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tv   Carl Erik Fisher The Urge  CSPAN  April 15, 2022 2:23am-3:28am EDT

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thank you so much for joining us. my name is nell pepper and on behalf of harvard bookstore. i am so pleased to introduce this virtual event with carl eric fisher presenting his new book the urge our history of addiction and conversation with leslie jamison. i hope you're all well and safe. thank you so much for joining us virtually tonight through virtual events like tonight's harvard bookstore continues to bring authors and their work to our community. every week we host events here on our zoom account and upcoming virtual events include nadifa mohammed in conversation with denomin guest do leonard mladenau discussing his new book emotional how feelings shape our thinking and sarah freeman in conversation with emma klein, please check out the event schedule on our website at
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harvard.com. and while you're there you can sign up for our email newsletter for more updates and to browse our bookshelves from home. this evening's discussion will conclude with some time for your questions if you have a question for our speakers at any time during the talk tonight, you can click on the q&a button on your screen and we will get through as many questions as time allows this event also will have closed captioning available depending on the version of zoom that you're using. you may need to enable captions yourself by clicking on the closed caption button on your screen. in the chat. also, i'll be posting a link to purchase copies of the urge on harvard.com as well as a link to donate in support of the series and of our store your purchases and financial contributions make events like tonight's possible and help ensure the future of a landmark independent bookstore in cambridge, and we really appreciate your continued
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support throughout these two bonkers years and and in the past even since since before this this strange time, we thank you for continuing to show up and tune in not only in support of our authors, but also the fantastic staff of booksellers at harvard bookstore. we truly appreciate your support now and always and lastly as you may have experienced in virtual gatherings technical issues may arise we of course hope that they don't but if they do we will do our best to resolve them quickly. thank you so much for your patience and understanding. and now i am pleased to introduce our speakers. carl eric fisher is an addiction physician and bioethicist. he is an assistant professor of clinical psychiatry at columbia university where he works in the division of law ethics and psychiatry. he also maintains a private psychiatry practice focusing on complementary and integrative approaches to treating
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addiction. his writing has appeared in nautilus slate and scientific american mind among among other outlets. leslie jameson is the author of the memoir recovering the essay collections make it scream make it burn and the empathy exams and the novel the gin closet. she is a contributing writer for the new york times magazine and her work has appeared in publications including the atlantic harpers the new york times book review the oxford american and the virginia quarterly review. she directs the graduate nonfiction program at columbia university. tonight they'll be discussing carl eric fisher's upcoming book the urge our history of addiction in this sweeping work karl eric fisher draws on his own experience as a clinician researcher and alcoholic and recovery as he traces the history and experience of addiction via explorations, not only of medicine and science but also of literature religion
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philosophy and public policy. the urge makes evident that our current decades long opioid opioid overdose crisis is only the latest iteration of a centuries long struggle one that has persistently reflected the broader questions of what it means to be human and to care for one another things over to our speakers. the digital podium is yours carl and leslie. thank you now. thanks now. and carl it's so great to be here with you tonight and to get a chance to talk about this tremendous new book which you know is about a subject very near and dear to my heart but really doing something. that i've never seen done before quite like this the the sweep of your gaze and the amount of research and the way in which you distill it and ask us to think about it and hold it in our minds and in our hearts,
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there's like a compassion alongside the rigor of this book that i appreciated the whole way through and and i was really struck and this is one of many things that i wanted to ask you about and by just the kind of synthetic and simultaneously kind of broad and deeply humane gays that the book achieves by virtue of really bringing together at least three pretty distinct perspectives this historical narration your experiences as a clinician, you know, we actually get to see you kind of working with a few particular patients in there struggles with addiction and then this this personal perspective in your own story. and so we're kind of moving between those narrators on the page the clinician the recovering alcoholic the kind of synthesizer of this broad vast history, and there's just something really powerful about getting to see all of those at
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once and and i guess i wanted to start you know, many people here will have some familiarity with this book and and what it covers but for those who do and those who don't i thought it might be useful to just giving a sense of what it holds and to get us there. i thought maybe i'd ask you them. how what do you think is the value of looking at this kind of broad history of addiction? like how can looking at the history of addiction deep in our understanding of addiction and maybe inform our sense of how to approach addiction crises. how does sort of you know this sense of its patterns? it's long sweep and what recurs what it what it what it what is the use of taking that sort of broad historical perspective? okay, great. thank you, leslie and thank you so much for the kind words. it means the world to me really because the recovering and your other work was such an
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inspiration. truly and such a different book and also i think some formal similarities and maybe tonal similarities. so i'm excited to talk about i'm excited to be in conversation with you specifically here. about some of the similar choices you made bringing in history bringing another other voices for me, you know, it proceeded pretty organically. i i was in recovery and i didn't feel like i was in danger once i got to a certain point of stability, but i was still really mystified and didn't have a sense of what had happened to me and naturally, i went to medicine because that's where i was that's what i had been studying and i probably don't need to say this to the audience that chose to come here, but it's very polarized. it's really divisive and even
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within medicine even within science and it seemed hard to find common ground or some sort of like sensible synthesis across different views and the i i really learned from my teachers the way i have in other domains of my life that i saw some of the best thinkers some of the people i admired the most would reach back into history and they they perceived the need to go to say philosophy or to cultural history or to the history of racism and oppression to make sense of a crisis whether it's an individual crisis or a clinical crisis or a sociological crisis, and that that really got me started and me thinking that we get addiction can't be understood in isolation by anyone field and i don't think that there is a synthetic definitive account to be crafted. that's also part of why i
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brought in the personal story is i don't think that there's a way to give the final word or solve addiction in any any way. but to try to represent my own attempt to make sense of it for myself in relationship. to to what i was seeing what i was seeing in clinical work to what i was seeing as i was starting off working in the criminal legal system. and to bring it back rigorously to myself. why does it matter? why does it matter? why does it matter because i i have such this is probably the way that you and i differ i have such a tendency to take it very high level and a little philosophy very ivory tower and i really wanted to fight that because otherwise, what's the point? yeah well and there's a way that the it creates such a meaningful experience for a reader at least
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this reader to to get these glimpses at the the personal experiences that were informing this research so you know you mentioned being in recovery and still feeling this sense of bafflement. not only about maybe addiction itself. but also the the sort of um disagreements polarizations inconsistencies even and how in the in the kinds of treatment you're receiving and i think one of the things i really appreciate about this book is that you're able to be really complex and how you document, you know, the inpatient treatment program that you are part of your you're really willing to give us like some of the things that you found deeply useful and also some of the things that you found problematic and to let both of these things be on the page at once i think is itself sort of perceptually or analytically a way of fighting the kind of black and white all or nothing mentality that can attend to addiction treatment really it
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has to be this way. it has to be that way. so there's a way that we but then to bring that sense of you as like a living human being going through your own version of this crisis to know that all of that personal investment that wellness that vulnerability that that bafflement that i think any of us who have struggled with addiction or been close to struggle with addiction of felt of like i can bring all my intelligence to bear on this thing and it just doesn't totally crack it open and to feel that sort of motivating the research. it's really powerful. and i'm curious, you know, it made so much sense to me when you were talking about the uses of sort of seeing any crisis in its broader historical perspective. and and i was wondering you know, what particular kind of patterns or echoes across centuries you were struck by in your research, you know, when i was reading this book, i was i was really struck by the way that like, you know a mother in william hogarth's jin lane engraving who's kind of like,
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you know failing to attend to her baby as it's like falling out of her arms echoed so powerfully like the way that the narrative of the crack mother was constructed in reagan era america as a kind of really racialized oppressive weapon, but this way that, you know female women who have struggled with addiction have so frequently been figured as you know, terrible mothers failed caregivers irresponsible in a sort of different way than men who struggled with addiction off and are you know, but just seat, but i was so powerfully struck by like jin lane from you know, 18th century. crack mother narrative from the 1980s, but how strong those resonances were across the centuries and so i'm curious if you could just give us a few more instances where you really felt those strong historical echoes and what they helped illuminate for you. yeah, i i want to say at the
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start that the the social phenomena like a moral panic or like a drug epidemic. we're interesting to me and it was also it was a difficult. the analytical and writing challenge to make sense of why i would talk about it in the first place because problems of addiction are not necessarily drug problems and vice versa that we see that in the current crisis that you know, the plenty of people are dying of opiate overdoses. they may not necessarily identify with the label addiction or they might not even have the experience of addiction. they might be a totally casual user who happens to stumble across a poisoned supply so i wanted to be careful to separate out what was important about those crises and what was important about gin lane and what was important about even earlier moral panics around tobacco and how that was associated with like so called native savagery because oftentimes one of the major themes was that our responses to
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drug epidemics reflect. the governing image of addiction and that image like you might like you just said might be conflictual right my admit of many different ideas about addiction and so many points in history simultaneously we've had that sort of oppressive set of stories about the wrong kinds of users and in many cases or ideas about a dictionary just really cover for xenophobia. oppression racism. misogyny patriarchy all that -- and also simultaneously they're the preserves this higher level supposedly compassionate attitude toward addiction. so addiction becomes a sort of like flexible construct that you can deploy, according to your whims and your prejudices and so as i say that, you know some of the other historical examples that come to mind or this division between medical and
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recreational use or medical and non-medical use or medical and luxurious use or whatever depending on the time period you're talking about which stretches back to the english romantics and even earlier and in a way was almost consciously adopted by people like thomas de quincy but not by samuel taylor coleridge in both of them had totally different ideas about what their problems were and i don't think either would call it addiction in the same way that people call that addiction at the turn of the 20th century or today, but the same sorts of divisions persisted and we're put to use in the crackdowns again. supposedly dangerous black cocaine users or supposedly invading chinese opium users or others that really motivated. prohibitionist movement through the 20th century that lasted us to the present day and this gets us back to the what you
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mentioned about. treatment, um because that became important for me to write about because i was seeing even though i had a pretty good experience in treatment. it wasn't perfect and i saw a lot of the problems with today's treatment apparatus. i also saw a simultaneously even in the same rehab it certainly once i went out to become an addiction clinician. i saw the way that those those. policies and the way that oppression was was put to use in the way addiction was used as a weapon in their service the way that that rebounded onto everyone and i don't know. so i guess i might have gotten a little way from your financial question. but okay, i was thinking about what you said before but the good drug bad drug divided i guess is what comes to mind over and over and over again mmm yeah, and and you know, i i really am. with so glad you said what you
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did about having to sort of wrap your mind around what it meant to be writing about moral panics or drug epidemics and in a book about addiction which seems like on on one level. it seems perfectly intuitive right about those things together, but i do think when you start to think hard about it. there are these really tricky questions. that i ended up, you know thinking about it quite a bit as well where it's like, okay, i at least in in my book i wanted so so deeply to honor. the the harms wrought by addiction itself and addiction like on a broad scale and also the harms rot by narratives about the harms that addiction does and and not so much of you know exactly what you're saying about how kind of addiction panic becomes a cover for so many other oppressive social
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forces that are geared towards preserving racial and class hierarchies, and so just sort of try to hold in mind both like addiction. um is a really kind of pernicious and baffling thing and also the ways that we talk about its perniciousness become themselves really toxic and do a lot of damage and how to kind of hold both of those treats at once and i think it's it's wonderful that you have given us this text that can sort of show and analyze those stupidly how those tensions play out over over time how they have played out and and ask you about that actually because you know comes to mind is um first time i think you do tremendous job with it in the recovering i'd probably don't need to say that but i think it's very clear from a very different angle. i was looking back at it earlier this week and and today and i you know, that really became
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clear the that sort of paradox almost of holding those two truths together. that's something i really wrestled with and i was just wondering if there's another thing i wonder if you have response to it in the book or if it was something that you you wondered about yourself, but i i also had this sense that addiction was profoundly real. and and also because of the ways that the concept has been deployed over time recognizing a sort of universality with the rest of human suffering and trying to honor both of those perspectives as well that there are people at the extremes of human behavior. i would consider myself one of them who they have almost like membership in a special little tribe where there's something really unique about that experience about that that's shared experience of powerlessness as people have described it over and over again, not just in step
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traditions, but and other recovery traditions through the years. but then also and i just making sense of the fact that like to me at least addiction is contiguous with the rest of human struggles with will and self-control and making sense of human agency. yeah, i mean it's a great question and and i'll can share a couple thoughts about it, but it also makes me want to read this short passage if it's okay from your book which was to ask you about so connected to that that very question of sort of how to treat addiction as a phenomenon and as an experience in its own, right, but also treat it as kind of connected to and illuminating of a broader experience rather than you know, you you push back really? uh in really necessary ways, think against this.
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binary of like, you know addicted or not addicted as these two completely siled categories and there's this there's this moment on 22 and your book where you say from the beginning the word addiction was not a narrow description of a medical problem, but an immensely rich and complicated term used to gesture toward core mysteries of the human condition. it was not just about drugs but about willingness and agency being someone who chooses and the related timeless puzzle of our seeming inability to control ourselves and and i guess maybe the the broadest and maybe to me most interesting version of the question i want to ask here is like what are the aspects of maybe the more universal aspects of human experience that you feel like a particular gaze that addiction points points us towards like certainly this question of willpower and and agency and what is mean to how much are we in control of our own lives? how much can we choose to be a certain way versus another way? what is actually what is what is
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freedom to what extent is freedom always a delusion, but i'm curious to you sort of say a little bit more like if we are gonna take up this i don't know this prerogative of this perspective of like addiction can show us things that are broader than just this particular experience. we'd call addiction. what what would some of those kind of mysteries of the human condition be for you? yeah, i my mind actually goes to the americanness of some of those stories not because it's uniquely american some of those characteristics of a dictionary were just talking about but because we see it reflected in i think in our reactions to american-ness and our ideas about americanists and over and over again across cultures. i saw people construct and identity around addiction and reaction to addiction against addiction or even for addiction i mentioned thomas to quincy, but then there are also a lot of folks who really found it
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necessary in american culture to define themselves as usually men self-made and you know masters universe and you know that that is commonly a theme is that when when someone's individual addiction you and i were talking offline about the sort of broader fear is about what is addiction threatened but like even individually like people for whom individuality and self-determination a really important. it seems a really threatened by addiction by the notion of addiction by the notion of powerlessness and i wonder might even set the set the dividing line a little sooner than somebody else somebody else might. and we even have some. we even have some cross-cultural data that kind of speaks to this. so we probably have time to go into but like looking people were at catholic versus protestant countries and how they make sense of their alcohol
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problems, but i you know, i think the the university of it is that people do reach a point where whether or not they call it addiction feel out of control? and that seems timeless and how people make sense of that is tremendously diverse, but again like the the phenomenon of it like the phenomenology of it of feeling lost in a drift in that way i think is a is a constant that i don't know is really instructive and in terms of like what it reflects about the prevailing cultural notions about what we value as individuals. between powerlessness and agency plays out inside. it's your describing mix the sort of experience of addiction itself. it plays out in these cultural narratives that say, you know in an american tradition that has completely valorized, you know
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in plenty of toxic ways too kind of like self-control discipline individual agency like, you know, pulling yourself up by your bootstraps is very connected i think both to a certain sense of the kind of fantasy of plasma ability, but also like the fantasy of like dominating agency, you know, and all that kind of focus on discipline will power you know is really is it sort of makes sense that it would villainize on a broad scale substances that seem to like attack those capacities, but there's also this really interesting tension. i think between yeah agency and and powerlessness in in various versions of the recovery process, right because it's like and you talk in really wonderful ways about complicating our notion of the disease model, but i think one of the things that can can feel limited about the disease model. it's like if or always struck me it's like okay if you're gonna take on the disease model, but
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also simultaneously hold that this is a condition that people can do something about in their lives even if you don't pretend to say exactly what that's something is or that it's the same something every time but there is admitting that there's some agency is involved and also powerlessness is involved in any sense of what you know, might look like has to sort of holds both of those at once and i'm i'm wondering um, i want to i see that there are a couple of wonderful questions already in the q&a and i want to encourage people to keep go ahead. you know, we'll talk for a few more minutes, but put your questions in when you have them because i'm sure they're gonna be a lot of wonderful questions and i want to make sure that they all get out there rather than sort of log jamming at the end of the session. so feel free to just pop them up and we'll turn to them soon. and in the meantime, i was curious to ask you a little bit about the decision as a as a writer and a sort of conceiver of what you wanted this book to be to include some of your own
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personal story and i guess both you know, what what made you want to what made you want the book to include that personal dimension? and then how did you go about kind of crafting that part of the book? what kinds of things were you thinking about as you turned your life into narrative because there really is a process of transformation decision making whittling. we can tell the same stories about our lives 10,000 different ways and you choose to tell them a certain way when you put them in a book, so i'm curious sort of what sorts of questions were you thinking about as you put your story into these pages. and then how did you think about the question of like your story kind of woven into these historical narratives? so, how did you think about kind of moments of contact or juxtaposition? yeah, the first question is easier if the first question is easier because i don't have a lot of reading experience frankly and i didn't didn't have a lot of models to go off on the
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craft question, but you know the motivation was multi-faceted it was that i felt that it for me would keep me honest. it would be more honest for me to disclose my own history and why i always doing the project if it was such a dominating. a motivation to make sense of myself, but then i just wrote history. the herb, like maybe made it about my parents but not about myself. i don't know. i don't even know how i would do it. it just didn't make sense to me. it didn't it didn't compute so and like i mentioned before i'm very analytical and like i i i i saw that tendency in me. to just make it intellectualizing. in fact, i i look back at earlier drafts of the book and it struck me that i didn't even put in the personal until much later in the process. and so this is this is answering both questions. i guess that i was writing
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personal narrat as a writing my personal recollections about my addiction history because it was really traumatic the way that i came to treatment was a manic episode with alcohol and adderall and i was completely out of touch with reality and i wrote pages and pages on that and barely any of it got into the book, but i needed to make sense of it and then a real page is in pages about family and very little of that. i mean enough that you get a sense of it, i think but i didn't know how they came together and was really struggling with all these ideas about, you know, maybe this this theme can be threaded through in that way. but you know the bottom line was once i started to get a sense of what the history was saying. of the themes it was probably only when i was about halfway through the book that i got a sense of that recurrence that you're describing that the same themes came up so boldly for me. i don't know that they're universal but like for me that that sort of medical non-medical
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divide that sort of romanticization of drug use and even addiction and the way that oppression rebounds to harm everyone those sorts of ideas came up to regularly then it became easy even in a chronological framework. i just started the beginning and i said, okay, you know what? what was going on earlier in my life that has to do with our that with capitalism and market forces in the way that those influence. drug crises and addiction well early in my life. there was a lot of discussion about tobacco and i saw it really in an outstanding way in both my parents because they were both chainsmokers, but that was that was only the tip of the iceberg and i think back then i knew implicitly but i couldn't have told you explicitly at like age 10 11 12 years old that that was that was only just the most obvious example of their lack of
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control. because the the alcohol was more insidious, but also like a bit more challenging in certain ways. and so i just at that point it came together very rapidly and then it was just a matter of writing the the personal parts. yeah, and it's it's fasting here you talk about that. figuring out which themes or ideas? kind of essential in a certain section or had been sort of generated by the historical material in that section and then using that idea to figure out what was relevant from your what needed to be there of your own personal experience because when you mentioned, you know those pages and pages of writing about the manic episode that brought you into treatment and and only a little bit of that ended up in the book or pages and pages of writing about family and only a little bit of that ended up in the book. it of course made the you know writer-minded me wonder well, what was the process like talk
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us through like, what was the material that ended up feeling like it mattered? and why and why did that? why did those other pages not matter like what when it ended up helping you figure out was essential to include? mmm, well some of it wasn't about addiction really and i had to get back to the central thesis of the book. and yeah, i i think addiction is an enormously complex multifaceted and really important phenomenon that has a lot to teach us, but it's not everything, you know, like their times there are times that i was an -- and i really heard people and i don't think that was addiction in some cases, you know in some cases it was and then i write about it but being very rigorous about like what is actually speaking to the thing that i am trying to figure out so when i am trying to figure out with that not figure out figure out the worst word possible to but when i'm trying to investigate say for example modes of rehabilitation. in this case, like what happened in the 1960s?
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it is weird multiplicity of different treatment modalities that came about and the vacuum left when organized medicine wasn't really doing a lot to treat people with addiction problems. the question there for example was what was happening to me in rehab that i could trace back to the 60s and i had no idea was coming from there. and also i i suspect that most of the treatment providers had no idea found their origins in those times and that actually wound up being the most fruitful way to kind of make sense of my experiences rather than for example, i don't know just writing about the most emotionally rich times because i don't know. they're really emotionally rich times if i just went for the part that bothered me the most of the part that was like the most painful that wasn't even. there wasn't even necessary i guess right right. yeah and there's a yeah there can sometimes just be an overwhelming.
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sense of infinitude when it comes to writing about your own life, but also an overwhelming fear that none of it matters and what's two forms of overwhelm. like there's so much and maybe none of it needs to be there, you know sort of so it can be really fruitful to have almost like a magnet to draw through the the infinity of experience and then the relevant bits can kind of cling on like little magnetic filings or something and okay. i have so many more questions, but i see there's so many questions already and i want to make sure we have time for all of them. so i'm gonna go ahead and start um bringing out some of the questions from the people who are here with us, and and hopefully we've been a few of my own as we keep going and but just to start with audrey wonders earlier we were talking about the kind of reagan air initiative of crack mothers. she says you mentioned the crackhead mom show, are there any portrayals of addiction and literature film and television that are particularly harmful and you think are helpful
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accurate? yeah, so many uh, i so many are harmful. some are helpful. i you know tropes i think are really beautiful and like leslie you've written about cliche and your love for cliche if i remembering that right, but i i think that tropes also are are pointing towards something true at least true at level of our commonly held cultural beliefs if not something real about the actual phenomenon. so one one trope that i think is actually reflective of truth is the the notion of coming together in community to solve a common problem in the dangers of individualism because i saw evidence over and over again of people. really achieving tremendous gains in in community.
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well before 12 step recovery or other mutual help movements in the 20th century. things like the 1840s washingtonians movement or say native american healing circles, which some of which came together explicitly as a response to the to the problem of addiction like i love the way that early. yeah those early traditions made in american recovery. it's really it's it's not known enough that history not at all, and it really affects. i mean it really affects us today. it's it's not just a reflection of all of the different ways. that causes and conditions come together to create drug epidemics. it also is a it's it's a it's part of a legacy of oppression that still has this effect today for sure, but there's only we can see the mirror image because you ask about bad trips, too. there's a trope of the firewater. myth is coming to mind the notion that in this case native americans have some sort of like particular sensitivity or vulnerability and an almost
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deterministic way to alcohol and that sort of brokenness metaphor has come up over and over and over again, and i think you know the crack mothers or the the jin lane stuff is really just like the same idea reflected through the lens of misogyny and i don't know that it's much different that. it's not all that complicated from that angle. there's a different version of the same kind of brokenness idea that i think was put on to other oppressed groups or to just people who use drugs as an impressed group. yeah, i think. yeah, all of all of these are like a board-hazy and garden of forking path or each one is like 16 more questions that i'd love to ask you and thelma who's here and says the way your book is described. it seems to me like the profit himself brought it down. she pre-ordered it good. everybody else here should too.
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however in your book and do you describe solutions or do you characterize it as a circle as an internal one with which a person should try to find the most effective way to cope or do you think one can ever leave this chapter of life behind? great question. so this gets to monocazoteaxophilia. i think which is one of leslie's favorite words, and it's just a love of single simple causes and i talk about a little more in the book and it's almost like a jokey aside, but it also is dead serious and a life or death issue that we have. we have a desire to reach for a single simple cause both in the case of drug epidemics, but also like we were talking about before our responses to the drug epidemics reflector ideas about how to deal with addiction and the pendular swing from simple reductionists answers to clinical and medical answers to mutual help answers without
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stepping back and appreciating the entire landscape of addiction has been a common thread throughout so i do there are these cycles and sometimes a really disheartening and really awful missed opportunities where i could feel it was so close to a compassionate response and understanding to addiction and then we we sort of lose it in in the historical thread but you know to the extent that there is a solution or at least a lesson that i took out of it that was helpful for me in my own journey was the need for thinking across multiple levels, which i think there's so many social and cultural forces conspiring against us in that regard right now and not just i'm not just talking about like social media also like the increasing specialization and commodification of medicine and even the academy overall and so i i think there's actually a great deal of freedom and and acceptance and sort of peacefulness and being able to think of about a complex
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phenomenon like addiction across the physical social mental spiritual communal economic spheres choose your spheres all all together. i don't know if that's even approaching a question and answer to the question, but i appreciate it. it's really it's really good one. yeah, it's one of the most important questions and and i fluently off your tongue mona caused the tax ophelia. i don't know if i've ever tried to say it out loud. i think that's important concept to carry around right like even if it was a bit choking, it's incarnation like that this the to have that we do i think all of us have this sort of love of what if there could be just a single cause that could explain why this is and so often like one of the things that i told my students and writing it's like people, you know, people never do anything for just one reason so they shouldn't do that in your work either. you know when it's you it applies to addiction as well and to the ways we might treat it.
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there are a couple questions here that i might bundle together because i think they're connected. does your book go into the notion of prohibition legalization of drugs or alcohol and also what is your opinion on safe injection sites and other similar treatments? i absolutely so prohibition is one of the big themes just to give people a preview to maybe entice you to pre-order the book from harvard bookstore and support your local bookstore is that i i describe four main social responses to drug scares and drug epidemics and just the notion of addiction altogether and one of those four is prohibitionist. one of those four is the tendency to try to crack down and to regulate drugs often solely through a supply side mechanism and back in the 1920s prohibition for sure. i didn't i don't know if you meant capital p prohibition, which is the constitutional amendment and the outlawing or
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the phenomena on our prohibition. but prohibition is absolutely essential theme in a major lesson, is that prohibition and isolation is just i mean it's caused incalculable harm incalculable harm ever since tobacco rolled across europe and asia after north american colonization and their accounts of people cutting off noses and even seizure of someone's entire property and the death penalty for tobacco at a time in the say the 1500 1600s when nobody had a sense of the health risk. it was all about like associations with savagery. and the wrong source of users back then which just goes to show how ineffective prohibition is, but we have a lot of trouble learning learning that lesson but i also don't think that legalization full. stop is the answer in at least in the sense that there are these other domains that come
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into play that scientific and the clinical and the mutual help and we also have examples of say the modern tobacco industry, which was unchecked and in the absence of adequate regulation or oversight these these addictions supply industries also caused incalculable harm. so it's really challenging but to find a reasonable middle ground in between is really important. and so then somebody asks about safe injection sites also known as supervised consumption sites or overdose prevention sites. i have a simple opinion on that. i think that they're vastly underutilized and they've been happening since the 1980s in europe and even more so they've been happening forever whenever whatever there's been prohibition or crackdowns people have gathered together in community to use drugs together because people use drugs for reasons and also to find ways of helping each other with the
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potential harms of drugs and you know, which for people who don't know overdose prevention sites are a safe supervised facility like in new york city right now where people can get access to sterile supplies and and use drugs such as opioids. where in a place where if they happen to overdose they can get medical help but also it can be a place of connection where people can get peer support and people can get connected to the services. they need not just sort of like strong armed into one model of recovery, hopefully but like getting engaged and provide a real human connection that allows them to do better and there are many many historical analogs throughout the book that you know for the interest of time and respect for the other questioners. i'll just leave it at that, but you know the notion of harm reduction writ large like capital h capital r harm reduction in in terms of like an organizing philosophy is a big is a big theme of the book for sure.
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yeah when you talk about in such necessary ways as you just did in concise form here, so i'm glad for that question and your response and there's a wonderful question from jamie hi, jamie. what was the most surprising or transformative idea you encountered in your research. how did it change your sense of the book? jamie come in with the tough question hi to me good to see you. even if it's just a jg and a little zoom box the there are a lot i couldn't choose and be honest and say it was the most for sure but the one that comes to mind because we've been talking about. the overall scope of the book is the the long tail and the long history of drug epidemics. i had a an outside sense that like, oh there had been problems. yeah grew up in north jersey and
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so in the 80s and 90s, i certainly was would witness to the the scares around crack. and i had a sense that there may be problems in the 70s and 60s and that was motivating some of the more recent drug policy but to see it go back to 1492 and earlier that was really amazing. just amazing to me in the sense of the the perennial struggle against the problems people have with self-control around drugs as well as the the struggles people have with drugs even when it's not necessarily addiction. yeah, and i think yeah, i think so much of the best and most important writing comes from those experiences whether they're personal or intellectual or emotional or some combination of all of the above that are that have that sort of startling revelatory overturning quality because it's part of what enables the book to kind of give
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that to readers that frame shifting as well. and a meats has a few questions and that i think are related or can be spoken to in a related way and how is addiction managed by individuals without pharmacological interventions? can you speak about 12-step programs such as aa are they useful for the majority and then a separate question that possibly connected managing addictions and individual agencies seems to be at cross purposes. how does woolpower power play a part if any great. thank you for these thoughtful questions. i don't want to punt and i don't want to sound too salesy or markety, but i i interviewed kelly, who is a a major psychology researcher who studies aa and is very nuanced and thoughtful about aa and we spent we we did like a good 30 minutes of an interview on this which i'll release my website in about a week or two.
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so i'm gonna punt that because it's just too much to say other than to say to usa programs i think are a tremendous good and have saved so many lives. and in a way our sort of like free lunch that we're not taking in medicine by not. this is john kelly's face the three lunch that we're not establishing like reasonable connections to 12-step programs in a lot of general medicine where people might have a severe substance use problems. when they're looking for that kind of thing and simultaneously they're in a lot of contemporary addiction treatment they in my view a rigid view of aa that's actually strayed quite a bit away from the founders' intention in a sort of compassionate pluralism has has ossified into a one size fits-all model that is often allied with coercion and allied with systems of power and has
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been warped in ways. so it's not a it's both and you know, it's a both end on aa you could talk about aa all all of our lifetimes. it's fascinating phenomena. and what was the other one? i forgot. i'm sorry. i totally forgot that agency and willpower and i think yeah, i mean, i think you you've spoken to it some or what we have a few more. so i want it i want to hit hit them and as you say so many of these questions, which is part of what's great about them and part of its great about this book. could be spoken about for ages and ages and are all themselves arguments and to engage with the book itself and to order it because it's so wonderful in this it's sort of longer treatment of all these incredibly complicated issues. um, so somebody wonders might you recommend any books that you feel are helpful for family members that i books that help
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writers and glean insights in their writing about loving addicts and the family patterns okay, i'm gonna give a very basic clinical one with the caveat that it's not medical advice and there's general information on purpose is only but i before i do that i'm going to ask you leslie if you could give a literary one that is helpful in terms maybe. a novel or some sort of a piece of art that is helpful for people struggling with this type of question. how do i help somebody who's suffering? how do i deal with the issue of? because i have encountered in my own life, but predominantly with my mother which i write about in the book when somebody is struggling with an addiction or another mental health condition. this is such a common problem. what do i actually do? i think one book written by a couple of colleagues is called beyond addiction. it is subtitle is something like how science and kindness help people and it's just a really nice distillation of a therapy called craft which comes out of
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the university of new mexico and is is not at all opposed to tossip programs like al-anon, which can be helpful. alan on is very diverse and you can find different attitudes of different groups. but i think this book beyond addiction is there's just a really nice distillation of some very common questions like how do i establish a healthy boundary without being punishing or? you know what? how do i keep the the person's well-being first when i think about say for example, like withdrawing and allowing negative consequences to happen from you so forth and so on. it's just my it's my number one go-to for people looking for like really practical practical underground questions like that. but leslie did say did you have because i also was thinking about like literary references. i was wondering if you had something. well, you know that the the first one that came to mind is and it's incredibly beautiful beautiful short story by james baldwin called sonny's blues, which is about for those who don't know. i'm sure some people here do but
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it's um, it's about two brothers one of whom struggles with heroin addiction and also an incredibly talented jazz musician, but it's one of the most complicated revelatory and just heartbreaking accounts of just what it feels like to love somebody and to be just baffled by their addiction and so i would i would recommend it to all um, oh my god, there's so many great questions here, and i hope we can get to all of them and this one from from the from much earlier on that. i didn't want to skip over in your estimation. perhaps observation is their correlation pertaining to addiction and being neurodiverse on the spectrum of autism or other disorders like adhd add. yeah, i read about this a little and i wouldn't want to say too much about adhd or autism because i don't have experience with that. i would refer you to my asphalovitz who's who has written about that particularly
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in unbroken brain? but i do write about this brought the i think we're going through a conceptual inflection point in psychiatry where we used to think of disorders as essences. there were things almost like you could hold in your hand and now there's a broader recognition that the notion of mental illness or mental disorders or whatever you want to call them are much more contingent and flexible and continuous and uh, the whole field is really wrestling with how to make sense of this, you know, if there is a continuum, there's no natural cut point that divides so called healthy from so-called disordered then what how do you do that? and that's that's a theme i take in it's the end of chapter 11 that i say that i finally say anything definitive about it, which is like the end of the book. um, but i i think it's a really really important thing to keep in mind because it balances against a tenancy to hold on to
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rigidly to labels and if i have any any sort of broader overarching hope for the book, it's a hit pause on the the sorts of labels that become over-determined and instead to think flexibly across multiple levels and fine points of connection and an integration, but i think there's a lot more that has to be written about that too. frankly because you know, we need people with different experiences. who also have addiction who don't have addiction to to investigate those questions in a in a similar integrative way. it's great to bring my sullivan's name into the conversation too because her work is so wonderful. yeah. okay. well, i think our time for one or two more and one from jane that actually is a great entry maybe also into the question of kind of behavioral addictions, but she asks and can the iphone be considered an addiction. yes. sure. that's that's my immediate question.
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but the reason is i take a more capacious view of addiction. i used to have a pretty tight. this goes along right with our last. question. yeah, i had a pretty tight notion of addiction when i was coming in that it was a specific type of extreme problem associated with substances necessarily and there's so much to learn from the origins of our terms the dance between concept and term is so instructive and particularly the way that addiction the word entered the english language. was so different than the way we think about it today in it was it was a word taking up by protestant theologians precisely because it seemed to get at that gray area between freedom and powerlessness and anything could be you could addict yourself to anything. i had to correct myself there because it wasn't a status. it was an action. i was like a thing. there's a thing you did. it wasn't a thing that happened
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to you, and i don't think that just having a tendency or habit to do something is addicted but the way that those earlier writers would have talked about it. is that anything could be addicted if you devoted it if you devoted yourself to it in a way that took away your will and so that's really i think that's really the key is the first person experience of control, right, right. well, and i think you know one. just thought i just had an iphone thing too. it's just it's just so much. i think anybody who had an iphone or been around anybody that i thought it's like it's a way of it can be a way of managing or avoiding discomfort. right? like if you're made it all uncomfortable by anything or bored or it's just a way of kind of in a very low key way avoiding presence in whatever is happening here and going somewhere else and at least so much of my experience of drinking alcoholically was also about you know avoiding the discomfort of being alive of like being fully conscious in my own skin, but you know that sort of sense of going somewhere else i think is because they're also
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shared. i think let's just do one more and then i think where we'll we'll wrap it up, but it's a great one to end on from judith who is an addiction therapist and looking forward to reading the book. how long had you been in recovery when you started the book and how did writing it impact your recovery process? well, i that i hesitate on that because i started writing about my experiences right as soon as i write as soon as it happened, which was unusual for me because yeah, well, it's not that unusual because i've always journaled a lot, but i was journaling in a very sort of disciplinary and sort of way in part because my parents as good as they were they there are ways that i had to raise myself and so constantly writing lists and trying to be the parent to myself and sort of disciplining myself like led lot of journaling.
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anyway, the what when i went through the manic episode that brought me to bellevue hospital and then got into treatment it was so disorienting and it was so profoundly challenging to the reality that i have. thought i had created about myself the story had written about myself that i needed to write it out and at first i didn't have a sense that i was. writing material for a book and again the point zero one percent of that made it into the book, but it was a process of writing. to make sense of what i really believed and what fell true to me and what felt authentic and coming into contact with my suffering which was such a glancing process of coming slightly closer slightly. just like what leslie what you're saying about the iphone just like slightly closer and then moving away slightly closer turning away through rationalization slightly closer. and so that took years and years
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and years. and so that was so that i mean the simple answer your question is i started immediately and then it took me 10 years to carry that through but then the more the more simple question of like okay when when was really in your mind as a book and one where you're protecting time in your schedule to do that and all the rest that was probably about like not even that is kind of porous. i don't even know if there's a real distinction there. yeah, that's so interesting here and especially another another conversation entirely, but that idea of our disciplinary journaling practice or the origins of journaling is coming from this sort of lists. and the managing of the self is really really interesting to me. so continue to thank you so much for this conversation. and for this book which everybody should order. thank you nell and harvard bookstore for hosting as you guys are great. i can't i've i can't wait to be back with you in person. please support them in the
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meantime bookstores are everything. we're so glad lucky lucky to have them so. thank you so much leslie. i i can't tell you how much it means that just to be here. it's a miracle that we are able to share this time together and to connect in this way all of us together over zoom and you know, you're careful reading and your thoughtful reflection on all those questions. mean, it's just it is a heartbreakingly supportive and i really appreciate it. so thank you for being here tonight pleasure. so much to both of you for this really just enlightening illuminating conversation. thanks to all of you at home for joining us. again. the link is is in the chat you can go to harvard.com and search for the book there again the urge. our history of addiction and yeah, thank you so much to both of you leslie and carl and to all of you have a lovely evening and keep reading andgood evenin.
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my name is where harmon and i'm the executive director of town hall seattle on behalf of our staff our friends at the institute for systems biology and our friends

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