Delirium Tremens - a Summing Up

Dr Lovell is of course free to post at any length in response to what follows, but for the moment I’d like to sum up the debate about ‘addiction’, ‘alcoholism’, free will and delirium tremens.

 

 

Mr ‘X’ has rightly accepted that one’s moral opinions on this subject may influence one’s judgement. He seems to think that I apply this only to him. I also apply it to myself.  The belief that the human being has the power to choose (interestingly explored in John Steinbeck’s masterpiece, ‘East of Eden’ which I am currently reading for what I think is the fifth time) is central to my view of the universe. What I express here is my opinion. I can choose that. But neither I nor my opponents can choose facts. They just are, or are not. We must all be careful not to mistake opinions for facts, and I believe that, by asserting the existence of ‘addiction’ my opponents make this mistake, based on their strong desire that it should be so.

 

 

 

It is my view that a belief in addiction must of necessity exclude the view that we are free to choose our actions.  When I say that ‘addiction doesn’t exist’, I am saying that there is no objective evidence for its existence. But it is certainly a common opinion.  It would be foolish of me to deny that it exists *in the minds* of many people, as an excuse for their actions or the actions of others, or as a pretext for intervention by states and governments into the private affairs of others.

 

There is an amusing paradox here. Belief without proof (i.e. faith) in the concept of human enslavement to various pleasures, or the medicalised explanation of human failings,  is particularly strong among materialists who deny the existence of God and reject the idea of a purposeful universe.  You might say, as the materialists say of Theists, that they have ’invented’ the concept of ‘addiction’ to make their universe explicable. They have done the same with various other concepts which suck responsibility out of the human experience – ‘dyslexia’, which exonerates bad teaching methods, ‘ADHD’, which exonerates bad parenting and bad teaching, ‘clinical depression’ , which allows us to seek a chemical explanation for moral and societal ills, not to mention all the mighty ‘genes’ which supposedly make us fat, greedy,  lazy,  angry, sexually incontinent or whatever it happens to be.

 

 

Ultimately, like so many of these arguments - especially the ones over drugs - this is all about morality. That’s why people get so cross about it.

 

But it is also, increasingly, about the way in which the big drug manufacturers have (aided by the American Psychiatric Association’s DSM) provided alleged chemical solutions for these various griefs, pains and failures.

 

At what seems to be the end of my exchanges with Dr Lovell (and with his forthright ally, Rhiann Lovell, whose connection with him is not so far clear) I am left dissatisfied on a few grounds. One, I don’t feel Dr Lovell has ever really answered or acknowledged my clear point about why the pharmaceutical industry, plus the doctors it so generously co-opts, might have an interest in promoting two ideas : one that ‘alcoholism’ is a treatable disease rather than a failure of will ;  and two, that ‘DTs’ are solely a ‘symptom’ of ‘withdrawal’ from ‘alcoholism’ which can also be treated, lo and behold, by a pill. This would be a much more interesting and important argument than the largely irrelevant one about the use of barbiturates, which undoubtedly did take place. Miracle drugs go in and out of fashion, as we know. Will the ones we use now be in fashion 20 years hence – or viewed with disapproval, as barbiturates are now? And what will that actually mean?

 

The few people who have followed this argument may have missed the following rather simple point. I know at least one who has. My disagreement with Dr Lovell dates from his  posting three days ago (his second on this subject) in which he aggressively stated as follows,  in reply to my statement that ‘I think you can achieve these symptoms [Delirium Tremens] without any attempt at ‘withdrawal':

 

 

He wrote (my emphasis) : ‘I'm afraid on this one you are just plain wrong. The DT's are a symptom of withdrawal, not ingestion of alcohol.’

 

I’ll repeat that.

 

He wrote (my emphasis) : ‘ I'm afraid on this one you are just plain wrong. The DT's are a symptom of withdrawal, not ingestion of alcohol.’

 

I hope this is clear.  He said I was ‘plain wrong’. And he said that DTs are *not* a symptom of alcohol ingestion.  I have never denied that withdrawal from alcohol can trigger DTs.  Why should I?  I know from discussions with victims of ‘antidepressants’ that sudden cessation of ingestion of mind-altering chemicals is often unwise,  so I have no reason to doubt that sudden cessation of heavy drinking can be unwise too. However,  I personally doubt that it is sensible to accompany gradual cessation with prescription drugs, which is what I suspect this argument is really about. To give up alcohol, and then to become a habitual user of benzodiazepines, seems to me to be a questionable procedure.

 

 All I have ever said is that the DTs can result from excessive alcohol consumption. Dr Lovell has assertively told me that I am wrong. I believe that he was mistaken to do so, and cannot prove his assertion. The fundamental cause of DTs is heavy drinking, and , while they can be triggered by sudden cessation, they can take place in other circumstances.

 

For those who are still interested in this controversy (and I have to say that I was unaware of it till now, and have found the investigation of it extremely interesting, in the light of the growth of pharmaceutical solutions to human difficulties) here are a few points and quotations.

 

If there is any literature establishing by experiment and observation that Delirium Tremens is definitely *not* ever caused by heavy habitual drinking, but *only* by abrupt withdrawal from the same, I haven’t found it. But if any can be produced, I will happily admit to my error.

 

From the Journal of the American medical Association (JAMA) .

 

‘Delirium tremens was first described by Sutton in 1813. Since that time many treatment approaches have been used, but the cause is still obscure. The frequency with which the condition is seen in hospitalized alcoholics varies in different series from 6.2% to 32%.1 It is not unusual to find a chronic alcoholic, however, who has had delirium tremens with transitory visual and auditory hallucinations on several occasions but has been hospitalized only once or twice. Therefore it would seem safe to presume that the individual patient may have incipient delirium tremens without seeking hospitalization, and that the frequency is higher than the records of alcoholics admitted to hospitals would indicate. (JAMA May 30th 1953, Jackson A. Smith M.D).

**

 

‘It is our purpose in this paper to present certain data on the history, etiology and pathology of delirium tremens and to call attention to a method of treatment which in our hands has given good results. In any discussion of delirium tremens it would hardly be possible to disregard entirely the larger problem of chronic alcoholism, of which delirium tremens is only a special phase or, one might say, a dramatic incident. However, if we refer at times to the problem of chronic alcoholism, it will not be in the attempt to contribute to its understanding but only better to clarify the various aspects of delirium tremens.’(William B. Cline and Jules V. Coleman (both MD)  8th August 1936).

 

They add (quoting R.R.Peabody) an entertaining if unsatisfactory definition of the difference between an ‘alcoholic; and a normal drinker ‘Chronic alcoholics are those to whom a night’s sleep is only an unusually long period of abstinence’ .

 

And they say ‘It is only among the group of habitually severe and consistent users of alcohol, then, that delirium tremens develops’

**

In another contribution the argument about its cause is described as an ‘old controversy’ . It certainly is.  In the 1990s edition of the Encyclopaedia Britannica, (Micropaedia, p.975 of the relevant volume)  we find the following definition, as a sub-set of delirium in general : ‘ Alcoholic delirium – called delirium tremens because of the characteristic tremor – is a result not merely of the excessive consumption of alcohol but of a complicating exhaustion. Lack of food and dehydration; prior to the outbreak of delirium, the patient has usually been deteriorating physically because of vomiting and restlessness’.

 

Ordinary delirium, in the same entry is said to   ‘often result[s] from an overdose of sedatives, especially bromide, and can be provoked by the too abrupt discontinuance of barbiturates in addicts’.

 

This is the only mention I can find in this reference to anything resembling Dr Lovell’s unequivocal assertion that DT is caused solely by withdrawal.

 

In an older encyclopaedia (not the Britannica) , retained by the Associated Newspapers library for historical purposes and apparently dating from the 1940s, I found : that ‘acute noisy delirium’ was said to be most frequently caused by poisoning,  ‘the most frequent form of which is long-continued alcoholism leading to delirium tremens’.

 

It adds,  ‘Delirium being a symptom and not a special disease in itself, treatment must be directed towards the condition which gives rise to it. (my emphasis). During an acute attack sedative drugs such as chloral and barbiturates may be given. In delirium tremens, the vitamin B complex must be given’ (NB, these suggestions date from many decades ago and I include them for historical interest)

I’d note that the current treatment with benzodiazepines may, in future years,  be supplanted by something else.

 

In my lifetime, several medical certainties, including the cause and treatment of stomach ulcers,  the medical recommendation of smoking for the treatment of asthma, and indeed the willing recommendation of certain brands of  cigarettes in advertisements by qualified doctors, the first-aid treatment of burns and the medical use of pre-frontal lobotomies, have been revolutionised or abandoned or are now regarded as actually shocking. The interesting thing about this is not the growth of knowledge, which is constant though not regular or smooth, but the absolute certainty with which doctors used to do the wrong thing, and the length of time for which they persisted in doing it without realising anything was wrong.

 

You will have to make your own minds up as to what significance that has for doctors and patients of the present day.

 

By contrast with these mentions of DTs, I note that a contributor with a tediously long name adduces several modern reference books which attribute DTs solely to ‘withdrawal’. ? Is there a watershed discovery which separates these? If so, what is it, when was it, who made it and where can I read about it? I have to admit, medical studies stating that x is *not* the cause of y, as previously thought, , though not unknown, are rare.

 

 If not, has opinion actually been influenced by the availability and promotion of certain drugs?