Smoking Is A Disease

I’ve been following the Spanish response to their draconian new smoking ban, and reading (as best I can) Spanish blogs and news reports. Today, in El Pais, I came across an article in which the following words appeared.

el tabaquismo es una enfermedad crónica, como recoge la Organización Mundial de Salud.

which I translated as

Smoking is a chronic disease, as recognised by the World Health Organisation

Unsure whether I’d translated it right, I googled “Smoking is a disease”. And found lots of links. Like this:

A group of researchers led by professor Edward Ellerbeck from the Department of Preventive Medicine & Public Health at the University of Kansas say that doctors need to be more forthright when dealing with smokers and to consider the smoking habit to be a chronic disease in itself.

Now I don’t mind people arguing that smoking causes disease. A month back on this blog we were arguing over whether smoking caused lung cancer. But saying that smoking is a disease sets off alarm bells. In my understanding of the word “disease”, smoking isn’t any such thing.

But there seem to be a number of people who’ve been claiming that it’s a disease. Like this chap, who seems to have got hauled up before a tribunal, and told:

“Smoking is a habit it is not a disease or condition even though It may be a contributary cause of, or may aggravate, a disease or condition such as bronchitis, carcinoma of the lung, arteriosclerosis and so on.”

He wasn’t alone:

Medical definitions have reinforced the idea that smoking is indeed a disease. For instance, tobacco dependence was included as a psychiatric condition by the American Psychiatric Association (APA) in 1980. Eight years later, the U.S. Surgeon General’s Report declared smoking to be an addiction. Since then, the majority of doctors have treated smoking as a disease requiring medical attention.

Once smoking was labeled a disease, research into its causes and effects increased and advanced our understanding of tobacco addiction. Scientists consequently developed medical treatments such as nicotine replacement patches, gums, sprays and even vaccines. Each treatment is based on the premise that smoking is addictive and leads to compulsive drug seeking.

Nor is the attitude particularly new. Lennox Johnston, who was an anti-smoking campaigner back in the 1940s (Chris Snowdon has a few pages on him in Velvet Glove, Iron Fist) also regarded smoking as a disease.

“Smoking is a disease, “one of our most serious diseases.” “Smokers show the same [delusional] attitude to tobacco as addicts to their drug, and their judgment is therefore biased [in denial] in giving an opinion of its effect on them [and others].”—Lennox Johnston, “Tobacco Smoking and Nicotine,” 243 The Lancet 741, 742 (19 Dec 1942).

But I think that to claim that smoking is a disease is to twist and deform language.

And if smoking is a disease, then what other behaviour might not also be described as a disease? Why not Drinking Is A Disease? Or Eating Fast Food Is A Disease? Or Reading The Daily Telegraph Is A Disease? Or Voting Conservative Is A Disease? Once smoking is classed as a disease, then any behaviour that might be construed to be compulsive or addictive can also be called a disease, and clinics and therapies set up to treat the patients.

And, in fact, this is exactly what is happening. It’s not just smoking, but it’s also drinking and over-eating. Why not reading the Telegraph, and voting Conservative?

Dissent becomes disease. And exactly this happened with dissidents in the late Soviet Union. They were sent to mental institutions, and injected with drugs in an attempt to “cure” them.

In our new version of the Soviet Union, it’s not just a few dissidents here and there who are incarcerated in lunatic asylums, but entire social groups. No need for closed institutions. Our towns and cities have become open prisons in which social groups like smokers and drinkers and fat people are subjected to continuous assault and harassment.

I suppose that it’s not too difficult to understand how the word “disease” should have changed its meaning. Once we just had physical diseases, whose symptoms would be those of weakness, coughing, sneezing, running a fever, coming out in spots or sores and so on. But now we also have psychiatric disorders whose symptoms are those of fears, delusions, “inappropriate behaviours”, and the like. There are no physical symptoms with such mental disorders. And once one sort of mental disorder has been identified, then the road is open to identify lots more. More or less any behaviour can be identified as “abnormal” or “inappropriate” or “self-harming” or “antisocial” or whatever. And this is what has happened.

But the word “disease” is almost self-defining. It means “dis-ease”. “Ease” is a subjective state. One is either “at ease” or “uneasy” or “ill at ease”. And “ill at ease” means “dis-eased”. The patient presents himself to the doctor, and announces himself to be “ill at ease” or “ill” or “dis-eased”. The doctor then tries to discover what it is that is troubling his new patient. He prescribes some treatment. And if this is successful, the patient discharges himself by saying that he is now “well” again, and “at ease”. It is the patient, not the doctor, who decides if he is unwell. And who also decides that he has been cured.

But the new doctors, the Lennox Johnstons and their descendants, feel able to inform people that they are “diseased” and “sick”. Smokers and drinkers and fat people might declare that they are “very well, thank you”, and say that they actually enjoy smoking and drinking and eating stuff, but the new doctors ignore this. They know better. They know that they are sick as soon as they learn that they smoke or drink or eat Kentucky Fried Chicken. Because these are all diseases, recognised by the WHO. They are addictions. They are recognised forms of psychiatric disorder. Like reading the Daily Telegraph and voting Conservative. You don’t tell them that you’re sick. They tell you. And in doing so they debase language.

I’d like to end with a quote from Friedrich Hayek’s Road To Serfdom, the chapter on The End Of Truth:

In this particular case the perversion of the meaning of the word has, of course, been well prepared by a long line of German philosophers, and not least by many of the theoreticians of socialism. But freedom or liberty are by no means the only words whose meaning has been changed into their opposites to make them serve as instruments of totalitarian propaganda. We have already seen how the same happens to justice and law, right and equality. The list could be extended till it includes almost all moral and political terms in general use.

If one has not oneself experienced this process, it is difficult to appreciate the magnitude of this change in the meaning of words, the confusion which it causes, and the barriers to any rational discussion which it creates. It has to be seen to be understood how, if one of two brothers embraces the new faith, after a short while he appears to speak a different language which makes any real communication between them impossible. And the confusion becomes worse because this change of meaning of the words describing political ideals is not a single event but a continual process, a technique employed consciously or unconsciously to direct the people. Gradually, as this process continues, the whole language becomes despoiled, words become empty shells deprived of any definite meaning, as capable of denoting one thing as its opposite and used solely for the emotional associations which still adhere to them.