Stigma and the other

This article has been on my mind, but I haven’t gotten around to posting anything on it. So, for today’s throw back Sunday post, I decided to use a related post.

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Dirk Hansen included this quote in a post on stigma:

“Psychological theories of illness are a powerful means of placing the blame on the ill. Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.”–Susan Sontag, Illness as Metaphor

It brought to mind this quote from Bill White:

How alcohol and other drug problems are constructed are not merely a theoretical issue debated by academics. Whether we define alcoholism as a sin, a crime, a disease, a social problem, or a product of economic deprivation determines whether this society assigns that problem to the care of the priest, police officer, doctor, addiction counselor, social worker, urban planner, or community activist. The model chosen will determine the fate of untold numbers of alcoholics and addicts and untold numbers of social institutions and professional careers.

It’s been on my mind because of this post in the Guardian:

The most miserable aspect of Labour’s methadone policies is that they encouraged people to believe that in switching from illegal drugs to methadone, they have become “clean”. This is a delusion. The most defeatist aspect is that the policies foster the idea that drug addiction is virtually impossible to overcome. Another delusion. . . . I’m not in favour of removing medical crutches that make addicts less of a threat (and I’d advise Cameron to think twice before doing it). But I’m not in favour of leading addicts to believe that they are not capable of doing any better by themselves.

Her use of the word “clean” really bothers me and it’s stuck with me all week. I’m not one to get too hung up on language and I often fear that recovery advocacy movements will hurt themselves by focusing on things like language and adopt a victim position that does little to advance the cause. However, the insinuations lurking in her quotation marks and calling it a delusion stirred very protective feelings toward these methadone clients. In the final sentence, her choice of the words, “by themselves” raises suspicions. Is she implying that they just need to pull themselves up by their bootstraps?

I suspect that the writer and I share a lot of common ground on policy positions (as they relate to methadone) and I agree with her concerns about the pessimistic message sent by methadone programs and policies, but I’m not sure I want her as an ally. I hate to sound cynical and tribal, but I often struggle with the influence of non-addicts in policy and the development of services for addicts.

tumblr_static_bfowdz4y4vwcgkgog0w84so80That sentiment brings to mind this Malcolm X story:

Several times in his autobiography, Malcolm X brings up the encounter he had with “one little blonde co-ed” who stepped in, then out, of his life not long after hearing him speak at her New England college. “I’d never seen anyone I ever spoke before more affected than this little white girl,” he wrote. So greatly did this speech affect the young woman that she actually flew to New York and tracked Malcolm down inside a Muslim restaurant he frequented in Harlem. “Her clothes, her carriage, her accent,” he wrote, “all showed Deep South breeding and money.” After introducing herself, she confronted Malcolm and his associates with this question: “Don’t you believe there are any good white people?” He said to her: “People’s deeds I believe in, Miss, not their words.”

She then exclaimed: “What can I do?” Malcolm said: “Nothing.” A moment later she burst into tears, ran out and along Lenox Avenue, and disappeared by taxi into the world.

I can relate to his sentiment that the most helpful thing others can do is leave us alone. (“Other” can be a pretty ugly word, no?) Then, when I’m a little less emotional, I’m left to consider my own cognitive biases and creeping certitude. I have to think about the contributions of people like Dr. Silkworth, Sister Ignatia, George Vaillant, A. Thomas McLellan, etc.

Malcolm X had a similar experience to this too:

In a later chapter, he wrote: “I regret that I told her she could do ‘nothing.’ I wish now that I knew her name, or where I could telephone her, and tell her what I tell white people now when they present themselves as being sincere, and ask me, one way or another, the same thing that she asked.”

Alex Haley, in the autobiography’s epilogue (Malcolm X had since been assassinated), recounted a statement Malcolm made to Gordon Parks that revealed how affected he was by his encounter with the blonde coed: “Well, I’ve lived to regret that incident. In many parts of the African continent I saw white students helping black people. Something like this kills a lot of argument. . . . I guess a man’s entitled to make a fool of himself if he’s ready to pay the cost. It cost me twelve years.”

Malcolm X realized, too late, that there was plenty this “little blonde coed” could have done, that his response to her was inconsistent with what he, his associates, and his followers wanted to accomplish.

Bill White wrote about the things that have allowed practitioners to avoid the cultural traps in working with addicts:

Four things have allowed addiction treatment practitioners to shun the cultural contempt with which alcoholics and addicts have long been held: 1) personal experiences of recovery and/or relationships with people in sustained recovery, 2) addiction-specific professional education, 3) the capacity to enter into relationships with alcoholics and addicts from a position of moral equality and emotional authenticity (willingness to experience a “kinship of common suffering” regardless of recovery status), and 4) clinical supervision by those possessing specialized knowledge about addiction, treatment and recovery processes. We must make sure that these qualities and conditions are not lost in the rush to integrate addiction treatment and other service systems.

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One response to “Stigma and the other

  1. This part of one of your qoutes really grabbed me:
    “Whether we define alcoholism as a sin, a crime, a disease, a social problem, or a product of economic deprivation”
    As a recovering alcoholic I can tell you that it is (or at least can be) all of those things. Occasionally I can hear a persons background and get an idea of what I think brought on their addiction, but most of the time I don’t know anything until they tell me what they think happened.
    Imagine what it must be like for people are not addicted and did not have someone that they love addicted. Someone who’s only familial connection to alcoholism is a crazy uncle that lives 3 states away. (to me you need to have been an alcoholic or lived with one to really get it)
    How do we explain to them that addicts just don’t pull themselves by their bootstraps (unless they are the 24% in the NIAAA study here: http://—pubs.niaaa.nih.gov/publications/arh29-2/131-142.pdf (remove —))
    How do we convincingly explain that the ASAM and the DSM have different definitions (slightly) and that those don’t match up with AA’s or the stuff they hear/see on television, and that equally respectable counselors disagree on what it is and how to treat it. Treatment claims range from you will be healed completely and forever to you will crave alcohol forever and will always need to be wary of relapse (also that relapses are common and expect them).
    I was lucky, before I completely fell apart my family knew me and my accomplishments. They could see a change for the worse.
    So while they didn’t know what it was called or how to fix it they did know it was awful and not normal behavior for me. They witnessed a slow disintegration. My family and friends understood alcoholism through me.

    What about regular people who know alcoholics but do not get the full flavor of the desperation and agony they feel. Maybe they only know the drunk from work. This sort of relationship gives a false reading of what is happening.

    We need to get a coherent message out there that normal people can use to help guide their thinking when it comes to alcoholism. Right now many people don’t know what to think because there are too many conflicting messages.

    Some people, occasionally with the help of alcoholics, make people in recovery seem heroic. Others expect the worse.

    I think Mr. White understands the average person’s frustration with alcohol addiction. I know I feel it.

    I do not believe it is possible to help a practicing alcoholic become a recovering alcoholic unless they believe the person helping them is sincere, credible, and has their interests, not anyone else’s, in mind.

    So many people could be helped, but the image of recovery is seriously compromised.
    When you don’t want to go anyway, all this confusion makes it easy to give a reasonable response for wanting to not sober up.