Many of us who have a loved one struggling with a substance addiction or are struggling ourselves with one have turned our experiences over and over in our minds trying to understand this complicated, frustrating, frightening, seemingly inscrutable affliction. Carl Erik Fisher has as well: about his parents’ alcoholism, and then about his own surprising descent into substance addiction. But this book is not about his personal experience, although it shifts back and forth through the chapters to his own battle with alcohol and other drugs. Fisher has not unraveled the tangled web of this disease — and even questions calling it a disease in the first place – instead, he provides us the opportunity to get a much-needed perspective on addiction as a component of the human experience. Carl Erik Fisher’s The Urge: Our History of Addiction is a very worthy addition to the many books written on this age-old, confounding, and complicated disease. Many books have come out recently that look at the current opioid crisis (Beth Macy’s Dopesick, Timothy McMahan King’s Addiction Nation, or Chris McGreal’s American Overdose, to name a few), but The Urge provides both the wide-angle view of a survey through history as well as a more closeup look at the personal experience of substance addiction.
Fisher is a clinician and educator, maintaining a private psychiatry practice in “complementary and integrative approaches to treating addiction” (yes, he calls it addiction…) and assistant professor at Columbia University’s Division of Law, Ethics, and Psychiatry. It is an often-repeated cliché that “addiction doesn’t discriminate” and Fisher is an example of that: addiction plunged this highly educated and accomplished doctor into the depths of confusion and desperation that is a hallmark of this disease. But while the disease doesn’t discriminate, society does and Fisher notes that, as a doctor, he had access to compassionate care and encouragement, which is not available to most who are afflicted. He writes about how the addiction treatment system has evolved through history, and that even today in America it remains tragically broken.
In his introduction Fisher sets the tone by explaining that he found most compelling the view of the “broadest-thinking and most creative scholars;” those who moved beyond the medical approach to addiction and sought understanding through the lenses of ancient philosophy, theology, and even sociology. Those of us with direct experience of addiction might be gratified in his approach which rests on his conviction “that medical science alone, while important, was insufficient for understanding addiction.” “Insufficient” – yes, that resonates. The opioid epidemic has devastated so many of our lives (and will continue to do so for the near future, unfortunately) and seems to be as anomalous as it is overwhelming in the magnitude of suffering it has caused. But it is not an anomaly, in fact. Fisher writes that “addiction” has always plagued humanity and epidemics of varying severities, involving various substances, have besieged us with “dismaying regularity for more than half a millennium.” Thus, Fisher opens a new door and invites the reader to enter into the vault of history to learn more about this affliction that seems so emblematic of modern life but isn’t, well not entirely.
Addiction has been with us before we even called it addiction. Fisher traces the ways mankind has written about the phenomenon of addiction through ancient Chinese and Hindu texts, to the Ancient Greek description of “akrasia” (a condition in which we do something we know we shouldn’t do, that we know will cause self-harm, but that we can’t not do in that moment). Yes, that resonates. He points out that Plato’s eventually saw it as an issue of self-control resulting from a “divided and conflicted self.” He tells us about historical figures who have suffered: Alexander III of Macedon, or Cleopatra’s Marcus Antonius, until he arrives at St. Augustine whose Confessions so eloquently and accurately capture the interior dynamic of that divided, conflicted self: “Give me chastity and continence, but not yet.” It resonates. Fisher explains that Augustine’s self-examination was an effort to understand this “deeply human phenomenon” which led hum to an understanding that this particular kind of suffering was not “discrete from other forms of human suffering.” Centuries have passed, addiction has remained with us, and unfortunately, we have forgotten what Augustine could teach us about it.
Fisher traces the many movements and organizations that have tried to address addictions of various kinds. He also notes the ways addictive substances were forced on groups of people in an effort to profit from their dependence in the same way that today’s Opioid Epidemic was caused by nothing less than corporate greed. Some readers might be surprised to know that the idea of addiction as a disease is not new nor is what we today call “medication assisted treatment.” (He warns against a “reductionist” approach to addiction, especially in the overemphasis on addiction as a biological disease.) And so, throughout history, we have tried to deal with the phenomenon of addiction and for the most part have failed. Certainly, mutual assistance organizations like AA or NA have been and continue to be a great help to those seeking recovery. Seeking his own path to recovery, he reflects on finally coming to “get a taste of the relief” he heard AA members talk about, “the feeling of being held by the earth and by something larger than [himself], something that could help [him] make sense of suffering and be of purpose in the world.” Oh yes, many of us would call this the spiritual healing only our Higher Power can provide. He acknowledges this just as he acknowledges that today’s medication assisted treatments have their place. But neither is quite enough, and this is the important take-away from this book which tells not only the historical story of human addiction through the ages, but also weaves Fisher’s own very personal struggle with his own substance addiction and the stories of some his patients. Addiction is complicated and often quite mystifying. But it is not anomalous, but rather, as Fisher says, at any given time through history epidemics of substance addiction have emerged from a variety of causations: iatrogenically (caused by medical treatment), a result of social, economic, and/or racial inequities, the oppression of a vulnerable group, or greed for profit (the addicted are repeat customers), or political forces. Fisher gives a sense of how complex the forces behind these epidemics are, and how complex recovery is as well.
Ultimately, The Urge helps readers gain perspective. For those of us who are yearning to understand the tragic and confounding affliction our loved one is suffering, or for those of us suffering it directly ourselves, this book can give us a much-needed perspective that helps dispel stigma. Knowledge is power, as we often hear, and it is particularly important in the case of addiction.
Fisher ends his book with this:
“This is what the history has been trying to say all along. Addiction is profoundly ordinary: a way of being with the pleasures and pains of life, and just one manifestation of the central human task of working with suffering. If addiction is part of humanity, then, it is not a problem to solve. We will not end addiction, but we must find ways of working with it: ways that are sometimes gentle, and sometimes vigorous, but never warlike, because it is futile to wage war on our own nature.”
This book provides the gift of perspective. What might happen if we adopted a new, more informed perspective on this disease? What if we began to see it as if through a wide-angle lens and begin to understand how this affliction fits in with the rest of human experience – from perspectives that are personal, yes, but also historical, cultural, social, as well as biological. The Urge helps us not only gain perspective, but perhaps begin to change our perspective, and if enough of us do that, maybe we have a chance of coping with this affliction in a way that truly promotes understanding, healing, and maybe even, as Fisher suggests, human flourishing.
Melinda D. Papaccio, MA, ITSC
21 August 2022
