When In Doubt, Stigmatise Pleasure

hunter_200I have come across libertarians who believe that there’s nothing wrong whatsoever with smoking and that the dangers from secondhand smoke are nonexistent. Me, I tend to trust the medics on this. Smoking kills and I think there’s certainly a case for some restrictions on smoking in public, if only for reasons of etiquette. But what to make of this report from the British Lung Foundation?

Smoking may be a sign of psychiatric illness, experts say. Doctors should routinely consider referring people who smoke to mental health services, in case they need treatment, they add.

The controversial recommendation from the British Lung Foundation, a charity, comes in response to a major report, Smoking and Mental Health, published this week by the Royal College of Physicians and the Royal College of Psychiatrists with the Faculty of Public Health. It says that almost one in three cigarettes smoked in Britain today is smoked by someone with a mental disorder. When people with drug and alcohol problems are included the proportion is even higher.

The reason is that smoking rates have more than halved over the past 50 years, but the decline has not happened equally in all parts of society.

‘Smoking is increasingly becoming the domain of the most disadvantaged: the poor, homeless, imprisoned and those with mental disorder. This is a damning indictment of UK public health policy and clinical service provision,’ the report says.

The Independent’s health editor adds: ‘The nation’s dwindling band of smokers, skulking outside office doors, already resent being treated as pariahs. The suggestion that they may be dotty, too, will only enrage them further… doctors would be remiss if they did not consider whether a patient’s fag habit disguised an untreated mental disorder.’

So cigarettes cause craziness. Er, wow! But is it really that simple? Premier mental health blogger Seaneen Molloy has pointed out potential flaws in the Lung Foundation’s thesis. She writes that ‘causation does not equal correlation.  A lot of people who have mental health issues smoke, ergo, people who smoke must have mental health issues?’ Seaneen also outlines the obvious practical problem with referring every single presenting smoker to an already overworked mental health service. And she draws on her experience from both sides of mental health care. ‘But in this environment, where you enter and go through the mortification process… the freedom to smoke is an important one. It gives a sense of bodily agency and autonomy in an environment where such things are flagrantly disrespected.’

I would add that there is an ideological movement against smoking, made up of government funded ‘charities’, career activists and public sector organisations that appear to be immune from national austerity. These are professional anti smokers who came up in the 1980s when Big Tobacco was the enemy. The world has changed since then, tobacco companies are nothing compared to the pharmaceutical cartels, but the caravan never moved on.

In 2007 ASH got its dream of a public smoking ban, but people continue to smoke. The tobacco control industry has never understood that some of us, more of us than the Independent’s health editor thinks, know the risks and make the decision to sacrifice potential quantity of life for quality and short term pleasure. All the No Smoking Days and glossy PR and Department of Health money can’t change that. So the tobacco control movement demands more petty tinkering – plain cigarette packages, restrictions on vending machines – without ever arguing for what it really wants: a complete ban on the sale of tobacco. Tobacco control activists don’t come out and have that argument because they know it’s an argument they’re going to lose.

There is also the question of enforcement. Pubs got round the 2007 ban by introducing heated outside smoking areas. The ones that didn’t went to the wall. Plain packages, if and when they come in, will likely flood the black market with cheap, easily manufactured smuggled tobacco. You’re not supposed to be able to buy cigarettes in pubs, but every one of my locals sells packets openly behind the bar. And some pubs will simply defy the ban. Last year a hilarious ‘special investigation’ by the Manchester Evening News found that at least fifteen of Rusholme’s shisha bars were letting people smoke inside. This put the city’s political elite in a difficult position between the Scylla of wanting to police people’s leisure time and the Charybdis of not wanting to offend Asian cultural traditions.

Seaneen writes that poor people are more likely to smoke because the working classes have never shared the ridiculous bourgeois taboo against tobacco. It’s a taboo with a long and reactionary history. Feminists of the late nineteenth century were smeared as ‘pallid, tired, thin-lipped, flat-chested and angular’ women, living in an ‘atmosphere of tea-steam and cigarette smoke’; women for whom ‘[t]he time of night means nothing until way into the small hours.’ And the Lung Foundation’s press release reads like something from the fevered drug wars of the 1980s.

We know more or less how lungs work. The mind is a stranger place. Anxiety, depression, psychosis, entropy and disorder are things we are only just beginning to learn about. The reasons some people develop mental health problems are complex, all bound up with biology, genetics, environment, and the circumstances of a unique human life. Simplistic general solutions help no one. And this particular idea could set a bad precedent for the principles of free healthcare. There are already resentful whisperings to the effect that people who overeat or drink too much have somehow ‘brought it on themselves’ and shouldn’t be treated. Should people who have smoked all their lives be turned away from crisis centres?

It is what Ben Goldacre identified as the dark side of the ‘you are what you eat’ philosophy. As Goldacre says, this is ‘a manifesto of rightwing individualism – you are what you eat, and people die young because they deserve it. They choose death, through ignorance and laziness, but you choose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see 78. You deserve it. Not like them.’

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3 Responses to “When In Doubt, Stigmatise Pleasure”

  1. Paul Murdoch Says:

    I can’t see this as stigmatising pleasure; this smacks more of a staggering deficit of empathy. It appears that the ‘winners’ in our new political-economic paradigm can’t conceive that the losers-those who’ve found themselves recast as corporate serfs-might find occasional relief from the soulless quotidian in the odd can of Special Brew, fag or spliff. Perhaps we feckless, self-destructive little ingrates lack the vision, nuance or moral fibre to embrace the new clean-living, sustainable meritocracy.

    I’m pretty sure that an intrinsic part of knowing ones place these days consists in keeping oneself in prime physical and mental condition, the better to service the demands of our vibrant new economy. To do otherwise offends against the new imperative for the non-professional, non-middle-class deskilled workforce: ie stay competative, stay cheerful and accept that you’re engaged in a race to the bottom. No doubt, if I had a secure well-paid career, private health plans, privately educated lids, a big house, domestic help and whatnot, my world-view might change. However, I hope that as a surveyed my surroundings I’d be a bit more understanding about the tendency of those with no security, no future and a daily reality of underpaid ritual humiliation to let rip occasionally and get right off their faces.

    This step is Stalinist. Ascribing a rejection of this new Utopia to mental health issues is no less than the elite’s demonisation of an underclass for their temerity in failing to show sufficient gratitude and deference in the face of a brave new economic model which fucks them up at every turn. just as legislation has produced an atmosphere of unparalleled ‘equality’ of opportunity and self-affirmation at one level, at the same time it propels those outside the tent towards a hotchpotch-pitch of casual unsecured uncertainty or crypto-indenture.

    The way to reduce people’s tendency toward self-destructive escapism is to give them a society in which escape isn’t the first impulse of anybody with an ounce of soul and self-respect. To this end, it’s no less galling to have a bunch of highly-rewarded professionals critiquing the lifestyles of the have-nots than it is to see the Toynbees, Pennysand Huttons proclaiming what’s best for them. This is class politics writ large…and as with all class politics these days, there’s one class that isn’t allowed near the keyboard.

  2. harleyrider1978 Says:

    JOINT STATEMENT ON THE RE-ASSESSMENT OF THE TOXICOLOGICAL TESTING OF TOBACCO PRODUCTS”
    7 October, the COT meeting on 26 October and the COC meeting on 18
    November 2004.

    http://cot.food.gov.uk/pdfs/cotstatementtobacco0409

    “5. The Committees commented that tobacco smoke was a highly complex chemical mixture and that the causative agents for smoke induced diseases (such as cardiovascular disease, cancer, effects on reproduction and on offspring) was unknown. The mechanisms by which tobacco induced adverse effects were not established. The best information related to tobacco smoke – induced lung cancer, but even in this instance a detailed mechanism was not available. The Committees therefore agreed that on the basis of current knowledge it would be very difficult to identify a toxicological testing strategy or a biomonitoring approach for use in volunteer studies with smokers where the end-points determined or biomarkers measured were predictive of the overall burden of tobacco-induced adverse disease.”

    In other words … our first hand smoke theory is so lame we can’t even design a bogus lab experiment to prove it. In fact … we don’t even know how tobacco does all of the magical things we claim it does.

    The greatest threat to the second hand theory is the weakness of the first hand theory.

  3. harleyrider1978 Says:

    This pretty well destroys the Myth of second hand smoke:

    http://vitals.nbcnews.com/_news/2013/01/28/16741714-lungs-from-pack-a-day-smokers-safe-for-transplant-study-finds?lite

    Lungs from pack-a-day smokers safe for transplant, study finds.

    By JoNel Aleccia, Staff Writer, NBC News.

    Using lung transplants from heavy smokers may sound like a cruel joke, but a new study finds that organs taken from people who puffed a pack a day for more than 20 years are likely safe.

    What’s more, the analysis of lung transplant data from the U.S. between 2005 and 2011 confirms what transplant experts say they already know: For some patients on a crowded organ waiting list, lungs from smokers are better than none.

    “I think people are grateful just to have a shot at getting lungs,” said Dr. Sharven Taghavi, a cardiovascular surgical resident at Temple University Hospital in Philadelphia, who led the new study………………………

    Ive done the math here and this is how it works out with second ahnd smoke and people inhaling it!

    The 16 cities study conducted by the U.S. DEPT OF ENERGY and later by Oakridge National laboratories discovered:

    Cigarette smoke, bartenders annual exposure to smoke rises, at most, to the equivalent of 6 cigarettes/year.

    146,000 CIGARETTES SMOKED IN 20 YEARS AT 1 PACK A DAY.

    A bartender would have to work in second hand smoke for 2433 years to get an equivalent dose.

    Then the average non-smoker in a ventilated restaurant for an hour would have to go back and forth each day for 119,000 years to get an equivalent 20 years of smoking a pack a day! Pretty well impossible ehh!

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