inAuthors: Dr. Howard Markel Riffs on Cocaine and Amy Winehouse

August 16, 2011 by inReads

Dr. Howard Markel, a professor of the history of medicine at the University of Michigan, is the author of An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine, which was just published by Pantheon Books. Here, he writes about the all-encompassing nature of the “seemingly innocuous white powder.”

The death of Amy Winehouse may be the stuff of headlines, but a closer look suggests a few pages ripped from a medical textbook. Poignantly, the talented singer’s fall from the pinnacle of popular success to missed concerts–and, ultimately, her far too early death–demonstrates how quickly an addiction to cocaine can turn tragic.

What is so compelling about this seemingly innocuous, white powder that compelled a talented woman to destroy her career, reputation, and life? Well, to begin, cocaine is a pharmacological version of the legendary Trojan horse. It brilliantly fools the brain’s pleasure center into sensing a virtual abundance of dopamine, a neurotransmitter, or chemical messenger that signals a rush of overconfidence and euphoria.

Taken to excess, however, cocaine soon seizes control. Like an immense power switch, once thrown, the cocaine-addicted brain’s pleasure circuitry is hijacked by an insurgency of bad judgment and risky behaviors that are only amplified by cocaine’s seductive ability to induce artificial states of well-being. After the high is long gone, this anatomical derailment continues to encourage the addict to pursue his destruction as his body progressively demands greater amounts in exchange for briefer moments of joy along with a cascade of physical and mental health breakdowns.

Over time, cocaine also damages the brain’s frontal cortex, the area charged with making decisions. Eventually, the brain screams to the pleasure center to “Go-Go-Go” for the immediate gratification of cocaine while simultaneously muting the inhibiting frontal cortex that stops most of us from engaging in foolish or dangerous acts. Such a scenario goes a long way in explaining many of Winehouse’s disastrous last concerts presented while under the influence.

But the most maddening symptom of any addiction is the stealthy process by which the addict’s mind conspires to convince that nothing, nothing at all, is askew or dangerous about something that most decidedly is. If one set out to design addiction as an implacable disease, he would be hard pressed to come up with a more diabolical symptom than denial, the need to lead a double life; feeding the addiction in private while struggling to starve, or at least conceal, it in public for long periods of time. Until, that is, the addiction completely takes over with disastrous results and public masquerade is no longer possible.

Make no mistake about it, denial definitely played a starring role in Amy Winehouse’s multimedia unfolding. Time and time again, she was warned that she needed to do something about her dangerous drug abuse. Negative, life-threatening consequences kept piling up. But Amy simply laughed and sang another chorus of “Rehab,” a song that ought to be the national anthem of practicing addicts. Sadly, Ms. Winehouse was never able to admit to anyone, least of all herself, the unmanageability of her situation. But discounting her fame, wealth, and notoriety, her signs and symptoms were so commonplace that even a first-year medical student could have made the diagnosis. But now it is too late.

Whenever a celebrity dies of a drug overdose, you can count on a whispering campaign that the death was a result of the superstar’s glitzy, show biz lifestyle, a moral failing, weakness, or a lack of self-control. As a physician who has treated many addicts over the years and who has studied the disease intensely enough to write a book about it, I find such judgments to be most unhelpful if not outright deadly. Addiction, be it to cocaine, alcohol, heroin, or any other mind-altering substance, is a voracious malady with predictable symptoms and pathological damage to the brain and body. It can profoundly harm its victims and those around them.

Addicts need medical attention, psychological counseling, and supportive therapies rather than derision or blame. While addiction often attacks the most vulnerable…celebrity, character, wealth, education, or intellect hardly protect one against it. Given an unlucky alliance of genetics, experiences, environment, and patterns of consumption, it is quite easy to unleash the Amy Winehouse that lurks within us all.

DEEPER DIVE

Read Russell Brand’s moving tribute to his friend Amy Winehouse.

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Elsewhere in inReads: In memory of another talented performer whose life was cut too short.