No brain is an island
Margaret Wente has ventured into the hornet’s nest of trying to understand addiction as either a medical condition or a moral weakness (Philip Seymour Hoffman Had A Habit, Not A Disease – Feb. 13). The psychiatric community itself is split. Witness the many mental-health programs that list addiction as an exclusion criterion, and the addiction programs which list mental illness as an exclusion program. Woe to the patient who has both.
No brain is an island. The new fields of epigenetics, neuroplasticity and interpersonal neurobiology are all providing evidence for what some of us have been saying for years – it’s not either/or, it’s both/and. Like patients with eating disorders, patients with addictions often lack insight and their symptoms only bother others, not themselves. This makes voluntary treatment extremely difficult, and calls for a multipronged approach in which the patient is both encouraged to take responsibility for his or her actions, and is helped by others, both professional and lay.
What is not helpful is blaming the victim. In the 21st century, we must embrace unified models in which nature and nurture are inextricably linked and mutually influence each other. If we don’t, addiction will continue to plague us and take individuals like Mr. Hoffman from us.
Dr. Marshall Korenblum, chief psychiatrist, Hincks-Dellcrest Centre for Children and Families, Toronto
That overcoming addiction involves therapy, counselling and the will to stay sober on a daily basis in no way disproves the notion that addiction has powerful biological underpinnings. It may not be the same as asthma or pancreatic cancer, but it is still a disease.
Dr. Jeffrey Eppler, Kelowna
Arguing for one definition over another, choice versus disease, fuels a specious and endless debate. Addiction behaves both like a disease and a choice, since it is a malfunction of our brains’ motivational system, the complex system involved in daily and long-term decision-making.
What’s wrong with showing some generosity of spirit? Compassion does not mean allowing people compelled by addiction to do whatever they want. What they need is the optimal balance of support and limits to nudge the decisional balance back toward health and good function.
Dr. Lisa Bromley, Sandy Hill Community Health Centre, Ottawa
In fact, people are born with predispositions to all kinds of diseases, including mental illness and addictions. “Selfish” lifestyle choices affect how all of these susceptibilities play out over a lifetime. Unfortunately, this kind of judgment is all too common – it’s the reason we still need campaigns against the stigma faced by the mentally ill.
Karen Breakey, Vancouver
Excuse me? Heart disease is not a failure of “personal agency”? Are exercise, good nutrition and stress reduction no longer related to cardiovascular disease? Should we stigmatize Type 2 diabetes as a new strategy for public health?
Jane Watkinson, Winnipeg
If we accept the notion of personal agency in the matter of drug addiction, then Mr. Hoffman committed suicide. The drugs were simply the weapon he turned on himself.
But is a death wish or suicidal impulse something that can be subdued by acts of will? Should we discard the strong neuro-scientific research in this area indicating different brain chemistry in suicidal individuals?
Not everyone gets to play the protagonist in Robert Frost’s Stopping by Woods on a Snowy Evening. Some cannot overcome the call of the dark woods, even though they have promises to keep.
Howard Greenfield, Montreal
Eliminating a gross unfairness is not a “pure windfall” (There’s A Better Way To Cut Taxes – editorial, Feb. 13). A family with a sole income earner in a high-pressure job slogging through 60 or 70 hours a week for $180,000 pays thousands more in taxes than a family of two teachers pulling a similar family income with 30 hours of required work each per week, two index-linked defined-benefit pensions and 12 weeks of holidays a year. Why is this fair? Why is fixing it with limited income splitting unfair?
Lyle Clarke, Whitby, Ont.
‘Tricks’ for gold
Your article pointing to the rise of Canada’s Winter Olympic success paralleling the introduction of new “sports” to the schedule (Why Canada Is Winning So Many Medals – online, Feb. 13) is very apposite.
Depressingly, and as in the Summer Games (trampoline, synchronized swimming), Canadians tend to excel in events that involve essentially doing “tricks” to earn points with a panel of judges, rather than sports in which the stopwatch or measuring tape determines the winner objectively, and frankly require more real athleticism and fitness.
We should work toward becoming more competitive in these “hard” disciplines rather than “Owning the Podium” in assorted variations of skateboarding.
Gordon Jones, Glen Margaret, N.S.
Acts of renunciation
Re Citizenship For Sale (letters – Feb. 12):
I am not a dual citizen. I am a Canadian citizen and have been since 1978. Any doubt about citizenship is resolved in swearing the oath to Her Majesty the Queen in becoming a Member of Parliament. The U.S. accepts such acts as renunciation, lest there be any doubt.
Elizabeth May, O.C., M.P., Sidney, B.C.
How refreshing to read about a child star’s graceful transition into adulthood (Shirley Temple, Former Hollywood Child Star, Dies At 85 – online, Feb. 11). Even more impressive than her precocious acting talent was her ability to successfully navigate the trappings of fame.
For all the enjoyment entertainers provide, we should wish them all such good fortune.
Giselle Déziel, Cornwall, PEI
Here’s to inbreeding
Patrick Cowan’s letter seeking an explanation for why the Danish zoo’s inbreeding policy doesn’t apply to humans (More Giraffe Ethics – Feb. 13), may be treasonous. I noted with some delight the juxtaposition of the giraffe story appearing in the same week that The Globe and Mail commemorated the wedding of Queen Victoria. To her first cousin (A Moment in Time – Feb. 10).
My understanding is that they had offspring. Where would we be without their great historic contributions? A descendant of that fine stock sits on the throne even now.
Derek Ground, Toronto
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