Applying the Disease Concept to Chronic Mental Illness and Substance Abuse

Perhaps you have heard of the disease concept of alcoholism.  It’s widely accepted in medical circles, and starting to be known and understood in the general population.  The disease concept postulates that alcoholism is a disease in the same way that diabetes is a disease, or cancer is a disease.  This means that alcoholism is not a simple matter of willpower, or moral fortitude.  Yet it’s hard for many people not to judge the alcoholic in the context of morals and will. 

Alcoholism is a disease.  You can’t cure a loved one of alcoholism any more than you can cure them of a physical ailment.  You can help support their “treatment”, and they can do their utmost to participate in their own treatment and recovery.  The same is true of drug addiction.  Addiction, to alcohol or drugs is a disease.  The desire to drink, or do drugs is strong.  They have bad brain chemistry.  It’s a disease.  No one would ask for this disease. 

If you’re with me so far on the disease concept, let’s apply this framework to chronic mental illness.  I know a family with an adult son who is schizophrenic.  His mother constantly rants at the destructive things he does, which are driven by his delusions.  It is not his fault that he is schizophrenic.  It’s not even his fault that he doesn’t always want to take his medication.  It’s very common for schizophrenics to not take their medications because their paranoia, or voices tell them it is poison, or inhabited by aliens, or otherwise dangerous.  It’s part of the disease.  Aside from that, most all of the medications have unpleasant side effects.  Who wouldn’t get tired of feeling lousy, and want to stop, or want to attempt to self medicate with alcohol or other drugs?  They have bad brain chemistry.  It’s common for the disease. 

Certainly no one would ask to be schizophrenic any more than someone would ask to have diabetes or cancer.  Yet his mother constantly seems to blame him for his illness.  But schizophrenia is a mental illness, a disability, and it is a disease. 

Bipolar disorder, or manic depression, is another mental illness that can be poorly understood and poorly tolerated by family members and caregivers. Mild but prolonged depression can “get old” to those around the depressed person. Severe depression can be terrifying to everyone. Manic episodes may be considered by some to be a welcome change. On the other hand, “hypomanic” episodes can be annoying, with the person being “hyper” and impulsive. They may be reckless, and a danger to themselves and others.

As with schizophrenia, people with bipolar disorder also have a history of not always taking their medication. And similar to schizophrenics, the medication, usually lithium, also makes you feel awful.  Many psychiatric medical providers say another reason is they enjoy the manic episodes. They don’t want to level out. They don’t think of the crash. That is part of their disease. They have bad brain chemistry. They have a mental illness, a disability. No one would ask for this disease.

Dementia, of which Alzheimer’s is just one type, is a mental illness or mental disease.  Like decreased memory, it is more common in the elderly.  Unlike memory issues, dementia is not “normal” at any age.  It is a disease.  No one would ask for it.  Yet caregivers sometime become impatient, or even angry at the person with dementia, as though they were intentionally trying to annoy.  But it is not intentional.  It is a form of mental illness, a mental disability, a disease. 

No one asks for cancer or diabetes.  If someone smokes, and gets lung cancer, I suppose you could blame them for their disease, the disease caused by their addiction.  If someone has breast cancer, or prostate cancer, did they do something to cause these diseases?  If someone has diabetes, and makes no effort to follow their diet, or take their insulin, they are not doing their part to manage their disease.  But they didn’t ask for the disease.  They didn’t want the disease. 

Alcoholics and drug addicts have a disease.  They didn’t ask for the disease of addiction.  Schizophrenics, bipolars, and people with other mental illnesses such as dementia have a disease.  No one asks for these diseases.  It is not their fault.