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FEATURE: Rebecca Coombes Cold turkey BMJ 2007; 334: 1190-1192 [Full text]

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Crystal meth: before and afterphotos as a time honoured way of oversimplifying complex problems

Dave W H Baillie, Mark Salter   (25 June 2007)

Crystal meth: before and afterphotos as a time honoured way of oversimplifying complex problems 25 June 2007
Dave W H Baillie, Specialist Registrar in Adult Psychiatry st London and the City Mental Health Trust, Mark Salter Send response to journal: Re: Crystal meth: before and afterphotos as a time honoured way of oversimplifying complex problems	With its foreboding talk of an impending epidemic that will overwhelm services and its eye grabbing before and after photos of a woman following two and a half years of taking crystal meth, Coombes article (Coombes, 2007) reminded us of an article published 80 years earlier (Ruddock, 1927), warning of yet another contemporary psychiatric epidemic. As in the BMJ article, a first photo shows a relaxed and dignified man before the “habits of the secret vice began to show”, while the second photo shows the same man, now haggard and furtive, “three years later, when he had become an inveterate victim of the vice”. What was this vice that threatened to overwhelm the asylums of the day? “Self-pollution, the unnatural and degrading vice of producing venereal excitement by the hand.” A recent nationwide electronic survey of psychiatrists by the National Director for Mental Health found no significant evidence of an increased prevalence of psychiatric disorder related to methylamphetamine (personal communication, Louis Appleby). Whilst the prevalence of the methylamphetamine use may be increasing (but probably remains less than the prevalence of masturbation), the argument for vigilance to its adverse effects does seem reasonable. However, there is a common theme running through both of these stories. Despite knowledge that mental health problems are almost always caused by a complex interplay of biological, psychological and social factors, a simple culprit, and a simple solution, will always be attractive to the public, the media and to policy makers (Goldacre, 2007). Driving home this message of bogus simplicity with before and after photos provides compelling visual evidence that implicitly supports the simple culprit. Public health measures, such as banning nasal decongestants, legitimise the concept of a simple solution and give the false impression that something useful is being done. Such measures misdirect attention and free all of us from the moral and rational obligation to address more ubiquitous social problems that adversely effect the mental health of our communities. They encourage us to withdraw from uncertainty and seek a safe haven in false truth, as in the words of Bertrand Russell, “what men really want is not knowledge but certainty.” Coombes, R. (2007) Cold Turkey BMJ 334 1190-1192 Goldacre, B. (2007) Given the choice, I’d rather have the miracle pill story The Observer, May 6, 2007. Ruddock, E. (1927) Vitalogy: An Encyclopaedia of Health and Home (1927) Vitalogy Press, Chicago Russell, B. (1979) History of Western Philosophy Allen & Unwin, London Competing interests: None declared