The Urge: Our History of Addiction
Carl Erik Fisher, 2022
Why does a person who has firmly decided not to drink walk to the store for vanilla extract? Psychiatrist Carl Erik Fisher, who has lived through addiction himself, traces how for centuries people explained the urge as sin, a “demon” drink, a diseased brain and bad genes. This book shows you why no single simple cause works, and what is left once you let it go.
Who it is for
For anyone trying to understand their own or someone else's pull toward drink, pills, gambling or the phone, and for everyone curious about how ideas of addiction have changed laws and lives.
I know what I need to do. I want to do it. But I don't do what I want to do.
A ward on the twentieth floor
New York, Bellevue Hospital, the twentieth floor. This is where patients with a dual diagnosis are treated: addiction plus another mental disorder. Among them is twenty-nine-year-old Carl Erik Fisher, a psychiatry resident at Columbia University. He grew up in a family where both his father and his mother drank, and he swore he would never become like them. But after weeks on stimulants and alcohol, he had a manic episode.
From a pay phone in the hallway, he calls a friend and asks a question that seems absurd even to him: “Do you really think I can never drink again?”
Later Fisher became a psychiatrist specializing in addiction and wrote a book that weaves together two stories: how people have explained addiction over the centuries, and how he himself found his way out of it. Every era found one simple cause: sin, weak will, a “demon” drink, a diseased brain, bad genes. Each of these causes explained something, but none of them gave the full answer.
Ahead are seven stories about how a simple explanation failed people, and what you can understand about yourself and the people you love once you let it go. Let's start with a dice player who is probably more than three thousand years old.
Neither free choice nor possession
Probably before 1000 BC, the “Gambler's Lament” was written down in the Indian collection of hymns called the Rig Veda. The dice have already cost the hero his wife and his mother. He swears he will stop playing, but when he hears the dice rattle, he rushes to them “like a girl with her lover.”
Fisher's patient Susan, a lawyer, had firmly decided not to drink that night and not to go to the liquor store. And then she watched herself walk to the corner store and buy a few bottles of vanilla extract, which is made with alcohol.
The usual argument is whether this is a free choice or an irresistible compulsion. Fisher believes neither picture matches real life: a person watches themselves making a choice and feels there is something wrong with the choosing. The ancient Greeks had a word for this, akrasia: acting against your own better judgment and knowing it at that very moment. It's like a driver watching his hands turn the wrong way, even though no one else is holding the wheel.
If you recognize this in yourself or in someone close to you, drop both verdicts: “weak will” piles on blame, and “it's stronger than me” takes away hope. Even a broken choice responds to circumstances: in studies Fisher cites, small rewards for clean tests helped people hold on longer. A more useful question is what pushes my choice, and what around me I could change.
About the author
Carl Erik Fisher is an American psychiatrist and addiction specialist who teaches at Columbia University. He went through alcohol addiction and recovery himself and spent ten years working on this book.
All books by this author: Carl Erik Fisher
Terms from the book
- heritability
- Beecher
- crack
- Mann
- Alcoholics Anonymous
- remission
- Zen
- Bellevue: A large public hospital in New York, known for its psychiatric wards for the city's most severe patients.
- dual diagnosis: What doctors call addiction combined with another mental disorder, such as depression or bipolar disorder.
- Rig Veda: An ancient Indian collection of hymns in Sanskrit, one of the oldest surviving texts in any language.
- akrasia: An ancient Greek word: acting against your own better judgment while knowing it at that very moment. Often translated as “weakness of the will.”
- soju: A strong Korean alcoholic drink, usually sold in small green bottles.
- Frith: John Frith, a sixteenth-century English Protestant burned for heresy in 1533. According to linguists, he was the first to use the word “addict” in English.
- pharmacological determinism: Sociologists' term for the idea that all the power of addiction lies in the substance itself, and the person is only its victim.
- Robins: Lee Robins, an American psychiatric epidemiologist who studied what happened to soldiers who came back from Vietnam addicted to heroin.
- Pöppel: Ernst Pöppel, a German brain researcher who coined the joking word “monocausotaxophilia.”
- monocausotaxophilia: Ernst Pöppel's joking word: the love of single causes that explain everything. Not a scientific term.
- Leshner: Alan Leshner, director of the U.S. National Institute on Drug Abuse in the 1990s, author of a well-known article on addiction as a brain disease.
- barbiturates: A class of strong sleeping pills and sedatives, popular in the middle of the twentieth century. An overdose can be fatal.
- Synanon: An American addiction treatment program founded in the 1950s. It became famous for its harsh group sessions and over time turned into a cult.
- gray matter: The brain tissue where the bodies of nerve cells are found. Its volume is measured on brain scans.
- Mayberg: Helen Mayberg, an American neurologist who was among the first to use deep brain stimulation for severe depression.
All terms
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