Mental Health Matters: Addiction no more a lifestyle choice than heart disease (opinion)
Mental Health Matters
I recently sat with several law enforcement officers and citizens for a discussion about first responders, emotional trauma and suicide.
The meeting included an introductory lecture on trauma and Post Traumatic Stress Disorder (PTSD) in first responders, followed by a brilliant, brief video about several first responders who ultimately committed suicide after exposure to traumatic events.
The video included poignant remarks from loved ones who experienced the death by suicide of a first responder. The audience, raptly attentive throughout the presentation, including yours truly, was moved by the witness testimonials.
One shocking statistic: In a national study of police suicides, police officers were three times more likely to kill themselves than be murdered.
Central to the meeting was a description of PTSD as a recognizable mental disorder caused by the experience of or witness to terrifying or life threatening events.
Shocking accident scenes, bludgeoned human beings, horrific battle sequences, infanticide and more form the visceral detail of the emotional trauma sometimes experienced by first responders including the police, firefighters, soldiers, and emergency medical workers.
Those with PTSD who committed suicide were movingly described as caring people who developed emotional symptoms over which they had no control and which eventually took their lives.
PTSD, like other serious emotional disorders including addictive disorders, involves distressing emotional symptoms which can devour even the slightest of life’s joys, eat away at the soul, and lead to suicide as the only solution to the agony of illness.
Some serious mental disorders, like PTSD, are caused by external circumstances that are relatively infrequent and extraordinary. Others, like a serious illness, a family death or major life reversals occur frequently.
Regardless, once you develop one of these conditions, you can’t simply shake it off. Taking a long walk, going on vacation, telling yourself life is good, that you are a good person, and that this will pass — none of these remedies matter much.
Other mental conditions, particularly endogenous psychoses, major depressive disorders and severe bipolar disorders are caused more by the genes, your biochemistry, your heredity. Again, you can’t just talk yourself out of them.
In general, people in the acute phases of more serious mental disorders have no more control over them than they would if they had an acute physical illness. You can’t talk your way out of a heart attack, a stroke or a bowel obstruction. Neither can you employ willpower to alter the cravings of addiction or the delusions of marked depression.
But here’s the thing: Whether you garner sympathy, assistance, support, kind and generous outpourings of genuine caring or disapproval, criticism, nasty comments about moral turpitude — or worse, depending on political and social factors — it has nothing to do with your ability to gain control over your illness. I hadn’t thought about it in quite those terms until that meeting some weeks ago.
Our heroes, and I count first responders high on the list, who develop PTSD are viewed with compassion and caring, even if we don’t always provide the financial and treatment support to help this “wounded” group of public servants.
But what if our hero, our first responder, should develop an addictive disorder instead of PTSD? After all, the traumas experienced by first responders cause increased levels of addictive disorder as well as PTSD.
If you’re an alcoholic first responder, the compassion and caring quotient drops off some, your behavior earns a mild level of disapproval, but so long as you don’t break any laws you won’t have the additional burden of being identified as a criminal.
What if you’re an addicted first responder? If your addiction is pills, particularly opiates for pain, there is modest disapproval, to be sure, but no one threatens to lock you up.
Then there’s the illegal drug using first responder. Now, in additional to your emotional troubles, you’re also a criminal because that is the law. By this point our caring and compassion index has dropped precipitously while the complexities of obtaining treatment have risen exponentially. After all, now you are asking for help for illegal activities.
Which is why I find the commentary about record breaking overdose deaths virtually every month so shallow, so incomplete.
Drug addiction is no more a lifestyle choice than obesity or heart disease. Addicts can’t “just say no” to their drug of choice. A craving is every bit as irresistible as a hallucination.
Drug addicts have the same cravings as compulsive gamblers and compulsive eaters. So long as we continue to criminalize and stigmatize drug addiction, we will continue to see, with puzzled inertia, ever higher levels of overdose deaths.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at firstname.lastname@example.org.