Addiction fatigue syndrome: The end of an intoxicating idea

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The idea that addiction is a disease is a recent one. It makes little difference whether it first surfaced in the 17th century or the 19th: The point is that it was not there before, and that cavemen, Greeks, Romans and knights in shining armour all managed to muddle along without it. Some people overindulged, others criticized them, a few even wanted to help, but one thing they did not do was turn their vices into so many pathologies.

Myself, I have never bought into the whole disease concept of addiction. The strongest argument in its favour, that the body undergoes physiological changes when its owner is hooked on a substance or behaviour, is at best descriptive: The fact is that all actions have a physiological component. When, for example, I think of Sarah Palin, I experience a build-up of acid in my stomach. Does that make it a disease?

Then there is a genetic argument. If you buy it, and a great many people in the research and treatment communities do, then addiction is involuntary and therefore must be a disease.

But that still leaves the old question of nature versus nurture, and so I am not exactly sure what this piece of the puzzle gives us.

Presumably parents who know their child has the "addiction gene" will know to lock up their liquor and medicine cabinets. Or perhaps their physician will advise against their having children in the first place.

The death of addiction?

The case for the disease concept of addiction becomes weaker still when you consider its tenuous place in the history of ideas. Sooner or later, maybe in 20 years, maybe in 50, the odds are that it will be dead and gone, buried alongside Mesmerism, phrenology, the Ptolemaic model of the universe, trickle-down economics and all the other ideas that seemed so good at the time.

I say this because ideas are ultimately only as credible as the people or groups making them. The point is something of a cliché among historians of science, but in the hands of Harvard University's Steven Shapin it becomes a starting point for thinking of science as a series of cultural "performances," performances that include "displaying the marks of integrity and entitlement: expertise, to be sure, but also the signs of dedication and selflessness."

In the case of alcoholism, to give the most obvious example, we have a term that was first coined by a physician, Swede Magnus Huss, and a pathology that has since been championed by institutions whose very names gleam with high purpose - the National Institute on Alcohol Abuse and Alcoholism, the Alcohol, Policy and Safety Research Center, the National Council on Alcoholism and Drug Dependence, to name just a few.

But what if the idea had originated with a Wiccan? Or if the institutions that variously research and treat it were headed up by performance artists? The idea would be the same, but would we automatically believe it?

Dr. Shapin is also a big believer in context. Context, in fact, is everything, and by this logic, scientific discoveries, far from being eternal verities, are merely the products of their time and culture and, by inference, potential casualties when their historical moment passes. In the case of the disease concept of addiction, we have an idea that came along just as physicians were starting to expand the number of ailments they could and would treat. But what happens when cash-strapped states start reducing the number of conditions they are willing to insure?

A disorder of choice

There are also signs of dissent within the citadel itself, starting with yet another Harvard iconoclast: Gene Heyman. Dr. Heyman made a big splash last year with the publication of Addiction: A Disorder of Choice. Note the choice of words: disorder - not disease. One follows the other because once you have shut the door on disease, you have, of course, opened it up to choice. Dr. Heyman's theories are based on a complex calculus involving short-term and long-term rewards - behaviourism, in other words. But at the end of the day, his core recommendations have a wonderfully old-fashioned ring to them: Individuals should cultivate self-control and "a more reflective approach to decision-making," while we as a society should cultivate "social traditions that encourage healthy levels of temperance."

But I wonder whether the rest of us even care enough to act on Dr. Heyman's sensible recommendations. I ask because there are unmistakable signs that we as a society are suffering from addiction fatigue syndrome - not the tens of thousands who make their living by treating or trying to figure out addicts, but the rest of us, the millions who somehow muddle through life without succumbing to our vices.

And those who do succumb are increasingly a source of entertainment - not pity.

Hooked on schadenfreude

Which brings me to one of literature's more ridiculous - and self-serving - genres: the addiction memoir. This is a case where the first, Thomas De Quincey's Confessions of an English Opium-Eater, is also the best. But was the trend it started a good thing? It is if you think that unedifying habits need to be placed in the public domain. Or if you seriously believe that binges and blackouts are every bit as important as, say, the rise of China or the discovery of the atom.

My quibble with De Quincey is not that he wrote about his bad habits but that he was a Romantic, and, by extension, a navel-gazer. This is the one thing his many imitators have in common with him - not the gorgeous prose, but the sin of solipsism.

There are so many of these imitators that I hardly know where to begin, but let me start with one that is famous for all the wrong reasons: James Frey's A Million Little Pieces. Mr. Frey, for those who do not know the story, got busted by the website The Smoking Gun for telling "a million little lies" about his brushes with the law and subsequent stint in rehab.

Oprah Winfrey, who had made the book one of her picks for 2005, was left with egg on her face, but if sales are any guide (five million plus), the controversy did Mr. Frey more good than harm. And while his publisher, Doubleday, took a hit, the lesson to other publishers was clear: Addiction memoirs sell.

Mr. Frey, in fairness, cannot be called a solipsist. The con he pulled in A Million Little Pieces was too calculating for that. But the incident does raise a basic question: Why do addiction memoirs strike so many people as both credible and authentic? I do not mean to judge, but it's not as though addicts have a sterling reputation for honesty. After all, if you want to reach Step 6 in Alcoholics Anonymous, you first have to come to terms with what the group's literature rightly calls a "disturbing reflection": "If all our lives we had more or less fooled ourselves, how could we now be so sure we weren't still self-deceived?"

Nor, as it turns out, was De Quincey himself being entirely honest. Virginia Woolf was a big fan, but nonetheless had a sneaking suspicion that he was telling her only what he wanted her to know, and that "even that has been chosen for the sake of some adventitious quality - as that it fitted here, or was the right colour to go there - never for its truth."

Robert Morrison's biography of De Quincey, The English Opium Eater, is in many ways a test of Woolf's hypothesis, and the result, whether intentionally or not, is a much-needed corrective to the trust so many people seem to place in addiction memoirs. And after carefully weighing the evidence, he reaches much the same conclusion she did: that for all his real aches and pains, De Quincey was also perfectly capable of exaggerating them "in order to garner sympathy, or create a diversion, or heighten a literary effect."

These are the sorts of tricks writers have employed since time immemorial, and the reader should especially be on the lookout for them in any book whose dust jacket promises a "candid memoir," a "deeply personal story of a man finally throwing a light on the darkest corners of his life," or, to go on and on, "an utterly compelling, beautifully written narrative from which you simply cannot look away."

The picture becomes muddier still when you have literary critics such as David Shields and memoirists such as Vivian Gornick practically begging writers to blur the line between fiction and non-fiction. Why did Ms. Gornick make up whole chunks of her memoir Fierce Attachments? Because "what happened is only raw material; what the writer makes of what happened is all that matters."

That is why I'm always suspicious when I open a memoir

and find page after page of smooth dialogue. There are really only two possibilities in such instances: The author is either making it up or is the sort of person who goes through life with a tape recorder concealed in his or her underwear.

I'm doubly suspicious when the author labours under the additional handicap of having been passed out, hallucinating, or otherwise non compos mentis when the conversations were taking place.

But if memoirists must make up dialogue, at least make it interesting! Consider the following conversation, which occurs, apropos of nothing, halfway through Superdad, Christopher Shulgan's "memoir of rebellion, drugs and fatherhood":

"Is it [the VCR]plugged in?"

"Yes, it's plugged in."

"And the TV is plugged in."

"Of course the TV is plugged in."

"Switch the thing on the back, the antennae thing."

The truth is that most of our daily conversations are as inane as the one I have just quoted. But the fact that they are a staple of so many of today's addiction memoirs underscores a basic point: that the stories themselves aren't very interesting.

Their sheer predictability - things go from bad to worse and then, with minor variations, from worse to better - is the first count against them. Susan Juby ( Nice Recovery) started drinking as a teen and stopped drinking as a young woman. Bill Clegg ( Portrait of an Addict as a Young Man) was a successful literary agent before he started smoking crack, and was a successful literary agent after he stopped smoking it. Mr. Shulgan - well, his life goes on pretty much goes on as before once he stops sneaking out for crack at all hours of the night.

But the real problem is that most of the people who write addiction memoirs happen to be middle-class, and, dare I say it, ordinary. They do not tame lions or hijack supertankers or go off and fight in the Spanish Civil War: They go to university - Mr. Shulgan to Queen's, Ms. Juby to the University of Toronto, Mr. Clegg to Washington College. Theirs are bourgeois tales with bourgeois endings.

And their reasons for quitting bear out something Dr. Heyman found in reviewing scores of interviews with addicts: Quitting is a choice people typically make when they are ready to take their responsibilities more seriously - Mr. Shulgan wanted to be a better father, Ms. Juby a better student, Mr. Clegg an even bigger kingmaker.

I have never been able to understand why anyone would want to read these memoirs, but my guess is that they do it for the schadenfreude. How else to account for our fascination with a second-rate actress such as Lindsay Lohan? Or the fact that A&E's Intervention is into its 10th season and Celebrity Rehab into its fourth?

Both shows insist that they are only trying to help, and Celebrity Rehab's Dr. Drew is forever telling his audiences that addiction is a chronic disease and that the show is a "teaching tool."

But we viewers know better. We like to watch people implode, not improve.

Addiction memoirs and reality shows depicting addicts at their worst can hardly be called edifying. But call them what you will, they are entertaining, and therein lies my point: The idea that addiction is a disease is one that fewer and fewer people are taking seriously. And if Gene Heyman is right, and I think he is, the new paradigm, that addiction is a choice, is going to look an awful lot like the one we had 200 years ago.

READING ADDICTION

NEVER PURE: Historical Studies of Science as if It Was Produced by People with Bodies, Situated in Time, Space, Culture, and Society, and Struggling for Credibility and Authority, by Steven Shapin.

Sixteen brilliant essays that will forever change how you think about science.

ADDICTION: A Disorder of Choice, by Gene M. Heyman. 

A behaviourist concludes that addiction is a behavioural problem.

CONFESSIONS OF AN ENGLISH OPIUM-EATER, by Thomas De Quincey. 

First published as two articles in 1821, then substantially revised in 1856.

A MILLION LITTLE PIECES, by James Frey. A semi-fictional account of one man's career as an addict - and the literary cause célèbre of 2006.

THE ENGLISH OPIUM EATER: A Biography of Thomas De Quincey, by Robert Morrison.

A superb biography.

SUPERDAD: A Memoir of Rebellion, Drugs and Fatherhood, by Christopher Shulgan.

Toronto writer juggles career, fatherhood and a serious crack habit.

NICE RECOVERY, by Susan Juby.

Nice prose too. Unsparing with herself, and well aware of the limitations of the genre.

PORTRAIT OF AN ADDICT AS A YOUNG MAN, by Bill Clegg.

Trendy young literary mogul temporarily goes to seed. Recovers and falls victim to the fad of writing in present tense.

BILL W.: My First 40 Years, by William Griffith Wilson.The highly readable memoir of the founder of Alcoholics Anonymous.

UNDER THE INFLUENCE: The Literature of Addiction, edited by Rebecca Shannonhouse and Pete Hamill. An anthology excerpted from memoirs, short stories, and novels.

Jessica Warner teaches at the University of Toronto's Institute for the History and Philosophy of Science, and has written extensively on the history of addiction. Her most recent article, United States of Abstinence, appeared in Playboy.