A Reading of The Urge: Our History of Addiction, Part I
I’d like to devote a few posts to chew over Carl Erik Fisher’s book, The Urge: Our History of Addiction. Fisher is an addiction psychiatrist, bioethicist, and assistant professor of clinical psychiatry at Columbia University.
The book presents the history of the concept of addiction and our response to it, paired with his personal history and recovery. In it, he demonstrates time and time, again, how wrong we are when we think we understand addiction as just a single thing only a few people have, whether it’s a biological thing, a socioeconomic thing, or a thing having to do with moral choice. Addiction is best understood as “profoundly ordinary, a way of being with the pleasures and pains of life”.
No matter who you are, the question you should ask is not, am I addicted? The question should be, how addicted am I, and to what? Addiction is universal because we are all guilty, some of the time, of mindless inflexibility. We can all admit to avoiding negative thoughts and feelings by disappearing into worry, rumination, stimulation, and other forms of mindlessness, as well as chemicals. We all have our ineffective, but persistent reactions to pain.
We don’t usually think of addiction this broadly. Instead, we select certain addictions to be our scapegoats and merrily go on with the rest. We’ve divided the world into marginalized people we call addicts, and those whose addictions we favor, we call non-addicted. We’ve been doing this so long we think the world is really divided that way. It justifies our cruel behavior towards those we call addicts.
Fisher is not alone. There’s a trend in psychiatry to think of all mental conditions as existing on a spectrum. We all have our autistic moments, some more than others, so there is an autism spectrum. Just so, none of us are strangers to depression, anxiety, narcissism, being affected by trauma, or even, if you’re willing to admit it, psychosis. The same could be said for addiction. We’re all addicted to something, whether it be things we put into our bodies, or a way of thinking or behaving. When we treat any mental disorder, including addiction, as a categorical, fixed entity, we mistreat it and the people we think have it.
Looking at the people I’ve known who are called addicts, there’s a tremendous variation in degree and nature of their addiction. We usually divide them up by the thing they are addict to. Alcoholics go here, heroin users there, and compulsive gamblers and sex addicts over there. These distinctions are not as substantial as the distinctions between the chronic user, the binge user, and the dabbler; or those who report a loss of self-control versus those who are happy to use. The true distinctions are a matter of degree, not kind.
Looking at my own habits, I can confess many mindless, inflexible thoughts and feelings. I image my friends and family know them better than I. For instance, when I’m listening to a person in obvious distress, as I am daily in my job, I have an overwhelming urge to interrupt them and say something that I believe will solve their problem. I’ve learned that, in most cases, my coming up with solutions to another person’s problem does not solve his problem, especially when he has not asked for my solutions. He must solve his own problem. Whenever I give unsolicited advice, I’m not solving his problem, I’m trying to solve my own.
My problem is that his hopelessness and despair is making me feel hopeless and in despair. I’m worried if I don’t hurry up and cure him, I’ll be a bad therapist. I try to avoid this feeling by telling him how easy it would be to solve his problem. However, if it were that easy, he would have solved it already. He would not be coming to me to sort through his options. The person I’m talking to can be an addict, in the usual sense of the word, who cannot find a way to say no to his drug. Meanwhile, I’m sitting there, unable to say no to my drug, which is giving unsolicited advice. Ironic, ain’t it?
Here’s a fun fact you may not know. Drugs that you do more often, with less immediate damage, and are socially acceptable are more addicting than drugs you seldom use, with more severe damage, and are not socially acceptable. By addicting, I mean harder to stop. So, my advice-giving, which I might do hundreds of times a day, is socially acceptable, and has few harmful consequences to myself, is far more addicting than my client’s heroin habit.
In calling my thing an addiction and saying it’s worse than his, I don’t mean to make light of his or trivialize his suffering. I do it as a way of understanding what it could be like for him and to have some idea of the enormous difficulty recovery can be. I’m proud to say that, when it comes to unsolicited advice-giving, I’m a grateful, recovering addict, in an early, tenuous phase. However, my addiction is cunning, baffling, and devious. By the time you read this, I may have already relapsed hundreds of times.
Next in the Series: The Origin of Addiction