Psychiatric Annals

Editorial 

Free Will vs. “Addiction”

Jan Fawcett, MD

Abstract

This month’s edition of Psychiatric Annals, guest edited by Joanne Caring, MD, covers a major problem in this country — obesity — paying special attention to patients with serious mental illness. The articles range from the epidemiology of obesity to bariatric surgery and pharmacologic induction and treatment.

One of these fascinating articles deals with the relationship of obesity to addictive brain processes, as well as cross-addiction to other substances. Could food, a substance necessary for our survival, become an addiction? Is there a relationship between the social anxiety associated with low self-esteem and food addiction?

Abstract

This month’s edition of Psychiatric Annals, guest edited by Joanne Caring, MD, covers a major problem in this country — obesity — paying special attention to patients with serious mental illness. The articles range from the epidemiology of obesity to bariatric surgery and pharmacologic induction and treatment.

One of these fascinating articles deals with the relationship of obesity to addictive brain processes, as well as cross-addiction to other substances. Could food, a substance necessary for our survival, become an addiction? Is there a relationship between the social anxiety associated with low self-esteem and food addiction?

This month’s edition of Psychiatric Annals, guest edited by Joanne Caring, MD, covers a major problem in this country — obesity — paying special attention to patients with serious mental illness. The articles range from the epidemiology of obesity to bariatric surgery and pharmacologic induction and treatment.

One of these fascinating articles deals with the relationship of obesity to addictive brain processes, as well as cross-addiction to other substances. Could food, a substance necessary for our survival, become an addiction? Is there a relationship between the social anxiety associated with low self-esteem and food addiction?

This led me to think about my preoccupation with what I see as humanity’s greatest flaw: our capacity for self-justification of ideas or behaviors. It makes me wonder: how much of our behavior is hijacked by the brain’s pleasure-reinforcement system, which, with mechanisms similar to the development of addiction, reinforce whatever we think or do in life, right or wrong?

The concept of addiction is expanding. For the first time, a behavioral addiction (gambling) likely will be included in the diagnostic list of addictions previously reserved for substances in the upcoming DSM-5. As the research to support behavioral addictions grows, other behavioral addictions are likely to follow, such as sex addictions, Internet and electronic game addictions. How far will it go?

Are we so in love with and unwilling to question our own ideas, beliefs, and “principles” because our brain reinforcement system rewards us for holding onto them? Does the concept of “me,” “my,” “mine” become reinforced by the same system that can lead to addiction to behaviors or to substances? Can we be addicted to our cherished “beliefs?” Is there any hope of objectivity or changing one’s mind in the face of evidence? Of course, we know susceptibility to addiction varies among individuals, so there may be hope.

If this logic — that our narcissism is reinforced by the same system that leads to addiction — is anywhere near reality, we may find that ‘ideology addiction’ is a large and growing category. If that is the case, then knowing this is a possible mechanism may help us be more objective.

Then the irony of the saying, “Don’t believe everything you think,” would ring true.

10.3928/00485713-20110921-01

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