Monday, July 28, 2014

Addiction as Faulty Metaphor

So, a few weeks ago I participated in a discussion over on the Media Ecology Association discussion list on the topic of media addiction. I normally don't get involved in exchanges on this subject, but another participant on the MEA list, Kent Walker, questioned the validity of referring to habitual media use as a form of addiction, so I decided to weigh in with my 2¢ on what might be considered a pet peeve of mine.

I do want to be clear that I understand that some folks are very involved and committed to the idea of media addiction, and if they want to use that sort of language, they are free to do so. I am not condemning it. But I am questioning it. I think some people may have felt threatened by me doing so, but that is the whole point of critical inquiry, isn't it?

Anyway, I think my comments on the discussion list were substantive enough to share here on Blog Time Passing, and I hope you agree, or at least will hear me out on why I think the current broadening of the term addiction is problematic.

Here are my first set of comments:

I think it may have been in a junior high school class in what was called "Hygiene" back circa 1970 that I first learned the medical meaning of "addiction" as referring to a substance that causes a physiological dependency in the user. Drugs that were categorized as addictive included alcohol, tobacco, opium/heroin, and barbiturates, while drugs like marijuana, LSD, mescaline, and amphetamines were categorized as non-addictive, but habit-forming. This came as part of a new effort at drug education, in response to the counterculture's embrace of illicit drugs, and the same distinctions were made when I was an undergraduate later on in the 70s, when I was taking a class in therapy and counseling and did some volunteer work for a drug counseling center.

As a former addict myself, in my case to tobacco, although cigarette smokers only occasionally referred to themselves as nicotine addicts, I can attest to the fact that there is a world of difference between substance addiction and habitual use of non-addictive drugs, or media, or any other sort of activity for that matter. I've known a few alcoholics as well, and that form of physical addiction seems even more intense, and it is well known that heroin addicts who go cold turkey rather than easing off of the drug can endanger their health, and even risk their lives.

This is why I personally do not support the current usage of addiction to apply to anything that is habit-forming. I know there are neurological explanations involving the brain releasing endorphins, but I just don't see that as comparable, and I do think the broader use of the term confuses an important distinction, and condition.

I suppose it could be argued that "media addiction" is a metaphor, like "media ecology" which of course I embrace. But not all metaphors are equally appropriate. Ecology can be understood as being about how organisms relate to their environments, and as such need not be confined to biology. Many of us in media ecology object to the use of literacy as a metaphor in "media literacy" because it ignores the distinction between the written word and other forms of communication. On the other hand, while I would prefer "media education", I can accept the usage of "media literacy" because the metaphor generally does not lead people to confuse television with books. And I don't go around objecting to folks who use the metaphor of "media addiction" because there is value in looking at our media use as habit-forming, creating media dependency, and generating withdrawal symptoms at times when people try to or are forced to go without.

But I don't use the metaphor myself, and I do think there is a problem in placing alcohol abuse in the same category as constantly checking your Facebook and Twitter feeds or playing games on your cellphone. When it comes to physical substance addiction, I think there's a difference there that makes a world of difference.

By the way, another point I should have made is that in addition to being a nicotine addict who has not had a cigarette in two decades, I also have the caffeine habit, to the point where I get a headache if I don't have at least one cup of coffee in the morning. But based on my first hand experience, it is clear to me that there is a world of difference between the yearning for my morning cup'o'joe, however strong it may be, and what I used to experience when going too long without a cig—what we referred to as a nic-fit.

Anyway, my post was troubling to some folks, and one response came from my old friend, Marty Friedman, who noted that there has been research done in this area that let to the changing definitions of addiction among professional therapists, as reflected in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), released by the American Psychiatric Association in 2013. So here was my response:

I know that psychologists change their views over time, and continue to do so, but that doesn't mean that the current view is correct, and there sometimes are political or social reasons that influence their "scientific" conclusions. The key distinction that they are overlooking, perhaps because they are psychologists rather than physicians, is that physical addiction is not just about psychological dependency or even neurological symptoms, but about actual change to the body, on a cellular level.

Now, people can use the term "addiction" to mean something other than physical addiction, but I am suggesting that that is best understood as a metaphor rather than a variation on the same phenomenon, and that it is an example of what Neil Postman referred to as the great symbol drain and the demeaning of meaning. And I think he would suggest that maybe we need different words for addiction that is physiological in nature, and the psychological sense of feeling as if you were addicted to some activity.

There is also the question of how far do we go in using scientistic terminology to talk about human behavior. We may not always want to frame behavior in terms of morality or ethics, but is every dysfunctional or negative behavior a syndrome or malady of some sort?

And I think there is definitely room for a media ecological critique of the tendency to frame behavioral problems as "sicknesses" in need of "treatment" or "therapy" of some sort. This comes out in some follow-up comments I made:

The value in looking at the broadening of the term "addiction" as being metaphorical is that it leads us to ask what is the purpose of the metaphor, what are the similarities, and the differences?

Referring to a habitual activity, be it gambling, sex, media use, or the use of substances that are not physically addicting as an "addiction" takes the activity outside of the individual's locus of control. This does reduce or eliminate personal responsibility for the behavior, which disallows any evaluation based on morality or ethics. This is important, given the long history of moral condemnation of behaviors that individuals have little or no control over, but leaves no room for any philosophical or spiritual views. It also undercuts the degree to which individuals can exercise control over their own behavior, and defines the problem as a medical condition, which requires the services of a professional specializing in the disorder. Of course this serves the interests of the psychotherapeutic profession, which is not to deny that there are many instances where therapy can be helpful, and at times necessary (and the same is true of pharmaceuticals). But this does fall into a kind of technical thinking, as in Neil Postman's technopoly and Jacques Ellul's la technique.

We know that some individuals exhibit Obsessive-Compulsive Disorder, and that many have this syndrome to a greater or lesser degree. And yet we don't use the metaphor of addiction for behaviors associated with OCD. We don't say, for example, that someone is addicted to washing his or her hands over and over again. OCD is the other extreme where we see the problem lying in the mind or as a neurological disorder, and not in the habitual activity. Does the metaphor of addiction simply point to the tendency that exists in human beings (and other species) to a greater or lesser degree to engage in repetitive behaviors? (Aside from OCD, repetitive behavior is also a characteristic associated with autism.) What is the difference between ritualistic behavior and addiction?

Considering addiction as a metaphor, it can be instructive to consider what habits are not labeled addictions. Are we addicted to showers if we take one every day? To brushing our teeth if we do so after every meal? Is there such a thing as being addicted to reading? If reading is not an addiction, can you look at anything with writing on it, a sign, a newspaper, book, flyer, poster, etc., look right at it, and not read what it says?

What I am trying to point out here is that we need different terms for different phenomena, and that the reification of metaphors can be the cause of confusion.

Addiction, even in the broad sense in which it is defined by the American Psychological Association, is an individual condition, psychology being about the individual mind, rather than the collective culture and society. But my friend, Eric McLuhan, got into the discussion to point out that we can also refer to an entire society as being addicted, say to television, or the internet, cell phones, or other technologies such as the automobile. Here is my response:

We mainly speak of addiction on the individual level, whether it's addiction to physical substances or addiction to certain activities. We might speak of addiction in a collective sense to talk about how large numbers of people were forced or encouraged to become physically addicted, for example that the British got China hooked on opium. But we still are talking about individual addiction, just that it's happening on a large scale.

But now, is it apt to say that, as a society, the United States, for example, is addicted to television, computers, cell phones, etc.? I certainly would argue that as complex systems, contemporary societies are dependent on various technologies for their existence, and would not be able to function without them. But to use the term addiction in this regard strikes me as even more of a metaphor than to use it to refer to individuals engaged in habitual or obsessive behaviors.

To give one example, it's been said that we are addicted to petroleum, and that is a powerful way to describe our dependency on that source of energy. But if we suddenly ran out of oil, and gasoline, and had no immediate substitute for it, the result would be more than just withdrawal symptoms, as the loss of trucking would mean that all of us living in major cities would run out of food very quickly. If roads are our arteries, and trucks are the cells carrying nutrients, then aren't they intrinsic to the social system (as a kind of organism), rather than acting as a foreign substance altering us collectively? If language is inherent in our species, then are the new languages that evolve to be considered a foreign substance or a natural development?

If we employ the metaphor, then we might make a distinction between dependencies due to addiction, and dependencies due to necessity, the distinction between say alcoholism and needing water to survive. This is the territory Innis was scouting out.

Anyway, what troubles me is not the use of the metaphor, but the loss of distinction between addictive substances on the one hand, and other forms of dependency, obsessive-compulsive behavior, and ritual and habitual behavior.

Following some further discussion the list on the subject, I decided to post some further thoughts:

a few more comments on the subject...

There has been a good amount of criticism about the possibility that children are being over-diagnosed as having ADD and ADHD. While there are cases where there is a genuine neurological problem that can be alleviated through appropriate medication, the concern is that anytime students exhibit any kind of behavioral or learning problems in school, they are given a medical diagnosis and prescribed drugs as treatment. In other words, the problem is that a medical framework is being extended inappropriately to areas where it doesn't belong.

I think it's reasonable to ask whether the same is occurring with addiction, which was earlier understood to be a physiological, and therefore medical problem. This sort of questioning is in the tradition of Neil Postman and especially Ivan Illich, not to mention Thomas Szasz. And again, the big problem has to do with clinical diagnosis, rather than the use of metaphor.

Also, in teaching about new media, I tell students about the famous early case involving a virtual community dealing with unethical behavior, as written up by Julian Dibbell under the title of A Rape in Cyberspace. And one question I ask is whether the term "rape" is appropriate for the kind of virtual act that occurred, or whether this usage discounts the seriousness of the actual, real word crime. I think the same question can be asked about virtual addiction, given the seriousness of actual physical addiction. Even when used as a metaphor, words have power to shape our understanding and our responses, and overuse and misuse can result in the demeaning of meaning, to use Postman's phrase.

And I will say in all seriousness that I was a heavy smoker for two decades, averaging 2-4 packs a day, and in that time I know I did some damage to my body that was irreversible. I'll also point out that, as cigarette smokers, Neil Postman and Christine Nystrom both died of lung cancer, and James Carey of emphysema. And I myself found it very difficult to quit, impossible to just go cold turkey, and only was able to stop smoking by being weaned off of nicotine via the patch. I have gotten hooked on all kinds of other activities, playing computer games all night, compulsively checking Twitter messages on my phone, etc., but nothing compares to what I went through trying to quit smoking. So from my personal experience, addiction represents a special and distinct category.

I also find it significant that recovered alcoholics continue to say that they are alcoholics, and always will be, and can never go back to having an occasional drink now and then. That need for absolute abstinence is not comparable to what may be termed sex addiction, or gambling addiction, or media addiction.

Now for something on the lighter side:

I am addicted to the English language. I can't help myself, I can't stop myself from using it. I think about it night and day, I can't get it out of my head. It's there even when I sleep. It affects my thinking, my emotions, my behavior, altering my very view of reality. And the addiction has harmful effects, in leading me to expect the world to be relatively static rather than dynamic, filled with things rather than events and processes, filled with isolated phenomena rather than a dense network of relationships, etc. There have been efforts to help people like me break this addiction, from Alfred Korzybski's general semantics to various forms of meditation and mysticism, but time and time again addicts like me find ourselves getting another fix, often without even realizing what we're doing. I know some use a methadone-like treatment, turning to immersion in a different language to break free of the hold that English has on them, but then they just find themselves addicted to that other language. As far as I know, the only known cure for language addiction requires direct action to remove or disable sections of the brain.

I'll stop now, lest someone accuse me of being addicted to this topic...

Now, in response to some criticism arguing for the extended use of addiction, here is the first part of what I had to say:

I don't think that the treatment for sex addiction requires lifelong celibacy, does it? I think there is a distinction to be made between addictions where the only cure or form of recovery involves complete abstinence, and other behavioral problems where moderation is sufficient. Is the solution to "internet addiction" to never go online and never use email? Does a recovering "news junkie" need to avoid newspapers and news broadcasts altogether? Is the answer to media addiction to completely cut media out of the individual's life, whatever that might mean?

I thought I was pretty clear on the fact that I am not denying that problems exist regarding habitual activity, compulsive behavior, and dependencies. These are very real and very serious problems, individually and collectively. I'm just questioning the use of the specific term "addiction" and asking if it's appropriate. I know that some people are especially invested in that metaphor, and I do agree that the metaphor refers to actual psychological and social problems. My concern is over precision in language, and the question of whether to frame the problems in medical terms, which would suggest they require clinical treatment, as opposed to alternate framings that allow the problems to be approached through education, for example.

Before continuing on, let me note that a couple of folks of the list pointed to the etymology of the word addiction, which is interesting in that it is based on the root term, diction, implying that it has something to do with language and communication. So, continuing on, here is my response to that:

I'm all for using etymology to understand concepts in instances where we are dealing with commonly used words, words that have vague or fuzzy definitions, etc. But in this case, the issue is not the root meaning of the word, but rather its operational definition. The term "addiction" has very specific clinical and medical definitions, and it is fair to ask whether the definitions being used are appropriate or useful, just as we may ask the same for the clinical definition of "deviance", for example, or "insanity". The etymology of the term "malaria" may be of some interest to historians of science, but it does not help us in understanding what the term refers to in current medical usage, and it would be absurd to argue that, given its root meaning of bad air, it should also be applied to diseases brought on by air pollution, or mustard gas.

I do hope, in raising these questions, I am not coming across as addictatorial...

And that is pretty much the sum of the points I made in the discussion, which I hope have been of some interest and utility to you, dear reader. But as a bit of an epilogue, let me note that there was one more email I sent to the list on the topic, which began with a brief  personal response to another list member that isn't relevant here, after which I added the following (true story!):

Now, I just opened a fortune cookie, and the fortune reads: "We first make our habits, and then our habits make us."

Coincidence? I think not...

As it turns out, that fortune is an aphorism that comes to us from a western source, the 17th century English poet, John Dryden, although some mistakenly attribute it to Charles C. Noble. This brings to mind my 2011 post about Neil Postman's quote, Children are the Living Messages We Send to a Time We Will Not See.

Anyway, maybe some folks are addicted to using the term addiction, but as to how the word will be used in the future, far be it from me to venture any prediction.

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