Dr Ellie Cannon wrote a critical response to my argument with Matthew Perry in the Mail on Sunday of 29th December 2013 . You can read it here.http://www.dailymail.co.uk/health/article-2530376/Yes-willpower-way-beat-DOESNT-mean-addiction-fiction-Peter-Hitchens-Doctors-response-Mail-columnists-TV-showdown-Friends-star-drugs.html
Well, it makes a pleasant change to be challenged on this subject by someone who does not instantly dismiss me as an ignorant idiot who has a bigoted closed mind. And I’m grateful for that.
But did the ‘whole thing descend into name-calling’? Not on my side. Nor did I say the whole debate was pointless. Had I thought it pointless, I wouldn’t have taken part. I don’t believe I called Mr Perry any names, or ever departed from an entirely logical and fact-based approach, or lost my temper. It’s an interesting reflection that the Twitter Mob clearly prefer Mr Perry’s combination of incoherent pseudoscience and personal abuse, thinking it a superior form of argument to facts, logic and dogged persistence. There’s not much hope for our civilisation if this is a general view.
Given that I was rather ill that night, thanks to the numerous side-effects of a disgusting and (literally) nauseating disclosing chemical I had taken as preliminary to a CT Scan due the following day, I rather pat myself on the back for that restraint. I described Mr Perry as smug and lofty at the end of the discussion (and complained about his lack of seriousness) because this seemed to me to be a factually accurate description of his attitude and behaviour. It still does. I only invoked Tinkerbell later because Mr Perry had introduced Peter Pan and Father Christmas into the matter. I would have invoked Tinkerbell that same night if I hadn’t felt so terrible.
I don’t ‘claim’ that addiction is offered as an excuse for a failure of free will. I state that it does not exist. If anybody disagrees, they only have to do what Mr Perry couldn’t do, and produce a testable proof of its existence. I argue that its popularity as an idea is the result of our general rejection of the idea that humans have free will and are responsible for their own actions. I challenge those who say that ‘addiction’ does exist to do the usual thing required of people making factual claims. That is:
*Define* the thing you say exists. *Describe* it. Show how we can detect its presence in an *objective, measurable and testable* way. The burden in such disputes is always on the advocate, not on the doubter.
This polite request meets either with silence, a painful grinding of gears as the subject is changed, or (more often) a stream of personal abuse. There’s also the danger of being enveloped in a thick fog of pseudoscience and psychobabble, which will leave most people lost.
I further state that if people want to give up the substances and habits to which they claim to be ‘addicted’, they can do so if they really wish to do so. I don’t say ( as has been alleged ) that this is ‘easy’. I say that it is possible. I can’t see how we can be said to be free or even properly alive if this isn’t so.
I repeat: as in all debates about science, the burden of proof is on the person who asserts the existence of a thing. Those who doubt its existence are a great help to the true scientist, who finds their scepticism helpful in refining his proof. But that’s always assuming he has a proof in the first place. Non-scientists, who accept claims on trust , or because of fashion, conventional wisdom or wishful thinking, are usually infuriated by scepticism. QED.
Where does one find the proof of the existence of ‘addiction’? Actually, there’s a question that comes before that. Where does one find a consistent definition of ‘addiction’ which remains valid at *all* stages of the argument about its existence, and which might even be testable?
Before we can prove its existence, we have to decide what it is. Otherwise we will get involved in a tricky bit of ‘bait and switch’ , much like those games of ‘Find the Lady’ into which unwise victims are inveigled by strangers on trains. A discussion of this problem in depth(in adversarial debate) may be found here http://hitchensblog.mailonsunday.co.uk/2013/12/can-we-be-friends-i-doubt-it-but-mr-perry-please-read-this-on-addiction/comments/page/3/ .
But the problem can be simply stated. If addiction is, as its advocates assert , a ‘compulsion’ , a force over which its victims are ‘powerless’ (as Russell Brand has said) , then how is it that so many ‘addicts’ do in fact give up the things to which they were formerly addicted?
I don’t, by the way, use the expression ‘pull yourself together’. That is a silly caricature. It’s very difficult to give up pleasing or self-indulgent habits even when they are obviously harming us. I have several such habits and weaknesses, and struggle with them. But I never pretend that they are anyone else’s responsibility, nor do I blame them on some external force. When I fail, I fail. If I sought excuses for them, I wouldn’t even try, and I would certainly never succeed.
Ellie says ‘But a huge number of those who are dependent on alcohol, cigarettes or tablets (often, first prescribed to control another illness) are ordinary Britons who don’t know they can’t stop until they try.’
She is assuming (she does this quite a lot) she has won the argument when she hasn't. By using the word 'dependent' she assumes that its truth has been proven. What does Ellie mean ' don't know they can't stop?' How do they *know* they *can't*. This is terribly prescriptive. 'Dependent', 'know' and 'can't' are absolute words, like 'compulsion' and 'powerless'. But the truth is that these absolute words cannot accurately be used here, because people *do* stop. Wouldn't it be better to say that they find it very difficult to stop, when they first try? And that the drugs are habit-forming, rather than that they are 'dependent' on them?
And could part of that difficulty experienced by these patients arise precisely because a huge consensus of media, doctors and ‘experts’ of all kinds have told them they *can’t* stop? Why, these days, I can’t even buy over-the-counter painkillers (which I have been taking occasionally without problems for years) without being earnestly warned that I might become ‘addicted’ to them. Twaddle. I hate them, and have hated them for years, but take them occasionally when the alternative is a splitting headache. This absurd belief in 'addiction' hovering over all of us can be much more damaging than that. A dying relative, in terrible pain, had to struggle to get sufficient morphine because of a ludicrous belief among doctors at the time that she might become ‘addicted’ to it. A less likely ‘addict’ never walked the earth, as the person involved was a tough-minded, self-disciplined and courageous nurse of the old Nightingale school, who had accompanied the Allied armies across northern Europe in 1944 and 1945, seeing horrors and stemming the pain and fear of others. But she still suffered from great pain at the end. She died before she could prove them wrong, God bless her.
I am interested to know in what way ‘psychological support’ is ‘proven’ to work in dealing with people who have damaging habits. My understanding, from friends, colleagues and acquaintances who have given up those very powerful habits, smoking and drinking, is that the only significant factor in their success was their own genuine desire to stop. I cannot see why deluding people with claims that they are not personally responsible for lifting the glass, or lighting the cigarette, and that doing so is a compulsion and a disease which is not their fault, will ever help them to that point.
Also, what precisely is ‘psychology’? It sounds scientific, but it is not based upon hard, objective, testable science at all. It benefits from the lay-person’s confusion of it with psychiatry, and is often wrongly believed to be a medical science. Even psychiatry is a soft and inexact body of knowledge, constantly altering, with many competing theories, and now in severe decline, but is more or less respectable because it is practised by people with proper objective medical qualifications. Those qualifications play little part in psychiatric practice, though – crucially – they allow practitioners to prescribe drugs, a fact much exploited by the pharmaceutical industry in its campaign to persuade us to take expensive pills to ‘treat’ various supposed mental illnesses. Pills have supplanted older therapies, since the Pharmaceutical giants became so generous with their conferences in nice resorts, free scuba-diving holidays and other rewards to doctors who recommended their pills.
So psychology, despite its grandiose Greek name, is at two removes from hard science and is about as ‘scientific’ as social work or sociology. Its claims are not gospel.
Then there’s this. When I asked for an ‘objective diagnosis’ of addiction I was not (as Ellie seems to think) necessarily seeking a blood test or chemical test of any kind. There are plenty of ways of diagnosing real physical diseases without such tests (though tests are often useful to confirm the presence of a suspected disease in cases of doubt).
A consistent list of observable, recordable*physical* symptoms would do, symptoms which could not, in that form, be present in a healthy person, and which were distinct signs of that disease and that disease *only* , and which could be independently identified and confirmed by more than one qualified practitioner, and further confirmed by a specialist in that area of medicine. The crucial word is not ‘chemical’ (which I didn’t use) , but ‘objective’ (which I did).
I think Ellie Cannon would accept that Parkinson’s for instance, can be pretty reliably identified through a number of distinct *physical* symptoms. If you don’t have them, you haven’t got Parkinson’s.
Also, Parkinson’s like most diseases, is not a matter of choice. But the alleged ‘addict’ has chosen his or her ‘addiction’, and pursued it with some diligence and determination. Nobody sets out to get Parkinson’s or embarks on a series of behaviours that are known to lead to Parkinson’s . I realise as I say this that there are some ‘lifestyle’ diseases, lung cancer being the most obvious, which people can pursue and often obtain in this way. But large numbers of people give up their dangerous habits (often at the cost of great effort) rather than continue. Willpower and responsibility once again come into the question, or none would give up.
The fact that someone voluntarily goes in search of criminal dealers, voluntarily breaks the known law by buying from them, pokes heroin into his arm or eyeball, or voluntarily drinks too much whisky , after a long, slow and deliberate process during which he or she has ignored a thousand warnings and pleas from his family to stop, and in the case of heroin has repeatedly broken the criminal law, is simply not in the same category as the rather compulsory, and much feared, signs of the presence of Parkinson’s.
If Parkinson’s sufferers could stop experiencing the things that their bodies do against their will and desire, they would. They really can’t. To confuse the two things is not just a category error, but a bit rude (I put it mildly) to sufferers from real, compulsory diseases. Nobody goes in pursuit of Parkinson’s.
So, that deals with that non-parallel.
Next we come to brain imaging. Now, brain imaging is very interesting, but it can be a trifle overstated. Brain imaging can show physical and chemical events in the brain. It can link them with external stimuli. And this is a good deal more than we used to be able to do. But it has absolutely nothing to say about such concepts as free will. To talk as if it does is like looking at Google Earth pictures of a city you have never been to, and trying to deduce from them what the people in that city are thinking and saying.(More on this below).
No doubt the frequent use of pleasure-inducing chemicals habituates the brain and other organs to those chemicals, and creates conditioned reflexes of many kinds. It undoubtedly increases the *desire* of the person for these things. But increased desire is not the same as compulsion. It merely makes it harder to stop.
And if ‘addiction’, so called, is not compulsion (and we have already established that it isn’t) then it lacks the crucial characteristic of a disease, the characteristic that makes us sympathise with the sick and has created the great professions of medicine and nursing, and which sustains the NHS with willingly-given taxes - that a disease is something you get whether you want it or not. The thing we call ‘addiction’ has to be energetically and knowingly sought over a long period, in defiance of morality and social disapproval, and often of law, and there is no evidence at all that the ‘sufferer’ cannot throw it off if he wants to. On the contrary, there are tens of thousands, possibly millions of cases in which people have given up heroin, alcohol and cigarettes.
I am sorry to say that sentences such as ‘Evolutionary neuroscience suggests that this compound is intrinsic to our ability to learn’ are not in fact statements of scientific truth. The word ‘suggests’ is imprecise, uncertain and vague . The phrase ‘intrinsic to our ability to learn’ is likewise unclear. It has to be because the claim it makes is unclear and so very hard to test. Alas, the use of such words can beguile the layperson into thinking something truly authoritative is being said.
The same goes for the formulation ‘neuroscience’, which first appeared in the dictionary in the 1960s. Let us first be clear about what it is not. There is a hard science of the brain and nervous system known as neurology (also a medical discipline and specialism). But like old-fashioned analytical and Freudian psychiatry, neurology has taken a bit of a back seat in recent years . This is perhaps because it is incredibly modest about how little it knows and how little it can do to heal or cure injuries to and diseases of the brain. It is also rather sceptical about prescribing pills for them, as it recognises that the actual operation of ‘antidepressants’, and ‘antipsychotics’ is mysterious at best .
Neuroscience is an ‘interdisciplinary’ science. It combines in one body chemistry, computer science, engineering, linguistics, mathematics, medicine, philosophy, physics and psychology. Most of these are real hard sciences. But several are not. And the presence in such a cocktail of any soft sciences softens the whole lot. It is also often linked with pharmacology, a development which I think is connected by the large (and in my view exaggerated) claims of pharmaceutical companies to have developed biochemical treatments for several ailments of the soul. Can they really? Perhaps not. A discussion of their claims to treat depression can be found in two powerful articles by the distinguished American doctor, Marcia Angell , here http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/
And here
http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/
(These articles are themselves reviews of books on this subject by well-qualified authors. Nobody interested in the current state of psychiatric medicine should be in ignorance of them).
The gap between much of this activity and real hard science is being widely debated in the current controversy over the American Psychiatric Association’s latest Diagnostic and Statistical manual – DSM 5 , which treats a large number of human conditions as medical problems, conditions which used not to be so treated. A good lay description of these difficulties can be found in the book ‘Cracked: Why Psychiatry is Doing More Harm Than Good’ by James Davies (Icon Books, 2013).
So I would beg readers to be careful with several passages in Ellie’s argument, which seem to me to be contentious, or not to be backed by hard science.
Animal studies cast little (in fact no) light on human will. As Ellie says ‘Whether or not these animals have willpower, no one knows’. You can say that again. And it is hard to see how anyone ever will know.
Then we reach what seems to me to be the crucial passage. I’m now going to examine it for hard science. My criticisms are inserted in Ellie’s text, marked ***
Ellie : ‘But the research does suggest something physical happens in the brains of those who are addicted.’
*** This statement begs the question. It presupposes the existence of ‘addiction’ without defining it or proving its existence. It would be more accurate to say that something physical happens in the brains of those who abuse substances. Well, yes, and so what? Nobody disputes that people’s brains are changed by experiences, by injuries and by drugs. But be careful what you deduce from this. Learning the streetmap of London to qualify as a licensed taxi-driver also physically alters the brains of those involved. This does not show that the taxi-driver became a taxi-driver *because* his or her brain changed shape. We know that these changes followed the learning process. It shows that acquiring and storing this concentrated body of knowledge altered his or her brain.
Many human behaviours have *effects* on the brain. Taking drugs which act physically or chemically on brain tissue will axiomatically change the brain. Taking the legal ‘medications’ often given to such people by doctors will likewise change the brain even more. You would expect drug abusers or heavy drinkers to have abnormalities of the brain. You would expect consumers of prescription psychiatric medications to have abnormalities of the brain. Again, so what? This shows a correlation between certain influences on the brain, and physical changes within the brain. And within very tight limits we can assume a simple, crude, cause and effect. Certain external experiences have physical effects on the brain. Beyond that we can say nothing for certain.
Ellie continues ‘ In human studies, scans have shown that areas in the brains of addicts ‘light up’ when they are exposed to the object of their desire.’
***Quite so. But we really have to be very modest in what we deduce from this. We know which part of the brain is involved. We know the nerve pathways which are travelled. But I think it difficult to say more, given our very limited knowledge of the brain and its operation.
Ellie : ’Numerous studies have shown a rise in the brain chemical dopamine which occurs in response to addictive vices, whether gambling or drugs.’
***Once again, this an event which happens *after* the action which Ellie is seeking to explain. We must not mistake description of a correlation, after an event, for an explanation of how and why the event took place. Interesting use of the word ‘vices’ though.
Ellie: ‘Dopamine is a neurotransmitter, a naturally occurring chemical produced by the brain that sends messages between nerve cells and signals pleasure.’
***I’ll assume for the sake of argument that that this statement ‘Dopamine…signals pleasure’ can be objectively shown. By the way, if that is so, its increased presence in the brains of gamblers and drug abusers presumably shows that they enjoy these activities (or ‘vices’), and get pleasure from them. Which is my explanation of why they keep doing it and don’t want to stop.
Ellie : ‘Evolutionary neuroscience suggests…’
*** Two red lights should flash here in the mind of the careful reader: This subject and verb are both contentious. ‘Neuroscience’ as discussed above, contains subjective elements. ‘Suggest’ is a conditional and cautious statement, well short of ‘says’. In terms of scientific solidity, this is soft currency, not hard currency.
Ellie’… that this compound is intrinsic to our ability to learn’
***Vaguer and vaguer. What does ’intrinsic to our ability to learn’ actually mean? And, I might add, what does it have to do with the claim that ‘addiction’ exists?
Ellie ‘– it acts like a ‘save button’
***I am sorry, but I do not think this can be called a scientific or medical statement at all.
Ellie ‘…and helps us remember to do things by giving us a good feeling when we do them.’
***I am also not sure how solid this claim is. We also remember to do things by getting a bad feeling when we forget to do them. Nor am I sure what it has to do with claims that ‘addicts’ are ‘compelled’ to take the things they take.
Ellie then says :’Famously, the psychologist Pavlov showed that even the anticipation of pleasure can elicit a physical response: his dog salivated at the sight of food, and by Pavlov ringing a bell as he served it, eventually, his dog salivated as soon as he heard the bell, without food being present.’
***Yes, and conditioned reflexes are without doubt powerful. But (as stated above) we do not even know if dogs have will. And involuntary drooling at the sound of a bell, in a dog, is hardly the same as supposedly involuntary drinking, smoking or poking of needles through the skin, in a human. It is a reaction, not an action. Such reflexes do not override human will in matters of action, and provide no evidence that brain changes resulting from a voluntary habit can, ever have, or ever could achieve such a result.
So the next statement that
‘Addiction is simply this reward process gone awry. Studies show that once people are addicted to a drug, the dopamine in their system spikes even with the expectation of ‘the hit’, and if it doesn’t come, the dopamine levels drop sharply. This feels bad.’
…is once again a great howling question-begger , in that it assumes the matter under discussion is resolved, in the course of trying to prove that it is This is against the rules of logical argument . ‘Simply’ indeed! Remove the first sentence, with its contentious and unproven claim, and the only coherent and uncontentious matter is as follows : ‘Studies show that once people are addicted to a drug, the dopamine in their system spikes even with the expectation of ‘the hit’, and if it doesn’t come, the dopamine levels drop sharply. This feels bad.’
Once again, yes and so what? Disappointment in the pursuit of pleasure is not compulsion to seek that pleasure. On the other hand, this would seem to be a clear scientific statement of my repeated claim that drug takers take drugs because they enjoy it, which I am always excoriated for saying.
I’ll leave it at that for the moment. I deal with a small but important extra point below, because I will need to return to it when I know more about it.
I’ve been unable to obtain full details of the alleged Mayo Clinic Gambling Compulsion study. Because of the infuriating unavailability of medical journal articles in newspaper library systems, details of this are scant.
But perhaps others can help me. What did these patients (presumably sober puritans with no previous urge to gamble) do when they were given these dopamine agonists?
Did they break out of the clinic and fly unguided to Atlantic City or Las Vegas, there to throw away their fortunes in slots or at the roulette table? Did they (when the drugs ceased) immediately abandon this gambling? Were they able to recall, describe or explain their behaviour while under the influence of the drugs? The unanswered questions are endless, especially since gambling is not (like, say, eating, drinking and a few other things) a natural human activity, but a culturally-conditioned recreation only available in advanced societies with concepts of money, ownership and mathematics. What would they have done in a society where gambling wasn’t possible?
The drugs involved seem to be very powerful. Those who take them do so in the hope of escaping the symptoms of very unpleasant conditions, so once again the matter is not one of fully voluntary choice. Perhaps they are comparable in effect to the physical brain traumas which cause people to start speaking Welsh, when they did not previously know the language, or to talk in foreign accents, or undergo other mysterious personality changes?
If so, then I don’t think they can really be compared to the process of voluntarily embarking on a bad habit, known to be habit-forming, expensive and dangerous to health( and possibly criminal) and then persisting with it until it is quite hard to give up, and then blaming an external force for your own stupid selfishness.
