By: Ariane Bakhtiar, PhD Candidate
Ariane is a Ph.D. candidate in philosophy at York University. Her area of interest includes philosophy of psychiatry and bioethics. Her dissertation focuses on decision-making capacity in the context of major depressive disorder and physician-assisted suicide. Her related interests include phenomenological accounts of mental disorders, patient narrative, and the use of psychedelics in psychiatric treatment.
As a researcher in philosophy of health ethics, I have come to better understand my own decade-long battle with addiction. I have read numerous academic articles attempting to define the nature and cause of addiction. Some researchers say that addiction is a problem of willpower and self-control. Other researchers claim that it is a chronic condition, explained as gradual changes to the brain. In recent years, some researchers have wanted to do away with the willpower-brain disease paradigm suggesting that addiction is a response to trauma or lack of socioeconomic options. I do not know if any of those explanations are accurate. Still, I have wondered if addiction is about an unwavering yearning for pleasure, despite the potential for destructiveness, or if it is something multi-faceted, as the newer research suggests.
Looking back at my first love, heroin, I recognize that pleasure was a big part of my addiction. It felt good to feel good. It felt really good to feel high. Even today, despite having beautiful children, a supportive husband, and completing a Ph.D., I feel nostalgic about my drug-using days. The euphoric rush of heroin has been described poetically to me as being wrapped up by joyous sunshine or a soft blanket. I see it as having access to an alternate plane of consciousness where I dissolve into pleasure—Nozick’s experience machine in action. We are wired to be drawn toward pleasure and to avoid pain. Yet, in my addicted mind, ordinary pleasure-seeking was not enough, I wanted to be FUBU (fucked up beyond recognition). The euphoric feeling after a run, a delicious slice of chocolate fudge cake, and making love to my partner was not enough. There was something heroin could give me that ordinary pleasurable experiences could not.
My past was not particularly traumatic. I probably suffered from anxiety from a young age and had difficulties coping because of issues with modulating my emotions. It is possible that the world felt like too much and heroin made it liveable for me. I did not have a bad life. I started heroin as an undergraduate student living in a comfortable residence with my boyfriend. I did not have to pay my rent. I enjoyed studying philosophy and had good grades. The external factors defining my life were typical. Internally, however, dread and anxiety were present in a way that distorted my perception. My life was relatively privileged, but something felt terribly wrong in a way that was hard for me to pin down. Drugs, especially opioids, made the world make sense.
As an addict, I was emotionally vulnerable and drugs helped me adjust my way of being in the world. Drugs were a useful tool for survival and it was useful to the extent that I could overlook the widespread damage that they caused me physically, financially, and interpersonally. Despite what some research suggests, this is not denial or an incorrect evaluation of the facts, it is survival. I recognized the harm I caused to myself and those around me, but I also needed to function. Heroin helped me switch perceptual gears in a way that made the world, other people, and my own sense of self intelligible.
T. Szasz was right when he said that drug use is medicinal. A good analogy I can use explains addiction in terms of being prescribed glasses after many years of being unable to see. It is relief, it is useful, and it is necessary for functioning. Heroin provided me with relief for something that never went away. It was a medicine that helped alleviate symptoms but did not treat them. And so, I was unable to use the heroin responsibly. I needed to take enough to achieve nothingness, and that was a risky endeavor because nothingness was at the precipice of a deadly overdose—FUBU. Even if someone had offered me a safe amount of heroin every day for the rest of my life (this is addiction treatment in some countries), that would not have been enough, because I yearned for more than the feeling of being high or the avoidance of withdrawal. I wanted the near-death experience. That is why I could not be a recreational user who could moderate her use. It was not because I was incontinent, to use Aristotelian terms, I was not akratic, it was because my sense of the world was skewed. I did not fit in. I felt strange. There was something wrong. M. Ratcliffe would call my sense of alienation an existential feeling. The problem is that because of possible legal ramifications, the cost, the risk associated with black market substances such as fentanyl in heroin, and the risk associated with ingesting high doses of drugs in general, using opioids to treat existential feelings was not sustainable. Even if heroin had been legal, as soon as my legal and safer high would pass, I would have had to start over and confront myself again. This is the self that feels wrong for the world.
What I think we need to do for addicts is to help them regain a sense of belonging (after making sure their basic needs are met). I mean belonging in the sense of helping them shift how they perceive the world; this is how they give and find meaning in the world. This will mean something different depending on the addict and their reasons for drug use. For me, I needed to learn that I was not wrong or broken or too much. If the world felt like too much, I had skills to learn to help make it more bearable. This is what helped alleviate my sense of alienation. I am also prescribed a medication like methadone which helped me get to a point where I could be receptive to therapy. Drug use is one of the many ways humans have learned to cope. It cannot merely be about pleasure because of this, nor can it be about a lack of self-control concerning one’s desires or because one has a neurological aberration. There is something quite voluntary about the way I understand addiction—it is about taking my broken into my own hands, trying to fix it, because no one taught me a better way.