Still smoking? You must be mad

By linking cigarettes to mental illness, anti-smokers are reviving an old authoritarian tactic: pathologising deviants

by Patrick Hayes 

No matter how long and hard the anti-smoking lobby preaches, some dirty smokers just don’t listen. Despite countless attempts to bang the drum about the harm the filthy habit causes and anti-smokers’ successful attempts to attain ever-greater restrictions on where people can smoke, a sixth of the UK population still continues to light up. What must be going on in their heads? Are they mad?

This, it seems, is the conclusion that some in the anti-smoking lobby are rapidly arriving at. A number of reports, most recently one by the Royal College of Physicians (RCP) published last week, have found that people with mental-health difficulties are twice as likely to smoke than the rest of the population. This follows a report earlier in the year by the US Centers for Disease Control and Prevention, which found that one in three people with a mental illness smoke, compared to one in five for the population as a whole. Or, as the New York Times reported it, ‘People with mental illness are 70 per cent more likely to smoke cigarettes than people without mental illness’.

Following the publication of the RCP’s report, Professor John Britton, chair of the RCP’s Tobacco Advisory Group, commented that, ‘as the prevalence of smoking in the UK falls, smoking is increasingly becoming the domain of the most disadvantaged in our society, and particularly those with mental disorders’.

If you’re poor, or have a mental disorder, the logic seems to go, the less likely you are to know what’s good for you. So you’re more likely to continue puffing away than the rest of the population. You are clearly in need of help.

Some, however, have gone even further, suggesting that as mentally ill people are more likely to smoke, smoking may itself be an indicator of mental illness. Professor Stephen Spiro, deputy chair of the British Lung Foundation, has advised doctors in response to the RCP report, ‘Routinely considering whether someone presenting with a lung disease, or indeed any patient who smokes, might benefit from referral to mental-health services, could make the key difference for many individuals.’

In the eyes of Spiro, it seems, the very act of smoking means that a referral to mental health services might be warranted. Spiro is hardly alone in this view, with other commentators viewing addiction to smoking as a mental illness, with the act of smoking not just causing illness but being an illness in itself.

As one so-called ‘nicotine-dependency prevention and cessation educator’ puts it: ‘People who have schizophrenia commonly hear voices, while dependent smokers sense want for more nicotine.’ Defending Spiro’s comments, the health editor of the Independent wrote that ‘It is not daft to suggest that smokers need psychiatric help’, arguing that despite the face that smokers may be ‘enraged’ by the suggestion they may be ‘dotty’, doctors would be ‘remiss if they did not consider whether a patient’s fag habit disguised an untreated mental disorder’.

That anti-smoking campaigners are now starting to come out and explicitly suggest that smokers need their heads examined is of little surprise. Indeed, it’s very much par for those with authoritarian instincts wanting to clamp down on those who fail to conform. Take, for example, the widespread diagnosis of ‘sluggish schizophrenia’ among political dissidents in the Soviet Union in the Fifties and Sixties leading them to be institutionalised and often be tranquilised or face electric shock therapy. Or, more recently, the pathologisation of people who dare question orthodoxies about climate change, casting them as ‘deniers’ who are using the wrong sides of their brains due to a ‘neural inability to face up to the catastrophe of global warming’. Authoritarians have long treated deviant behaviour or dissenting beliefs as a sign of mental malaise. That way they can be written off as irrational and treated, rather than engaged with or having their behaviour tolerated as a personal choice.

Sadly some smokers are starting to cast themselves as having mental health problems due to their habit. For example, one writer for the Guardian put it recently when fighting cravings: ‘I can already see there’s nothing good about cigarettes at all. I still want one. And that’s because I’m mentally ill.’ A recent survey of 2,000 smokers for the Co-operative Pharmacy found that a third of smokers blame their ‘addictive personality’ for not being able to quit.

One in five smokers dared confess in the survey that they smoked not because they were addicted but simply because they enjoyed it. What heretics! Given that such a confession may increasingly mean they will be referred to the loony bin, it’s surprising that it’s as many as that.