The Tragic Death of Phillip Seymour Hoffman is Very Sad. What can we learn from it?

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The tragic death of Phillip Seymour Hoffman has once again brought drugs back into public consciousness. His death is very sad. Life is precious. This is most pertinent to those who knew him and loved him. That does not include you or me. The only reason we even know about his death is because he was a celebrity. We do not know Phillip Seymour Hoffman. Some anonymous person dies a sordid heroin death just like his every two hours. It is happening right now as I write, and more will have died as you read. His death is not anymore tragic (or any less tragic) than those who are dying right now.

I don’t know anything about his actual life. And neither do you. As a psychiatrist, I have had the occasion to learn the real truth about many lives. I do know that the actual story behind every life is very different than its public image. I have treated celebrities, and they are no different from you or me. We all have the same human struggle.

Every patient evolves a character adaptation from early childhood which reflects the way his temperament fields his emotional environment – responsiveness, abuse, and deprivation. With a good enough foundation we are then able to traverse the temptations of adolescence that we are all susceptible to. Thus we construct our characters. Why do some kids experiment with and then stop self-destructive behavior, while other kids go deeper into the dark side of life? The teenager who has had good-enough loving in childhood retains the presence of his Authentic-Being as the core of his self. The Authentic-Being is the rudder by which one navigates through the smorgasbord of experience and life’s temptations. When this adolescent strays too far in a self-destructive avenue, as all kids do, there is a quiet voice inside him that says, “What am I doing? I’ve got to stop this.”

Substance abuse is but one among the many temptations of adolescence that to one degree or another we are all subject to. The list is not long: sex, drugs, drink, gambling, eating (from gluttony to anorexia), reckless action and sensation-seeking, stealing and cheating, egotism, and sadomasochistic attachment and anger.

So I don’t know Phillip Seymour Hoffman’s story. But I do know he is no exception, just because he is a celebrity. He did not have that voice inside and he came by it honestly. Even though I don’t know what they are, I know he had problems at his core. Remember, a person who is real good at pretending that he is another person isn’t necessarily the model of a fulfilled self.

I do know that it was not his dealer’s fault that he OD’d. He’d have found another dealer. He is responsible, like anyone, for putting the needle in his arm and disregarding the welfare of his children, of the mother of his children, of his friends and those who loved him. He is not just a victim. As much as this is a tragic loss, Phillip Seymour Hoffman is not a hero, and he is not a model. This is not meant to be cruel. His death is a tragedy and I feel bereft by it.  I am very sensitive to the pain one must face to mourn and recover one’s core in therapy. I know how difficult addiction is to deal with. I treat it every day.

There are many misleading myths of popular and psychiatric culture today. Addiction is not a disease. The temptations of addiction can be almost anything, even your cell phone. But it is not a neurobiological disease. Yes, I know this sounds like a heresy. Being old, I was there when substance addiction was falsely granted ‘disease’ status. It began as a ploy on the part of Alcoholics Anonymous to further the idea that alcoholism is not your fault, and you can’t control it. In the seventies the disease idea was promoted. It wasn’t so before then. It was a conscious decision, known to be a metaphor and not really true. [In fact, of all the addictions, alcoholics do the thing they allegedly can’t do -They successfully stop drinking at a very high rate.]

Then as psychiatry falsely developed its own (faulty) disease ideas regarding depression and anxiety, etc., suddenly alcoholism and substance abuse, like all the rest of them was considered a real biochemical disease. Then with the neuroscience explosion, these ideas became even more cemented as facts. But it is not true. It is a house of cards. The human condition is as it always has been. And now we aren’t just dealing with the relatively small and horrific heroin epidemic, but a huge pharmaceutical epidemic that reaches far more people and brings in over $75,000,000.000 a year to big Pharma.

4 replies
  1. Dave in IL
    Dave in IL says:

    This was an excellent post Dr. Berezin. I found this article on the Psychology Today website and decided to check out your blog. I agree with you that calling addiction a disease is problematic. Coming from a non-sectarian Buddhist perspective, I’d say addiction is mostly an attempt to escape or obscure reality instead of confronting it.

    I have been troubled by the medicalization of personal problems for some time now. I have worked in the healthcare security field for more than a decade now, so perhaps I have earned the right to be a bit cynical about this phenomenon. For example, is everyone Bi-Polar these days? I swear it seemed like every other problem patient I was called to deal with some weeks claimed they were Bi-Polar. Sometimes I felt like asking, “so have you been diagnosed as Bi-Polar or are you just Bi-Polar when you get yourself into trouble?”

    Now I have seen patients that were–in this layman’s opinion–in a manic state and probably would have been easily classified as Bi-Polar. But often it seemed like our “Bi-Polar” patients were just people who had low tolerance for frustration and liked to pick fights with people (nurses, doctors security officers) who worked for a living and had the responsibility of telling them “no.”

    Anyway, thanks for a great piece on addiction. I look forward to reading more on your blog.

    Reply
  2. Robert Berezin
    Robert Berezin says:

    Dave,
    Thank you for your thoughts. Yes there is such a thing as real mania. When its prresent it is obvious. There is a lifetime struggle for people who have this psychotic character. People now receive a ‘bipolar’ diagnosis at the drop of a hat. Most of them do not have manic-depression. And you are correct. they wear their false ‘bipolar’ diagnosis as a badge of honor and take the license not to take responsibility. Notice that I call the real item – manic-depression. I use ‘bipoar’ for its proper designation when talking about batteries which have two poles, not people.
    The incidence of manic-depression has not changed. I wish my field field were as clear as you are.

    Reply
  3. Joe
    Joe says:

    I do not claim to know the exact definition of “neurobiological disease”, but the Merriam-Webster definition of “disease” is: “an illness that affects a person, animal, or plant : a condition that prevents the body or mind from working normally” and yes, “a problem that a person, group, organization, or society has and cannot stop.”

    Perhaps the second definition does not apply. Some could argue that a number of addicts do stop using, while others (including, I believe, most everyone in recovery) would argue that ceasing their drugging, drinking, gambling, etc, does not mean that they are no longer addicts. But, going by the first definition, would addiction not qualify as a disease? I understand it is meant to be more of a metaphor, than a clinical diagnosis. Recovery groups often refer to it as a “physical, mental, and spiritual disease.”

    I guess what I don’t understand is your referring to the usage of the word as a “ploy on the part of Alcoholics Anonymous to further the idea that alcoholism is not your fault.” This seems to imply both that the people of AA have some sort of ulterior motive other than staying sober and helping other alcoholics achieve sobriety, and that you do in fact think that addiction is the addicts fault. I do not see it as a matter of fault. Should the focus not be more on stopping an addict’s usage, than if it was their DNA, upbringing, or cell phone that “made them” an addict? I understand the necessity of examining a problem’s root in order to attempt the prevention of it happening again and again, but whether it’s meant to be metaphor, a simile, or some sort of abstraction, I wonder where you see the harm in deeming addiction a disease?

    If it is simply a question of semantics, that’s one thing, but as a person who “treats addiction every day”, are you saying that AA and other recovery programs who refer to addiction as a disease, are hindering peoples recovery? Or that psychiatrists have a better success rate of treating addiction? In my experience as a person who struggles with addiction, and is a member of AA, I would like to make it clear that AA does not claim that alcoholics “cannot” stop drinking, so much as it claims we cannot do it alone. Which is obviously my simplified way of putting it, and also not universally true. But whether it’s a recovery program who claims addiction is a disease, that you can’t beat it alone, or that you need the help of a higher power, or a psychiatrist who claims that it is not a disease, you can beat it by yourself, or with the help of a trained professional, if it helps someone not ruin their life and that of those around them, I ask again, “where is the harm?”

    Reply
    • Robert Berezin
      Robert Berezin says:

      Joe
      I appreciate your comment.
      It is simply literally true that the AA organization made a marketing decision to appeal to more alcoholics by calling alcoholism a disease. Prior to this decision it was not called a disease. This is fact. At the time I questioned this because it wasn’t true. And the rationalization was that it would aid in getting more people to stop drinking so what is the harm. I didn’t agree then and I don’t agree now. The truth is important. AA has usually been very good about adhering to its principles, which I have always respected.
      This falsity mushroomed into other beliefs. And eventually it became (false) and conventional knowledge that most of psychiatry is composed of neuro-biological diseases. This is not so. I appreciate that AA has been the most effective tool for many alcoholics to stop drinking.
      I do my best to address the truth as I understand it to be. It is disingenuous for you to say that AA does not say that an alcoholic cannot stop drinking. The first principle is to acknowledge and profess that you are powerless over alcohol. That is what that means. And the mechanism is to give over to God. “Higher Power was a compromise between Bill W. and Dr. Bob.
      This makes one dependent on AA for the rest of one’s life. Is it better to drink? Of course not, and I would never advocate that, obviously. I propose, however, in my next post what is involved in becoming whole.

      Reply

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