Why You Don't Get a Free Pass

I was at a dinner party at a neighbor's last winter, great food, great house, nice folks. Except for this one guy, who struck me as sour and contrary. He and I began having a rather, um, spirited debate about anti-depressants, my position being, they're over-prescribed, his being, he's got so many psychological issues (which his wife confirmed) that his very life depends on them, and that if I were a more decent human being, I would accept that most people actually need what they take.

Somehow, this conversation segued into one wherein he was claiming, certain ethnic groups have no control over their behavior and thus, are not responsible for it. The ethnic group in question was Native Americans, and the behavior, alcoholism. I don't know how it happened, but he and I wound up alone in the living room, sitting on the floor in front of the fire with our desserts and glasses of port, our temperatures getting higher and higher until we were barely civil, and then, were not; he was yelling that my contention that Natives do have a choice about whether or not to become alcoholics was bullshit; that their genes put this completely out of their control, and I was saying, oh fucking yeah? Guess what? I spent seven years living with an alcoholic Native man, the father of my child, and that he certainly did have a choice. That I'd found and fed his starving nieces while their mother partied in the next room with friends, yelling for me to give her some beer money, and hey, could she use my car to go get it?

"She didn't have a choice!" said this guy, saying it was her genes that couldn't handle the alcohol. I countered that anyone's genes give out after 16 tallboys and a fifth of Seagram's 7.  He called me culturally insensitive and cruel. I felt my fingers curling, and I thought, I actually want to hit this guy, I want to start bashing his head against the floor...

I did not. He and I agreed to disagree. That, or our respective spouses came in, saw the foam around our respective mouths, and pulled us apart.

When I read a few months later that Ashkenazi Jews and Asians possess the same mutated gene as Native Americans, the one that supposedly makes them more susceptible to becoming alcoholics, did I want to bang on this guy's door and say, "And what about the Jews, huh? Huh?" Yeah, I did.

But I didn't.

It's not that I don't love my ex. In many ways, he's a lovely man; he adores his children; he hasn't had a drink since the week I left him in 1992. His sister also quit more than ten years ago. I have no idea how the dinner party guy would handle this information, seeing as he's put choosing to not drink completely out of their control. But I still get hot thinking about it, about his telling me how it was in our world, when we were the ones who lived it.

Which, I think, is why I responded so viscerally to "False Apology Syndrome - I'm Sorry for Your Sins," a really, really good essay by Theodore Dalrymple (the nom de plume of the really, really good writer Anthony Daniels), and in particular, this:

[A] blanket apology and the granting of group economic privileges is hardly the way to cultivate a sense of personal responsibility in a population now decimated by alcoholism and brutalized by family violence. Quite the contrary: psychologically, if not in strict logic, it will allow a man to beat his wife and blame history.

No blanket apologies, no. Do read the essay if you get a moment, it's extremely worthwhile.

Comments

[Jackie Danicki]

NB Anthony Daniels is also an MD.

[aroyo]

I'm not sure what to think here. Alcoholism I think is very misunderstood. I think that it can vary in degree and that one's mental status in other areas weighs in, and that in many cases it may not be a matter of choice.

Last January, a dear friend of mine finally and literally drank himself to death. His organs just shut down. He was a Falstaffian-figure in our lives....loved food, wine, socializing, and - unfortunately unbeknown to us - slugging down a half-gallon of gin every day. He loved life, but knew his drinking was going to kill him. His doctors told him so. Yet he couldn't stop. He didn't have the mental capacity to do so. He was found passed out on his livingroom floor by a next door neighbor on Christmas morning who noticed his front door had been left open (in mid-Winter) for two days. They rushed him to the hospital, he was put in a de-tox unit for 30 days, and never left. Thank God he didn't have a wife or kids (or, maybe if he did, they would have been his incentive to stay alive...we'll never know).

To me, he is proof that alcoholism is a DISEASE, and that some are more suseptable to it than others. Maybe there are some that use their craving as an excuse to get drunk...take the gene issue as an enabler. But I think there is a legitimate issure with some alcoholics as to whether they are capable of stopping on their own.

[Nancy Rommelmann]

I would say for most alcoholics, it is nearly impossible to stop drinking on their own. It's horrible to watch them try to stop and not be able to. I watched my ex white knuckle it for months on end, knowing, he would not be able to hang on.

But he did eventually stop. It was very hard but he knew he had to or he was dead, and he chose (with the help of his personal savior Jesus Christ) to stop, and he succeeded.

You do nobody any favors when you maintain certain people have no choice, as this dinner guest did; that it was all in the Natives' genes; they were doomed and had no free will, and thus, should be exonerated for all behavior. He has no right to rob people of their dignity and freedom, no matter how dimly it may be flicker.

[Mike LaRoche]

I've never liked the characterization of alcoholism as a disease. In my eyes, describing alcoholism that way absolves (if unintentionally) the alcoholic of responsibility to address his or her condition.

I agree that it is nearly impossible for most alcoholics to kick their habit, but I look upon that unwillingness or inability as a weakness, not a disease.

[aroyo]

I maintain that "certain people" do have no choice. It is wrong to blanket a group with that label, but you have to look at each person individually.

If you accept that alcoholism is a mental/genetic disease, in my mind you have to accept that there are going to be degrees of it that may reach beyond "choice".

Its a genetic illness combined with a mental/chemical dependency. But if Native Americans are more genetically prone to this disease, and obviously have fewer resources to combat it (ever been involved in the Reservation health care system?), I think your nemesis at that party may have had a point.

[aroyo]

Mike, do you have any friends/family with other mental illness? I do. My younger brother has been Dx with several mental conditions that make him virtually unemployable. He is as intelligent as anyone, but cannot leave his home. This is not his "choice", it is his "condition". I don't consider it his mental weakness. I consider it a disability. The human brain is a difficult organ to understand or diagnose.

[Michael J. Totten]

Theodore Dalrymple is one of my new favorite writers. Sometimes he can be excessively negative and annoyingly conservative, but he's brilliant and always worth reading, and I'm working my way through his books right now.

[Brett]

What other "disease" can you just quite if you decide you don't like it anymore because it's ruining your life?

It is not a disease.

[Brett]

quit -- darn it!

[Mike LaRoche]

"Mike, do you have any friends/family with other mental illness? I do."

Two members of my immediate family, in fact. One of whom is deceased.

I've arrived at my opinion of alcoholism through a lifetime of painful observation - an experience I would rather have not gone through.

[aroyo]

"What other "disease" can you just quit if you decide you don't like it anymore because it's ruining your life?"

Brett....I think the point is that you can't just "decide" to quit if you are an alcoholic. Maybe some can, but the hardcore can't.

[Jason S.]

That's a great article and post. (Reminds me of the movie "Affliction" for some reason.)

On the other hand, I know Native Americans that have never touched a drop of liquor in their entire lives because they fear the gene. I think that's a cop-out; I'd like to think of it more as a celebration of personal determination -- them (or anyone) seeing the detrimental effects of alcoholism to mammals across the board -- rather than because of genetics.

[Hillary]

I think we have adopted a point of view that pits nature vs. nurture, which is as ridiculous as an article I was once hired to write with the unfortunate title of "Eggnog vs. Fruitcake." Some things just aren't questions of either/or. A phenomenon as complex as alcoholism is extremely complex, involving behavior, biochemistry, genetics, and socialization, and the proportions of the roles these play varies from individual to individual. The sociologist Alfred Lindesmith and the anthropologist Marvin Harris are excellent soruces for understanding how our cultural interpretations influence the behaviors of individuals.

[Matt Davis]

Reminds me of the guy apologizing on behalf of his race for buying a dog in a gentrified neighborhood without realizing the cultural associations.

[Brett]

I didn't mean to be unsympathetic to those who struggle with alcoholism.

I see it as an addiction not a disease and I do believe there is a genetic component of addiction that is especially difficult to overcome if the addiction begins during childhood or adolescence.

But calling alcoholism a disease relieves one of personal responsibility for one's behavior. It is a addiction and it leaves lives ruined in it's wake.

[Nancy Rommelmann]

What Brett said.

[Robey]

As an alcoholic in recovery (22 yrs now)I am firmly in the alcoholism is a disease camp. However, that does not mean that it relieved me of the responsibility to do something about it. If I had cancer, I would be an arsehole not to get any treatment available to me. Same with alcoholics. Many choose to die (directly or indirectly) of substance abuse, some of us accept help and have been able to stick with a program. Blaming genes and giving people a pass is a cop out and that type of thinking is at the root of the nanny state. BTW, I enjoy Dalrymple's occasional perspectives on British society on the WSJ op-ed page.

[Loren Minnick]

A little late to this particular party, but...
For all you "suck it up" and I-did-it-all-myself-and-you-should-too-libertarians out there, I point you this a-way:
http://www.nytimes.com/2008/10/21/health/21mind.html?_r=1&ref=science&oref=slogin
Now, I'm a charter member of of the suck it up school of life and athletics... got it from my mom, I guess, and it has certainly worked for as a mostly normal red-blooded American male.
And for years I really didn't know what to think about so-called depressives... they look OK... no iron lungs, limps or obvious disfigurements. They must be trying to get attention. (They certainly can!)
Most of the people in my karass (is that term still around?) -- white/middle class/educated/ironist/slightly smug sense of having achieved wondrous things by my own efforts/impatient with those who won't suck it up -- pretty much come down on the doing it for attention side of things and generally advocate a kind of herbal-tea-instead-of-drugs/tough love approach. It certainly shouldn't be something covered by any satanic Socialized Medicine(tm) scheme!
Then, a few years ago, my family ran into someone with depression. This person was/is an accomplshed artist (Letterman/Grand Ole Opry/in-demand session musician) who reached out to us for help.
Of course, being traditionally unemployable she had no health care, and hence no help beyond calling 911 and a three-day stint in an LA hospital pauper ward known for rapes, etc. (Thanks Ronnie)
She certainly had no means to afford the arc of treatment described in the NYT article. She had been living with her affliction (sucking it up) for years and her resistence finally cratered.
As any of you would do, we stepped in physically and financially ($8000+) with a few others to help her. (If you ever tried to piece together a depressive's apartment, you can picture what a pile of 6 month old unopened mail looks like: bills, royalty checks, fan letters... it's pretty heartbreaking.)
Anyway, we got a look at the real hell on earth of untreated clinical depression, And we especially got to see society's reaction to it, including the medical establishment. Her experience is detailed EXACTLY in the NYT article: the mind-boggling and expensive array of drugs, which are incredibly expensive yet necessary and sometimes effective.
Until a tolerance builds up.
Endless therapy sessions (often at $250 a pop) followed by the final blame the victim diagnosis of "borderline personality disorder."
Then, finally, almost miraculously, something that works. In her case electro-shock treatments -- two per week -- at the hands of therapist who refused to give up.
Almost overnight, a semi-whole person emerged... like the old king in LOTR who emerged from the Mordor spell. It was literally that dramatic.
And, finally, a determination from the mental health community to the State of California that this person is profoundly DISABLED. This gives her help in paying for the treatments which allow her to resume working.
(Without the shocks, she slips back under with a month or so. One side-effect of the treatment is the erasure of short-term memory after each session. The previous day is gone... something that happens twice a week. Take good notes! She has to review her notepad after each session. ("Now why am I supposed to call Brian Wilson?")
These people can work and function -- often at a very high level -- but they ain't going to be working for IBM or Disney.
So, after nearly 15 years of this stuff, she has attained (at least temporarily) some kind of stability. As long as she can afford to pay someone to drive her to her treatments! It never ends.
Personal aside: One of the arguments I always hear about any kind of universal health care is that we will all have to wait too long to get medical care. How about waiting 15 years!

Fruther reading: http://www.noondaydemon.com/http://www.noondaydemon.com/