April 21st, 2016
[Editor’s note: This article is excerpted from Diseasing of America by Stanton Peele, which was first published in 1989, remains remarkably relevant today, and became available as an e-book this week. You can find more details below.]
Obviously, it all depends where you draw the line in deciding who has a disease, in eating or in any other area. Just as obviously, the tendency has been to expand these boundaries, to label more and more people as diseased. This tendency originates in part from treatment personnel and specialists in each disease area. But contrary to the disease notion of denial, many people seem eager to claim a disease for themselves. Having a disease is apparently so appealing that people stretch the criteria in order to include themselves, or perhaps even expand their behavior to meet the criteria. Whatever the reasons, very many Americans now fall within the defining limits established by experts for various diseases.
Since from 15 percent to 50 percent of Americans (or more) are potentially diagnosable as obese or suffering from an eating disorder, eating might be considered the most diseased activity that Americans engage in. Compared with eating disorders, far fewer people can be treated for alcoholism. However, if we accept the claim that children of alcoholics and those who marry or date alcoholics, or codependents, also suffer from a disease, the 20 million Americans alleged in The Courage to Change to have the disease of alcoholism are then multiplied into 80 million. Among the young, chemical dependence (combining drug use and drunkenness)—which involves more than half of teenagers—could be considered the most common disease. At the same time, about 30 percent of adult Americans still smoke, and nearly all of them—unlike illicit drug users—can probably be said to be addicted. And, while alcoholism is said to affect 10 percent of Americans, the National Council on Compulsive Gambling maintains that 12 percent of Americans are diseased gamblers.
While compulsive gamblers are nearly always men, women are more often among the addicted shoppers who have begun forming AA-type support groups, although compulsive shoppers also join Debtors Anonymous, which enrolls as many men as women. For those who see these ailments as slightly fatuous, disease experts and counselors hasten to make clear the truly painful, compulsive and addictive nature of the problems: “‘shopping addiction . . . is a compulsive disorder—it’s a syndrome much like gambling and alcoholism,’ says Janet Damon, a Brooklyn psychotherapist who specializes in compulsive disorders”; “Dr. Marilyn Jacovsky, a psychotherapist who specializes in dependency, says: ‘The compulsion to use debt and credit is just like any other compulsion—the compulsion to overeat, for example. It is progressive, and it finally gets out of the individual’s control.’”
The point is, of course, that once we start viewing drinking as a disease rather than a human weakness, shopping and spending are no less eligible to be labeled diseases. We have seen, primarily, that loss of control defines alcoholism and that loss of control is a subjective experience. People can certainly feel out of control of their spending and therefore label it a disease. Indeed, those scientists who want to establish the biological basis for alcoholism must deal with the heartfelt pleading and suffering of compulsive gamblers. Many of these same people are also alcoholics who claim they experience no difference in the addictiveness of the two compulsions. On what grounds can a scientist claim that one type of compulsion is biological and genetic and that the other is not?
Aside from the laundry list of addictive and appetitive disorders, two maladies that many Americans—and particularly women—say they suffer from are anxiety and depression. Although these conditions have long been around, we have returned to them in the 1980s as primarily biological and inbred maladies, and we often approach them like addictions—for example, by creating AA-type support groups for sufferers. According to Mark Gold, “Between 20 and 30 million people are plagued by an illness commonly called depression,” and, “1 in 4 of all Americans will have a significant depressive illness in their lifetime.” In The Anxiety Disease, Dr. David Sheehan finds anxiety to be more prevalent than depression, and that 80 percent of those who suffer from it are women. Putting these estimates together, “affective” diseases like depression and anxiety may claim one-third or more of women.
Yet anxiety and depression are not the most common emotional disorders (discounting entirely the addictive and appetitive disorders, from smoking to obesity to alcoholism to drug addiction to gambling to shopping). When the National Institute of Mental Health (NIMH) published the results of its survey of Americans’ mental disorders in the fall of 1988, an emotional disorder largely unknown to the public—and unsuspected by the psychiatric researchers—was revealed to be most prevalent. This is obsessive-compulsive disorder (OCD), in extreme cases of which people spend nearly all their time preoccupied by rituals such as washing their hands. Less severe cases include people who must return to their house to check whether they have left any appliances running or who clean their homes daily. The NIMH survey discovered that OCD is twenty-five to sixty times as common as previously supposed, and the researchers predicted that “like other stigmatized and hidden disorders in the past, [OCD] may be ready for discovery and demands for treatment on a large scale.”
In discovering all at once that a major mental disorder such as OCD has appeared in our midst, we see how such diseases are a matter of fad and fashion. In some cases, OCD reminds us of agoraphobia, a disease that prevents primarily middle-class women from leaving their homes to enter public places—for example, OCD and agoraphobia both describe the case of the woman who cleans her home constantly instead of venturing outside. When a 1987 PBS drama entitled Dottie dramatized agoraphobia, an accompanying press release indicated that millions of Americans with the disease never leave their homes. It might seem that agoraphobia will be supplanted by obsessive-compulsive disorder as the illness used to describe, among others, those preoccupied with their chores at home.
What diseases loom next on the horizon? One candidate, perhaps, is Cyclothymia. McCall’s magazine warns that “one to two percent of American adults are affected by constant, sudden shifts in mood to such a degree that it can devastate their lives and those around them.” Apparently, from this article, most of the sufferers are women. We can compare the one to two percent rate McCall’s claims for Cyclothymia to the two to three percent rate the NIMH discovered for obsessive-compulsive disorder that qualifies OCD for epidemic demands for treatment and support groups. In Cyclothymia, we may see the anatomy of a building epidemic.
If women in our society are most often the victims of all these diseases of emotional tension and suppression, the diseases we discover in men more often take the form of antisocial acting out. Alcoholism and gambling are examples of the latter. Conditions tied to violence, most often by men, that are said to be epidemic (but also to be hidden) are spouse and child abuse, which are now often regarded and treated as illnesses. If being abused creates a disease state, consider that 38 million Americans have had some form of sexual contact with adults when they were children. Another disease affecting men that often has violent manifestations and that is frequently featured in the media is post-Vietnam stress. War trauma is part of a larger category called post-traumatic stress disorder, found in women as well as men who have lost babies or spouses or have been crime or accident victims.
Peculiar to women, of course, is premenstrual syndrome (PMS). Hazelden’s July, 1983, Professional Update magazine for counselors called PMS “The Disease of the 80’s.” A wide variety of drug (along with hormone and vitamin) therapies, as well as psychological counseling, are now actively marketed for relieving PMS symptoms. Later in the 1980s, PMS has been joined in popularity by postpartum depression (PPD). At the International Congress of Psychology in Australia in the fall of 1988, I (along with all other attendees) was presented with a packet including an advertisement from a private treatment center saying a third of mothers suffer from PPD. What is interesting about PMS and PPD is the frequency with which they appear as defenses for women’s violence against their mates or children. Women who accept being brutalized, on the other hand, are said to suffer from the battered woman syndrome. But this syndrome has also, paradoxically, become the standard defense to explain why women may eventually kill their husbands, or why (à la Hedda Nussbaum) they tolerate or cooperate in violence by their spouses against their children.
The American family seems to be an increasingly dangerous place, and violence often characterizes intimate relationships. But psychiatry and other helping professions now often regard intimate relationships themselves as diseased, whether or not anyone is physically maimed. Several books in the 1980s sought to describe how some women are biologically driven to repeatedly form inappropriate and destructive relationships with men. The misdirected, compulsive drive for love has formed the basis for a myriad of best-sellers along the lines of Robin Norwood’s Women Who Love Too Much. Books like Norwood’s are directed specifically to women. Men are more likely to suffer from “sexual addiction”—compulsive sexual contact with numerous women—which has prompted the creation of a Sexaholics Anonymous movement based on the AA 12-step approach.
Timemagazine, 60 Minutes, and the New York Times science section, to name a few, have run stories on sexual and love addictions. One pamphlet describes sexual addiction counseling as follows:
Almost daily, newspapers across the country carry seamy accounts of sexual misbehavior. Congressman, clergy, and professionals get the most press, but the addiction traps people of all pursuits—white-collar workers, blue-collar workers, and homemakers. Their sexual compulsiveness ruins their lives and careers. For many of these people, those who want to stop but cannot, it is an addiction which falls like a shadow over all those who are affected. It penetrates and influences every aspect of their lives. Often the addiction is handed down from generation to generation and becomes the family’s best kept secret. But the shadow deepens as the addictive behaviors escalate.
Sexually addictive behaviors range from the need to have constant affairs or masturbate, on one end of the spectrum, to incest and rape on the other end. Addicts, on the average, have at least three behaviors over which they have no control. With support and help, sexual addicts can integrate new beliefs and discard dysfunctional behaviors. Without help from others, the addict cannot regain control because the addiction feeds itself.
According to the quote from the National Association on Sexual Addiction Problems at the front of this chapter, perhaps 10 percent—or as many as one quarter of all adult Americans—suffer from sexual addiction problems. Sexual addiction as described in the advertising pamphlet has all the traits that characterize the diseases popularized by the alcoholism movement and the addiction treatment industry—loss of control that often serves as an excuse for misbehavior (according to this pamphlet, a sexual addiction could be used to defend rapists); the inherited, possibly biological nature of the malady; the ever-deepening addictive progression that can only be interrupted by treatment. The bottom line for this and other discoveries of new diseases is increased counseling services. Treatment corporations, private hospitals, and other institutions are hungry to expand the net for addictions and compulsive behaviors in this way. Alcoholism treatment provides the model for these new services, while the new diseases allow alcoholism treatment groups to expand their client base and to sustain their growth. CompCare and Hazelden are two organizations that have thrived by building from their roots in alcoholism first into the area of drug dependence and then into such areas as obesity, PMS, and sexual addiction.
In discussing sexual addictions and compulsive love affairs, I am obligated to mention my own role in the movement. I wrote (along with Archie Brodsky) the book Love and Addiction, which appeared in 1975 and which most works on love and sexual addictions use as a primary source. I concentrated on two goals in Love and Addiction. First, I wanted to make clear that drug addiction is not a medical disease, since it has the same compulsive profile as many behaviors we regard as quite ordinary and nonbiological, like love affairs. My aim there was turned on its head when subsequent writers agreed that compulsive love and sex were like drug addictions; therefore, they also were diseases. Second, Love and Addiction was a social commentary on how our society defines and patterns intimate relationships. But all of this social dimension has been removed, and the attention to love addiction has been channeled in the direction of regarding it as an individual, treatable psychopathology.
In calculating all the diseases I have listed in this section (and there are others), it seems that each American must have at least one such disease and, in addition, must know many people who altogether have a score of other diseases. It is hard to escape the conclusion that ownership of an emotional-behavioral-appetitive disease is the norm in America. And in the cases of PMS, postpartum depression, and love addiction, we see the ultimate definition of the ordinary discomforts and challenges in life as diseased events. To summarize the points of this chapter—the exaggerations and dangers inherent in the massive disease industry—I want to give some feeling for how shocked ordinary people, scientists, and public commentators typically are when one of these diseases is first explained to them.
In 1986, a physician wrote in the Wall Street Journal about the pervasiveness of PMS and the enormous costs it exacted of the work force; the article provoked four letters that were published in the Journal:
I can scarcely believe my eyes! Premenstrual tension is a disease. How about that! It’s even been given a label. The biological phenomenon that heralds a girl’s coming of age into womanhood—all girls, all women—is a disease.
It just goes to show. Here I always thought my monthly periods indicated that all was right with me and my world, that I was functioning normally and that, in time, as indeed happened, I would be able to have children.
—Sylvia Hornstein, Encino, Calif.
In your article a physician estimates that “the illness costs U.S. industry 8% of its total wage bill.” Let us ignore arguendo the facts of lower female participation in the work force, the wage differential between working men and women, and the proportion of the female workforce that is post-menopause, and assume for the sake of simplicity that: (1) 50% of the labor force is female; and, (2) women’s wages are at parity with men’s. . . . One is then forced to the conclusion that each woman worker, on average, loses 16% of her productive time due to PMS, or approximately 35 workdays per year. This is utterly preposterous.
—Steven S. Bremner, Seattle
As PMS has been the basis for a growth industry, it is entirely appropriate for the Journal to report on it. In recent years, a number of therapists have devoted their practices to this presumed ailment, and pharmaceutical companies have made money from drugs developed to treat it.
There is, however, a growing uncertainty on the part of researchers about exactly what PMS is, as well as considerable skepticism about the extent to which it exists as a definable ailment. . . .
—Prof. Cynthia Fuchs Epstein, Russell Sage Foundation
In my 77 years I have known only one, possibly two, such cases, although I have lived in a college dormitory and worked in a school teaching seniors. PMS is an abnormality that does not affect most young women, and it usually improves after a woman becomes sexually active (mine did with marriage). It affects no woman past middle age [emphasis added]. If PMS affects a woman at all, the effect is for hours not days.
Your story indicated great concern that women get a fair shake: Executives should make allowances for their special problems, and so on. But once employers had thought all that through, maybe, just maybe, they’d conclude they’d be better off to hire a man. . . .
—Florence Wagner, Gainesville, Fla.
Here a group of readers of the Wall Street Journal have ably outlined the following problems with new disease diagnoses:
- A normal experience for approximately half the population is declared an illness.
- The disease is being blown out of proportion, and the preposterous inflation of its ubiquity and severity concocted for national media consumption is deflated by the most straightforward of calculations.
- Those who profit from the new illness are disingenuous in raising these alarms—they make money from them.
- The scientific community fails to agree on the basic premises of the illness, including whether it can actually be identified and separated from normal experience.
- Typical observations by people well familiar with supposedly high-risk populations (in this case, all women, or all young women) are that the problem is rare, variable, and disappears almost entirely as people mature.
The last sardonic observation about PMS by Florence Wagner is the most biting and double-edged. She points out that PMS, defended in the name of helping women, actually dredges up harmful images of women that have traditionally been used to debilitate them. This debilitation is external in that it reinforces among employers hoary stereotypes of female inferiority and unreliability. More crushing, however, is the personal temptation for women to impose this diagnosis on themselves. For example, Bernadette Peters—while appearing in the Broadway production Song and Dance—announced to a national television audience on Late Night (the David Letterman show) that she suffered from PMS and would not be at her best because her period was coming on. Viewers might have tried to calculate when Peters’s PMS would interfere with her performances, so as to avoid attending her show on those dates.
Disease theories of life have struck on a fundamental truth: Everything that humans do—eating, drinking, sleeping, drug taking, loving, raising children, learning, having sex, having periods, feeling, thinking about oneself—has a healthy and unhealthy side, sometimes both at the same time or often alternating with one another. By elevating the unhealthy side of normal functioning to the status of disease state, therapists and others who claim the mantle of science now guarantee the preeminence, pervasiveness and persistence of sickness in everyday life.
The article above is excerpted from Influence columnist Stanton Peele’s groundbreaking book, Diseasing of America: How We Allowed Recovery Zealots and the Recovery Industry to Convince Us We Are Out of Control, which was first published in 1989. Diseasing of America was made available on Kindle this week and can be purchased here (or here as a regular book).
Some praise for Diseasing of America:
“Stanton Peele was the real pioneer. Diseasing of America provided (and still provides) the foundation of the current revolt against the disease model of addiction. It opened my eyes when I read it, and it will open yours, too.”
—Marc Lewis, Ph.D., author of The Biology of Desire: Why Addiction Is Not a Disease; professor of neuroscience, University of Nijmegen
“Stanton Peele’s Diseasing of America is the one book about addiction from our era that will continue to be important in the future.”
—Patricia Erickson, Ph.D., Adjunct Professor of Sociology at the University of Toronto and Scientist Emerita in Public Health and Regulatory Policy at CAMH (Canada’s national Centre for Addiction and Mental Health)
“After I completed treatment the first thing I did was head to the library to see what the science had to say. The only book on the shelf that talked science instead of mythology was Stanton Peele’s Diseasing of America. It is thanks to the work of Dr. Peele that I decided to make it my mission in life to help people with drug or alcohol problems with science, not superstition.”
—Kenneth Anderson, Executive Director of HAMS: Harm Reduction for Alcohol
Stanton Peele is a columnist for The Influence. He has been at the cutting-edge of addiction theory and practice since writing, with Archie Brodsky, Love and Addiction in 1975. He has since written numerous other books and developed the online Life Process Program. His latest book, with Ilse Thompson, is Recover!: An Empowering Program to Help You Stop Thinking Like an Addict and Reclaim Your Life. His website is Peele.net. Dr. Peele has won career achievement awards from the Rutgers Center of Alcohol Studies and the Drug Policy Alliance. You can follow him on Twitter: @.