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3.93 AVERAGE
3.93 AVERAGE
medium-paced
hopeful
informative
inspiring
medium-paced
Good! When I picked it up I expected it to be more about ancient history (NOT MY FAULT, the cover has ancient Greek-esque art on it), but it really focused on 18th through 21st century America. Still very insightful and I'm happy I finally got around to reading it.
hopeful
informative
reflective
medium-paced
I went into this book thinking it would be a hard read, what with the subject matter and the author's credentials. Instead, I zipped through it, and found myself bringing it up in conversation. This is nonfiction, and it dives into the history of the term "addiction" and what that term means to us as humans, and as Americans, in the past and the present. The author also weaves his own personal stories into the book, which gives it a nice touch and helps the book flow smoothly. I recommend this book to anyone who has been touched by addiction or alcoholism, or to anyone interested in the history of the way addiction has been addressed or handled over the years. It is a surprisingly quick read, and definitely thought provoking.
Informative. On other reviews: The book offers a broad view of addiction taking into account many facets of it. It does not excuse addiction by environmental circumstances, in contrast: it emphasizes individual choices and scopes fo action.
challenging
dark
emotional
hopeful
informative
reflective
sad
medium-paced
"The Urge" is a well rounded overview of how we've viewed, spoken about, treated, and approached addiction as a society and how it effects a personal perspective for those with one through time. My primary experience with addiction is through my own community, family, and studying its effects and how it's affected by the criminal justice system.
Being introduced to the different treatment perspectives and philosophies was an appreciated insight. What I found probably more intriguing was the institutional treatment and the progression of how history framed those who were experiencing addiction. Or, even, if they'd even consider what we would in modern day to be one. The insight to the failings of treatment due to bureaucracy were frustrating as it is unlikely to be sorted out any time soon.
While I appreciate the author sharing his own personal story, I didn't feel like it always was a natural transition between his own biography and the next section. As he already had to address some aspects nonlinear it wasn't always the smoothest brain adjustment. I also wish he had dipped his toes into a little more than the most prominently talked about substance abuses and gave a little more of a nod to those not tied to drugs.
Being introduced to the different treatment perspectives and philosophies was an appreciated insight. What I found probably more intriguing was the institutional treatment and the progression of how history framed those who were experiencing addiction. Or, even, if they'd even consider what we would in modern day to be one. The insight to the failings of treatment due to bureaucracy were frustrating as it is unlikely to be sorted out any time soon.
While I appreciate the author sharing his own personal story, I didn't feel like it always was a natural transition between his own biography and the next section. As he already had to address some aspects nonlinear it wasn't always the smoothest brain adjustment. I also wish he had dipped his toes into a little more than the most prominently talked about substance abuses and gave a little more of a nod to those not tied to drugs.
Addiction is a terrifying breakdown of reason. People struggling with addiction say they want to stop, but, even with the obliterated nasal passages, scarred livers, overdoses, court cases, lost jobs, and lost families, they are confused, incredulous, and above all, afraid. They are afraid because they cannot seem to change, despite the fact that they so often watch themselves, clear-eyed, do the very things they don’t want to do.
Fisher connects that eloquent description of addiction with the Greek word akrasia (“often translated as ‘weakness of the will’”). I’ve never dealt with substance abuse, but that last sentence perfectly captures a significant part of my teenage years and early twenties—it’s exactly the relationship that I, and many other devout Christian boys, had with pornography. At the end of the book, Fisher compares his own alcoholism with his patients who are “struggling with food, work, cheating, power, money, or anger”, seeing these problems as related:
We all suffer from a divided self, and we all have too much confidence in our judgment and our ability to exert power over our environments and ourselves.
Fisher favors a nuanced view of addiction: it has many causes and manifests in many ways and degrees; no single criterion can define the problem and no single solution is right for everyone. (Even the akrasia conception of addiction is not the whole story, he notes: it’s focused on the individual’s subjective perception of internal conflict, but substance use sometimes leads to problematic behavior even in people who feel no desire to change their habits at all.) Among other things, he argues:
- Addiction is not just about physical dependence and withdrawal symptoms; drugs which lack those aspects can still be the subject of dangerous addictions.
It is misleading to draw a boundary between “physical” and “psychological” addiction, especially because that notion has long been used to suggest that a so-called psychological addiction is not a “real” addiction, often to the benefit of market interests and people in power.
- Addiction is not an inevitable biological result of taking particular drugs; a study on war veterans found:
Just shy of 20 percent of the men had been addicted to heroin in Vietnam … but only 1 percent were addicted during their first year back. In other words, 95 percent of people addicted to what was supposedly the most powerful drug in the world had simply stopped using. Over a longer time horizon, no more than 12 percent of the people who had been addicted in Vietnam relapsed at any time in the three years after their return.
- Genetics and environment both play substantial roles in addiction and we should not exaggerate the role of genetics:
heritability of addiction … ranges from about 25 percent to 70 percent
- Taking the disease model of addiction too far can encourage a counterproductive and unjustified fatalism among addicts. But regarding addiction as primarily a moral problem results in useful treatments being ignored, as in the tragic underutilization of methadone and buprenorphine (which can be astonishingly effective) in the US.
The book provides a taxonomy of “four broad approaches that have recurred throughout history” in society’s handling of addiction: “prohibitionist”, “therapeutic”, “reductionist”, and “mutual-help”, and discusses how these have been applied in several so-called drug “epidemics” throughout history (like 18th-century England’s “Gin Craze” and the 19th-century American opioid epidemic). It’s unsurprising to see harsh, moralistic responses in the past, but I was encouraged to see that more compassionate approaches have also been with us for a long time. (In its early years, for example, the prison and treatment center called the United States Narcotics Farm, which opened in Kentucky in 1935, was apparently quite enlightened.)
Ultimately Fisher advocates for a combined approach. Unsurprisingly, he thinks prohibitionism is too influential in the US. He also thinks our healthcare system is too prone to viewing addiction as outside the scope of ordinary mental health care and pushing addicts into a separate addiction treatment system.
One of the most eye-opening things for me in the book was the discussion of how industries that cater to people’s addictions, such as alcohol producers, can have a vested interest in propaganda and legislation that frames substance abuse as a moral failure on the part of a small subset of users, because this hurts their profits less than approaches that might actually lead to a widespread reduction in consumption.
…in the 1980s, industry groups funded organizations like Mothers Against Drunk Driving and Students Against Driving Drunk—groups that focused on individual responsibility and advocated retributive legal penalties rather than the systemic change, such as advertising reform, which was being championed by other consumer protection groups.
(crosspost)
‘The Urge: Our History of Addiction’ by Carl Erik Fisher disappointed me. It certainly is focused telescopically, and thus seemed myopic to me, on a history of the use of the word addiction, basically. His sources are mostly from what has been written in America about addiction. Most of the book is quotes and restatements of documents and articles from science and psychological research papers and academic newspaper/magazine interviews. They reveal social attitudes and sympathies have been the main driving forces in thinking about addiction, which have tainted scientific theories and medical/religious treatments for addictions through hundreds of years. I think the author has a bias to see addiction sympathetically, and it affected his book as well, a case of not seeing the speck in his own eye while pointing out the specks obscuring the vision of other researchers. There ARE a lot of different specks in the atmosphere surrounding addictions, though! I read more than a hundred books a year, and I have thought sometimes I am an addict of reading, probably to escape real life, which might be why some people drink or use drugs to excess, right? Shut up.
I have copied the book blurb:
”Named a Best Book of the Year by The New Yorker and The Boston Globe -An authoritative, illuminating, and deeply humane history of addiction—a phenomenon that remains baffling and deeply misunderstood despite having touched countless lives—by an addiction psychiatrist striving to understand his own family and himself
“Carl Erik Fisher’s The Urge is the best-written and most incisive book I’ve read on the history of addiction. In the midst of an overdose crisis that grows worse by the hour and has vexed America for centuries, Fisher has given us the best prescription of understanding. He seamlessly blends a gripping historical narrative with memoir that doesn’t self-aggrandize; the result is a full-throated argument against blaming people with substance use disorder. The Urge is a propulsive tour de force that is as healing as it is enjoyable to read.” —Beth Macy, author of Dopesick
As a psychiatrist in training fresh from medical school, Carl Erik Fisher found himself face-to-face with an addiction crisis that nearly cost him everything. Desperate to make sense of his condition, he turned to the history of addiction, learning that our society’s current quagmire is only part of a centuries-old struggle to treat addictive behavior. A rich, sweeping account that probes not only medicine and science but also literature, religion, philosophy, and public policy, The Urge introduces us to those who have endeavored to address addiction through the ages and examines the treatments that have produced relief for many people, the author included. Only by reckoning with our history of addiction, Fisher argues, can we light the way forward for those whose lives remain threatened by its hold.The Urge is at once an eye-opening history of ideas, a riveting personal story of addiction and recovery, and a clinician’s urgent call for a more nuanced and compassionate view of one of society’s most intractable challenges.”
This was a non-fiction cozy in my opinion. For instance, the author describes his addiction to alcohol as a problem for him throughout the book because he was often late in showing up at work or remembering where he had been in his off-hours. The biggest mental block he seemingly had to deal with was admitting he was drinking too much alcohol too often that was causing him to be late for work. If he kept showing up late at the hospital for his shifts, or failed any drug tests, he couldn’t be a doctor. He finally permitted himself to be involuntarily committed when he had a couple of days of delusions that scared him and his family and friends. This is seemingly as deep as his bottom was before he finally admitted he was an alcoholic. Maybe it was his bottom because he is an upper-class white guy with a lot of financial and networking privileges while training to be a doctor. What was the bottom for him seems like a mildly wild Spring break to me. At least, this is the impression from what he is willing to reveal in these pages.
The entire book appeared very genteel, keeping the tone at a quiet level. Fisher walks down a very narrow road of explanations and history focused on philosophical/medical ideas pro and con about the changing meaning of and feelings of shame about addiction. The medical or psychological ‘cures’ (apparently cures are very very rare indeed) throughout history reflect either supportive or punitive fixes to the problems of addiction. It is all described in severely censored or obfuscating academic-speak.
The fixes for addiction were dependent more on social/religious mores of whatever decade where solutions were being tried out in approaching the problem of addiction, and nothing else, based on the documentation, papers and articles the author has researched and quoted from. Politics and religion obviously does not make for good science.
I know people really like this book. I liked the history, especially in reading about those decades I personally lived through. There is no question the author is accurate about the history because of the academic sources he has used. I did not have a problem with the author mixing academic information in with his own and others’ personal experiences with addiction. However, because of the genteel high-end philosophical academic manner in which the book is written I felt the author’s was seemingly trying to sooth anxious fears of sensitive readers of his book. The doctor describes how addiction throughout history is defined whenever there is apparently a problem of not being able to stop using drugs or alcohol. But he does so with an airbrushing out of any disturbing details, sticking the landing to pinpoint precision on the meaning of addiction and how political and medical society handled it in academic philosophical ideas. Although he does generally mention addiction is a problem because people are unable to stop taking drugs despite the ongoing degrading of their quality of life, causing terrible shame, he really really really avoids getting into any explicit reasons why people have shame or why being unable to stop despite growing degradation is a problem. From how he has approached writing about the subject of addiction with academic-speak full of euphemisms, apparently to veil the uglier aspects of an addicted person’s life, if one had absolutely no awareness of the fallout from being addicted to drugs and alcohol, it actually could cause an ignorant reader to feel it was silly to be very upset about addiction. Such an ignorant reader would gasp at the brief descriptions of the inadequate and sometimes cruel solutions to force people to stop drinking or using drugs, although censored carefully in description by the author. Of course, the author does describe finally the delusions he had had, publicly acting out under the influence of mixing drugs and alcohol one night, finally an explicit explanation of why he felt shame, although he could not accept that he was an addict at that moment. The ignorant reader might wonder if personal psychotic delusions are the reason drugs and alcohol abuse is bad from what can be gleaned in the book, causing the shame (as well as being late for work too much). But except for being unable to stop using drugs, and that one mention of delusions, and being late for work a lot, there is nothing else in this book about symptoms, or damages, such as the permanent physical effects on the body from long-time abuse of drugs. Or about how relationships are destroyed, or financial stability disappears, or senseless beatings of children and animals occur, and other forms of extreme violence and uncontrolled general mayhem are set loose by drunken sprees which never seem to end for years, particular the horrors of vehicle crashes while driving drunk. I liked the history, but not the genteel airbrushing about the actual effects of alcohol and drugs on people’s lives, using academic-speak about what the fuss is all about if someone is addicted to using drugs and alcohol too much. After all, isn’t it the behavior of people under the influence of alcohol and drugs the first clue that something is wrong? So why avoid describing behaviors which cause concern about an individual in the first place?
The book has photographs and illustrations, as well as extensive Notes and Index sections.
I have copied the book blurb:
”Named a Best Book of the Year by The New Yorker and The Boston Globe -An authoritative, illuminating, and deeply humane history of addiction—a phenomenon that remains baffling and deeply misunderstood despite having touched countless lives—by an addiction psychiatrist striving to understand his own family and himself
“Carl Erik Fisher’s The Urge is the best-written and most incisive book I’ve read on the history of addiction. In the midst of an overdose crisis that grows worse by the hour and has vexed America for centuries, Fisher has given us the best prescription of understanding. He seamlessly blends a gripping historical narrative with memoir that doesn’t self-aggrandize; the result is a full-throated argument against blaming people with substance use disorder. The Urge is a propulsive tour de force that is as healing as it is enjoyable to read.” —Beth Macy, author of Dopesick
As a psychiatrist in training fresh from medical school, Carl Erik Fisher found himself face-to-face with an addiction crisis that nearly cost him everything. Desperate to make sense of his condition, he turned to the history of addiction, learning that our society’s current quagmire is only part of a centuries-old struggle to treat addictive behavior. A rich, sweeping account that probes not only medicine and science but also literature, religion, philosophy, and public policy, The Urge introduces us to those who have endeavored to address addiction through the ages and examines the treatments that have produced relief for many people, the author included. Only by reckoning with our history of addiction, Fisher argues, can we light the way forward for those whose lives remain threatened by its hold.The Urge is at once an eye-opening history of ideas, a riveting personal story of addiction and recovery, and a clinician’s urgent call for a more nuanced and compassionate view of one of society’s most intractable challenges.”
This was a non-fiction cozy in my opinion. For instance, the author describes his addiction to alcohol as a problem for him throughout the book because he was often late in showing up at work or remembering where he had been in his off-hours. The biggest mental block he seemingly had to deal with was admitting he was drinking too much alcohol too often that was causing him to be late for work. If he kept showing up late at the hospital for his shifts, or failed any drug tests, he couldn’t be a doctor. He finally permitted himself to be involuntarily committed when he had a couple of days of delusions that scared him and his family and friends. This is seemingly as deep as his bottom was before he finally admitted he was an alcoholic. Maybe it was his bottom because he is an upper-class white guy with a lot of financial and networking privileges while training to be a doctor. What was the bottom for him seems like a mildly wild Spring break to me. At least, this is the impression from what he is willing to reveal in these pages.
The entire book appeared very genteel, keeping the tone at a quiet level. Fisher walks down a very narrow road of explanations and history focused on philosophical/medical ideas pro and con about the changing meaning of and feelings of shame about addiction. The medical or psychological ‘cures’ (apparently cures are very very rare indeed) throughout history reflect either supportive or punitive fixes to the problems of addiction. It is all described in severely censored or obfuscating academic-speak.
The fixes for addiction were dependent more on social/religious mores of whatever decade where solutions were being tried out in approaching the problem of addiction, and nothing else, based on the documentation, papers and articles the author has researched and quoted from. Politics and religion obviously does not make for good science.
I know people really like this book. I liked the history, especially in reading about those decades I personally lived through. There is no question the author is accurate about the history because of the academic sources he has used. I did not have a problem with the author mixing academic information in with his own and others’ personal experiences with addiction. However, because of the genteel high-end philosophical academic manner in which the book is written I felt the author’s was seemingly trying to sooth anxious fears of sensitive readers of his book. The doctor describes how addiction throughout history is defined whenever there is apparently a problem of not being able to stop using drugs or alcohol. But he does so with an airbrushing out of any disturbing details, sticking the landing to pinpoint precision on the meaning of addiction and how political and medical society handled it in academic philosophical ideas. Although he does generally mention addiction is a problem because people are unable to stop taking drugs despite the ongoing degrading of their quality of life, causing terrible shame, he really really really avoids getting into any explicit reasons why people have shame or why being unable to stop despite growing degradation is a problem. From how he has approached writing about the subject of addiction with academic-speak full of euphemisms, apparently to veil the uglier aspects of an addicted person’s life, if one had absolutely no awareness of the fallout from being addicted to drugs and alcohol, it actually could cause an ignorant reader to feel it was silly to be very upset about addiction. Such an ignorant reader would gasp at the brief descriptions of the inadequate and sometimes cruel solutions to force people to stop drinking or using drugs, although censored carefully in description by the author. Of course, the author does describe finally the delusions he had had, publicly acting out under the influence of mixing drugs and alcohol one night, finally an explicit explanation of why he felt shame, although he could not accept that he was an addict at that moment. The ignorant reader might wonder if personal psychotic delusions are the reason drugs and alcohol abuse is bad from what can be gleaned in the book, causing the shame (as well as being late for work too much). But except for being unable to stop using drugs, and that one mention of delusions, and being late for work a lot, there is nothing else in this book about symptoms, or damages, such as the permanent physical effects on the body from long-time abuse of drugs. Or about how relationships are destroyed, or financial stability disappears, or senseless beatings of children and animals occur, and other forms of extreme violence and uncontrolled general mayhem are set loose by drunken sprees which never seem to end for years, particular the horrors of vehicle crashes while driving drunk. I liked the history, but not the genteel airbrushing about the actual effects of alcohol and drugs on people’s lives, using academic-speak about what the fuss is all about if someone is addicted to using drugs and alcohol too much. After all, isn’t it the behavior of people under the influence of alcohol and drugs the first clue that something is wrong? So why avoid describing behaviors which cause concern about an individual in the first place?
The book has photographs and illustrations, as well as extensive Notes and Index sections.
This memoir/historical blend was informative and engaging, especially as someone who tends to lean away from non-fiction as a whole. If I could change one thing, I would have loved the historical pieces to have been in chronological order. I know this would have massively changed the structure of the book, but I do still find myself wishing.
Overall, the author’s personal experiences with addiction made for powerful additions and I appreciated his awareness/vocalization of the privilege and luck he was afforded on his road to recovery. An expansive read, especially if think you don't have any preconceived notions around additicion.