Carl Erik Fisher, 29, a young doctor just starting out in his career, arrives at Bellevue Hospital in Manhattan, a public hospital known for treating the most challenging mental illnesses. However, Fisher was admitted as a patient and locked in a double diagnostic ward after using alcohol and Addingerall to trigger a manic episode. If you walk through his room in the halls, you might think of him as "Nurse Jackie" – a doctor who also has addiction problems of his own.
*Translator's Note
*Adderall is a medication for attention deficit hyperactivity disorder (ADHD).
**Dual diagnosis, also known as co-occurring disorders (COD) or dual pathology, refers to conditions in which both mental illness and substance abuse are present
Nurse Jackie is the main character of the American medical TV series "Nurse Jackie" and a substance abuser.
Carl Erik Fisher: Psychiatrist, bioethicist, and author on addiction. Assistant Professor of Clinical Psychiatry at Columbia University, where he researches and teaches laws, ethics, and policy related to psychiatry, neuroscience, and particularly issues related to substance use disorders and other addictive behaviors. He has worked as a screenwriting consultant for the American Film Academy and as the host of the podcast Flourishing After Addiction, a talk show focused on addiction and recovery.
Fisher's meticulously written new book, The Urge: Our History of Addiction, is his self-description as an alcoholic and professional addiction physician. He has been forced to urinate in a cup in front of a urine tester for several years since he was discharged from the drug rehabilitation center. As he recalled this surreal, embarrassing scene, he began to think about how he (or anyone else) could be better. "As someone who has experienced it firsthand, I know that the addiction treatment system is fragmented. But the reason is puzzling: Why is addiction treatment a completely separate system? Why do we distinguish addiction from all other mental disorders? ”
The book "Desire" ultimately presents more than an addictive memoir. At a time when the "opioid epidemic" is a major crisis, the book presents an individual's journey of reflection on addictive substances and arguments for redefining addiction. Fisher writes: "This is the story of an ancient disease that has destroyed countless lives. Those people include not only addicts, but also those around them. It's also a story about a confusing, complex, and controversial view — one that hasn't been clearly defined for hundreds of years. ”
One of those misconceptions, Fisher writes, is that addiction can somehow be eradicated or corrected. "The primary goal should not be to defeat or cure addiction." Fisher writes, "Rather, it mitigates the injury and helps people live with it without torture — in other words, rehabilitation." ”
The body of the book is just over 300 pages long, and the anecdotes and details are compressed into tightly intertwined illustrations. In the first chapter, Fisher describes one of his patients: a woman who is determined to quit drinking but is addicted to drinking vanilla extract. He then brings up the earliest known case of addiction: the sanskrit hymn Rig Veda, the story of a gambler who tries to quit gambling before meeting the saint Augustine*. He also mentioned his first "magical" beer and the etymology of the word "addiction."
*Translator's Note
This refers to the hymn "The Gambler's Lament", which recounts a gambler's confession for indulging in the game of dice, from the tenth book of the Pear Veda.
Desire: A History of Our Addiction
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Published by Penguin Press
Fisher takes the reader into resonant scenes, intertwining historical moments in his own memory. Reading that when he was forced to inhale secondhand smoke in his parents' car on his journey to the Jersey Shore, you almost wanted to open the window for a breath of fresh air. This scene comes on the heels of a brief description of the punishment of European tobacco users* in the 17th century – an example of an xenophobic, intimidating ban on tobacco that is not actually linked to the medical harms of tobacco. Intimidation, then and now, cannot stop addiction. In fact, Fisher notes that during the reign of Murad IV in the 17th century, even the death penalty could not prevent soldiers from hiding their pipes in their sleeves and secretly taking a sip.
*Translator's Note
King James VI of Scotland and I of England published "Against Tobacco" in 1604 against the introduction of tobacco to Europe by American immigrants.
Thanks to many previous achievements, Fisher is now a practicing clinical psychiatrist and a professor at Columbia University. Rather than sifting through interviews with researchers or archives, he recounted stories about drugs that we had heard, including Thomas De Quincey (an English Romantic writer who is an essential figure in all books on opium), Benjamin Rash (the founding father of the United States, one of the first to define addiction as a disease), alcoholics Anonymous Anonymous, an international mutual alcohol rehab organization), Narco (a large prison hospital and treatment center in Kentucky, U.S.), and Synano (a cult-like group that laid the framework for exploitation in drug rehabilitation centers). Some of the sources used by Fisher are clear, and some are still to be examined.
The language of the book is light, but it is not too lively. Fisher's insights are very unique, especially about alcohol. For example, he called the Mohican missionary Samson Occom "well ahead of his time" because he associated alcohol with the oppression of Native Americans in the 18th century. Combining prohibition and helping each other is what many Native American leaders emphasize as community healing—a principle of Alcoholics Anonymous and other peer support groups today. This look back also helped Fisher recognize his own family's history of addiction. Subsequently, when he was forcibly admitted to a drug rehab and attended feedback sessions, he began to appreciate the ideas that underpinned the workings of these groups: a common group and support from people who understood addiction, because they also had first-hand experiences.
Sometimes Desire seems to focus too much on nuances. Fisher explained that he avoids using stigmatizing language like "addict" or "junckie." He also avoids common terms such as "non-medical drugs" and uses "recreational drugs" to refer to substances used outside of medical authorization. (Fisher argues that this definition is misleading in historical terms, because people had been drunk and entertained long before modern medicine came along.) ）
- John Holcroft -
Taken together, these reinforce his central thesis: according to a growing consensus, addiction does not stem from moral corruption, nor is it a simple disease caused primarily by brain problems. Fisher redefines that addiction is more than just the effect of substances on the brain. Addiction is narrowly defined as a disease or a biological phenomenon that cannot encompass its effects in other dimensions (e.g., mental and psychological). He went on to write that current treatment also does not see rehabilitation as a "continuous process of positive change." And it's not just about making symptoms stop coming back. More importantly, he argues, "drug use is not synonymous with addiction, and criminalizing drug use is not a rational measure to reduce the harm of drugs." In fact, this is often the main factor in the harm. ”
These arguments are compelling. Although the U.S. crackdown on drug use ended in a disastrous failure, the United States continued to take such punitive measures to combat substance abuse. But this approach is not necessary: drug use is not necessarily so lethal. While some argue that treatment is a step in the right direction, Fisher argues that treatment has shaped the system of treating addiction by diverting attention from the oppression of racial discrimination and mass incarceration. (While the role of redefining addiction is unclear, Fisher said he will prioritize policies and approaches that recognize drug use and addiction as part of life, and focus on measures to reduce their harm.) ）
If Fisher hadn't had his own experience, these grand historical concepts, from prohibitionism to the latest rehabilitation research, would have fallen apart. I don't want to go back to the story of what happened to him in his small fifth-floor apartment in New York after he was discharged from the hospital,* against his doctor's will. While this is shocking, it is not surprising. Subsequently, Fisher realized that his "treatment" at the time was not the norm: as a clinician, he witnessed too many incidents of arrested patients not being able to access life-saving drugs. He realized that if he wasn't a "white man living in manhattan's upscale neighborhood," he could also be imprisoned or shot.
*Translator's Note
According to NPR, Fisher was asked to leave the apartment by the New York City Police Department (NYPD).
- Laurent Hrybyk -
The point of this book is not about guiding advice on policy (although there are some), nor is it a way to narrow the gap between those in need (in the terms of a mitigatingist*) and their needs, and to meet all their needs.
*Translator's Note
Harm reduction refers to a series of public health policies that reduce the negative impact of behaviors on society or the body, without requiring withdrawal. Common measures include needle exchange, drug substitution therapy, etc.
This is also the best part of the book Desire. Fisher didn't pretend to know how to treat addiction. In his narrative, addiction has always existed in the way people "crave freedom" and cope with pain. He was rigorous, but he didn't have the sense of preaching. He has abstained from alcohol, but admits that prohibition does not apply to everyone.
In one chapter, Fisher uses a great deal of scientific literature on addiction despite warnings from authorities. "The drug rehab counselors told me that it would be very dangerous to scrutinize the science of addiction — they said my illness might cause me to misinterpret this information and deny the truth — but I still wanted to know more." He wrote, "I wanted to understand how research could help me recognize who I am and who I will become." ”
If his narrative seems to lead the reader somewhere, it must be something most lacking in the discussion about drugs: curiosity.
God is now a small investigation