What You Can Change _. And What You Can't - Martin E. Seligman [104]
Rejoinder: Recall the Japanese proverb cited earlier. As alcoholism worsens, voluntary control gets weaker. Calling alcoholism a disease highlights how little control its victims come to have. Choice mattered at first, but in its later stages, alcoholics have almost no choice. A driver who chooses to speed down a freeway in a car with defective brakes and winds up spending years in casts made some bad early choices that had long-term disastrous consequences. But his broken neck and useless arm are now illnesses.4
AND so the dispute continues through another half dozen attacks and rejoinders. There is a decent argument on each side: There are good reasons to call alcoholism a disease, but there are almost equally good reasons not to. The dispute is roughly a draw.
But a disease, unlike a triangle or a benzene ring, is not an object of science. Disease is not well defined; rather, it is a label that lies outside science itself and is used to introduce specific topics. It is a term like cognition as opposed to short-term memory in psychology, or life as opposed to gene in biology, or cure as opposed to spinal-cord damage in medicine. There is some latitude about whether or not to attach the label disease to alcoholism, and therefore I believe that other considerations come into play. Primarily, we should ask if people who label themselves diseased with alcoholism are better off. Are helpers of alcoholics more effective if they think they are treating a disease? Is change more likely?
Tactics. The way we explain our failures to ourselves, unlike the truth of the disease concept of alcoholism, is not merely academic. In fact, how we label our troubles has sweeping consequences. When we believe an explanation that is permanent, pervasive, and personal, we do much worse than when we explain our problems in temporary, local, and impersonal terms. For example, if we explain our unemployment as “I have no talent” (permanent, pervasive, and personal), we get depressed, we feel helpless, we don’t look for a job, and our failure bleeds into the rest of our lives. If, on the other hand, we believe that the cause is the recession (temporary, local, and impersonal), we soon try to find another job, we fight off depression, we don’t feel worthless or helpless, and we go on in the other domains of living. This is the main concern of my book Learned Optimism, and it applies directly to the disease concept of alcoholism.
When someone finds himself dependent on alcohol, and it finally dawns on him that his life, his family, his career, and everything else he values is in danger, how should that man explain this to himself? As it turns out, he doesn’t have many choices. He can explain it as a disease. The other possibilities are to explain it as a vice, a result of bad choices and bad character, or as sin. Compare disease to vice. Disease is more temporary (it is often curable), whereas vice is more permanent (it stems from bad character, and character changes little if at all). A disease is more specific (it comes from an accidental biology and environment), whereas vice is global (it comes from being a bad person). A disease is impersonal, whereas a vice indicts you because you chose it.
The upshot is that a disease is a more optimistic explanation than vice, and optimism is about changeability. Pessimistic labels lead to passivity, whereas optimistic ones lead to attempts to change. It follows that alcoholics who label themselves as ill will be less depressed, less helpless, have higher self-esteem, and, most important, will try harder to change or be changed than alcoholics who label themselves bad people. There is another benefit of the disease label: It is a ticket into the medical care system.
I come down on the side of the disease concept of alcoholism. Not because it is unimpeachably true (I doubt that), but because it is more