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Alcoholism a Myth?
Skeptical Inquirer, 14:4, 441; 1990.
Letter to the editor regarding a review by Jeffrey Schaler of Herbert Finagarette's book Heavy Drinking: The Myth of Alcoholism.
The latest references quoted by Jeffrey Schaler date only to the 1960s. Where has Schaler been during the explosion of medical science in the last 20 to 30 years?
First, if one goes even as far as to define the terms Schaler is discussing, his argument crumbles. A disease is "any deviation from or interruption of the normal structure or function of any part, organ, or system (or combination thereof) of the body that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown" (Dorland's Medical Dictionary, 1988). Because alcoholism (Cecil Textbook of Medicine, 1988) is a drug dependence syndrome (a set of symptoms) characterized by specific complications and effects-including a neuropharmacologic action on neuronal cell membranes, metabolic tolerance due to increased efficacy of hepatic enzymes, numerous structural and functional changes in multiple organ systerms (alcohol affects the liver, heart, and brain), self-perpetuating mechanisms producing addiction (including physical tolerance and withdrawal as well as psychological conditioning)- alcoholism seems to fit the definition of disease. Schaler's support of Fingarette's statement that "clearly it is each drinker's perception . . . and not an uncontrollable abnormal chemical physiological reaction, that decisively affects the choice to drink" illustrates his lack of knowledge in the areas of tolerance, withdrawal, and neuronal adaptation.
Although there is a fourfold greater incidence of alcoholism in the adopted-away children of alcoholic biologic parents when they reach adulthood (Cecil Textbook of Medicine, 1988), Schaler argues that "the unaccounted for variance between those genetically predisposed individuals who do not get the disease and those not genetically predisposed who do become alcoholics can only be attributed to a strength in will." Schaler is obviously unaware of some basic mechanisms of genetics, including incomplete penetrance, recombination, mutation, and the interaction of dominant and recessive genotypes. Schaler says: "There is no clear definition of what the mind is, let alone an understanding of the relationship between the mind and brain/body. To a neurologist there is no such thing as the mind. " The psychologic definition (Random House College Dictionary, 1980) of the mind is "the totality of conscious and unconscious mental activities of the organism." As board eligible in neurology and psychiatry, I agree with this definition and disagree with Schaler's comments about neurologists.
Schaler says that "a disease is a dysfunction of the body" and that since " the relationship between the mind and the body is unknown, it is inaccurate to state with certainty that a behavior like alcoholism is a disease. . . " The relationship between the mind and body is complex but far from unknown. When you see a gun pointed your way your brain causes you to feel fear, your heart to race, and the blood vessels in your muscles to dilate. Secretion of adrenalin by the brain's neuroendocrine system mediates the effects in this simple example.
Schaler's statement that "the mind can't be sick" and that mental illness" is a "contradiction in terms" has absolutely no logical basis in fact. Parkinson's disease is a lack of the neurotransmitter dopamine in certain areas of the brain; seizures are caused by abnormal electrical neuronal discharges; schizophrenia, manic-depression, and major depression have been shown to have genetic components, have abnormal chemical profiles in the cerebrosinal fluid, blood, or urine, have abnormal findings on brain imaging, and show improvement to specific pharmacloogic approaches compared to placebo (Kandel and Schwartz, Principles of Neural Science, 1982).
Doug Berger, M.D.
Instructor of Clincial Psychiatry
Einstein College of Medicine
Bronx, New York