email page print pageAll Topic Reviews
"Are You There Alone?""How Come Boys Get to Keep Their Noses?""My Madness Saved Me"10% Happier365 Days49 Up56 UpA Beautiful MindA Beautiful MindA Beautiful MindA Book of ReasonsA Can of MadnessA Child's Life and Other StoriesA Dangerous LiaisonA Fight to BeA First-Rate MadnessA Good Enough DaughterA Heartbreaking Work of Staggering GeniusA Lethal InheritanceA Lethal InheritanceA Life ShakenA Life Worth LivingA Little PregnantA Message from JakieA Million Little PiecesA Numerate LifeA Pocket History of Sex in the Twentieth CenturyA Slant of SunA Special EducationA Tribe ApartAbout FaceAddicted Like MeADHD & MeAEIOUAgainst Medical AdviceAgents in My BrainAileen - Life and Death of a Serial KillerAlgernon, Charlie and IAll Out!All Seasons PassAlphavilleAlways Too Much And Never EnoughAlzheimer'sAn Anthropologist on MarsAn EducationAn Unquiet MindAngela's AshesAngelheadAnna Freud: A BiographyAnnie's GhostsAnother Bullshit Night in Suck CityAnthology of a Crazy LadyApples and OrangesApproaching NeverlandAre You There, Vodka? It's Me, ChelseaAs I Live and BreatheAs Nature Made HimAt Home in the Heart of AppalachiaAt the End of WordsAvalancheBad BoyBad GirlBeautiful BoyBeautiful WreckBecoming AnnaBen Behind His VoicesBequest and BetrayalBereftBertrand RussellBlackoutBlanketsBloodlettingBodies in Motion and at RestBoneBorn on a Blue DayBoyBoy AloneBoyleBrain on FireBreaking ApartBreaking the SilenceBrokenBulimics on BulimiaBuzzCamus and SartreCharles DarwinChasing the HighCheeverCherryCity of OneCluesClumsyComfortComplications Compulsive ActsConfessions of a Cereal EaterConfessions of a Former ChildConfessions of a Grieving ChristianConfessions of the Other MotherConfidingConquering the Beast WithinContesting ChildhoodCrackedCrazyCry Depression, Celebrate RecoveryDamned to EternityDancing at the Shame PromDante's CureDaughter of the Queen of ShebaDavid Sedaris Live at Carnegie HallDays With My FatherDefeating the VoicesDementia Caregivers Share Their StoriesDepression and NarrativeDescartesDetourDevil in the DetailsDiagnosis: SchizophreniaDirty DetailsDirty SecretDivided MindsDivine MadnessDon't Get Too ComfortableDown Came the RainDress Your Family in Corduroy and DenimDrinkingDriving My FatherDrunkardDryEarly Embraces IIIEinsteinEinstein and OppenheimerElectroboyElegy for IrisElijah's CupElliott Smith and the Big NothingElsewhereEnough About YouEpilepticEvery Girl Tells a StoryEverything In Its PlaceExamined LivesExiting NirvanaFaces of Huntington'sFamily BoundFast GirlFearless ConfessionsFind MeFinding Iris ChangFirst Person Accounts of Mental Illness and RecoveryFirst Person PluralFixing My GazeFlanneryFolie a DeuxFor the Love of ItFortress of My YouthFrank Ramsey (1903-1930)Franz KafkaFraudFree RefillsFreudFreudFreudFriedrich NietzscheFrom Joy Division to New OrderFumblingFun HomeFuriously HappyGalileo Get Me Out of HereGirl in Need of a TourniquetGirl Walking BackwardsGirl, InterruptedGirl, InterruptedGirls on the VergeGoing BlindGoing Through Hell Without Help From AboveGraysonGrowing Up JungGuttedHalf a Brain Is EnoughHardcore from the HeartHead CasesHeal & ForgiveHeal & Forgive IIHeavier than HeavenHeinz KohutHeinz KohutHello from Heaven!Hello to All ThatHer HusbandHer Last DeathHigh PriceHole in My LifeHolidays On IceHolidays on IceHope's BoyHouse of Happy EndingsHouse of Happy EndingsHow I Stayed Alive When My Brain Was Trying to Kill MeHow to Lose Friends & Alienate PeopleHow to Make Love Like a Porn Starhow to stop timeHumeHunger Makes Me a Modern GirlHurry Down SunshineI Feel Bad About My NeckI Never Promised You a Rose GardenI Remain in DarknessI'd Rather Eat ChocolateI'd Rather LaughIf I Die Before I WakeImagining RobertIn Search of FatimaIn the Realms of the UnrealIn the Wake of SuicideInside TherapyInternInvisible No MoreIt Happened to NancyIt Takes a Worried ManJack Cole and Plastic ManJean-Paul SartreJohn Stuart MillJourneys with the Black DogJust CheckingKafkaKantLa SierraLab GirlLast Flight OutLearning to FallLet Me Make It GoodLife As We Know ItLife InterruptedLife ReimaginedLimboLincoln's MelancholyListening in the Silence, Seeing in the DarkLittle PeopleLive For Your Listening PleasureLive Through ThisLiving in the Shadow of the Freud FamilyLiving With SchizophreniaLiving with SchizophreniaLockeLonelyLong ShotLook Me in the EyeLooking for The StrangerLoose GirlLosing Mum and PupLosing My MindLove Is a Mix TapeLove SickLove Times ThreeLove Works Like ThisLove You, Mean ItLuckyLudwig WittgensteinLyingMad HouseMad PrideMadame ProustMadnessMagical ThinkingMalignant SadnessManicMarcel ProustMarcus AureliusMary BarnesMaverick MindMe Talk Pretty One DayMeaningMelanie KleinMemoirMemoirs of an Addicted BrainMemoirs of My Nervous IllnessMen-ipulationMisconceptionsMiss American PieMockingbird YearsMomma and the Meaning of LifeMommies Who DrinkMonkey MindMore, Now, AgainMortificationMy Age of AnxietyMy Body PoliticMy Brain Tumour AdventuresMy DepressionMy Father's HeartMy First Cousin Once RemovedMy Flesh and BloodMy Horizontal LifeMy Life Among the Serial KillersMy Sister LifeMy Stroke of InsightName All the AnimalsNeural MisfireNietzscheNietzsche: The Man and His PhilosophyNinety DaysNo Hurry to Get HomeNo Impact ManNo More ShavesNolaNotebooks 1951-1959NothingOdd Girl Speaks OutOedipus WreckedOf Spirits & MadnessOn Being RapedOn the Edge of DarknessOn the MoveOne Hour in ParisOne Hundred DaysOphelia SpeaksPagan TimePassing for NormalPeople Who Eat DarknessPerfect ChaosPerfect ExamplePermanent Present TensePersepolisPlanet of the BlindPlaying with FirePlease Don't Kill the FreshmanPoisoned LovePollockPOPismPortraits of Huntington'sPoster ChildProzac DiaryPsychiatrist on the RoadPsychosis in the FamilyPuppy Chow Is Better Than ProzacQuitting the Nairobi TrioRaising BlazeReasons to Stay AliveRebuiltRecovered, Not CuredRelative StrangerRescuing JeffreyRestricted AccessRevengeRewind, Replay, RepeatRichard RortyRiding the Bus With My SisterRobert Lowell, Setting the River on FireRoom For JRosemaryRough MagicRunning After AntelopeRunning with ScissorsScattershotSchizophreniaSchopenhauerSecond OpinionsSectionedSeeing EzraSeeing the CrabSet the Boy FreeSex & Single GirlsSex ObjectShakespeareShe Bets Her LifeShe Got Up Off the CouchShut the DoorSickenedSilencing the VoicesSimone de BeauvoirSinging in the FireSkin GameSlackjawSlut!SmashedSome Assembly RequiredSome Kind of GeniusSometimes Madness Is WisdomSongs from the Black ChairSongs of the Gorilla NationSoren KierkegaardSpeak to MeSpeaking Our Minds: Revised EditionSpecial SiblingsSpentStandbyStick FigureStill LivesStretchSunset StorySurviving OpheliaSwing LowTales from Both Sides of the BrainTales of PsychotherapyTalk to HerTell Me Everything You Don't RememberTellingTelling Tales About DementiaThe Accidental BillionairesThe AddictThe Anatomy of HopeThe Anti-Romantic ChildThe Bastard on the Couch CDThe BeastThe Bell JarThe Best Seat in the HouseThe Big FixThe Body SilentThe Boy on the Green BicycleThe Boy Who Loved WindowsThe Buddha & The BorderlineThe Burn JournalsThe Camera My Mother Gave MeThe Cancer Monologue ProjectThe Center Cannot HoldThe Chelsea WhistleThe Churkendoose AnthologyThe Day the Voices StoppedThe Devil WithinThe DisappearanceThe Discomfort ZoneThe Doctor Is InThe Eden ExpressThe Family SilverThe Farm Colonies: Caring for New York City's Mentally Ill In Long Island's State HospitalsThe Fasting GirlThe First Man-Made ManThe First TimeThe Geography of BlissThe Glass CastleThe Good DoctorsThe Hillside Diary and Other WritingsThe Incantations of Daniel JohnstonThe Last AsylumThe Last Good FreudianThe Last Time I Wore a DressThe Liars' ClubThe Lives and Loves of Daisy and Violet HiltonThe Lives They Left BehindThe LobotomistThe Long GoodbyeThe Looked After Kid: Memoirs from a Children's HomeThe Loony-Bin TripThe Madness of Our LivesThe Making of a PhilosopherThe Making of Friedrich NietzscheThe Man Who Couldn't EatThe Man Who Shocked the WorldThe Man Who Tasted ShapesThe Marvelous Hairy GirlsThe Maximum Security Book ClubThe Me in the MirrorThe Memory PalaceThe Mercy PapersThe Mistress's DaughterThe Naked Bird WatcherThe Naked Lady Who Stood on Her HeadThe Night of the GunThe Noonday DemonThe Notebook GirlsThe NursesThe Only Girl in the CarThe Orchid ThiefThe Other HollywoodThe OutsiderThe Philosopher's Autobiography The Philosophical Breakfast ClubThe Philosophical IThe Pits and the PendulumThe Pornographer's GriefThe Private Memoirs and Confessions of a Justified Sinner The Professor and the MadmanThe Psychopath TestThe Quiet RoomThe Red DevilThe Rescue of Belle and SundanceThe Ride TogetherThe Rules of the TunnelThe Secret of LifeThe Shaking Woman or A History of My NervesThe Shared HeartThe Shiniest JewelThe Siren's DanceThe Statistical Life of MeThe Story of My FatherThe Strange Case of Hellish NellThe Summer of a DormouseThe SurrenderThe Talking CureThe Thought that CountsThe Three of UsThe Undoing ProjectThe Vagina MonologuesThe Velveteen FatherThe Winter of Our DisconnectThe Woman Who Walked into the SeaThe Years of Silence are PastThe Yellow HouseThe Yipping TigerThick As ThievesThinThis Close to HappyThomas S. SzaszTiger, TigerTits, Ass, and Real EstateTo Redeem One Person Is to Redeem the WorldTo Walk on EggshellsTransforming MadnessTrue CompassTruth & BeautyTruth Comes in BlowsTuesdays with MorrieTweakTwitch and ShoutUltimate JudgementUndercurrentsUnholy GhostUnlikelyVoices of AlcoholismVoices Of Alzheimer'sVoices of CaregivingVoices of RecoveryVoluntary MadnessWaiting for DaisyWar FareWashing My Life AwayWastedWaveWe're Not MonstersWeather Reports from the Autism FrontWeekends at BellevueWhat Did I Do Last Night?What Goes UpWhat I Learned in Medical SchoolWhat's Normal?When a Crocodile Eats the SunWhen Breath Becomes AirWhen Do I Get My Shoelaces Back?.....When It Gets DarkWhen the Piano StopsWhen You Are Engulfed in FlamesWhere Did It All Go Right?Where is the Mango Princess?Where the Roots Reach for WaterWhile the City SleptWhile They SleptWho Was Jacques Derrida?Why I'm Like ThisWildWill's ChoiceWinnicottWinnieWish I Could Be ThereWith Their EyesWomen Living with Self-InjuryWomen, Body, IllnessWrestling with the AngelYou Must Be DreamingYour Voice in My HeadZeldaZor
Kyle Keegan became a heroin addict as a young adult and messed up his life, at the same time as repeatedly lying to his parents, breaking his promises, stealing, and even totaling his mother's car. He went into detox and rehab many times, and relapsed nearly as many, but eventually he recovered. His story ends with him married with a baby and a life full of promise. In Chasing the High, with the help of psychiatrist Howard Moss, he sets out his experience in the context of the modern scientific understanding of addiction. It has the standard views one would expect: addiction is a brain disease; some people have a genetic predisposition to addiction; the risk of addiction is increased by some social circumstances; addiction is sometimes associated with other mental disorders such as depression or bipolar disorder; addiction is a livelong disease for which there is no cure; addicts need to get treatment, and are unable to end their self-destructive behavior on their own. At the end of the book, Keegan explains in broad terms the different kinds of available treatment, and there is a list of frequently asked questions with answers at the end of the book.
The sorts of views Keegan advocates are very similar to those promulgated by US government agencies, especially the National Institute on Drug Abuse, (NIDA) and as those set out in the HBO Addiction series. Yet they are problematic in their rhetoric and for what they leave out. The most jarring piece of rhetoric is the repeated appeal to the term "brain disease." The term brings to mind conditions such as brain cancer, Alzheimer's, Parkinson's, and neurosyphilis, but of course if one is an addict, one does not make an appointment with a neurologist. Addiction is associated with changes in the brain (as shown in the publications of NIDA), and it is certainly true that long term drug use can cause brain damage. It does not follow from this, however, that addiction is itself a brain disease. Indeed, if addiction is a brain disease, why is it not listed in standard lists of brain disorders? (For example, look at the US Department of Health and Human Services list of Brain Diseases or the Australian Brain Foundation's A-Z of Brain Disorders.)
Why indeed does this view insist on using the word disease, when the American Psychiatric Association's classification manual (the DSM) is a list of disorders? The definitions of both these words are not clear, and there's no real way to draw a distinction between them, but disease sounds more serious than disorder. Mental disorders include all sorts of conditions, including depression, anxiety, cognitive developmental delays, personality disorders, and pedophilia. So the motivation in calling a mental disorder a disease is to say "this is really a medical condition, not just a psychological problem or a form of deviancy."
The problem with this sort of special pleading is that it undermines its own message, because it looks like propaganda. Keegan says he was unable to change his behavior before he was in recovery, and gives many examples of incredibly self-destructive behavior. But then he says he made a decision to change, and this led to his recovery. This contradiction is at the heart of all such narratives of addiction depicted as involuntary behavior: it leaves utterly unexplained why the previous resolutions to change did not work, and the final successful one did work, and it makes it a mystery why acts of will to end one's addiction are ineffective at one point, but are effective later.
Furthermore, despite the allegiance to science in this series from the Annenberg Foundation, there is no mention of the success rates of different forms of treatment compared to the recovery rates of people who never go for treatment. At the end of the chapter on "Trying to Get Help," Keegan says "I know from my own experience that effective treatment can get you free of drugs and start teaching you the skills you'll need for the ride that comes next: living your life -- hopefully, the rest of your life -- in recovery." This from a man who went into treatment many times with no success at all. But the more important point is that no testimonial can count as evidence for the effectiveness of treatment. A recent survey of treatments for substance abuse reported, "Many widely practiced methods remain unsupported by scientific evidence, whereas other treatments with strong evidence of efficacy are rarely delivered in practice." (Miller et al, 2006). Another review of evidence-based treatment found that the best treatments were cognitive–behavioral, community reinforcement approach, motivational interviewing, relapse prevention, and social skills training (Miller et al, 2005) This shows that there are treatments that have success, but it does not say what the recovery rates are. The evidence surveyed by Gene Heyman in his recent book Addiction: A Disorder of Choice show that recovery rates for treatment programs are low, and that the recovery rates for people who have not gone into treatment are higher. A recent study of heroin addiction says that little is known about the recovery process, and that the only predictors of recovery in a ten-year follow up of heroin addicts were ethnicity, self-efficacy, and psychological distress -- the treatment programs used by the addicts did not predict recovery. (Hser, 2007).
Any approach that is not open about the scientific evidence regarding the different effectiveness of treatments and the poor prognosis of many condition of addiction risks problems with its credulity. Any approach that ramps up the rhetoric risks further suspicion. However, a more fundamental worry is that the constant emphasis by defenders of the medical model on the idea of addiction as a brain disease is that it may backfire, and convince addicts that they cannot change. Corrigan and Watson (2004) have argued that framing mental illness as a brain disease can be disempowering to people with the disorders, and reinforces beliefs that recovery will not be possible. Furthermore, in the case of addiction, if we tell people that they don't have control over their behavior, they will start to believe us and stop trying to change.
In short then, Chasing the High is a good example of a humanistic application of the medical model, and as such it is problematic. Some of its advice is especially questionable. For example, in the Frequently Asked Questions section at the end, asks: "I drink on the weekends with my friends, and sometimes we smoke pot. But nothing bad has ever happened. Why should I stop?" Keegan and Moss then supply the answer, starting "Because eventually something bad will almost inevitably happen; whether it's something as immediate and serious as a bad car wreck, as seemingly minor as a fight with your boyfriend or girlfriend, or as remote as eventual damage to your body." This sort of puritanical scaremongering is not backed by any evidence. It is true that there is some danger associated with alcohol and marijuana, but that's a far cry from the "almost inevitable" bad consequences the authors specify, and again, it undermines the credibility of the whole book. The Annenburg Foundation Trust at Sunnylands' website says that its aim is "to advance public understanding of and appreciation for democracy and to address serious issues facing the country and the world" and the aim of the Adolescent Mental Health Initiative is to "synthesize and disseminate scientific research on the prevention and treatment of mental disorders in adolescents." Unfortunately, in sponsoring the publication of Chasing the High, they as much engaged in promoting ideology as conveying the results of psychiatric science.
Corrigan, P. and A Watson. "At Issue: Stop the Stigma: Call Mental Illness a Brain Disease" Schizophrenia Bulletin, 30(3):477-479, 2004.
Hser, Yih-Ing "Predicting Long-Term Stable Recovery from Heroin Addiction: Findings from a 33-Year Follow-Up Study, Journal of Addictive Diseases; 2007, Vol. 26 Issue 1, p51-60
Miller, William R., Joan Zweben, Wendy R. Johnson "Evidence-based treatment: Why, what, where, when, and how?," Journal of Substance Abuse Treatment, Volume 29, Issue 4, December 2005, Pages 267-276.
William R. Miller, James L. Sorensen, Jeffrey A. Selzer, Gregory S. Brigham. Disseminating evidence-based practices in substance abuse treatment: A review with suggestions, Journal of Substance Abuse Treatment, Volume 31, Issue 1, July 2006, Pages 25-39.
Link: The Annenberg Foundation Trust at Sunnylands' Adolescent Mental Health Initiative
© 2009 Christian Perring
Christian Perring, Associate Professor of Philosophy, Dowling College, New York.