![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 80. Go back in thread:
Posted by ClearSkies on November 5, 2005, at 21:15:27
In reply to Re: i see, posted by alexandra_k on November 5, 2005, at 21:07:38
> see ya people.
>
>Wow, it's a night for goodbyes for you, isn't it?
Posted by alexandra_k on November 5, 2005, at 22:28:14
In reply to Re: This was a rhetorical question everyone » alexandra_k, posted by ClearSkies on November 5, 2005, at 21:14:24
> Is that a Do Not Post request?
Not at all. I just don't want you to get too upset by anything I have to say and risk getting blocked over it.
> From the free online dictionary:
> de·bate (d-bt)
> v. de·bat·ed, de·bat·ing, de·bates
> v.intr.
> 1. To consider something; deliberate.So you want me to stop considering and deliberating on things?
> 2. To engage in argument by discussing opposing points.
Or is it that you want me to stop presenting opposing points?
> 3. To engage in a formal discussion or argument
Or perhaps you think I'm doing that? I'm not sure what they mean by formal...
> I must ask you for clarification. What do you think is going on? I don't understand what you are implying, please don't guess that I know what you mean.???
I'm getting a little lost at this point too...
I thought...
You were upset with something I said
I'm just trying to work out what is up with that
That is all...
Posted by mama141 on November 6, 2005, at 11:05:02
In reply to Re: This was a rhetorical question everyone » ClearSkies, posted by alexandra_k on November 5, 2005, at 22:28:14
Whew,
I go out of town for a couple of days without my laptop and the ball rolls!!
Hang in there Verne, I am happy for you!
Three thoughts concerning "disease --
First,if you want a real eye-opener read the book:
"Diseasing of America : How We Allowed Recovery Zealots and the Treatment Industry to Convince Us We Are Out of Control" -- by Stanton Peele
http://www.amazon.com/exec/obidos/search-handle-form/002-7844095-7367237Secondly, WHEN was the part about "society" added? And WHO did the adding?
"n : an impairment of health or a condition of abnormal functioning"
Thirdly -- what about "choices" -- I sure didn't choose to get polio as a kid!! I did however CHOOSE to use alcohol the drown my sorrows so to speak, and I made that choice EVERY time I took a swollow.....
(Next trip the laptop goes along!!) >>>MAMA
Posted by Larry Hoover on November 6, 2005, at 11:37:36
In reply to Re: This was a rhetorical question everyone » ClearSkies, posted by alexandra_k on November 4, 2005, at 19:10:13
> the concept of disease has been stretched still further in order to make addictive behaviours out to be a disease.
The etymology of disease traces back to Old French, with written use at least as early as 1330. Probably came from the Norman conquest in 1066. Anyway, the early meaning, from "diseasu", was "not at peace" or "not at ease".
Once I discovered the history of the word, I personally found it very much easier to accept that I had the "not at peace" of addiction.
> that is something that is (and IMO should be) resisted.
>
> because...
>
> if addictive behaviours count as a 'disease'...
> then shouldn't that go down on your health record as an ongoing condition?Not all diseases are chronic, i.e. active over an extended period. Mumps is a disease, but once experienced, it is still a relevant part of the subject's medical history.
> you have the disease forever and ever even if you have been clean for 50 years...
...you would still have a history of the disease of addiction.
> i don't see how this helps...
> i think it is more likely to harm...Only if you label people based on their medical history.
Lar
Posted by SLS on November 6, 2005, at 12:03:31
In reply to Re: This was a rhetorical question everyone, posted by alexandra_k on November 5, 2005, at 18:39:56
Hi A_K.
When you say to me "Sorry but... It just ain't that simple...", I think I had already grasped that concept prior to submitting my first post along this thread. Complexity attracts me. Simplicity is often a brilliant way to manage the complex.
> This one talks about the EXTREMISTS on both sides. So... The truth probably lies somewhere in the middle:
No. I don't think so. I think the Truth lies in all direction and in all places all at once. I believe there are spectrums of contributions to the resulting phenotypes about which we are discussing.
As far as the native American example that I gave, the majority of the resulting alcoholic phenotypes WOULD NOT result without the contributions of the predisposing genotype.
With a sizeable percentage of cases of axis I mental illnesses, the pathological phenotype does not occur without precipitating psychosocial stresses. That you need an environmental trigger for the onset of these illnesses makes them no less the diseases that they are. Many cases have no trigger at all. Their induction is spontaneous. The sole contributor to their diseased phenotype is their genotype.
Excessive stress in general can leave one vulnerable to or directly cause disease.
Again, just because it might be necessary for epigenitic factors to contribute to the evolution of pathology does not render that pathology ineligible for the designation "disease".
> > Do you think it has been too much of a stretch?
> Okay... I think that what is most useful here is to look at WHY some people consider it to be a disease and WHY some people don't want it to be a disease.
I was asking the question of you personally. I want to know whether or not YOU consider mental illnesses to be diseases. Which of the following do you NOT consider to be diseases? I don't need to know why. I just want to see where you are at with things.
1. Schizophrenia
2. Schizoaffective disorder
3. Bipolar disorder
4. Major depressive disorder
5. OCD
6. GAD
7. SAD/Social phobia
8. PTSDI'm going to let personality disorders and addiction remain separate because their etiological dynamics are more complicated. I am not prepared to discuss them in this post. It would require much research and deliberation that I have not performed. On a philosophical level, these things are easier to deliberate. They are all diseases.
As you have said, it will depend on what is the definition of disease as to how to categorize each pathology.
So.
What is your definition of what disease is? (As opposed to what disease is not).
It would also be informative that you perhaps post those definitions you mention that may be found in medical dictionaries or biological dictionaries.
Can a mind be diseased?
I will go back and reread the material you cited. I don't think the concept of disease should be changed by a council with a social agenda. Nor should it be legislated in my opinion. Although appropriately dynamic, it should be based upon the science of the organism and its environment.
- Scott
Posted by Larry Hoover on November 6, 2005, at 12:16:16
In reply to Re: This was a rhetorical question everyone, posted by alexandra_k on November 5, 2005, at 18:39:56
> > Guess what? According to this dictionary definition, both mental illness and addiction would qualify as disease. I think this definition serves as an interesting guideline to further this discussion.
>
> I would say that a medical dictionary would be one better.Here are some medical dictionary definitions I found on the net:
Disease
A definite pathologic process with a characteristic set of signs and symptoms. It may affect the whole body or any of its parts, and its etiology, pathology, and prognosis may be known or unknown.an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors
Illness or sickness often characterized by typical patient problems (symptoms) and physical findings (signs).
An alteration in the state of the body or of some of its organs, interrupting or disturbing the performance of the vital functions, and causing or threatening pain and weakness
An interruption, cessation, or disorder of body function, system, or organ. Syn: illness, morbus, sickness
A morbid entity characterized usually by at least two of these criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomic alterations.
Literally, dis-ease, the opposite of ease, when something is wrong with a bodily function.
What I see is that a disease is disruptive of health, has a recognized etiology, with characteristic signs and symptoms.
> But I don't see how considering it a 'disease' helps.It allows people, the community, to direct supportive treatment and resources to those so afflicted. If for no other reason, bureaucracy requires a disease definition.
There are also issues of attribution of responsibility, but I don't intend to get into discussions of blame or such.
Posted by alexandra_k on November 6, 2005, at 15:11:29
In reply to Re: This was a rhetorical question everyone » alexandra_k, posted by Larry Hoover on November 6, 2005, at 12:16:16
>> But I don't see how considering it a 'disease' helps.
>It allows people, the community, to direct supportive treatment and resources to those so afflicted. If for no other reason, bureaucracy requires a disease definition.
Right then. Disease it is.
Though bureaucracy treats other non-disease afflictions does it not?
I fail to see why this needs to be a disease for people to get treatment.is gambelling a disease?
how about use of mj?
other drugs?or just alchohol?
remember... broken legs aren't typically considered diseases (though they would seem to be diseases based on the dis-ease definition of disease)
if i'm feeling a bit uneasy, having a bad day, is that a disease too?
Posted by Dr. Bob on November 6, 2005, at 18:25:57
In reply to Re: This was a rhetorical question everyone, posted by mama141 on November 6, 2005, at 11:05:02
> First,if you want a real eye-opener read the book:
> "Diseasing of America : How We Allowed Recovery Zealots and the Treatment Industry to Convince Us We Are Out of Control" -- by Stanton PeeleI'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book, movie, or music without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though, and doesn't *have* to be used. If people *choose* not to use it, I'd be interested why not, but I'd like that redirected to Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
Posted by alexandra_k on November 6, 2005, at 20:32:42
In reply to Re: This was a rhetorical question everyone, posted by mama141 on November 6, 2005, at 11:05:02
> I go out of town for a couple of days without my laptop and the ball rolls!!
heh heh. yeah, you can't leave the boards for a couple days. maybe you are discovering your babble addiction / disease lol.
> Secondly, WHEN was the part about "society" added? And WHO did the adding?
I did the adding. I did the adding because somebody posted about native americans and how they seemed to have more of this alchohol disease thing going on than non-native americans. and about how they have a genetic difference that supposedly determines that they have this disease more than non-native american populations.
what interested me was the point that over here maori have more addictions than non-maori. in fact... if you look at a minority group with a history of opression then what do you find? greater prevalence of addiction. and so my thought was... perhaps these people are more prone to inherited defect / disease (though one must be careful here... this is often used as a rationale for eugenics). and perhaps the history of opression (and the point that they have not fully recovered from that) actually has a lot to do with it...
> Thirdly -- what about "choices" -- I sure didn't choose to get polio as a kid!! I did however CHOOSE to use alcohol the drown my sorrows so to speak, and I made that choice EVERY time I took a swollow.....
yeah. and the more sorrows you have... the more likely you are to choose short term high over long term benefits.
at least... that sounds fairly common-sense to me....
Posted by mama141 on November 7, 2005, at 8:53:29
In reply to Re: This was a rhetorical question everyone » mama141, posted by alexandra_k on November 6, 2005, at 20:32:42
> > I go out of town for a couple of days without my laptop and the ball rolls!!
>
> heh heh. yeah, you can't leave the boards for a couple days. maybe you are discovering your babble addiction / disease lol.
>
> > Secondly, WHEN was the part about "society" added? And WHO did the adding?
>
> I did the adding. I did the adding because somebody posted about native americans and how they seemed to have more of this alchohol disease thing going on than non-native americans. and about how they have a genetic difference that supposedly determines that they have this disease more than non-native american populations.
>
> what interested me was the point that over here maori have more addictions than non-maori. in fact... if you look at a minority group with a history of opression then what do you find? greater prevalence of addiction. and so my thought was... perhaps these people are more prone to inherited defect / disease (though one must be careful here... this is often used as a rationale for eugenics). and perhaps the history of opression (and the point that they have not fully recovered from that) actually has a lot to do with it...
>
> > Thirdly -- what about "choices" -- I sure didn't choose to get polio as a kid!! I did however CHOOSE to use alcohol the drown my sorrows so to speak, and I made that choice EVERY time I took a swollow.....
>
> yeah. and the more sorrows you have... the more likely you are to choose short term high over long term benefits.
>
> at least... that sounds fairly common-sense to me....
> ----------------------------
> Alexandra -
I may have mentioned this before, but I noticed that you are in New Zealand. We spent one term at university in Dunedin -- it was a great time, wonderful folks and terrific food. (I seem to remember being a bit chilly some of the time however.) We have lived all over the world and New Zealand is one of those places we have returned to, and hope to again one day. We've not really spent much time on the North Island yet.
As for the genetics -- it is a strange thing this inherited or not stuff. ie....There is a strong tendency toward mental illness in the female line on my mother's side. Of 15 women in four generations, eight have been diagnosed with some type of mental illness, myself included. It is rarely the same dx -- everything from bipolar to depression to dissociative disorders. In that group there have been four suicides.
Our oldest son has worked with Native Americans (he's a doc) and he says he has little doubt that there is a "genetic predisposition" of some type, but he says just what you did. He refers to it as "cultural depression". However regardless the "gene pool", you can STILL choose to stay out of the water or at least learn to swim and not drown in it!! MAMA
Posted by SLS on November 7, 2005, at 8:58:13
In reply to Re: This was a rhetorical question everyone » mama141, posted by alexandra_k on November 6, 2005, at 20:32:42
> > Secondly, WHEN was the part about "society" added? And WHO did the adding?
> I did the adding. I did the adding because somebody posted about native americans and how they seemed to have more of this alchohol disease thing going on than non-native americans.They don't?
I am guessing - perhaps incorrectly - that what you call "this alcohol disease thing" is what others call alcoholism.
> and about how they have a genetic difference that supposedly determines that they have this disease more than non-native american populations.
More and more evidence is accumulating that genetics represent a contributory factor in the expression of alcoholism. I have never stated or inferred that genes were the sole determinant in the evolution of alcoholism in any given individual or sociological group. Furthermore, the genetics of alcoholism does not involve any single gene. They have been difficult to sift out, but some progress is being made. It appears that the biological susceptibility to alcoholism involves multiple genes acting in concert with psychosocial factors. However, twin studies have shown that alcoholism is heritable.
Native Americans also have a genetic predisposition towards diabetes. On average, Native Americans are more than twice as likely to have diabetes as non-Hispanic whites of similar age. One tribe in Arizona has the highest rate of diabetes in the world. About 50% of these adults between the ages of 30 and 64 have diabetes.
Any focus on the predisposition of one population over another towards disease is important to identify. It serves to understand and treat disease; prevention being the goal. I could identify such conditions for populations all over the world. Why is bipolar disorder so prevalent in Amish populations? Diseases are not racist. Only people are.
> > Thirdly -- what about "choices" -- I sure didn't choose to get polio as a kid!! I did however CHOOSE to use alcohol the drown my sorrows so to speak, and I made that choice EVERY time I took a swollow.....
For some people, it is an insatiable craving for the chemical itself that drives their decision making process. The cravings are libidinal, not cerebral. Sorrows have nothing to do with it. For other people, their addiction to alcohol is the result of self-medicating for the disease states of bipolar disorder or PTSD. Sorrows have nothing to do with it.
> yeah. and the more sorrows you have... the more likely you are to choose short term high over long term benefits.
>
> at least... that sounds fairly common-sense to me....Whose?
Perhaps that leaves mine as being uncommon.
I doubt it, though.
For some, the more sorrows they have, the more they commit themselves to counselling for the long term benefit.
That's only common sense.
Or is it?
What differences must lie between the two people who choose different ways to address the same sorrows?
Is it genetic?
I guess it ain't that simple.
Hee hee.
:-)
- Scott
Posted by verne on November 7, 2005, at 9:06:45
In reply to Re: This was a rhetorical question everyone » alexandra_k, posted by SLS on November 7, 2005, at 8:58:13
Posted by mama141 on November 7, 2005, at 19:06:56
In reply to Very educational (nm) » SLS, posted by verne on November 7, 2005, at 9:06:45
I guess what everyone chooses to drink/drug over varies -- but the fact remains, they CHOOSE, and that to me, seems to be the key between a behaviour and a disease. MAMA
Posted by SLS on November 7, 2005, at 20:21:49
In reply to Re: Very educational, posted by mama141 on November 7, 2005, at 19:06:56
Hi.
> I guess what everyone chooses to drink/drug over varies -- but the fact remains, they CHOOSE, and that to me, seems to be the key between a behaviour and a disease. MAMA
Schizophrenic behavior is not the result of a disease? The freedom of choice still remains intact for the victims.
Suicide is often the behavior chosen by people who have major depressive disorder or bipolar disorder. The freedom of choice still remained intact for the victims.
When it comes to pathological behaviors, the job of deciding for society which are diseases and which are not is not an easy one. I think it often depends on the purpose of the designation rather than the pathology itself.
One question worth debating is whether or not all behavior involves choice.
- Scott
Posted by mama141 on November 7, 2005, at 21:44:27
In reply to Re: Very debatable » mama141, posted by SLS on November 7, 2005, at 20:21:49
Hummmm --you make some excellent points Scott.
Schizophrenic behavior, appears to me to be a RESULT of the disease,
Whereas suicide, a choice, is not necessarily chosen because of the depression, and therefore not a behavior CAUSED by the "disease". Nor is it necessarily a RESULT of the disease alone -- it remains a choice.
Wow, you are right --- who decides which behaviors are pathological and what are socitial norms?
My own personal belief is that all human behavior involves choice; and therefore fore-thought.
When I drank I chose to drink. While I did not completely choose to be depressed, I believe that my ability to choose how I handled/reacted to that state,(depression) remained intact and therefore my responsibility. MAMA> Hi.
>
> > I guess what everyone chooses to drink/drug over varies -- but the fact remains, they CHOOSE, and that to me, seems to be the key between a behaviour and a disease. MAMA
>
> Schizophrenic behavior is not the result of a disease? The freedom of choice still remains intact for the victims.
>
> Suicide is often the behavior chosen by people who have major depressive disorder or bipolar disorder. The freedom of choice still remained intact for the victims.
>
> When it comes to pathological behaviors, the job of deciding for society which are diseases and which are not is not an easy one. I think it often depends on the purpose of the designation rather than the pathology itself.
>
> One question worth debating is whether or not all behavior involves choice.
>
>
> - Scott
Posted by SLS on November 8, 2005, at 11:09:46
In reply to Re: Very debatable » SLS, posted by mama141 on November 7, 2005, at 21:44:27
> When I drank I chose to drink. While I did not completely choose to be depressed, I believe that my ability to choose how I handled/reacted to that state,(depression) remained intact and therefore my responsibility.
I have an enormous amount respect for you and the self-discipline it must take to remain clean. You have chosen a route of responsibility and empowerment. Not everyone has been blessed with such self-directed vigilence.
One thing that I think has so far escaped our attention is the realization and acceptance that not everyone's addiction is like our own. Just as there is a spectrum of different kinds of depression, so there is for addiction. I think it is a mistake to generalize our own addiction to all others. I think we must respect peoples' failures as much as we respect peoples' successes. We just don't know the nature and extent of anyone else's hells but our own.
A friend of mine, as much as I have seen him try his best over the last month, has "failed" again at abstinence from heroin. His success has been the honesty and forthrightness with which he has communicated with his significant others his addiction. He has placed himself on waiting lists for rehab, but has not yet been placed. Timing is everything. It was his choice to seek help on his own. It was not his choice to be denied immediate attention. He used. His enormous cravings, both biological and psychological, were more than he was able to manage and cope with. It is not his choice to have such cravings. His behavior to pick up and use again occurs as a direct result of unwanted drives. As he acquires more tools to work with to maintain his sobriety, I can only hope that it continues to be his choice to use them.
I am not him. Neither are you. Neither is anyone else on Psycho-Babble. His addiction is unique. I am not inclined to judge the extent of his "free will" to choose by comparing my ease at maintaining sobriety to his.
- Scott
Posted by mama141 on November 8, 2005, at 15:53:53
In reply to Re: Very debatable » mama141, posted by SLS on November 8, 2005, at 11:09:46
I understand and respect your thoughts on individuality and differences. My concern in all of this is just how much of our ability to choose or implied loss of that ability, has been culturally imposed? ie: "I have a "disease" therefore I cant help the way I am" -- is the one end of the spectrum. How about what we pass on to our children? Or what our culture teaches them as far as self-control and personal responsibility?
Thank you for your kudos for my "self dicipline, but for me it goes WAY beyond that and that discussion really belongs on the faith board.> > When I drank I chose to drink. While I did not completely choose to be depressed, I believe that my ability to choose how I handled/reacted to that state,(depression) remained intact and therefore my responsibility.
>
> I have an enormous amount respect for you and the self-discipline it must take to remain clean. You have chosen a route of responsibility and empowerment. Not everyone has been blessed with such self-directed vigilence.
>
> One thing that I think has so far escaped our attention is the realization and acceptance that not everyone's addiction is like our own. Just as there is a spectrum of different kinds of depression, so there is for addiction. I think it is a mistake to generalize our own addiction to all others. I think we must respect peoples' failures as much as we respect peoples' successes. We just don't know the nature and extent of anyone else's hells but our own.
>
> A friend of mine, as much as I have seen him try his best over the last month, has "failed" again at abstinence from heroin. His success has been the honesty and forthrightness with which he has communicated with his significant others his addiction. He has placed himself on waiting lists for rehab, but has not yet been placed. Timing is everything. It was his choice to seek help on his own. It was not his choice to be denied immediate attention. He used. His enormous cravings, both biological and psychological, were more than he was able to manage and cope with. It is not his choice to have such cravings. His behavior to pick up and use again occurs as a direct result of unwanted drives. As he acquires more tools to work with to maintain his sobriety, I can only hope that it continues to be his choice to use them.
>
> I am not him. Neither are you. Neither is anyone else on Psycho-Babble. His addiction is unique. I am not inclined to judge the extent of his "free will" to choose by comparing my ease at maintaining sobriety to his.
>
>
> - Scott
>
>
>
Posted by SLS on November 8, 2005, at 19:57:26
In reply to Re: Very debatable » SLS, posted by mama141 on November 8, 2005, at 15:53:53
> I understand and respect your thoughts on individuality and differences. My concern in all of this is just how much of our ability to choose or implied loss of that ability, has been culturally imposed? ie: "I have a "disease" therefore I cant help the way I am"
I often hear "Now that I know that I have a disease, I can help the way I am."
I am unprepared to label sweepingly alcoholism or addiction as being diseases. However, they are what they are. We can understand and treat them without the label of disease as long as we have an accurate description.
> -- is the one end of the spectrum.
Exactly. There is quite a bit of interindividual variability in the proportion of biological versus psychological (if one can make such a distinction) components along that spectrum.
> How about what we pass on to our children?
Yes. Codependency is a learned behavior. The addict and the enabler are roles within a dysfunctional family unit that is often repeated through generations.
> Or what our culture teaches them as far as self-control and personal responsibility?
This is where I think it is important to understand the dynamics of addiction and to recognize that they are not the same for everyone. It might be the place of culture to teach self-control and personal responsibility within the context of that culture, but it cannot fashion the nature of addiction in its own idealized image. It is what it is.
What is disease?
Is addiction a disease?
Do people have a responsibility to participate in their own recovery from disease? When an addict relapses, is it at that moment that they no longer participate in their own recovery?
- Scott
Posted by AuntieMel on November 9, 2005, at 9:26:33
In reply to Re: Very debatable » SLS, posted by mama141 on November 8, 2005, at 15:53:53
I've got to disagree with a few points that have to do with the 'powerless' parts. I truly do believe that an addict needs to face that they are powerless - and that they need help. Or at least that it increases the odds of success.
I am one of the most stubborn people on the earth, and my hubby always used to tell me that if I really wanted to quit nothing would stop me. But it didn't happen until I got some help and *broke* the dependence on myself. I had a great support system at home, but I could never admit that I couldn't do it on my own.
"I have a "disease" therefore I cant help the way I am"
or another way - "I have a disease and I need to seek treatment for it"
I think that admitting powerlessness and considering it a disease actually *gives* us power - the power to ask others to help us - the power not to hate ourselves for our 'weakness' - the ability not to see what we are doing as a character flaw.
And it gives us a chance to teach our children empathy and that even their parents - as much as we love them - are human with human flaws. I think it can be used to show them that they should be wary of falling into the same trap.
I think admitting that you have a disease can show our children another aspect of personal responsibility - admitting that our behavior was self destructive and that it is important to set things right (make amends.)
"for me it goes WAY beyond that and that discussion really belongs on the faith board."
Isn't that another way of saying you got help??
Does the help need to be AA? I don't think so - I got a lot more help from the IOP I went to than AA. BUT - I also went to AA while I was in IOP and for a good while afterwards. Does it have all the answers? It didn't for me. But it does teach one thing that I believe helps the newly sober: Quit thinking and just do it. There is one AA slogan that a newly sober person needs to take to heart - "my best thinking got me here" - and I think that is why following the steps works for so many, that it's a way of getting them to quit thinking.
Because addicts are amazing thinkers. We have to be in order to maintain our addictions and survive. One of my IOP counselors always said that the recovered addicts are the next CEOs of the world because we are so clever.
Posted by SLS on November 10, 2005, at 9:24:17
In reply to Re: powerlessness » mama141, posted by AuntieMel on November 9, 2005, at 9:26:33
Hi.
> I truly do believe that an addict needs to face that they are powerless - and that they need help. Or at least that it increases the odds of success.
I agree. For some people, the resolution of their addictive behavior only becomes possible once they assume a posture of powerlessness over it. This is not necessary for all addicts, but for many, this admission of powerlessness is the most powerful choice they can make to defeat the addiction. Likewise, the disease model of addiction enhances some people's chances of regaining control over something that they are otherwise powerless to manage on their own. It works. 12-step programs work. Non 12-step also programs work. As diverse as is human personality and the composition of each addiction, so, too, is the diversity of treatments necessary to care for so many unique individuals.
For some, admitting powerlessness over addiction might begin by admitting to the inability to exercise control over it in the moment. Momentary powerlessness does not necessarily indicate perpetual impotency. However, as powerless moments accumulate despite the desire to break the addiction, there begins to develop a trend. The trend is simply that the addict has not yet found a way to exercise control over the addiction independently. Some people define themselves by their independence and self-reliance. This often seems juxtaposed to a recognition of powerlessness. However, we are not omnipotent. It is the refusal to admit this that often gets in the way of change. Indeed, it is through the admission of one's history of perpetual failure that momentary powerlessness can be transformed into perpetual empowerment and the possibility of success. It is a powerful individual whom uses his independence to ask for help.
It took you only two sentences to say what I needed two paragraphs to express. That leaves you being the brilliant one.
:-)
- Scott
Posted by AuntieMel on November 10, 2005, at 11:49:25
In reply to Re: powerlessness » AuntieMel, posted by SLS on November 10, 2005, at 9:24:17
Not so brilliant. It only took two sentances, but it took a whole lot of years before I could say it.
Posted by alexandra_k on November 14, 2005, at 12:00:53
In reply to Re: This was a rhetorical question everyone » alexandra_k, posted by mama141 on November 7, 2005, at 8:53:29
> We spent one term at university in Dunedin -- it was a great time, wonderful folks and terrific food. (I seem to remember being a bit chilly some of the time however.)
I haven't been down south since I was a little kid. Yeah, I've heard it gets pretty cold down there.
> We've not really spent much time on the North Island yet.
:-)
THats where I'm from. Its warmer the further up you go...> Our oldest son has worked with Native Americans (he's a doc) and he says he has little doubt that there is a "genetic predisposition" of some type, but he says just what you did. He refers to it as "cultural depression".
Yeah. The nature / nurture debate has been settled. I'm not sure how many people know this... But the debate really has been settled once and for all. And the answer it BOTH. And there it is. If you try and argue that it all comes down to nature it is just too easy to find counter-examples, and if you try and argue that it all comes down to nurture it is just too easy to find counter-examples.
The difficulty... Lies in detailing just what the inherited as opposed to environmental componant is... But then... That is probably fairly idiosyncratic across individuals...
Posted by alexandra_k on November 14, 2005, at 12:29:09
In reply to Re: This was a rhetorical question everyone » alexandra_k, posted by SLS on November 7, 2005, at 8:58:13
> More and more evidence is accumulating that genetics represent a contributory factor in the expression of alcoholism.
I never denied that. Thats what I meant when I said that there was indeed a heritability componant with respect to addictive behaviours. (I'd prefer to stick with 'drinking behaviours' or 'addictive behaviours' terminology because that leaves the CAUSE of the behaviour (ie the relative contributions of nature / nurture open to debate rather than building in the ASSUMPTION that nature is the most significant component).
>I have never stated or inferred that genes were the sole determinant in the evolution of alcoholism in any given individual or sociological group.
Right. That is just as well because if you were to claim that then that would be false. I mean... Surely there has to be the environmental componant of the substance being AVAILABLE in the persons environment at the very least ;-)
>... twin studies have shown that alcoholism is heritable.
Twin studies have shown that addictive behaviour HAS A HERITABLE COMPONANT. There is a difference. It might sound picky but it is the difference between having the heritable componant thus HAVING to display the addictive behaviour, versus having the heritable componant thus BEING MORE LIKELY to display the addictive behaviour. If you are the person with that heritable componant... That is a very big difference indeed...
> Native Americans also have a genetic predisposition towards diabetes. On average, Native Americans are more than twice as likely to have diabetes as non-Hispanic whites of similar age. One tribe in Arizona has the highest rate of diabetes in the world. About 50% of these adults between the ages of 30 and 64 have diabetes.Right then. Do you want to talk about the contribution of the environment there too? Tell me about their diet and their exercise... Once again... Heritable componant...
> Any focus on the predisposition of one population over another towards disease is important to identify. It serves to understand and treat disease; prevention being the goal. I could identify such conditions for populations all over the world. Why is bipolar disorder so prevalent in Amish populations? Diseases are not racist. Only people are.
My issue is that the main focus on differences between different ethnic / racial / cultural groups seems to be to focus on biological differences. One fairly good example of this is intelligence. The bell curve. That was a study on how intelligence seemed to be heritable. It ended up 'ranking' the 'inherited intelligence' for different ethnic groups. There is nothing wrong with such a study. The danger comes in focusing on biology so much that environmental factors aren't investigated or aren't emphasised, or are simply passed over.
The data in itself isn't racist. You are right about that. The difficulty comes when we appreciate that people interpret the data and people discuss the significance of their findings. The bell curve... Was used as justification for providing less education to african-american kids. They were thought to be innately less intelligent than white kids. The bell curve study showed that to be so... Or so it was thought. That is just one example of the dangers that come from the over-focus on biology to the point where environmental factors are passed over. I do believe... It took some guy from Wellington (New Zealand) to dispense with the bell curve conclusions...
;-)The utility of focusing more on biology than providing a more balanced treatment of the contribution of various kinds of environmental factors may actually turn out to be something that hinders our understanding and ability to understand and treat various things. What good does it do me to know that I have inherited a disposition (because there is a heritable COMPONANT it is not determined exclusively by biology)? That is something that is outside my power to change. I can't change my biology. I can however... Change my behaviour. And my environment can be changed. Other people can help me with that. And I can take things into my own hands too. I mean... If you want to stop drinking too much a good first step would probably be to rearrange your environment so there isn't any alchohol in the house...
Or maybe you think we will be able to screen embryos for this heritability componant? Remember... It just increases the liklihood... And I would say... It increases the liklihood most significantly when certain environmental factors are met.
> For some people, it is an insatiable craving for the chemical itself that drives their decision making process. The cravings are libidinal, not cerebral.Right.
> Sorrows have nothing to do with it.
?
They don't tend to make the cravings worse?
I remember hearing this. HALT. Don't get Hungry, Angry, Lonely, or Tired. Those were supposed to be things that... made the 'libidinal cravings' worse. Made one less likely to resist them in the face of knowledge of the long term harm. Trouble with this analysis is that... Those things just are part of the human condition and I don't know how helpful it would be to try and arrange things so you never felt those feelings. I don't think that would be possible. What may well be possible, however, is that the knowledge that the cravings get worse under those circumstances (and knowledge that the cravings will pass) well, that might be what helps give you the strength to resist them...> What differences must lie between the two people who choose different ways to address the same sorrows?
> Is it genetic?
> I guess it ain't that simple.
Yeah. Not nature OR nuture...
Nature AND nurture...And there it is.
:-)
Posted by alexandra_k on November 14, 2005, at 13:40:55
In reply to Re: Very debatable » SLS, posted by mama141 on November 8, 2005, at 15:53:53
> My concern in all of this is just how much of our ability to choose or implied loss of that ability, has been culturally imposed? ie: "I have a "disease" therefore I cant help the way I am" -- is the one end of the spectrum. How about what we pass on to our children? Or what our culture teaches them as far as self-control and personal responsibility?
Yes indeed. With respect to considering schizophrenia a disease (a chronic disease at that) what are we doing to a person when we give them that label? What we are doing is making a very negative judgement about the likely course their life is going to take. And if they manage to get better... Well... Then we put that down to 'misdiagnosis'. So... Schizophrenia is chronic by definition because if someone gets better we say they 'never really were' schizophrenic.
And the same with addictive behaviours. If someone manages to stop or cut back on drinking without AA attendance then we say 'they aren't an alchoholic because an alchoholic couldn't do that'.
Posted by alexandra_k on November 14, 2005, at 13:47:38
In reply to Re: Very debatable » mama141, posted by SLS on November 8, 2005, at 19:57:26
> I am unprepared to label sweepingly alcoholism or addiction as being diseases. However, they are what they are. We can understand and treat them without the label of disease as long as we have an accurate description.
My difficulty with the AA model is that it ASSUMES that addictive behaviours ARE a disease. And so what that does is it promotes the idea that we do not need an unbiased investigation into the nature of addictive behaviours. (What I mean by an unbiased investigation is an investigation where both genetic and environmental factors are considered). To say that addictive behaviours ARE A DISEASE is to promote the idea that the nature of addictive behaviours has been discovered and all sorted out already, and that it has been discovered that addictive behaviours are the result of a DISEASE process. The AA party line is that the DISEASE is CHRONIC and that AA attendance and surrender to god is the ONLY WAY to achieve TOTAL ABSTINENCE which is considered to be the ONE AND ONLY GOAL that it is legitimate to have.
So the problem is... If we accept this model of addictive behaviours then why would we bother investigating the nature of addictive behaviours? We think we already know... So why would we bother?
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