From: bagg@ellis.uchicago.edu (matthew john baggott)
Subject: Re: LSD and alcoholics posting on usenet
Reply-To: bagg@midway.uchicago.edu
Organization: University of Chicago Computing Organizations
Date: Tue, 29 Dec 1992 18:29:17 GMT

In article <1992Dec27.012019.1@pomona.claremont.edu> cblanc@pomona.claremont.edu (Muffavore) writes:

(I'm going to use this quote as a launching point for some rambling.)

>	You're forgetting that alcoholism is a disease, whether a mental or
>physiological addiction...having a good experience isn't going to affect the
>alcoholic's drinking -- he will still need alcohol to function.

What is the substance of this claim?

When you say something is a disease, you can be making any combination of
several claims.  Some which pop into my mind are:

A sociological claim: a disease is something which is treated by a
certain kind of person (a medical practitioner).

A causal claim: a disease is something which is caused in a certain manner 
(genetic causes, viral causes, environmental causes?).

A moral claim: a disease isn't the moral fault of the disease-bearer.

A claim about the helplessness of the diseased: a disease is something which
the disease-bearer cannot moderate.

A claim about incurability: a disease cannot be cured, only treated.

I have no doubt that others can easily add more claims to this list.  I
don't necessarily believe these claims, BTW.  Here's my main point:
I think it is important to consider that many of our ideas about 'diseases' 
are not medical ones.  Many of them, in fact, say little about the disease 
and more about how it is 'appropriate' for people IN OUR CULTURE to behave 
towards those with diseases.  For example, modern medicine has tried to
move away from the idea that people get sick because they have sinned
(or have otherwise commited a moral transgression).  However, the idea
that people get ill because they did something morally wrong has very
deep roots in human culture.  Thus, while in principle, we don't ascribe 
moral culpability to the bearer of a disease, there are frequently deep 
moralistic undertones to non-technical discussions of disease.

I don't want to discuss these non-medical aspects of disease too much, but
I would like to point out how much more controversial this all becomes when
one begins to discuss addiction (whether as a disease or not).  I think
much of this comes from the place recreational drugs have in our larger
culture.  Drug addiction is, according to the stereotype, a problem of
the poor.  As such, the ways in which we understand addiction are closely 
connected to issues such as poverty and crime (which are also problems
which we think of as originating in the ghetto).
  
For my part, I think that the prevailing ideology in this country creates a 
bias towards analyzing events on the level of individuals which, in turn, 
warps our understanding of systematic problems.  I tend to think that
addiction isn't a problem which can be fully understood if one frames it
as a problem with people.  To effectively reduce addiction, I think you 
would have to address the larger economic and systematic forces
which (I feel) create an environment which supports chronic pathological
behavior.  On the other hand, I realize that my conception of the problem
is motivated by my desire to reduce human misery.  People with different
goals will understand the problem in a different manner.  (However, I
tend to feel that an understanding of addiction which lets you manipulate
the phenomenon is probably on the right track.  This observation could
be expanded into an argument against current treatment modalities.)

One thing which I like about the above approach to addiction is that it
avoids making a category mistake about addiction.  I get the term 'category
mistake' from Gilbert Ryle who made a famous criticism of his contemporaries'
understanding of mind.  He argued that it was a mistake to think that 'mind'
was a thing or object and that this 'category mistake' was responsible for
many further problems in trying to understand the mind.  I would be
concerned that discussions about addiction as a disease might have
similar tendencies.  As it stands, we don't really know why some people
become addicts while others remain controlled users.  Addiction is, on
the surface, a complex set of behaviors.  That's really all we can say
with certainty; all else is hypothesis.  And these hypotheses will be
deeply influenced by one's goals in understanding addiction.  We
shouldn't expect a final definition for alcoholism.

So, anyone who want to discuss addiction as a disease is welcome to
do so, but it would help immensely to explicitly state the specific hypotheses
one wants to support.

ramblin' I got ramblin all on my mind...

Newsgroups: alt.drugs