Addiction and Mental Health,
the Need of a New Perspective
Historically, the United States has grappled with difficult concepts surrounding addiction and mental illness. What drives addiction, what causes mental anguish, how to legislate substances that cause addiction, how to provide appropriate care for addicts and mental health sufferers, and perhaps the most complex and ignored, how to acknowledge the humanity of those suffering from addiction or from a mental illness? Current approaches for treating both populations seem to be fraught with economic, political, logistic, medical and moral challenges. These entanglements are not only effecting the individual who suffers, but profoundly affecting our society.
By Cara Crew
One prominent theory ties addiction and substance abuse issues with mental illness and vice versa [i]. This dual diagnosis has provoked cultural misconceptions of addicts and mental illness, resulting in a convoluted understanding of this sufferer. Thus, negatively conflated attitudes towards mentally ill and addicted populations have been embedded in the cultural fabric of the U.S., and altered ethical possibilities for nuanced treatment and care [ii]. In a western society that obsesses over perfect health, we tend to imbue pejorative judgement on those who suffer from any malady; chronic, infectious, physiological and psychological. Addicts and mental health sufferers bear the stigma of a diminished moral status, in need of medical and policy-driven assistance.
Let's frame the conversation of addiction as it's playing out in our current opioid public health crisis. Over the last few decades, U.S. jurisprudence regarding opioid use has oscillated between restrictive and lenient policies. Imposing limits for healthcare providers has resulted in fear of prescribing. Shifting the focus away from those who require personalized care and tapering plans, which increased illicit drug use, overdose and death [iii]. On the other hand, lenient U.S. policies provoked drug manufacturers to systematically abuse policy, releasing billions of opioid drugs into circulation. This laid the groundwork for a highly addictive drug to become rampantly misused among millions of individuals in the U.S. [iiii]. What seems to be discounted in these policy-backed pendulum swings, is a fundamental understanding of an individual’s phenomenological human experience with their addiction. Opioid addiction is a subjective experience and the potential and probable connection to some type of mental illness, anguish or condition complicates U.S. law and subsequent treatment practices.
"Our nation is in the midst of mental health epidemic, and we must address the comorbidity of mental illness, suicide and addiction."
Turning to mental health, reports of mental illness and suicide rates have increased in the United States. The Centers of Disease Control states that death by suicide has gone up in nearly every state since 1999; and that mental health issues are the leading contributor [v]. Recently, a study published by the American Psychological Association found that the “iGen generation” (age 14-23) reports higher levels of emotional distress, depression and anxiety, contributing to the highest statistical U.S. record of young people committing suicide [vi]. These researchers state the reason for the sharp incline of suicides among iGen, is strongly tied to heavy use of digital communication and social media. While in older adults, main factors for suicide and suicidal ideation are relationship issues, substance abuse and depression [vii]. Whatever is causing these extreme spikes in psychological isolation and suicide is subjective to these sufferers. Our nation is in the midst of mental health epidemic, and we must address the comorbidity of mental illness, suicide and addiction. The extremely dire outlook the statistics show on these concurrent crises, indicates a cry for a deeper ethical evaluation.
Reconciling notions of societal shame associated with addiction and mental illness must begin with a basic shift in our dialogue. We must look towards uncovering a fundamental acceptance of the subjective nature of an individual's experience with their own illness. How can our pluralistic society understand addiction qua addiction and mental illness qua mental illness through our various biased political, cultural, religious, and medical lenses? How can we uncover ethically nuanced care in lieu of neglect, criminalization and contemptuous perceptions, to find compassion for the human person and their experience? Addicts and mental health sufferers are part of an ongoing commingled moral dilemma, and the statistics exemplify that the existing means of addressing treatment, care, and prevention is failing. We must find assistance through a new lens. There is an ethical imperative for guiding appropriate support and care for those who suffer enmeshed in the field of bioethics. Bioethics is not a siloed philosophy. Bioethics is multidisciplinary, where the tenents of law, medicine, anthropology, and humanities collaborate to ground subjective guidance from various moralities and experiences. These complimentary approaches seek to offer insight and forge new paths toward humane, compassionate, and legislatively sound care. Bioethicists should be a voice in the moral discourse as we address this epidemic and try to care for the addicts and mental health sufferers who live among us.
Johann Hari, "The Opposite of Addiction is Connection"
Click Here for Various TED talks on, "The Struggle of Mental Health"
"One Nation Under Stress"
Trailer for HBO Documentary
ABOUT THE AUTHOR
Cara Crew is a second year graduate student and a research fellow for the Bioethics Institute at LMU. She is passionate about ethical and bioethical issues surrounding mental and behavioral health.
Read the Atlantic's "Have
Destroyed a Generation?"
Listen to Sam Harris "The Problem with Addiction" with Psychologist
Listen to Bioethicist Travis Rieder's interview, "Motorcycle Crash Shows Bioethicist The Dark Side Of Quitting Opioids Alone"