9 Questions with Dr. Carl Fisher, author of The Urge, on the disease model, addiction supply industries, the difference between faith and hope, and the history and future of recovery
Tess thank you for pulling all these out. So deeply appreciated. Perhaps substack will do that? I use Instapaper which lets me save and keep notes/make highlights most articles. Love you. Thank you again for this
My biggest takes aways from this interview are 1) the concept of writing a proud history and 2) faith instead of hope. Writing a proud history is not a new idea - I have written letters to my future self before for example - but a "proud history" feels more profound. I am still going through the "worst year of my life" and I'm really struggling, writing a proud history of this time feels like it might be just the thing, or something, that I could do to lay some bricks on my path through this.
Pema Chödrön talks about hope as attachment. Dante wrote "abandon all hope ye who enter here" on the sign that stands at the entrance to the gates of hell in his Divine Comedy. It took me a while to accept this concept but I stuck with it and I get it now. Hope whiffs of desperation, pleading, hopelessness, attachment, victim. It is an awful, far more familiar place than I would like to admit. Tweaking the dial to faith feels held, supported and encouraged. Faith makes me feel like I can trust myself and the universe I live in. Faith feels like light in the dark whereas hope feels like darkness waiting for light to come and save it.
I love this Caitlin. I love imagining a proud history of how we take care of each other and ourselves and I think that's where we are headed. This is such a beautiful way to navigate the nuance of hope vs. faith. this past year has been a pledge of "this is enough" right here right now, abandoning hope for a different life so I can pay attention to this one. Speaking of dante did you read the way of integrity? Did we talk about this?
I think that this "a proud history of how we take care of each other and ourselves" is where so many of us are already and its wobbly and unpaved. I find myself constantly fishing myself out of what I have known so I can return myself into what I KNOW know. What I Know know feels so true and strong and also completely intangible and illusive - all the better not to grasp on to - but holy hell I find myself screaming out for solid ground some days. If even just for one feckin' day. But there is no solid ground. There never was. I'm just more aware of it than I have ever been. I think it's the same for a lot of us.
The cool part about this, of course, is that the proud history of which we speak is now more possible than ever. All the old structures are falling down and there is not a damn thing that anyone can do about it. Which is good. Great. Miraculous. And fucking scary.
And yes, when I pay attention to right now, it is always enough. It is always ok. It could always be worse. Even in the "worst" situations. I spent the last two nights in the hospital with my daughter. She has a confluence of kidney infection, flu, ovarian cyst and her period. She was so sick. AND she was breathing. We were in a hospital. She was being monitored. She was on a drip with heavy antibiotics. I was able to convince/scare the night nurse into allowing me to stay with her in her room over night. You know? In every moment, even though it was scary and NOT what I would ever wish for, we were ok. Now we are home and she's all cute and cuddly and cracking jokes again. She is actually the master of Faith and letting shit go. She came in that way.
And finally, yes I have read The Way of Integrity, multiple times. I had to put it down, a lot, the first time I read it. It was so painful to see how deep in the Dark Woods I had gotten myself and how much more vulnerable I would need to be to get through. Martha Beck was my heaven sent psychopomp and the reason I called the ep that I released last year PSYCHOPOMP DEMOS. The Way of Intergrity came right at the beginning of "the worst year" and is still guiding me through. Let's talk about it sometime.
Holly, I really loved this interview with Dr Fisher and I knew I would because his book is both profound and concerning in so many ways. I will have to re-read this a few times and reflect further but this quote is really what stood out for me, “ I have faith that humans can change, that we can recover, and we can work for meaningful change in our communities.” The conversation about the notion/term of alcoholism as disease is one that I’m not sure where I land on. As someone new to recovery, I am thankful that my treatment is covered by insurance which is likely due to it being coined as a disease. On the other hand, the stigma that it creates as “other” is hard to swallow. I appreciate what Dr Fisher said regarding that anyone is susceptible to addiction and I need to ponder that a while longer. On the face, I agree, given access to substance/behavior, lack of other coping skills, stress; that feels fair. I think it’s a pretty radical notion though and one that most may disagree with. Thank you for the thought provoking interview!
I love this. Regarding this: "The conversation about the notion/term of alcoholism as disease is one that I’m not sure where I land on. As someone new to recovery, I am thankful that my treatment is covered by insurance which is likely due to it being coined as a disease. On the other hand, the stigma that it creates as “other” is hard to swallow." when i see this, I go back two steps to the why; why does it have to qualify as x to get care. I fully understand what you are saying; recognition of disease means money, care, validity, research, even sympathy. Extremely complex.
So so so much good stuff in this interview. Let's just stop and appreciate for a moment a doctor, a psychiatrist speaking candidly about his own personal experience with addiction, as well as offering, from his own inside baseball perspective as a medical professional: "Even more importantly, treatment is only one part of the puzzle—medicine alone is insufficient to respond to the challenge of addiction." Medicine alone is insufficient to respond to the challenge of addiction. That feels like a huge statement. And also in writing the book: "The scope and enormity of the problem is soothing to me." Me too!!! And YES to, instead of framing addiction as a special kind of sickness, seeing it as an everyday human problem. What is so interesting to me: with all the completely limiting, unhelpful, and noxious ways humans have framed the phenomenon of addiction over thousands of years, this marrying of the American ideal of hyper-individualism with viewing addiction as a brain disease/lack of willpower seems to be the epitome of an extremely corrosive, shaming, and damaging framing of the whole issue, perpetuating so much suffering on top of suffering - thus the issue of needing to "undo" so much of our thinking around all of this. To include another reference to Buddhism - we've gotten ourselves into a kind of "Hell Realm" with the way we've come to think of it, and kudos to Dr. Fisher for lighting a lamp to highlight all the nuance and complexity surrounding addiction and offering faith that there is another way to come at all of this.
"The scope and enormity of the problem is soothing to me." I didn't even process that but lol yes. That is so specific. Thanks for this entire comment and pulling out those things.
I really appreciated this take on addiction, and ending with exquisite compassion for one’s self to reduce harm one self and others is impactful and fills me with love. 💕
Highly thought provoking and I too will need to ponder and re-read. American hyper individualism is part of it , but capitalism itself is founded on ‘insourcing’ profits and ‘outsourcing’ the social, health and environmental costs of making those profits. This is the ‘free’ market in action and why we are facing catastrophe on several fronts - climate, well-being, peace.
No but I will! Same thing came to mind when listening to your podcast on the issue of the medicalisation (= monetisation) of addiction. Capitalism exploits the feature/bug through amplifying it and appearing to offer a solution to it.
I enjoyed reading the interview. I too have been confused about why the disease model feels bad. I like thinking about it as one aspect of the bigger picture. It always felt like an excuse to me and disregarded the fact that anyone can become addicted. The idea of connecting addiction to suffering and recognizes that (most) everyone experiences some level of suffering really speaks to me. Looking forward to listening to the podcast on Wednesday. Thank you Holly.
The last part of the interview reminded me of one of my favorite reflections on hope by Vaclav Havel - "hope is an orientation of the spirit". I learned of it at my first post-college job. I worked at an AIDS service org and my boss would often include an excerpt in her remarks at our events... I think she had seen it taped to the refrigerator of a friend who died of AIDS:
". . . [T]he kind of hope I often think about (especially in situations that are particularly hopeless, such as prison) I understand above all as a state of mind, not a state of the world. Either we have hope within us, or we don’t. . . . Hope is not prognostication. It is an orientation of the spirit, an orientation of the heart... Hope, in this deep and powerful sense, is not the same as joy that things are going well, or willingness to invest in enterprises that are obviously headed for early success, but rather an ability to work for something because it is good, not just because it stands a chance to succeed. The more unpromising the situation in which we demonstrate hope, the deeper that hope is. Hope is not the same thing as optimism. It is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out. In short, I think that the deepest and most important form of hope, the only one that can keep us above water and urge us to good works, and the only true source of the breathtaking dimension of the human spirit and its efforts, is something we get, as it were, from ‘elsewhere.’ It is also this hope, above all, that gives us the strength to live and continually to try new things, even in conditions that seem as hopeless as ours do, here and now.”
Alex I love this. In Arlen Hamilton's book she says her mom said something like, the seed never sees the petal; this reminds me of that. It's a beautiful reflection and a reminder that hope means so many different things to so many different people. Can't wait to hear what you think of the audio portion!
I so loved this interview. I have had his book since it came out, but thesis writing has taken over. I am going to have to etch some time out to start it this week because I love what he has to say so far. Thank you so much for sharing Holly!
I save all mail from you. Why isn’t is possible to highlight in newsletters?!? Or am I missing something?
A few of the gems:
… unless you are completely free from suffering, you have some addiction in you.
… to realize I’m not sick in some extraordinary way.
… They are not interested in the issue of addiction as a problem of sickness or disorder, but as an everyday human problem
I have faith that humans can change, that we can recover, and we can work for meaningful change in our communities.
We can do tremendous good just by working on stopping harm to ourselves and to others—it’s a beautiful and noble thing, and it should be celebrated.
Shunryu Suzuki Roshi: “to shine one corner of the world–that is enough. Not the whole world. Just make it clear where you are.”
Tess thank you for pulling all these out. So deeply appreciated. Perhaps substack will do that? I use Instapaper which lets me save and keep notes/make highlights most articles. Love you. Thank you again for this
I will check them out. TY
My biggest takes aways from this interview are 1) the concept of writing a proud history and 2) faith instead of hope. Writing a proud history is not a new idea - I have written letters to my future self before for example - but a "proud history" feels more profound. I am still going through the "worst year of my life" and I'm really struggling, writing a proud history of this time feels like it might be just the thing, or something, that I could do to lay some bricks on my path through this.
Pema Chödrön talks about hope as attachment. Dante wrote "abandon all hope ye who enter here" on the sign that stands at the entrance to the gates of hell in his Divine Comedy. It took me a while to accept this concept but I stuck with it and I get it now. Hope whiffs of desperation, pleading, hopelessness, attachment, victim. It is an awful, far more familiar place than I would like to admit. Tweaking the dial to faith feels held, supported and encouraged. Faith makes me feel like I can trust myself and the universe I live in. Faith feels like light in the dark whereas hope feels like darkness waiting for light to come and save it.
I love this Caitlin. I love imagining a proud history of how we take care of each other and ourselves and I think that's where we are headed. This is such a beautiful way to navigate the nuance of hope vs. faith. this past year has been a pledge of "this is enough" right here right now, abandoning hope for a different life so I can pay attention to this one. Speaking of dante did you read the way of integrity? Did we talk about this?
I think that this "a proud history of how we take care of each other and ourselves" is where so many of us are already and its wobbly and unpaved. I find myself constantly fishing myself out of what I have known so I can return myself into what I KNOW know. What I Know know feels so true and strong and also completely intangible and illusive - all the better not to grasp on to - but holy hell I find myself screaming out for solid ground some days. If even just for one feckin' day. But there is no solid ground. There never was. I'm just more aware of it than I have ever been. I think it's the same for a lot of us.
The cool part about this, of course, is that the proud history of which we speak is now more possible than ever. All the old structures are falling down and there is not a damn thing that anyone can do about it. Which is good. Great. Miraculous. And fucking scary.
And yes, when I pay attention to right now, it is always enough. It is always ok. It could always be worse. Even in the "worst" situations. I spent the last two nights in the hospital with my daughter. She has a confluence of kidney infection, flu, ovarian cyst and her period. She was so sick. AND she was breathing. We were in a hospital. She was being monitored. She was on a drip with heavy antibiotics. I was able to convince/scare the night nurse into allowing me to stay with her in her room over night. You know? In every moment, even though it was scary and NOT what I would ever wish for, we were ok. Now we are home and she's all cute and cuddly and cracking jokes again. She is actually the master of Faith and letting shit go. She came in that way.
And finally, yes I have read The Way of Integrity, multiple times. I had to put it down, a lot, the first time I read it. It was so painful to see how deep in the Dark Woods I had gotten myself and how much more vulnerable I would need to be to get through. Martha Beck was my heaven sent psychopomp and the reason I called the ep that I released last year PSYCHOPOMP DEMOS. The Way of Intergrity came right at the beginning of "the worst year" and is still guiding me through. Let's talk about it sometime.
Holly, I really loved this interview with Dr Fisher and I knew I would because his book is both profound and concerning in so many ways. I will have to re-read this a few times and reflect further but this quote is really what stood out for me, “ I have faith that humans can change, that we can recover, and we can work for meaningful change in our communities.” The conversation about the notion/term of alcoholism as disease is one that I’m not sure where I land on. As someone new to recovery, I am thankful that my treatment is covered by insurance which is likely due to it being coined as a disease. On the other hand, the stigma that it creates as “other” is hard to swallow. I appreciate what Dr Fisher said regarding that anyone is susceptible to addiction and I need to ponder that a while longer. On the face, I agree, given access to substance/behavior, lack of other coping skills, stress; that feels fair. I think it’s a pretty radical notion though and one that most may disagree with. Thank you for the thought provoking interview!
I love this. Regarding this: "The conversation about the notion/term of alcoholism as disease is one that I’m not sure where I land on. As someone new to recovery, I am thankful that my treatment is covered by insurance which is likely due to it being coined as a disease. On the other hand, the stigma that it creates as “other” is hard to swallow." when i see this, I go back two steps to the why; why does it have to qualify as x to get care. I fully understand what you are saying; recognition of disease means money, care, validity, research, even sympathy. Extremely complex.
So so so much good stuff in this interview. Let's just stop and appreciate for a moment a doctor, a psychiatrist speaking candidly about his own personal experience with addiction, as well as offering, from his own inside baseball perspective as a medical professional: "Even more importantly, treatment is only one part of the puzzle—medicine alone is insufficient to respond to the challenge of addiction." Medicine alone is insufficient to respond to the challenge of addiction. That feels like a huge statement. And also in writing the book: "The scope and enormity of the problem is soothing to me." Me too!!! And YES to, instead of framing addiction as a special kind of sickness, seeing it as an everyday human problem. What is so interesting to me: with all the completely limiting, unhelpful, and noxious ways humans have framed the phenomenon of addiction over thousands of years, this marrying of the American ideal of hyper-individualism with viewing addiction as a brain disease/lack of willpower seems to be the epitome of an extremely corrosive, shaming, and damaging framing of the whole issue, perpetuating so much suffering on top of suffering - thus the issue of needing to "undo" so much of our thinking around all of this. To include another reference to Buddhism - we've gotten ourselves into a kind of "Hell Realm" with the way we've come to think of it, and kudos to Dr. Fisher for lighting a lamp to highlight all the nuance and complexity surrounding addiction and offering faith that there is another way to come at all of this.
"The scope and enormity of the problem is soothing to me." I didn't even process that but lol yes. That is so specific. Thanks for this entire comment and pulling out those things.
I really appreciated this take on addiction, and ending with exquisite compassion for one’s self to reduce harm one self and others is impactful and fills me with love. 💕
Me too.
Highly thought provoking and I too will need to ponder and re-read. American hyper individualism is part of it , but capitalism itself is founded on ‘insourcing’ profits and ‘outsourcing’ the social, health and environmental costs of making those profits. This is the ‘free’ market in action and why we are facing catastrophe on several fronts - climate, well-being, peace.
this is an obscure reference based on this thread, BUT, Koa Beck's book White Feminism is so spot on to this comment. Have you read it?
No but I will! Same thing came to mind when listening to your podcast on the issue of the medicalisation (= monetisation) of addiction. Capitalism exploits the feature/bug through amplifying it and appearing to offer a solution to it.
yes! yes.
I enjoyed reading the interview. I too have been confused about why the disease model feels bad. I like thinking about it as one aspect of the bigger picture. It always felt like an excuse to me and disregarded the fact that anyone can become addicted. The idea of connecting addiction to suffering and recognizes that (most) everyone experiences some level of suffering really speaks to me. Looking forward to listening to the podcast on Wednesday. Thank you Holly.
Thanks Andrea <3 I think you'll like the podcast <3
Ordering today! Thanks Holly!
Let me know what you think!
Will do!
This is EXCELLENT! I'm getting this book! The last paragraph especially moved me. Thank you so much. ❤️
The last part of the interview reminded me of one of my favorite reflections on hope by Vaclav Havel - "hope is an orientation of the spirit". I learned of it at my first post-college job. I worked at an AIDS service org and my boss would often include an excerpt in her remarks at our events... I think she had seen it taped to the refrigerator of a friend who died of AIDS:
". . . [T]he kind of hope I often think about (especially in situations that are particularly hopeless, such as prison) I understand above all as a state of mind, not a state of the world. Either we have hope within us, or we don’t. . . . Hope is not prognostication. It is an orientation of the spirit, an orientation of the heart... Hope, in this deep and powerful sense, is not the same as joy that things are going well, or willingness to invest in enterprises that are obviously headed for early success, but rather an ability to work for something because it is good, not just because it stands a chance to succeed. The more unpromising the situation in which we demonstrate hope, the deeper that hope is. Hope is not the same thing as optimism. It is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out. In short, I think that the deepest and most important form of hope, the only one that can keep us above water and urge us to good works, and the only true source of the breathtaking dimension of the human spirit and its efforts, is something we get, as it were, from ‘elsewhere.’ It is also this hope, above all, that gives us the strength to live and continually to try new things, even in conditions that seem as hopeless as ours do, here and now.”
Disturbing the Peace, pp. 181-182
PS: excellent interview - looking forward to the podcast ep. I need to read this book!
Alex I love this. In Arlen Hamilton's book she says her mom said something like, the seed never sees the petal; this reminds me of that. It's a beautiful reflection and a reminder that hope means so many different things to so many different people. Can't wait to hear what you think of the audio portion!
I so loved this interview. I have had his book since it came out, but thesis writing has taken over. I am going to have to etch some time out to start it this week because I love what he has to say so far. Thank you so much for sharing Holly!
I think it's really worth it. The podcast interview as well was super good.
Yes it was!!
oh yay!