Claudewell S. Thomas, MD, MPH, DLFAPA, is an established psychiatrist currently retired and living in Rancho Palos Verdes, California. He received his medical degree in 1956 at SUNY Downstate College of Medicine and specializes in social psychiatry, public health psychiatry, and forensic psychiatry. Dr. Thomas was board... more
The most recent edition of The American Scientist featured an article which challenged assertions made by last September's National Geographic magazine and JAMA, American Journal of Psychiatry, American Journal of Neurology among many others. It challenges the assertion that addiction is a brain disease.
Disputes over jurisdiction are not unusual in medicine. Sometimes they are related to claims of superior competency, sometimes they are related to anatomical jurisdiction, sometimes they are fueled by professional concern, and sometimes they are fueled by competitive compensation concerns. Addiction is no exception but its many links to other diseases (pulmonary, hepatic, gastrointestinal, cardiac, etc.) make it fascinating and instructive. The discovery that sheets of cells act as organs, leading to queries as to whether the interstitial layer is an organ, seems similar to the "discovery" over a century and a half ago that the skin is an organ.
Similarly: The discovery of the intestinal biodome! As was said before, the disputes that arise over treatment suzerainty sometimes involve disputated compegtencies, sometimes organ-specific jurisdiction, but often about the right to compensation for involvement. I suggest that the meaning of addiction may be a reasonable path to follow in our attempt to deal with an apparently increasing scourge and the impossibility of ready resolution of the foregoing.
The ghat, kat, or betel juice of the east Indian, the opium of the 19th century Chinese, the methamphetamine of contemporary east London or middle America--they are either recreational toys for the elite, or survival instruments for the wretched of the earth (often both). The cheaper the drug, the more likely it is to be associated with wretchedness and the need to increase the tolerance of drudgery-induced pain (physical and psychological). If this is the primary source of addiction in an area, conventional doctor-patient intervention cannot work. The Public Health approach should tell us what we are dealing with if the necessary instrumentation and reporting are in place. An interlocking public health consortium of individual countries with poorer countries helped fiscally by richer ones would make for a true World Health Organization, particularly since it would apply pressure toward elements of world government even if this last is ultimately unobtainable.
What is the Purpose of Government?
More and more are being concerned by the Firstisms that are sprouting worldwide at the same time that national budgets are showing less predilection for health and more for defense. At the very least, the purpose pf government has to be ensuring that we have a world within which we can defend our borders!