Monday, November 26, 2018

Thinking about the phenomenology, psychology, and philosophy of addiction

In sharing my transdisciplinary bibliography on “addiction” with a Facebook group devoted to psychoanalytic psychology, I wrote the following by way of “an introduction or perhaps provocation.” Immediately below, I repeat in the first paragraph material from the original introduction to the bibliography which, as you’ll see, was stated rather abstractly and summarily: 

More than a few titles are not about addiction qua addiction, but deal with subject matter pertaining to the psychological, ethical and cultural questions that surround addiction as self-destructive behavior in the context of variables, causes, and consequences that are, we might say, at once individual or intrapersonal and interpersonal (in an intimate sense) and social. Yet the distinctions serve a purpose, as they are essential in addressing the specific dynamics and dialectics of interaction between these two dimensions or poles so as to better understand the nature of addiction in the contemporary world. 

For what it’s worth, I’ll cite five volumes I’ve found particularly sophisticated, philosophically and psychologically speaking. In other words, these volumes contain or suggest arguments that are, by my lights, both sound and persuasive: Elster (1999), Fingarette (1988), Heyman (2009), Poland and Graham, eds. (2011), and Radoilska (2013). Together, they suggest—in varying degrees or ways—a model of addictive behavior (especially with regard to alcohol and drugs) which (i) rejects the “brain disease” or simply disease explanatory account of addiction (even its use as a metaphor may be counter-productive), (ii) that addiction is a “disorder of choice,” and (iii) thus “the use of evaluative and especially ethical vocabulary” remains relevant if not central: 

“… [N]egative moral appraisal strengthens the person with addiction by reengaging with her as an apt valuer that could also act under the guise of the good, not only the apparent—and disappearing—good of her addiction. For … evaluative immaturity is what necessarily leads to less than successful pursuits, such as akrasia, weakness of will, and addiction. At the same time, however, evaluative immaturity is always object- or pursuit-centered rather than global: less than successful agency will take place under the guise of the good. And so success in action is never completely ruled out.” — Lubomira Radoilska, Addiction and Weakness of Will (Oxford University Press, 2013)

Nothing said above need contradict the following from Marcia Angell’s powerful review essay, “Opioid Nation,” in The New York Review of Books, (Dec. 6, 2018): 

“Three years ago, the Princeton economists Anne Case and Angus Deaton published an explosive paper about the surprising rise in mortality, starting at the turn of this century, among middle-aged white non-Hispanic men and women. The increase was greater in women than in men. They found three main causes: drug and alcohol overdoses, suicide, and alcohol-associated liver disease. They later called these ‘deaths of despair,’ because they were most common among workers in tenuous jobs, with only a high school education or less, who were struggling to stay afloat in isolated regions of the country. Dragged down by these deaths, in the past three years overall life expectancy in the United States has started to drop.

It’s not hard to see reasons for the despair. Most working-class Americans have not benefited from our booming economy, the fruits of which have gone almost entirely to the richest 10 percent. For the bottom half of the population, income has scarcely budged since the 1970s, while expenses for necessities like housing, health care, education, and child care have skyrocketed. In Appalachia, where the opioid epidemic first took hold, many coal miners were unemployed and would probably remain so. People expected they wouldn’t live as well as their parents had, and had little hope for their children. It is true that African-Americans still have higher overall mortality rates than whites, but that gap is closing rapidly for people under the age of sixty-five, particularly for women. By 2027, white women will have higher mortality rates than African-American women. Mortality for African-American men is falling even faster than for African-American women; it is projected to be equal to that of white men by 2030. But the epidemic has extended to all parts of the country and to all ethnic groups, so it’s unclear how the effects will be distributed in the future. 

By the middle of this decade, the grotesque inequality in this country began to get the attention it deserves. And the growing awareness of that inequality fed the populist passion that, when twisted and distorted, produced the election of Donald J. Trump. It’s probably not coincidental, then, that the opioid epidemic got its second wind at about that time. It certainly marks the time when the opioids of choice changed from prescription drugs to the witches’ brew of street drugs. Did the epidemic explode because people were becoming aware that the American Dream was no longer theirs to dream?

As long as this country tolerates the chasm between the rich and the poor, and fails even to pretend to provide for the most basic needs of our citizens, such as health care, education, and child care, some people will want to use drugs to escape. This increasingly seems to me not a legal or medical problem, nor even a public health problem. It’s a political problem. We need a government dedicated to policies that will narrow the gap between the rich and the poor and ensure basic services for everyone. To end the epidemic of deaths of despair, we need to target the sources of the despair.” 

(Of course one does not have to share my assessment of the crème-de-la-crème of the available literature to benefit from acquaintance with the titles in this compilation.)


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