There are many bad things about being a smoker in New Zealand today. Smokers are treated like lepers. Harsh language sees them sent outdoors "to indulge their filthy habit"; sometimes not only outdoors, but off the property altogether if they happen to be a hospital patient or a student.
It is not long since I overheard a conversation between two health workers in a hospital lift. They were speaking of a specialist and his seriously ill patient.
"What's he going to do?"
"He's not going to do anything till she promises to quit smoking." This exchange seemed to epitomise the life and death attitude we now have towards smokers.
The disadvantages of smoking are economic, physical, social (outcast in many settings), and psychological (poor self-image and anxiety). It all adds up to a horrible problem for smokers. So the question is, if it's so punishing, why does 20 per cent of our population smoke?
In the past skilful advertising played an important role in persuading young people to start smoking. But it is now illegal to advertise cigarettes, and hideous pictures of disease now adorn the packs. So this can no longer be the reason people smoke.
It is likely both family and peer group play important roles. If you're brought up in a household with at least one smoker, you're more likely to smoke yourself even if the smoker protests you should do as they say, not as they do. For teenagers the peer group can provide the motivation. If all your girlfriends are smoking, you will want to too, to be part of the in-group.
There is little doubt that once started it can be hard to quit. The most likely reason for this is that nicotine is addictive. But unlike addiction to illegal drugs, which can be very difficult to treat, nicotine is less addictive than most and plenty of smokers do quit when circumstances allow.
Perhaps it is time to ask why people enjoy smoking. In describing their difficulties in giving it up, ex-smokers might help us understand why they liked smoking in the first place. Some said "I didn't know what to do with my hands" and "I felt something important was missing". Others made comments to do with the mouth. "I had to keep chewing" and "I put on weight".
Such comments give us a clue. Unfashionable as it is to even mention Sigmund Freud, it is perfectly possible that his theory of oral comfort provides just the help we need to explain the mysterious hold smoking has on people. Basically, the idea is that oral comfort helps damp down anxiety - usually deep level anxiety, which means something which arose very early in life.
Suppose that smoking offers oral comfort that helps damp down deep-seated anxiety. Suppose too that deep-seated anxiety exacerbates illness. In spite of decades of expensive research by our best brains, no one yet knows definitively what causes cancer. What we do know is that smoking is strongly associated with cancer, heart disease, diabetes and other illnesses. We also know that anxiety disrupts normal body processes.
Two weeks ago the Herald published a report showing that the net economic situation with regard to smokers is that the rest of us are now making a profit out of their habit. This was calculated by adding the amount of money gathered in sales tax on cigarettes to the savings made from many smokers dying earlier than average. However, it could be that these savings are already being spent in additional costs caring for the obese.
If there is a relationship between oral stimulation and anxiety, and if both smoking and eating provide comfort, surely we could throttle back on making people feel terrible and instead look for ways to help calm their anxieties. Perhaps we could find alternative ways of providing oral comfort - ways which would neither contaminate the lungs nor pile on the weight.
If we reduced the hard-edged social ostracism we could even reduce anxiety. Then we might all be better off.
Valerie Grant is an honorary senior lecturer in the Department of Psychological Medicine at the University of Auckland.