American Psychologist, 36: 807-818, 1981
Can Biochemistry Eliminate Addiction, Mental Illness, and Pain?
A growing consensus is emerging that the best hope for understanding and dealing with psychological problems lies with work being done in genetics, biology, and the neurosciences. Research in the neurosciences, especially, is expected to revolutionize the treatment of mental disorders in the coming years. The public is kept abreast of progress in this field in article after article in mass publication periodicals. Moreover, psychologists appear so eager to accept neurological and biochemical explanations for behavior that psychology is in danger of losing its status as an independent body of knowledge. This reductionist trend of thought, as well as having major scientific implications, affects popular attitudes toward self-regulation in key areas of human functioning. Yet not only has biochemical and neurological research not explained basic aspects of human behavior and mental disorder—it has fundamental problems in attempting such explanations. A psychology that accepts and accounts for subjective human experience is presented as a counterpoise to the reductionist thrust.
Reductionism is the point of view that human behavior can successfully be resolved into its biological components, components that may then in turn be described as chemical and electrical events. Reductionism is not itself a theory, since it does not present testable hypotheses that tend either to support or to disprove it. It is more of a philosophy or a faith in the ultimate nature of things. The eventual goal from the reductionist perspective is to find neurological correlates for individual actions, perceptions, feelings, thoughts, and memories-as well as for entire behavior syndromes such as addiction and schizophrenia. When this occurs, psychology and psychiatry will be subsumed by the field Restak (1979) calls “psychobiology”.
A breakthrough mentality now exists among many biologists, neurologists, and psychologists, who feel that we are on the verge of discoveries in the fields of biology, genetics, and the neurosciences that will remove some of our most persistent human problems. This optimism centers around several areas of research and speculation in the neurosciences: the discovery of neurotransmitters such as serotonin and norepinephrine and of endogenous opioid peptides (endorphins); the potential relationship between these substances and schizophrenia, depression, addiction, and pain; and the genetic predisposition to mental disorders transmitted through the balance of these chemicals in the body.
The appeal of reductionist thinking lies in its concreteness and its conciseness. It organizes behavior into exact, discrete categories; by drawing physical connections between behavior and the nervous system, it offers compact causal explanations; finally, and most important to its appeal, reductionist thought holds out the promise of clearcut remedies to problems that otherwise seem painfully beyond solution.
There is, however, an alternative view of psychology that contradicts many manifestations of reductionism. This is the belief that the study of psychology is intended to make sense of the world as it is experienced by human beings and that any psychological analysis or treatment which fails to incorporate individual personality and subjective needs or situational and cultural variables is bound to be incomplete. From this perspective, contemporary psychotherapies based on biochemistry represent a historical line of thought in which the role of the sentient person and his or her setting in psychic maladies has been ignored. Throughout the 19tb and 20th centuries this outlook has taken the form of faddish treatments for mental disorders. Today it regularly confuses investigations of contributory factors in the basic sciences with complete accounts of the behaviors and mental states that these factors influence.
Reductionism in the Mass Media
The extent of the rise in contemporary reductionism is indicated by the amount—and kind—of coverage that biochemical research on human behavior receives in the mass media, including our most respected mass circulation periodicals. Articles are written not only by science reporters but by scientific professionals—often those conducting the research themselves—that create the impression for most educated Americans that the study of human behavior is being revolutionized. For example, an article by neurologist Richard Restak (1977) in Saturday Reviewreports,
Medical researchers tend to frown on overenthusiastic claims about “miracle cures” and “wonder drugs.” Yet behind the scenes in medicine today, waves of high excitement are being generated by a group of biochemical agents called endorphins.
So far, researchers have carefully avoided hyperbole in their descriptions of the endorphins. But it’s hard to leave out the exclamation points when you are talking about a veritable philosopher’s stone—a group of substances that hold out the promise of alleviating, or even eliminating, such age-old medical bugaboos as pain, drug addiction, and, among other mental illnesses, schizophrenia. (p. 7)
Prominent endorphin researchers such as Snyder (1977) and Goldstein (1976) have themselves put forward explanations for addiction based on endorphins in popular science journals. Also writing for Saturday Review, Kety (1976) reports on his work in biological psychiatry in an article entitled “It’s Not All in Your Head.” The subtitle states that “there are now substantial indications that serious mental illnesses derive from chemical, rather than psychological, imbalances” (p. 28). The research of Kety and others is also given popular expression in an article entitled “From Joy to Depression: New Insights Into the Chemistry of Moods,” which appeared in theNew York Times Magazine (Scarf, 1977). The article traces the case of a woman who has alternating fits of euphoria and depression. The woman invested a relationship with a man she knew briefly with tremendous emotional significance. When she found the relationship to have been largely imaginary, she suffered a severe depression. The article notes that this woman, called Judith,
is maintained on the drug lithium carbonate, which not only controls her moods . . . but actually prevents them from happening. If the “cure” is chemical, Judith is convinced, then what is being cured must be some biological abnormality. “This has nothing to do with ‘psychological issues’ or what’s going on in my life at the time, or that sort of thing,” she says. “It’s not me you see; it’s my biochemistry.” (p. 31)
The article continues by describing investigations of serotonin and norepinephrine imbalances in depressed patients.
Reports in the popular psychological and scientific press keep building the sense that laboratory breakthroughs on behavior are taking place. The New York Timesweekly science section, for example, published the following articles in 1979 on physiological and brain research that had behavioral implications: “Chemical Curbs Memory Losses” (January 9), “Chemical Signals Linked to Behavior” (May 29), and “Studies Relate Physical Causes to Delinquency” (June 26). There was also an article indicating that pregnant women given hormones have less sexually stereotyped male and female offspring (“Psychologists Advance Theories of Sex Development,” September 4). And finally, there were the expected optimistic articles on opiate receptors and endorphins (“Chemistry of Pain Begins to Emerge,” May 1) and tranquilizer receptors (“Researchers Tracking Brain’s Own Tranquilizers,” April 10).
Obviously, the Times cannot do other than report on research in the sciences that is considered promising. Yet the density of articles like those listed above in a one-year period conveys a sense of imminence and potency in the “brain revolution.” Not infrequently, the most speculative hypotheses about brain-behavior relationships find their way into the newspaper’s pages. Complex behavioral and social arguments, on the other hand, do not seem as appropriate for scientific reporting. While they may be used in the body of an article as countervailing viewpoints, they invariably seem secondary and less inviting of the reader’s attention (cf. the Times science section article “Schizophrenia: Vast Effort Focuses on Four Areas,” 1979).
Reductionism in the History of the Treatment of Mental Disorder
The thinking apparent in primitive reductionist approaches to psychology often continues uninterrupted into the present. The concept behind phrenology—that specific areas of the brain correspond to the various components in a person’s character—finds a strong parallel in the concept underlying modern psychosurgery. In the last century treatments for insanity included strapping people into a centrifugal rotator (based on the idea that insanity was caused by insufficient circulation of blood to the brain) and shocking their systems by dunking them in cold water. Electroshock treatment follows approximately the same kind of thinking. In order to appreciate just how alluring explanations for mental disorders that propose straightforward physical mechanisms for observed mental conditions are, consider that shell shock was originally thought by 20th-century psychiatry to be due to concussion or inner ear injury (Robitscher, 1980). The most consistently popular reductionist approach to psychotherapy has been drug therapy. At various times such chemicals as the narcotics, cocaine, Benzedrine, hormones, radioactive substances, and, most recently, LSD and tranquilizers have been endorsed as therapeutic agents. Some of these, like insulin, were accorded the same enthusiasm that antidepressant drugs engender today.
At the same time that reductionist thought has always existed and has often been present in popular treatments for mental disorders, the degree of acceptance for such thinking has fluctuated greatly from one era to another. Typically, one set of ideas (whether mechanistic and reductionist, psychodynamic, humanistic, or other) has dominated the field for a time and has had dramatic claims for success attributed to it. As evidence mounts that the particular approach does not eliminate mental disorder, or may not even be any better than what preceded it, disillusionment sets in and a new philosophy rises to replace it. There have been eras before the present one when reductionist ideas held sway. The mid-19th century was such a time, and it was believed that insanity was on the verge of being cured. In this period, the German authorities declared “that the only legitimate research for the alienist was pathological anatomy of the nervous system” (Bromberg, 1975, p. 133), and autopsies of the insane were widely carried out in the United States as well as in Germany. The accumulated results of such autopsies proved uninformative, however, and around the same time Pliny Earle showed through statistical analyses that the actual cure rates for mental patients were far below those being claimed. It was as this particular age of reductionism wound down that the Freudian revolution began to take hold.
Today the pendulum has swung the other way, and we are at the end of a long downswing in the popularity of psychodynamic psychotherapy. A host of books and popular articles appeared in the seventies sounding the death knell for psychoanalytically oriented psychiatry (cf. Tennov, 1976; Torrey, 1974; “Psychiatry on the Couch,” 1979). One book that gained attention in the late seventies was Gross’s (1978) The Psychological Society, which builds from a standard list of the studies that have shown psychoanalytic therapy—and conversational therapies generally—to be of doubtful effectiveness into an argument for genetic and biological causation and treatment of mental disorder.
While Freudian psychology has been the dominant single approach to psychotherapy in the 20th century, its appeal has been limited by the intensity of self-examination it requires as a part of treatment. Other strands of therapeutic thought in this century, such as the concept of mental “illness,” have attempted to sidestep the guilt associated with psychodynamic interpretations, which are often seen to imply that the afflicted individual is responsible for his or her own problems. These drawbacks to psychoanalytically oriented therapies have become as important as their lack of demonstrated efficacy in a contemporary social climate in which introspection, searching one’s own actions and thoughts for flaws, and blaming oneself for difficulties one encounters have become decreasingly popular. Today one of the most damning criticisms against a particular psychological analysis is that it “blames the victim.”
One best-seller in the seventies, Greenfeld’s (1978) A Place for Noah, expresses this viewpoint from the perspective of the father of an autistic child who maintains that the child’s malady is the result of brain damage induced by prenatal or birthing conditions. Greenfeld is reacting in particular against Bettelheim’s (1967) explanation of autism as being caused by rejective behavior by parents toward a child. Greenfeld notes that psychodynamic theories have not led to demonstrably effective treatment and that what is called autism actually represents a variety of childhood syndromes. Most important in forming Greenfeld’s viewpoint is his unwillingness to accept the stark image of parenting that Bettelheim depicts as the source of autism.
However much one empathizes with Greenfeld, his own observations do not provide support for his hypothesis of congenital brain damage in his son. The boy’s development was not significantly abnormal until well after his first year, and it was a period of regression during his second year that finally led to his being diagnosed as autistic when he was three (Greenfeld, 1970). Years later, it was still not possible to measure neurological damage in the child. In another popular work by the father of an autistic boy (Kaufman, 1976), parents seeking assistance for their child also found established psychological treatment ineffective and often cruel. In its place, they devised their own form of therapy for autism. Stemming from their experience with a school of self-exploration called the Option Method, the therapy was based on constant, intensive one-to-one interactions with the child. From 70 to 80 hours a week, members of the family and a paid helper attempted to relate to the boy through his own autistic means of expression (such as rocking back and forth). Eventually the family “broke through” and “removed” the child into their own world, thus producing a rare successful outcome for a condition that has defied any general strategy of treatment.
Both of these cases of autism testify to the work psychology should be doing and is not. The Greenfeld account holds out the hope that biology will succeed where psychology has failed. At least as reasonable a conclusion from the two cases is that there are psychological keys to autism and its cure whose nature has eluded us.
Psychologists and Reductionism
The examples of reductionism given in this article thus far have come from the expansion of the medical and biological sciences into what had previously been the domains of psychology and psychoanalysis. The fields that incorporate this expansion—some of them newly defined—include psychophysiology, psychopharmacology, neuropsychology, behavior genetics, and biological psychiatry, along with one reductionist discipline, sociobiology, that is not experimental or laboratory based. Yet what most reveals the trend toward reductionist thought is the extent to which psychologists as a group have turned to the biological sciences for direction and for theoretical underpinnings to their work.
Indications that the American Psychological Association as an organization is increasingly supportive of reductionist approaches comes from the APA Master Lecture Series. Of the first four Master Lecture Series sessions, two were specifically devoted to reductionist topics. The first session, in 1974, dealt with physiological determinants of behavior and included papers on biochemistry and schizophrenia, the biological basis of memory, behavior genetics, and brain functioning and human behavior. The fourth session, in 1977, was given over to brain-behavior relationships and contained papers on several of the same topics presented at the first session, as well as on such topics of growing popularity as the physiology of consciousness and the lateral organization of the brain. It seems fair to say that the series marks a rapid movement away from non-physiologically based areas of psychology such as cognition, learning, perception, and abnormal and social psychology, as well as away from the humanistic, experiential, and applied areas that at one time appeared as though they might dominate psychology in the seventies. All continue to sustain themselves—and some even to grow—but none can claim the centrality in psychology that is now reserved for biochemistry and neurology.
The area of psychology in which this shift is most apparent is that having to do with psychopathologies and their treatment. The study of neurosciences is now often the one common link in training programs for counseling, clinical, and educational psychology, as psychology practitioners come to believe that such grounding is necessary for their work. Blau (1977), in his presidential address to APA, indicated that after 16 years of clinical practice with children, he has found that schizophrenia and other problems his young patients evince are related to their tendency to draw circles with a clockwise motion—a tendency he traces to brain functioning and genetic factors. The single most galvanizing concept today in abnormal psychology is vulnerability, or a child’s inbred susceptibility to schizophrenia (cf. Zubin & Spring, 1977).
Such shifts in theoretical developments often leave psychologists’ traditional concerns dangling. In his contribution to the 1975 Master Lecture Series session on developmental psychology, Norman Garmezy employed the vulnerability concept to make the argument for including genetic factors as primary determinants of childhood schizophrenia. As Garmezy (1975) stated his vision, “We stand on the threshold of advances in the biological sciences so relevant to psychopathology that one can look forward in the decades ahead to an ultimate resolution of the major psychotic disorders that have plagued mankind for centuries” (p. 4). Garmezy used as a climactic example in this paper a description of an “invulnerable” child (one highly resistant to mental disorder). This boy had lost his father, and Garmezy cited a speech the boy’s mother made in which she inspired her son with the belief that he and she both would be able to survive the father’s death. However, it is not clear how the attitudes this woman expresses, and the effect they apparently have on the child, are related to genetic predispositions.
Another paper from the Master Lecture Series, this one presented by Rodin (1977) in the 1977 brain-behavior session, embodies the sometimes dramatic changes that have overtaken classic lines of psychological research. Rodin’s paper emphasizes the physiological mechanisms in obesity and grew out of her work with Schachter on the situational cues overweight people use in evaluating their bodily states to determine if they are hungry (see Schachter, 1971). Schachter’s and his students’ obesity research, in turn, grew out of Schachter’s hallmark study of the influence of cognitive and social factors in individual responses to drug-induced states (Schachter, 1964). At the time this work stood out against the notion that chemical and physiological inputs are universal and inflexible determinants of mood and behavior.
Now, reversing the position he took in his early research, Schachter (1978) argues for a model of cigarette addiction that is purely physiological in nature and takes into account only the effect of the drug on the user’s system. He may still say about smokers who do not conform to this pure model that their behavior “can be understood in terms of such notions as self-control, concern with health, restraints, and so on” (Schachter, 1978, p. 111), yet he no longer sees any reason to introduce such variables as self-labeling, social influence, or other social or cognitive factors into his model.
Support for the idea of approaching smoking behavior from the standpoint of underlying physiological mechanisms comes from another surprising source, Ovide Pomerleau, a pioneer in behavioral medicine. Pomerleau (1979) has formulated an integrated approach for dealing with overeating, smoking, and problem drinking as learned patterns that can be modified. In doing so he has come into conflict with the prevailing medical model of alcoholism as a disease, which holds that alcoholics have a physiological, genetic weakness that causes them to drink to excess whenever they are exposed to alcohol. Pomerleau’s summary of the evidence on the disease concept stands as among the strongest and most reasonable refutations of that idea (Pomerleau, Pertschuk, & Stinnett, 1976). Pomerleau, too, has now shifted his attention to uncovering the physiological key to smoking (Pomerleau, 1980), despite the opposite stance he earlier took toward drinking and his success in dealing with smoking as a behavioral problem.
The Misguided Reliance on Reductionism
Inconsistencies in the work of Schachter, Pomerleau, Garmezy, and others are a sign that reductionist approaches have not been well integrated with existing knowledge in psychology, including often the research of such psychologists themselves. Another level of misconception is introduced when psychologists not familiar with the complexities in fundamental theories rest their interpretations of psychological phenomena on their assumptions about these theories. Examples come from the writings of two applied psychologists whose thinking has been influential in their fields and who resort to reductionist models that their work actually seems to run counter to rather than to support. Both psychologists have written about addiction; both attempt to expand what has been a pharmacological concept to areas of behavior other than those involving drug use.
William Morgan is a preeminent sports psychologist who introduced the idea that running can create a “negative” addiction. In a section of his article entitled “Physiologic Mechanisms of Running,” Morgan (1979) employs indirect evidence to argue that “running influences the central nervous system at a cellular level” (p. 58). It is on the grounds of this possibility that Morgan is willing to argue that running can serve as an addiction akin to a drug addiction. He does not go beyond this point to explain why the hypothesized central nervous system changes would lead running to be addictive for some people. No doubt many activities affect the central nervous system—how this does or does not lead to addiction, and for which individuals addiction appears, are the important questions. Moreover, the data presented in the article are entirely in the form of clinical studies of runners who manifest addictive behavior with regard to running. Morgan makes no attempt to ascertain whether—or how—running addicts differ neurologically from nonaddicted runners or from nonrunnners.
What makes Morgan’s theoretical speculation more misleading is that the clear addiction model he implicitly attempts to tie his work into does not exist. Despite more than a half century of research by pharmacologists directed toward uncovering the physiological mechanisms behind addiction, none have been identified. A basic medical text reports that the term addiction “can no longer be employed without further qualification or elaboration” (Jaffe, 1975, p. 285) because of the confusion surrounding the physiological basis of habitual drug use. It is for this same reason that the World Health Organization’s Committee on Addiction-Producing Drugs, a group led by pharmacologists, discarded the term addiction in favor of drug dependence.
Nicholas Cummings is another psychologist who has approached addiction as a behavioral phenomenon that extends beyond the matter of drug abuse. His APA presidential address (Cummings, 1979) outlined his uncommonly successful treatment methods for addictions using cognitive, behavioral, and experiential techniques. In the theoretical introduction preceding the description of his clinical practices, however, Cummings (1979) declares that “some people are born with a genetic predisposition to become addicted. For others it is congenital and in utero” (pp. 1120-1121). Cummings presents no evidence to support this statement; nor does he discuss evidence presented by others. Yet the theoretical questions the statement raises are substantial. For instance, how do addictions caused by genetic, congenital, and in utero factors differ from what Cummings calls “acquired” addictions (or, indeed, from each other)? Since Cummings uses addiction to refer to a general behavior syndrome, and not one connected to any one substance, does this mean that all the addictions he identifies—including overeating and gambling—may be genetically predisposed and so forth? Or does a genetic predisposition exist toward all addictions simultaneously, since Cummings indicates that the same addictively predisposed individual can become addicted to practically anything?
What is more disturbing is Cummings’s discussion of disease conceptions. As has been noted, the disease conception of alcoholism is a widely accepted notion of a behavior disorder that is determined by physiological and genetic factors. Cummings indicates that he considers alcoholism to fall within the category of those addictions that some people are genetically predisposed toward. Yet he can declare that “in our program we stress that the concept of addiction as a disease is useless” (Cummings, 1979, p. 1121). In this statement Cummings rejects on the basis of his practice the usefulness of the theoretical distinctions he has previously argued for accepting. It seems that as a psychologist dealing with matters also of concern to pharmacologists, Cummings naturally defers to their more “scientific” formulations and splices his own ideas onto these, however ill-fittingly.
What is lost from both Morgan’s and Cummings’s significant psychological insights is the opportunity to make necessary contributions to addiction theorizing. When a distinguished group of World Health Organization pharmacologists declared of the syndrome that they now labeled psychic dependence, “this mental state is the most powerful of all of the factors involved in chronic intoxication with psychotropic drugs . . . even in the case of most intense craving and perpetuation of compulsive abuse” (Eddy, Halbach, Isbell, & Seevers, 1965, p. 723), they left the door open for—in fact invited—psychologists to make sense of what many still prefer to label addiction. Instead of reformulating the addiction concept to account for their data, Morgan ignores the implications of his evidence that addiction can take place with a non-drug-related activity like running, and Cummings dismisses his own clinical experience that addiction is best dealt with in the absence of a priori physiological assumptions. This leads both to adopt notions that either are controversial or have already been discredited within the community of biologically oriented researchers.
Theory Validation—Reductionism and Addiction
That psychologists, among others, view reductionist approaches to psychology as inherently more scientific raises the issue of how science evaluates competing theories, for the use of reductionist theories and the overall viewpoint they represent will be worthwhile only to the extent that they can be shown to have greater validity than alternative approaches. The topic of drug addiction is good ground for making such comparisons, since the fact that addiction obviously engages both chemical and human inputs has made it the object of both pharmacological and psychological scrutiny. Several criteria of scientific validity offer help in assessing opposing viewpoints in this area of human behavior.
The Criterion of Accuracy
The most basic scientific goal in accounting for a class of behavior is that the account accurately describe the behavior and the data that have been accumulated about it. This involves first identifying and labeling the behavior. Reductionist conceptions often imply distinct and well-defined syndromes that do not represent the complexity the social scientist sees. Washburn (1978), for example, rejects the majority of sociobiological theorizing because it proposes individual genes to explain such social phenomena as monogamy, alcoholism, crime, altruism, and so on, when the behavior incorporated under these labels is so diverse and inconsistently defined. The same difficulty arises with any effort to explain multifaceted and variable psychopathological syndromes, such as psychosis, depression, and addiction, in terms of any single factor.
Thus pharmacological theories of addiction that have focused on the addictive characteristics of various drugs have not been able to deal with the diversity of usage patterns found with these drugs. Pharmacological accounts have typically ignored the finding from field studies of narcotics use that many people who take in substantial amounts of narcotics do not become addicted (cf. Zinberg, 1974). Recently, however, endorphin researchers like Goldstein (1976) have attempted to explain this inconsistency by suggesting that it is individuals whose bodies are deficient in endorphins who become addicted when they are exposed to a narcotic. For these individuals, narcotics perform pain-relief functions that occur naturally for most people through endogenous morphine (endorphin) production.
The Goldstein hypothesis continues to account for addiction with essentially one factor. Thus while it makes sense of some data that were previously undigestible by pharmacological descriptions of addiction, it does not add to their ability to explain other phenomena related to human drug use. For example, addicts have often been identified as having personality syndromes involving passivity, a negative outlook on life, and a readiness to form dependent relationships other than those connected with drugs (Chein, Gerard, Lee, & Rosenfeld, 1964). Could these personality traits in the addict also be accounted for by a deficiency in endorphins—or by some other biological means? If not, why do those who become addicted to drugs simultaneously display such traits? At a cultural level, addiction to a substance such as alcohol varies from place to place according to historical events and social attitudes (cf. Blum & Blum, 1969; McClelland, Davis, Kalin, & Wanner, 1972; Zinberg & Harding, 1979). Thus genetically related populations have been shown to have different rates of alcoholism depending on their degree of assimilation from a culture with a low alcoholism rate into a culture with a high alcoholism rate (Jessor, Young, Young, & Tesi, 1970).
Most research on human narcotic users has had the severe drawback of studying people who had drawn attention to themselves through their maladaptive life-styles. It was therefore a significant research advance when government-sponsored investigations of drug use among soldiers in Vietnam led to the study of more representative populations of narcotics users. The results of this research included the following findings. Up to one third or more of the soldiers in Vietnam were thought to be using narcotics. Seventy-five percent of the soldiers detected as having narcotics in their systems said they were addicted in Vietnam. Many of these men were able to give up enormous heroin habits with surprising ease when they returned home (Zinberg, 1974). At the same time, a full third of the “drug-positive” sample continued to take narcotics in the United States. Yet less than 10% of the original narcotic-using group showed signs of drug-dependent behavior stateside, prompting the investigators to declare that “contrary to conventional belief, the occasional use of narcotics without becoming addicted appears to be possible even for men who have previously been dependent on narcotics” (Robins, Davis, & Goodwin, 1974, p. 248). The endorphin model which proposes that susceptibility to addiction varies with a person’s characteristic level of endorphin production does not explain such a setting-related variation in a person’s likelihood of being addicted given continuous use of a narcotic by that individual.
One reason that social, personality, and cultural variables have not been taken to be as scientifically meaningful as biochemical factors is that they are not easily made a part of experimental designs. The Vietnam veteran data represent the observational, experiential, and survey research that typifies the study of human addiction. Most of the research concerning biochemical processes, on the other hand, is conducted in the laboratory, most often with animals. Because the organism in the laboratory—whether human or animal—is studied in isolation from the normal environmental conditions surrounding drug use and addiction, some of those who have conducted such research have questioned the validity of generalizing laboratory findings to human addiction in the field (Yanagita, 1970).
It was thus especially interesting when a group of social-pychologically oriented researchers studied the effects of setting variables on the self-administration of morphine in rats (Alexander, Coambs, & Hadaway, 1978). The rats were divided into two groups: one in which the rats were isolated in cramped quarters identical to normal laboratory conditions, the other in which the rats were given expansive and pleasant surroundings that they shared with other rats. The experimenters habituated the rats to a morphine solution by offering them only this solution to drink for 53 days. Four days when both water and solution were available were scattered throughout this period, and a choice was also given on several occasions following the period of habituation. On these choice days, the isolated rats drank far more morphine solution than did the social rats (p<.001)—so much so that there was virtually no overlap between the populations. This study (one of a series with similar results conducted over a period of four years; Alexander, Hadaway, & Coambs, 1980) experimentally validates the Vietnam data in showing that the actual process of addiction, up to and including the appearance of withdrawal, is crucially influenced by social and environmental variables. Once again the data present insurmountable difficulties to biochemical models that focus exclusively on pharmacological properties of drugs or even those that incorporate hypothetical variations in the constitutions of individual organisms.
The Appropriate Level of Analysis and the Criterion of Parsimony
Explaining interactions between an individual and his or her setting requires a more dynamic biological model, such as one which holds that the organism undergoing stress is a different biological creature from the one who is not, that this difference is regular and significant, and that it combines with the individual’s characteristic biochemistry in potentially predictable ways. By making this adjustment in thinking, it becomes possible to propose that under stressful circumstances the organism requires a higher endorphin level and will thus be susceptible to narcotic addiction as an artificial way of attaining this level.
Introducing such complexities into reductionist theorizing brings into focus the issue of separate levels of analysis. One position is that, a priori, there must be some measurable biochemical correlate to every input into the organism’s life, such as stress or any other stimulus, and to the organism’s reaction to the input. According to this thinking, personality variables, and even the effects on the individual of different social and cultural milieux, should be mirrored by neurological differences. The ultimate statement of a relativistic levels-of-analysis viewpoint is that each level of analysis—psychological, behavioral, and cognitive on the one hand and biological, chemical, and physical on the other—is legitimate and that each can be applied with equal validity to a given psychological question.
This resolution of the respective domains of the biological and the social sciences has much appeal. At the present time, however, when the claims made for reductionist explanations have become so all-encompassing, it is important to express a contrary position, namely, that some problems may only be meaningfully analyzed at a social or a psychological level. Cultural variations in alcoholism rates, for example, are related to the very way in which drinking is conceived of in different cultures. In some cultures in which problem drinking is practically unknown (such as rural Mediterranean societies), drinking does not lead to the destructive disinhibition and antisocial behavior (such as fighting, reckless driving, blackout, sexual aggression) that in fact define alcoholism in our culture (Blum & Blum, 1969). Thus, translating the effects of drinking into biochemical events while excluding the cultural meaning of drinking does not allow one to determine the presence or absence of alcoholism in an individual.
While the first criterion in evaluating a scientific model is its accuracy in describing a phenomenon and the factors that lead to and surround it, an additional criterion is parsimony. This has to do with the reasonableness of a model as indicated by the economy with which it explains events and how well it does so in keeping with existing knowledge. Let us consider in terms of this criterion the use of state-dependent biochemistry to account for the behavior of the isolated rats and the beleaguered GIs. What is gained through postulating neurological changes brought about by the presence of stressful stimuli which make it more likely that a rat or other organism will succumb to the effects of a narcotic (or through postulating neurological effects from positive stimulation which make the organism more resistant to addiction)? Is this more concise and understandable than a conception that rats find narcosis not to be desirable when it interferes with successful intraspecies competition and with the appeal of a diverse and welcome environment?
In the same vein, what is gained by imagining that a GI undergoes changes in his nervous system under war conditions in Asia that increase his likelihood of being addicted, rather than conceiving of a soldier’s finding a narcotic’s effect more alluring because he is uncomfortable, fearful, deprived of rewarding enterprise and intimate relationships, and not in control of his environment? When one considers that these conditions not only distinguish between addictive drug use in Vietnam and nonaddictive use stateside for the same person but also are found to pertain to the daily lives of domestic addicts, one sees that the same experiential model works to explain addiction both for the normal person undergoing exceptional stress and for the disabled individual undergoing what he or she experiences to be the regular circumstances of life (Peele, 1979). Similarly, McClelland et al.’s (1972) model of alcohol intoxication as the fulfillment of otherwise unsatisfied needs for power succeeds in accounting for both problem drinking in our society and cross-cultural differences in alcoholism. Indeed, were it not for the predisposition to see biological and laboratory-based experimentation as being inherently, more scientific, there would seem to be little reason to devise convoluted and secondary biological formulations for phenomena that can already be understood in social-psychological terms.
The Criterion of Efficacy
Good science works. Our confidence in those areas of physics used for spaceflight is strongly reinforced by moon landings and photographs of Venus and Saturn. Although we cannot expect such definitive indications of the validity of psychological theories, we do look to success in treatment as a sign of their worth. Cummings’s allegiance to models that his treatment of addiction proves to be “useless” is thus a violation of the canons of science. It is more appropriate, in the words of the task force that prepared the recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), to accept that “the ultimate issue in judging . . . [any] proposed definition and criteria for medical and mental disorder is simply that it is useful” (Spitzer & Endicott, 1978, p. 37).
Implications of Contemporary Treatments in a Reductionist Mode
The levels-of-analysis question is an important one for treatment. Our faith that a malady “exists” at a given level affects how we respond to it. The depressed woman quoted earlier in this article who believes that antidepressant drugs are “curing” her depressive problems is expressing the logical outcome of the viewpoint that the source of her disorder is biochemical.
Depression is a pivotal clinical category because at the same time that drug therapy has become the favored treatment modality, depression is often seen to involve important strands of cultural conditioning. A strong cultural influence is apparent through observations that the diagnosis of depression is increasingly frequent in our society and that depression appears from 1.5 to 3 times as often in women as it does in men (a ratio that also varies across cultures; Weissman & Kierman, 1977). Some have tried to trace this difference in the sexes to biological differences such as hormones or X chromosomes. Yet, in a reversal from other trends of thought identified in this article, our cultural climate currently disapproves of biologically based explanations for personality distinctions between males and females and between the races.
The two models most often used to account for the more common appearance of depression in women are social psychological in that both relate social factors to the observed sex-linked psychological differences. One focuses on the conditioning of women toward personal relationships, particularly with men (Arieti & Bemporad, 1978). In terms of this model, girls are reared to seek security from significant others and to doubt their self-worth when social reinforcement from such people is not forthcoming. It is because of this learned pattern that women are more dependent and more frequently experience loneliness and depression. The learned helplessness model (Seligman, 1974) is more general, but has been found to have special relevance to women. It is based on the discovery that animals which are not able to influence whether or not they receive noxious stimuli react by withdrawing. People who have learned that they cannot influence their environment in significant ways develop a similar response, which in humans is often labeled depression.
Both of these models emphasize that it is the sex role allocated to women in our society which leads them to be susceptible to depression. Proponents of the more sophisticated reductionist arguments outlined in the previous section may expect to find that helplessness or other learned response tendencies have explicit correlates in the nervous system. Whether or not a doctor or therapist employs this justification, certainly many treat with drugs cases of depression that would seem to be described by these two social-psychological models. Let us return to the case (described early in this article) of the woman who reported great exhilaration because of her relationship with a man and the project they were working on together, followed by extreme depression because the relationship did not develop the way the woman had hoped. This syndrome has been given the name hysteroid dysphoria (Liebowitz & Klein, 1979) in an effort to fit it into the DSM-III categoryaffective disorder. Hysteroid dysphoria is characterized by “repeated episodes of abruptly depressed mood in response to feeling rejected. Individuals with this disorder . . . spend much of their time seeking approval . . . especially of a romantic nature, to which they respond with elevation of mood and energy. The hallmark of the disorder is an extreme intolerance of personal rejection, with a particular vulnerability to loss of romantic attachment” (Liebowitz & Klein, 1979, p. 555).
Liebowitz and Klein propose that sufferers of this disorder have abnormal regulation of the neurotransmitter-like substance phenylethylamine and that this can be remedied by injecting the antidepressant phenelzine. Thus, this diagnosis enables physicians and others to administer mind-altering drugs to people for problems they have in forming adequate relationships. The women who are typically the patients in these cases also ideally undergo psychotherapy to increase their awareness of the patterns their relationships follow. Yet at least some doctors and patients—including the woman whose case was introduced earlier—would not feel that this step was necessary and would be supported in their belief by the new brain-behavior hypotheses. Whether or not patients participate in psychodynamic therapy as well, undoubtedly some of those treated with drugs are not able to change the cyclic and unsatisfying nature of their intimate relationships. They may, however, continue to welcome a treatment that removes their feelings of depression without giving them the ability to modify the social and personal factors that contribute to these feelings.
Consequences of Ignoring the Individual’s Social and Psychological Reality
It is not yet possible to assess the effects of the large-scale use of antidepressant drugs in our society.1 It is instructive, however, to consider the case of tranquilizers as an example of a mood-altering treatment that has often been employed without attention to the conditions in the person’s life that led him or her to need medication. Once welcomed as widely as antidepressants are today, tranquilizers have now been identified as the objects of considerable abuse—so much so that medical and scientific bodies have recommended major corrections to what have become standard practices for prescribing these substances. In particular, instances have been publicized in which prominent people have become addicted to Valium and other sedatives or tranquilizers that were prescribed to them by doctors (see Gordon, 1979). The basis of this addiction is that the individual substitutes the anxiety-reducing effects of the drug for the capacity to cope with anxiety and its sources (Gray, 1978). Instead of developing adequate psychological resources, the person comes to rely on the drug to ensure a sense of well-being. It is under such circumstances—circumstances not different from those surrounding the use of antidepressants—that the bodily readjustments brought about when drug use is halted are experienced as pathological withdrawal (Peele, 1979).
Problems with sedatives and tranquilizers fit into a pattern of drug abuse in the United States. Since the turn of the century, American pharmacology has sought drugs that can relieve pain (along with anxiety and tension) without being addictive (cf. Eddy & May, 1973). During this time, we have witnessed the introduction of heroin (to replace morphine), barbiturates, synthetic narcotics such as Demerol and methadone, and nonbarbiturate sedatives. All were initially greeted as being nonaddictive; all are now recognized as having addictive properties. Despite the considerable resources invested in it, pharmacological research devoid of an awareness of the psychological needs of the addict and his or her social setting has succeeded only in creating new drugs to which people may become addicted. What brought about this substantial miscalculation was the failure to understand that those who become addicted welcome the elimination of troubling sensation and the dulling of awareness that all of these drugs produce. This means that any drug which is effective for analgesic or related purposes will by definition be addictive, since it is this very experience the person seeks in an addiction (Peele, 1978).
The promise of new analgesics that will be synthesized along the lines of endorphins, but that will not be addictive because they derive from chemical compounds which occur naturally, in the body (cf. Kosterlitz, 1979), can thus be seen to take a place in the long line of such efforts that have proved futile. It is also possible to conceive that if stress responses in the nervous system were to be completely identified, then these could be eliminated directed in war settings or ghettos, where addiction is especially likely. This might be accomplished chemicals, or—even more futuristically—through stimulation of appropriate points in the brain (Shaffer & Burglass). Why these efforts would produce results different from current patterns of narcotic and other depressant drug use is not clear, however, since it is for just this stress-reducing effect that soldiers and laboratory animals presumably self-administer a narcotic in what we label as addiction.
Attacking the problem from the other side, we might imagine implanting electrodes into the brains of isolated rats (or using drugs) to simulate the effects of a rich environment that in fact is not present for the organism. Similar stimulation could be artificially provided for the human addict in a deprived environment or for the individual who is incapable of creating rewarding involvements with people or work. The addiction-prone individual would then be made neurologically identical to the individual who has superior resistance to addiction. While it is hard to believe currently that anyone would seriously suggest such alternatives, they seem to be legitimate derivations of the analysis which says that reality occurs at the biochemical and neurological level.
In George Orwell’s 1984, one finds a society in which trauma and despair have been eliminated, while curiosity and emotions such as caring and love exist in only vestigial forms. This society is vaguely hinted to have been brought about through political repression. We will not be held in political chains in 1984, however. One of the first issues in the eighties of the modish magazine New York features on its cover an article called “Medicine for the Eighties: Better Living Through Chemistry” (1980), which lists 17 drugs “to keep you happy, healthy, and sane.” These include an endogenous peptide that “can serve as the prototype for a generation of safe, natural sleeping pills”; a hormone that “overcomes psychological impotence”; an endorphin painkiller “200 times more powerful than morphine, [yet] nonaddictive”; norepinephrine and serotonin to eliminate aggression; a peptide that “may one day cure obesity”; peptides that heighten “powers of concentration”; a hormone that “stimulates memory,” lost, for example, in an alcoholic blackout; a drug that blocks the brain receptors which produce fear symptoms and can thus stop such things as stage fright; and so on. It is in this way that 1984 will be upon us, brought by futurists, medical technocrats, and the cultural elite. We may wonder whether there will continue to be a psychology—one that accepts human sentience and self-regulation—to counteract this magical vision of life.
- Evaluations of antidepressant treatments devised by biological psychiatry are already far from uniformly favorable, and one researcher in that field has substituted a cognitive “mood therapy” for drug and shock therapies, which he had found to be unhelpful in his clinical practice (Burns, 1980). Back
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