In defense of smoking

Steven A. Schroeder, head of the Smoking Cessation Leadership Center at UCSF wants the mentally ill to stop smoking and advocates banning smoking from mental health facilities. See A Hidden Epidemic in the Washington Post.

Almost half of all cigarettes sold in the United States (44 percent) are consumed by people with mental illness. This is because so many people who have mental illnesses smoke (50 to 80 percent, compared with less than 20 percent of the general population) and because they smoke so many cigarettes a day -- often three packs. Furthermore, smokers with mental illness are much more likely to smoke their cigarettes right down to the filters.Yet for years, mental health professionals ignored smoking. Why did patients, their families and clinicians do nothing to help smokers quit?One reason is well-intended but uninformed compassion. The reasoning goes something like: "Poor Joe is suffering so much from his illness and gets such pleasure from his cigarettes that I don't want to take them away from him." Another reason lies in the extent to which smoking is integrated into mental health treatment. In psychiatric hospitals the denial of the opportunity to take a smoke break is used as a disciplinary tool, and cigarettes have become part of the culture -- often being traded for goods or sexual favors as a form of currency.

I have two issues with this argument:First, there must be a reason why almost every schizophrenic smokes. Probably because smoking helps them feel less crazy. Why doesn't Schroeder mention this? It's still probably worth encouraging some mental health patients to quit but it's not probably not so clear cut.Second, if the mentally ill are smoking almost half the cigarettes they're probably also paying about half the cigarette taxes. It's been popular in recent years to jack up the cigarette tax to pay for social programs. Is it really fair to have the mentally ill pick up a disproportionate share of the tab?