Report on the University of Michigan Meeting on “Sex/Gender and Psychoactive Substances”

Longtime Points readers no doubt know that one of the blog’s founding interests lies in bridging (or breaching) the institutional, material, and conceptual boundaries that separate historians from on the one hand, policy/public health folks and, on the other, “brain scientists” and their ilk.  Joe Gabriel blogged about the difficulties of this project in an early post, and some of the tensions involved in the project were discussed in last winter’s symposium on David Courtwright’s recent article on “Addiction and the Science of History,” the last piece of which you can find here, with links back to the five installments. As a small group blog, Points is limited in what it can do about this silo-ing problem– we can point it out, and we can provide a venue for work that attempts to address it, but (apologies to all the technological utopians out there) we lack the institutional muscle necessary to really change the structures of knowledge production.

Fortunately for those of us who still hold out revolutionary hope for genuine inter- or cross-disciplinary work, somebody out there does seem to have such muscle and, equally important, the will to put it to good use.  Even better, Points editors Nancy Campbell, Michelle McClellan, and Trysh Travis have gotten hooked in with them.  We participated a couple of weeks ago in a small working conference on Sex/Gender and Psychoactive Substances, sponsored by the University of Michigan’s Substance Abuse Research Center and its Center for Advancing Research and Solutions for Society, Institute for Research on Women and Gender, and School of Social Work.

U. Michigan Working Conference

Along with about fifteen other researchers from a wide range of disciplines (full list of participants below), we talked quite candidly about the conceptual assumptions of our various disciplines, our institutions’ demands for certain “outputs” and “deliverables,” and our combined interest in and skepticism about one another’s research.   The conversation was structured around the topics of normative drug use, problem drug use, recovery and relapse, and we considered what we know and don’t know about these topics, as well as current controversies in the field and how they might be addressed by research, clinical practice and policy.  There was very little showboating, and a lot of genuine conversation and learning. Continue reading →

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Laughing at / with the Dead

I recently had the pleasure of attending the annual meeting of the American Association for the History of medicine in Baltimore. It’s a great conference, filled with friendly and interesting people doing what academics generally do at such events – talking, schmoozing, drinking, and so on. If you work on the history of health, disease, or medicine I heartily recommend attending. There are always at least a few panels about drugs, and there are always people around who know a tremendous amount about the history of addiction and related topics. Plus, there’s always good food. This year they gave away free Haagen-Dazs ice cream and warm chocolate chip cookies. What’s not to like?

Anyway, I attended a number of interesting presentations at the conference, two of which got me thinking – not so much about the topic of the talks, but about the question of how we talk about the past. The first was a presentation on biomedical research in which the presenter made a number of amusing comments, some of which were at the expense of the people she was talking about. This is actually a pretty common dynamic at this conference – speakers will sometimes describe something objectionable that physicians did in the past, for example, and then sort of smirk or otherwise indicate their disdain for the behavior they are describing; audience members will react by chuckling or perhaps groaning in a sort of “I can’t believe they did that” type of response. In this particular case, the presenter made a few humorous comments about the research subjects who had been experimented on, at one point poking fun at one of their poems that she had discovered in an archive. The poem was admittedly quite bad, but there really wasn’t any reason to include it in the talk except for comic relief. Those people sure did write terrible poetry, didn’t they? Hah hah!

This sort of thing always makes me uncomfortable. It seems to me that we should be respectful of the people we study, even if they are dead and even if we disagree with what they thought or how they behaved. I’m not sure why I feel this way, but I do: it just strikes me as sort of rude to make fun of people, especially if those people don’t have the opportunity to make fun of you back. Of course, I also realize that I’m a bit uptight when it comes to these types of issues, and I recognize that I sometimes come off as a bit of a prig. I mean, really, what’s wrong with poking a bit of fun at people, especially if they aren’t around anymore to take offense? Beats me. All I know is that it makes me squirm in my chair and want to go out and get one of those cookies that I mentioned earlier. So there I sat, listening to the jokes about people being experimented on in years past, feeling both slightly offended and somewhat defensive about my own stuffiness. I probably should have just called it a day and gone back to my room for a nap.

Not Funny!

On the other hand, I also saw a talk in Baltimore in which the presenter was very serious – and I mean very serious – and spent a significant amount of time chastising other historians for not adequately addressing the suffering of the many people who died due to a certain catastrophic event. The speaker didn’t seem to realize that he was speaking to a friendly audience – I mean, historians of medicine are more than happy to talk about death and destruction, and to assign blame for said death and destruction – and he came off as both insufferable and self-righteous. That was a decidedly unfunny talk, and I can’t say that I left it any more pleased than I left the talk about medical experimentation. One was too funny, or perhaps funny in the wrong way, while the other was decidedly not funny enough, or at least not enjoyable enough. In both cases I probably would have preferred to be somewhere else. Continue reading →

Addiction, History and Historians: David Courtwright replies

Editor’s Note:  We’ve been very pleased to post a series of responses to David’s Courtwright’s essay on addiction, history and historians.  Now that Nancy Campbell, Alex Mold, Daniel Bradburd, and Samuel Roberts have all had their say, it seems fitting for David Courtwright to offer a brief reply to their thoughtful responses.  For Points readers not familiar with David, he is currently Presidential Professor of History at the University of North Florida.  He’s also the author of several books, including Dark Paradise: A History of Opiate Addiction in America (updated edition, Harvard University Press, 2001), Forces of Habit: Drugs and the Making of the Modern World (Harvard University Press, 2001), and No Right Turn: Conservative Politics in a Liberal America (Harvard University Press, 2010).

Addiction Neuroscience, the Progressive Implosion of Pathology, and Historical Explanation.

The U.S. National Institute on Drug Abuse (NIDA) claims to support “over 85 percent of the world’s research on the health aspects of drug abuse and addiction.” The figure may be a stretch, as it is unclear which health aspects, which drugs, and which addictions the research covers. As Alex Mold notes, NIDA has no monopoly on scientific investigation. Yet I do not doubt that NIDA’s current brain disease paradigm commands the high ground of funding, prestige, and publicity. Should NIDA and the National Institute on Alcohol Abuse and Alcoholism merge to form a new National Institute of Substance Use and Addiction Disorders, the unifying brain-disease model will become even more dominant. NIDA Director Nora Volkow puts the Grand Unifying Theory succinctly: “Addictions tend to move together, sharing many triggers and a great deal of biology.”

Historians and social scientists do not necessarily regard these developments with equanimity, as the Points responses and other comments on my work make clear. Dan Bradburd captures the worried mood by likening the brain disease paradigm to a head on the aroused Hydra of reductionism, and by suggesting that, in their own ways, Charles Murray and Nora Volkow are bent over the ancient oars of naturalized and problematized difference. Why, then, do I remain guardedly hopeful that there is something positive for historians in addiction neuroscience? Continue reading →

Addiction, History and Historians: Samuel Roberts’ Response

Editor’s Note: Today, we present the final set of reflections in our Points symposium on addiction, history and historians.  Last week’s reflections on David Courtwright’s essay included thoughtful posts by Nancy Campbell, Alex Mold, and Daniel Bradburd.  Our final essay comes from Samuel Roberts, Associate Professor of History at Columbia University, and Associate Professor of Sociomedical Sciences at the Mailman School of Public Health.  Prof. Roberts is author of Infectious Fear: Politics, Disease, and the Health Effects of Segregation (University of North Carolina Press, 2009).

“There are Other (Quarrelsome, Social) Scientists”

On Thursday 17 February, 2012, Fox News commentator Eric Bolling, in a mock address to Congresswoman Maxine Waters, advised her, “Congresswoman, you saw what happened to Whitney Houston. Step away from the crack pipe, step away from the Xanax, step away from the Lorazepam, because it’s going to get you in trouble.” These words Bolling had addressed to Waters in response to a speech the congresswoman (D-CA) had made at a rally the previous weekend, In the speech, Waters had labeled the House Republicans (specifically Speaker John Boehner and  Majority Leader Eric Cantor) “demons” from whom she wanted Democrats to take the majority. Singer/actor Whitney Houston had been found dead in the bathtub of a Beverly Hills hotel room, only six days before Bolling’s response. Houston’s battles with drug abuse for years had been grist for late night punch lines, gossip pages, and even, implicitly, a reality show featuring her, her husband (R&B singer Bobby Brown), and their family. Although no official cause of death had been announced at the time of Bolling’s remark, it was widely rumored to have resulted from a combination of alcohol and Xanax, a benzodiazepine. 

Viewers rightfully criticized Bolling for his callousness. On one hand, it was disrespectful to Houston’s family, who at the time had yet even to bury her. Nor for that matter were Bolling’s comments befitting a news anchor’s discussion of a statesperson. Congresswoman Waters, he justly might have remarked, was using perhaps inappropriately hyperbolic language in her description of House Republicans as “demons” (of course, at the Fox News desk, where hyperbolic language is commonplace, the allegation could not have come off anything but disingenuous). Liberal critics decried the implication that Waters had been using mind altering substances as clearly racist and sexist. There never has been any evidence that her use of illicit or licit substances has affected her work performance, or that she ever has used illicit substances or licit substances inappropriately. The only aspect of their lives which Waters and Houston may have had in common was their both being black women.

Such natural guilt by association was one of many things bequeathed to us through the politics of crack cocaine during the Reagan-Bush-Clinton 1980s & 1990s. That inheritance also includes draconian mandatory minimum sentencing established by President Reagan and a Democratic Congress, a condition which helped to produce a spiral of carceral aggrandizement on an unprecedented scale. A cost accounting of the drug war must also consider the massive escalation of law enforcement and the retraction of recovery services for substance abusers. Nobody had sympathy for users. “Crackhead” became the punchline of a joke, synonymous with fool, anyone lacking reason. More insidiously, female users by the late 1980s drew particular fire, popularly labeled “crack whores”, “strawberries”, or worse, combining a lack of sympathy with misogynist loathing, as Fullilove, Lown, and Fullilove argued in 1992. The gendering and racialization of crack cocaine in political discourse extended to reproductive politics and law, especially on the issue of fetal drug exposure, where black and Latino women, and poor women more generally, often have been made to carry the burdens of inequality, as argued by legal scholars Dorothy Roberts and Laura E. Gomez, cultural anthropologist Aline Gubrium, and sociologists Assata Zerai and Rae Banks.

At first blush, this has little to do with the subject matter of David Courtwright’s “Addiction and the science of history,” a robust call to historians for historians to abandon, or at least stay, their oppositional stance in favor of the pursuit of an understanding of the (more empirically objective) neuroscience of drug action.  Failure to do so jeopardizes the little bit of dialogue which we historians have enjoyed with our bench science colleagues on the other end of campus. “While we have not yet reached such an impasse,” Courtwright warns, “I worry that mutual distrust and incomprehension will end the tenuous cross-fertilization between scientists and historians concerned with addiction.” There are good reasons for this call for at least two reasons. First, while I have come to regard claims of “objectivity” with great suspicion (as someone exposed to History of Science methods in the mid-1990s, I share this distrust with many of a similar training and cohort), I do – as do most scholars, I would hope – prefer studies whose arguments rely on well-measured evidence collected through transparent methods. I find it difficult to understand a historian – or most social scientists – who claims true objectivity, simply because outcomes may be different depending on the evidence collected, the manner in which it is collected, and the methods by which it may be analyzed. However, when a scholar is rigorous and honest about the data sets employed, an argument may be, as they say, “true within its method and approach.” This is not objectivity – which implies to me a third person omniscience – but it is good enough for me in that it maintains a standard of research at least largely insulated from bias. What also makes Courtwright’s advice worthwhile is similarly simple: any facility one group of scholars may develop through or for the purpose of interlocution with another group of scholars probably will produce positive results.

These are two worthy points. However, I am uncomfortable with what seems to me a conflation of the two: neuroscience with objectivity. If I may take one telling passage: “To avoid appearing foolish, scientists need to understand that history is the fruit of disciplined research, not something cobbled together from memory, oral tradition and prefaces from old journal articles. Historians, for their part, will gain credibility and insight by adding the new language of addiction neuroscience to the familiar languages of paradigms past. Historians, who are interested in the diachronic development of multiple scientific approaches, are multi-lingual in the classical languages of addiction; laboratory researchers, who are interested mainly in the synchronic elaboration of the current paradigm, are monolingual in their modern language—and blissfully unaware that it, too, will pass into the classics under the pressure of revision. Even so, historians should do their best to understand the latest dispensation.” (p3, italics mine). While I agree that there are valuable insights to be garnered from a facility with “the new language of addiction neuroscience,” I am not convinced that the “credibility” to be gained would be universal, even among neuroscientists. For one reason, a deep familiarity of the current science in brain-drug interactions, for example, would afford the ability to write an informed history of the development of the field. However, this knowledge on its own would not be sufficient to write a real history or to earn one the credibility of one’s peers. Unless one were to write a simple and whiggish “milestones” history, such a work necessarily would have to bring into relief the junctures – in past and present – at which consensus has not been assured, even at which actors are in determined disagreement with one another. A historian could be thoroughly versed in the language of neuroscience and still find that there would be historians and neuroscientists  alike (and for similar or different reasons) who might question the conclusions. This is simply because the field (at least in my understanding) is not entirely unified. Many advances have come as a result of research on drug action on the brain over the past fifteen or more years, but there still remains disagreement over some not-so-fine points. Continue reading →

Addiction, History and Historians: Daniel Bradburd’s Response

Editor’s Note: Our symposium on addiction, history and historians continues today, with a response to David Courtwright from Prof. Daniel Bradburd.  If you’re just catching up with our series, start with David’s essay first.  Readers may also wish to review the previous responses to the essay in this series, from Nancy Campbell and Alex Mold.  We are pleased to post Daniel Bradburd’s reflections today–he’s Professor of Anthropology at Clarkson University and, among other scholarly endeavors, he has published (with William Jankowiak) Drugs, Labor, and Colonial Expansion (University of Arizona Press, 2003). 

David Courtwright ‘s essay is short and has an elegant narrative;  it is a pleasure  to read, and on its surface provides a straight forward narrative of both the developing field of drug and alcohol history and of the relationship of historians working in that field to laboratory based drug and alcohol research.

As Courtwright notes, historians have compiled a considerable, and growing, body of work on addiction and drugs which seek to provide an ‘understanding of how historical actors saw evolving situations.’   Speaking as an anthropologist, much of the work that Courtwright cites is outstanding;  the body of historical scholarship emerging on drugs, alcohol, and addiction is an impressive one.  Put slightly differently, in my view drug and alcohol history as a field of study  is both making significant contributions in its own field and provides a base of very useful knowledge for those examining the use of drugs and/or of addiction in other disciplines.

Courtwright’s essay is not just a paean to historians. Courtwright notes tensions in the relationship between historians (and other social scientists) studying alcohol and drugs and those doing  laboratory based work, and he worries about the consequences of those tensions.   Courtwright is far better placed than I to judge the discomfort of lab scientists with historians, but I would like to expand a bit on the roots of the tensions he perceives, setting out what are for me, personally, some of the concatenated issues that generate skepticism with and concern over the ‘NIDA paradigm’ and its accompanying or underlying ‘brain disease paradigm.’

First, there is the question of a paradigm that, as Courtwright notes, can appear reductive, and intellectually and politically reactionary to historians and other social scientists.  Courtwright may be too polite to say it, but the problem with this problem is an  old one.  The tools and techniques and the analysis involved in the science may be new, but recourse to reductionist explanations of complex human activities is not. Social Darwinism, a reductive view of evolutionary biology, was adduced to explain social class; nominally scientific theories proferred as good scientific practice justified discrimination based on race and gender.  So some historians and anthropologists may be concerned, as Courtwright notes, that ‘reductive’ explanation ‘sheds no light on culturally specific phenomena.”  Others may be concerned about the political ends to which that reductive work may be put, ultimately fearing its likely use as a means for simultaneously naturalizing and problematizing difference.   (Charles Murray’s recent work, and the small media frenzy surrounding it, provides a contemporary example of why this is a concern.)

Separating these concerns is not easy. At the least, it involves teasing apart the feelings of intellectual trespass that arise from reductionist explanations of complex social phenomena  from worries about bad social policy, in a context in which both science and social policy have become deeply politicized.  While it is important to note and stress that there is no direct link between the ‘brain disease paradigm’ and policies like the ‘War on Drugs,’ high rates of incarceration, particularly  of minorities in the US and death and destruction in Colombia, Peru, or Mexico, they are nonetheless parts of the same overall project. What Courtwright calls the ‘oppositional camp’ of scholars does not arise from nothing.

Another irritant, perhaps trivial but none-the-less real, is that reductionism seems to be in fashion, as evidenced by the re-emergence of socio-biology and evolutionary psychology.  Those, who like me, are not sympathetic to arguments of this kind see their hydra-headed appearance as evidence of a problem not a solution and are thus more likely to be skeptical about any work that has that cast. Continue reading →

Addiction, History and Historians: Alex Mold’s Response

Editor’s Note: Our roundtable on addiction, history and historians continues with a commentary on David Courtwright’s essay from Dr. Alex Mold.  Alex is currently Lecturer in History at the London School of Hygiene & Tropical Medicine, where she has been since 2004.  She received her PhD in Modern History from the University of Birmingham, and (in 2008) published Heroin: The Treatment of Addiction in Twentieth-Century Britain (Northern Illinois University Press).  More recently, Alex (together with Virginia Berridge) has authored Voluntary Action and Illegal Drugs: Health and Society in Britain Since the 1960s (Palgrave Macmillan, 2010).  We are delighted to post her commentary on David’s essay.  If you’re new to this roundtable, feel free to go back to the introduction, or read Nancy’s Campbell’s response (the first in the series).

Addiction Acrobats? A Response to David Courtwright, ‘Addiction and the Science of History’, Addiction, 107:3 (2012) pp. 486-92

David Courtwright is an adept addiction acrobat; deftly balancing on the high wire that spans the two worlds of addiction science and addiction history.  In ‘Addiction and the science of history’, he makes a powerful case for what historians and scientists have in common, where they differ and what they might learn from one another.  The piece is written with the lucidity and verve we have come to expect from one of the field’s leading historians, and also offers a brief survey of some of the key works in drug (and to a lesser extent alcohol) history over the last 30 years.  Courtwright locates this scholarship on a spectrum that runs from ‘oppositional’ (critical of the status quo) to ‘accommodationist’ (mildly reformist) to ‘dominant’ (conservative).  Unafraid to hint at addiction history’s cardinal sins as well as its cardinal virtues, the essay represents an attempt at outreach to a scientific community who, Courtwright suggests, need us as much as we need them.

Circus Types

Can you spot Prof. Courtwright in the line-up?

The call for historians to engage with the contemporary science of addiction, made by Courtwright in his keynote lecture to the Alcohol and Drug History Society conference in 2004, and published in the society’s journal in 2005, has been echoed by other historians such as Howard Kushner and taken up by (among others) Nancy Campbell, Tim Hickman and Virginia Berridge.  The development of what Howard Kushner has a called ‘a cultural biology of addiction’, bringing together biological and social perspectives, is an important project.  The challenge, as I see it, is to absorb this work without ‘going native’: to take on the recent developments within addiction science but at the same time maintain a sense of critical distance.  Drug and alcohol historians, well versed in the knowledge-power play of addiction science over the last 200 years, are able to expose the socially constructed dimensions to addiction as they change over time and space.

All of this I think David would agree with.  My concern with the essay is not so much

Brain Imaging, MDMA

The Imaging of Ecstasy/The Ecstasy of Imaging

about what is said, but rather the way in which it reflects, and thus may serve to reinforce, two dominant approaches: one scientific and the other historical.  Contemporary addiction science, as it is presented in this essay, is closely allied with what Courtwright calls the ‘NIDA paradigm’ which regards addiction as a chronic relapsing brain disease, albeit one with social and genetic components.  Yet, neuroscience is not the only game in town and nor is NIDA (National Institute on Drug Abuse) the only agency interested in addiction and associated issues.  Browsing down the contents list for the issue of Addiction in which Courtwright’s essay is published reveals a wide variety of addiction research, taking place in a range of settings, and making use of numerous disciplines and methods.  Articles by scientists, physicians and social scientists offer insight into aspects of addiction such as the relationship between childhood depression and problem alcohol use, and the transition from first illicit drug use to injecting drug use amongst users in the Appalachians.

Of course, not all such work contradicts the brain science model, but the diversity of current addiction research should not be ignored.  Indeed, the NIDA paradigm is far from being universally accepted.  In a recent forum in Addiction a number of commentators questioned the extent to which the chronic relapsing disorder model was an appropriate way to view alcohol dependence.  Historians may think that they can hold themselves apart from such debates, but the difficulty with the chronic relapsing model is, as Jacek Moskalewicz points out, that it individualises drug and alcohol problems.  Locating addiction in the brain of the addict downplays the social, political, economic and cultural dimensions of the issue, the very elements that historians tend to be concerned with.  By engaging with the NIDA paradigm are we in danger not only of unquestioningly accepting the dominant view, but also of doing ourselves out of a job? Continue reading →

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. Continue reading →