On Thursday 16th October, Professor Kenneth Kendler delivered his second (and final) Loebel Lecture, entitled ‘The dappled causal world for psychiatric disorders: implications for psychiatric nosology’. You can view it online here or listen here.
Whilst Kendler’s first lecture – summarised by Roger Crisp here - focused on empirical issues, the second lecture was more philosophical. Kendler’s key question in the second lecture could perhaps be formulated as: Given the complex aetiology of mental disorders, how can we best understand and explain how they arise? Continue reading
The Genetic Epidemiology of Psychiatric and Substance Abuse Disorders: Multiple Levels, Interactions and Causal Loops
What causes psychiatric disorders, such as depression or alcohol abuse disorders? It’s obvious that background and upbringing often play a significant role, as do life events, such as losing one’s spouse or one’s job. And we also know now that genetic propensities are important. But how do these different factors inter-relate with one another? For over three decades, these issues have been at the centre of the research of Oxford’s first Loebel Lecturer, Professor Kenneth Kendler.
Professor Kendler is one of the world’s leading, and most highly cited, psychiatric researchers. He uses a range of methods, including family studies, twin and adoption studies, and molecular genetics. He also has a serious interest in the philosophy of psychiatry. His first Loebel Lecture — The Genetic Epidemiology of Psychiatric and Substance Abuse Disorders: Multiple Levels, Interactions and Causal Loops – was presented at the Oxford Martin School on Wednesday 15 October 2014, and is now available on Youtube and as an MP3 audio file. Continue reading
German MP Michael Hartmann was recently in the news because of his crystal meth use. The media was quick to compare Hartmann to other politicians who use other substances: the past marijuana use of Clinton and Obama, and the recent scandal around the crack addiction of Canadian mayor Rob Ford. The media also stresses that it is hypocritical that Michael Hartmann previously publicly opposed the use of cannabis. The media enforces the image most people have: all substance use is the same and equals addiction, low self-control and bad morals. Continue reading
Recently a neuroscientist discovered he was a psychopath. He was studying the brain scans of psychopaths, and intended to use some brain scans of family members and one of himself for the control group. Now one of the brain scans from the control group show clear signs of psychopathy, so he thought he must have misplaced it. He checked the reference number, and found out it was his own brain! This came as a total surprise to him, he never showed any signs of psychopathy, yet, he was very convinced that if his brain scan showed similarities with that of psychopaths, he must be a psychopath himself. Retrospectively his wife admitted that she thought he had some of the signs like lacking in empathy, and he found some famous murderers in his family. Instead of hiding this intimate fact about himself, he wrote a book about it, showing how amazing brain scans are. His book argued that brain scans can detect a psychopath like him, who never had any compelling symptoms of psychopathy. Continue reading
A new study among students, found that those who smoked cannabis performed better academically than their tobacco smoking, stigmatized peers. The study has been collecting data among students (8,331 in total) in grade 7,9 and 11 for 30 years, and noticed the following trends. While the use of tobacco around the 90ties decreased, the use of cannabis increased. While the use of tobacco became increasingly associated with a slow and painful death due to cancer, the cry for legalization of cannabis for medicinal purposes (for example to treats side effects of cancer treatment) gave cannabis a more positive image. The study emphasizes that performing worse academically has nothing to do with the substance tobacco itself. Although it is well known that cannabis can effect one’s memory, no such effect is known about tobacco. The fact that tobacco users perform worse than cannabis users has all to do with changing social norms and the marginalizing of tobacco smokers. The study seems to suggest that it is a double effect: marginalized students will choose to smoke tobacco rather than cannabis, but this will marginalize them further. Students who use marijuana are more like the general population, so perform better academically than the marginalized group. Instead of zooming in on the effects of marginalization of tobacco smokers, the study chooses to warn again the normalization of cannabis use, which, according to the study, is a very dangerous substance, in many aspects as dangerous as tobacco. Non-users of tobacco or cannabis still perform better than cannabis users. The study wants to make a case against the legalization of cannabis.
Zinberg famously distinguished three aspects that determined the effect of a substance: the properties of the substance itself, the characteristics of the person taking them, and the social setting wherein the substance is taken. This study nicely illustrates the importance of setting, or social norms around substance use. It shows that setting determines more of the negative effects of the substance than the properties of the substance itself, and how hard it is to determine the negative effects of a substance separated from the social context. It shows that the attractiveness of certain substances is more determined by their social status than by their properties. Many studies have also shown that the effect of a substance in a vulnerable population is different than in a general population. The famous veteran study of Robins showed that Vietnam veterans who became dependent on heroin in Vietnam, had no problems giving up their habits once returned to the United States. The general population mostly succeeds better in the recreational or temporarily use of a substance, because they have more incentives to control their use, and less other problems to self-medicate for. Continue reading
In a fascinating paper presented at the St Cross Ethics Seminar in Oxford, on 27 March 2014, Professor Neil Levy (Oxford and Melbourne) sought to solve the following puzzle about addicts: on the one hand, addicts are thought to lack control, but on the other they appear to engage in the kind of reason-responsive behaviour typical of rational agents (for example, many addicts for a small financial incentive will avoid the objects to which they are addicted).
Levy’s central claim was that addicts do lack control, but that this lack of control consists in a lack of control over belief-formation, leading to a change of mind – or ‘judgement-shift’. So addicts are rational in so far as they are acting on the basis of their current beliefs about what is best for them. Continue reading
A Dutch program pays chronic alcoholics in beer for cleaning the streets and parks. A Canadian homeless shelter provides their alcohol clients with six ounces of white wine every 90 minutes. Giving alcohol to alcoholics, it seems counterproductive from a ‘just say no’ perspective, but I would like to argue that it makes sense on many levels.
The strongest case for giving alcohol to people with chronic alcohol dependence is based on the principle of ‘harm reduction’. Canadian ‘wet-shelter’ programs have emerged for two main reasons. The first is that many homeless shelters are abstinence based which means inveterate drinks would continue to sleep rough, even in freezing winter months, resulting in tragic deaths. The second reason is that chronic inebriates often consume non-beverage alcohol like hand sanitizer, mouth wash and aftershave thereby exacerbating already severe health problems. A recent study by the Centre for Addictions Research found that a “managed alcohol program” approach reduced emergency hospital visits and arrests among participants at the Kwae Kii Win Centre Managed Alcohol Centre by 40-80%. Significant changes among program participants included an improvement in accommodation renewed contact with their families, and better diet. Whilst participants still receive their alcohol throughout the day the alcohol is given by staff in controlled doses at fixed intervals. The dose is enough to prevent withdrawal symptoms, but not high enough to cause intoxication. Although there are many formal harm reduction programs for heroin users, it is less common for people who are alcohol dependent, despite the fact that withdrawing from alcohol can be lethal. Continue reading
This week, I’ve been thinking about smoking. Full disclosure: My name is Jim and I am a smoker. I have smoked for nearly a decade now – since around 2005 – and I only smoke menthol cigarettes. I am addicted to the sweet menthol smoke, where that touch of red fire at the end of a white stick seems so perfectly suited to almost any occasion from celebration to commiseration. I give up on average for a month or two a year, every year. I always come back, though. The reason I say this is to highlight that I am by no means one of these dour-faced moralizers, condemning smokers for their ‘filthy habit’. Like a snot-nosed child, it may be filthy, but it’s my filthy habit. Most efforts to encourage people against smoking focus on the idea that smoking is personally damaging: it causes illness and death, it costs a lot of money, it harms others, it litters the environment, and so on. This week, however, I’ve been thinking about whether the real concern is that smoking might be morally wrong. (NB: I’m discussing where whether it is morally wrong, not whether it should be legally banned or whether people should have the ‘right’ to smoke – these are distinct questions). Continue reading
The death of celebrities due to addiction: on helpful and unhelpful distinctions in destigmatising addiction
Philip Seymour Hoffman is dead. Probably due to an overdose of heroin. Hoffman didn’t have to die if he wasn’t so ashamed of his substance use that he did it in secrecy. Because he overdosed alone, no one could call an ambulance on him that would have probably saved his life. http://truth-out.org/news/item/21645-philip-seymour-hoffman-didnt-have-to-die#.UvAI48u3dcc.facebook Some are using the media attention surrounding his death to push for better drug laws. Some want to treat heroin addicts with heroin while some simply want to draw attention to a secret demographic: high educated, rich, white, middle age heroin users. Both attempts try to destigmatise heroin use. Continue reading
The laws that prohibit possession of certain drugs are ostensibly justified because they protect people from the health risks that are associated with uncontrolled or heavy use. Some have argued that criminalizing possession of small quantities of drugs for personal use is overly paternalistic (people should be free to make potentially risky choices as long as they don’t put others at risk) or even counterproductive (criminalizing drug use fuels a black market, many aspects of which present greater dangers to individual drug users and wider society). I find these arguments intuitively persuasive (although clear evidence would be needed to substantiate the claim that criminalization is in fact counterproductive).
So, if there is a justification for putting controls on personal drug use it seems that it ought to appeal solely to the physical and social harms that would result from a policy of drug liberalization. Such an approach is roughly reflected in the UK drug laws: the graded classification system, which determines the maximum penalty for possessing drugs in each class (A to C), considers only the harmfulness of the drug: punishment is linked to risk to health. Criminalization of drug use thus has nothing to do with a moral evaluation of this drug use.
However, a news story this month raises the question of whether moral considerations are sometimes playing a role in the sentencing of those convicted of possessing illegal drugs. Continue reading