Cohen, Peter (2000), Is the addiction doctor the voodoo priest of Western man? Extended version of an article that appeared in Addiction Research, Special Issue, Vol. 8 (6), pp. 589-598.
© Copyright 2000, 2001 Peter Cohen. All rights reserved.
Is the addiction doctor the voodoo priest of Western man?
For Harry Levine, who invented the 'discovery' of addiction.
In this essay on the concept of 'addiction', my efforts will not be directed at trying to explain the behaviour of the 'addict'. Rather, I am interested in tracing the evolution of the social logic and history of the 'addiction' concept, and its continuing functionality today. I want to approach the concept of 'addiction' in a slightly different way than John Davies who speaks about addiction as a 'myth'. Davies explains the creation of this myth through attribution theory. I share with him the conviction that 'myth' is the right concept to use here. But my purpose is to try to understand where the need to create this 'myth' comes from, and why the construct of 'addiction' is so extraordinarily charged in our culture.
I will first look at some conceptual and social origins of the concept of the 'individual' in whom 'addiction' is assumed to reside. Then I will argue that the concept of 'addiction' is a necessary by-product of the concept of the individual; a by-product that most of us need, but not something that refers to a phenomenon that really 'exists' outside our socially constructed perception. The term 'addiction' is now used to identify a large number of different behaviours or behavioural elements, these behaviours being lumped together because they share a seemingly involuntary repetitiousness or an unusual centrality in someone's life. These behaviours, varying from the ingestion of food to gambling, do, of course, exist. So also do their social consequences, such as the perception of these behaviours as being diseases, or deviant, sometimes leading to marginalisation or (compulsory) 'treatment'. The term 'addiction' brings a series of theoretical explanations to these behaviours, and unifies them into one category in spite of their vastly different etiologies and psychological or social functions. It is this lumping together, and the attached explanatory theories that create a unified 'addiction' phenomenon. I would argue, along with John Davies, that this creates a myth, a myth that is based on a social construction. The rest of this essay does not require that the reader share this vision on the concept of 'addiction'. It is sufficient to be interested in the questions that I will try to answer.
This essay is not written in soft colours. On the contrary, it is closer to an expressionistic painting, trying to exaggerate the essential colours, forcing out the subtleties that make 'reality' so hard to understand.
In describing the evolution of the logic that leads to the concept of 'addiction', we may have to start looking at the periods of the Renaissance and the Reformation, with sufficient perspective to understand their main relevant aspects.
During the Reformation, mankind invented the idea that the road guaranteeing a man's salvation was not through the Church, as represented by its official technicians of the soul, the priests. Rather, the individual believer was saved directly through the Grace of God, even if he or she was a sinner. Being a sinner could no longer be redeemed through confessing sin to a licensed priest, the broker between man and God. Instead, the relationship between God and man was direct. In modern terminology, man now saw himself as an individual in the eyes of God. The problems that resulted from this point of view for a religious world view were enormous. If an individual was judged and accepted directly by God, how did this relate to the assumed supreme power of the Church? This question did not only cause ages of conflict between the old Catholic Church and the Reformation in general, but also within the Reformation. The ambivalence within the Reformation was how much an individual person could contribute to their being 'saved'. Those within the Reformation that could not accept individual responsibility (because it conflicted with views on God's power), could, in modern terms, be described as struggling against the consequences of a reformist way of establishing a direct relation between men and God. Is speaking about the individual's power to reach salvation not at the same time a denial of the omnipotence of God to which mankind is subjected?
This ambivalence is in a nutshell the core of the problems that the Reformation created for people that were living inside a religious world view. However, once the concept of the individual as a locus of responsibility and power is introduced, a religious world view is doomed. This, of course, is what happened. After the Reformation, an incredible development of Western men started to unfold. Not only did men became more and more responsible for their own soul and its salvation, men also became responsible in relation to kings. If a king subsequently extended to any political authority was doing 'wrong', it became right to oppose him. One can, therefore, see the Reformation as a formidable spiritual innovation that made it possible for men to navigate more freely in the world. This freer navigation not only developed in relation to the positions men held versus the old agents of power, it also facilitated the creation of modern empirical science. Scientific notions, born during the Renaissance, started to undermine old securities.
Galileo Galilei posed a threat to the way the world was understood and structured as his computations on the astronomical positioning of the Earth implied that the previous belief held by the Church was invalid. This was threatening not only to the dignitaries of the Church, but to mankind generally. Imagine that the tools to comprehend one's world are faulty. How then is it possible to distinguish between right and wrong? If the Church were wrong on the cosmological location of Earth, could it also be wrong in all of its moral theses and on the dogmas of how God should be addressed? In other words, it was in everyone's interest and not only the Church's to see it proven that Galilei was a heretic and fool.
When new ideological or religious notions enable individual men to navigate more freely in the world, tools have to be developed to enable steering. The development of empirical science and the abandoning of the Aristotelian cosmology made it possible to recognise new cosmological phenomena. This enabled perfection of the use of the stellar system for marine navigation and for map making, thus increasing the subjective perception of 'being in control', and 'being at the helm'. Better compasses, and angle and time measuring instruments were needed, so that new lands and powers could be discovered after the realisation that the Christian world was not flat.In a universe liberated of the belief in a flat world, and of the middleman between God and mankind, new techniques for spiritual navigation will develop. From the moment the helmsman was no longer God or a priest or a King, but the 'individual', it was the individual that developed the need for both inner and outer navigational tools. The individual became 'responsible' for how he used those tools and where he took himself. The individual 'conscience' became the inner GPS. The structuring of right and wrong became more of an individual activity then ever before. This hatching process of 'the autonomous individual' was sufficiently completed by the 17th or early 18th century that it made possible, even necessary as I will argue below, the 'invention' of concepts that depict the 'loss' of individuality. Levine states that the "conception of alcoholism as a progressive, 'addictive' disease dates from the late 18th century," immensely propagated by the creation of a middle class in the non feudal society of America.  
Religious and other views of the world
Given that during the centuries of religious world view the only good came from God, and bad came from the devil, it was the devil that represented the ultimate fear. To master that fear, the devil had to be recognized and wiped out. A whole science was developed on how to recognize the deeds or presence of the devil. Usually, the devil would seek out particular men or women, in order to usurp the powers of these people and contaminate the world against the will of the good God. In order to be freed from such contamination the bedeviled people had to be recognised, and either neutralised or killed. The concept of the devil can only exist and have regulatory power in a religious world. In such a world the concept of the devil may seem 'objective' or 'scientific'. Of course, it is instead a cultural concept that will die with the death of the religious world view. The same is true for other theories of moral decision-making and of what motivates the acts of men. Take the animistic world view. This proposes that spirits or ghosts live in stones, animals and plants, and that human behaviour is directed by these ghosts. If human behaviour takes the wrong direction, 'bad' ghosts are deemed responsible, and therefore tools to recognise this and liberate one from these evil ghosts will be developed. This concept of 'ghost' contains a theory of motivation, just as the concept of the 'devil' does. Another example may be found in voodoo. Spirits and ancestors are believed to have great powers and are able to influence one's fate, radiating into a man impulses that are sometimes good, sometimes bad, that can lead to illnesses, or even death.
In a Christian religious world view the 'priest' will be made responsible for diagnosing and curing a devil-infested person. In an animistic world, the person to turn to is the 'sorcerer' or 'shaman'. And in a voodoo world the central person is the voodoo priest who knows how to interpret the many behaviours and other signs in humans that spirits or troublemaking others choose with which to manifest themselves. The culture in which these concepts are embedded will guarantee the occurrence of countless observations where these cultural concepts of causation or motivation are validated. A victim of a voodoo spell would run aground if he would visit a modern, western style doctor, because this doctor uses completely different concepts of the causes of illness or signs of valid suffering. But going to a voodoo priest is very gratifying, since only there will the victim find recognition of not only the suffering, but also of the expectation that something will be done about it.
Doctor and client mutually validate their knowledge of how the world works, made possible by sharing a common cultural concept of the causation of the suffering or the acts of the particular person that seeks help.
In our modern western world we do not believe in the devil, or in ghosts, or in magic, but we believe in the 'individual'. We have beliefs about individual responsibility, about how we are motivated to act, and to what good purposes individual capacities should be used. The good purpose for medieval men was to praise the Lord and to seek the soul's salvation. The good purpose for modern western man is the bloom of the 'self' within a Protestant entrepreneurial work ethic. All beliefs about our 'individuality' point to precious navigational powers that reside inside the person, powers we need in order to develop the self in an aggressive and chaotic world. The beliefs that we entertain about these navigational and motivational powers, and how they work, are not relevant in themselves for this discussion. From Freudian to Behaviourist, psychologists operate mainly within the realm of the 'individual' and psychological theories are all identical in that respect.
Our theories concerning the individual are deeply cultural. Scientifically, they are at best lacking, farcical at worst. They are inherited from the Reformation and its Renaissance roots. It is, of course, a fiction that individual persons steer themselves, as if an inner compass were installed in each of us. Our 'personal' steering is a socially developed, relational and cultural ability that allows a few variations, although for us it seems as if this variation constitutes the summit of individuality. The steering forces that shape men and move them in relation to each other (history, role, climate, economic conditions, etc.) are so inherent to location, cultures of upbringing and period in which a person develops, that the imprints they make determine human beings at least as much and probably much more than the differences between them. True, no two waves in the sea are the same, but how important are these differences to understand the phenomenon of waves?
In our world view we are taught to detect the smallest of differences between humans and amplify them into major differentiators between ourselves. Another person wearing their hair slightly longer than my own makes that person vastly different from myself. The way in which a person shows bonding or sexual behaviour may mean the difference between belonging to a group or being totally ostracised. But ask the British to see differences in a group of Japanese, and the British will swear the Japanese all look the same, and vice versa, as if one were looking at a corn field. Suddenly the all-overpowering differences between humans that are necessary for us to perceive in a world view of the individual (within one's own world of 'individuals') melt as snow in the sun once we leave our home grounds of cultural meanings and images. Gone. Corn is corn is corn.
The counter positions on the uniqueness of man and his strictly individual 'steering ability', versus his socially determined amorphism (and his 'being steered') is of the same scientific order and importance now as the Reformation arguments in the 15th and 16th centuries about the power of a man versus the power of the Church to reach salvation. It is not necessary to take sides in this discussion to understand how vital the 'uniqueness' of the individual and the imagery of his self-steering (controlling) capability is to western man.
The concept of 'addiction' regulates the bewilderment that is felt in our middle class culture if people do particular things that are considered strange, not 'possible' without some exotic explanation, and certainly not worthwhile if we maintain that the individual is able to self steer, to self control, and to pursue good causes. (Other strange things are called 'mad' and not yet included in the concept of 'addiction'.) In the cultural environment of the religious world view the supreme evil (the devil) had to be recognisable (and exorcisable) in order to enable the continuation of believing in the reign of the good God. In our cultural environment of the world view of the self-steering, independent and entrepreneurial individual, it is 'loss of control' that is the supreme evil that has to be recognisable and exorcisable.
Loss of control is also perceived by the victim himself. He can not perceive otherwise, just as the voodoo victim of a Spirit can not perceive otherwise. The notions and the words that structure behaviour and make it 'recognisable' are inescapable social constructions. The individual whom we decide has lost control, will go or will be forced to go to the addiction doctor, and sees himself in need of 'help'. The addiction doctor will immediately recognise the victim's ills in his self-reported behaviours. Exactly those behaviours are seen as the core elements of 'addiction' and codified as key behaviours in DSM-IV. Of course, the culture that constructs loss of control ('addiction') as a supreme evil will construct the necessary diagnostic tools, as did the scientists of the devil during the times of the religious world view.
The addiction doctor is the voodoo priest of Western man
The concept of 'addiction' does a great deal for us. It re-establishes our world view. Time after time, the validity of our theories of the individual is established, with each perception of an 'addict' or the establishment of the 'addictive' power of a substance. It grounds our individualistic world view in the construction of 'evidence' about loss of control. Just as it is impossible to argue the myth of Spirit power with any person living in a culture of voodoo causation, it is impossible to argue that 'addiction' is a myth with any lay person or any doctor in Liverpool or Osaka. Modern man needs the concept of 'addiction', and its evils, as Mediaeval men needed the devil or the heretic. Both the heretic, the addict are the different sides of the singularly important same coin (God is good, the individual can control his or herself). This is why the concept of 'addiction' in our western industrial culture is universally shared within the cultural language of the individual. It is as deeply religious as it is data proof because its function is to manage our fears about how much 'we are in control'.
We have chosen some drugs to be supremely undermining of our 'self control' (but not some other drugs, or car driving, power, working, ambition, or looking at the stars). I do not understand why. It might be that their foreign origin helped to create the necessary emotions of alienation and fear. We have a need to constantly see new drugs as even more powerful, even more threatening to our self-steering powers when the old drugs seem to lose their teeth. Or, we imbue new powers into old drugs, as soon as the old drugs seem to become tame and not even evil any more (like marijuana in the United States of America). This is what underlies the drug scares that continue to appear in our field of vision, certain like the faces of the moon.
Summary and Conclusion
Since the 18th century, western man has organised particular behaviours into a specific, unitary phenomenon namely, 'addiction' as if this combination of behaviours is a distinct and real entity. The reasons why this combination of behaviours is created is not different from the reasons why the behavioural entity 'possessed by the devil' was created as the by-product of a past, religious, world view. These reasons are located in the necessity to recognise barriers that keep us from reaching our ultimate cultural ambitions, and to manage the fears these barriers instil within us. 'Addiction' is easily recognised by the culturally initiated, in the same way as in voodoo culture the impact of particular Spirits is recognised out of behavioural elements that a non-initiated person would not even see, or would understand in a completely different way. The construct of 'addiction' will serve modern man as long as it lives inside a world view that understands humans as self-steering, autonomous and entrepreneurial. The positive cultural construct of the autonomous individual, "tempered by self-examination, self-discipline, self-control" is highlighted by the cultural construct of its negative counterpart. Modern man will marginalise, kill, maim, imprison or ignore 'addicts' to the degree that they threaten the core of his individualistic interpretation of himself, or that they instil fear that he may loose the characteristics by which this interpretation is defined. Modern man is a witch hunter and Inquisitor.
With thanks to David Shewan for editing the original text.
Last update: February 9, 2010