if i were going to speculate on why murder rates fluctuate, and why they're climbing, i would focus primarily on the epidemiology of addiction, which is extremely complex ('multifactorial') and in some ways mysterious. the h is back in town, baby.
folks keep bringing this to my attention: the irrationality of alcoholics anonymous. what i want to say is this: i have seen 12-step programs work for many people, and i have never seen anything else work. i believe that total abstinence is the only possibility for people like me; i believe i know that as well as anyone can know anything. and i have a funny feeling that some brief therapeutic intervention and drugs drugs drugs are going to have an even more impressive rate of failure. also i will say say that most doctors, neuro-obsessives, and gabrielle glazer do not understand what addiction is. also aa is spiritually profound. also perhaps rationality will kill you in the end.
now this is not to say that the whole aa thing is well thought-out on the philosophical or scientific levels. it originates basically among non-scientists of the 1930s; really it was founded by desperate alcoholics, ok? smart people but not harvard profs. this is also why it does work, when it does. now the big book asserts flatly that alcoholism is a disease. then again, it doesn't say what 'disease' means, exactly. at one point it even tries 'allergy'. but actually it's apparently an early version and one of the fundamental sources of the flat medicalization of addiction that now takes the form of genetics and neurotransmitters. but then 'made a list of all the people we had harmed and became willing to make amends to them all' (for example) is an odd therapy for a genetic or neurological disorder.
so i don't think that aa or 12 step really has a coherent notion of addiction. also i think the disease model of addiction is really very half-assed and ill-thought-out, though people sort of insist on its literal truth, whatever that would mean exactly. what 12-step programs have is the insight - not really compatible with the notion of alcoholism as an organic disorder - that really you've got to undergo a kind of spiritual transformation, however you want to think about that. that the transformation begins with surrender is one of the profound bits. now, what the scientists and docs that glazer recommends don't have is any sort of connection to the phenomenology of addiction: what it's like to be an addict. you really really do not want to turn the matter over to them.
but honestly, no one has a clear conception of addiction, i believe. it is a great puzzle in ethical theory, especially as it bears on free will and responsibility. we are poised between all sorts of medical, moral, and spiritual models that are not nearly as distinct as people think. the brainboys have no more sense of what they're looking for than did jung, and there have been few more primitive stabs at the thing than the whole 'lights up your pleasure pathways' or 'dopamine' route: really, pathetic. but however, no one is doing much good here. you'd have to know what you're looking for to find it in someone's brain, yes? but it's not in a brain: it's in a brain embedded in a social and physical world.
this piece, from the atlantic, on 'privileged, white' twenty-something addicts, is typical of a certain style of middle-brow, pseudo-profound analysis, a genre pioneered by people like malcolm gladwell and, um, jonah lehrer. liz kulze produces a seemingly definitive account that is just a mess. now i am going to attack almost any 'external' account of addiction; i think if you are explaining addiction as something bizarre and external that needs to be explained sociologically or medically, you've already missed everything, or you have little credibility; the only real explanations include the first-person experience of addiction, which does not come from collaging quotes to make your pre-conceived points. but just one problem with kulze's account: it accounts for addiction in this sort of person, first, on the grounds that these kids are coddled and spoiled so much that they never form a self, and second, because their parents are always driving them to succeed, that they grew up in excessively-structured contexts, both in their families and in educational institutions. surely these things are in tension with one another. but either way, over and over, she moves straight from incredibly vague cultural observations that apply perfectly well to non-addicts and addicts alike (but really apply to no one in particular) to an explanation of particular people's addiction.
first off, i doubt that addiction is a greater problem in this population than in many others. but it is an explanatory problem: how can people like me end up like that? i'm going to tell you exactly how: the same way people not like you end up like that. the essence of addiction is in the relation betweeen the person and the substance: demographic explanations are going to be wrong, especially if you start by assuming that certain people should be immune. addiction among privileged, white twenty-somethings is exactly no more puzzling than among trailer-dwelling rednecks or inner-city black people, and that you think the one needs explaining and the other does not only displays all your prejudices right there on the page. you might start out instead, if you have to go sociological or whatever, with addiction patterns among the parents of these people. and then that you offer pseudo-profound pseudo-explanations that do absolutely nothing just shows that you've been reading way too much new yorker. on both counts, you need to get out of your own little demographic spider hole.
chris hedges introduces a piece in salon on oxycontin in coal-mining country as follows: "During the two years Joe Sacco and I reported from the poorest pockets of the United States, areas that have been sacrificed before the altar of unfettered and unregulated capitalism," etc. let's say the rest of the piece doesn't really support this diagnosis:
About half of those living in McDowell County depend on some kind of relief check such as Social Security, Disability, Supplemental Security Income (SSI), Temporary Assistance for Needy Families, retirement benefits, and unemployment to survive. They live on the margins, check to check, expecting no improvement in their lives and seeing none. The most common billboards along the roads are for law firms that file disability claims and seek state and federal payments. “Disability and Injury Lawyers,” reads one. It promises to handle “Social Security. Car Wrecks. Veterans. Workers’ Comp.” The 800 number ends in COMP.
Harry M. Caudill, in his monumental 1963 book Night Comes to the Cumberlands,describes how relief checks became a kind of bribe for the rural poor in Appalachia. The decimated region was the pilot project for outside government assistance, which had issued the first food stamps in 1961 to a household of fifteen in Paynesville, West Virginia. “Welfarism” began to be practiced, as Caudill wrote, “on a scale unequalled elsewhere in America and scarcely surpassed anywhere in the world.” Government “handouts,” he observed, were “speedily recognized as a lode from which dollars could be mined more easily than from any coal seam.”
Obtaining the monthly “handout” became an art form. People were reduced to what Caudill called “the tragic status of ‘symptom hunters.’ If they could find enough symptoms of illness, they might convince the physicians they were ‘sick enough to draw’… to indicate such a disability as incapacitating the men from working. Then his children, as public charges, could draw enough money to feed the family.”
now i suppose you could regard the capitalism as the prob. or you could regard the problem as not enough capitalism. or you could regard the problem as precisely these government programs, which have dominated the economy of the area for decades without curing its difficulties. or you could represent the problem as insufficiently elaborate welfare-type programs, despite the fact that he describes the area as having been subjected to the some of the most elaborate welfare programs in the history of the world. anyway, before you feed everything into your socialist interpretive machine, you might want to think about the information you are yourelf developing.
i do think bachmann is kinda toast. santorum will be the next dropout though.
chris matthews: we've got to win the science! against india and china! please, bitch. it's gotten so insanely generalized: pro-science or anti-science? well i like the physical sciences in some contexts better than i like the social sciences in any context. i reserve the right to think about what you're saying, even if you're saying it on behalf of 'science.' how many scientists think we need to win the science against indian scientists, whatever that can mean? stop reading thomas friedman before i come over there.
really no collapses or gaffes at all. that's always kind of disappointing, like if you go to a nascar race, you want to see a crash, sort of. or a hockey game etc.
9:49 paul did come on toward the end. they're all singing his tune about the fed now.
9:43 the crowd is cheering for the death penalty. yes! that's what we wanna hear. i wouldn't go to texas and kill their children.
9:38 rick perry reduced nitrous oxide levels in texas. that's hilarious!
9:35 huntsman's wielding science as a campaign strategy; we can't win if we don't believe in science! (believe in science, har har.)
9:33 like santorum: we can impose our vision on the world. maybe he didn't say 'impose.' santorum did frame the decison: we've got to decide whether we're an isolationist party.
9:32 they are still way divided and equivocal on the wars and interventions. they're still stumbling toward a coherent position. they got burned by bush.
oh shoot! cain! thanks, dong.
9:19 they're all fence-builders (except ron, who rocked that one). be bridge-builders! huntsman did say 'let's remember we're dealing with human beings.' more than generous, from these folks.
9:15 bachmann's for a cash test for immigrants: if you're broke, you can't come.
9:11 newt's still on english as the national language. dude. take that shit and go.
9:09 perry just said he'd secure the border with predator drones. romney is going back to building a 2000-mile fence. not clear whether he means mexico or canada.
9:02 paul just does not come off that well in this kind of context. he doesn't seem perfectly fluent. he's better in a one-on-one interview.
8:45 santorum says things like: 'it's not about saving money, but saving people's lives.' (on 90s welfare reform, for which he atkes credit.) he's like a real christian, not an ayn rand christian,, a capitalist christian. remember when jesus gave the money-lenders the old heave-ho and denied rich people the kingdom of heaven? the 'i'm for rich people increasing their capital! thing of perry's is just not going to rally with his super-sincere social beliefs etc. this is the republican problem. party of capital or something else? the original wave of tea-partiers were probably no happier with wall street than with obama.
at a break: it's actually a competent group. no one has embarassed themselves. so far so good for perry.
8:37 well paul says that eliminating the minimum wage would 'help the poor.' er.
8:29 cain is for 'loser-pay' laws; like if you sue wal-mart, and lose, you pay their expenses. well that will end all suits against large corporations.
8:25 perry blames the federal gov for tx being last, with 25% of the pop uninsured. that is just nonsense.
8:19: newt is always better than you think he'll be. he actually says something; not mere focusgrouped bits
8:14: ooo michelle looks a little...embalmed. same old schtick, already getting old. don't count those foster children again!
8:11: cain: 'if 10% is good enough for god, 9% is good enough for the federal government.' crisp. sounds cheap too!
8:09: despite myself, i'm often impressed with santorum. he's kind of thoughtful and sincere, though spouting catch-phrases here a bit shrilly. well, he's desperate. already.
8:06: damn romney and perry both sure look like presidents. like if you were hiring some handome, spray-tanned old stiff to play the president in one scene of your tv movie. their voices too: like veteran sportcasters: perfect inflection.
8:00: brian williams: "the toxic gridlock that is washington dc." geez, that's my home town! the traffic does suck though.
ok i'magonna try to do this liveblog thing right this time. one entry, with times noted, growing from the top.
i want to write a paean to my great love: nicotine gum. i have been addicted to it literally for years. it has its drawbacks, especially that it's kind of expensive. but i'll tell you this: it shows addiction in its pristine form, and in my life the distractions and layers of jive have slowly been pared away through the administration of pain, and i realize that there's nothing left but an addict in his pristine form.
so, there are all kinds of reasons people engage in substance abuse, or that they say they do. they are medicating their depression/anxiety/psychosis. they love the social dimensions down at the bar and the crack house: it's the fellowship, baby. they love the ritual: filling the bong, fumbling with the cigarette, cooking the h. every and any reason besides that they are actually addicted to the active ingredient. now i suppose nicotine is some sort of mild stimulant: even if so, no dose at this point actually has any discernible psychotropic effects on me. the stuff makes no change in my consciousness that i am aware of. (of course, sadly, people can reach this point with vodka or crack too. but i don't think anyone would say they chew nic gum for the way it makes them feel, much less for the social aspect, or to treat their depression. indeed, i can keep drinking or smoking pot even though i actually hate the way it makes me feel. i've had moments where i liked the way booze or pot made me feel, but whole long periods where i didn't at all, where i just felt stupid and sick and profoundly inactive. that just isn't the reason i did them; indeed it might be closer to true to say that i did them because i wanted to feel bad. (maybe that sounds bizarre. but let me ask you this: have you ever wanted to be sick? every feigned sickness or convinced yourself you were sicker than you were? ever wallowed in sickness, lingered over it, delectated it?) but after a bit, it hardly mattered either way.)
no, the only thing addiction to nicotine gum has going for it is that you chew it, then you spit it out, then you jones for another piece. believe it or not, you start to think it's beautiful; you start to love the non-flavor, the funky caulk-like texture. but that's just your mind, addicted: actually these things just can't be lovable; without nicotine they palpably would have no allure. i've heard people after they smoked like mad for years saying that they're as addicted to the ritual as to the nicotine, or even that nicotine has nothing to do with it. um, horseshit. you'll tell yourself any damn thing to keep going; you'll actually feel the amazing allure of the ritual or whatever even though you actually don't feel it at all, believe it or not. this shows you with extreme clarity the human capacity for self-delusion.
it would surprise me if alcohol or heroin was used as a treatment for depression: it makes depression worse in a dozen ways at once. that doesn't matter, because you're addicted. then you try to work it out in therapy. good luck.
addiction to nicotine gum won't destroy your life, or end you up in the cancer ward (i hope!). so it's a good addiction in that sense. on the other hand, it won't alter your consciousness, which might be unfortunate. but it is addiction - real disease and real commitment - in its crystalline form: the very essence. it is me, purified.
well, if the obamas' relationship is anything like mine have been, i wouldn't just take michelle's word for it that barack has stopped smoking. been on both ends of: smoking (etc)? of course not! yo what were you doing down there in the garage, over at her house, driving around in the car? oh, you know, adjusting the belts on the ride-on mower or whatever it may be. but smoking (etc)? i told you i quit! no secrets between you and me, michelle. don't you trust me?! i am deeply deeply offended.
and aside from all that, something tells me that michelle might be someone with whom many people - even the commander-in-chief of the greatest military the world has ever known - might try to avoid conflict at almost any cost. prosecuting the afghan conflict might seem easier, though of course buying time with big fibbing might also not be the best long-term strategy for conflict avoidance. cute and formidable is a hot combination, though, so i'm thinking the whole thing might have its...compensations.
i'd say the anti-smoking police have ramped up the hysteria to maximum: Even One Cigarette Can Prove Lethal, U.S. Surgeon General Says. or even one moment anywhere near someone who's smoking: instant death. where the surgeon general can go after that is not clear, so i guess that's her last appearance on television; thank god we've heard the end of that. still you can't argue with Science. it's almost hard to imagine the litigation atmosphere this creates.
kathleen parker is right that there's twelve-step stuff behind beck, including a basic stance of kind of desperation for god's help. but there are also many ways and reasons that what beck is doing is bad 12-step practice, however excellent it may be in other directions, or not. one thing to say: twelve-step programs have no leaders, no one who owns the ideology. the principle of anonymity means that aa, e.g. has no spokespersons, and they constantly emphasize "principles, not personalities." i do think beck presents himself in many ways that are immediately incompatible with 12-step practice.
parker by the end says that 12-step programs proselytize, or are "evangelical." i'd say this is a complete misunderstanding. the twelfth step inculcates "carrying the message to the alcoholic that still suffers." and helping others recover is presented as an essential dimension of one's own recovery. but this means one at a time, helping particular people who need and want help find help by sharing your story. it has absolutely nothing to do with ranting for hours on national television, or getting up on the steps of the lincoln memorial and gesticulating. at the heart of the program is a severe and serious cultivation of humility. i'm not sure that beck's declarations of his own humility are entirely sincere
glenn beck, let's say, is the opposite of bill w., who didn't even want to give his name, who never presented himself in public as a leader or spokesman: there are no leaders or spokesmen. i was perfectly serious when i said that it's likely that beck's twelve-step sponsor basically thinks that all he's doing is courting a relapse. well, we'll survive glenn beck's relapse, and twelve-step programs have a survived a thousand distortions/appropriations by a thousand egomaniacs, a thousand attempts to profit or to promote oneself.
Tradition Eleven—Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio and films. Trad Twelve—Anonymity is the spiritual foundation of all our Traditions, ever reminding us to place principles before personalities
i thought i might have a crack at some examples of what i might call strategic beliefs, which i think raise important questions in both epistemology and actual science and social policy. so here are my examples:
(1) alcoholism (or in general addiction) is a disease.
(2) people are born straight or gay.
(3) depression (or for example bipolar disorder) is a chemical imbalance in the brain.
now i am not a researcher and i haven't really had a serious crack at the evidence. but my view is that these assertions are either false, misleading, or so vague as to be unevaluable for truth value (for example: the notion of "disease" is an extremely vague, ambiguous, and problematic folk concept). but i also think that in certain situations each of these might be extremely important to believe: those circumstances are, roughly, treating addiction or depression, and making peace with one's sexual orientation and allowing people to have whatever sexual orientation they have.
each of these claims relieves the depressed, addicted, or gay person from personal responsibility for their situation: they all declare that the situation is not the result of the free decisions of the subject. now i think this actually has basically good consequences. i think this is the fundamental reason, for example, for the success of twelve-step programs, which i have experienced at first hand. it is a dogma in aa that alcoholism is a disease (or, as the big book says at one point, an allergy). if you think that your alcoholism is your fault, you will be filled with self-loathing, particularly at the point where it has destroyed your career or family. well this self-loathing will get you drinking. the typical drinking alcoholic is in a cycle where he desperately tries to exercise will power over his condition, which might work for a while, then lead to a collapse in which he succumbs. the typical addict runs through this cycle again and again. so you "turn your will over," you stop thinking that you can make yourself stop and are a horrible person because you fail. then you can stop.
so i would say that the recovering addict may need to believe that alcoholism is a disease (whatever that means, exactly). i might encourage someone to believe this - and i have - because it is more or less essential to recovery. and recovering addicts often are entirely outraged even by asking questions about this. but that does not make it true, which shows among many other things that the pragmatic theory of truth is false.
the "evidence" that depression is a chemical imbalance in the brain is kind of pathetic. i'll believe that when doctors are diagnosing depression by pet scan or urine test. depression is diagnosed on the basis of..sleep patters or energy levels, "suicidal ideation," etc. and of course even if there were chemical changes in the brain associated with depression, that would not establish direction of causation: the emotional condition could be causing the brain changes as well as the other way round. the fact that seratonin re-uptake inhibitors are (sort of) effective in treating depression no more shows that depression is a chemical imbalance than the fact that you can treat pain with morphine shows that pain just is a morphine shortage.
try saying something like this to someone who believes or needs to believe that bipolar disorder is a chemical imbalance, and you will just get rejected with extreme dogmatic insistence. no it just is a fact. but that you believe it the way a christian loves jesus doesn't show it's true.
honestly i think that sexual orientation probably has extremely complex or chaotic origins, including i would think the nature of one's early sexual experiences, what sort of person one comes to associate with orgasm. but saying that is dangerous: it indicates that we could manipulate people into heterosexuality etc; it hints at a kind of genocide or something. it hints that if we want our kids to be het we should keep them away from gay people at all costs. basic acknowledgment of the full humanity and basic rights of gay people may be well-served by 'born that way.' but that doesn't make it true.
there might be a hundred-year scientific consensus that depression is a chemical imbalance. but then, one might notice that much of the research is actually paid for by people who manufacture chemicals. and after it's over it might be entirely obvious that the claim was vague, ill-formed, and...wrong. that doesn't mean science doesn't converge on it for decades. to say that scientists are subject to social consensus, economic context, peer pressure, the models under which they were educated, etc is an understatement. well, there will be a new social consensus in 2045, and science will explore and explain the useful or consensus notion as the objective truth. it's happened many times, and will happen many more.
once upon a time i had a student named alex, one of the more problematic in my career as a teacher. i taught him in several classes from his first to last semester, which was a year ago. he usually showed up full of enthusiasm for the first couple of classes, then disappeared for weeks or months on end, then desperately tried to get the work done the last week or whatever. bright as hell, albeit the only student i ever saw drinking a beer in class.
he initially did the disciple thing a bit, was all about my books and blog etc. but he went off me because i was way too depressing and pessimistic. he cultivated optimism as a religion and became an aficionado of the ray kurzweil singularity thesis, which i hadn't previously heard of. he spent a few hours in my office trying to persuade me, indeed proving the whole thing mathematically: some moore's law-type argument, mustering all the greatest advances in human history into an accelerating pattern of amazing and inevitable progress. not only were we, in particular he, going to live forever, but when we achieved immortality we'd immediately realize that war and environmental destruction were non-optimal. in other words, if we could make it to 2035, we would be living in heaven. forever. it would be perverse or crazy, he said, to disagree with people as smart and informed as these singularity dudes.
he was disappointed that i just kept rolling my eyes, kept saying i doubt it, and kept saying i am just not the sort of person who can believe something like that, being profoundly disaffected, cynical, etc. i kept telling him that the people who were going to be doing all this were, unfortunately, people, and that it could be expected to be a disaster, whether or not it was immortality. he was extremely disappointed by my irrationality.
the singularity was an argument, in alex's hands, for smoking, drinking, and doing drugs: soon it wouldn't matter what you were doing to yourself. the dickinsonian, unforgivably, does not give causes of death. but i assume alex died of an overdose. of optimism.
thought i might do a little rap on 12-step programs.
now first off, let me say that i got sober in aa in 1990, stayed sober until 2003 or so, relapsed for a few years, and then got sober without aa (sobriety date 1.1.08). aa got my dad off booze in the last years of his life, and na got my brother jim off heroin/cocaine. no program could help my brother adam, who died of an overdose while out from rehab for a court date.
there is one reason above all that the 12-step model is compelling: it was designed by alcoholics: people who actually knew from inside what addiction is, not doctors or priests or public health officials. every page of the aa "big book" comes from the actual experience of addiction from the inside. and the power of aa, of course, derives largely from the fact that the people in it share this experience.
aa is an amazing organization, for one thing a kind of model of anarchist organization. it has no leaders and no hierarchy. anyone can start an aa group, and "the only requirement for membership is a desire to stop drinking."
the first step - "admitted we were powerless over alcohol and that our lives had become unmanageable" - is actually what allowed me to stop. it is a fundamental 12-step insight that the addict suffers not from too little but from too much willpower, or "self-will run riot." "i can stop anytime i want" is a lie in the service of death; admit you can't stop, just let go, and stopping becomes possible. this is a great paradox, but it is the only thing i've actually seen work. this is also a profound, let's say spiritual insight: letting the world or yourself be is the way to transform it or you.
aa promotes a very dogmatic "disease" model of addiction. at one point the big book refers to alcoholism as an "allergy." this is important for several reasons; it's a treatment for the overwhelming burden of shame which arises from and keeps you drinking. that is, i think the result is more strategic than medical.
the disease model seems, for one thing, to deny personal responsibility for decisions etc, or to deny the role of free will. this, again, is an important strategic moment and connected to "powerlessness," but actually much aa teaching is in direct tension with it. in the twelve steps, taking responsibility is the fulcrum, as in "made a list of all persons we had harmed and became willing to make amends to them all"; "made direct amends to such people wherever possible," etc. you wouldn't take a cancer survivor and tell him that to get better he has to make amends to everyone whom his cancerous condition has harmed. i think the disease model is interesting but inadequate, even from within the aa orientation, but try saying that in an aa meeting.
the question of moral responsibility and free will in addiction, i think, could make philosophers among others think harder about these issues. it is a tremendously complex matter. you can't force yourself to be sober if you're an addict by a sheer choice. on the other hand, without a sense of the moral significance, you wouldn't be trying, basically, and you want to reach a point where you can take responsibility fully even for actions that do not proceed precisely from free decisions. this, briefly, should be used to re-theorize the "free will problem."
the "spiritual dimension of the program" is of course a problem for an atheist like me. the aa conception is wide open, and your higher power can be anything but yourself. it also forms a way of describing the release moment, where you get out of the cycle of forcing yourself to not use, and then using anyway: let go and let god, as they say. and like the theme of service to others, it is a way to try to get the addict out of a narcissistic entrapedness in the self that is the most truly torturous part of addiction.
some aa groups are more open than others, however, and i'd be lying if i didn't say the very-christian orientation of groups i've been in in alabama and central pa wasn't offputting at times. other groups are far more mellow, including those i first got into in nashville. but the religious barrier can be overcome, and any decent aa group is pretty non-dogmatic about any religious orientation or doctrine, which is what the big book teaches.
on the other hand, aa does descend into very rigid doctrine, as in the unquestioning assertion of the disease model ("i'm not a bad person trying to get good; i'm a sick person trying to get well"). what keeps me away from aa meetings as much as anything is sheer repetition: let go and let god; one day at a time: i'm not sure i can even hear these things any more; i've heard them tens of thousands of times. they help, and the repetition helps, especially for "the newcomer," for whom it is best to "keep it simple." on the other hand, my god, and i'd like to go deeper. and a series of slogans is not, by itself, a way of life.
oprah initially defended frey by saying that, though a million little pieces wasn't factually true, it was emotionally true. well, no, it was factually and emotionally false. but if you want to see how one would write something that is at once fiction and sincere autobiography, you could do a lot worse than sitting with rehab, taking notes.