Brain, Mind, Body and the Disease of Addiction
&gt; The slogan that addiction is a chronic disease of the brain is meant to put the addict beyond the reach of moral reproach — and addiction itself squarely into the domain of the medical rather than the moral.<p>&gt; Now, I agree that addicts should be treated with love and compassion instead of judgment and punishment. But what does it say about us if the only way we can muster compassion and love for those among us with substance abuse problems is by suggesting that they are solely bystanders unjustly afflicted by mechanisms in their brains?<p>This is a recurring problem that I think is only going to get worse once we get more knowledgeable about many things. Genetics, mental processes, ethics.<p>I believe it&#x27;s tightly coupled to the idea of total free will, and as long as that idea is the dominant philosophy of a society, it cannot have compassion for these people as it perceives them as acting freely. This leads to the just world hypothesis. We feel compassionate about injustice; negative outcomes coming from free will are, by definition, not unjust. Among those whose desire to have compassion is great enough, they have to say that the people in question are dealing with a physical problem, as physical causes are the only things that are perceived as capable of encroaching on total free will.<p>In reality, there is no problem. A person may have a mental model that leads them to addiction. That mental model, most likely, makes sense to them and in their circumstance. Note that mental problems are not fully logical - we&#x27;re not solving the framing problem. Genetics and environment are pieces here. Given this model, they choose addiction, because in their model, it makes sense. It turns out (we think, md224 has some interesting comments on that part of the equation) that their model is somewhat faulty, and now in addition to having a faulty model and knowing that it&#x27;s faulty somewhere, they have the expected effects of physical addiction to deal with. Just reading this paragraph shouldn&#x27;t lead anyone to believe that it will be straightforward for them to suddenly develop a perfect mental model to deal with the addiction from this situation, even if such a thing is possible. The person has made a choice, but it doesn&#x27;t really matter that they did, and the choices they continue to make, may, again, not matter. There&#x27;s nothing magical about choices, they&#x27;re still limited by one&#x27;s mental model and therefore will never be truly free. They may find a way through to a good model. Or maybe some good people will help them make their way there. Or perhaps a physical intervention will accomplish the same even faster.<p>Feeling compassion towards someone trying to navigate this complex world? Easy. Just get rid of the idea that we&#x27;re all sitting in front of two nicely presented plates where one clearly has good choices on it and the other clearly has bad choices on it. That&#x27;s not how it works.<p>But we can&#x27;t think like this. The philosophy of total free will does not allow it. A person either has free will or they don&#x27;t. Therefore the plates must clearly be there, and any good person will choose things from the right plate. Therefore, any person choosing addiction is fully aware of the outcome and expects exactly the same thing that we expect, so if it happens to them, we get to blame them and put the <i>full</i> weight of the responsibility that free will implies upon them. And from there comes pain.<p>The terms we use when we talk about agency: attitude, personal responsibility, consequences. These terms became steeped in guilt and shame and authority. Because that is the price we put on agency: if you want to have it, you must feel constant guilt and shame, over any decision you make that <i>we</i> didn&#x27;t want you to make that has a negative outcome. These are not light emotions, and especially those raised to be good and conscientious will be rather vulnerable to them. These inform of one&#x27;s status and worthiness and acceptance in the tribe. To feel constant guilt is to not just make mistakes, but to also be wrong fundamentally, as we know one must not feel it constantly. What is one to think when they are convinced by others that they, completely freely, constantly make bad choices? That&#x27;s a hell of a cross to bear.<p>Little surprise is it, then, that many people decide that they don&#x27;t want any of that agency if it comes at the price of constant pain and living life at the lead of someone else. We want to avoid pain, not experience it. They either deny the choices themselves, or deny that they made them, or deny that the choices existed. Anything else leads to pain. They are not allowed to merely banish guilt and shame and reclaim their agency due to the philosophy of total free will, so they just banish all of their agency all together.