In the aftermath of actor Matthew Perry’s death, many fans are still mourning a life taken too soon. Many continue searching for answers and somebody to blame — somebody other than Matthew Perry himself. The truth of the matter is that Matthew Perry fostered an addiction to alcohol and opioids, an addiction that began in his early teens. Perry, whose mother divorced his father when he was just a year old, began smoking, stealing money, and underperforming in school by the age of ten. He later attributed his behavior to his feeling like a family outsider who no longer belonged once his mother remarried and began having children with his stepfather. As Perry put it, “I was so often on the outside looking in, still that kid up in the clouds on a flight to somewhere else, unaccompanied.”
Despite fifteen rehab stints, sixty-five detoxes, and spending an estimated $9 million on recovery, Perry was an addict until the day that he died.
Perry’s struggles with alcohol began at the age of fourteen, and by his late teens, he was drinking daily. His addiction led to a near-fatal rupture of his colon in 2018, putting him in a coma for two weeks. At the time of his accidental fatal overdose in October of 2023, he was suffering from an out-of-control addiction to (unsupervised) ketamine. Perry died from the acute effects of this drug: the Los Angeles County Medical Examiner's report noted that the high levels of ketamine in his system caused cardiovascular overstimulation and respiratory depression, which led him to lapse into unconsciousness and subsequently submerge into the water. He was found unresponsive and floating face down in the hot tub at his Pacific Palisades home on October 28, 2023, at the age of 54.
Perry was a strong believer in the idea that addictions like his qualified as a disease. It was not without some assistance, from groups like the American Medical Association (AMA), that Perry held the belief. Indeed, in 1956 the AMA passed a formal resolution recognizing alcoholism as a medical condition rather than a moral failing, and in 1987 the AMA and other medical organizations officially termed all substance addiction as a disease. In 2011, the American Society of Addiction Medicine (ASAM) joined the AMA to explicitly define addiction as a chronic brain disorder, further shifting public and medical perspectives away from viewing it as a behavioral or choice-based problem. Unfortunately, these classifications appear to have been motivated, at least in part, by social and political pressures, not purely by reason or evidence.
The truth of the matter is that most “addicts” would probably “cure” themselves overnight if they were offered $100 million to quit. That, in and of itself, would prove the point that addictions (like those to drugs and alcohol) are not really “diseases”, and certainly not “diseases” in the way that cancer and epilepsy are. For this reason, it appears that the classification of addiction as a “disease” may constitute a simple category error. After all, where any condition remains sensitive to motivation, incentives, and decision-making, that condition is not strictly a “disease” in the way that most people ordinarily think about diseases — conditions that are either objectively measurable/detectable or beyond the immediate control of the afflicted.
Although addiction of one kind or another may stem from a reaction to a genuine disease, disorder, or trauma, as a means to cope or to manage one’s condition — or to self-medicate — the addiction itself remains continually subject to the decisions and motivations of the addict, who (however great the challenge) always retains the ability or option to quit or to abstain from the habit. This is not the case for “diseases” in the conventional sense, in which cases the conditions are objectively measurable and detectable, physically or observably present in the body, whereafter decisions and healthy habits may aid only in alleviating symptoms or markers, supplementing medical treatment, or curing the condition over time. For reference, Merriam-Webster.com defines the word “disease” as “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.” The National Library of Medicine includes the following definition: “Diseases, in the scientific paradigm of modern medicine, are abnormalities in the function and/or structure of body organs and systems.”
For any addiction, however, there is no provable causal link to any “abnormalities in the function and/or structure of body organs and systems.” On the contrary, in the case of addiction, the condition is specifically behavioral and continually subject to the individual’s willpower and decision-making — taken in isolation, all markers of addiction are completely dormant when the individual is sleeping, unconscious, or otherwise inactive. What’s more, the neurological changes associated with addiction may demonstrate the effects of repeated substance use, but they do not necessarily establish that addiction itself — as distinct from the physiological consequences of the substance — is a disease. Evidence of neurological adaptation resulting from chronic drug use must not automatically be conflated with evidence that the addiction itself constitutes a disease.
The lynchpin of the “addiction is a disease” argument is the claim that the individual is afflicted by some agent, force, or inhibitor that impairs his agency or self-control. Yet there is no evidence that such a force or inhibitor exists. What’s more, while a diabetic has, in many cases, made decisions that contributed to the development of his disease, once the disease is present it remains objectively identifiable through physiological markers. With addiction, by contrast, the primary evidence consists of (1) a recurring pattern of behavior and (2) the suspicion — never conclusively proven — that the individual’s agency has been impaired.
While an addiction is often symptomatic of some other condition (often undiagnosed or untreated), the addiction itself is ordinarily not the primary source of the problem. What’s more, the addiction itself (in isolation, independent from the bodily harm caused by the vice) is observable only through the active decisions and intentional actions of the individual who ultimately decides to continue the patterns of behavior; an individual who finds comfort in the vice or otherwise seeks to stave off the pains of withdrawal by continuing to engage in it (often without, or with little success in, treating the underlying causes of the addiction).
The addiction itself is often supported by excuses and enablers who, in qualifying the addiction as a “disease”, often run the risk of conflating categories, treating the individual as a helpless victim, and enabling the addiction, often to the extremes of irreversible bodily harm and even death. Meanwhile, the critics who insist otherwise, who insist that the “disease” classification generally overstates the condition, that the diagnosis isn’t exactly scientific, and that the addiction is not as all-consuming as a disease and that there is hope after all, are cast off as quacks, kooks, or worse. The sad irony is that, in most cases, the critics are the ones most sincere in their efforts to help addicts to overcome their addictions; and the critics (if the addicts would welcome them in their lives) are often the ones whose advice is most capable of helping the addicts to regain control over their lives. In the case of most addicts, however, they push the critics away and prefer the company of fellow addicts, or yes-men and enablers whose agreement and tolerance keep the addict on the track to his own destruction. As for those addicts who are famous or popular, they have the further benefit of a near-infinite supply of yes-men and enablers who (unwittingly) cheer them on to an early grave.
Ultimately, the death of Matthew Perry, as with the lives of many addicts, is perhaps better described this way: as living testament not merely to a “disease” of any particular kind, but to the epidemic of broken families and parental neglect. This is what so often sets dysfunction in motion, and because of the continual expansion of medical diagnoses seeking to deal with the symptoms, the common cause is often either concealed, ignored, or clinically explained away, and it appears that adults are generally satisfied with this result.
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