When Amy Keeps Saying No, No, No

A few days ago the Coroner’s verdict on Amy Winehouse’s death was issued: as many of us had suspected, it was the legal drug alcohol, rather than illicit substances, which cut short the life of this talented singer blessed with that rich, mellifluous voice and uniquely soulful singing style.

No less than 416mgs of alcohol per decilitre of blood had been found in her system. That’s five times the level permissible for driving purposes in Malta and the UK, and eight times that allowed in most other European countries.

Amy Winehouse’s problems with substances (and apparently eating disorders and some form of affective condition) were well-publicised. She had reportedly tried residential treatment on more than one occasion; but these appear to have been short-lived, half-hearted attempts, which, unsurprisingly, failed to bring about any lasting change.

Her doctor has gone on record as saying that Winehouse was against psychological therapy and wanted to battle her demons on her own. Three years ago, she kicked an illicit-drug habit, but found alcohol a much harder nut to crack. She persisted with the drinking with a pattern of stop and start: stopping drinking unaided (except for tranquillisers) for a short time, only to succumb to temptation within weeks.

Understandably alarmed for her safety, some members of her entourage and her father tried hard to persuade her to undergo proper treatment, but her response is now immortalised in the lyrics of one of her best-known hits “Rehab”: “They tried to make me go to rehab, I said, ‘No, no, no’.” Her remains lie cold in her grave.

There were reports that her father tried to get her “sectioned”, that is to say, compulsorily admitted to hospital, but apparently did not succeed. It is not known exactly on what grounds he tried to have Amy treated in hospital against her will. What is known is that, in the UK, it is impossible to have anyone undergo compulsory treatment purely because of addiction alone. In 1983, the (then) new Mental Health Act specifically forbade the enforced admission to hospital for reasons of substance addiction “on its own”. The 2007 amendments did not alter the situation.

This was in contrast to the provisions of the previous Mental Health Act enacted in 1958, of which the current Maltese Mental Health Act (1976) is practically a carbon copy. Compulsory admission of alcoholics and drug addicts in Malta is still legally possible, but is no longer as commonly resorted to.

Over the years, doubtlessly because of the influence of changing values and attitudes, addiction – at least in the context of enforced treatment – is being viewed less in terms of an illness, and increasingly as a “lifestyle choice’’. How anyone can ‘choose’ to become an addict, i.e. enslaved to a substance which conditions the way one lives, and often defeats genuine and painful  attempts to eradicate from one’s existence, is of course not very easy to explain for those who espouse this view.

We live in a rights-driven world. The emphasis on the right to self-determination has perhaps at times reached such Alice-in-Wonderland levels of absurdity that we are losing sight of situations where one is objectively not in a state to decide what is best for one. Addiction to alcohol or drugs – a state where one is compelled to ingest a substance to function - is by definition a condition which affects volition. How can one make choices if the capacity to evaluate options is impaired? How can one speak of freedom when the perception of reality essential to the process of actually deciding on one course of action rather than another is substantially distorted?

Shall we allow those suffering from anorexia nervosa to starve to death because they are not psychotic, and therefore “in touch with reality” and capable of taking “rational” decisions? Can ever the decision to destroy oneself – especially, though not only, when alternatives clearly may exist, although the sufferer cannot perceive them - be considered rational and worthy of over-riding all other considerations?

Many would answer these questions with a resounding "no". Yet, when faced with the prospect of translating that “no” into concrete action – such as campaigning for legislation which re-allows compulsory treatment, or even applying that legislation when (as currently is the case in Malta) laws are in place, they balk. The prevailing climate of “live and let live” (die, actually, in this case) and “let everybody choose what’s best for them” casts its insidious shadow on many well-meaning people’s choices – and they, almost unwittingly, choose to root for death rather than for giving sufferers a fighting chance for life.

The culture of death has many faces. One of them is a mask called unlimited freedom.