It also does not include physically measurable symptoms. It only requires social and/or legal problems.
The DSM IV criterion for diagnosing alcohol dependence requires only one physical symptom that is a result of drinking too much, which is alcohol withdrawal.
Following this logic, if a person smokes cigarettes they do not have a problem, but, when they stop smoking and go through nicotine withdrawal, they are then diseased.
Yet, most treatment professionals seem oblivious to these blatant contradictions. (Keep in mind that cigarette smoking is not a disease according to DSM IV, although it causes far more health problems than does the use of alcohol and other drugs combined.)
Sociologist and psychologist have long since been aware of the dangers of medicalising deviant behaviors. Most encourage extreme caution when diagnosing mental illness because of the potential for damage in doing so. People who are labeled usually conform to the standards that the label calls for whether the diagnoses is correct or not. Its dangerous ground that is commonly tread upon by professionals today.
What's even more disheartening is that a large percentage of diagnoses are not made by doctors, but by unqualified "drug counselors."
Treatment and AA are recommended by counselors as a way to "nip it in the bud" but these recommendations do far more damage to the individual than if they had just been left alone (which will be discussed later).
It should be pointed out that there is a major conflict of interest among drug counselors, a conflict of interest that cannot be ignored. The majority are, themselves, members of 12 step groups and are believers in AA dogma. These non-professional counselors have been manipulated into believing 12-Step propaganda. And, like the AMA, their status allows them to convince patients they need help because they are sick.
The disease concept oozes into every crevice of our society perpetuating harmful misinformation that hurts the very people it was intended to help.
It is a backwards situation where the assumptions of a few were adopted as fact by the medical profession, without evidence, and soon after, accepted by the public. With this said, visiting the history of the disease concept gives us all a better understanding of how and why all of this happened.
It is speculated that the disease concept originated in the 1800's with a fellow by the name of Dr. Benjamin Rush. He believed alcoholics were diseased and used the idea to promote his prohibitionist political platform.
He also believed that dishonesty, political dissention and being of African American decent were diseases as well. The "disease concept" was used throughout the late 1800's and early 1900's by prohibitionists and those involved in the Temperance Movement to further a political agenda.
Prior to this time, the term alcoholic did not exist. Alcohol was freely consumed but, drunkenness was not tolerated.
Many sociologists contribute its non-existence to the very stigma the disease concept removes. In fact, "Despite an ardent search, however, temperance adherents never identified an account of a drunkard before the 1800's who reported that he has lost control of his drinking." (Stanton Peele "Diseasing of America" pg 37)
"Drunkenness was not so much seen as the cause of deviant behavior-in particular crime and violence- as it was construed as a sign that an individual was willing to engage in such behavior." (H.G. Levine, "The Good Creature of God and the Demon Rum," in Alcohol and Disinhibitition, eds. R. Room and G. Collins.)
During this period of time social ties and family played a much more influential role in an individual's life. Therefore, deviant behaviors were undesirable and less likely to occur. It was not until industrialization began, when the importance of social ties diminished, that alcoholism became a problem. We now live in a society that encourages binge drinking as a social norm, but at the same time, we live in a society that discourages it.
The "recovery" community's adoption of the disease concept began with an early AA member named Marty Mann. Her efforts, combined with a somewhat dubious scientist named E.M. Jellinek, began national acceptance of the disease concept.
It was Jellinek's "scientific" study that opened the door for the medical communities' support. E.M. Jellinek's study was funded by the efforts of Marty Mann. And, like so many other circumstances involving Jellinek and Marty Mann, the study was bogus if not outright fraudulent.
The surveys he based his conclusions on were from a hand picked group of alcoholics. There were 158 questionnaires handed out and 60 of them were suspiciously not included. His conclusion was based on less than 100 hand picked alcoholics chosen by Marty Mann.
Mrs. Mann, of course, had a personal agenda to remove the stigma about the homeless and dirty alcoholic or "bowery drunk" in order to gain financial support from the wealthy. By removing the stigma, the problem becomes one of the general population, which would then include the wealthy.
The first step was Jellinek publishing his findings in his book "The Stages of Alcoholism." Later, E.M. Jellinek was asked by Yale University to refute his own findings. He complied. E.M. Jellinek's Stages of Alcoholism did not stand up to scientific scrutiny.
Earlier in this century, the validity of the disease concept was often debated in medical circles.
However, in 1956 the American Medical Association (AMA) proclaimed alcoholism an "illness." Then, in 1966, the AMA proclaimed alcoholism a disease.
The decision was wrapped in controversy. Historically, Marty Mann had her hand in much of this and manipulated information and doctors into agreeing with the disease concept. Marty Mann used her position as founder of the NCA (National Counsel for Alcoholism) to promote the disease concept through Jellinek and a somewhat clandestine relationship with the founder of the NIAAA (National Institute for Alcoholism and Alcohol Abuse) whose founder worked with Marty Mann during the institute's early development.
The founder of NIAAA (Smithers) was a major contributor to and promoter of the disease concept. It was his money that funded Jellinek's work at Yale. Smithers was also responsible for gaining insurance coverage for patients in treatment (hence the 28 day program).
Smithers was certainly not altruistic in his efforts. At that time he had already launched a treatment program for which he was lobbying for insurance payments.
Acceptance by the medical community was the only way this could happen; alcoholism had to be a medical problem in order for medical insurance to pay for programs. We can see the influence of these "advances" everyday in treatment programs. Today the treatment industry is a multi-billion dollar industry, with insurance paying the lion's share of the costs.
While it can be argued that Smithers's efforts played an important role, it was Jellinek's study that was such a monumental turning point for the supporters of the disease concept it.
The current disease paradigm was, in part, developed and promulgated by Jellinek and various other partial participants with personal agendas.
Today, Jellinek's "Stages of the Alcoholic" is still widely used to diagnose substance abusers. But, these stages are based on a corrupt study that the author, himself, later refuted. Jellinek not only published a fraudulent study, he defrauded members of his academic community, and apparently lied about his educational background to gain acceptance.
Nonetheless, it was Jellinek's "Stages of the Alcoholic" that led to diagnosing alcoholism as a disease and eventually to the medical acceptance of alcoholism as a disease. Astoundingly, the inception of the current disease and treatment paradigm is based on fraud.
But the misinformation and fraud did not stop with Jellinek, et al. More recently in an attempt to prove a genetic link for alcohol and drug abuse, most studies only provide roundabout evidence of a predisposition, not a cause for alcoholism.
With this said, we should point out that the predisposition can only prove a difference in bodily processes, not a difference in thinking.
'Knowing the sequence of individual genes doesn't tell you anything about the complexities of what life is,' said Dr. Brian Goodwin, a theoretical biologist at Schumacher College in Devon, England, and a member of the Santa Fe Institute in New Mexico.
Goodwin goes on to explain single gene mutations are not accountable for, and cannot explain, complex behaviors. Genes produce proteins they do not guide behaviors. The truth is a predisposition for substance abuse, if it does exist, has no bearing on subsequent behaviors.
Chemical processes do not make a person an alcoholic. The person makes the conscience choice. Altered processing of alcohol in no way determines choice or behaviors. Obsessive drinking is not a reaction to bodily processes, but merely a choice. The amount consumed is determined by the individual not by the body.
Nevertheless, news stories surface every year proclaiming discoveries of the genetic sources of emotional and behavioral problems while ignoring the mountains of evidence that refutes such preposterous assertions.
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