A little while ago I read an article from the field of medical anthropology, one of the many subjects that I wish I had time to study properly. The article, by Jennifer Cole, began with the following observation:
In some cases, the interpretation and treatment of pain can have a depoliticizing effect, particularly when people interpret the suffering caused by wider social and economic processes as an individual phenomenon.[1]
Cole’s example was nervos, the shaking disease suffered by desperately poor women in Brazilian favelas, for which they blame their own bodies, rather than the harsh economic system that places such strain on those bodies. She contrasted this view with others “in which the sick individual body is interpreted as a sign of disease in the wider social body” (87).
This contrast supplies a useful way to think about addiction. Our culture says: addiction is your disease, so the responsibility for it is on you. We can argue about whether the cause is your genes or your upbringing or your character or your faulty learning or some combination of the above, but the problem is you, not us. That’s an ideological stance, though most Americans would call it “just the way things are,” because that’s how ideology works.
This ideology is pushed hard by the people who profit from addiction, though they’re only part of the picture. Terrified by Prohibition and determined to stave off any recurrence, the alcohol industry worked to shift blame for alcohol abuse off of alcohol and onto drinkers.[2] This strategy found an improbable ally in Alcoholics Anonymous, born of a religious movement that saw all political problems as rooted in individual sin.[3] Between them, they steered public scrutiny away from alcohol and alcohol culture and toward “alcoholics,” or defective individuals.
Their efforts were abetted by a general–and growing–tendency to “privatize” all mental health problems as the dysfunction of individuals, rather than of the system in which they live. Despite the efforts of scholars such as Anne Case and Angus Deaton to link mortality from suicide, alcohol, and drugs to widespread social and economic pressures,[4] most Americans accept the “defective individual” hypothesis without even realizing that there are other ways to look at the problem.
Mark Fisher would have us “reframe the problem.”[5] Writing about the endemic problem of stress, he argues:
Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of stress that has taken place over the last thirty years, we need to ask: how has it become acceptable that so many people, and especially so many young people, are ill?
We should ask the same question about drug and alcohol addiction. When ten to twenty percent of our population depends on drugs to cope with (or make an exit from) life, there is something wrong with our system. Drugs, including alcohol, have been around forever. Widespread addiction, however, is relatively rare. We have to ask systemic questions to figure out why it’s happening now.
Such questions don’t go over too well in the recovery community, in my experience. I can’t tell you how many times I’ve been told that thinking politically about addiction is pointless intellectualizing, a distraction, a defense mechanism. I had a lot of outpatient group therapy a while back, and one of the group leaders used to roll her eyes when I said something about the politics of alcohol abuse. I would have assumed eye-rolling was discouraged in counselor training, but, heck, what do I know? Maybe it’s considered a form of “tough love.”
“Make ‘I’ statements,” the counselor would say.
“I think that having to make ‘I’ statements is political,” I replied once. The counselor led the group in a group scowl.
The most positive response I ever got from an addiction professional could be summarized this way: yes, the politics of alcohol abuse is an interesting topic, but it’s pretty much irrelevant to your sobriety, so you should think about it later. Much later. Sometime between your tenth AA birthday and never.
Here’s the thing, though: thinking systemically helped me get sober, and it helps me stay sober. I didn’t realize, until I allowed myself to think more systemically, how thoroughly I had absorbed the idea that it was all me, me, me—my genes, my history, my habits, my thoughts—and how onerous that burden was. When I shed some of it, the feeling was like that lightness you feel when you’ve had long hair for years and you cut it short. For a few days, your head feels light and free, and you realize that, though you were never aware of it, your hair was actually kind of heavy and prone to get caught in things that you didn’t necessarily want to be attached to.
Let me finish by insisting that thinking systemically doesn’t mean relinquishing responsibility for my behavior. I’m not saying that my problems have never been my fault. I’m not trying to skirt the work necessary to stay sober. I’m “just saying no” to taking all the blame—in fact, I’m saying that making addicts take all the blame is maybe not such a smart idea, given the dismal results of our current treatment strategies, so maybe it’s time to question the value of taking all the blame. In other words, maybe it’s actually more responsible to feel less responsible.
[1] Jennifer Cole, 2004, “Painful Memories: Ritual and the Transformation of Community Trauma,” Culture, Medicine, and Psychiatry, 28, p. 87.
[2] There’s an excellent summary of the industry’s efforts in the American Medical Association’s publication Alcohol Industry 101.
[3] The Oxford Group believed that only individual moral reform, one believer at a time, could bring about political change. For specifics, see the Wikipedia article, which is a pretty good introduction.
[4] Anne Case and Angus Deaton, “Mortality and morbidity in the 21st century,” Brookings Papers on Economic Activity, Thursday, March 21, 2017.
[5] Mark Fisher, Capitalist Realism: Is There No Alternative? Winchester, UK: O Books, 2009, p. 19. PDF available here.