Stigma Hurts Everyone

I read an interesting post recently, from a self-described “functioning alcoholic” discussing the possibility of treating alcoholism with pharmaceutical drugs. While there’s no successful pharmaceutical treatment at this time, there are a few things in development and it’s seeming increasingly probable that the drug companies will focus research and development efforts on coming up with something.

More interesting to me than the potential treatment itself were the issues raised in the post about concerns raised by this treatment possibility – because all of the concerns seem to be based on observations of how psychiatric medications have been implemented and viewed since their development. (These issues also obviously apply to pharmaceutical treatments for other conditions, including fibromyalgia, migraines, etc.)  The issues raised by the author of the original post include:

• “Is it appropriate to battle a chemical addiction with another chemical?” This is parallel to the often-voiced concern about whether chemical/medication-based treatment is an appropriate response, or if it will just replace the symptoms of mental illness with dependency on psychiatric drugs.

• “Won’t the pharmaceutical companies “define alcoholism down” in an attempt to get the broadest possible consumer base for their products?” – This is parallel to the concerns about encouragement to overdiagnose mental health conditions such as ADHD and depression in order to broaden the market for pharmaceutical interventions. It also draws from concerns about advertising Abilify and other psych drugs directly to consumers through TV and print marketing.

• “Is life really worth living if you’re sober all the time?” – while the original author clearly intends this as a joke, I find it similar to arguments I’ve heard that “messing with someone’s emotions” through pharmaceutical intervention will inherently result in significant changes to that person’s personality and identity. This seems similar, in that it questions whether life will be the same if such a fundamental component of their self is being affected by pharmaceutical treatments.

• “One of the arguments against a medicine-based treatment of alcoholism is that while it may certainly curtail the physical addiction it does nothing to address the underlying reasons why someone might choose to drink—anxiety, depression, an unwillingness to be in the world without some kind of sedating agent to take the edge off of existence.” This idea is often used to argue that medication-based psych treatment alone is insufficient, and must be combined with some kind of psychotherapy to effectively address the underlying emotional issues driving the mental illness. It is also sometimes used to suggest that taking medication alone is “cheating,” by mitigating the symptoms of underlying trauma or disorder without addressing the root causes, allowing the patient to ignore the root causes and eventually causing greater harm.

• “I’m not unsympathetic to the argument that a certain amount of drinking is just fine. I know plenty of folks who drink almost as much as I do and manage to keep it all together. Why castigate their actions or make them think they need “treatment” for what could be considered just another lifestyle choice?” This parallels many of the discussions regarding what constitutes a mental illness and ties into the ideas of “neuroatypicality,” where a person’s mental functioning is described as different than typical mental functioning, without a value judgment as to whether typicality is better or worse than atypicality. It also references the underlying conception that being labeled as someone who could benefit from pharmaceutical treatment is shameful or stigmatizing, a judgment which would surely spread to those on the borders of atypicality.

I found all this fascinating because, while I’m used to hearing these arguments and issues raised in the mental health treatment context,  it’s clear that they are permeating our society and discourse beyond their direct application to mental illness.  Here, the spectre of passing out ADHD drugs in every elementary school classroom is being raised as a potential concern in the as-yet hypothetical development of a treatment for alcoholism – a serious condition which can lead to significant health consequences up to and including death.

To me, this says that addressing these issues – the misinformation, the stigma, and the bad acts of pharmaceutical companies – is important not only to people with mental illness, but also to the groups who could benefit from pharmaceutical developments and interventions yet to be developed. It is clear that these issues are so significant that they could discourage people from supporting or even considering the possibility of future treatments that could potentially help millions.