Smoker? You Must Be Mad.

What should a patient with severe mental problems expect from the doctor he sees for help?

If it's up to University of California professor Steven A. Schroeder, that patient, if he uses tobacco products, needs nothing so much as a lecture about smoking. And it's urgent that all mental-health facilities ban smoking, not only indoors but outside, too. No more smoking breaks for people who are a little funny in the head.

Schroeder seems to claim he's advocating such a solution out of perfectly selfless solicitude (never mind that he earns his salary by helming something called the "Smoking Cessation Leadership Center"). But underneath the faux-humanitarian varnish, his little newspaper essay fairly crackles with nastiness and innuendo.

[S]moking is concentrated among people with mental illness, often compounded by substance-abuse disorders such as alcoholism. ... The facts about smoking and mental illness are stark. An estimated 44 percent of the cigarettes sold in the United States are consumed by people with mental illness. This is because so many people who have mental illnesses smoke (estimates run from 50 percent to 80 percent, compared with about 20 percent of the general population) and because they smoke so many cigarettes a day.

This veers very, very close to planting the suggestion that people who smoke are by definition mentally ill, or might as well be. Certainly Schroeder does nothing to dispel that notion.

And consider this tell-tale cri de coeur:

Why did [mental] patients, their families and clinicians do nothing to help smokers quit? One reason is well-intended but uninformed compassion. The reasoning goes something like: "Poor Joe is suffering so much from his illness and gets such pleasure from his cigarettes that I don't want to take them away from him."

You'd expect some riposte at this point, some explanation — however cursory — of why such a sympathetic weighing of pro and cons, risks and benefits, must be considered out of the question, but Schroeder doesn't provide it.

I shouldn't be surprised. In the world of the Tobacco Taliban, no gray areas exist, no ethical or humane conundrum could ever present itself when the subject is as clear-cut as smoking. Even thinking about such ambiguities, much less actually discussing them, would be an affront to the new orthodoxy that smoking is always bad, no matter how good it makes people feel.

Comments

[David]

By now, you should know that for "public health" types, even the greatest joy is not worth the slightest risk.

[Phelps]

I hope that this fool isn't a medical doctor, because I would pray that any real medical health professional would know that nicotine reduces the delusions brought on by schizophrenia and that it is commonly believed that they chain smoke as a way of self medicating (just like the alcohol.)

[lynda]

i smoke about 7 cigs a day and dont really think its a problem.these days people go on as if its an illegal drug.