Mental Health

How Intellectuals and “Experts” Undermine Moral Agency

December 06, 2019

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How Intellectuals and “Experts” Undermine Moral Agency

Like The New York Times and other leading liberal newspapers, The Philadelphia Inquirer frequently publishes articles which seek to persuade readers that criminals are really victims, and that, therefore, what they deserve is not retribution but “treatment.” Profoundly biased, contrary to common sense, and the result of what psychologists call “motivated reasoning,” such articles afford abundant examples of the sorts of insidious errors that people must be educated into believing.

For it is simply not natural or normal for a person to believe, for example, that drug relapse is not indicative of a personal failing, or, in the case of repeated drug relapses, of a persistent character flaw or problem. Nevertheless, in our confused and irresponsible intellectual class, there are many fancy “experts,” quite impressive to ordinary people, who give us to understand that the apparent choice to do illegal drugs is really the effect of a “substance use disorder” (SUD) or of a “disease.” Therefore, instead of being active and accountable moral agents, people are thought to be mere objects, “victims” of their faulty brains, which, however, can be corrected by means of “therapy.” What “experts” lack in common sense they make up for in rationalist hubris, which also affords them plenty of lucrative rackets.

And how terribly influential these persons are. Thus, in “Punishing Addiction,” an Oct. 24 article in The Philadelphia Inquirer, Samantha Melamed and Dylan Purcell relate the story of

Eric Virelli, who was 19 and consumed by addiction when he committed a robbery in 2007. He was initially sentenced to state prison, followed by five years’ probation that he would repeatedly fail to complete. Instead, he’d be resentenced four times for relapsing, either for new drug-possession charges or refusing to report, knowing he’d fail a test and face incarceration. Each time, the punishments mounted—until, in 2017, he was resentenced to one to six years in state prison.

“They wouldn’t punish a diabetic or someone with cancer,” he wrote in a letter from Phoenix state prison, “so why punish a person with a drug problem when what they really need is help and ongoing treatment?”

It’s clear that Virelli’s fallacious reasoning elides some important distinctions, which the liberal journalists don’t see fit to point out, of course. Although some instances of type 2 diabetes and of cancer may be caused by bad lifestyle decisions, these diseases are hardly analogous to a man who repeatedly chooses to do illegal drugs and commits a robbery in order to fund the bad habit. And yet, since bad science permeates the intellectual air, Virelli easily can liken himself to a cancer patient. Having an “addiction,” the man effectively lacks free will. What he, too, needs is “help and ongoing treatment.”

Now, human nature is never in need of help when it comes lying to oneself or to others concerning the dark truth of one’s behavior. For if there’s one thing all men and women share, it’s the tendency to delusion. But it’s this very help—a kind of sentimental kiss of death—that so many “experts,” even when they’re well-intentioned, unwittingly provide.

Consider the case of Julie Eldred. In 2016, having spent almost half her life addicted to drugs, she got caught stealing jewelry, a crime she had committed to support her addiction. She was put on probation for a year on a larceny charge, the probation conditions stipulating that she remain drug-free and submit to random drug tests. One of those tests, taken just twelve days after she was placed on probation, came up positive for the opioid fentanyl. Having thus violated her probation, Eldred was sent to jail.

Her case ended up going to the Massachusetts Supreme Judicial Court, Eldred’s lawyers arguing that incarcerating her for relapse was unconstitutional cruel and unusual punishment for her so-called disease, that is, substance use disorder (SUD). The remarkable thing about this story is the amicus brief submitted by attorney Amy M. Belger and filed on behalf of the Massachusetts Medical Society, six other prominent medical organizations, and 28 additional amici curiae. Eldred certainly had a great many “experts” on her side. But for all that, the amicus brief is a tissue of conceptual errors, confusion, and crude neuro-reductionism.

“There is medical consensus,” the brief claims, “that SUD is a chronic brain disease involving continued use of a substance despite negative consequences.” Now, this is a very irresponsible and, perhaps indeed, disingenuous claim, because as Heyman et al. observed in their trenchant and principled amicus brief (filed in opposition),

[D]espite claims that the [brain disease] model [of addiction] is “generally accepted,” it is in fact highly contested and exceedingly controversial in the scientific community. Many eminent scholars reject it, and those who do accept it often do so based on reasons extraneous to its validity.

What that last clause concerns is the bias, the value judgments, the personal interests that often motivate scholars to accept the brain disease model of addiction. “[A]ddiction-as-disease was an important factor in scientists’ efforts to obtain funding and build research teams,” Heyman et al. explain, quoting psychologist Rachel Hammer and colleagues of the Mayo Clinic. They also quote Alan Leshner—author of “Drug Addiction is a Brain Disease,” a seminal article published twenty years ago in Science—who has written that “Mental health advocates started referring to schizophrenia as a ‘brain disease’ and showing brain scans to members of Congress to get them to increase funding for research. It really worked.”

It’s an unhappy fact that from psychoanalysis and behaviorism to positive psychology, evolutionary psychology, and neuroscience (the latest fashion), psychology has been marked by shoddy thinking (mere speculation presented as fact, mistaken notions of causation, inferences that don’t follow). In the case of the brain disease model of addiction, there’s strong evidence of confirmation bias. “Experts” say that addiction has a “neurological basis,” but as Heyman et al. remind us, “all human action has biological causes at the level of the brain. That is simply a fact about human beings.” “All mental states and actions…have genetic underpinnings but they are not necessarily involuntary” because of those underpinnings.

“Experts” describe and, through magnetic resonance imaging, represent the brain changes associated with being high and drug addiction, as if such changes established the truth of SUD. But as Heyman et al. note, “If brain changes signified a disease state per se…we would all be diseased all the time.” After all,

Essentially any experience that changes behavior or consciousness must also change the brain. For instance, brain-imaging studies report persistent changes in the brain as a function of reading a novel…. Reading and writing this brief changes the brains of the readers and writers. Thus, the question is not whether drugs change the brain, but whether they do so in a way that renders drug use no longer voluntary.

The simple truth seems to be that, for a number of reasons, many “experts” want to accept the brain disease model of addiction, and looking, as it were, for a reason to do so, they use changed brains to that end. They practice confirmation bias, that is to say.

But the crucial, and fairly simple, issue is this: Is drug use “voluntary” or not? In other words, do people have free will or not? We certainly do. (If you don’t think so, see whether you can’t stop reading this article for a moment and return to it afterward.) Accordingly, Heyman et al. provide an

overview of data demonstrating that addiction is a set of behaviors whose course can be altered by foreseeable consequences. The same cannot be said of conventional brain diseases such as Alzheimer’s or multiple sclerosis. The best scientific and clinical data we have do not support the view that addicts are unable to refrain from using substances by choice.

By contrast, consider the wildly inaccurate claims in the brief filed on behalf of the Massachusetts Medical Society and all the rest.

“In the case of the brain disease model of addiction, there’s strong evidence of confirmation bias.”

“The fact that relapse is an almost inevitable feature of SUD leads to the straightforward conclusion that relapse is ‘not a weakness of character or will.’”

Although relapse is common among drug addicts, it doesn’t follow that such relapse is “almost inevitable,” or that theirs is “not a weakness of character or will.” And if relapse is “not a weakness of character or will,” then what on earth is?

The sentence quoted above is an example of educated stupidity; it is people who have graduate degrees who engender this sort of mischief, though before long it spreads throughout society. And as a result, ordinary people have a handy tool that allows them to avoid taking responsibility for their lives. Meanwhile, as society undergoes moral decline, the “experts” of the administrative state enjoy an endless stream of “therapeutic” work.

“Only a minority of patients who successfully complete opioid detoxification (i.e. medically supervised withdrawal), or long-term treatment of any kind, can abstain in a prolonged fashion from opioid use.”

Only a minority can abstain? This is an astonishing claim about human possibility. It’s difficult to believe how facile this is in regard to free will and moral agency. Again, even if most drug addicts (or opioid addicts) relapse, this doesn’t show that they had to do so. It’s true that opioid withdrawal in particular involves some highly unpleasant effects, but that doesn’t mean people are not able to choose not to use opioids.

“Adverse consequences should not invariably result from a positive drug screen alone, because most people need at least three months in treatment to achieve abstinence.”

As far as I could determine, the finding that “most people need at least three months in treatment to achieve abstinence” hasn’t been replicated in a random, representative sample of addicts. In any event, notice the weird, question-begging sense of “need” in the sentence quoted above: Even if most people do take “at least three months in treatment to achieve abstinence,” does that mean they need that amount of time, in the same way that we need food, water, and sleep to stay alive? This use of the word need assumes a determinism that hasn’t been established.

Suppose you’re the manager of a café and most of your employees show up late to work in the morning. Would you think that they simply “need” more time to get there? That 9 a.m. is too early? Or does the fault lie with the employees?

The analogy is apt, for what the reasoning in question amounts to is: “Most people need at least three months to stop engaging in bad behavior; therefore, they shouldn’t face ‘adverse consequences’ (e.g., going to jail for a positive drug test) for that behavior.” Such reasoning is quite mischievous, being nothing but a rationalization of vice, expressed in the guise of scientific authority. (To which many if not most people will respond with credulity.)

In the most devastating passage of their brief, Heyman et al. write:

[T]he core of [Eldred’s] argument, which depends largely on the implications of the brain-disease model of addiction—namely, that the brain changes associated with addiction render the addict incapable of behavioral control—is demonstrably untrue. The mere association of drug taking with expected neurobiological changes in the brain is not evidence that drug use is beyond control. This is abundantly evident from the large volume of data demonstrating that addiction is a set of behaviors whose course can be altered by foreseeable consequences. The same cannot be said of conventional brain diseases such as Alzheimer’s or multiple sclerosis.

Those behaviors can be altered because, like the rest of us, addicts are affected by incentives and reasons. They’re capable of rationality. Most addicts eventually quit, and they typically do so in response to the negative effects of drug abuse. Yet this ability to control their own behavior poses an insuperable problem for those who subscribe to the brain disease conception of addiction. Heyman et al. capture this in their dry comment:

Addiction seems to be among the most spontaneously “remitting” of all the conditions termed major mental disorders, which is a very inconvenient fact for the position that addiction is a “chronic and relapsing brain disease.”

Alas, many “experts” are bewitched by their own scientistic confusion. Moreover, they sneak in liberal prejudices in the name of scientific objectivity. Just how harmful is their influence? Consider that Eric Virelli and Julie Eldred are just two of the many ordinary people who use weighty scientistic abstractions to justify their own bad choices and self-deceptions.

As it happened, Julie Eldred lost her case; it’s not unconstitutional cruel and unusual punishment, the Massachusetts Supreme Judicial Court found, to incarcerate someone who violates probation by relapsing. The court also rejected the dubious argument that Eldred’s relapse was a symptom of a “disease” she couldn’t control.

Still, the baleful influence of the intellectual class continues with respect to addiction, and it is likely to be with us for a long time. The signs are all around us. Samantha Melamed and Dylan Purcell, in another recent Inquirer article, “The Probation Trap,” write:

Courts recognize substance-use disorder is a disease. Yet some judges continue punishing relapse with ever-longer probation and even prison…. Probation is meant to keep people out of jail. But intense monitoring leaves tens of thousands across the state at risk of incarceration.

Where is the injustice? Yes, if you violate your probation, you may well be incarcerated. That is what it means to be on probation. Nor does anything here establish that probation is unjust. And yet, given their faulty premises—namely, that addiction is “a disease,” and that the concept of “substance-use disorder” is coherent—Melamed and Purcell can imply that the “intense monitoring” is wrong. Not every reader will notice their error. Indeed, it’s precisely through such lazy work that bad and corrupting ideas are constantly circulating through the culture. (As if people these days needed any more excuses for viewing themselves as victims.)

One thing that I think Jonathan Haidt and other researchers in moral foundations theory get quite right is that, compared with conservatives, liberals have a limited conception of society as a whole. Focused on the experiences and, all too often, the mere feelings of individuals, and being motivated by pity and/or resentment, liberals commonly fail to see that things such as probation and parole serve to maintain social order, a value that is much more important than the life of this or that individual. On the purpose of probation and parole, Heyman et al. are characteristically acute:

Staying drug-free is a universal condition of criminal justice supervision. Not only is possession of controlled substances a crime in itself in all jurisdictions…it is well-known that for many reasons, including feeding their habit, addicts often commit other crimes related to the addiction. If addicts cannot be sanctioned for violating this condition of probation and parole, the state will lose this powerful contingency management technique for assisting addicts to remain free of drugs and for protecting society. The threat of being incarcerated or re-incarcerated or sanctioned in some way gives the addict an extremely powerful incentive to stay clean….

What would be the effect of losing this tool on sentencing judges and parole authorities? The inability to impose sanctions will almost certainly increase recidivism substantially. Many judges and parole authorities who are conscious of their duty to protect society would hesitate before granting probation or parole that might otherwise give people a chance to live a productive life in freedom. In an age in which our society is criticized for too much incarceration, this would be an unfortunate outcome.

Of course, we don’t hear such good sense from liberals like Melamed and Purcell, and the liberal media don’t want to reckon with voices that oppose their simplistic takes. Stephen J. Morse, of the University of Pennsylvania, is one of the scholars who wrote the opposing brief in the Eldred case. My friend Amy Wax, Morse’s colleague in the law department at Penn, has informed me that he coauthored an op-ed about the parole/probation series in The Inquirer, but the paper rejected it. That is unfortunate, for having read several papers by Morse, as well as the said brief, I can tell you that his is a first-rate mind (in addition to being a law professor, the learned Morse is also a professor of psychology and psychiatry), and his op-ed surely would have been a useful corrective.

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