The Myth of Normal 176

Anonymous will speak about “my disease,” as in “My disease wants me dead” or “My disease made me hurt the people I love.” No doubt such programs have helped millions, and the language used is a big part of helping people think and act in new ways. I will only suggest that “disease” is more therapeutically useful as a metaphor rather than a literal fact. As with most chronic conditions, viewing addiction as a dynamic process to be engaged with rather than a demonic force to be feared or battled can ultimately expand the possibilities for healing. For a more grounded take on addiction, we need to consider not just people’s genes or brain circuitry, but also their real encounters with their world. We need to look closely at people’s life experiences.[*] Addictions of any kind are not abnormal ailments, willfully self-inflicted maladies, brain disorders, or genetic short straws. Properly understood, they are not even that puzzling. As with other ostensibly mysterious conditions named in this book, they are rooted in coping mechanisms. To be sure, they may take on some features of disease: a dysfunctional organ, tissue damage particularly with extensive drug use, physical symptoms, impairment of certain brain circuits, cycles of remission and relapse, even death. But to call them “diseases” is to miss both the point and the opportunity to deal with them intelligently. Addictions represent, in their onset, the defenses of an organism against suffering it does not know how to endure. In other words, we are looking at a natural response to unnatural circumstances, an attempt to soothe the pain of injuries incurred in childhood and stresses sustained in adulthood. Two Essential Questions Over my decades of medical practice and thousands of conversations, I have learned that the first question to ask is not what is wrong with an addiction, but what is “right” about it. What benefit is the person deriving from their habit? What does it do for them? What are they getting that they otherwise can’t access? This inquiry is key to understanding any addiction, whether to substances like alcohol, opiates, cocaine, crystal meth, sniffed glue, or junk food, or to behaviors such as gambling, compulsive sexual roving, pornography, or binge eating and purging. Or to power and profit, for that