Addiction, History and Historians: Nancy Campbell’s Response

Editor’s Note: This week, Points offers readers a series of responses to David Courtwright’s reflections on history, historians, and addiction.  Today’s first entry comes from Nancy Campbell, a Points Contributing Editor.    

David Courtwright’s prose sparkles with wit and insight. The current stakes in the ongoing conversation between addiction researchers and historians of addiction are high. As a historian of addiction research, I share David’s sense of urgency that we might miss the intellectual opportunities now available.

The scientific communities who make addiction science—the behavioral pharmacologists, geneticists, medicinal chemists, molecular biologists, and neuro-imagers—inhabit what Courtwright calls “the latest dispensation.” I study this space—where addiction science comes alive. Some of my subjects are alive; others are dead. Some are as multi-lingual and hyper-aware as we historians. Others are reductionists. What moves scientists to reduction ranges from compassion, to the complexities of biography and memory, to the burning urges of scientific curiosity, and to widely held notions of what counts as scientific excellence, clinical significance, or objectivity. None are what I would call “mono-lingual” or hypo-aware of the stakes of their science.

Courtwright takes aim at persuading two groups of people to take each other’s insights more seriously. The first group is addiction researchers who have not yet realized the significant contribution that historians can make to the phenomena that they are trying to understand. Now I am familiar with this group, but I prefer to think of them as addiction researchers who have been overtaken by cravings and uncontrollable urges. They are in the grip of scientific fascination—and in that state nothing else is so compelling as the objects and subjects of desire.

The second group is historians who remain skeptical that “it’s all about the dopamine.” Historians who have not yet incorporated ‘the NIDA paradigm’—or historians like me who are unconvinced that a unified scientific paradigm is necessarily desirable or possible. Historians who would, like Courtwright and me, like to see more flourishing cross-over between the social side and the “brain” side.

We are all creatures who inhabit time and space. Since I have been graciously granted a “green card” in the hallowed halls of history, I will confess that I worry about what “science” means almost as much as I worry about what “addiction” means. My home country is Science and Technology Studies (STS)—a far-flung, interdisciplinary knowledge production enterprise that studies science as a particularly influential form of cultural production.

Scientists are trained not to see history as relevant to science. So it is important to look at when they do turn to the social and human sciences, to anthropology, history, and sociology, to the maddeningly long, slow, empirical, and interpretive work that is done in non-scientific disciplines. Ripping a page from Michael Agar’s play book, they do so “when paradigms crash.”

When paradigms crash, reductive methods fail. Phenomena exceed frameworks advanced to make sense of them. Even reductionists are forced to call for complexity. Today addiction is understood as a complex disorder, borne of social location and dislocation, mutation and permutation. Historians know that, and addiction researchers do, too.

But there is one thing historians that know that scientists find hard to see. Historians know that those whose activities they study are constrained by material conditions that are not always discernible. Knowledge-making goes on regardless of who is making it, proceeding not in serendipitous but in systematic fashion, conditioned by material conditions, social settings, relationships within research networks, and rules that allow some interpretations and disallow others.

But the rules for systematic knowledge production within a research culture change along the way. While history is cumulative, it is also open to reinterpretation. Paradigms shift. Epistemes give way. Enunciatory cultures—a term used by cultural anthropologist of environmental and informatic sciences Kim Fortun—become dissonant. Today’s cutting-edge is tomorrow’s hypothesis disconfirmed.

Scientists at the top of their game might have been paradigm-shifting rebels in their youth. Now they adhere to current configurations and latest dispensations. To understand this, let us turn to the prescient Ludwik Fleck, recently reclaimed as a founding figure in STS (see Ilana Lowy’s work on Fleck). His book title, Genesis and Development of a Scientific Fact, still generates consternation. As Thomas Kuhn noted in his preface to the most recent edition: “How can such a book be? A fact is a fact. It has neither genesis nor development” (1981, viii).

Fleck’s finger was on the crux of several tenets of the thought style that became STS. He wondered how unthinkable things transmute to become so highly ‘thinkable’ that they congeal into ‘stylized’ systems closed to new ideas. He meditated on how science develops social structure, becoming so highly organized that capacities for knowledge-making came to exceed the capacity of any one individual. Cognition is, in Fleck’s words, “socially conditioned” (1981, 42).

The social character inherent in scientific activity has consequences. Words become slogans. Sentences become calls to battle. To Fleck they “acquire a magical power.” Think about “it’s all about the dopamine,” or the redefinition of addiction as a “chronic, relapsing brain disorder.” Certain individuals are “carriers” or “standard-bearers” who convey a dominant thought style. Over time, fields entrain and prepare individuals, who are received into what Fleck called a “self-contained world.” Initiates forget their initiation; their “habits of thought” merge with the prevailing thought style.

“Discovery” is therefore a social event. “All empirical discovery can therefore be construed as a supplement, development, or transformation of the thought style” (Fleck 1981, 92). Aware of sociological thinkers like Durkheim—whose idea of the force of social structure upon individual agency remains an important insight in the sociology of science—Fleck felt that Durkheim’s heirs exhibited “excessive respect” for science and scientific facts. This remains an occupational hazard against which STS scholars work.

Is it possible to be “addiction-research-friendly” and not be too enthralled to the dominant theory of the moment? Too convinced that the “latest dispensation” is right or wrong? Too willing to give up the social for the sake of the scientific? Yes, if following Fleck, you understand that “The fact represents a stylized signal of resistance in thinking” (1981, 98). Facts resist thinking. We in STS cannot resist ‘unpacking’ them, ‘dissecting’ them, ‘precipitating’ them. We are fascinated with the production of facticity, the process by which claims are made that accumulate into the position that “addiction is a chronic, relapsing brain disorder” or “it’s all about the dopamine.” The process by which that becomes the One and Only Way to think about the addictions and all that is entailed by them.

My own work follows the contours of grand challenges, the internecine debates *within* the neurosciences of addiction. See my own play-on-words-title, Discovering Addiction

Articulate adherents to particular points of view typically gain the institutional and scientific clout to enshrine their views as dominant. For me there is always some discomfort with scientific orthodoxy, some distance from claims that seem to issue from everywhere and nowhere.

What do historians do with doubt and discomfort? Some hedge. Some throw in our lot with the winners. Some side with the outsiders. Some occupy a more technocratic position. Some create platforms from which to proselytize. Yet there is doubt on the scientific side as well. Get an addiction researcher to reflect on his or her work in laboratory or clinic, and you will always hear more to the tale than the neatly wrapped journal article, PowerPoint presentation, or poster. The social world is never far from the lab in this arena of science.

Why is the social world never far away from addiction science? Because with all of the knowledge and scientific acumen so far, we still don’t know what we’re really up against. We don’t know how to prevent addiction. We don’t know how to treat it as effectively as we would wish. We don’t seem to be able to reduce the harms associated with it. We simply don’t know enough. It will take *all* of our knowledge, our skill, our commitment, and our political will to do something constructive about it. That’s why we need to talk to each other, learn from each other, and write to each other rather than past each other.

That is why David Courtwright is right.

CODA

Writing this post, I challenged myself not to use the phrase most associated with STS—“social construction.” My scientific interlocutors have gotten to me. Perhaps it is all about the dopamine, after all. Perhaps addiction is a chronic, relapsing brain disorder. But perhaps we could co-construct new forms of knowledge capable of grasping that social, economic, and political conditions shape our brains just as surely as our brains have become social actors on the stage of early 21st century life.

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