The medical and treatment
establishments tell us that drug addiction is a brain disease, not an absence
of willpower. Technicolor brain scans are presented as proof, and millions of
dollars are invested in the search for pharmaceutical remedies.
What is unfortunate about this
definition is not that it plays down the willpower dimension of addiction—the
“just say no” injunction was too superficial to be of much help anyway. The
danger instead lies in the black-or-whiteness of both propositions: If
addiction is a brain disease, addicts are mad, sick and defective; if addiction
is a failure of will, users are bad, immoral and weak.
In “The Biology of Desire,” Marc
Lewis, a neuroscientist, takes a less Manichaean approach, arguing that
addiction entails both biological alterations in the user’s brain and changes
in his personal agency. He offers an insightful take on the interaction of mind
and brain against the backdrop of the addict’s life circumstances.
Mr. Lewis is no white-coated lab
shut-in. In his 20s, he consumed vast amounts of alcohol, opiates, psychedelics
and stimulants, an odyssey that he chronicled in “Memoirs of an Addicted Brain”
(2012). In that book and in this one, he writes about bursting
neurotransmitters and sinewy neural circuitry with remarkable passion and
Biology of Desire
By Marc Lewis
PublicAffairs, 238 pages, $26.99
When it comes to nomenclature, Mr.
Lewis prefers “habit” to “addiction”—not to minimize the devastation of what
users can incur but to point up the fact that the biology of habit formation is
relevant to the compulsive use of substances. “The neural circuitry of desire
governs anticipation, focused attention, and behavior . . . ,” he writes. “This
process is grounded in a neurobiological feedback loop that’s present in all
In other words, people who discover
a substance—or an activity, such as gambling—that helps them assuage pain or
elevate their mood will form a strong attachment to it. Repeated behavior
becomes harder to stop over time, though even a strong attachment need not
create an unchangeable pattern. Addiction is “an inevitable feature of the
basic human design,” Mr. Lewis writes. That design revolves around
“neuroplasticity,” the ability of the brain to reorganize itself by forming new
neural pathways and connections in response to modes of thinking and acting as
well as inputs from the environment.
As people repeatedly look forward to
and then experience certain drugs—or other strongly desired forms of pleasure
or relief—the brain adjusts its mechanisms, intensifying the release of
neurotransmitters in the regions involved in processing emotion and motivation.
“Each network of synapses,” Mr. Lewis writes, “is strengthened and refined, so
that the uptake of dopamine gets more selective as rewards are identified and
habits established.” The drug habit is learned more deeply than others, Mr.
Lewis explains, “due to a narrowing tunnel of attention and attraction.”
Competing desires and imperatives get shunted aside or obliterated.
“The Biology of Desire” is not
entirely a survey of brain science. Its middle part is devoted to portraiture,
presenting real people who were once in the grip of an addictive habit, tracing
the reasons for it and, finally, showing how each managed to stop. There is
Natalie, for example, a college student who is drawn to OxyContin and then
heroin because, she says, it “relaxed you by abolishing the sensation of
threat.” Natalie gets arrested and finally realizes the state she is in.
Through meditation she learns to tame her impulses and endure a craving without
giving into it. She also reunites with her mother. The sounds, sights and
experiences that, in her brain, she so tightly links with heroin lose their
The same basic arc applies to other
figures in Mr. Lewis’s portrait gallery: Brian the methamphetamine user, Donna
the opiate addict and Johnny the alcoholic. All these young adults are in some
way broken; all find solace in substances, both licit and illicit. They don’t
want to be addicted, and their self-loathing only intensifies once they believe
they are. But they desperately want immediate relief and so surrender.
All of Mr. Lewis’s case studies end
well or at least optimistically. At the heart of the recoveries are new, more
constructive habits, identities and relationships—and, in the brains of the
subjects, the sculpting of new synaptic patterns. As Mr. Lewis shows, the
physiology behind the addiction process can be intentionally engaged by addicts
to put them on the path to recovery. By exploiting the neuroplastic capacities
of the brain, individuals can develop strategies for self-control.
It may well be, as Mr. Lewis says,
that addiction is a form of normal habit formation. But isn’t it more like a
normal process gone awry? When outcomes are so dire, how is this not a
pathological state? Mr. Lewis is deeply humane in his regard for people trapped
in compulsive habits, so much so that he seems reluctant to impose any rules on
their behavior and ends up treating them more like patients than he might like
to admit. He is big on the so-called Vancouver model in which addicts are
guided to safer drug-using methods and gently encouraged to get themselves
together. But he de-emphasizes the importance of behavioral shaping through
external incentives and sanctions, which are at the core of drug treatments
that divert addicts from the criminal-justice system.
“The Biology of Desire” says a lot
about the brain mechanisms underpinning addiction but, to its credit, does not
stop there. With minor exceptions, we do not help addicts (and they do not help
themselves) by ministering directly to their brains. As Mr. Lewis stresses
throughout this unorthodox but enlightening book, people learn to be addicts,
and, with effort, they can learn not to be addicts, too.
Dr. Satel is a psychiatrist and
resident scholar at the American Enterprise Institute. She is co-author, with
Scott Lilienfeld, of “Brainwashed: The Seductive Appeal of Mindless
7/12/15. Published in the Michigan Psychology Newsletter, Spring 2015
I am going to live forever. So far, so good.
--- Steven Wright
Most people don’t know that the songs that defined
the boomer generation have taken on new meanings
for this aging population.
For instance, take Ray
Charles’s 1959 song What’d I Say:
The memorable lyric in this song is:
See that girl with a diamond ring
she knows how to shake that thing
Baby boomers take this song literally due to hearing
loss (“Why is everybody mumbling?”) and memory
And what about Aretha Franklin’s great 1967 tune
The memorable lyrics in this song are:
Find out what it means to me
Take Care, TCB
Aging boomers crave respect because they tend to
think of themselves as special, very different from
previous generations, rejecting traditional values,
seeking higher levels of consciousness through drugs,
sex, and an expectation to change the world for the
But, try telling your grandchildren about your
specialness and see how much RESPECT you get.
Then there was Motown’s Marvin Gaye who sang
What’s Going On in 1971.
Even today, this is a frequently heard greeting
members of the boomer generation: “Hey, what’s
But the memorable lyric from this tune was:
Brother, brother, brother…
There’s far too many of you dying
I hate to tell you this, fellow baby boomers, but when
someone in your weekly card group doesn’t show up,
it’s not because they found another group to play in.
And remember At the Hop by Danny and the Juniors
And remember when you, aging boomer, could
actually hop, roll, and stroll -- and not fall down?
But think of the memorable lyrics from At the Hop:
You can rock it, you can roll it;
Do the stomp and even stroll it.
At the hop
If you were to listen to this song today, you’re more
likely to say to yourself: “Why is this music so loud,
and why can’t I hear anything?”
Of course, everyone’s favorite rock ‘n’ roll group
was the Rolling Stones. In 1965, they sang (I Can’t
Get No) Satisfaction. This song captures the spirit of
aging, although today, for us boomers it should be retitled:
I Can’t Get the Satisfaction I Used To.
But recall the memorable lyrics in the Rolling Stones
And that man comes on to tell me,
How white my shirts can be,
But he can’t be a man cause he doesn’t smoke
The same cigarettes as me.
You know as well as I do that your greatest
satisfaction today is eating an early dinner and going
to bed at about the same time your children and
grandchildren are leaving their houses to go to a
concert, restaurant, or bar. And if you’re still
smoking cigarettes, it’s likely to be on the porch or in
the garage --some satisfaction!
To comment on this article, contact Steven J. Ceresnie, Ph.D., at
7/12/15. Published in the Michigan Psychology Newsletter. Spring, 2015
I don’t think I’m either pessimistic or optimistic; I’m
realistic. I don’t disparage your joy, but I think true
joy only arises from acknowledging our despair.
--- Rollo May, Ph.D.
As part of their training, psychologists have worked
to understand the roots of their joys, miseries and
despair. None of us wants to suffer, or experience
pain, but we learn, and relearn to acknowledge, bear,
and put into perspective our inevitable unhappiness.
This learning often brings greater emotional maturity,
resilience and empathy --- post-traumatic growth
some say, making us better prepared to help others.
There is an upsurge of research on positive
psychology to teach people ways to aspire to virtues,
character strengths, and happiness.
Since suffering is inevitable, it makes sense to teach
our patients methods to systematically promote selfpunishment,
guilt, and anxieties ---- on the route to
post-traumatic growth. If you know how to make
yourself miserable, just think what you can do with
Teaching misery is not easy task.
Tolstoy, in the first sentence of Anna Karenina, tells
us why understanding unhappiness is so challenging -
-- “All happy families resemble each other; each
unhappy family is unhappy in its own way” (Tolstoy,
The message here is that happy people have no
history --- they get up in the morning, go to work,
and come home --- drama, they don’t have.
Psychologists are exposed to the dramatic stories of
their patients in predicaments and interesting events -
-- the more narrative a life is, the worse it is.
Unhappy families all have stories ---- and each story
is different (Morson, 2015).
Since each story is different, we must teach our
patients some general principles of misery that apply
to all unhappy people.
To help psychologists teach
their patients how to make the most of their
individual unhappiness, I turn to a wonderful book:
“How to Make Yourself Miserable. Another vital
training manual” (Greenburg, 1966).
SOME GENERAL PRINCIPLES OF MISERY
Seventeen Basic Pessimistic Philosophies
1. I can’t do it.
2. I never could do anything right.
3. I have the worst luck in the world.
4. I don’t have a chance, so why try?
5. I’m all thumbs.
6. I’d only get hurt.
7. It would never work.
8. It’s not in the stars.
9. It’s never been done before.
10. It’s not who you are, it’s who you know.
11. It’s too late now.
12. It’s later than you think.
13. You can’t take it with you.
14. What good could come of it?
15. The piper must be paid.
16. The wages of sin is death.
17. The paths of glory lead but to the grave.
How to Make Yourself Miserable about the
1. Refuse to accept what cannot be changed.
2. Establish unrealistic goals.
What not to accept
1. Don’t ever accept your age, or your weight, or
your height, or your face, or your ethnic
group, or your socioeconomic level.
2. Don’t ever acknowledge the fact that you
3. Don’t ever accept the possibility of failure,
and don’t ever prepare for it with alternative
4. Don’t ever accept the fact that most people
will never realize how great you are.
5. Don’t ever believe that the things other people
have which you’ve always thought would
make you happy aren’t making them happy
What goals to establish
1. Find the perfect mate.
2. Find the perfect job.
3. Write the Great American Novel.
4. Get even with the cable company.
5. Develop a foolproof system to beat the stock
6. Fight City Hall, and win.
7. Get revenge for every injustice you’ve ever
had to put up with in your entire life.
8. Never be unrealistic again.
THE REJECT-ME MOVE:
YOU: “Tell me frankly, what do you think of me? Be
REJECTOR: “I think you’re very nice.”
YOU: “No, tell me exactly what you think. I admire
frankness more than any other quality.”
REJECTOR: “Well…to be perfectly honest I do
think you act a little neurotic at times.”
YOU: “Is that so! And I suppose you think you’re
I could go on and on with sure-fire methods to be
miserable -- but did you expect all the principles in
Tolstoy, L. (2014). Anna Karenina. New Haven, CT:
Yale University Press.
Morson, G. S. (April, 2015).
The moral urgency of Anna
Karenina. Commentary, 139 (4), 1-3.
Greenburg, D. & Jacobs, M. (1966). How to make yourself
miserable. New York: Random House.
The following response is from Dr. Aaron Ceresnie (full disclosure: my nephew)
article seems to be drawing conclusions from a lack of perspective of a person
who identifies as transgender and from the perspective that being a transgender
person is itself a medical/psychiatric problem. I would suggest that "transgendered"
also isn't the correct language, and identifying as a different gender than
given at birth is not in and of itself is not a mental disorder, unless it
causes significant functional impairment and distress. The much larger
incidence of suicidal thoughts/attempts in that population should also take
into account (which this article does not) the proportional amount of
harassment and violence transgender people are subjected to on a regular basis
from as early as they begin identifying that way publicly, or even if trying to
pass discreetly. There are no anti-discrimination protections for
transgender people, and they are often victims of hate crimes. I didn't see any
discussion regarding the influence of constant bullying, a lack of social acceptance,
or recognition of their identity as legitimate. Also, people who are
transgender in one form or another have always existed and have been documented
in indigenous cultures. The 10 year follow-up study that found
an increased risk of suicide was comparing transgender individuals to
a non-transgender population. I'm wondering how that data compared to other
transgender individuals who wanted but could not get the surgery. The author's
statements also reflect an assumption that the transgender population is
homogenous, which isn't the case. A lot of people who are identify as the
opposing sex never want surgical interventions. There's just more nuance and
heterogeneity than suggested in the article.
Moreover, Bradley/Chelsea Manning isn't a good example and it seems
presumptuous to say he wanted to identify as female for a lesser punishment.
Military documents show he started questioning his gender and asking about
reassignment surgery in 2009 and he didn't provide WikiLeaks with any
information until 2010. I don't see a good connection there.
I'm also not aware of any research
showing success of psychiatrists or therapists "restoring natural gender
feelings to a transgender minor", which sounds a lot like conversion
therapy for people who are gay (which has also not been successful and
denounced by the American Psychological Association due to its coercive
Sexual reassignment surgery of
minors is a legitimate concern, and I would argue a consenting adult who has
really thought about it should be entitled to the surgery. This article seems
to be more concerned with how Medicaid allocates money than the legitimacy
of the surgery itself or the socio-cultural environment in which transgender
individuals exist. The article is making the case that surgical
intervention is never a good idea, and I'm not sure there's evidence to support
that claim either. More research is always a good idea. One could make a
similar argument about elective plastic surgery.