Unintended Consequences of Neuroscientific Explanations

René Magritte, Les Amants (1928)

In Madness and Civilization, French philosopher and activist Michel Foucault wrote that, “from the fifteenth century on, the face of madness has haunted the imagination of Western man.” Foucault argues that the concept of ‘madness’, at least in the 1800s, was characterized as a loss of ‘reason’ – the essential mental faculty which made human beings distinct from other animals. Those who lacked reason (which all rational beings possessed) were perceived as a threat to humanity. Eventually barriers were raised – both literally and figuratively – which separated these ‘irrational’ individuals from the rest of humanity.

Such stigmatizing and social-distancing attitudes towards those living with mental illness are still deeply enmeshed in the social and cultural norms of many industrialized nations. In the 1960s, sociologist Erving Goffman spoke of stigma as a “spoiled identity;” more closer to us Bruce Link and Jo Phelan conceptualize stigma as occurring when “elements of labeling, stereotyping, separation, status loss, and discrimination occur in a power situation that allows them.” A related concept, social distance, is defined as the degree of proximity an individual is comfortable with in relation to an individual who is living with mental illness, particularly as it relates to the perceived dangerousness or unpredictability of that individual. Prevailing views amongst the public see the behaviour of individuals living with mental illness as volitional; at times these individuals might be considered ‘lazy’ (in the case of major depression and the ethical values tied to participation in the workforce), and so, intuitions about mental illness are believed to be justified blaming these individuals, or perhaps even punishing them.

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The Depiction of Addiction

Over at The New Republic, Sally Satel, psychiatrist and resident scholar at the American Enterprise Institute, recently reviewed the controversial book Addiction: A Disorder of Choice by psychologist Gene Heyman. Heyman’s thesis is that conventional wisdom about addiction being a ‘disease’, or perhaps a ‘brain disease’, is incorrect. Satel quotes Heyman by saying, “that the idea [of] addiction [as] a disease has been based on a limited view of voluntary behavior.” Accordingly, addiction is not an “irresistible act”, as he claims the term ‘addiction’ implies, and is in fact a “disorder of choice”. [Note: I have not read Heyman’s book, so I will not comment on the book directly]. Indeed, Satel conveys Heyman’s position as one that is in opposition to perspectives from powerful public figures that support the view that “Addiction is a Brain Disease, and it Matters.” Satel agrees with Heyman’s position, namely that if addiction is a disease, it is a disease the person chose for herself.

Satel’s review of Addiction prompted a response from writer Sascha Z. Scolbic and Peter Scolbic (TNR’s executive editor), who argued that Satel was puting up a “straw man” argument. [See Satel’s reply to the Scolbic’s here].

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