Brave New Kitty

Disease: a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment.—dictionary.com

I caught a few minutes of a program on HBO last week about treating stimulant addiction. At the end, this statement was made (this is paraphrased): “With all the advances in science and medicine, addiction will be routinely viewed and treated as a disease in the near future.”

This is absolutely wrong.

Let me state unequivocally something that is misunderstood not only by the general public, but by doctors, treatment counselors, psychologists, and addicts themselves: addiction is not a disease, not by any existing medical definition of disease. It is not the result of genetic or developmental errors (contrary to popular belief), it is not an infection, not a poison, not a nutritional deficiency, not a toxicity. Certainly, addiction sometimes results in some of these things, but they are not causes. The truth is, physical evidence of the “disease” of addiction has never been found, not in genes or chromosomes or body tissue or brain slides or post mortem examinations of addicts. There is absolutely no evidence that addiction has an organic cause on any level. If you don’t believe me, do the research yourself. You will find a lot of speculation and theorizing and proselytizing, but scientific evidence, you will find none. Because there isn’t any.

The idea that addiction is a disease doesn’t even have its roots in medical science. Of all places, it evolved out of the temperance movement. When Alcoholics Anonymous was born (also having evolved out of the Evangelical Christian/temperance world), it sought legitimacy through medical science, and the disease model was born.  For various reasons, most people approved of this theory, so they sought evidence to support it and ignored evidence that didn’t. To this day, stories of scientists finding the “addict gene” make front page news, while the discrediting of such research—which has followed every single instance—never seems to reach the same audience. The statement made on that HBO program has been made repeatedly for at least thirty years, always with unquestioning confidence of evidence yet to be found.

In the field of addiction research, dogmatic belief seems to take precedence over the scientific method.

Everywhere, I see and hear this disease theory spoken of as fact by people who should know better. The other day on Science Friday (a National Public Radio show), an administrator from Hazelden Treatment Center spoke about the “chronic, progressive, and fatal disease of addiction.” So accepted is this view that the statement went unchallenged by the show’s typically insightful host Ira Flatow. It was said in relation to a bit of pork attached to the $800 billion bailout bill requiring health insurance providers to cover addiction and mental health costs at the same rate that they cover medical and surgical costs. This means that most members of Congress must view addiction as a disease, as well. (Put in a clearer light, can you imagine legislation forcing health care providers to consider diabetes or arthritis or muscular dystrophy to be “real” diseases? It would never be necessary, for obvious reasons.)

This all indicates that the default view of addiction is that it is a disease, and if you don’t seek to actively challenge that view, it’s likely to be the one you will believe.

If it isn’t the case, then why are people so invested in seeing addiction as a disease? In AA, I think it began with giving alcoholics a way to seek help without moral judgment, certainly a worthwhile goal—at first glance, anyway. And in all the mental health fields, there is a great striving for legitimacy equal to medical doctors (a standing simply not possible, as it is an apple-and-orange comparison), and addiction is no exception. You would think this trend would dissipate with the growing evidence that behavioral problems are not synonymous with medical diseases, and that treating them as such has created more problems than it’s solved, but instead it seems to only gather momentum; this is probably because of the widely held but short-sighted belief that science can fix everything. Between addicts who want to help other addicts get help, treatment counselors who want to be taken seriously, and the unquestioning faith of modernity that science can solve all our problems, the disease model has taken on a life of its own.

When I was going to AA meetings regularly, I didn’t think it mattered whether or not people wanted to call addiction a disease. All that mattered was if they got the help they wanted. So if calling their problem a disease allowed them to seek help, that was fine; whatever worked, right? I think this was the view underlying the founding principles of AA, and still holds today: Get them in the door, get them coming back, then get them working on the moral, spiritual, and emotional issues that cause them to drink.

I don’t believe that it doesn’t matter anymore. I now believe an ideology that attempts to negate personal responsibility when personal responsibility is exactly the problem is seriously flawed, so much so that it must be addressed. This equating of psychological issues with physical diseases where no such equation exists has eroded moral choice and robbed us of essential human qualities: dignity, autonomy, and personal choice. Literalizing the disease metaphor (particularly in professional circles), taken to its logical conclusion, makes automatons out of us all, helpless victims of our brain chemistry, unable to choose for ourselves what’s important to us or the kind of lives we want. I can’t think of anything that could possibly matter more.

Addiction is a choice we make, whether we are honest with ourselves about that or not. Ask any addict! When he gets sober, whether in a 12 Step setting or somewhere else, he does not do so by taking medicine or seeking a doctor’s care. He does so by admitting his problem, owning his mistakes and shortcomings, and working to create better relationships with himself and the people in his life. In short, he takes responsibility for his behavior and works to create a good life for himself, because these are what will keep him sober. If he does seek help, it is not medical in nature. He may call his meetings medicine, but he knows he is speaking metaphorically. He knows there is no actual medicine to cure addiction. He knows a “psychic change” is required to overcome his problem, and the only “cure” is to change his behavior. Even if sober addicts are sometimes confused in the language they use, they understand this principle better than most doctors.

I’d like to live in a world where addiction is acknowledged as an issue of personal responsibility, and yet addicts who’ve made bad choices could seek help without shame. (For that matter, a world where all people with all types of problems could seek help without shame or fear of judgment.) It doesn’t have to be an either/or: we don’t need to pretend addiction is something it isn’t in order for people to get the proper help. This only leads us down a path of dishonesty and irrationality that hurts everybody in the long run.

Addiction is a complex, deeply rooted, tragically human problem. But it is not a disease, so let’s not pretend it is. Rather than seeking exoneration from personal responsibility, we ought learn to embrace it, because scary as it is, it’s our only hope for a satisfying life and a shot at self-actualization.

Since Peggy died on September 29, I’ve been struggling. Jim and I have both been struggling. We’ve been sad (of course), but mostly we’ve been kind of…flailing. Feeling lost and purposeless. Like nothing was ever going to be okay again. I’ve been thinking a lot about my own mortality, trying to come to terms with it. I’m at the age now where I don’t feel invincible anymore. A woman I know, my age exactly, just had a double mastectomy. I keep thinking about people I’ve known or heard of over the years who’ve died awful, untimely deaths, about the fear in their eyes and their lives so unfinished and the terrible injustice of it all. I keep seeing symptoms of serious illness in every part of my body; since I tend to carry my emotional stress physically, this wasn’t hard to do.

This morning, I woke up feeling like everything was back to normal. My body felt sound, my psyche, excited about the day. Things to do, places to go, people to see. A life to enjoy. The sadness and dark thoughts haven’t left me, but they seem to have taken a back seat to the mostly enjoyable tasks of daily living. I’m not sure why I feel better, or why today, what happened, or even how to think about it. But the phrase “you have to act your way into right thinking” occurred to me, because I think on some level, that’s what I did.

“Acting your way into right thinking” is a phrase I first heard in AA meetings many, many years ago. I don’t know where it originated. In AA, it basically meant that you were supposed to do what’s in front of you to do, or do the next right thing, whether you wanted to or not, and eventually your wrong-headed thinking would follow the behavior and become right-headed thinking.

In retrospect, I can see how such a mentality might be used to make people do something against their will if they could be convinced that it was the right thing to do. I’m sure many AA critics will frame it like that. But that was not my experience. My experience of acting my way into right thinking was overwhelmingly positive. I can’t speak for all AA members who’ve found solace in this adage, but I know that I used it to act on what I knew rather than what I felt, when what I felt was self-destructive.

Most people, addicts especially, I think, have a pretty good idea of what’s self-destructive and what isn’t. But they aren’t always good at getting themselves to do what’s best, because it’s hard, or it’s scary, or it’s foreign, or it’s just easier not to. A life philosophy that includes “acting your way into right thinking” is helpful in getting through these struggles. I suppose in most situations, the trickiest part is being honest with ourselves about what’s going on; this is why it’s important to seek counsel in making big decisions (and the idea behind “sponsorship” in AA).

I think the biggest error people can make with acting their way into right thinking, especially in a masculine-oriented organization like AA, is self-flagellation; of being too hard on themselves while going through the process. We try to conquer feelings instead of embrace them. We think if we don’t “fix” bad feelings quickly enough we’re doing something wrong. We can find myriad ways to feel bad about this process if we want to. It’s incredibly easy to do.

Being too hard on yourself is a common pathology of a predominantly masculine approach to life. This makes sense, as the masculine type tends to react to threatening events with harsh discipline (just look at the repercussions of not believing in Jesus or Allah!). While this hard sell can be useful in certain situations, such as creating an army or running a business, in the realm of emotions, all it does is hamper our growth by squelching that which ought to be encouraged: self-acceptance, curiosity, tenacity, and the like.

So let’s not throw the baby out with the bath water. If we’re able to temper the urge to beat ourselves up, there is gold to be found in the process of acting our way into right thinking. If we can introduce the more feminine principles of tolerance and understanding, we can learn a lot, for acting our way into right thinking is one way we become deeper, more sensitive, more caring, more complete emotional beings.

The key word here is “process.” Going through any emotional upheaval is a process that we must learn to, on some level, be comfortable with. The more we can accept the inevitability of upheaval in our lives, the more we’ll be able to glean from going through it. The more we can forgive ourselves for not being the way we think we’re supposed to be, the more we open ourselves to growth, unfettered experiencing of our emotions, and the ability to accept life on life’s unalterable terms.

I think all those years of acting my way into right thinking in AA became kind of a default outlook for me, and it brought me through the process of grieving Peggy’s death. Not in the sense of meeting obligations and carrying on despite how I felt (although that was part of it), but more in the sense of not fighting my feelings and being patient enough to let them happen until they, well, stopped happening. I felt off, sad, depressed, anxious, and didn’t know what to do with myself for about three weeks straight. As much as I disliked being in that place, I knew I had no choice but to just be there. I’m not saying I knew this consciously, or had a conversation with myself about it. In fact I’m saying the exact opposite: that I stuck it through and came out the other side without trying to force anything or be any different because, somewhere along the way, I’d embraced this idea of acting my way into right thinking. I allowed the feelings to occur, dealt with the repercussions of them, and didn’t try to change them. And slowly but surely, the feelings began to turn into something more positive.

It’s tempting to do anything but this, to distract ourselves in any way possible from painful feelings. Sometimes, perhaps it’s even necessary in order to get through something–temporarily. But we have to, at some point, deal with our feelings. Otherwise, we lose something. We lose part of who we are. We become hollow inside where those big feelings are supposed to be. We become less whole instead of more so. We wither. And I think we lose the capacity to experience joy fully, too, because it’s a yin-yang: you can’t have one without the other.

I haven’t done a perfect job with my grief, but I do feel good about letting myself experience it and letting myself be in that dark place without too much self-flagellation. And I wish I had a better way to tie up the “right thinking” with the “right feeling,” which is what this piece really seems to be about. But I don’t. I know they’re intimately related, though, so I guess I’ll leave it for you to figure out.

If you come up with anything, let me know.