
What's a disease? Or: shoud fat/shy/alcoholic people be blamed or treated? - brazzy
http://lesswrong.com/lw/2as/diseased_thinking_dissolving_questions_about/
======
rauljara
When I was a psych major, we dealt with questions like these all the time. I
think the author raises excellent points, but presents a rather limited view
of the social pressure that people can exert. "We should blame and stigmatize
people for conditions where blame and stigma are the most useful methods for
curing or preventing the condition, and we should allow patients to seek
treatment whenever it is available and effective." There are many conditions
that are susceptible to influence by social pressure, but very rarely are
blame and stigma the best means of exerting that influence. In most cases, I'd
say they are downright harmful.

Take alcoholism. The most effective treatment today for alcoholism is AA.
(there are many thing about aa that kind of creep me out, but it is a fact
that it has the highest success rate of any course of treatment that has been
studied). AA works almost entirely through social influence. But a key
component of its social influence is talking about alcoholism as a disease, as
something separate from an individual which can be done away with. Talking
about alcoholism as a moral failing simply does not help. If you are morally
bankrupt, what are the odds of your morally bankrupt self digging your way out
of that hole? If you have a disease, though, maybe you can find a cure.

Similarly, as a child, people yelling at me that I was a lazy bum just didn't
help. My primary reaction was resentment, not shame. Though I had shame, too.
Its just not so easy to motivate oneself when feeling like a shameful failure.
When I started thing of laziness as a behavior that I happened to have, rather
than something that was intrinsic to myself, (i.e., I am being lazy right now,
what can I do about it, as opposed to I am lazy), I started being able to have
more control over it. Not perfect control, of course, but much more than I
had.

~~~
jheriko
"Similarly, as a child, people yelling at me that I was a lazy bum just didn't
help. My primary reaction was resentment, not shame. Though I had shame, too.
Its just not so easy to motivate oneself when feeling like a shameful
failure."

This varies with personality and situation - I know exactly what you mean
because I was shouted at for being fat and lazy as a child and it never did
any good, but I can also think of many situations in my own life where the
opposite was true and people yelling at me for failing provided the impetus to
do better...

I think the risk of not doing anything is worse though. If poor behaviour is
tolerated, and not given some kind of negative feedback then it can become
accepted. I suspect this is part of the obesity problem - if living as a fat
person were really horrible less people would be inclined to do it and, at the
risk of sounding cruel, if medical help were refused for obesity related
problems then the genetic element would take care of itself...

I'm fat - and if I die because my heart clogs up with all the byproducts of
that fatness then it is my own /stupid/ fault.

~~~
steveklabnik
> This varies with personality and situation - I know exactly what you mean
> because I was shouted at for being fat and lazy as a child and it never did
> any good, but I can also think of many situations in my own life where the
> opposite was true and people yelling at me for failing provided the impetus
> to do better...

Yep, absolutely. Maybe it's that I listened to too much punk rock as a kid,
but I have this odd personality trait where if someone criticizes me for
something that I consider illegitimate, I get this instant, visceral "fuck
you" response, and their critique does me no good.

In other cases, I take too much to heart.

Human emotions are silly, fragile things.

~~~
jamesbritt
' Maybe it's that I listened to too much punk rock as a kid, but I have this
odd personality trait where if someone criticizes me for something that I
consider illegitimate, I get this instant, visceral "fuck you" response, and
their critique does me no good.'

Oh, been there, done that. :)

I used to despise the people who would give me grief for smoking. They were
wasting their time, and it was none of their fucking business.

Later, after I quit smoking, it occurred to me that those admonitions helped.
Much as I hated to accept that, the regular jibes kept alive the idea of
quitting.

I hate being told what to do, especially if it's coupled with the idea that
what I'm currently doing is both wrong _and_ stupid, but that's just pride.

I didn't quit smoking because people told me to, but having people constantly
tell me to quit did help keep the idea percolating in the back of my head, a
contribution to my finally coming to terms with what needed to be done and
mustering the reserve to just do it.

There's the risk that some people will spite themselves just to show the world
how independent they are, and the more you tell them what that _must_ do, the
less likely they are to do it. But provoking people into reconsidering their
actions, even if it annoys them, may help in the long run.

~~~
petewarden
I've reluctantly come to a similar conclusion. I moved to California from the
UK in 2001 thinking that the anti-smoking laws in bars, etc were oppressive
'nanny-state' measures. I was finally able to give up smoking though, and it
really helped that it was socially unacceptable to light up a cigarette in
most situations. It also helped that I left behind my smoking friends and hung
out with people who didn't smoke, so it wasn't just the laws, but it made me
reconsider my previous position on paternalistic regulations.

~~~
jamesbritt
When I was quitting smoking I noticed that there were many places I could not
smoke, and that when there I did no have quite the same impulse to smoke as
when I was, say, home.

Basically, so long as I knew I had the option to smoke I was way more inclined
to want to do so, and found it harder to resist. This was sort of encouraging,
because it suggested that a lot of the urge was psychological, which seemed
better than a relentless chemistry-driven compulsion I might never beat.

That's not to deny the physical addiction part, but to note that appreciating
that it's not _all_ physical addiction makes it seem less impossible to beat.

(I also noticed that the urge to smoke in the morning was greater after I had
that first one. I then started throwing any remaining cigs down the toilet
before going to sleep. _That_ took will power. :) Sure, I would buy smokes on
the way to work, or at lunch time, but it helped me cut down. I must say,
addiction sucks.)

------
latch
Honest question: What I don't get about the "obesity is genetic" is, why is
the obesity rate climbing? Are obese people proliferating at a quicker pace
than before? Are the genes responsible dominant?

~~~
rauljara
Well, with any gene, it takes the proper environmental factors for it to be
expressed. So while very few people would argue that height isn't largely
genetic, most people also accept that it takes proper nutrition in order to
grow tall. So even though height is genetic, and South and North Koreans
largely share the same genetics, South Koreans are way taller than North
Koreans.

The genetic argument for obesity is that in areas of occasional famine, it
made evolutionary sense to horde food in your gut, particularly fatty food.
Until very recently in human history, there just wasn't that much fatty food
for your average citizen to horde. Now there is, particularly because food
corporations have realized over time that the fattier the food, the more of it
they sell, and those previously advantageous genes are running amok. Not
everyone has those genes because in places of plenty, those genes aren't that
advantageous.

I'd agree that that isn't an entirely convincing argument. But I do think it's
part of the story.

~~~
adrih
Can't we directly conclude from your argument that the obesity epidemy can be
entirely solved by fixing the environment, which is probably easier than
fixing the genes ?

Heroin harms us because of our genetic makeup, yet we don't talk about how
heroin-induced illness has genetic causes. We simply try to keep people away
from heroin.

~~~
MichaelSalib
Not necessarily. The point is that given the current environment, some people
become obese and others do not. The difference between the two groups may be
partly due to genetics.

And actually, we do talk about the genetic basis for opioid addiction. I
recall one doctor suggesting that a small percentage of the population are
born addicted to opioids from birth whereas most people will have greater
difficulty developing opioid addiction.

~~~
jamesbritt
"And actually, we do talk about the genetic basis for opioid addiction."

Plus, a major health issue with heroin is the shit product being sold.
Attempts to restrict access makes it more dangerous to use.

------
DanielBMarkham
Sometimes I think all interesting questions boil down to semantics.

One nit: libertarian (classic, not anti-government) attitudes were described
thusly: * People who make good decisions are intrinsically good people and
deserve good treatment; people who make bad decisions are intrinsically bad
people and deserve bad treatment.*

Er no. Libertarian thought tells us that variations in individuals are more
important than societal standards. Not that people are "bad" or "good"

 _Taking a determinist consequentialist position allows us to do so more
effectively._

This strikes me as the difference between an academic argument and a practical
one. Academically, sure, the numbers add up. Practically, this is completely
terrible advice, for the sole reason that the criteria suggested are not only
indeterminate but suffer large variations as applied by different individuals.
And offering up some sort of scientific committee or standards for what to
blame people for is totally whacked, for reasons I'll leave as an exercise to
the reader.

I liked the observation that people who condemn others may do so because
others have not sacrificed. This fits intuitively with what I have observed.

I'd add another detail, though. There is a long tradition in western thought
that the individual's struggles with character traits that he or she don't
like has value in itself. We always should have a place we would like to be
that we cannot attain. Western medicine and ideals, however, seem to feel that
if we commonly view one condition as "better" or "worse" than another, some
sort of chemical or social intervention is required in order to make people
better. This worked great when "worse" = the plague, but the model is falling
apart when "worse" = too fat. The types of structures and systems of thought
we have set up for the plague do not naturally extend to shyness. The word has
stretched too far.

I support looking at the necessary and sufficient conditions, but I felt the
analysis was loose and incomplete, which led to a muddled set of conclusions.

~~~
steveklabnik
> libertarian (classic, not anti-government)

Slightly offtopic, but did you mean 'classic liberal?' I thought original
recipe libertarians were anarchists. I only ask because I only recently
learned that fact, and found it interesting.

~~~
DanielBMarkham
Be careful of words with political annotations -- liberal, conservative,
libertarian. The problem is that there is the theory, and then there is
application of the theory. For instance, "liberal" has changed quite a bit
over the last hundred years, as has "conservative"

You can cherry-pick various people or parties that have called themselves
liberal or conservative and come up with all sorts of positions. It's a fun
parlor game, but the only thing it proves is that people can take a simple
idea and twist it into all sorts of things. Doesn't mean the idea is whacked.

Libertarian is the same as the rest of them.

I'll go with first line in the wiki article _The term libertarian in a
metaphysical or philosophical sense was first used by late-Enlightenment free-
thinkers to refer to those who believed in free will, as opposed to
determinism_

Historically yes, it was grabbed by anarchists. And you can find examples of
libertarian "thought" being used to justify all sorts of crazy stuff. But the
point here is that if you are telling me that I am good or bad, you are
applying deterministic thought which implies some sort of control. Better to
say that we are both free agents acting in our own best interests. If I cut
off my toe, you may get very upset. What a bad thing to do! But it was my toe,
and if I didn't like it, it was my right to get rid of it. Your tendency to
view my actions in terms of your morality is an attempt to layer your version
of deterministic morality over my right to do things which may frighten or
offend you. The next step would be for you to start labeling my toe-cutting a
form of sickness that society would be justified in "fixing" for me.

It's exactly the same thing as the church did, it's just dressed up in science
and medicine instead of religion and myth.

~~~
steveklabnik
Thanks for the well-thought out response. You touch on a subject that I find
to be really interesting, in a game-theory sort of way: words are always
changing, that's the nature of language. Yet in order to have reasoned
discourse, we need to nail down what words actually mean. There's a certain
push and pull that goes on between those two sides, I guess, which is why it's
so hard to talk about these things. Everyone has different meanings for
everything.

------
solson
Neither, they should be held responsible for their actions. Only a change in
their actions can change the outcome. Treatment is a nonsense word in this
application. "Treatment" is just a way to use social tricks to get them to
make different choices while making them believe it's a disease so they don't
resist treatment. Real treatment for alcoholism is a liver transplant. Real
treatment for obesity is liposuction. They only way to stop damaging yourself
is to take responsibility and stop doing what you've been doing. Telling
people they are powerless robs them of their dignity and is an outright lie.
The person with the problem is the only one with the power to change! The
treatment industry in America is a racket that is mostly based on the AA 12
Steps. At best it has a 5% success rate. (<http://www.orange-
papers.org/orange-effectiveness.html>) If you want a good book on the subject,
read Rational Recovery [http://www.amazon.com/Rational-Recovery-Cure-
Substance-Addic...](http://www.amazon.com/Rational-Recovery-Cure-Substance-
Addiction/dp/0671528580/ref=sr_1_1?ie=UTF8&s=books&qid=1275311441&sr=8-1)

~~~
Daniel_Newby
"Neither, they should be held responsible for their actions. Only a change in
their actions can change the outcome."

Experiments strongly suggest that choice and strength of willpower have little
to do with body weight. Controlled overfeeding experiments in humans have
demonstrated a wide variation in weight gain. Some people's bodies are simply
resistant to storing excess food, while other people's store it avidly and
gain weight rapidly. After the overfeeding phase of the experiment finished,
they then lost weight rapidly with no perceived effort or exercise of
willpower.

Meanwhile various nonhuman animal experiments have found that body fat is
fairly sensitive to things like gut microbes, details of food composition, and
subtle differences in the environment. Not one of these can be changed by
simply resolving to eat less.

"Real treatment for obesity is liposuction."

Obesity is a disorder of food conversion and storage, not body fat.
Liposuction causes temporary and cosmetic changes. Real treatment is a drug
that alters the brain centers responsible for metabolism and hunger. (And
indeed such drugs exist and are spectacularly effective. Unfortunately the
existing ones also have spectacular and dangerous side effects, but much
better ones are rapidly being developed.)

------
rjett
Understanding why many of these controversial diseases are problems in the
first place is made a little clearer if we look at the problem through the
lens of behavioural economics. Alcoholics, nicotine addicts, many obese
people, sexaholics, etc place huge discount rates on future rewards so that in
the present, these future rewards are almost worthless. Put another way, these
people place the most value on their next item of consumption which allows
them to overcome the long-term costs of their destructive behaviour or the
long-term benefits to quitting (if we assume these people make an
instantaneous cost-benefit analysis each time they eat/drink/smoke/etc). This
sort of radical discounting behaviour has been shown to be reversible in those
who seek treatment.

Now, to one of the main points of the article: What constitutes an acceptable
form of treatment to these gray-area diseases? An economist would probably say
that you would have to consider the individual in question and then formulate
a solution based on that individual's preferences, likelihood of success, and
cost of change. For one obese person, gastric bypass might be the only
solution between life and death. For another obese person, paying $25,000 for
gastric bypass surgery might be "worth it" and allow them to change their
eating habits in a way that would benefit them long-term without having to go
through the anguish of months or years of diet and exercise. For another obese
person with another preference set, diet and exercise would be far less costly
than gastric bypass. Why bring right and wrong into the argument when looking
at treatment methods?

Edit: Giving the issue some further thought, some might make a value judgement
as to how bad or good heavy temporal discounting is. Given the assumption that
it is wrong or bad, then you could hypothesize that the American culture of
consumerism has gradually conditioned our population as a whole to shift their
preferences to the present, valuing the quick fix over long-term, less costly
approaches.

------
igravious
l;bra (long; but read anyway)

Articulately put and yummy intellectual fodder. Thank you for the submission
brazzy.

Cancer and Obesity should always be "cancers" and "obesities" when we're
talking about how we should treat the potential/actual sufferer as it varies
from type to type. As pointed out by the article it would seem unhelpful to
yell at a cancer patient but we should whine at our kids if they start
smoking. Also, as obesity comes in many shapes and sizes maybe do do we know
whether Sandy has an underlying genetic condition or whether she likes jam
donuts too much.

As a commenter to the article said: a lot of the choices a consequentialist
would make sound like utilitarian choices. I'm not big on utilitarianism so I
guess I'd be leery of consequentialism.

I absolutely love the idea of breaking down a complex issue into its component
parts. It is interesting how some people use outliers rather than type
specimens to try to destroy coherent notions which is really unhelpful. For
instance to use the example of disease; obesity fails some of the criteria for
disease, thus we need to rethink what disease means for us!

Less iPad/Flash submissions and more of this sort of thing would be greatly
appreciated :)

~~~
brazzy
Articles on these "rationalist" sites often tend towards a mix of smug
superiority about one's ability to analyze other people's supposed biases, and
lots of references to pet concepts. I posted this one because it does such an
excellent job of analyzing the issue in clear, objective terms.

~~~
Goladus
_Articles on these "rationalist" sites often tend towards a mix of smug
superiority about one's ability to analyze other people's supposed biases, and
lots of references to pet concepts. I posted this one because it does such an
excellent job of analyzing the issue in clear, objective terms._

I think the article you linked is an excellent example of smug superiority
with lots of references to pet concepts while deficient in regard to the core
subjects under discussion. The author demonstrates little practical experience
with or research into the actual science around obesity, the actual medical
practices related to obese patients, the reality of being an obese person, or
the linguistic meaning of the word disease.

~~~
brazzy
It seems you haven't read much else there, and have missed the point; it's not
about the scientific details of obesity. And what exactly _would_ be the
"linguistic meaning" of the word disease?

~~~
Goladus
I think I've missed the point because there isn't really a point.

The author talks about a hypothetical Doctor but doesn't really seem to know
much about medicine. The author asks "what is disease" but doesn't bother to
do any real work to answer that question.

To answer your second question, a linguistic analysis of the word disease
would look vaguely like the author's "What is a disease?" section, except it
would involve real observation about how the word is used and in what
contexts. The result is that rather than throwing your hands up in the air
saying "it's meaningless to talk about whether something deserves to be a
disease" you can say something like: "In a medical context, disease means
this' in a research context, disease means this, in a casual context, there
are two broad groups of people for whom disease means two different things"
Armed with this more accurate language, you can start talking about actual
concrete examples and explore more detailed and relevant hypothetical
examples.

------
Goladus
The semantic criteria listed in the article for defining 'disease' are not
rigorous at all and rules out the following conditions that most people would
agree are diseases:

Alzheimer's Disease (rule 1)

Any STD, like AIDS (rule 2)

Any pandemic (rule 3)

The Common Cold (rules 2, 3)

Scurvy, Rickets (rules 2, 6)

Also, I'm skeptical that given a clear medical definition of obesity (or more
more likely, metabolic syndrome), that it would fail rule 5.

~~~
fhars
I think you misunderstood the list. It is not a list of normative criteria for
the definition of disease, but of descriptive criteria, and not even a list of
descriptive criteria for disease, but for uses of the _word_ disease. That is
twice removed from what you seem to be seeing here. Your observation that many
common conditions fail several of the criteria is exactly the point of the
list.

~~~
Goladus
There is no real point to the list, that's my point.

You're exactly right. It's a partial list of some of the ways that people
sometimes under certain conditions use the word disease. That would be merely
boring except that he compares the list to the far more carefully specified
definitions 'rube' and 'blegg' and subsequently uses the list as criteria in
the next 3 paragraphs. He treats the list as if it's an actual list of
semantic features, when in fact it's not.

Ultimately he gives up on the question entirely:

 _So, is obesity really a disease? Well, is Pluto really a planet? Once we
state that obesity satisfies some of the criteria but not others, it is
meaningless to talk about an additional fact of whether it "really deserves to
be a disease" or not._

What a waste of time.

------
jheriko
Interesting article.

I do object to the medical approaches to obesity, depression etc. it seems a
very "un-medical" way to approach the problem and, I'm sorry to say, very
American. In many of these cases people do themselves harm through their own
actions or inactions - using medicine or surgery to "solve" these problems is
curing the symptoms rather than the cause.

Having the freedom to do what we want doesn't free us from the consequences of
our actions...

~~~
dagw
As a counterpoint, I enjoy skiing. My enjoyment of skiing has directly lead to
a fairly serious leg injury. Fortunately surgery completely "cured" this and I
was back skiing next season, ready to potentially do more harm to myself as if
nothing had happened. Did the doctors do the right thing fixing up my leg or
should they have let me walk with a limp for the rest of my life as a
consequence of my actions?

~~~
jheriko
Good point. Its definitely not black and white... but I'd lean on the side of
leaving you limping unfortunately. I wonder though - would you ski anyway, if
the doctors didn't exist? I'd suspect so...

I "feel" that there is some difference between the injury type situation and
the self inflected harm of depression or obesity though - its possible to ski
without any injuries, but its not possible to put on loads of weight, or take
a depressed approach to life without suffering the consequences. I guess I am
more inclined to feel sorry for you because the risk from skiing is such that
you might have avoided the injury if the situation were more favorable... its
more "unlucky" than "inevitable".

~~~
natrius
If you think depression is a choice, you are incredibly ignorant.

~~~
jheriko
Thanks for the wealth of information with which to undo my supposed
ignorance...

I never said its a choice anyway, just that behaviour can cause it... whether
its intentional or not is another story, and I'm not going to claim that all
depression is not physiological - I'm sure there are real
hormonal/neurological problems which lead to depression. My personal
experience however is that change in behaviour solved my own depression... so
in at least one case it is true. My doctor prescribed me pills and his
attitude towards it was unhelpful, despite being very sympathetic and
supportive - a good slap round the face about my attitude would have been much
more effective.

I should probably add that I'm pretty fat, bordering on obese perhaps, but I
don't consciously over eat...

------
Dove
I applaud the author's instincts: when you're not sure whether something
really is an X, and hence deserves Y, the right thing to do is unpack the
definition of X and ask what about it implies Y in the first place. In logic,
definitions may have hard edges, but in real life the edges are fuzzy. Is a
sham marriage really a marriage? It depends on why you want to know. The
answer changes depending on whether you want to seduce the wife, settle a tax
dispute, or research domestic social patterns.

The author stops short of really applying this approach. He rightly unpacks
the definition of disease and observes that obesity only partially satisfies
it. But he then discards the definition as useless and regresses all the way
to first principles! You don't want to do that. That definition embeds some
wisdom; there's got to be a reason we have it, after all. The next step is to
ask which bits of the definition are relevant to the question at hand and see
how well obesity satisfies those bits. The question he should be asking is not
merely "What is a disease?" but rather "What is it about disease that warrants
sympathy or treatment?"

The framing of deontology and consequentialism is particularly poor, and I
find it unfair to the deontologist. (It is certainly quite silly to say the
deontologist is trying to distinguish good from bad _people_. It's just a way
of thinking about ethics, man, not a religion.) I would say that deontology
says intentions matter and some actions are inherently bad, while
consequentialism says results matter and some conditions are inherently bad.
It is unfair to the deontologist to paint him as ignoring consequences;
inasmuch as they can be known, they count as intentions. And it is unfair to
the consequentialist to paint him as ignoring character; inasmuch as effects
on character can be controlled, they count as results. Allow the two
philosophies to account for all the known facts, and you'll find they give you
very similar answers.

So, what's the difference between a disease and a character flaw? Why does the
one warrant sympathy and the other warrant reproach? Why should the one be
treated and the other conquered?

Asked that way, the answer is obvious. Diseases are unpleasant and involuntary
-- simple misfortune. Treatment and sympathy are how you alleviate the misery,
and there's no more to the story. But character flaws are more complex. They
degenerate and run in packs. A sick person doesn't get new diseases, but a
person with poor self control definitely accumulates problems. A person needs
to conquer himself, conquer his problems, or he will lose his ability to do
so. So our efforts are targeted at motivation. The misery of the situation is
a mixed blessing: it sucks to experience, but it also teaches you consequences
in a way you'll take seriously and motivates you to change. Quick and easy
treatment can be counterproductive, and reproach can be useful to briefly
raise the pain above the decision threshold--to shock the boiling frog so he
jumps. (I say "can be" because people are always complicated...)

The distinction is critical. Treating a disease is the right thing to do, but
treating a character flaw actually does damage. We need to avoid using a fire
extinguisher on a flood or throwing an inflatable life raft on a house fire.

So is obesity more like a disease or more like a character flaw?

It depends on the case! It can be either or neither or both.

I know someone who is a very large woman--beautiful, self-confident, merry,
old and full of life. "Eat right, exercise, die anyway," she might say. As an
intentional choice, her obesity is not a character flaw. And it's certainly
not a disease. She needs neither treatment nor motivation, sympathy nor
reproach. The right reaction is to respect her right to make her own
decisions, and not call it a problem if she doesn't think it is one.

I know someone who just had a baby and is carrying a lot of pregnancy weight.
She is generally a motivated and disciplined person, and hates being so fat.
She misses her old clothes and her old lifestyle. In this case, the obesity is
most like a simple disease--unintended (if not exactly unforeseen), a simple
misery. Sympathy is appropriate, and if there were an easy medical fix, it
would do no harm.

Then again, look at that same woman a few months later. After a good stab at a
diet, losing fifteen pounds, she succumbed to stress and sleep deprivation,
abandoning the diet in an attempt to stay sane. Months passed. She built
eating habits she didn't want, regained much of the weight she'd lost. Life
improved, she started getting sleep, and she didn't go back on her diet. She
became more used to her condition, though still unhappy about it, and the
simple inertia of the circumstance left her with little motivation to change.
What had originally become a simple disease was gradually becoming a character
problem; she will need to ultimately address it or risk doing damage to her
disciplined nature. Perhaps she still deserves sympathy, but a raised eyebrow
when she goes for a second bowl of ice cream would probably do more good than
harm. A quick medical fix might not help anymore (and might indeed do harm);
she has habits that need to change, and only she can do that.

People are complex. That's the real moral here. Just as "disease" has a
definition with fuzzy boundaries, obesity is not all the same. Understanding
whether it is a disease means modeling the individual case and understanding
the causes and effects and consequences.

Reality is almost always more complex than our definitions. The important
thing is to learn to ask the right questions.

~~~
indiejade
The interesting thing about the treatment of addiction is that one of the most
effective solutions (Overeaters Anonymous, AA, Narcotics Anonymous, etc.) is
that getting a bunch of these "addicts" in the same room to talk about their
addiction can actually help. The first step in all of these programs begins
with the word "We".

One of the little euphemisms I've garnered from friends and such through the
years is that "Wellness begins with 'We'; Illness begins with 'I'." Most
addictive habits are actually resultant from one thing only, and that is
loneliness. OA, AA, NA, etc. WORK for people because they actually force them
out of their little isolated states, into situations where they can actually
communicate their "feelings" (I know! such a dirty word!) to people who
actually understand and "get" where they are coming from. Some of the happiest
people I've known are members of AA or some other 12-step program. I think
it's true: give more than you think you've received, and you'll be happier.

------
anamax
It's always good to ask why something is a problem and whose problem it is.

In this case, many people are saying "{x} is a problem and I want to help".
That's okay, if it stops there. However, many then conclude "people with {x}
are obligated to make my help as inexpensive/effective/etc as possible".

That's incorrect. The folks with {x} are not obligated to do what the helpers
deem appropriate. The helpers are free to refuse to help if the helped don't
cooperate, but that's the extent of the helper's power.

------
detcader
It's a fairly political question in the US. Emotional people believe in
emotional solutions, like the death penalty, physical discipline, healing
prayer. Logical people believe in logical solutions, like medicine, research,
and education. The main difference that persists is that those approach any
issue emotionally will end up ignoring the _source_ of the problem and just
attack the result, while the permanent cure is to fix the source.

------
araneae
Well, in 23andme, my obesity probability is listed under "disease risk" :)

Interestingly, the average obesity risk according to 23andme is 59%, which is
higher than any other "disease" that 23andme offers risk evaluation for. (Type
2 diabetes comes in 2nd at 18.2%)

If something is found in the majority of the population, that sounds less like
a disease and more a systemic problem.

------
dennisgorelik
Blaming fat/alcoholic is part of the treatment. It works, because blame gives
ill individual additional reason to fix the problem. Blame can backfire, so it
should be used with caution.

------
c00p3r
Everything that is obviously possible to overcome with self-will, patience and
persistence - drug addiction and alcoholism (except the last, incurable
stage), smoking, obesity, shyness, and especially ignorance - should not be
tolerated. Most people didn't even tried. They are just blaming everything and
everyone else.

There are a few of special cases, like children of dopers or alcoholics,
inherited diseases and other genetic disorders, but even in such cases it is
possible to improve their conditions with a right effort.

btw, in the so-called third world word 'disease' means condition which cannot
be reversed or cured, such as AIDS, cancer, liver or kidney damages and so on.
Everything else, like a fly or stomach aches are just a changing phenomena
like weather.

People who cannot stop shooting, drinking, smoking, eating, and passively
watching are ignorant, not sick (leaving aside the clinical stages). At least
from the point of view of the one who did.

~~~
jamesbritt
"Everything that is obviously possible to overcome with self-will, patience
and persistence."

There are people who can lower their blood pressure though relaxation and
meditation. Should we withhold blood pressure medication?

"Most people didn't even tried. They just blaming everything and everyone
else."

And you know this how? You're just making shit up.

"People who cannot stop shooting, drinking, smoking, eating, and avoiding
people are ignorant, not sick. At least from the point of view of the one who
did."

From the POV of one who did that is quite an ignorant opinion.

~~~
c00p3r
Oh, it could be a long discussion, especially in terms of 'withhold
medication'.

There are some basics, like the difference between symptoms and their causes.
In the cases in which it is possible to deal with causes, not the symptoms,
using self-will and altered behavior one should do it.

Medications, in most cases, are eliminating the symptoms but not their causes.
Prozac and is the best example.

The complex of cognitive, behavior and psycho therapies in the sub-clinical
cases and with medication in the clinical ones usually help, while just a
medication without changing the habits will probably fail.

------
lujz
Disregarding glandular, hormonal, or similar problems, obesity is certainly
not a disease: <http://www.youtube.com/watch?v=RXTq2_3LfXM>.

~~~
chwahoo
Out of curiosity, did you read the full article? It does a great job in making
the point that disease/not disease may not be the right question to ask (which
is a good thing because it isn't straightforward to answer).

