Following up on last week’s exploration of how an undergraduate class grapples with the complex interdisciplinary construct of “addiction narrative,” guest blogger Eoin Cannon talks about how his students defended the “truthiness” of the disease concept against the choice-based model advanced by psychologist Gene Heyman.
In my last post I discussed one of the challenges of teaching about alcohol, drugs, and addiction in the humanities: dealing with the often intense– and rapidly changing– experiences, beliefs, and discursive habits that undergraduates bring to the classroom. I talked about using my course’s topic of “addiction narrative” as a comparative category, one that would allow students to gain critical distance from the language they already used for talking about addiction, as well as from the discourses I was introducing them to.
But this strategy worked better for some texts than others; I found especially that when we read contemporary memoirs, students would reach more automatically for the language and values of popular therapeutic culture. Here I’ll describe how one addiction scholar’s visit to my classroom helped push back against this tendency in a way that shed light on how disease-model claims slide back and forth between scientific and therapeutic registers.
Gene Heyman’s 2009 book Addiction: A Disorder of Choice was one of the scientific texts we scrutinized in class, looking both at the ways it incorporates narratives of individual lives and at how it invites us to read such narratives in the future. Heyman’s argues that addiction is not constituted by a passage from voluntary into involuntary behavior (i.e., into brain disease), but can be understood entirely as a problem of faulty choice-making. Though the meat of his argument is found in a quantitative model of voluntary behavior, early in the book Heyman quotes from several drug users’ narratives to illustrate the role of choice at each stage of addiction.
The book came to my attention in a series of press and radio interviews Heyman did, which surprised me for the easygoing way the interviewers were willing to set aside the disease model to consider his arguments. I had been operating under the assumption that the disease concept had reached a kind of sacred cow status, in both popular culture and in the increasingly neurology-influenced psychological sciences. Knowing that Heyman worked near my own institution, I invited him to visit my class, and he graciously agreed.
I was a bit hesitant about his being the only scholarly guest speaker during the term, because it risked giving his views undue weight. But his approach at the seminar table alleviated that concern. He took what I would describe as a gentle but insistent Socratic approach, which met students where they currently were in their thinking on addiction and asked them to consider the implications of their observations. In this manner, he nudged them toward recognizing the contradictions that he sees at the heart of the disease model. As well as being an effective teaching strategy, this also demonstrated the analytical approach he takes toward established models of addiction.
In his book, Heyman constructs the problem his argument will address as a series of contradictions: between what is implied by simultaneous legal punishment and mandated treatment; between broad social survey data indicating widespread untreated remission and clinical treatment results showing chronic relapse; and between widely accepted aspects of addiction and the qualities by which we usually define the categories contained in the phrase “chronic, relapsing brain disease.” He argues that these contradictions flow not from popular confusion, but from flawed definitional logic within the dominant scientific model.
After summarizing the genesis of his work, Heyman asked the students about the most recent addiction narratives they had read for the class, and what constituted addiction in them. A couple of students mentioned Mary Karr’s most recent alcoholism memoir, Lit, focusing on Karr’s classic hitting-bottom scenes of drunken mothering, her in-patient treatment (which was minimal beyond detox), and the twelve-step odyssey that led her to take up Catholicism.
Heyman essentially asked them to reinterpret these clinical and spiritual phenomena through the lens of choice: e.g., when the costs of the short-term choice to drink became too high to justify the avoidance of pain that drinking afforded Karr, she sought tools to help her reorient her decision-making toward the longer term. Some students resisted this as a kind of bad-faith reading, asking why narrators like Karr report the hitting bottom and early recovery experiences as a kind of involuntary mental shift with spiritual connotations, rather than as an analytical insight that results in decisions. One student in particular called on the therapeutic function of the disease model, arguing that the liberating effect recovering addicts have long attributed to it is grounds for preserving its status as popular truth. Heyman asked whether this therapeutic pragmatism was not a doubtful way of establishing scientific fact. The student cited the problems that the adoption of Heyman’s views could present to addicts, such as the excuses it could give to politicians to defund treatment.
But for his part, Heyman is no moralist, and when I asked him, he said that he felt no common cause with those who have long critiqued the disease model on the grounds of “personal responsibility.” In his book, he argues for the greater incorporation of positive reinforcement strategies into legal and clinical responses to addiction, as a way of reframing users’ choice calculus without the harmful effects of traditional punitive measures. And he doesn’t demonize therapeutic culture, interpreting twelve-step practices, for example, as effective ways of altering users’ choice horizons in accordance with his theory.
Significantly, out classroom exchange put therapeutic and scientific values into play as objects of analysis in this narrative, in ways that (despite my efforts) they had not been before, because Heyman was offering a particular alternative framework. However, I’m not sure this level of analysis would have been possible if Heyman had not been actively engaging with addicts’ narratives, including popular published memoirs, as he elaborated his ideas.