An Existential Phenomenology of Addiction

Anna Westin

• Editorial: Bloomsbury Academic
• Año: 2020
• ISBN:
  9781350114234
• Edición: 1
• Categoría: Filosofía
• Categoría: Fenomenología en filosofía

Existential phenomenology can be a particularly helpful philosophical method for understanding human experience. Starting from the perspective of the subject, it can clarify and problematize subtle everyday relations, enabling greater insight into difficult situations. Used by contemporary philosophers as a way of understanding the embodied experience of illness, this method has been helpful for understanding physical illness in the medical humanities, offering a fruitful way of reading the subjectivity of mental states. An Existential Phenomenology of Addiction examines how the experience of addiction engages both mental and physical phenomena within the existence of a particular human life, using the philosophy of Emmanuel Lévinas and Søren Kierkegaard. The book maps out an existential phenomenology of subject-in-relation. Both Lévinas and Kierkegaard use decidedly psychological and theological language to situate their philosophy, discussing the subject through concepts of love, otherness, responsibility and hope, while played out in a situation of anxiety, suffering, desire and revelation. Combining existential phenomenological discourse with contemporary addiction discourse, Westin argues that the concept of subject as 'addict', as found in the Twelve Steps Program and disease models of addiction, ought to be replaced with the free and relational identity of subject as 'addicted'.

Part One

1

Existing discourses on addiction

Addiction is deeply interconnected with how we engage in the world around us. In Ringwald’s account of addiction, he draws on the story of a New Yorker named John. John recalls his experience of addiction, stating: ‘I was always in pain. The drugs stopped working and I was left with me’ (2002: 1). There are generally two ways of looking at addiction. Either the person is an addict, or the person has an addiction. The classifier reflects an understanding of the role of addiction on the identity of the subject. People often use the two terms interchangeably, but I will argue that philosophically speaking, it is important to distinguish between the two. This is because each provides a different account of the interaction between addiction and human experience. Either the addiction experience is the permanent primary relation of an individual’s human experience or the experience can be changeable, and is secondary in defining human experience. It is the difference between saying ‘I am an addict’ and ‘I have an addiction’. In this chapter, I will attempt to explain this distinction between being an addict and having an addiction through surveying the addiction literature. This chapter will therefore provide the situation for the discourse to unfold. This requires looking at what characterizes this relation between addiction and the subject, while accounting for the loss of freedom and questions of responsibility that highlight the addiction experience.

Previously I have suggested that addiction is a part of the human experience. In order to explore this, I need to look at how different theories of addiction reflect particular ways of understanding what it is to be human. Before I can ask how the existential phenomenology of Lévinas and Kierkegaard helps us to understand these experiences, I will therefore need to look at some of the existing theories of addiction. I will not be able to provide an outline of all viewpoints in this discourse, but I will examine how the past views of addiction have shaped contemporary discourse. In order to clarify this conversation, I will divide the discussion on addiction into three general categories of discussion: addiction as physiological, addiction as psychological and addiction as relational.¹ I am aware that there may be overlaps between each category, and will explain the reasoning behind these distinguishers as the chapter progresses.

I An evolving concept: The history of addiction

Addiction discourse generally includes a specific set of relations.² In this book, I will mostly examine the addicted person from the point of view of the subject, with an occasional recourse to seeing the addicted person as other. The healthcare professional and other carers will generally be understood in terms of the other, as will any mention of God. Anticipating the philosophical language of Lévinas and Kierkegaard, I will use the subject to refer to a single person, and the other to reference a person other than the human subject. Aside from these relations, I will examine the addicted person’s relation to the object of addiction, as a non-human other. I am aware of the complexity surrounding the term person in bioethical literature,³ but will here assume that the person is a human being with a psychological and physical self, and a capacity to relate. This will be further developed through Lévinas and Kierkegaard’s understanding of the subject in subsequent chapters.

Before we look any further at how we want to figure out the philosophical significance of addiction, it is important to know how the term has been used. Recorded experiences similar to what we now refer to as addiction have been found in early accounts of human history (Cook 2006: 9).⁴ Over time, views on addiction have changed. Theories of addiction dating before the middle of the nineteenth century predominantly defined it as a moral or spiritual deficit: being addicted was equated with lacking in a moral character. The addicted person lacked the necessary willpower and self-control necessary to behave in a morally and righteously virtuous manner (McKim and Hancock 2013: 92). The subject is blamed for choosing a destructive behaviour that could have been avoided.⁵ Currently identified as the moral model, the perspective states that ‘addictive behaviour, whatever its differences from ordinary behaviour, is sufficiently under the control of the agent for him or her to be held responsible of it’ (Levy 2011: 89). That is, addictive behaviour is just another form of behaviour that is ‘normal (enough)’. It is the goal rather than the behaviour itself that differs (89).

However, it is tricky to classify addictions as immoral when some of the contributions that substances give a self could be linked to her own understanding of self-flourishing. Seen from this perspective, the status of virtue could be viewed quite arbitrarily. For instance, the poor women drinking gin could be classified as being morally corrupted, while the distinguished opium-eating poets could be seen as courageously authentic. This suggests that there is an ambiguity in defining addiction as essentially ‘immoral’, aside from context and social status. This moral model also raises another question: what if the person chooses to be addicted? Addiction could be seen as an authentic choice that enables the self to develop as a creative or as a successful business person. As illustrated through accounts such as Thomas deQuincey’s Confessions of an Opium-Eater, it seems that some behaviours that could be classified as addictive (he cites opium) can also be linked to the development of creativity, etc. (2009). Framing addiction morally may be an easy default, but it may be problematic when looking at the complexity of why people are in some instances choosing particular behaviours.

The second common conception of addiction, the disease model, developed as a response to the moralism of the former model. In the early 1900s, with the emergence of new humanitarian movements and the development of medicine and psychology there was a widespread push to move beyond defining addiction as morally corrupt and chosen behaviour to defining addiction as a disease (McKim and Hancock 2013: 92). As new diseases were discovered and explored, addiction was understood in a similar way. It started out as a hypothetical understanding of addiction, but became more definitive as time went on (Orford 1995: 2).⁶ The shift from moralism to disease was significant, because it moved the addicted person from a classification of ‘moral corruption’ meriting punishment to an ill member of society.

This theory was later embraced through the establishment of the Twelve Steps Alcoholics Anonymous movement in the middle part of the twentieth century (McKim and Hancock 2013: 92). Schalow illustrates the intricacies of developing this ‘first program for treating addiction’ (2017: 26), which he suggests contains an implicit self-questioning characteristic to the phenomenological method. But founder Bill Wilson was no philosopher; he was ‘a man of unremarkable qualifications’, a stockbroker, who along with Dr. Robert Smith, developed the Twelve Steps that involved an honest self-recognition of helplessness, and the need for the other’s help in getting through. These steps then formed the core of the Alcoholics Anonymous community, which later branched into other anonymous Twelve Steps groups, bringing addiction from an isolated moral failing, into the context of a community of peers with a similar experience.

Though officially AA does not align itself with any one definition of addiction, it usually invokes the disease model as a way of distinguishing addiction from moral failing and individual responsibility. Yet usually understanding something medically under the ‘social construction of disease’ brings the treatment into the realm of medical professionals (Murphy 2015: 8). This can be helpful in terms of taking it away from moralism’s limitations, but can also raise problems when ‘issues previously seen as “natural” or nonclinical’ are studied as medical cases (8). As Orford identifies, another challenge of the disease model is that there are different views on what is seen as addictive behaviour, and thereby what is classified under the disease. The classifications fluctuate even among researchers. For instance, whereas addiction traditionally relates to the triad of drugs, alcohol and sex, some researchers wish to expand this definition to include gambling and food behaviours (1995: 3).⁷ Defining addiction as a disease is also challenging when it comes to assessing whether it is a chronic, relapsing or temporary experience. When quantitative analyses suggest that most people ‘mature out’ of addictive behaviours, the compulsion that defines the disease is put into question (see, for instance, Pickard 2012: 40).

It used to be that the disease model was seen in contrast to the moral model, but as we can see from its problematic definition, it actually seems to contain moral claims within it. Helplessness is just medicalized. As the sociological work of addictions experts such as Jennifer Murphy show, the disease model can be problematic because of how often it uses moralistic language to identify behaviours. Now the moralistic model and the disease model overlap. Whereas the disease model was initially developed to save people from the stigmatizing labels of moral deficiencies, Murphy actually suggests that it ‘promotes the paternalistic⁸ policy of coerced treatment, because the state [carer, etc.] is actually saving sick people from themselves’ (2015: 47). This once again shows that there is a difficulty in defining addiction. There are different distinctions that have been made, such as, on what it is to be addicted, what it is to have an addiction and what it means to have had and no longer have an addiction. This short overview already shows that there are two ways of looking at it predominantly that are still being used. These two models show the complexity of understanding whether someone is an addict or is addicted. I will come back to the moral model and the disease model. However, there is more to be said about addiction. In the next section, therefore, I will look at a few contemporary examples of different perspectives contributing to the discourse.

II Addiction as physiological

Examining the history of addiction, we can see how moral and disease models developed as particular ways of addressing what it is to be addicted. Researchers still debate over what ought to be classified as addiction, though most embrace a definition that encompasses ‘both substance and “process”, or behavioural addictions’ (Katehakis 2016: 74). The literature points to how this discourse is developed in a particular way, through addressing addiction physiologically, psychologically and relationally.

Let me explain a bit more about this threefold distinction in addiction literature. First, I have suggested that one of the ways that addiction can be explained is through human physiology. I have used this term to encapsulate perspectives on addiction that focus on the biological structures of the body.⁹ Recent neurobiological research has also brought a new angle on addiction, by highlighting the importance of brain physiology in this process. Understanding the different physiological approaches will therefore show how the physical body mechanisms interact in addiction. Second, addiction can be understood in terms of psychology. Researchers such as Jim Orford have contributed significantly to what is known about addiction through examining how it affects a person’s psychological wellbeing. Third, I will examine the relational dimension of addiction.¹⁰ The rise of sociological studies on addiction populations, the role of stigma and the presence of others in the addicted person’s experience suggest that relation plays a significant role. It also raises the challenge of understanding the similarities and differences in relating to another human versus relating to the object of addiction, and whether there is space in addiction discourse for the concept of a Higher Power, or God.

In the next section, I will examine how addiction is understood physiologically. Looking at addiction physiologically means that it is understood and treated through its effects on the body. Physiologically, we can look at how addiction engages the brain and other parts of the body to bring about particular behaviours. Treating the body’s physiological structures is then paramount in addressing the addictive behaviours. However, this theory is particularly tricky, because there is so much going on in a human’s physiology. One perspective that is currently enjoying significant status in the discussions is scientific research on the effect of addiction on brain structures. Here, the physiology of the brain takes centre stage. According to this perspective, the brain is ‘critical to our identity, the organ of individuality and mind that gives us our unique thoughts, personality and behaviour’ (Kagan 2006, qt. in Carter and Hall 2012: 1). The structures and mechanisms of the brain therefore become central in defining and understanding how to treat addiction. Often addiction has been referred to as a process in which the brain is ‘hijacked’ by a substance. The addicted person’s brain processes are overwhelmed to a point whereby he or she lacks the capacity for responsible control and choice over a specific behaviour (Pickard and Pearce 2012: 1, 6). In this situation, an addicted person cannot have responsibility for their behaviours because he or she lacks the preliminary agency of control. According to this theory, if someone were addicted to alcohol, she or he would have little choice but to drink to excess.

Looking at the physiology of addiction, other researchers such as Marc Lewis have pointed to the role of learning in the brain. Drawing on research about the neuroplasticity of brain structures, Lewis suggests that addiction is learned and engrained as a particularly salient habit. So addiction is explained in terms of physiology, but this physiology is one that is adaptable and changing. He writes that ‘addiction may be a frightful, devastating and insidious process of change in our habits and our synaptic pattern. But that does not make it a disease’ (2015: 44), citing how the limbic structures of motivation are engaged in the addictive process (45). For instance, the amygda...