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Summary
Summary
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.
As a psychiatrist-in-training fresh from medical school, Fisher was soon face-to-face with his own addiction crisis, one that nearly cost him everything. Desperate to make sense of the condition that had plagued his family for generations, he turned to the history of addiction, learning that the current quagmire is only the latest iteration of a centuries-old story: humans have struggled to define, treat, and control addictive behavior for most of recorded history, including well before the advent of modern science and medicine.
A rich, sweeping history that probes not only medicine and science but also literature, religion, philosophy, and sociology, The Urge illuminates the extent to which the story of addiction has persistently reflected broader questions of what it means to be human and care for one another. Fisher introduces us to the people who have endeavored to address this complex condition through the ages: physicians and politicians, activists and artists, researchers and writers, and of course the legions of people who have struggled with their own addictions. He also examines the treatments and strategies that have produced hope and relief for many people with addiction, himself included. Only by reckoning with our history of addiction, he argues--our successes and our failures--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 expansive, nuanced, and compassionate view of one of society's most intractable challenges.
Reviews (5)
Publisher's Weekly Review
Fisher, an assistant professor of clinical psychiatry at Columbia University, makes a striking debut by skillfully combining a cultural history of addiction with his own story of recovery. He first looks to ancient philosophers and thinkers, noting that early definitions of addiction hinged on a "gray area between free will and compulsion." This anticipated the contemporary notion that mental disorders, including addiction, exist on a continuum. Fisher focuses mainly on the U.S., where the idea of addiction as a disease gained traction around the time of the Revolutionary War and later spawned religious temperance movements, Alcoholics Anonymous, and the war on drugs. He also shows how treatments have swayed between compassionate, rehabilitative approaches and prohibitive crackdowns, and argues that the current quality of care is "woefully" inadequate. Along the way, he shares plenty of moving stories of the scientists, preachers, and patients on the front lines of addiction and movingly recounts his own struggle with alcohol and Adderall addiction while he was a physician in Columbia's psychiatry residency program: "The fear, shame, and strategizing were exhausting." There's as much history here as there is heart. Agent: Libby McGuire, The Gernert Company. (Jan.)
Guardian Review
George Santayana's aphorism "Those who cannot remember the past are condemned to repeat it" doesn't make an appearance in this book. But it could well serve as the subtitle. For if ever a field should heed the lessons of history it is the making of policy on alcohol and other drugs, and their associated addictions. Carl Erik Fisher takes the reader on a vivid tour over several thousand years of multiple cycles of science, medicine and literature, woven together by the thread of the author's own alcohol and amphetamine addiction and treatment. It is made even more emphatic and moving because he is also a psychiatrist who treats such patients. At the end of 2021, the British government set out a "once in a lifetime" policy for tackling drug crime and drug use. It was a remarkable document not least because it contained no references to any previous research in this field - as if the last two millennia had taught us nothing. The authors of that report should now read this book and realise how wrong most of their ideas are, how their new vision will probably repeat a relentless cycle of failed policy approaches. Given that they are unlikely to do so, I will try to summarise the key messages from Fisher's book. Those are, first: don't conflate drug use with addiction or even with harm - heed the research by Lee Robins on Vietnam vets, for example, which showed that most of those who used heroin in that war stopped once they returned to a normal life. Punitively extending the tentacles of drug-testing is harmful, because many will fail at some point, become marginalised and be driven from legal work into crime. Second, abstinence isn't the only - or even necessarily the safest - goal of treatment. We know this because of the major contribution of methadone and, more recently, buprenorphine to opioid addiction treatment, though neither of them are yet fully utilised. Third, do not "wage war" on drugs, because that instantly becomes a war on drug users, with poor, non-white and disadvantaged people the most likely victims. Of course, none of these insights will be a surprise to experts in this field - they are established facts. But this book is not a polemic, and one of its pleasures is the succession of historical nuggets it serves up, many of which were unknown to me. For example, the word "addiction" was used for the first time in reference to chocolate. I was also unaware of the deliberate use of cheap alcohol to undermine Native American communities by the early white settlers. This led to the Code of Handsome Lake, the first mutual support group explicitly focused on addiction recovery in America, predating Alcoholics Anonymous by almost 150 years, and surviving to this day. Though I was familiar with the presumed role of cannabis and ephedra in the origins of Hinduism, I had not realised that gambling addiction appeared so early in literature, in the Rig Veda: hearing the sound of dice, the gambler rushes to them "like a girl with her lover". He "goes to the hall of play asking himself, 'Will I win?' puffing himself up with 'I will win!'" The book is rich with similarly potent quotations, among them two that capture the different faces of alcoholism. This one from Edgar Allan Poe, who died very young from the effects of drinking, sums up the paradox of self-destructiveness: "the unfathomable longing of the soul to vex itself, to offer violence to its own nature, to do wrong for the wrong's sake". Whereas Caroline Knapp describes how "liquor occupies the role of a lover or constant companion". William Burroughs recounts that "heroin is momentary freedom from the claims of the ageing, cautious, nagging, frightened flesh". Which of us hasn't had similar longings to escape? And then there's Fisher's own remarkablestory, which includes an amphetamine-induced manic episode during which he was Tasered by the police before being forcibly taken into detox. Months later, on his first weekend leave from rehab, he describes walking back into his lonely apartment and finding the Taser wires "tangled on the floor, like a loose, copper bird's nest". The child of two alcohol and smoking addicts, he explores the reasons for both their and his vulnerability, though he cautions that "it is rarely useful to attempt to arrive at one major 'cause' of anyone's addiction". His mother, he writes, learned from her stressed immigrant father that "alcohol was a way to cope with a difficult world". Even when she is dying from lung cancer she still drinks, though it messes with her treatments, and has an expert doctor as a son trying to stop her. His parents' denial of their addictions translated into his own failure to recognise when his drinking had become out of control. Fisher is now working as an addiction psychiatrist and medical ethicist, but still undergoes regular alcohol and drug testing that he feels helps keep him clean - though it hasn't been as successful among other medical professionals in his treatment group. If testing often fails among these people, what hope has it with those who have little or no incentive? Fisher argues that non-judgmental encouragement and understanding is the right approach. The book is thorough and revealing. It is largely US-centric, but, given the overwhelming influence that country has had in driving global drug policies, the narrative is still internationally relevant. Fisher's personal saga, together with case studies of his patients, lend it an additional human depth. Pulling it all together is this final reflection, a mature view of the topic from someone with immense experience of it. "Addiction is profoundly ordinary: a way of being with the pleasures and pains of life, and just one manifestation of the central human task of working with suffering. If addiction is part of humanity, then, it is not a problem to solve. We will not end addiction, but we must find ways of working with it: ways that are sometimes gentle, and sometimes vigorous, but never warlike, because it is futile to wage a war on our own nature." One can only hope the British government - and others like it around the world - is listening.
Kirkus Review
A blend of memoir, critique, and history of the impact of addiction and the struggle to treat it. Despite the subtitle, this is more than standard history. Fisher, an addiction physician and professor of clinical psychiatry at Columbia, presents an account of his own struggles with addiction; his experience as a psychiatrist treating people with intractable addiction issues; a history of humanity's struggles with addictive substances; and a scathing critique of government policy toward drugs and drug abuse. Fisher has synthesized an enormous amount of material and is on firm ground when he writes on what he knows. Steeped in the history of medicine, his accounts of how doctors and self-help pioneers have dealt with addiction are vivid and well informed, and his insights into Alcoholics Anonymous and other therapeutic programs are buttressed by vast experience. He shows tremendous empathy for addicts and their challenges, and his personal story, of an addiction that almost derailed his medical career, is powerful and dramatic. However, his critiques of government policy toward addiction are largely one-sided. His chief targets are laws and programs that demand abstinence to ensure recovery, but Fisher skates over the other side: why those programs are popular and why many authorities believe they work. He also filters issues through the lenses of race and class, whether germane or not. For example, writing about a crucial Supreme Court decision on the legality of a Black man's drug arrest, he labels judges of the time "old white men," suggesting they were racist and out of touch. That may have been true, but their 1962 decision decisively favored more rights for the accused. After robust and sustained criticism of most current approaches to treating addiction, readers will hope for more information about what does work, but recommendations for the "pragmatic and pluralistic perspective" remain general. Readers familiar with the issues will engage; those seeking more insight into what causes this "baffling" human burden--and how they can manage it in their own lives--should look beyond this book. A useful but flawed personal and professional examination of addiction and how it has impacted humans and baffled experts. Copyright (c) Kirkus Reviews, used with permission.
Booklist Review
Smart phones, video games, coffee, cigarettes, junk food, gambling. Fisher, a psychiatrist and a patient recovering from addiction, wonders, "Is everyone somewhere on the addiction spectrum?" What factors--biological, psychological, social, cultural--play a role? He reviews addiction, remedies, and recovery throughout human history and adds a discussion of his personal battle with substance use disorder (alcohol and the stimulant Adderall). The irony of his predicament does not escape him. "I went from being a newly minted physician in a psychiatry residency program at Columbia University to a psychiatric patient at Bellevue." He participates in a rehab program for doctors, resumes his professional training, and becomes an addiction medicine specialist. His historical overview of addiction includes discussion of Prohibition, Alcoholics Anonymous, the 1980s "War on Drugs," the U.S. Narcotic Farm (Narco) in Kentucky, breakthroughs (methadone, buprenorphine), racial inequities, two opioid epidemics, tobacco, and crack cocaine. Fisher identifies four recurrent responses to addiction across history: prohibitionist (criminalization, punishment), reductionist (science-based handling), therapeutic (medical treatment), and mutual support (grassroots healing). A unique perspective on a frustrating, often devastating problem.
Library Journal Review
An entrancing overview of social constructions of addiction. Fisher is an addiction specialist and professor of clinical psychiatry at Columbia and writes that he himself is in recovery from alcohol addiction. Exploring everything from early religious texts to public policy actions in the present-day United States, Fisher reveals interesting historical details of addiction and its treatment and explains a lot about how we have arrived where we are today. With its perspective that pure abstinence may not be the answer for everyone who struggles with addiction, this work is sympathetic and understanding; it is not a work of self-help but one of perspective. Mark Deakins does an admirable job narrating the audiobook, shifting adroitly between its memoiristic passages, its history of addiction treatment, and its arguments for how addiction should be treated in the future. VERDICT This combination-memoir/history of addiction would be welcomed by any who want to learn more about addiction and how societies address it. Recommended.--Eric D. Albright