Addiction Beat

Why we have it all wrong

Conceptualizing Addiction and Mental Illness is No Cinch

A bit of Foucault might help explain why psycho-behavioral disorders confound us

Many have been critical of the new DSM. Psychiatric nosology has long been more controversial, and less amenable to consensus, than its biological counterpart. Often one is asked, for example, whether chronic, excessive drinking is a disease. Many would say that is it. However, when you think about it, what we have identified is, in fact, the behavior – more properly speaking a symptom of what may be an underlying disease. Yet, that answer does not always satisfy: what if someone had this “disease” yet exhibited no symptoms? By what standard can we call this person diseased? In the end, those of us dealing with behavioral afflictions are often haunted by a peculiar reality: is a certain behavior a disease, symptom of a disease, or both? Maybe the best answer is that the behavior is both disease and symptom.

Still, that can’t be right, can it? Our reasoning in that case would be hopelessly circular. Yet even the inebriety theorists of the 19th century struggled with this paradox, unable to escape the need for a kind of circular reasoning still often used today—and we are now in the early 21st century.

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If any reader thinks that I am simply playing word games or logical tricks, please note: this confusion over symptom and disease is far less likely to haunt a strictly biological affliction like the measles.

There is a difference, perhaps not absolute but still poignant, when we try, despite all odds, to make sense of the human soul rather than material reality. The logic of our inquiry will shift, with the very structure of our conceptualization changing with it.

Foucault did a magnificent job of explicating this issue in ways with which few could argue. He pointed out, for example, that one could envision a sociology of sociological practice, or perform a psychology of psychological practice; yet a physics of physics, like a chemistry of chemistry, is simply not feasible. The self-referential nature of what Foucault called the human sciences changes the very structure of our thinking, leaving us with paradoxes that might not haunt the harder sciences (or, if nothing else, the paradoxes are less troublesome). Consider how the sociological study of sociology could, itself, be studied sociologically. Take that same line of thought going inward to the human soul, and a very similar infinite regress can ensue: questions are pushed farther back, into the recesses of the soul—an issue that renown addiction scholar Robin Room discussed when trying to make sense of the notion of “craving” often said to accompany all addictions. Addictions are explained by reference to “craving”, yet this simply gives the phenomenon a name, pushing the purported answer farther back—leaving us with a process that could go on ad infinitum.

Some would argue that all this simply shows that the mental and behavioral diseases we posit are fictitious, though there is no denying the reality of the suffering many experience. How to proceed?

Perhaps some intellectual humility is in order. Care should be placed when employing terms that label anyone, whether we are dealing with a disorder (addict, schizophrenic, delinquent) or simply a finalizing designation (homosexual, heterosexual).

This is certainly not the right forum for a thorough discussion of these conceptual dilemmas. Even if I wrote a whole book on the topic my efforts might justly be viewed as introductory. So I raise some issues we can all ponder, and will leave you with one more thought to consider: I once read somewhere that, at academic conferences, humanities and social science scholars pause and say “um” several times more often than physicists, chemists, and other natural scientists. It could be that Foucault, when trying to unravel the many difficulties that haunt the human sciences, was trying to address a conceptual dilemma that becomes apparent whenever we—scholars of the human condition—pause, scratch our heads, and say “um."

 

Peter Ferentzy, Ph.D., is a research scientist with the Centre for Addiction and Mental Health in Toronto.

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