Should hospital patients with mental illness be allowed–or even encouraged–to smoke?
That's the question Pam Belluck raises in a front-page story in The New York Times under the (online) headline, "Smoking, Once Used to Reward, Faces a Ban in Mental Hospitals."
After decades in which smoking by people with mental illness was supported and even encouraged — a legacy that experts say is causing patients to die prematurely from smoking-related illnesses — Louisiana’s move reflects a growing effort by federal, state and other health officials to reverse course.
She could have dropped the boilerplate "experts say," but otherwise I was interested to read that this dangerious practice may finally be on the way out. I have two conflicting thoughts about this. One is that it seems a horrible waste to put a huge effort into treating people with mental illness only to have them die prematurely of heart disease or lung cancer due to smoking. The other is that if people with serious mental illnesses drive pleasure from smoking or are using it to self-medicate, why should we not allow them one thing that will give them some bright moments during the day? But the question Belluck raises is not only about allowing smoking, but also encouraging it, or using it as a reward to persuade mentally ill patients to behave correctly or follow rules. That, I think, is highly unethical.
Belluck, a science writer, does not express an opinion, of course, but she does a fine job of reporting what's going on in hospitals and in research, where scientists are exploring nicotine's antidepressant effects and its ability to "dampen extraneous thoughts and voices" in people with schizophrenia.
Unless I'm mistaken, however, she missed one statistic that I find disturbing. According to a 2000 study in JAMA, people with a mental illness in the month before they were studied consumed 44.3 percent of all cigarettes smoked by a nationally representative sample of 4,411 people.
This study is not the last word on the subject, and other assessments might differ, but it is shocking nonetheless, and might take a moment to sink in: Nearly half of all cigarettes smoked were smoked by people with a recent episode of mental illness. The tobacco industry is hugely dependent upon people with mental illness, and it derives enormous profits from them.
And, as Belluck reports, the tobacco industry might have encouraged people with mental illness to smoke:
[One study] mentioned a 1986 magazine advertisement with a doubled image of a pack of Merit cigarettes, under the word “Schizophrenic,” that said, in part: “Big taste, lower tar, all in one. For New Merit, having two sides is just normal behavior.”
The author of the study told Belluck "it was unclear" whether the ad was supposed to appeal to people with mental illness. Draw your own conclusion.
-Paul Raeburn
Leave a Reply