Compulsive gambling appears to be the latest in a growing list of self-destructive behaviors viewed as uncontrollable "illnesses" that can be "diagnosed" and treated" by psychologists and psychiatrists.
For example, in 1983, the public disdain toward professional football player Art Schlichter's hefty gambling losses was substantially changed into concerned shock by the equally dramatic "revelation" that Schlichter was suffering from psychiatrically certified "pathological gambling."
The newspaper and magazine stories that continue to abound on this newest alleged psychiatric disorder are almost always the same. Horror stories are recounted of how irresponsible gamblers lost big money and left themselves and their families destitute. Then the analogies to alcoholism or drug abuse are trotted out, since the public has no doubt these constitute "addictions" over which the sufferers have no control. Numbers of sufferers are always estimated in the millions.
In a Sports Illustrated cover story last month, once again the "insights" about "compulsive" or "pathological" gambling are applied to the celebrated Schlichter case. The article's author, Armen Keteyian, quotes psychiatrist Robert Custer, whom he calls "the nation's leading expert in the field," as saying that "Art has suffered the full effects of his disease."
In 1980, the American Psychiatric Association (APA) in its most recent update of the Diagnostic and Statistical Manual (DSM-III) elevated gambling to one of its categories of "impulse disorders," or, more specifically, a "Disorder of Impulse Control Not Elsewhere Classified."
But the APA is of two minds on the issue of whether people can control their behavior. In the aftermath of John Hinckley's acquittal by reason of insanty in the shooting of President Reagan, the APA issued a position paper on the insanity defense that disavowed psychiatrists' ability to measure "volition" -- the ability of an individual to control his or her own behavior. The APA statement said that when psychiatrists testify today on responsibility, they "no longer [address themselves] to medical concepts, but instead must infer or intuit what is unspeakable; namely, the probable relationship between medical concepts and legal or moral constructs such as free will."
The question of control is critical in assessing whether "compulsive" gambling is any different from any other gambling, including investing in the stock market, real estate or business enterprises -- activities in which people are presumed to engage by choice. And despite the APA's equivocation on psychiatric ability to measure volition, virtually all reports and articles on "compulsive" or "pathological" gambling reflect the certainty of mental health professionals that there is an identifiable sub-population of gamblers who cannot control themselves.
Yet, as the APA so belatedly seems to recognize in the area of "legal insanity," there is simply no way to confirm such an assessment, since control is a subjective experience. The only available evidence of the presence or absence of control is the presence or absence of the behavior or the claims of the individuals who enage in these behaviors. The suspicion that gambling can be out of the individual's control comes mostly from the consquences of their actions and people's incredulity that anyone would choose to subject himself to such misery: the horrible financial straits and wrecked family lives that the "pathological gambler" faces.
But, as with other temptations, the tempted do not anticipate the consequences. If a gambler is a winner, he or she is not a "pathological gambler" but a "rich entrepreneur."
Linked to the belief that gambling can be uncontrollable is the belief that it is some sort of "disease." Yet psychiatrists usually do not explicity state that gambling is a disease. reference to any pathological change or deviance, referring only to financial, legal or familial problems as "diagnostic criteria."
When asked by a columnist whether pathological gambling is a disease, Dr. Robert Politzer, former director of Johns Hopkins Center for Pathological Gambling, said that "it is an impulse . . . that renders a person helpless as surely as a physiological disease like leukemia."
What are the consequences of the public's acceptance of "pathological gambling" as uncontrollable and an illness? The gambler's avoidance of responsibility for his or her actions on the one hand and status and financial support for the "doctors" of this ailment on the other. More and more states and health insurance programs are subsidizing treatment for "sick" gamblers -- which consists of persuasion and prodding, which, incidentally, have yielded little independently validated success.
Often we come up with wrong answer by asking wrong questions. The questions that should be debated are these: What is the state's responsibility to citizens whose habits leave them destitute? Are such citizens as worthy of help as the unemployed or the disabled?
If these questions were asked, perhaps some of these alleged "uncontrollable" impulses would be reined in quite quickly.