I do write a lot and act on the "fact" that changing minds for good is the most fundamental and important trait than love. If my memory serves well, as a young man a long time ago, first time I had changed my mind was - I stopped blaming addicts and understood the importance of perceiving addiction as a disease.
For years with Max, I saw addiction is not limited to alcohol or drugs but also spans across politics, sports, religion, and ideologies in general. But world still focuses only on "objective" addictions and largely ignores plethora of "subjective" addictions.
Nevertheless, I quit drinking on the day Max passed away and I don't miss it a bit. I was never a big drinker to begin with but the stories about addiction did scare me . I am nothing but a biological entity like other living beings. I understood the limitations of my biology.
Read this heart-breaking story of Carl Erik Fisher; who went from a budding psychiatrist at Columbia University to patient at Bellevue. There are tons of wisdom in Carl's message but try not to read with a political mindset. He almost .. almost captures the causal reasoning behind this epidemic and he understands the subjective addictions as well.
I don’t intend to diagnose my parents or grandparents. It is rarely useful to attempt to arrive at one major “cause” of anyone’s addiction – genes, environment, trauma, the trauma of everyday life. But it has helped me immensely to see their addictions at least in part as a function of their unprocessed pain. Like everyone else, they were drinking and smoking for a reason: because those substances did something for them. Sadly, their use simultaneously helped them to cope and made their problems much worse, perpetuating a vicious spiral.
This is the core of the addiction-as-dislocation theory. Beyond soothing the concrete effects of physical dislocation, people use drugs to address an alienation from cultural supports. This kind of alienation is what Émile Durkheim, the founder of modern sociology, called anomie: the social condition of a breakdown of norms and values, resulting in an existential lack of connection to meaning and purpose. This sense of dislocation, some scholars argue, is one of the core drivers of today’s opioid epidemic.
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To this day, I am not entirely sure how to think about that rehab programme. Was it too harsh, or did I need to be challenged? Was all their focus on character and personality rehabilitation overkill? I am convinced that I did need to be coerced, in the sense of being faced with a hard choice. Most people going to addiction treatment are going with some form of coercion – at least informal coercion, from family and friends – and I was there because I had to be, at least if I wanted to practice medicine anytime soon. I am glad that I was coerced in that sense; if I hadn’t had the monitoring programme in place, I might not have stuck with treatment and entered recovery, and I could have harmed other people, or died myself. Still, I’d like to believe that whatever deeper rehabilitation I experienced had more to do with connection than confrontation. I didn’t really need to be broken down, and the most meaningful and transformative experiences were less about the formal treatment and more about being put in a situation where mutual help could take hold and do its work.
After residency, I devoted a year to training in forensic psychiatry. I spent one day a week at New York State’s maximum-security prison for women, and it seemed as though every patient sent to our psychiatric clinic had both a low-level drug offence and trauma history. Many of them jockeyed to get time off their sentences by going to tough-love boot camps, where their heads were shaved and they did push-ups in the snow while staff screamed at them. I couldn’t shake their stories. The injustice of how, if not for an accident of birth, my own story could have been entirely different. The NYPD chose to take me, a white guy living in an upscale Manhattan neighbourhood, to a hospital rather than booking me. If I’d been a person of colour in a different neighbourhood, I could have been imprisoned, like so many of the people who populate our current system of mass incarceration, or even shot and killed.
Disparity in access to medical treatment remains one of the strongest examples we have of the stark racial disparities in the understanding and treatment of addiction. Black and Brown people have long had to fight for treatment. Addiction in communities of colour, perennially a major problem, is too often explained in a stigmatised way that justifies prohibitionist approaches: portrayed as self chosen and irresponsible. On a structural level, addiction is explained away as the intractable effect of poverty or other root causes, treated as inevitable and expected, and thus left to the criminal legal system.
In my psychiatry practice, I see “non-addicted” people struggling with food, work, cheating, power, money or anger all the time. One psychotherapy patient of mine uses compulsive bingeing and purging as a way of managing negative emotions such as fear and shame. Another cannot put down his phone or stop checking his email – despite his clear intentions and plans to do so, and despite the fact that it causes real problems in his marriage – because of a crushing need for external validation from his work. I don’t insist that they call themselves addicted, and in general I don’t assume that the roots of my own addiction are similar to others’, or that others need what I have needed to recover. But I also don’t see a tremendous division between me and them. We all suffer from a divided self, and we all have too much confidence in our judgment and our ability to exert power over our environments and ourselves. And in that, I think we share a fellowship, in that addiction is simultaneously a tremendous problem that causes unthinkable suffering, and something contiguous with all of human suffering.
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