Saturday, September 3, 2011


I'm shifting today into a more cerebral mood, questioning a principle many of us take for granted.

Let's start with an online item,, which claims that a new definition of addiction might dramatically shift its popular image, much as the American Medical Association changed our view of alcoholism when it lifted it out of the gutter by defining it as a disease.

Following four years of consideration by eighty experts, the American Society of Addictive Medicine (ASAM) now defines addiction as "…a primary, chronic disease of motivation, brain reward, memory and related circuitry…" This new definition shifts emphasis away from behaviors and focuses more on brain dysfunction.

That is, addiction is now a brain disease. Indeed, there's evidence for this view. The website says, “Twenty years of neuroscience has proven that chemical changes in the brain can help explain the difficulty a person experiences when trying to break free of addictions even after detox and treatment.”

That’s a carefully worded statement. It doesn’t say chemical changes in the brain “cause” addiction, only that it coexists with those changes. Brain chemistry alterations are also associated with depression, aggression, meditative states, and a host of other emotions and behaviors.

It's easy, then, to jump to the conclusion that chemistry drives subjective experience: we’re hooked or blue or angry or in love because our neurotransmitters bend us that direction.

But it ain't necessarily so. In fact, conscientious scientists take pains not to state the case like that since—now, get this: no one’s ever proven a causal relationship. Nevertheless, hearing of such research again and again, we develop the notion that chemistry inevitably creates our experience. That's the view I was taught in med school. Our physiology professor called human beings “sacks of enzymes.” He insisted that all we can do is jump or spit—that is, operate muscles or glands. He said we’re nothing more than molecular contraptions, and that any consciousness we sense in ourselves is actually an illusion orchestrated by chemical play.

The point is critical. If we're to craft a style of healthcare as though people matter, we need to see ourselves as something beyond chemically directed gadgets. Fortunately, my professor's perspective isn't the only one available.

Another possibility is, strangely, the opposite, that consciousness drives chemistry. For example, the feeling of depression—or addictive craving, or anger, or any emotion—changes brain chemistry. In this view, we’re primarily emotional beings whose molecules tag along accordingly. When I'm peaceful, I release brain endorphins, not the other way around. (Of course, this looks more complex when, say, we fall into a longterm depression; the consequent depression molecules, so to speak, become resident enough to create a vicious cycle.)

A third possibility is that chemistry and emotion are two profiles of one single phenomenon, like lightning’s flash and thunder. Neither causes the other. The problem with this view is that it admittedly can’t answer the question of where human behavior ultimately comes from. If you find yourself in this camp, you need to get comfortable living with mystery.

So what's the answer? Are we primarily chemical gizmos, emotional beings or utter mysteries? Sorry, but there’s no way even to reliably research the issue. Think about that. How would you devise an experiment? You’d necessarily have to include subjective consciousness—a messy business, what with its time lag and questions of interpretation and honesty—in a project you’d prefer to be cleanly objective. 

So we can't know, but still need to live a life. So we choose, and can choose only from preference. How do I wish to see myself, as having free will or as trapped by my chemistry?

I don’t raise this issue just to exercise my intellect in order to stave off dementia. The fact is that our choice of self-image dictates our behavior. If I view my obesity and type 2 diabetes, say, as something visited upon me by a quirk of chemistry, I'll likely feel powerless to personally challenge it, and instead put myself in the hands of chemical engineers. But if I understand that it results from decades of chosen behavior, I might decide deliberately to alter my life.

I've long ranted here about how illnesses in America are so commonly based in lifestyle. Everyone's capable of converting their behavior from pathogenic to healthy, but only provided they sense the personal power to do so. Too much of medical practice amounts to enabling neurosis, and that itself isn't healthy. We'll do better as we realize that chemistry isn't our master, but our servant. 

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