Essays

ART , PROPAGANDA , AND EDUCATION

Bloomberg News of Aug 5, 2019 reported that 13 murals depicting the life of George Washington , the WPA-funded work of Victor Arnautoff , were once again under attack . Far from correcting a ruling-class version of his life , the murals instead should be condemned for their realistic -and horrific - depictions of African American people in bondage . Honest and subversive , or paternally well-intentioned ? A haunting reminder , or a daily dose of humiliation ? A people's history , or merely another re-telling from the colonizer's perspective ?

Of 49 freshmen ( in a school overwhelmingly attended by Asian-Americans ) assigned to weigh in on the topic , only 4 called for the removal of the murals . One of these students wrote, " The fresco shows us exactly how brutal colonization and genocide really were and are ."

Before taking on the furor attending the propriety of the murals we must first attend to the terms proper to the discussion : art , propaganda , and education . Propaganda is the dissemination of a statement , belief , or practice . The term itself was first used to denote the committee of Roman Catholic Cardinals engaged in foreign missions spreading the faith . Propaganda , as we know it now , is material of whatever sort destined to convince the public of some fact or belief . The truth or falsity of the material is irrelevant ; nevertheless the word has come to denote a cynical disregard for the truth on the part of the propagandist . The “lies” of the state that the Soviet public learned to treat with contempt has its mirror image in the liberal West : advertising . (My own grand-father , once president of an association of advertisers in New York , wrote a short book entitled “How to Sell Anything” , which has an eerie resemblance to certain totalitarian assurances .) One imagines oneself immune to such productions : one is too sophisticated to be drawn in . Allow me a moment in which to share my own personal experience of artful propaganda .

In 1964 , in the thaw following the demise of Stalin , a film , “Yo Soy Cuba”, a Russian -Cuban co-production scripted , directed and shot by Soviet artists , was made , and 30 years later distributed in the West . I saw it in Paris shortly after the attacks of 9/11 , and was impressed by how it combined realistic psychology with Marxist politics . In one of its four episodes , an American tourist ( the bearded liberal of his pack) , sincerely appears to care for the bar-girl supporting her family , which in Marxist terms only confirms his bourgeois sentimentality , i.e. his weakness . In a second vignette , off -kilter camera angles frame the desperate resistance of a cane-farmer choosing to burn his fields rather than sell-out to the Yankee fruit company , whose agents arrive on horseback (never a good omen for the peasant). We left the movie-house fired up and ready to write the song that might tell the truth of the falling towers of Wall Street - the movie , as propaganda , had done its job , but not through a ham-handed depiction of artless stereotypes . Only later did one realize what was at work : that humanism could find its way into agit-prop just as easily as any other credo , if the time was right . The characters in the film are recognizably human , not card-board cut-outs . It was art in the service of Soviet propaganda in an era decadent by Stalinist standards . (The mere existence of such a film being produced by the Nazi regime is so improbable that the double-standard applied to the twinned examples of totalitarian state terror becomes a tad more comprehensible .) I was not , as I had thought , wholly immune to propaganda , even were it in a film more or less in line with Soviet ideology .

In the issue of the extensive mural decorating the halls of Washington H.S in San Francisco we must address several questions : what is art , what is history , what is education , and how propaganda relies on their subordination . Education , as distinct from instruction , is the process of bringing out and developing what is within the student. The school-age child has reason , however nascent , a feeling for beauty , however uncultivated : an aversion to what is ugly or nonsensical . Aesthetics concerns the perception of what is beautiful , and thus rests on being able to feel , as is suggested by its antonym , ‘anesthetics’ , agents of numbness . Therefore , education rests on the development of reason and feeling . Instruction shows us how to do things , but education gives the student the necessary tools with which to profit from the instruction .

Students nonetheless appear to be merely empty vessels it is our obligation to fill with , or “expose to” , the proper knowledge . Applying moral judgements to historical figures we now condemn as racists is not educational , whereas even an elementary course in logical thinking would prepare most students to collate what they’d been taught about Washington and then draw their own conclusions . Disabusing oneself of swallowing whole the foundational myths of our nation is neither painless nor difficult . Let’s see : this president had an estate in Virginia , Virginia was a slave -state , thus : did he hold slaves ? That he did has never been a secret , notwithstanding the protests of those defending the mural as evidence of such . The moral judgement we may pass on Washington would seem to close the case , but only among those whose questions end at such a juncture of history and ethics . Knowing him to have been a slave-holder is necessary , but is only the beginning of any serious investigation . Americans may not have a monopoly on this end-game moralizing , but we have made a specialty of it .

With art , based as it is on sensory perception , the process may be less straightforward , but we can stipulate that visual creations worthy of being called ‘art’ have a singular defining quality : they compel one to keep on looking at them , whether out of curiosity , awe , bafflement , or pleasure . Items of decor that one passes by each day , which , strictly speaking , include the mural in question , cannot but fail to keep us looking . Even were it not so situated , its poverty as a work of art would become apparent , for once you have figured out the points the artist wished to make , you are done with it . Great art doesn’t work that way ; as it challenges our immediate apprehension , it rewards our repeated viewing and concentrated observation . The mural is not art ; it is propaganda . As well-intentioned as the muralist’s work may have been in the 1930s , when museums were properly the domain of the leisured , and the masses were left to commandeer whatever wall they might , in today’s over-saturated landscape a mural’s capacity to get the attention it might deserve depends wholly on the willingness of institutions to underwrite its production , and , in the case of the mural , will predictably caress the liberal pieties of those nostalgic for an era of ‘class solidarity’, ‘people’s art’, and a willing ignorance of Communist terror as practiced behind the Iron Curtain . The massed populations of industrial society have mutated into the atomized consumers of today , vainly reasserting their obligations to discern , amidst the flood of images meant to seduce them , those that they judge harmful or , less judgmentally , “incorrect”. Thus has a mass of images superseded , as elements to monitor and control , the human masses of yesteryear , and , in the case of the mural , it is the concerned middle-class citizen , the ambitious young politician , or the self-appointed curator that steps in to pass judgement . It is as if the masses of workers to be organized had been replaced by a mass of pictures , both in need of a rationalizing system of value .

In HBO’s “Chernobyl” a Soviet official , an ‘apparatchik’, is sent out to conscript local miners - a part of the working -class noted for a solidarity the state only pretends to honor - to dig a tunnel crucial to cleaning up the mess at the highly toxic nuclear energy site now in ruins . One might , perhaps fancifully , see the curatorship of our own ‘experts ‘, so sure of their ability to discern , out of the flood of images competing for our attention , what might best enlighten our students , as analogous to the apparatchik’s naive claim on the mass of workers a portion of which he must enlist in the great , on-going struggle for socialism . The Soviet flunky demands of the workers a courage he can’t even imagine for himself ; today’s ‘curator ‘ , a partisan for the mural , and for free expression , pats himself on the back for exposing the real world to the unlearned masses whose actual concerns he cannot address . In both situations the establishment - be it school-board or Soviet ministry - imposes its will upon the everyday masses . That the masses of students are convinced neither of the mural’s importance nor , sadly , of the need to study history in the first place , makes the extravagant cost of painting over the mural the grotesque trump-card putting the controversy to rest : it will be covered up with plywood so as to avoid the outrageous sums required to paint it over .

Those who sought to have the mural painted over pointed to the trauma it routinely was thought to revive in those students who could claim some kinship with the oppressed figures -the enslaved people and Native Americans- depicted in the mural . Those who , in opposition , claimed to represent free expression , especially in the publicizing of popular struggle , declared that you cannot paint over history . (Those who defended the artist in question were tilting at windmills when they asserted he wasn’t ‘glorifying slavery’ - nobody is that clueless .) Neither the pleaders for “safe spaces" nor those encouraging a fearless look at the past engaged the question of how to honor the victims of bestial oppression . Despite its pretensions to fearlessness , the mural nevertheless presents a sanitized version both of slavery and Western expansion : the enslaved in the fields are not in tatters , nor in chains ; neither are they whipped into submission or made to wear the grisly irons made to silence them . In a neat row they tend to the crop , in modest but clean garb : a picture of order . But in its perversion of economics , sexual morality , kinship , and justice , slavery was anything but a picture of order : it was disorder writ large . The slain Native American male at the feet of his vanquisher might very well have perished in battle - a noble end . But what of the countless elders , women and children routinely massacred by the agents of Manifest Destiny ? They are nowhere to be seen , not because they don’t count , but because such a depiction would be obscene , as would be that of the tortures visited upon the slaves .

Horror is sacred . The memory of it risks paralyzing those who survived , and visits shame upon those who look on . The inadequacy of the liberal argument for ‘free expression’ , or for not turning away from painful truths , is in its failure to assess and respect the spiritual weight of historical trauma . This became clear to me when I viewed , for the first time , the footage shot by Allied troops entering the concentration camps abandoned by the Germans at the end of WW11 . This documentary presented by KQED arrived on our TV screens with no fanfare , much less a warning . Watching it made one feel dirty , as if one were now complicit in the radical dehumanization of the victims . And this under the auspices of a liberal institution , namely KQED . This was not just another show ; neither was it merely “informative” , and one can’t help but wonder at the secular mythology that informs such tone-deaf programming : it’s as if in the absence of God mankind were left to figure this out alone , and could do no better than to reduce a moral cataclysm to the status of a nature documentary .

While it may seem impertinent to mention God in such a debate , consider this : the worst wholesale killings of human beings were , or more properly , have been, carried out by regimes that didn’t fear the judgement of Heaven : Nazi Germany , the USSR, and Red China . Totalitarian ideology would make anything possible ; the technical mastery that bloomed in the 19th century could now operate in tandem with a moral mutation according perfect license to the state . Recall the rather ‘old-fashioned’ warning delivered by Hannah Arendt at the finale of the eponymous bio-pic : ‘…the manifestation of the wind of thought is not knowledge , but the ability to tell right from wrong , beautiful from ugly… ‘ Hypocrisy , we are told , is the compliment vice pays to virtue ; paying mere lip-service to the pursuit of the ‘good’ , even if it only succeeds in avoiding the worst , is music compared to the quacking of ideologues promising the perfection of human society .

A contemporary , the philosopher John Gray , distinguishes between the prescriptive and proscriptive moral ideals : the former tells us what to aim for , the latter what to avoid , and this dichotomy is present in the two different versions of the Golden Rule . ‘Do unto others as you would have them do unto you ‘ assumes a universal (prescriptive ) set of values ; the obverse , ‘Do not unto your neighbor what you find hateful to yourself ' is proscriptive : it would avoid the worst expressions of human behavior , as in murder , rape , or torture , and not pretend to prescribe what is best for all people in all eras and in all places . The menu is limited . If this sounds conservative , it’s because a sense of the limits of human endeavor is so ; that this sense of limitation usually comes from a reading of history shouldn’t surprise : writing history is a way of conserving the past , and in this sense it is essentially conservative in its function . The idea that one could wipe the historical slate clean , and simply start over from nothing , with all prejudice and hurtful memory banished , is a pipe-dream from which one usually awakes facing a firing-squad , or face down awaiting the guillotine’s blade .

In spite of the data-driven narratives that would convince us otherwise , history is not a science , and the pants-down shock that marked the ’sudden’ end to Soviet rule is potent evidence of how impossible it is to reliably predict the future of political bodies . Nevertheless , historiography does share one important quality with the physical sciences : its theses are continually being re-evaluated in the light of new data . In retrospect , WWI , if not its worst aspects , seemed inevitable , but in 1913 all seemed for the best , with the robust trade between nations a sure barrier to ruinous aggression . The raft of scientific study that today can verifiably predict the unchecked spread of a virus among throngs of the heedlessly unprotected is no less factual for the blithe disregard of the selfish wanting to get on with their lives ; the troves of quasi-historical narratives are no more true for the prejudices they may have sanctified in popular lore .

Hannah Arendt touched a too-sore spot when she argued a generalized moral degradation as the culture in which totalitarian rule could develop . This wasn’t to ‘blame the victims’ of such rule , but , rather , to hold responsible all those who made accommodations to an ever-expanding dominion of lies and terror from which they hoped to be spared . Said degradation is easy to illustrate but hard to quantify , and the judgement it demands rests on moral principles rather than on the contingencies of politics . Today’s climate of outrage , be it fed on grotesque misinformation or the shocking gullibility of its targets , itself feeds on the thin gruel of humanist expectations : no one today invokes the commandment against bearing false witness when confronted with outrageous accusations ; we are too modern , too ‘enlightened ‘ to stand on that rock - the patently immoral act becomes merely ‘problematic' ; the division between right and wrong is reduced to that which is useful or ineffective . If the pragmatism of our age still must refer to the notion of practice , can we not then insist on the exercise of moral imperatives ? Can we conveniently ignore the spiritual foundation that nourished the long , long battle for civil rights in our country ?

The partisans of the mural are not alone in their belief that there is identifiable progress in human affairs , a credo which operates as a sort of moral haven from which we can assess the injustice and barbarity of the past . This errant optimism resembles that of the battered wife who takes her spouse’s tearful apology at face value , when experience teaches that those who hit will hit again . The well-meaning exhortation of "Never Again !" assumes that learning the lessons of the past might rid our world , once and for all , of its worst manifestations . Anne Applebaum , a respected historian of the Gulag and the state-imposed famine in the Ukraine , reminds us that if such mass murder happened once , it can happen again . There is no immunity . The struggle to assert our humanity over and against the demonic may benefit from periods of respite , but the progress made in such periods is not cumulative . The promise of heaven on earth is a desperate one ; it appeals to those who imagine they have nothing left to lose . One nameless victim of inhumanity left us this : " As long as we can say this is the worst , then it’s not the worst ." This reference to the final injustice , the injunction to simply shut up , to disappear into the maw of the past , transmuted into the moral imperative taken up by the Jews condemned to do the dirty work in the death-camps : they had to do whatever it took , not merely to survive , but to live to tell the tale , to bear witness , to insist on justice for the murdered . As dire as their predicament was , these heroes knew what was at stake , what still hung in the balance : the truth to be told . The very worst fate would have been silence .

There is no comparison possible between an illustration , however balanced , of a founding father , and the published account of a survivor of a genocide . Images are not words , and it is in the very privacy of reading that one may confront the terrible ambiguities lurking in the narratives of inhumanity . Primo Levi , an Italian chemist and partisan fighter sent away by the Nazis , is a case in point . As painful and morally challenging as his story is , his account of life and death under Nazi slavery is a breath of fresh air compared to the politically charged inquisitions that banish Hitler and Co. to an arid wasteland , as if these arch-conspirators could take human evil away with them . It’s no feat of research to uncover the complicity of major German firms with Nazi crimes ; much more difficult is it to assay the complicity of multi-national corporations in the killing and devastation that extractive industries have wrought in the Congo , all in the service of supplying the coltan and other minerals without which our smartphones and computer-systems would go dark .

The two sides in the mural debate talked past one another in stale repetition reminiscent of any number of controversies . That it was the young facing down the old is a sure reflection of the shaky promises made by the latter to the former : that the truth shall make you free , or that there is no limit to what you can achieve , or , finally that , in light of the issue at hand , a knowledge of the past allows us to rectify present and future evils . Telling the truth can easily get you run out of town , or worse ; our vaunted meritocracy more than ever now rewards those with superior resources ; and as for history , the old will gladly foot the bill for its exhibition , but the bill for the future will be borne by the young , and by them alone .

Les chiens aboient , la caravane passe .

Introduction

The epidemic of opioid addiction in the U.S. and its overwhelming of entire communities has put in high relief the professed centrality of the Twelve-Step approach to recovery that originated with Alcoholics Anonymous (AA), a template that threatens to wither into virtual irrelevance in the face of this societal disaster.

The hue and cry in response to today ‘s crisis of addiction often occurs off-stage, as it were, in the voices of outsiders. Critics outside the recovery community come primarily in two forms:

1) the medical professional who, often as not, misinterprets critical elements of AA ; and

2) the dissatisfied ex-participant for whom the program ‘didn't work.'

Partisans of AA and its offshoots routinely dismiss such sources as, respectively, outsiders ignorant of the process, and those not having invested enough of themselves in ‘working the program.'

What is sorely missing are reports from the inside. Two conditions prevent insiders from setting things straight: the unquestioned AA tradition of anonymity , and the circular thinking within the fellowship that too easily conflates criticism with one‘s own personal shortcomings, a reflex in line with an approach to substance abuse long on faith and notably short on evidence.

As a recovering addict/alcoholic, I, with some trepidation, will break with the hallowed tradition of anonymity. I will also explore the cultural and religious conditions in which AA developed in order to make sense of its strong but limited appeal. During this essay you might wonder which ‘side’ I am on: The answer is both. I can neither deny what AA did for me nor ignore the failed paradigm of treatment it continues to offer to the broader public.

An AA veteran speaks out :

“Rarely has a person failed who has thoroughly followed our path,” begins the preamble to nearly every AA meeting I have attended in my eight years of sobriety. I would appear to be one of AA 's ‘winners.’ For three months, I attended two meetings a day per the expectations of my rehab; I read AA 's ‘Big Book’ and worked the Twelve Steps with a sponsor ; I took his advice and participated in my recovery by taking meetings into detox centers, half-way houses, psychiatric wards and jails. My program worked, as they say, because I worked it.

MY PROGRAM WORKED: I HAD ADVANTAGES

It also worked, I dare say, because I am white, educated, had good health insurance and live in a cosmopolitan, tolerant and monied city full of ex-partiers grateful for the chance to give back what was freely given to them in the fellowship of AA. I have an ethnic advantage in this area for the simple reason that my side of the city hosts way more AA meetings than do poorer Black and Latino neighborhoods. My education allowed me a teaching position with a health plan. And the mix of people in my ville is at one with the tolerant attitude it fosters.

It was not a pill, nor belief in a dogma, but a commitment to service in a community of the recovering that saved me, but this personal turnaround happened in specific circumstances at an opportune time. If it takes a village to raise a child, then I can honestly say too that a richly appointed AA “village" raised me anew as a sober citizen. But the apologia that follows our opening screed - that those who fail are very likely born without the faculty of rigorous honesty - not only ignores what can be learned and turned to one‘s advantage in a relapse, but the straitened circumstances of those many without ready access to the services and opportunities to serve that appear crucial to recovery. I here allow a widening of the AA net to include the all substance abusers, whose numbers have drastically surged across depopulated towns and villages, many of which can barely support a clinic, much less a “recovery community." Even with the best will in the world, an addict who has reset her physical addiction by a stint in detox will find it nearly impossible to remain clean and sober all by herself. Is the depressed addict stuck in a depressed town in a depressed area really relapsing due to some congenital defect? Is anyone really born dishonest? (And if so, how could we fault him for such an inherited failing?) The primacy of fellowship so determines success that atheist AAs have recourse to a re-definition of God as a “Group Of Drunks.” The particular circumstances of AA ‘s birth and growth did not prevent its adoption of a universalistic spiritual ethos. Only the particular application of the principles seems to be problematic.

The Affordable Care Act meanwhile has made rehabilitation programs recently more readily available to millions more Americans but not nearly all who need them. These centers utilize the 12-Step programs that originated with AA or, more precisely, facilitate entry into them. Kaiser Heath ‘s substance abuse program counselors were explicit with me in this regard: I was told that the program I worked there was ”training-wheels for AA.”

AA: AUTONOMOUS NO MORE?

A major tenet central to AA is its vaunted autonomy: “AA is not allied with any sect, denomination, politics, organization, or institution …” While this may have been wholly true at its inception and during its early years, the common practice in rehab services today of not only recommending attendance at AA meetings but requiring them as a condition of treatment seriously compromises a tradition that few in AA would choose to abandon. The claim of autonomy ignores the symbiotic relationship between AA and the rehabilitation industry. Push comes to shove, for example, when a convict ‘s terms of parole stipulate such attendance or when a custody battle can only be resolved in this way. AA participation now amounts to a proof of good faith, as if such proof were a conditional element of medical treatment.

This ‘independent’ statement of purpose reiterated at most AA meetings also didn’t foresee the sweeping enlistment of AA as primary adjunct of state-licensed programs in which the primary caregivers assessing patient progress are counselors whose main qualifications are their own histories of overcoming addiction and a basic minimum of education.

The industry sends its patients into AA and other similar programs as a matter of course and has so invested in that handoff that neither AA nor the quasi-medical staffers of the industry have much stomach for any competing model of recovery. But given the absence of reliable follow-up data that could justify that position, one remains in a quandary as to the hold the 12-Step model has on the public mind, and the responsibility of AA in that regard.

Without meaning to particularly, and without any comprehensive agreement with AA, the health-care giant Kaiser (among others) itself partnered with government-funded or mandated insurance companies, has enmeshed AA in an industry still finding its way towards a reliably proven model of addiction. In the meantime, the programs don’t actually have to work:

They simply have to attract clients.

In many cases, severe psychiatric distress is papered over by the temporary relief sobriety offers from the physical degradation and social isolation often accompanying addiction. For those at the very bottom of the social ladder, those leaving prison or so socially debilitated that they have no recourse but to pledge themselves to something like the strict regimens of the Salvation Army, AA is the only port in their storm; such are the realities of medical care in the US. And it is the practiced referral of these people to AA that established through the back door the kind of de facto alliance with institutions that AA explicitly disavows.

When I had to have my attendance slip signed as proof that I was complying with the recommendations of my rehab (Kaiser), I had occasion to question how coercive a practice this might be, but any doubts I had were quelled by considering how coercive my addictions themselves had, in fact, been. That the coercive power of my addled state wasn’t to be compared to a recovery model whose efficacy hasn’t been objectively tested, much less proven, never occurred to me, but this kind of self-serving rationalization is all too common among those who have ‘drunk the Kool-Aid.’

When I felt I had been verbally abused by a counselor, I resisted, and wrote an indictment of several pages to my old therapist, sent it off, and was seized, the following day, by a remorse informed by the sure knowledge that blowing the whistle on this health-care professional wasn’t going to help me stay sober; as it turned out, the letter was never delivered and a new counselor was made available without any fuss.

This points up the peculiar position of one renouncing power over what one cannot change in the interest of his sobriety; the client is clearly no longer in a position to provide the feedback necessary for staff evaluation. If we credit AA with a spiritual approach in harmony with our major faiths, we nevertheless must assess its application in light of the social acceptance that ignores its inefficacy.

BREAKING WITH ANONYMITY

Another of AA ‘s most hallowed traditions, which I am in some sense violating here is anonymity. “Anonymity is the spiritual foundation of all our traditions.” This dictum is meant to assure that principles and not personalities direct our efforts. AA has no "leader” and abjures any stand on public issues, no matter how relevant they may seem to our mission. My parting of the ways with anonymity is deliberate and has not been taken lightly, though I am not a public figure and hardly prominent enough to generate appreciable controversy.

Anonymity was enshrined by AA a century ago when the disease model of alcoholism was just finding its feet (also due to AA). For most Americans, drunkenness was a sin, a stain on one ‘s reputation and easily attributable to one’s poor character, lack of willpower, selfishness or even demonic possession. It would have been madness to expect widespread understanding or compassion then from a broad public untutored in psychological theories about substance abuse.

In the years that have followed, we have largely stopped openly castigating the drinker/user, adopting a kinder public stance - without, however, making any concomitant, appreciable dent in the overall rate of alcohol/drug-based self-destruction. This failure is most visible in the current and overwhelming opioid crisis in which the slow or sudden death of thousands has become a major threat across the nation.

And despite attitude changes, alcoholism (and addiction) still breeds shame. We are ashamed of our drunken father, our sloppy date, our out-to-lunch spouse or our wayward child. As children of the afflicted, we had little notion of the origin of the problem. We only viewed the consequences and felt little to no ability to actually help. As adults, we wring our hands and hope against hope that utter destruction isn’t inevitable and that the doctors and counselors will know what to do. As active alcoholics, we contrive myriad excuses for our behavior and an equal variety of strategies to control our intake. If only spectators (and not parents), we feel shame, not guilt: It 's not our fault someone else is courting jail, hospital or grave. The shame we feel all around is too common to be unnatural , and an enlightened muting of this reaction won’t make it go away. It is part of the human condition, and for AA it is the elephant in the room.

The tradition of “anonymity” is a defensive strategy so well-worn that the very mention of attending a “meeting” without a name is enough to reveal both one 's affiliation and condition. To be sure, there is virtue in maintaining the tradition, among other things to restrain the temptation to ‘dine out’ on the colorful tales one is privy to as an AA member. What is said in the ”rooms” stays in the rooms, at least in principle. This rule doesn’t prevent all violations of confidence but it performs the useful function of setting boundaries.

At the same time, in AA meanwhile the threat of ‘heresy’ (as in rejecting a principle like anonymity) is also very real to its members: The threat is existential, as it endangers their foundation, a belief system perhaps less decisive than the action it engenders, but nonetheless critical to AA 's inner cohesion and its interface with the therapeutic community.

But if we are to engage in honest re-appraisal of recovery as promulgated by AA in conjunction with public health professionals, how can we do this without the open testimony of those who have ‘walked the walk', the clean and sober members of AA? All the talk of programs and funds allotted to treatment, the harrowing statistics of rising rates of drug/alcohol abuse, the frequently arcane statistical studies, and all the government figures testifying to this or that: How can they be properly evaluated without the explicit feedback of those who have been through the mill?

Those central actors in the debacle of addiction treatment - caregivers with skin in the game - are naturally likely to cling to models of addiction and recovery that prevailed during their professional formation in a field now industrial in scale. The very size of the recovery business makes its own ‘weather’ as if the breadth of recovery options testified to their efficacy.

As one who completed a rehab of several months, I was polled the year following to assess my sobriety. As a scientific evaluation, this hardly passes muster, but no matter, my health provider Kaiser can no doubt point to mine as part of their “encouraging numbers” for public relations. (In another field where self-reporting seems the only option, that of sexology, the unreliability of this method renders the hopeful researcher a hapless figure of fun.)

SUCCESS EXAGGERATED

With a success rate estimated at less than 10 percent of those who start or ‘try' AA, the organization cannot credit its methods with any proof that they work reliably for alcoholic or addicted people generally. AA doesn’t actually pretend to science but dabbles at the edge of medical practice. ‘Proofs’ of AA ‘s efficacy are to be found only in the trove of anecdotal narratives that fill the second part of the organization‘s Big Book and other AA publications.

With all the attention brought to bear on the problems of alcoholism and addiction, one might expect happier outcomes, but a 10% AA recovery rate appears to be a generous estimate. One might very well re-word the opening declaration of “How It Works” to read:

“Rarely have we seen a person succeed at this program; we wish we knew why."

So why did our dear founder Bill Wilson pretend to know why the AA antidote works for some and not others?

CHALLENGING AA UNIVERSALITY

I mean to question AA ‘s supposed universality by

1) noting the peculiarly American nature of its associative ethos, and how AA derives from, and depends on, the ethos of a guilt-based culture;

2) questioning the relevance of the AA model in serving depressed communities awash in pharmaceutical opiates; and

3) also questioning, not the authenticity of personal narratives of recovery, but the reliability of a method whose success may well derive not from its efficacy but from the sample population it fits so well with.

Starting with #3, in other words, perhaps the successful post-AA sober among us might have achieved sobriety using any number of therapeutic models, simply because we were ready to ‘get well’ and had lives we felt worth salvaging. Could AA be a sugar pill of sorts, a placebo? Susan Sontag’s critique of therapeutic models operating in fuzzy ignorance of verifiable systems of cure in her study , “Illness as Metaphor” , is surely relevant in this regard.

So What’s the Evidence, Anyway?

While there is much to be said for the community, compassion and ethical norms cultivated in AA, its working engagement with addictive behavior was never based on scientific research. AA’s preeminence originated in an era when the scourge of alcoholism had so defeated the medical establishment that it was only too glad to hand over its burden to a group whose early successes became the stuff of legend. The failures were discounted as those who revealed themselves, in founder Bill Wilson’s words, as “men and women who are constitutionally incapable of being honest with themselves.”

Because AA doesn’t keep records, estimates of its success vary wildly from anecdotal numbers cited in AA history - around 75% - to the 5-8% cited by epidemiology researchers. The rehabs themselves provide glowing statistics on the sobriety of patients while under care, typically a 28-day stay, a regimen mandated by insurance policies rather than the real needs of the addicted.

In “The Sober Truth” by prominent addiction researcher Dr. Lance Dodes , the reader wanders through the confused muddle of statistical studies determining the effectiveness of AA and other treatment options. One is quickly lost in the jargon of researchers who, for the most part, haven’t been able to examine the actual outcomes of a meaningful swath of AA members for the simple aforementioned reason that AA ‘s brief doesn’t include toting up numbers of winners and losers.

GENERAL PROBLEMS ASSESSING ‘TREATMENTS’

Human research falls into two different models: observational vs. controlled studies. The former, observing the world as it is, are prone to making correlations between behaviors and outcomes that so routinely ignore crucial confounding factors as to render results useless or worse. For example, one might find that alcoholics who attend AA meetings maintain sobriety more often than those who don’t, but this ignores the”compliance effect” whereby attendees could well be those who would trust and follow a doctor ‘s orders in any case. They are in a sense pre-selected to succeed.

In randomized controlled studies, which seem virtually impossible to conduct in this domain, one must locate test subjects who can willingly be randomly separated into comparable groups, one following the regime or ‘treatment’ being tested and a ‘control group’ with no ‘treatment’ or a well-established one. In this way, the “selection bias” that undermines the observational study is eliminated.

AMBIGUOUS RESEARCH RESULTS

The Cochrane Collaboration, a cohort of 30, 000 researchers devoted to evaluating evidence-based medical studies, reviewed eight studies involving some 3,400 subjects undergoing treatment for alcoholism and found no proof of the effectiveness of 12-step programs. The studies that supported AA ‘s effectiveness were compromised by their samples, which consisted of people who chose to go into AA (not surprisingly), the perfect recipe however for compliance error.

Another study found comparable favorable outcomes for those in various forms of non-12-step therapy and AA, but of 600-plus subjects, only a hundred self-reported follow-up data on which conclusions were based. How many lapsed drinkers will admit their failure at either alternative to data compilers, one might wonder. Researchers admitted that the self-selection of those seeking either treatment precluded firm conclusions about the efficacy of AA or other treatments. A 2012 study bumped up against both the absence of any records from AA or NA (Narcotics Anonymous) and the in-and-out participation of those studied. (Narcotics Anonymous, an AA offshoot, closely follows the main tenets and suggestions that AA offers the alcoholic ; in medical terms , addiction, as a concept, incorporates alcohol abuse.) Another, atypical, study showed decreases in hazardous drinking corresponding to decreased AA attendance.

One bottom-line conclusion Dr Dodes drew is that active involvement in AA seems to make a difference for a small minority. Relying on this study or that, Dodes concluded that of the 25-40% of the alcoholics who start AA who were reported to subsequently be active in AA programs for at least a year, about a fifth stayed sober all the way through that first year, and so he came up with a first-year success rate of 5-8%. Just as ‘sobering‘ are the rates of people getting better without “medical intervention,” including in this case AA, cited as somewhere between 4 and 18 percent.

FRESH AIR

One voice cutting through the noisy welter of conflicting statistics and health-claims is that of Dr Mark Willenbring , a psychiatrist who has specialized in addiction for decades . From 2004 -2009 he was the Director of Treatment Research for the National Institute of Alcohol Abuse and Alcoholism (NIAAA) , part of the NIH , where he oversaw dozens of studies . He now runs a private clinic offering a variety of approaches to addiction , which include medications to alleviate the long-term psychological stress that follows withdrawal .

How big a problem did he confront ? The Center for Disease Control (CDC) counted nearly four times as many deaths from opioid use in 2013 than in 2002 . An NIAA study of 43 000 alcoholic subjects over a three-year period followed outcomes . It turned at least a couple of rehab myths on their head : alcoholism isn’t necessarily progressive ; and it found no evidence to support ‘cross-addiction’, ie , that one addiction will succeed another as an expression of an ‘addictive personality’. In any given year some 17 million Americans over the age of 18 are diagnosed with alcohol-abuse disorder ; of those only 2 million receive treatment : who , then , are the other 15 million ? In an on-line interview Dr Willenbring profiled them as people with less co-morbidity (they aren’t drinking themselves to death ) ; they have more social capital (a better safety-net ) ; and most suffer an episode of only a few years - one that ends and doesn’t recur . The episodic nature of the illness, plus the high cost of private rehabilitation facilities , might explain why so many ‘heavy drinkers’ forego treatment plans that usually end in a hand-off of the patient to AA . This hand-off is a poor substitute for the extended care proper to a chronic disease ; it can take up to a year for the patient to learn how to cope with the normal vicissitudes of family , job , and other social settings , without drinking .

“With addiction , the penetration of evidence-based practice is almost nil .” That is , Dr W says , there operates a huge disconnect between what research has established and what is practiced in hospitals and rehabs , a situation he experienced when he left the NIH to work at a private non-academic hospital . Counter to the AA insistence on abstinence as a viable measure of recovery , Dr W contends that the research he reviewed supports the idea that a relapse doesn’t measure outcome ; recurrence does not spell failure . He cites one long-term study in which but 6% of the subjects in treatment maintained perfect sobriety - a 94% failure rate ! This kind of evaluation doesn’t wash as medical science : it makes simple , everyday recurrence a moral defeat .

Neither does the ‘one-size-fits-all’ approach jibe with the demography of actual alcohol-use disorder : one study found that only a third of drinkers were of the ‘early-onset’ type (age 18-25), and that the disorder peaks from age 18-20 : by age 25 50% of those are well again ; by age 35 75 % are well. Without a family history of alcoholism it’s uncommon to develop 'tolerance' , which manifests itself in four ways : drinking offers relief , not just relaxation ; one quickly develops a high capacity for booze ; one is relatively protected from hang-overs ; and one feels stimulated rather than sleepy from excessive consumption .

Where the NIAAA defines alcoholic binge-drinking as taking 5 or more drinks five times a month - getting hammered about once a week - Dr W sets the following parameters for what he calls a ‘polygenic’ disease : with no genetic coding more than 5 drinks per day is unlikely ; a ‘moderate’ abuse of alcohol amounts to 8-12 per day ; severe cases take up to 16 drinks per day . The primary marker of addiction is heavy use , which is genetically determined ; addiction shows itself in the inability to stop once you have started , rather like going down a water-slide - no way your will-power will kick-in after just a few yards . The decision to drink becomes automatic , and one spurred on by the delicious anticipation the drinker experiences .

Dr W’s solution to the addiction crisis is simple : health-care . Chronic illnesses require long-term case management , not the 28-day rehab followed by insertion into 12 Step orthodoxy .

THOSE STAYING IMPROVE, MOST WHO LEAVE DON'T

It comes down to this: The people who stay in AA are those who are generally getting better, and that big majority who leave generally don’t get better in the foreseeable future. The people who succeed represent a fraction of those who start in AA; the drop-out rate is high. Ascribing efficacy to AA on the basis of success stories - the longer you stick with AA, the better you are likely to be – Dodes skeptically equates to saying the longer you live, the older you will be when you die.

The oft-quoted adage equating insanity to a repetition of what hasn’t worked in the past doesn’t seem to apply to those who go in and out of the rooms for years on end without clear change. These poor pilgrims aren’t doing it right, or, in the famed dismissal of the Founder, are ”constitutionally incapable of being honest with themselves.”

Studies taken as proof of AA ‘s efficacy routinely base their findings on the minority of subjects who remain in AA and report better outcomes, while ignoring the huge swath of subjects who drop out in mid-study. In the examination of treatment of disorders, it is only in 12-Step addiction models that the active participation of the afflicted assumes the decisive role. All of which tallies with the AA adage that “the program works if you work it,” a tacit admission of a behavioral model of remission foreign to accepted notions of how to treat a so-called ‘disease.’

AA: WORKING FOR A FEW

So the spiritual model of AA has worked, as well as it can be determined, for only a small fraction – no more than one in ten - of those opting for, or inducted into, its program, though its cadre of the “willing” refuse to admit of other treatment options but that which succeeded with themselves. At the same time, its vaunted independence from outside bodies is increasingly compromised by intimate interface with parole and licensing boards beholden to the would-be efficacy of AA.

I cannot ignore the cognitive dissonance of my own situation, for I know that AA helped me in crucial ways that therapy did not. But I also know that my service work in hospitals, detoxes, jails and half-way houses is, if regarded with the rigorous honesty demanded by AA, utterly self-interested and of questionable medical value. So how can I, in good faith, continue to promote a program that hasn’t been shown to be effective?

It ‘s all very well to enjoy the respect and warm welcome of those staffing the facilities I visit as an AA emissary , but such good feeling doesn’t justify my propagation of a model of addiction that is, at best, unproven.

One foundational story dear to the AA fellowship – and similar to a formative experience of our founder Bill Wilson – tells of two crusty alcoholics in AA ‘s early days who stayed sober by tending to men at a rustic drying-out camp. When the camp assignment ended, they took stock of their efforts and realized not one of the 100-plus men in their care had stayed sober - but they had, through the power of the service they freely gave.

But isn’t this finally a lot like baking a cake for a party of 20, none of whom care to eat it, and then enjoying it yourself?

The promise to leave off self-serving behavior doesn’t appear to tally with such strategies as are now widely welcomed in half-way houses, detoxes, hospitals and lock-ups. No one knows how many substance abusers with mental and legal problems benefit from the meetings AA brings to them. We should accept both the unsubstantiated promise of AA and its self-interest in “serving” the afflicted as proof of our good intentions.

But the heartfelt willingness to spend hours at these facilities if even one person is helped is hardly a basis for a program of public health, and I bring it into the discussion due to the massive and self-perpetuating symbiosis that exists between facilities of rehabilitation and AA, which lends immense credibility to a theory of recovery heavy on spiritual rehabilitation and notably short on scientific validation. Like it or not, AA is a player in a public disaster that isn’t responding to its calls for “spiritual progress.”

RELIANCE ON 12 STEPS STOPS RESEARCH INTO ALTERNATIVES

It is precisely the desperate reliance on the 12-Step method that has frustrated adoption, or even research into, alternative therapies.

Addiction science specialist Dodes has noted that only a small fraction of the million physicians in the U.S. specialize in addiction treatment, though others have it as a sub-specialty, and that patients for the most part are not enrolled in care that has proven to be effective. His focus is on individual psychotherapy.

AA frowns on any therapies that aim to help alcoholics drink in moderation. Its canon includes the warning that “One drink is too many and a thousand aren’t enough.” This may well be true for the minority of alcoholics who have a lethal engagement with alcohol that leads to hospital, prison or the grave, but what of the majority who are neither drinking themselves to death nor responding to the moral psychology upon which AA is based, that one can get well by doing good? AA in fact came to see early on that not all alcoholics were of the extreme variety and devoted a good portion of the Big Book to the stories of those who ”stopped in time,” who got sober before going to jail, being hospitalized or losing their family. But any further refinement of the varieties of alcoholic experience stopped there. And while AA champions the notion of powerlessness over alcohol – good as far as it goes – the very ‘miracle’ of overcoming one’s affliction can overshadow problems less virulent but of comparable gravity .

Many potential alternative therapies meanwhile include drugs, such as Naltrexone, the use of which not only goes against the ethos of AA but which recalls the problems caused by the Valium prescribed in the 50s and 60s that aggravated the addictions of many patients.

EVIDENCE AROUND ABSTINENCE

What specifically of abstinence, a central AA principle? The findings of researcher John David Sinclair are curiously mirrored in the lore of AA. Sinclair found that abstinence produces an alcohol-deprivation effect in lab rats he habituated to alcohol, and then deprived of it. They drank like veritable fish when re-introduced to it, in quantities way beyond what they had consumed before. In AA it is likewise common knowledge that one’s addiction “does push-ups” during sobriety, i.e., it gets more virulent, and this is thought to explain the ferocity and train-wreck speed of the typical relapse. Where it may have taken months or years to arrive at a consuming addiction, phantom ‘push-ups’ compress the ensuing debacle into a matter of days or even hours. Abstinence has one saving grace: It is simple, and if your addiction is of the all-consuming variety, it is probably your best bet. But if it is not, the question remains.

ALCOHOLIC FACES TOTAL CONFUSION (NOT QUITE WHAT HE NEEDS)

In this welter of very ambiguous and often half-baked statistical analysis, the lay reader, especially one in desperate need of treatment, is very much at sea. The ordinary addict/alcoholic is utterly unequipped to evaluate the supposed evidence on view, rather like the hapless jury member confronted by the competing claims of psychiatrists as to the sanity of one accused of a capital crime. What ultimately decides the juror may be decidedly un-scientific, and in like manner, the treatment seeker may end up believing what he or she wants to believe. The addict‘s pocketbook, or insurance plan, will likely determine the plan of action they commit to in a rehab industry rife with competition and untested but superficially attractive side therapies, and notably short of the one-to-one psychotherapy with doctors trained in addiction science that Dodes favors.

FOUNDATIONAL IDEAS – THE ‘DISEASE ‘ MODEL

The foundational ideas of AA are few, but crucial: The first, as laid out in the ”Doctor ‘s Opinion,” asserts that alcoholism is a disease. This was reportedly suggested to Wilson as an approach by his doctor the fourth and final time he was hospitalized for over-drinking. The second foundational concept, according to Wilson, is that that ‘disease’ is but a symptom of a spiritual problem that reveals itself in the ‘character defects’ of the afflicted. Another is that alcoholism untreated is progressive, incurable and fatal.

The ‘disease model’ aimed to lift stigma from the patient: If we but look at the social attitudes toward TB and cancer (per Susan Sontag in Illness as Metaphor), for example, in the years when those diseases hadn’t found cures, and how those judgments evaporated once a cure, or at least a correct diagnosis, was found, we can see that the stigma attached owed more to society‘s mystification than to the illness itself. The tubercular were ”too sensitive,” the cancer-ridden ”repressed.” In like manner, the riddle of addiction has saddled the addict/alcoholic with “selfishness,” to name but one of the character defects in the AA battery of shortcomings to be overcome.

Should we more or less automatically tax the thousands of injured who are prescribed pain medications only to fall into addiction with the ‘character defects‘ that twelve-step programs maintain must be confronted and ameliorated? These victims, of both accident and the predations of Big Pharma, need medical treatment that works reliably. If we don’t know what to do with them, we should say so, and not add insult to injury by locating and underscoring their supposed defects of character.

Illness as Metaphor ? : Sontag on Disease

The baffling power of alcoholism places us squarely on the playing field Susan Sontag laid out in her examination of illness as metaphor. If alcoholism and drug abuse are uniquely destructive to lives and are defined ( by AA ) as “cunning, baffling and powerful” , we are up against a conception of a disease (if it is indeed that) remarkably similar in that way to both TB and cancer in earlier times, both in the hold addiction has on the public mind and the riddle it poses to those treating it.

In this short but now-famous book, Sontag took issue with the “uses of illness as a figure or as a metaphor.” In Part One she examined tuberculosis and cancer, which she called ”spectacularly“ weighed down by metaphor historically. When diseases confound us, she said, we become complicit in the mystery that hollows out a space normally reserved for science in the body of a cure, for lack of which fanciful etiologies – purportedly scientific causes - are advanced such that the ailment takes the form of a metaphor, as in, for example, the “cancerous” sprawl of suburbia. The dread surrounding an incurable disease makes it not just physically but seemingly even morally contagious. So demoralizing was a diagnosis of cancer at times in the past that attending physicians often thought better of being honest with their patients. When having TB amounted to a death sentence, one was wary of even saying the name. Even later, in the year (1977) the essay was written – although that period had ended – hospitals were still sending nearly anonymous communiques to their patients so as to guard their secret even from concerned family. A treatment for, and laboratory results suggesting, cancer are the only exemptions from the disclosure of information mandated as open to the public under the 1966 Freedom of Information Act. Cancer patients are lied to not only due to the incurability (and questionable permanent curability) of many forms of the disease, but, Sontag says, because of what has been widely conceived of as its abominable, even obscene nature. Its ominous mystery, she said, opens a space for morbid, shameful conjecture.

Sontag critiqued the way cancer was long pictured: If the cancer patient appeared low in spirit, with complaints of an empty life itself the dead-end of an unhappy childhood, those would be attributed to the disease though they are part of the broader human condition, widely shared, e.g., we are up, we are down, we experience loss and grief, but we don’t all get cancer,

Sontag described how TB and cancer figured in the public imagination as emblems of, respectively, excessive sensitivity or a want of passion. Syphilis, another prominent scourge of the 19th century, meanwhile by contrast had neither mystery attached to its cause nor personality type attributed to it. Sontag traces how disease was attributed through the ages, either to a blow from the gods, deserved or not , retribution for wickedness, or as unconscious expression of character. In all three cases social biases stood in for reliable diagnoses.

Bill Wilson ‘s own experience meanwhile convinced him that altruistic behavior was a sure antidote to alcoholic relapse ; when all else failed, helping another alcoholic would keep him dry. One might conclude that selfishness, then, seemed to play a part, forming a metaphor, that excess sensitivity or repressed libido did before with the aforementioned illnesses. Once again, a fanciful etiology can be seen as substituting in the public mind for evidence-based treatment.

For those interested in further discussion of Illness as Metaphor, please see the addendum.

DISEASE VS. BEHAVIOR

Dodes argues straightforwardly that addiction is not a disease, but in fact a behavior. This departs fundamentally from the model AA pioneered that is gospel throughout the rehab industry and appears to revive an obsolescent, ‘politically incorrect’ yet easily believed and superficially obvious “commonsense” perception that nonetheless may seem threatening and dangerous to both alcoholics and the rehab community widely.

While the disease hypothesis purported to de-stigmatize the addict, it wasn’t accompanied in the early decades of AA ‘s growth by any of the long-term studies usually considered essential to make conclusions in the field of medical science. Doctors had been at a loss to explain or treat alcoholism and left the field to AA, which could boast a stunning rate of recovery among its founding members, many of whose stories make up the second half of the basic text of AA, the Big Book.

That fully half of these ”recovered alcoholics” did not maintain their sobriety is a fact unknown to the mass of AA members. (But also, to be fair, any true stories of success may have still been considered virtual miracles at the time.)

Probably the most convincing rebuttal of the notion that addiction is inborn and fatal, though, came from a study of Vietnam veterans who returned to civilian life addicted to heroin. Some 90% went into remission post-detox. They stopped using, apparently for the logical reason that their departure from the war zone relieved them of the unbearable helplessness that spurred their drug use while stationed in Vietnam.

Looking Deeper Into Issues in Recovery

‘PROMISES,’ PROMISES: PAST REGRETS, FUTURE HOPES

Another crucial but potentially overlooked aspect of AA is its poetically aspirational side, which comes out in the litany of drawbacks and victories listed in the “Promises,“ a page often read at the closing of a Twelve-Step meeting. This document has inspired many an AA participant, myself included, with its oppositional imagery of regret of the past combined with refusal to shut the door on it, with articulation of one‘s inchoate goals and quiet victories tempered by a sober assessment of where we had faltered in days past. It puts into words what we had only dimly been aware of, giving form to an experiential admixture of striving and acceptance.

But take a moment to examine the overarching psychological profile of the alcoholic that the Promises proposes: We suffered from egotism, selfishness, a critically low self-esteem barricaded behind a grandiose critique of the world that fed on our own swollen assessment of our hidden worth. We were “a turd around whom the world turned,” to cite one of the pithier metaphors in circulation. We were afraid both of people and economic insecurity; we lived in the past or the future, feeding on the bitter herbs of regret and resentment and the wispy fantasies of future success. We kept grudges. Resentment gets the starring role in this scenario of self-evaluation : We didn ‘t know how to forgive and sought relief from the pain we nurtured. We got sore and stayed sore: Alcohol and drugs served as softening agents for our hearts grown hard. Finally we were alone with our liquid and chemical consolations, convinced we were at once unwelcome in a world not good enough for us.

‘ALCOHOLIC PERSONALITY’?

The notion of an alcoholic ‘personality’ - selfish, resentful, dishonest, among other things - has no more going for it than the personalities once ascribed to those stricken with tuberculosis or cancer, as spotlighted by Sontag. (e.g., The qualities ascribed to alcoholics in the Promises are sadly distributed much more widely and could likely arouse broad recognition in non-alcoholic groups as well.)

The difference between alcoholism and the more obviously physical diseases comes out swinging in the question as to whether substance abuse is a disease. For TB, a cure was found; for cancer, treatments of varying efficacy and discomfort.

But AA ‘s prescription of right action, with its emphasis on positive behavior, flies in the face of the disease model it has pushed for decades. And so attached are its proponents to the spiritual nature of sobriety that they are loath to consider any therapeutic approach aside from their own. It should be noted that AA ‘s emphasis on behavior doesn’t disprove the disease model , only that AA’s method may seem inconsistent with it.

RECOGNIZING ONE’S FAILINGS

The Twelve-Step programs derived from that of AA and used in a variety of therapeutic settings are heavily weighted in favor of recognizing and fixing the sufferer ‘s “character defects.” The shock of recognition of such personal shortcomings as experienced in sobriety is the fuel that powers a new attitude, one that foregoes the intoxication of success and despair of failure and looks a lot like the ”Middle Path” of the Buddha, or it might also more simply be the renewal of a maturation process waylaid by drugs and alcohol.

In AA, we are told that without this fearless inventory of our failings and active steps to repair the social harm we have done, we will share the fate of the”dry drunk” - sober, but a problem for everyone around him or her, or, more piquantly, a once drunken horse-thief now a sober one. Bill Wilson ‘s intelligence and compassion no doubt informed his aversion to dogma and embrace of tolerance, but his own addictive mind reasserted itself in a destructive smoking habit and a career-long compulsive pursuit of sex - his ”womanizing”- that would be seen today as pathological or even predatory.

ALTRUISM GIVES BACK: BEHAVIOR AS ANTIDOTE

“We give freely of what has been given to us.” Fair enough, and I personally testify to the role service has played in my own recovery. Apparently altruism works! Who knew? One Dr. Silkworth, a prominent physician, certainly was impressed enough to write, in the mid-1930s, an appreciation of such that became the opening chapter of the Big Book.

The crucial point here is that AA, as a program of action - primarily atonement and service - explicitly proposes a change in behavior as the sine qua non of a change in heart and mind, and God knows it worked for this grateful member. But this very emphasis on action weakens the case for the disease model, and empowers the obvious alternative: That addiction is a behavior and not a disease.

From personal experience of having worked the ‘Steps ‘ I can attest to the emphasis on and efficacy of behavior as an antidote: What we think and feel about our reliance on drugs or alcohol will do little in the way of remission. We must rather go into action, by owning up to another the resentments we have nurtured, admitting the harm we have done to those harmed, adopting a spiritual practice, and above all by actively addressing the needs of others in the grip of abuse.

So even among the small minority of those who benefit greatly from the 12-Step method, it is accepted that a change in behavior is the sine qua non of recovery: Go into compassionate action consistently enough and a change of heart and mind will follow.

AN ELITE ?

And if, as every meeting‘s preamble assures us, those who fail to stay sober, despite having our guidance and support before them, are essentially unfit due to an innate inability or refusal to marshal the requisite “rigorous honesty,” wouldn‘t that make us winners some kind of spiritual elite? Or perhaps, as I have posited, are we those lucky to have been in the right place at the right time with the right resources at hand? I can vouch personally for the efficacy of re-casting myself, with all my assets and debits, as a simple ”worker among workers.” How to square that egalitarian ethos with the elite percentile of the recovered by virtue of the AA program is a mystery to me. And how we can give up on those who fail due to inherent defects is another one.

OBESITY & SUBSTANCE ABUSE: INDUSTRIAL-SCALE RECOVERY FAILURES

The treatment of substance abuse is meanwhile not unique in its fealty to a received wisdom underpinning a recovery model applied on an increasingly industrial scale. An analogous problem of consumption and dysfunctional strategies is obesity. The losing battle with obesity worldwide can be traced to a paradigm so powerful in its simplicity that any revision might take generations to prevail: You get fat because you eat too much and exercise too little - you take in too many calories and expend too few. For decades we have flogged this theory of weight gain, urging even the poor and overworked to hit the gym (Who ‘ll watch the kids?), and avoid fatty foods and the convenience foods which, re-engineered with more sugar, only compound the problem.

The science on obesity was all too clear up until the 1960s: morbid weight-gain was caused by a metabolic disturbance itself brought on by an excess of carbohydrates in the diet . Nature, during our millenia of hunting/gathering, one might argue, programmed us to store, not burn, extra calories from carbohydrate-rich foods, so as to tide us over the food-poor winter. So in the fall, we very wisely gorged ourselves on all the berries, fruits and fatty meats we could get our hands on. The grains that we later consumed thanks to agriculture didn’t create one in three obese American adults - that only arrived with the introduction of refined sugar (itself a carbohydrate) in the forms of fruit juice, powders, corn syrup and the like. The high carb levels available in the autumns of long ago told the body to store calories: Winter is coming, you ‘ll need them. But more recently, once we had all the sugars we could desire all-year round, obesity and its attendant illnesses came knocking at the door.

Even so august a body as the World Health Organization (WHO) can endorse the longstanding paradigm of gluttony and sloth, and at the same time admit that its programs to reduce obesity haven’t worked in the past, aren’t working now, and have little chance of working in the foreseeable future . Isn’t it time for a new paradigm, based on science, not “common sense,” and not beholden to an industrial complex? ( It is worth noting that in the genesis of strategies for both combating heart disease ( a reliable correlate of obesity) and alcoholism a single voice drowned out all others : in the case of cardiac failure it was the physiologist Ancel Keys who cherry-picked data to support his anti-fat thesis ; for alcoholism it was a stockbroker drinking himself to death prior to finding God , AA’s founder , Bill Wilson.)

What is AA ?: History and Dynamics

Drinking has never been a practice universally welcomed by us Americans and the rifts it provoked came to a head with the passage of Prohibition a little over a century ago. The orderly adult enjoyment of alcohol seemed almost drowned in a post-adolescent flouting of the law, a quasi-criminal embrace of the ”modern” and intoxication itself. (The “Jazz Age” followed closely on the worst public health disaster the nation had ever experienced; the half million deaths from the influenza pandemic were quickly, and quietly, forgotten Although the consumption of alcohol remained technically legal, its production, distribution and sale did not, and so the shame normally attached to uncontrolled drinking became politicized : Only the “Drys” - the Prohibitionists, the killjoys - invoked shame, and we might conclude that the psychological underpinnings of the focus on sobriety that would undergird AA came to be derived solely from feelings of guilt, from an inner feeling of wasting or destroying one’s life.

Bill Wilson had a serious problem sticking to his own credo. If , as he wrote , “Alcohol is cunning, baffling, and powerful,” then why did he pretend to know why certain people failed ? Intelligence and reasonableness informed most of the pronouncements of Founder Wilson and to his credit, he humbly allowed that the AA program barely scratched the surface of helping a significant proportion of the afflicted, and no one today pretends that AA is anywhere near as successful as it was in its early days.

In my own experience, I have seen how the ardor of AA ‘s early days can be re-experienced, for I have attended many a meeting of only a few souls - where either I and my fellows stood up and were counted or the meeting would simply wither on the vine. We had to make it work on our own and this was indeed the starting point for AA in general. There was no institutional support and few referrals from hospitals, rehabs and the like. AA was on its own, and “doing it the hard way” was, one imagines, a prime factor in its early success. Today, the perceived need to “own” one ‘s own recovery can be sapped by the sheer volume of interventions designed to reorient the substance abuser, by the sheer number of rehabilitative facilities ready to take the alcoholic/addict in hand. Recovery has become industrial in scale, the addict the raw material.

There is an ahistorical, almost ‘fairy tale‘ quality to the story of AA ‘s founding, as if the fellowship ‘s openness transcended any effort to locate it in the temporal order of things, as if it grew independently of the conflicts and passions of its era, as if its spiritual content - even in its inclusiveness – hadn’t been cultivated in a particular time and flavor of Christian belief and practice.

AA ‘s origins in the so-called Oxford Group (later known, under a more universalistic umbrella as Moral ReArmament and later still as Initiatives for Change), an initially evangelical Christian sect founded in 1921 by an American Lutheran priest who argued the roots of human problems lay in individual struggles with fear and selfishness and the solution in “surrendering one ‘s life to God ‘s plan” - aren’t a secret. Bill Wilson owned up to having drawn heavily on Christian tradition in devising the 12 Steps and the 12 Traditions as a way to attract members at ease with such symbolism. (He apparently got the idea to de-stigmatize alcoholism and so make alcoholics more amenable to change by labeling it an “illness” from his doctor the fourth and last time he was hospitalized.) No doubt Wilson was more than a little flummoxed by the intractability of alcoholism as it appeared in most of the people he first tried to help: It seemed like they must have been born that way.

The most crucial thing Wilson learned from his early, rarely successful efforts was that as he usually failed despite his maximum effort to help others, he himself was staying sober as he never could have before , through that very devotion.

Bill ‘s own recovery resulted from a spiritual transformation both sudden and compelling, yet he was careful to admit equal value to those changes more gradual and educational in nature. But his rather peremptory dismissal of the unreachable was a piss-poor evaluation of a therapeutic conundrum that continues to bedevil the medical establishment. The axis around which our frustration ceaselessly turns is the moral psychology dear to AA - get well by doing good, in short - prescribed for an illness whose moral provenance we can no longer allow : You are not addicted because you are a bad person.

GUILT VS. SHAME: U.S. CULTURE & AA

That our dominant Protestant culture conforms to the contours of a guilt-based society intersects nicely with the AA dictum that one must get sober for oneself, above all, and jibes as well with the acceptance of a disease model that explicitly refuses to act out of shame in the pursuit and maintenance of our recovery. But wasn‘t AA membership to be ‘anonymous’ precisely in order to avoid the shame and stigma long attached to alcoholism? (Sontag writes convincingly of the shame once likewise attached to cancer and TB.) To be fair , it should be noted that AA takes pains to not have its credo and practice attached to personalities, so as to avoid identification of its spiritual path with the fortunes of any necessarily flawed human individual.

The ethos of a guilt-culture was reflected in the AA credo of accepting responsibility for the wrongs inflicted by our drinking and the imperative to atone for them. The shame attached to substance abuse - “I’m no good”- was transmuted into awareness of the damage we caused -”I have done wrong.” Not only was there a reckoning with one’s past, but a moral inventory taken in association with others in the fellowship of AA. And this opportunity and talent for association has been widely considered peculiarly American. No less an observer than Alexis de Tocqueville, the noted French author of Democracy in America, remarked on it as he toured our fledgling republic in the 1830s. We appeared, he wrote, to have a positive genius for voluntary association by people around shared interests, free of government control and without need of external support. Such associations ideally resist centralization, corporate control and institutional co-optation. AA would have been impracticable in, say, Stalin ‘s Russia, save in a form replete with government minders and KGB agents.

If we look for a moment at the elements common to shame and guilt, we can see where AA stands. Shame, one may say, usually derives from an apparently inherent flaw, is diffuse in its application, defines a character, pushes one to withdraw (duck the heat), saps empathy in defensive attempts to avoid the shame itself and is imposed from without. Guilt, on the other hand, is tied to events, to what a subject has done, to what can potentially be atoned for, is other-oriented, empathic and self-referenced (the subject may be alone in knowing his wrong).

We can see that, no matter the actual mix of shame and guilt in the tangled narrative of recovery, the mechanisms of shame won’t get us far in working the Twelve Steps or following the precepts of AA, one of which – “What other people think of me is none of my business” - tidily sums up the guilt ethic in no uncertain terms. Shame, of course, is all about what other people think of you.

The regret that makes a play for one’s attention derives from behavior the drinker remembers fitfully at best. It’s hard to feel guilt (or, even more so, shame) for what has escaped one’s memory, and whatever shame might attach can be shrugged off in the company of other drinkers, or as likely in the isolation alcoholism usually imposes.

It is in the sobriety after detoxification that one can and must come to grips with one’s situation, and in this pass, shame is useless, for it pushes us to hide away or downplay our wrongs, to blame others if at all possible, and to make restitution nearly impossible. One can atone for what one has done, but not for what one is. The First Step reads: “We admitted we were powerless over alcohol, and that our lives had become unmanageable,” not: We looked bad, or , We brought dishonor on our family. WHAT OTHER PEOPLE THINK

It may be helpful to recount , as discreetly as possible , the situation of a young father I helped to work an AA program. He had married into a family from SE Asia, and though his wife was highly educated , it was obvious to him that her family had little or no active interest in aiding his recovery. They wouldn’t disown him as long as he didn’t bring shame on the family; his drinking per se wasn’t at issue, it was public appearance that counted. When I offered that he seemed to be dealing with a shame-based culture, he could only assent. We ruefully owned up to how inapplicable the aforementioned adage (“What other people think of me is none of my business”) was to his situation, in light of his in-laws’ attitudes. His individual destiny was trumped to some extent in this case by that of the collective, which would ignore his airing of dirty laundry as long as it stayed in the confidential realm of an AA meeting.

In my AA experience, this notion that “What other people think of us is none of our business” empowered me to ignore what I had imagined: the disapproval of others, their real or fancied resentments of what I might have done or their misguided opinions as to the validity of the AA program of recovery. In short, I was to put my own house in order and not bother with worrying about or fixing the world, at least for the time being.

So far, so good. But unless one has the moral stamina and courage of a Socrates, this dictum will prove chronically at odds with a society in which questions of status are as compelling as they are routinely discounted.

If, as the cliches proclaim, you can be whatever you want to be in our troubled meritocracy, failure to succeed is entirely your own.

And although the only real promise AA holds out is the power to help another alcoholic , in its meetings a sober life is regularly cited as the source of what are called ”cash and prizes,” i.e., increased income and improved personal relations. We regain the status we had lost, or enjoy one even better than what we had known before. “Status,” remember, though a human construct , is not a mirage . That such positive regard can shade into fear or envy doesn’t diminish its power, a power so heady that , in AA , both riches and romance are seen as the prime booby-traps waiting to upend the newly sober. Such benefits can convince us of our wholeness to the point where we imagine ourselves newly immune to the substances over which we so recently acknowledged so little control.

Addiction and the devil-may-care attitude that usually accompanies it can conspire with our fall in the eyes of the world so as to help us reject the reality of status concerns: The world is a trap, a scam; its inducements are bogus - You can’t fool me! In fact we made a virtue of necessity , and only for a short while was a balance struck between our decomposing self-image and the consternation it provoked in others. With an uninhibited revelry, we called the prudent killjoys ; our unbridled tongues took aim at the hypocritical. When we got sober and rejoined the world in a serious way, we imagined it as composed of “normal” people, a construct based on their supposed normative reaction to alcohol, but one that too easily assumes a standard of behavior that our crises of shootings, consumption, debt and social vitriol cannot support. The illusion of normality may be a useful goal for the recovering addict, but that doesn’t make it real.

Am I alone in finding unsettling the notional “normality” for which it seems the AA participant is expected to strive or at least ready himself ? Many would question what this normality means and whether it is a worthwhile goal. Can we deny that the flat , normalized conformity that became the therapeutic goal of post-World War Two psychoanalytic practice has been comprehensively de-throned in both the psychoanalytic world and the larger American society? Does the decisive prescription of action - an existential course if ever there was one - as a means of building sobriety deserve to be watered down in a bid for a vague, indifferent and unrewarding ‘normality’?

To aggravate this further, in the Big Book, Bill Wilson explicitly recommends the “herd instinct” as a saving grace for the previously isolated drinker. To conflate the mental debility of substance abuse with an unbridled individualism, and therefore sobriety correspondingly with ‘going along (happily) with the crowd’ is to mischaracterize both. Alcohol abuse usually leads to isolation more than egotism and selfishness is hardly the exclusive domain of drunks and addicts. Also, if most of your friends and family are alcoholic themselves, joining the ‘herd’ may not be the soundest of strategies.

Should it be such a rude surprise to find the world, after one has abjured the fickle sanctuary of drink , much as one had left it: peopled by a myopic herd still prey to status-anxiety and now to the constant updating demands of the new world of Facebook “friends” and “likes”?

IS AA A RELIGION?

AA is at pains to deny being a religion yet its active members feel unquestionable pride in attending meetings “religiously” ; it is not a church, yet its litanies and rhythms of call and response, and the autonomy granted to each meeting recall that of the Protestant sects that structured American life at its founding. Who would argue that a dogmatic, centralized, hierarchical structure like that of the Roman Catholic Church would have had anywhere near the attraction or staying power demonstrated by AA as constituted, especially in the United States? Outsiders to AA often mistake its traditions for evidence of a cult , but only a little experience taught this member that a daily reminder of repeated suggestions of love and tolerance was a necessary corrective to the sometimes fractious reactions common to those recently-arrived participants uncomfortable with their new-found sobriety. With them in mind, AA is characterized by this pronounced autonomy granted to each meeting, an independence balanced by a common ethos as represented in our traditions, and reiterated at each gathering, ‘lest we forget’. Quick to deny its being a religion, AA favors instead a broad path to spiritual improvement. If it did espouse the Christianity it borrows from, it might feel pressed to acknowledge the revolutionary character of the Gospels and act accordingly, having to challenge, and not accept, the world as it is, making it a very different kind of fellowship.

The tradition of service, at meetings and in the wider community, mimics that of religious bodies, for just as the dissatisfied AAer may have neglected to engage in service to others, so the disgruntled churchgoer may grumble that Sabbath meetings don’t do anything for him, ignoring the reality that attendance or belief isn’t sufficient to the task, since true faith requires practice and action as well as Sunday attendance.

IS AA A CULT?

I have a clear memory of a rehab counselor explaining with certainty why AA is definitely not a ‘cult’: It has no deified leader; it exacts no onerous proofs of fidelity in the forms of cash payments or deeds to property; it has no dogmas; each meeting is autonomous; and membership is open and voluntary. What a genuine relief it was to hear a common complaint so summarily dismissed! And yet the very definition of a cult is hard to frame: One man’s cult is another’s faith, and the origin of the word itself leads us back to the French, in which it is synonymous with a religious body, from the Latin ‘cultus’, the past participle of ‘adore.’ For the Jews of the Roman period the splitting of God into the Trinity and the deification of a human being was proof of Christianity’s idolatry and qualified it as a cult in the modern sense.

A belief in the mediation of an unseen and unproven power relies on faith, not evidence. The acceptance of the 12-Step model of recovery occurred independently of any scientific evidence to support it. While the fellowship of AA has undisputed advantages for the once-isolated alcoholic, the shared anecdotal narratives of trial and redemption therein cannot constitute an equivalent alternative demonstration of efficacy to the peer-reviewed medical trials necessary, for example, for the prescription of life-saving drugs. It is in this belief without evidence that AA may be described as a cult.

. SO IS AA PSYCHOTHERAPY?

Although AA denies offering therapeutic services, there is undeniable psychic relief in unloading one’s regrets and worries among one’s peers, at least for a hard-to-define minority. What is more, the introspection needed to work the Twelve Steps operates in tandem with organizational, meeting-oriented commitments - making coffee, greeting attendees, acting as secretary, sponsoring the newly sober - to enhance and deepen one’s sobriety. The associative nature of AA testifies to the presumption that the care available from one’s own family by contrast will not suffice in the face of a dread malady and simply hushing it up is not the answer. AA meanwhile expresses no opinion on outside matters, which includes officially not meddling with members taking medications prescribed for psychological reasons.

But this equanimity doesn’t prevent even experienced AAers from practicing an amateur psychology wedded to a very basic and at best rather naive theology. What I’m getting at here is that the while work done with a sponsor relieves the isolation the alcoholic has backed himself into, it might very well be -for some - a kind of sugar pill taking credit for recovery that owes more to having a life the alcoholic now deems worthy of salvaging.

AND IS ALCOHOLISM INSANITY?

AA ‘s Step Two states: “We came to believe that a power greater than ourselves could restore us to sanity.” The obverse of the sanity invoked here refers most prominently to the maddening repetition of the same uncontrolled drinking that can produce states of mind akin to psychosis. The well-known definition of insanity as doing the same thing over and over while expecting different results is also enlisted in the anecdotal equation of mental illness with addiction, though addiction science expert Dodes, a psychoanalyst by training, flatly denies any link between mental illness and addiction. (Of course, he is the same expert who denies that alcoholism or addiction is any kind of ‘illness’ , mental or physical.)

GROUP SEGREGATION/VARIATION

The AA vision obviously hits different American subcultures and racial/ethnic groups differently. Not only those based in a more shame-based culture (potentially East Asian) but also people at pains to maintain a home refuge of sorts from a hostile dominant culture might feel compelled to keep their dirty laundry within the family, for example.

To imagine that AA has thrown off the social limitations imposed by the de facto segregation that surrounded its founding and early years (though not its ethos) meanwhile is to give in to a naivete unworthy of a fellowship nurtured on “rigorous honesty.” It may well be, for example, that people from ethnicities historically indebted to the social mission of their church may disproportionately find AA ‘s program of spiritual redemption simply redundant: If one needs to”get right,” well, this pew’s for you.

NOT THINKING TOO MUCH?

“The Varieties of Religious Experience” , by William James , was Bill Wilson’s prime source for philosophical reflection . It confirmed , for AA’s founder , that his own dramatic turn towards a Higher Power had been shared by enough everyday people to put spiritual progress front and center in the AA program of recovery . James’ investigations were part of a popular embrace of ‘positive thinking’ , but he was careful to accord equal spiritual opportunity to those burdened with melancholic dispositions . For these ‘sick souls’ the evils of the world cannot be wished away , and if we demote figures such as the great poet Goethe , for whom daily life was an uphill battle , we will be the poorer for it . The prescription to avoid thinking too much , in the tumult of early recovery, is sound advice. But in a larger sense, it poorly serves a movement that prides itself on its spiritual nature and mission. The greatest spiritual lives have never renounced doubt and challenging reflection , and an audience of smiling ‘happy faces’ is unlikely to welcome the deeper, darker epiphanies of the spirit. On a practical level, such audiences often reject out of hand any other road to sobriety than the one they ‘ve taken.

Paradigms of Perfection, Fatal Flaws : The Party and AA

About two years ago I called my old therapist to discuss my transition out of AA, a process I imagined to be as fraught for me as that which confronted those who left the Communist Party at various points after its American heyday in the 1930s. My leaving AA is analogous for one major reason: I feel the beliefs central to AA no longer correspond to reality. Americans joined the Party to bring about social and economic justice, and in the Depression, the Party often seemed the best bet to accomplish this. Its writers and ideologues seemed to have correctly analyzed the failures of capitalism and the Party took decisive action in response. It also provided a wonderful camaraderie as an alternative to the predominant haves/have-nots paradigm of a society riven by class and race. One’s commitments in fellowship transcended one’s own private ambitions.

That the mother lode of Communists -- the Soviet Union -- was a hideous charade from the very start wasn’t apparent to the believers: Hadn’t the revolution overturned a repressive, backward regime? Wasn’t it a beacon for all those struggling against oppression worldwide? By fits and starts, the edifice began to crack: the state-sponsored famines of the late 20s and early 30s, the institution of slave labor, the pact with Hitler, the show trials and purges, and then the brutal repression of Hungarian liberty in 1956, were all reasons to part ways with the Communist dream, which came to resemble a nightmare for man as such .

It was the Party’s disciplined central role in the fight for social justice that delayed the defections. How could one abandon the poor and oppressed by reason of some faraway foreign imbroglio irrelevant to the task at hand and about which one‘s knowledge was necessarily uncertain and incomplete? Those who did leave the Party did so despite the disruption to their social life and worldview. They could no longer abide the lies propagated and crimes committed in their name as Communists. Underlying the evident ”excesses” of Communism in action was a foundational belief that began to seem like it might actually be untrue : Perhaps class struggle wasn’t the fundamental mechanism of social change in human society. Perhaps the actual continuing poverty and stifling repressiveness of such regimes were the true measure of their viability.

And just as the Communist Party appeared to be the best hope for progress in a world torn by war and economic chaos, so did AA enter the world as the best hope for alcoholics at war with a problem no one knew how to fix, and it became not just the only game in town, but the model for therapeutic approaches for decades to come. Following as it did on an era of wild consumption that supported the rise of criminal cartels and blithe disregard for the very real dangers of excessive drinking, AA became not just a haven for the individual but a social movement of growing influence.

But the rising standard of living coupled with growing concern for civil rights in mid-20th Century America could no more be attributed to the Communist vanguard than recent progress in addiction research can be deduced from AA’s efforts. And many prominent addiction researchers bemoan the apparent monopoly of 12-Step therapeutic models as a real obstacle to the development of evidence-based therapies. Because it is not a medical organization and partly because of the nature of its own ideology, AA meanwhile has never kept records and the self-reporting of outcomes so far has proved unreliable to even the most neutral observers.

Both the Party and AA benefitted from a cognitive imprint stamped on the public mind during the uncontested primacy they each enjoyed in their emerging period of popular acclaim and early victories. Both seemed the last, best hope - for a cruelly unjust society or for an alcoholic with nowhere else to turn. But that doesn’t mean the basic tenets of the two could permanently escape critical evaluation and judgment: Communism could not explain the progress of capitalist societies and the stagnation of its own. Likewise, AA cannot explain, especially as regards the current opiate use epidemic, how its emphasis on moral regeneration can deal with this staggering social crisis, especially given its structural incapacity to measure efforts against results.

Above & Beyond AA: The Crisis of ‘Superfluous’ Humanity

We can stipulate that feeling useless commonly results from substance abuse ; but what if society has told you as much already? If society turns its back on you, with little in the way of a safety net, and drugs flood your community, be it in West Virginia or South Central LA, the message is clear: You are not needed.

Hannah Arendt, in “The Origins of Totalitarianism” , identified the isolation and superfluity of ordinary people as a prime factor in the perversion of the ‘people’ into a mass to be manipulated by unscrupulous demagogues bent on total control. Today ‘s rejects find themselves left out of a global capitalist machine driven by financial schemes that benefit a minority wedded to technologies increasingly free of human labor. Redundant, expendable, dispensable, unwanted: All of these terms define the state of the superfluous. Only a generation or two separate the black crackhead from the white Oxycontin pill head, and the irrelevance of Twelve-Step remedies is evident in both cases.( The spread of opiate addiction to middle-class communities in recent years has a lot to do with updated delivery networks , especially those exploiting smart-phones , that have passed under the radar of parents beholden to the classic imagery of across-the -tracks drug dealers and their immiserated clientele .)

The actual, and intractable, phenomenon of addiction settled first on Afro-American communities, whose workforce after World War Two was no longer tethered to a national mission, and which became superfluous, much like today’s depressed white towns of the Rust Belt. To be fair, AA at its inception was not involved with those addicted to ‘hard drugs.’ But the 12-Step movement it fostered hasn’t proved capable of addressing the superfluity of those perishing from diseases of despair, for whom opioids are the nail in the coffin. The re-segregation of a large chunk of Afro-America into the ‘projects’ concretely defined how the government helped marginalize a demographic whose distressed housing it had thought to improve. The atomization of people in such high-rises mimics the social isolation the same type of buildings produced in Communist states . So we can assert that, while AA mainly ‘worked‘ for those society deemed worthy of rehabilitation, its program was never intended for those people most dramatically plagued by addiction. And here we can identify the social reality Hannah Arendt posed as the catalyzing agent of totalitarian movements: Superfluity, the damning sense that one has simply been left out of the story, that one’s travails no longer matter to the world at large. Totalitarian regimes then demonstrate their power through a willful sacrifice of enormous swaths of mankind, be they foreigners or countrymen , by mass starvation or industrial slaughter. The message is the same: The Party is in charge, and human life is not sacred -- ‘Look at what we can do, and tell us different.’

AA had little to offer an addict in Harlem or a crackhead in South Central, or an opiated ex-miner in West Virginia. The social controls and complements of care that facilitated my own recovery - my education, my work as a public school teacher bolstered by union membership, and the health plan that covered my rehabilitation - are glaringly absent in the crises of despair that grip the un-needed, those we treat as superfluous.

AA ‘s broad , inclusive path to spiritual development nevertheless harbors a serious drawback , for if it honored the Christianity it borrows from it would have to acknowledge the revolutionary character of the Gospel , and act accordingly . It would have to challenge , and not accept , the world as it is , and suffer the consequences of those who question a world in a state of amnesia akin to a dream in which justice is not achieved by the struggle of men and women but is dispensed from on high .

CONCLUSION: Why I Speak Here and Now

The quandary over addiction and strategies to combat it have provoked a debate from which at least one crucial actor is largely absent: the recovering addict willing to forgo a spurious ‘anonymity.’ This is why I have lent my voice to this discussion. My success in AA recovery has been solid, but nonetheless contingent on factors of social station, education, personal history, temperament and opportunity.

Although few spiritual paths offer the imprimatur of scientific ‘proof’–

as potentially in the case of certain meditative practices – AA ‘s claims reflect on the credibility of a much larger present-day recovery industry whose purported effectiveness relies heavily on anecdote and which remains notably short on clinically proven results.

Self-serving bromides like ”The program works if you work it”, cannot disguise AA ‘s spotty efficacy and therefore its limited relevance in the face of an epidemic of opioid abuse.

AA ‘s specific but limited appeal owes much to the particular circumstances of its inception, the American ‘genius’ for associative cooperation; philosophic and ethical refusal of shame as a social factor in curbing harmful behavior, embrace of the ‘disease model’ in a therapy that nevertheless promotes moral action as key to recovery, and the positing of moral and emotional failures peculiar to the alcoholic in a psychological portrait that may be as arbitrary as the characterological infirmities once thought specific to those suffering from tuberculosis and cancer.

The putative independence of AA may not survive its de facto partnership with a virtual industry of recovery that must deal with insurance companies, parole boards, divorce and custody courts, all of which seem to accept attendance at AA meetings as a bona fide of clean living and social re-entry. In this proliferating administrative hall of mirrors, AA ‘s claim of ‘rigorous honesty’ is likely to have reduced weight going forward, and its own inflated sense of its effectiveness plays into the prerogatives of institutions of social control for whom it is but a virtual pawn in a much larger game.

Addenda

AA MYTHS PER DR. DODES, ADVOCATE OF ‘BEHAVIOR’ THEORY

Dodes addresses AA’s purported ‘myths’ in chapter 8 of his “The Sober Truth” and his critique merits review in light of his distinctive model of addiction as behavior.

Myth #1 is the necessity of “hitting bottom” before accepting powerlessness over alcohol. One‘s particular ”bottom,” says Dodes, has little to do with physiology and everything to do with the consequences of drinking and of how one reacts to them. It is a behavioral model: You did such and such, experienced the dire consequences, and then decided to change your response. You gave up drink altogether; instead of moving away from the scene as a way to leave it behind you, you stayed and faced the music, having admitted you carried your problem with you wherever you went.

Myth #2 is that of ”surrendering one ‘s will” in a recognition that one is powerless over alcohol. This is, really, no more than a recognition of one ‘s alcoholic infirmity. Couched as it is in spiritual terms, it will raise the hackles of more scientifically-inclined minds and denies agency – or ‘will power’ – ”when it’s needed most.” The enigma of the will harnessed to a higher power doesn’t cut any ice with Dodes, whose theory of helplessness would place empowerment, not surrender, in the addict ‘s toolbox. I feel he ‘s quibbling over a semantic difference.

Myth #3 concerns the use of the number of days/weeks/years abstinent as if it were a foolproof marker of sobriety. The moralistic reset in AA practice all the way back to zero in the event of relapse Dodes considers punitive and overblown given the wide variety of ‘steps‘ backward; one error does not, and should not, negate all the progress made. The “benefits are no less cumulative for the interruption,” i.e., relapse. In AA, I might add, relapses are often cause for useful reflection, but without a trained counselor to help the addict who stumbles, they might for some just be another step in the revolving door of treatment, recovery and relapse, tapping out a discouraging rhythm of failure.

Myth #4 is that ‘we ‘re all just drunks.‘ This reassuring egalitarian statement ignores the obvious variety of addictions; it also defines addicts for what they supposedly ‘are’ rather than for what they do and have done. The one-size-fits-all methodology may benefit AA fellowship but it poorly serves the need for individual treatment.

Myth #5 is the orientation to ”one day at a time,” which of course has more than a passing resemblance to Jesus’ advice in his Sermon on the Mount that ”Sufficient unto the day is the evil thereof.” Dodes’ point is that learning to predict what situations may trigger one’s sense of helplessness is too valuable to ignore and that, like learning an instrument, maintaining sobriety gets easier over time. As with so many criticisms of AA, this one zeroes in on what is in fact useful particularly for the newly sober, whose concerns for family and job may take precedence over the very real challenge of going to bed without having taken a drink.

Myth #6, to “stick with the winners,” reinforces AA ‘s dismissal of other treatment options, and, should a newcomer not be able to reproduce the same outcome as the”winners,” counter-productive shame might result. The labels ‘winners’ and ‘losers’ favor those whose success may be more tenuous than is readily apparent and not that majority for whom AA simply did not work. In fact this means to be commonsense advice: Follow the example of those who have remained sober.

Myth #7 takes aim at the suggestion that participants attend 90 meetings in 90 days. Dodes finds this as arbitrary as the 28-day rehab stay, a set-up for failure, and a needless strain on those with family obligations. He seems to ignore how the plan operates as a way to prioritize one’s recovery and get tight with the fellowship; as an aspirational goal, I feel it has a lot going for it, and, in my experience, no one is “shamed” for falling short. There also is persuasive medical testimony as to the three-month somatic re-set necessary to recovery.

Myth #8 concerns the battery of ‘character defects’ that AA says beset the addict, but which are, in Dodes’ view, simply essential elements of the human condition. Some addicts are greedy, some selfless to a fault; the AA view of ‘defects’ plays into the universalizing approach of AA ‘s spiritual program. Dodes is categorical: He argues that the idea that one could cure an addiction by being less gossipy or judgmental is nonsense. Neither does the ambition to morally improve oneself, he believes, have anything to do with addiction. His dismissal accords with the analysis Sontag makes in ”Illness as Metaphor.”

Myth #9, that only an addict can treat an addict, is AA ‘s pragmatic response to the shame preventing full disclosure of one ‘s illness to a ‘normie’ (another alcoholic will more likely listen without judging ). But in practice, this perspective can have very negative consequences due to the roles the under-qualified play in treatment in accord with AA ‘s sponsorship model. Sponsors can only rely on personal experience, Dodes argues, which is no substitute for medical training.

Myth #10, that insanity is doing the same thing over and over while expecting a different result, Dodes slams for equating addiction and insanity, as if addicts were unaware of their behavior. In general, I feel he aims at straw men in this section, skewing the AA paradigm to support his foundational critique. It’s like shooting fish in a barrel; given AA ‘s spotty effectiveness, any and all of its adages can be shot full of holes. Whereas AA is explicit in debunking the idea that the alcoholic can take one drink without his allergic reaction kicking in , and that the repetition of this constitutes a type of ‘insanity’ – not the medical category, but simple irrationality - Dodes , in his debunking , willfully misreads the adage.

WILLIAM JAMES

William James was the philosopher critical to Bill Wilson’s spiritual journey. In the late 19^th century, he wrote so convincingly of the variety and nature of religious experience that AA’s founder cited him in the Big Book, AA ‘s foundational text.

Religion, to James, derived from the “feelings, acts, and experiences of individual men in their solitude … in relation to the divine … it is.. out of religion that theologies, philosophies and ecclesiastical organizations … grow.” Religion is an attitude toward what one deems a ”primal truth.” The fundamental teaching of religion, he asserts, is that something is wrong, and that it can be set right. In other words, it is useful. This model seems tailor-made for the alcoholic who wants to acknowledge what is broken, and make it whole again - from dysfunction to function, from futility to usefulness, from despair to hope.

This theology of Progress, in which the dire figure of Fate seems to have been nudged off stage by the utilitarian optimism of the age, evidently stood in need of correction. James valorized elements common to the religious experience: “a new zest … a gift for life, an assurance of safety and a temper of peace,” and, in relation to others, a ”preponderance of loving affections.” James recognized that the healthy-minded and the sick soul lend themselves to different religious temperaments. The former, as embodied in the mind-cure movement of his day, believed in the positive thinking that entertained courage, hope and trust, and that felt contempt for worry, fear and doubt. This strategy has a direct line to the AA warnings against indulging in ‘stinking thinking,’ the enemy of the AA participant active in his or her recovery.

James‘ own bouts with the blues doubtless moved him to appreciate the rejuvenating effect of positive thinking. Yet he could also allow that while some seem to have been born cheerful, others are brought into the world close to the pain threshold, restless and irritable. Does one type need a different religion? (This notional choice of spiritual menu would surely dumbfound those of a less utilitarian bent.) For the irritable constitution, a healthy-minded perspective may not be appropriate, for ‘morbid-mindedness’ cannot simply ignore the evils of the world. A positive outlook, James asserts, is impotent in the face of melancholy, and is inadequate as a philosophical doctrine, given that the evil present in the world, and the attention it demands of us, may be a key to the meaning of life as it opens our eyes to the deepest truths.

One only has to recall the carefree life of a young prince who, when first disturbed by the travails of the unfortunate, came to understand that life is suffering, which is not pain exactly, but how you deal with it. He was the Buddha. Did that make him a: “sick soul”? James‘ typology can appear simplistic.

James reminds us that the sick soul is not a sign of weakness; many very accomplished men and women were not happy campers. Among them was the great German writer Goethe, who described his life as a daily Sisyphean labor. All the same, James allowed how the sheer contrast afforded by the happy absence of morbid thought can open up a vivid appreciation for life, as if one had been twice born. James conjures up life as a real battle, failing which it is but a play from which one may retire at one ‘s choosing. But it felt to him like a real fight against something wild in the universe that we need to redeem.

ADDENDUM: SONTAG’S ILLNESS AS METAPHOR

There is an introductory discussion (pp. 27-29) to this short book in the main body of this essay, in addition to a summary of Part One. In this addendum, the remainder of the book is digested and summarized below for the interested reader.

2: Both cancer and TB have, at their root, the image of swelling, protuberance and morbid growth. And only after 1882 was it possible to definitely separate the two, when TB was proven to be caused by a bacterial infection.

TB is a disease of contrasts: languor and excitation, pallor and blush, a hacking cough and normal respiration. Cancer, however, progresses steadily, the patient weakens inexorably, his pallor unchanging. TB patients can see the evidence:of the X-ray image, the blood on the hankie, whereas the cancer-ridden may see no sign until the last stage before death. TB was associated with extra sensitivity -even to the erotic - with the poetry of life and the appetite for it; cancer is death to appetite and hardly poetic in its denial of desire. While the rosy cheeks of the tubercular may actually indicate fever, the signs of cancer never prevaricate. TB is sputum, blood, liquid; cancer is a hard foreign body. TB burns you up; cancer invades and impedes function. In the long ago TB, as”consumption,” galloped along, compressing time, now become precious; cancer spread, and stood for idleness and sloth as early as 1564:”that infectious canker, idleness.” TB takes hold of the poor in the frigid garret; cancer thrives due to the chemical effluvia or too-rich diet concomitant with a middle-class life. The TB patient is sent to the high, dry places where his lungs might rid themselves of the excess fluids endangering his breath; for the cancer-ridden, there is no less carcinogenic environment recommended to cure his interior. TB makes for a gradual soulful death, in which only the spirit remains; cancer is but pain and humiliation.

The myths connected to TB derived from the imagery of breath and life associated with the lungs: the upper, spiritualized part of the body, so unlike the bowels, the rectum, prostate, breast, testes: the lower parts. While a disease of the lungs is one of the soul, cancer is always of the body, without a transcendent possibility.

3: Both cancer and TB can be seen as diseases of passion. The metaphorical content of TB predates the Romantics, with love as a”consuming”passion. The Romantics inverted it to cast TB as a variation on love, as illness as salvation. If TB was thought to arise from too much passion, cancer in the modern age is thought to afflict those sexually repressed or unable to channel their anger. A host of heroes in novels of the 19^th century die of longing, of passion thwarted. Today it is cancer that attacks the repressed, that steps in where rage should have taken the floor. Wilhelm Reich, the disciple of Freud who consigned all dysfunction to blocked sexuality, defined cancer as a “disease following emotional resignation.” TB also brought on resignation as the sufferer grew inured to his eventual demise. The romantic elevation of TB into a spiritual challenge made of normal health something vulgar and banal by comparison.

4: By 1773, TB was well-known in London society as being the”anti-gout,” the mark of being genteel, sensitive, delicate. If a new social mobility made of clothing and manners the exterior markers of status, the right kind of illness became an interior necessity. The tubercular look was all the rage among the high-born, and the 20^th century fashion of anemic thinness is the last survival of the Romantic cult of illness. The person dying young was a romantic trope that served well into the modern age. The sick were more interesting than the merely healthy. To be sad, to be powerless, to embrace, finally, the role of the masochist, was a mark of refinement in an age of imperial thuggery. Melancholia was the artist ‘s illness, the property of the creative being, of one apart from the grasping crowd.

TB was a goad to travel, to leave the nexus of the dreary for sunnier climes in which to test one ‘s languor against foreign vitalities. It was a method of retreat. TB as a sign of a superior nature, as a ‘becoming’ frailty, survived all medical evidence well into our own times. Its mythic dimension was dispelled only with the discovery of cures in the 1940s and 50s.

Sontag (writing in 1977) posits insanity as the modern repository for attitudes once attached to TB: for some, it is proof of a superior sensitivity, and like TB it requires a kind of exile, and the most common metaphor for a positive psychic reorientation is - a trip, as in an LSD experience. Illness exacerbates consciousness as per the Romantics. Madness is romanticized as the rude acting out of paroxysmic wisdom, in default of which one succumbs to the disease of the repressed, cancer.

5: TB was a disease that set one in relief against society; one was singled out, to people the rungs of the fatally elect, as it were, due to a predisposition anchored in a character both passionate and repressed. Syphilis, the other great scourge of the age, was acquired from a carrier; there was no mystery, neither was there any special “type.” There was a moral judgment as to illicit sex, but not a psychological one. If in the ancient world, it was the gods who punished us with disease, our modern era sees TB and cancer as forms of self-betrayal. Character had once been drawn out by the disease - it being a test of one’s grit- rather than being the cause itself of the affliction. The whole point of the plague in Bocaccio‘s Decameron was to show how badly citizens behaved under its lash. TB, however, came as a redemptive ordeal in most narratives that featured the disease as mover. The patients suffering its ravages come to make amends or learn to live fully in the little time left to them.

6: A supernatural punishment, a form of possession, or merely a natural consequence, disease for the ancients could be gratuitous or deserved, could be visited on one due to a personal fault or in payment for the sins of one’s fathers; but with Christianity a truer, less happenstance correlation of illness and personality takes the stage, as with the hideous disfigurement of Mme Merteuil in “Dangerous Liaisons,” which showed her true face to the world. Her soul, ugly with lust and deceit, expresses itself on her body. In the modern age, disease comes to express character; it speaks through the body, gives form to the mental, a representation of what is within. The default is not excess of passion but passion unexpressed. Diseases become a secret language of the body to be deciphered. ”He who desires, but acts not, breeds pestilence” - William Blake. Today ‘s ideal candidate for cancer is the unfeeling anti-hero of The Stranger, not moody but simply, tragically, dissociated.

Judging disease to be, not the objective correlate of a faulty character or a sinner but the expression of a psychology, turns out to be an even harsher moral categorization. Karl Menninger wrote that “Illness is … what the victim has done with his world, and with himself.” Such odious claptrap diverts both patient and doctor away from what might actually prove useful. There is shame, as useless as it is potent, attached to the sufferer who is supposed to lack passion, who represses his self. The losers in life, be they the grief-stricken widow or the frustrated politician, are cancer’s chosen.

7: Cancer doesn’t align itself with the romantic dimensions of TB; the depression linked to cancer is but ”melancholy minus its charms.”When Sontag wrote this piece (1977) the links between the disease and painful feelings were becoming common knowledge; that the human condition always encompasses loss, grief and regret is no secret, but that these emotions could be proved a cause of cancer wasn’t a step too far for many researchers and writers publicizing their findings. Having discovered a correlation between depressive states and cancer, due to unfulfilled lives or what have you, medical professionals went on to demonstrate “how your personality can kill you,” to cite just one example.

Victorian-era cancer sufferers were burdened with care, anxiety, grief, poverty and overwork - not by the impossibility of ‘meaningful relationships.’

Rage and hyperactivity had to be damped down. Stoicism was invoked as a palliative; one must not “give way” to grief’s crippling power. This is a far cry from the “letting it all hang out” directives current in the 1970s. Distress may very well suppress immune response but it doesn’t follow that emotions cause diseases, much less in any specific fashion.

TB followed a similar story: One year before the bacillus causing it was discovered, a standard text gave the causes of TB as heredity, a sedentary life, poor climate, stale air, gloomy interiors and depressing emotions. As late as 1920, Kafka could attribute his pulmonary distress to mental illness.

Much as the plague-menaced of the 17^th century were counseled to stay happy, today ‘s afflicted are advised to improve their emotional state for want of sound medical treatment. The history of various forms of quackery is a long one. Our elevation of psychology as a secular religion rests on the Freudian notion of unconscious motivation, such that certain acts are revealed as having very different goals, as in overeating: You ‘re not that hungry, what you really want to consume is love or esteem etc. Only a short step then to divining the hidden meaning of a disease: Cancer means you are repressed, and this diagnosis gives you a spurious agency - you are in control - and all you have to do is let it all hang out and get your emotional needs met. This is where the ‘secular religion’ can spread its wings in the triumph of spirit over matter.

Way before a trait such as shyness became a medical condition, Sontag had discerned the enlargement of the category of mental illness in two respects:

1. social deviation, for example, as an illness whereby criminals can be treated and cured, and 2)

2. that every illness has a psychological component - that people get sick because they in some sense want to (getting the flu so as not to do one ‘s duty ), and can will themselves to get well.

The first hypothesis - that you are not the author of your crime, but subject to an illness - relieves guilt, while the second - that your agency is crucial to health -reinstates it: You ‘wanted’ it, you ‘got’ it, it’s your fault.

8: Treating cancer becomes a ‘war,’ a ‘crusade’ against a ‘killer’ that makes the luckless sufferer a soldier who shoulders the shame of his defeat. Leprosy in its heyday was equally emblematic of corruption, of moral decay, and as a metaphor it, and other incurable states, were then attached to other phenomena, as in the ”cancerous” spread of suburban sprawl. By 1513 ‘pestilence’ – originally in literal terms, the bubonic plague - came to mean that which is “injurious to religion, morals or the public peace.”

Whereas such metaphors were attached to endemic diseases in ages past, come the modern age it was syphilis, an individual pestilence, that captured the public imagination. Its moral and physical horror lent itself to antisemitic polemics. The starring role Hitler assigned it in Mein Kampf was but a grisly exaggeration of the uses of illness as metaphor in general usage. Syphilis hadn’t the metaphorical staying power that cancer can boast, though: Its horror was offset by a clear knowledge of its proximate cause - it was carried from one person to another. TB was wholly mysterious, as riddling and multifarious in origin as cancer is considered today. It is possible that the many forms of cancer might be traced to a single agent, but for the time being, the multi-determined nature of the disease (or more correctly, the assortment of diseases) lends itself all too well to its misuse as a metaphor for social and moral wrongs.

TB and cancer not only lent themselves to fantasies of contamination but to ideas of energy, as in weakness or strength; the former a stand-in for sensitivity and powerlessness, the latter a symbol of predatory ruthlessness.

Getting TB signaled a defect of vitality coupled with a heightened sensitivity. Cancer, as per Wilhelm Reich (a renegade Freudian who exaggerated the consequences of unfulfilled libido, not getting the right, or enough, sex), becomes TB ‘s mirror opposite in its over-production of energy together with a muted emotional life. Our economy, in its wasteful plethora of the unnecessary and its mindless red tape, could be a model for such imagery. Cancer is seen as ‘runaway growth,’ as a chaotic expansion invading a body weakened by a deadened spirit. If early capitalism discovered the value of sound accounting and frugal spending, TB, in the waste of vitality, was its image in negative.

TB was widely understood as a one-sided battle in which the patient had to rest, cultivate cheerfulness, get exercise etc. The cancer-ridden meanwhile get little pampering; in fact the treatment is often seen as worse than the disease. We go to war with cancer; it ‘invades‘ the body, metastasizes as if colonizing far sites in the victim, its renewed assaults bleeding one ‘s defenses. Patients are ‘bombarded’ with toxic counter-assaults so deleterious that one could be forgiven for passing on treatment altogether. In the era of Sontag ‘s writing, the ceaseless bromides of doctors promising a future cure are eerily reminiscent of the “light at the end of the tunnel” that prolonged the post-colonial war in Vietnam.

TB consumes the body, stripping away one ‘s defenses to reveal a shining, poetic soul, but with cancer one is invaded by atavistic, zombie cells: a ‘non-self.‘ Cancer is the Other, a being at one with science fiction scenarios replete with mutant expansion blotting out the human. Sadly, the consequences of atomic radiation, as found in Hiroshima and Nagasaki, confirm the environmental theories peddled by Reich. The fears of real exposure give life to all sorts of paranoid strategies of recovery. The John Birch Society produced a video called “A World Without Cancer,” presumably to hawk some curative agent such as Laetrile. Even the merely open-minded become convinced that a whopping majority of cancers are caused by pollution, or smoking, or processed meats, or pesticides. Evidently some habits and occupations risk exposure, and such cases are presumably preventable. But the view of most cancer generally as the result of industrialization is unsupported. It is not in fact a ‘modern disease.‘

The medieval scapegoating of the Jews in a plague-ridden Europe found no echo in the worldwide influenza epidemic of 1918-19 that killed more people than World War One. In diseases viewed as modern such as cancer, the scapegoat and patient engage in a dismal union, and one whose spread is likened to a plague or epidemic.Addenda

AA MYTHS PER DR. DODES, ADVOCATE OF ‘BEHAVIOR’ THEORY

Dodes addresses AA’s purported ‘myths’ in chapter 8 of his “The Sober Truth” and his critique merits review in light of his distinctive model of addiction as behavior.

Myth #1 is the necessity of “hitting bottom” before accepting powerlessness over alcohol. One‘s particular ”bottom,” says Dodes, has little to do with physiology and everything to do with the consequences of drinking and of how one reacts to them. It is a behavioral model: You did such and such, experienced the dire consequences, and then decided to change your response. You gave up drink altogether; instead of moving away from the scene as a way to leave it behind you, you stayed and faced the music, having admitted you carried your problem with you wherever you went.

Myth #2 is that of ”surrendering one ‘s will” in a recognition that one is powerless over alcohol. This is, really, no more than a recognition of one ‘s alcoholic infirmity. Couched as it is in spiritual terms, it will raise the hackles of more scientifically-inclined minds and denies agency – or ‘will power’ – ”when it’s needed most.” The enigma of the will harnessed to a higher power doesn’t cut any ice with Dodes, whose theory of helplessness would place empowerment, not surrender, in the addict ‘s toolbox. I feel he ‘s quibbling over a semantic difference.

Myth #3 concerns the use of the number of days/weeks/years abstinent as if it were a foolproof marker of sobriety. The moralistic reset in AA practice all the way back to zero in the event of relapse Dodes considers punitive and overblown given the wide variety of ‘steps‘ backward; one error does not, and should not, negate all the progress made. The “benefits are no less cumulative for the interruption,” i.e., relapse. In AA, I might add, relapses are often cause for useful reflection, but without a trained counselor to help the addict who stumbles, they might for some just be another step in the revolving door of treatment, recovery and relapse, tapping out a discouraging rhythm of failure.

Myth #4 is that ‘we ‘re all just drunks.‘ This reassuring egalitarian statement ignores the obvious variety of addictions; it also defines addicts for what they supposedly ‘are’ rather than for what they do and have done. The one-size-fits-all methodology may benefit AA fellowship but it poorly serves the need for individual treatment.

Myth #5 is the orientation to ”one day at a time,” which of course has more than a passing resemblance to Jesus’ advice in his Sermon on the Mount that ”Sufficient unto the day is the evil thereof.” Dodes’ point is that learning to predict what situations may trigger one’s sense of helplessness is too valuable to ignore and that, like learning an instrument, maintaining sobriety gets easier over time. As with so many criticisms of AA, this one zeroes in on what is in fact useful particularly for the newly sober, whose concerns for family and job may take precedence over the very real challenge of going to bed without having taken a drink.

Myth #6, to “stick with the winners,” reinforces AA ‘s dismissal of other treatment options, and, should a newcomer not be able to reproduce the same outcome as the”winners,” counter-productive shame might result. The labels ‘winners’ and ‘losers’ favor those whose success may be more tenuous than is readily apparent and not that majority for whom AA simply did not work. In fact this means to be commonsense advice: Follow the example of those who have remained sober.

Myth #7 takes aim at the suggestion that participants attend 90 meetings in 90 days. Dodes finds this as arbitrary as the 28-day rehab stay, a set-up for failure, and a needless strain on those with family obligations. He seems to ignore how the plan operates as a way to prioritize one’s recovery and get tight with the fellowship; as an aspirational goal, I feel it has a lot going for it, and, in my experience, no one is “shamed” for falling short. There also is persuasive medical testimony as to the three-month somatic re-set necessary to recovery.

Myth #8 concerns the battery of ‘character defects’ that AA says beset the addict, but which are, in Dodes’ view, simply essential elements of the human condition. Some addicts are greedy, some selfless to a fault; the AA view of ‘defects’ plays into the universalizing approach of AA ‘s spiritual program. Dodes is categorical: He argues that the idea that one could cure an addiction by being less gossipy or judgmental is nonsense. Neither does the ambition to morally improve oneself, he believes, have anything to do with addiction. His dismissal accords with the analysis Sontag makes in ”Illness as Metaphor.”

Myth #9, that only an addict can treat an addict, is AA ‘s pragmatic response to the shame preventing full disclosure of one ‘s illness to a ‘normie’ (another alcoholic will more likely listen without judging ). But in practice, this perspective can have very negative consequences due to the roles the under-qualified play in treatment in accord with AA ‘s sponsorship model. Sponsors can only rely on personal experience, Dodes argues, which is no substitute for medical training.

Myth #10, that insanity is doing the same thing over and over while expecting a different result, Dodes slams for equating addiction and insanity, as if addicts were unaware of their behavior. In general, I feel he aims at straw men in this section, skewing the AA paradigm to support his foundational critique. It’s like shooting fish in a barrel; given AA ‘s spotty effectiveness, any and all of its adages can be shot full of holes. Whereas AA is explicit in debunking the idea that the alcoholic can take one drink without his allergic reaction kicking in , and that the repetition of this constitutes a type of ‘insanity’ – not the medical category, but simple irrationality - Dodes , in his debunking , willfully misreads the adage.

WILLIAM JAMES

William James was the philosopher critical to Bill Wilson’s spiritual journey. In the late 19^th century, he wrote so convincingly of the variety and nature of religious experience that AA’s founder cited him in the Big Book, AA ‘s foundational text.

Religion, to James, derived from the “feelings, acts, and experiences of individual men in their solitude … in relation to the divine … it is.. out of religion that theologies, philosophies and ecclesiastical organizations … grow.” Religion is an attitude toward what one deems a ”primal truth.” The fundamental teaching of religion, he asserts, is that something is wrong, and that it can be set right. In other words, it is useful. This model seems tailor-made for the alcoholic who wants to acknowledge what is broken, and make it whole again - from dysfunction to function, from futility to usefulness, from despair to hope.

This theology of Progress, in which the dire figure of Fate seems to have been nudged off stage by the utilitarian optimism of the age, evidently stood in need of correction. James valorized elements common to the religious experience: “a new zest … a gift for life, an assurance of safety and a temper of peace,” and, in relation to others, a ”preponderance of loving affections.” James recognized that the healthy-minded and the sick soul lend themselves to different religious temperaments. The former, as embodied in the mind-cure movement of his day, believed in the positive thinking that entertained courage, hope and trust, and that felt contempt for worry, fear and doubt. This strategy has a direct line to the AA warnings against indulging in ‘stinking thinking,’ the enemy of the AA participant active in his or her recovery.

James‘ own bouts with the blues doubtless moved him to appreciate the rejuvenating effect of positive thinking. Yet he could also allow that while some seem to have been born cheerful, others are brought into the world close to the pain threshold, restless and irritable. Does one type need a different religion? (This notional choice of spiritual menu would surely dumbfound those of a less utilitarian bent.) For the irritable constitution, a healthy-minded perspective may not be appropriate, for ‘morbid-mindedness’ cannot simply ignore the evils of the world. A positive outlook, James asserts, is impotent in the face of melancholy, and is inadequate as a philosophical doctrine, given that the evil present in the world, and the attention it demands of us, may be a key to the meaning of life as it opens our eyes to the deepest truths.

One only has to recall the carefree life of a young prince who, when first disturbed by the travails of the unfortunate, came to understand that life is suffering, which is not pain exactly, but how you deal with it. He was the Buddha. Did that make him a: “sick soul”? James‘ typology can appear simplistic.

James reminds us that the sick soul is not a sign of weakness; many very accomplished men and women were not happy campers. Among them was the great German writer Goethe, who described his life as a daily Sisyphean labor. All the same, James allowed how the sheer contrast afforded by the happy absence of morbid thought can open up a vivid appreciation for life, as if one had been twice born. James conjures up life as a real battle, failing which it is but a play from which one may retire at one ‘s choosing. But it felt to him like a real fight against something wild in the universe that we need to redeem.

ADDENDUM: SONTAG’S ILLNESS AS METAPHOR

There is an introductory discussion (pp. 27-29) to this short book in the main body of this essay, in addition to a summary of Part One. In this addendum, the remainder of the book is digested and summarized below for the interested reader.

2: Both cancer and TB have, at their root, the image of swelling, protuberance and morbid growth. And only after 1882 was it possible to definitely separate the two, when TB was proven to be caused by a bacterial infection.

TB is a disease of contrasts: languor and excitation, pallor and blush, a hacking cough and normal respiration. Cancer, however, progresses steadily, the patient weakens inexorably, his pallor unchanging. TB patients can see the evidence:of the X-ray image, the blood on the hankie, whereas the cancer-ridden may see no sign until the last stage before death. TB was associated with extra sensitivity -even to the erotic - with the poetry of life and the appetite for it; cancer is death to appetite and hardly poetic in its denial of desire. While the rosy cheeks of the tubercular may actually indicate fever, the signs of cancer never prevaricate. TB is sputum, blood, liquid; cancer is a hard foreign body. TB burns you up; cancer invades and impedes function. In the long ago TB, as”consumption,” galloped along, compressing time, now become precious; cancer spread, and stood for idleness and sloth as early as 1564:”that infectious canker, idleness.” TB takes hold of the poor in the frigid garret; cancer thrives due to the chemical effluvia or too-rich diet concomitant with a middle-class life. The TB patient is sent to the high, dry places where his lungs might rid themselves of the excess fluids endangering his breath; for the cancer-ridden, there is no less carcinogenic environment recommended to cure his interior. TB makes for a gradual soulful death, in which only the spirit remains; cancer is but pain and humiliation.

The myths connected to TB derived from the imagery of breath and life associated with the lungs: the upper, spiritualized part of the body, so unlike the bowels, the rectum, prostate, breast, testes: the lower parts. While a disease of the lungs is one of the soul, cancer is always of the body, without a transcendent possibility.

3: Both cancer and TB can be seen as diseases of passion. The metaphorical content of TB predates the Romantics, with love as a”consuming”passion. The Romantics inverted it to cast TB as a variation on love, as illness as salvation. If TB was thought to arise from too much passion, cancer in the modern age is thought to afflict those sexually repressed or unable to channel their anger. A host of heroes in novels of the 19^th century die of longing, of passion thwarted. Today it is cancer that attacks the repressed, that steps in where rage should have taken the floor. Wilhelm Reich, the disciple of Freud who consigned all dysfunction to blocked sexuality, defined cancer as a “disease following emotional resignation.” TB also brought on resignation as the sufferer grew inured to his eventual demise. The romantic elevation of TB into a spiritual challenge made of normal health something vulgar and banal by comparison.

4: By 1773, TB was well-known in London society as being the”anti-gout,” the mark of being genteel, sensitive, delicate. If a new social mobility made of clothing and manners the exterior markers of status, the right kind of illness became an interior necessity. The tubercular look was all the rage among the high-born, and the 20^th century fashion of anemic thinness is the last survival of the Romantic cult of illness. The person dying young was a romantic trope that served well into the modern age. The sick were more interesting than the merely healthy. To be sad, to be powerless, to embrace, finally, the role of the masochist, was a mark of refinement in an age of imperial thuggery. Melancholia was the artist ‘s illness, the property of the creative being, of one apart from the grasping crowd.

TB was a goad to travel, to leave the nexus of the dreary for sunnier climes in which to test one ‘s languor against foreign vitalities. It was a method of retreat. TB as a sign of a superior nature, as a ‘becoming’ frailty, survived all medical evidence well into our own times. Its mythic dimension was dispelled only with the discovery of cures in the 1940s and 50s.

Sontag (writing in 1977) posits insanity as the modern repository for attitudes once attached to TB: for some, it is proof of a superior sensitivity, and like TB it requires a kind of exile, and the most common metaphor for a positive psychic reorientation is - a trip, as in an LSD experience. Illness exacerbates consciousness as per the Romantics. Madness is romanticized as the rude acting out of paroxysmic wisdom, in default of which one succumbs to the disease of the repressed, cancer.

5: TB was a disease that set one in relief against society; one was singled out, to people the rungs of the fatally elect, as it were, due to a predisposition anchored in a character both passionate and repressed. Syphilis, the other great scourge of the age, was acquired from a carrier; there was no mystery, neither was there any special “type.” There was a moral judgment as to illicit sex, but not a psychological one. If in the ancient world, it was the gods who punished us with disease, our modern era sees TB and cancer as forms of self-betrayal. Character had once been drawn out by the disease - it being a test of one’s grit- rather than being the cause itself of the affliction. The whole point of the plague in Bocaccio‘s Decameron was to show how badly citizens behaved under its lash. TB, however, came as a redemptive ordeal in most narratives that featured the disease as mover. The patients suffering its ravages come to make amends or learn to live fully in the little time left to them.

6: A supernatural punishment, a form of possession, or merely a natural consequence, disease for the ancients could be gratuitous or deserved, could be visited on one due to a personal fault or in payment for the sins of one’s fathers; but with Christianity a truer, less happenstance correlation of illness and personality takes the stage, as with the hideous disfigurement of Mme Merteuil in “Dangerous Liaisons,” which showed her true face to the world. Her soul, ugly with lust and deceit, expresses itself on her body. In the modern age, disease comes to express character; it speaks through the body, gives form to the mental, a representation of what is within. The default is not excess of passion but passion unexpressed. Diseases become a secret language of the body to be deciphered. ”He who desires, but acts not, breeds pestilence” - William Blake. Today ‘s ideal candidate for cancer is the unfeeling anti-hero of The Stranger, not moody but simply, tragically, dissociated.

Judging disease to be, not the objective correlate of a faulty character or a sinner but the expression of a psychology, turns out to be an even harsher moral categorization. Karl Menninger wrote that “Illness is … what the victim has done with his world, and with himself.” Such odious claptrap diverts both patient and doctor away from what might actually prove useful. There is shame, as useless as it is potent, attached to the sufferer who is supposed to lack passion, who represses his self. The losers in life, be they the grief-stricken widow or the frustrated politician, are cancer’s chosen.

7: Cancer doesn’t align itself with the romantic dimensions of TB; the depression linked to cancer is but ”melancholy minus its charms.”When Sontag wrote this piece (1977) the links between the disease and painful feelings were becoming common knowledge; that the human condition always encompasses loss, grief and regret is no secret, but that these emotions could be proved a cause of cancer wasn’t a step too far for many researchers and writers publicizing their findings. Having discovered a correlation between depressive states and cancer, due to unfulfilled lives or what have you, medical professionals went on to demonstrate “how your personality can kill you,” to cite just one example.

Victorian-era cancer sufferers were burdened with care, anxiety, grief, poverty and overwork - not by the impossibility of ‘meaningful relationships.’

Rage and hyperactivity had to be damped down. Stoicism was invoked as a palliative; one must not “give way” to grief’s crippling power. This is a far cry from the “letting it all hang out” directives current in the 1970s. Distress may very well suppress immune response but it doesn’t follow that emotions cause diseases, much less in any specific fashion.

TB followed a similar story: One year before the bacillus causing it was discovered, a standard text gave the causes of TB as heredity, a sedentary life, poor climate, stale air, gloomy interiors and depressing emotions. As late as 1920, Kafka could attribute his pulmonary distress to mental illness.

Much as the plague-menaced of the 17^th century were counseled to stay happy, today ‘s afflicted are advised to improve their emotional state for want of sound medical treatment. The history of various forms of quackery is a long one. Our elevation of psychology as a secular religion rests on the Freudian notion of unconscious motivation, such that certain acts are revealed as having very different goals, as in overeating: You ‘re not that hungry, what you really want to consume is love or esteem etc. Only a short step then to divining the hidden meaning of a disease: Cancer means you are repressed, and this diagnosis gives you a spurious agency - you are in control - and all you have to do is let it all hang out and get your emotional needs met. This is where the ‘secular religion’ can spread its wings in the triumph of spirit over matter.

Way before a trait such as shyness became a medical condition, Sontag had discerned the enlargement of the category of mental illness in two respects:

1. social deviation, for example, as an illness whereby criminals can be treated and cured, and 2)

2. that every illness has a psychological component - that people get sick because they in some sense want to (getting the flu so as not to do one ‘s duty ), and can will themselves to get well.

The first hypothesis - that you are not the author of your crime, but subject to an illness - relieves guilt, while the second - that your agency is crucial to health -reinstates it: You ‘wanted’ it, you ‘got’ it, it’s your fault.

8: Treating cancer becomes a ‘war,’ a ‘crusade’ against a ‘killer’ that makes the luckless sufferer a soldier who shoulders the shame of his defeat. Leprosy in its heyday was equally emblematic of corruption, of moral decay, and as a metaphor it, and other incurable states, were then attached to other phenomena, as in the ”cancerous” spread of suburban sprawl. By 1513 ‘pestilence’ – originally in literal terms, the bubonic plague - came to mean that which is “injurious to religion, morals or the public peace.”

Whereas such metaphors were attached to endemic diseases in ages past, come the modern age it was syphilis, an individual pestilence, that captured the public imagination. Its moral and physical horror lent itself to antisemitic polemics. The starring role Hitler assigned it in Mein Kampf was but a grisly exaggeration of the uses of illness as metaphor in general usage. Syphilis hadn’t the metaphorical staying power that cancer can boast, though: Its horror was offset by a clear knowledge of its proximate cause - it was carried from one person to another. TB was wholly mysterious, as riddling and multifarious in origin as cancer is considered today. It is possible that the many forms of cancer might be traced to a single agent, but for the time being, the multi-determined nature of the disease (or more correctly, the assortment of diseases) lends itself all too well to its misuse as a metaphor for social and moral wrongs.

TB and cancer not only lent themselves to fantasies of contamination but to ideas of energy, as in weakness or strength; the former a stand-in for sensitivity and powerlessness, the latter a symbol of predatory ruthlessness.

Getting TB signaled a defect of vitality coupled with a heightened sensitivity. Cancer, as per Wilhelm Reich (a renegade Freudian who exaggerated the consequences of unfulfilled libido, not getting the right, or enough, sex), becomes TB ‘s mirror opposite in its over-production of energy together with a muted emotional life. Our economy, in its wasteful plethora of the unnecessary and its mindless red tape, could be a model for such imagery. Cancer is seen as ‘runaway growth,’ as a chaotic expansion invading a body weakened by a deadened spirit. If early capitalism discovered the value of sound accounting and frugal spending, TB, in the waste of vitality, was its image in negative.

TB was widely understood as a one-sided battle in which the patient had to rest, cultivate cheerfulness, get exercise etc. The cancer-ridden meanwhile get little pampering; in fact the treatment is often seen as worse than the disease. We go to war with cancer; it ‘invades‘ the body, metastasizes as if colonizing far sites in the victim, its renewed assaults bleeding one ‘s defenses. Patients are ‘bombarded’ with toxic counter-assaults so deleterious that one could be forgiven for passing on treatment altogether. In the era of Sontag ‘s writing, the ceaseless bromides of doctors promising a future cure are eerily reminiscent of the “light at the end of the tunnel” that prolonged the post-colonial war in Vietnam.

TB consumes the body, stripping away one ‘s defenses to reveal a shining, poetic soul, but with cancer one is invaded by atavistic, zombie cells: a ‘non-self.‘ Cancer is the Other, a being at one with science fiction scenarios replete with mutant expansion blotting out the human. Sadly, the consequences of atomic radiation, as found in Hiroshima and Nagasaki, confirm the environmental theories peddled by Reich. The fears of real exposure give life to all sorts of paranoid strategies of recovery. The John Birch Society produced a video called “A World Without Cancer,” presumably to hawk some curative agent such as Laetrile. Even the merely open-minded become convinced that a whopping majority of cancers are caused by pollution, or smoking, or processed meats, or pesticides. Evidently some habits and occupations risk exposure, and such cases are presumably preventable. But the view of most cancer generally as the result of industrialization is unsupported. It is not in fact a ‘modern disease.‘

The medieval scapegoating of the Jews in a plague-ridden Europe found no echo in the worldwide influenza epidemic of 1918-19 that killed more people than World War One. In diseases viewed as modern such as cancer, the scapegoat and patient engage in a dismal union, and one whose spread is likened to a plague or epidemic.

AN OPEN LETTER TO AA

Some time ago I called my old therapist to discuss my transition out of AA , a process I imagined to be as fraught as that which confronted those who left the Communist Party at various points after its American heyday in the 1930s . I think my leaving AA is analogous for one major reason : the beliefs central to AA no longer correspond to reality . Americans joined the Party to bring about social and economic justice , and in the Depression the Party seemed the best bet to accomplish it : its writers and ideologues had correctly analyzed the failures of capitalism , and the Party took decisive action in response . It also provided a camaraderie as an alternative to the haves/have-nots paradigm of a society riven by race and class . One’s commitments in fellowship transcended one’s own private ambitions .

That the mother-lode of leftists-the Soviet Union - was a hideous charade from the very start wasn't apparent to the believers : hadn't the revolution overturned a repressive , backward regime ? Wasn't it a beacon for all those struggling against oppression world-wide ? By fits and starts the edifice began to crack : the state-sponsored famines of the late 20s and early 30s , the institution of slave-labor , the pact with Hitler , the resumption of purges in the early 50s , and the brutal repression of Hungarian liberty in 1956 were all reasons to part ways with the Communist dream , which came to resemble a nightmare for man as such . It was the Party's disciplined central role in the fight for justice that delayed the defections -how could one abandon the poor and oppressed by reason of some foreign imbroglio irrelevant to the task at hand ? Those who did leave the Party did so despite the disruption to their social life and world-view ; but they could no longer abide the lies propagated and crimes committed in their name as Communists . Underlying the evident "excesses" of Communism in action were the foundational beliefs that turned out to be untrue : perhaps class-struggle wasn’t the fundamental mechanism of social change ; perhaps the actual poverty and stifling repressiveness of such regimes were the true measure of their viability .

Just as the Communist Party appeared to be the best hope for progress in a world torn by war and economic chaos , so did AA enter the world as the best hope for alcoholics at war with a problem no one knew how to address , and it became not just the only game in town , but the model for therapeutic approaches for decades to come . Following as it did an era of wild consumption that supported the rise of criminal cartels and which showed a blithe disregard for the very real dangers of excessive drinking , AA became not just a haven for the individual but a social movement of growing influence . But the rise in the standard of living coupled with a concern for civil rights can no more be attributed to the Communist vanguard than the progress in research into addiction can be deduced from the efforts of AA. In fact many prominent addiction researchers bemoan the apparent monopoly of 12-Step therapeutic models as a real obstacle to the development of evidence-based therapies.

Both the Party and AA benefitted from a cognitive imprint stamped on the public mind during the uncontested primacy they enjoyed in their nascent period of popular acclaim and early victories . Both seemed the last , best hope - for a cruelly unjust society or for an alcoholic with nowhere else to turn . But the basic tenets of the two cannot escape critical evaluation and judgement : communism , as noted , could not explain the progress of capitalist societies and the stagnation of its own , and AA cannot explain , especially as regards the current opioid - use epidemic , how its emphasis on moral regeneration can deal with the staggering social crisis in its very midst , given its structural incapacity to measure efforts against results . Because it is not a medical organization , AA has never kept records , and the self-reporting of outcomes so far has proven statistically unreliable to even the most neutral observers . The collectivist model of communist ideology produced repressive governance and stunted development under the direction of an in-grown power structure , the "nomenklatura" ; the spiritual model of AA has worked but for a small fraction -one in ten- of those opting for , or inducted into , its program , and has seen its minute cadre of the "willing" refuse to admit of any other treatment options but that which succeeded with themselves ; moreover , its vaunted independence from outside bodies is increasingly compromised by its interface with parole and licensing boards beholden to the would-be efficacy of AA .

I cannot ignore the cognitive dissonance of my own situation , for I know that AA helped me in crucial ways that therapy did not ; I also know that my service work in hospitals , detoxes , jails , and half-way houses is , if regarded with the rigorous honesty demanded by AA , utterly self-interested and of questionable medical value . How can I , in good faith , promote a program that hasn't been shown to be effective ? It's all very well to enjoy the respect and warm welcome of those staffing the facilities I visit as an emissary of AA ; but such good feeling doesn't justify the propagation of a model of addiction that is , at best , unproven .

I have a clear memory of a rehab counselor explaining ,with no uncertainty , why AA is not a 'cult': it has no deified leader ; it exacts no onerous proofs of fidelity in the form of cash payments or deeds to property ; it has no dogmas ; each meeting is autonomous ; and membership is open and voluntary . What a relief it was to hear a common complaint so summarily dismissed ! And yet the very definition of a cult is hard to frame : one man's cult is another's faith , and the French origin of the word itself is cause for reflection , for it is synonymous with a religious body : from the Latin ‘cultus’ , the past participle of 'adore' . For the Jews of the Roman period , the splitting of God into the Trinity , and the deification of a human being , namely Jesus , was proof of Christianity's idolatry : it qualified as a cult in the modern sense . Simply put , a belief in the mediation of an unseen and unproven power relies on faith , and not evidence . The acceptance of the 12-Step model of recovery occurred independently of any scientific evidence in support of it . While the fellowship of AA has undisputed advantages for the once-isolated addict/alcoholic , no one pretends that the shared anecdotal narratives of trial and redemption therein constitute an alternative to the peer-reviewed medical trials necessary to the prescription of life-saving drugs . It is in its belief without evidence that AA may be described as a 'cult' .

Is AA dogmatic ? There are plenty of stories of individual AA members hewing to rigid ideas they confidently seek to impose on others ; but they do so without the authority of AA behind them . The foundational ideals of AA are few , but crucial : the first , as laid out in the "Doctor's Opinion" , asserts that alcoholism is a disease ; the second , according to AA's founder , Bill Wilson , is that it is but a symptom of a spiritual problem that reveals itself in the 'character defects' of the afflicted ; another is that alcoholism is progressive , incurable , and fatal . The 'disease model' aimed to remove the stigma from the patient : if we but look at the social attitudes toward TB and cancer in the years when those diseases hadn't found a cure , and how those judgements evaporated once a cure , or at least a correct diagnosis , was found , we can see that the stigma attached owed more to society's mystification than it did to the illness itself . The tubercular were "too sensitive" , the cancer-ridden were "repressed" , and so on . In like manner the riddle of addiction has saddled the addict/alcoholic with "selfishness" , to name but one of the character defects in the AA battery of shortcomings to be overcome . In AA we are told that without a fearless inventory of our failings and active steps to repair the social harm we have done we will simply share the fate of the "dry drunk" , sober , but a problem for everyone around him or her , or , more piquantly , a once drunken horse-thief now a sober one . Bill Wilson's intelligence and compassion no doubt informed his aversion to dogma and his embrace of tolerance , but his own addictive mind reasserted itself in a destructive smoking habit , and in a career-long pursuit of sex -his "womanizing"- that would be seen today as pathological , or even predatory .

“Progressive , incurable and fatal” ? In any given year some 17 million Americans are diagnosed with an alcohol-use disorder ; of these about 2 million receive treatment . Who , then are the other 15 million ? According to an addiction specialist , Dr Mark Willenbring , they are those with less comorbidity (serious illness accompanying their drinking), and with considerably more social capital . Most have an episode of a few years that dissipates of its own and that never recurs ; i.e. not a progressive illness . Incurable ? Addiction is a disease of the brain , and if the on-the -ground strategies of rehabs muddling along in AA’s footsteps have chosen not to act on the most recent findings of researchers , then how is one to credit an axiom brandished more than a half-century ago ? Bill Wilson , by his own word , had a lethal engagement with booze ; most do not .

Another tenet central to AA is its vaunted autonomy : "AA is not allied with any sect , denomination, politics , organization , or institution …" This held true until the widespread acceptance of the 12-Step model of recovery , and still holds true only if one ignores the symbiotic relationship between AA and the rehab industry . The industry sends its patients into AA and other similar programs as a matter of course , and has so invested in the hand-off that neither AA nor the quasi-medical staffers of the industry have much stomach for any competing model of recovery . Given the absence of reliable follow-up data that might justify such a refusal , one remains in a quandary as to the hold the 12-Step model has on the public mind , and the responsibility of AA in that regard .

"We give freely of what has been given to us." Fair enough , and I personally testify to the role service has played in my own recovery . Apparently altruism works ! Who knew ? One Dr Silkworth , a prominent physician , certainly was impressed enough to write, in the mid-30s , an appreciation that became the opening chapter of the Big Book. The crucial point here is that AA , as a program of action -of atonement , retribution , and service - explicitly proposes a change in behavior as the sine qua non of a change in heart and mind , and God knows it worked for this grateful member . But this very emphasis on action actually weakens the case for the disease model , and empowers the alternative : that addiction is a behavior , and not a disease . The most convincing rebuttal of the notion that addiction is inborn and fatal came with the study of Vietnam veterans who returned to civilian life addicted to heroin . Some 90% , post detox , went into remission , i.e. they stopped using , for the simple reason that their absence from the war-zone relieved them of the unbearable helplessness that spurred their drug use while stationed in Vietnam . This bit of data extracted from the archives of Dr Lance Dodes is intended to support his counter- argument that addiction is not inborn , but behavioral . AA’s advice - to get well by doing good - doesn't disprove the disease model ; it’s merely inconsistent with it .

Cutting through a lot of the noise is Dr Mark Willenbring , the director of treatment research at the NIAAA from 2004-2009 . His expertise in the etiology of addiction is worth a listen : as to a disposition to alcoholism , without a family history of such it is uncommon to develop 'tolerance' , a state characterized by relief (as opposed to mere relaxation) , an absence of physical consequences in the short -term (hangovers ), and stimulation rather than sleepiness when drinking heavily . For those with genetic markers , drinking , even to excess , acts as an elixir .

“Your addiction doesn’t care which shirt you put on .” This was the warning I received in rehab , that my core disposition would inevitably reassert itself should I stop imbibing without an (AA) program in place ; this is the popular version of cross-addiction , which a 3-year study of some 43 000 alcoholic subjects found no evidence for . In AA , however , the anecdotal evidence has been so compelling that dogma has resurfaced in the guise of self-evident truth .

In AA the threat of 'heresy' is very real to its members : the threat is existential , as it endangers their foundation , a belief-system perhaps less decisive than the action it engenders , but nonetheless critical to AA's inner cohesion and its interface with the therapeutic community .

In " Illness as Metaphor" , Susan Sontag critiqued the fanciful explanations attached to diseases as yet incurable by examining the psychological and social typologies current in the 19th and 20th centuries . The riddle of addiction makes it a close cousin of both TB and cancer . One might ask what broader social forces belie the notion that individual responsibility and spiritual regeneration are the keys to fighting the wave of addiction now facing down (white) America . We can stipulate that feeling useless commonly results from substance abuse ; but what if society has told you as much , what then ? If society turns its back on you , with little in the way of a safety net , and drugs flood your community , be it in West Virginia or South-Central LA , the message is clear : you are not needed . Hannah Arendt , in “The Origins of Totalitarianism” , identified the isolation and superfluity of ordinary people as a prime factor in the perversion of the ‘people’ into a mass to be manipulated by unscrupulous demagogues bent on total control . Today’s rejects find themselves left out of a global capitalist machine driven by financial schemes that benefit a small minority wedded to technologies increasingly free of human labor . Redundant , expendable , dispensable , unwanted : all of these terms define the state of the superfluous . Only a generation or two separate the black crackhead from the white Oxycontin pill head , and the irrelevance of Twelve-Step remedies is evident in both cases . ( The spread of opiate addiction to middle-class communities in recent years has a lot to do with updated delivery networks , especially those exploiting smart-phones , that have passed under the radar of parents beholden to the classic imagery of across-the -tracks drug dealers and their immiserated clientele .)

The actual , and intractable , phenomenon of addiction settled on Afro-American communities first , whose workforce after WWII was no longer tethered to a national mission , and which became superfluous , much as today’s depressed white towns of the rust-belt . To be fair , AA in its inception had no truck with those addicted to hard drugs ; but the 12-Step movement it fostered hasn’t proved capable of addressing the superfluity of those perishing from diseases of despair , for whom opioids are the nail in the coffin . The re-segregation of a large chunk of Afro-America into the ‘projects’ concretely defined how the government marginalized a demographic whose distressed housing it had thought to improve . The atomization of the citizenry in such high-rises mimics the social isolation they produced in communist states in which common participation in the political process was entirely scripted . So we can assert that , although 12 -Step programs mainly ’worked’ for those society deemed worthy of rehabilitation , its program , as an adjunct to medical care , was never intended for those people most dramatically plagued by addiction . And here we can identify the social reality Hannah Arendt posed as the catalyzing agent of totalitarian movements : superfluousness , the damning sense that one has simply been left out of the story , that one’s travails no longer matter to the world at large . Following their capture of those ‘left out’, totalitarian regimes go on to demonstrate their power through a willful sacrifice of enormous swathes of mankind , be they foreigners or countrymen , by mass starvation or industrial slaughter . The message is the same : the Party is in charge , and human life is not sacred : ‘ Look at what we can do , and tell me different .’ Although the licensed flood of opioids cannot be equated with state-sponsored mass starvation or execution , the lives blighted and lost , and the billions of dollars devoted to managing the consequences of a profit-driven response to ‘pain management’ confer a discomfiting relation between the two .

AA , or its offshoots , had little to offer an addict in Harlem , or a crack-head in South-Central , or an opiated ex-miner in W Virginia . The social controls and complements of care that facilitated my own recovery - my education , my work as a public-school teacher bolstered by union membership , and the health-plan that covered my rehabilitation - are glaringly absent in the crises of despair that grip the un-needed , those we treat as superfluous .

My defection has been a while to take final shape . What my head insisted on my heart was slow to follow ; I hedged my bets as if superstitious , but eventually I shook off my misgivings . My case is more common than AA would like to admit : many like me - still sober- simply outgrow the very particular attractions of the fellowship , and go on our way , still in gratitude .

Diet

As soon as I got sober I started to gain weight. At a physical, towards the end of my first year sober , the nurse taking my vitals informed me I weighed 185 lbs , a full 20 lbs. over the weight I had maintained since college. I offered that she must be mistaken ; it wasn’t possible. How could I have put on these pounds without knowing it ? Of course , I had other fish to fry at the moment. At a follow-up soon after , the number remained the same. I had to admit it : without any great change in diet -save the booze, mainly wine , that I had foregone - or exercise , I had gained weight. Four years later , coming in at 205 , I shared my concern with my primary care physician , someone I respected. We shared a laugh over my aversion to ‘blue (skim) milk’: His rueful ‘You can get used to anything ‘ seemed funny at the time. And he sent me on my way with the food pyramid devised under the Carter administration , which counseled reducing fats and sugars , and increasing grains. Nothing happened. I was on my way to being a blimp : 240 was in sight if nothing changed.

Then one fine day I happened to be tuned in to NPR and heard a presentation on obesity by a science-writer and researcher. Gary Taubes convinced me that calories-in calories -out was a myth ; that fat doesn’t make us fat ; and that it was a disruption in the body’s metabolic rate that brought on obesity. I looked at his YouTube video , took notes , bought the book , took more notes , and then changed my diet accordingly.

Bacon and eggs , salads and meat , yogurt and cheese , and a few crackers to assuage the bread lover in me. But no rice , pasta , potatoes , or , most arrestingly , fruit. Anything with sugar , anything sweet , anything that quickly turned to sugar in the blood was off-limits. For a few months there was no change , then , at a VA hospital where I was chairing an AA meeting , I checked my weight on one of the digital scales : 195 ! I was on the right track , without counting calories , without exercising beyond the daily 45 minute walks I’d always favored. This is where I’ve stayed ever since , except for during a period of dental work which obliged me to eat soft foods , when I allowed myself jam , ice cream , puddings and plenty of mashed potatoes , and my weight shot up to the previous warning level of 205 : a confirmation of the ketogenic theory , in fact. A few weeks after I resumed the low-carb diet my weight went back down.

So , not only did I stop gaining weight , I actually lost 10 lbs , and my vitals today are fine , especially my blood-glucose levels. Another video I watched , one featuring some altogether serious nutritionists , demolished the relevance of cholesterol levels to physical well-being , as well as that of the statins routinely prescribed to lower one’s cholesterol. When I told my new doctor I was discontinuing the statin regimen I had retained -hedging my bets , as it were - she didn’t argue the point , not at all , and it became clear to me that an uneasy complicity of MDs might be at work : some of them knew what a crock it might prove to be , but were justifiably wary of going on record. This is just one reason why charlatans might get the ear of patients. In the case of statins a lot of money is involved , given the automatic enlistment of even those with only an outside chance of developing heart disease.

One anti-carb researcher noted that , until the 1960s , every British housewife knew that the way to slim down was to banish bread from the diet. People with skin in the game , those whose appearance determined their livelihood or performance - models , wrestlers , etc - were equally sold on the no/low-carb diet. It worked. Its chief proponent , Dr Atkins , was dismissed by establishment dietitians as a quack.

My food budget increased by at least 50% , for the simple reason that chicken costs more than pasta , sausage and bacon more than toast , and salmon considerably more than rice. For a good while demographers have noted the correlation of poverty with obesity , but who among them have been willing to go the extra mile and suggest that one is fat because one is poor : this would suggest that obesity is not the result of individual choice but of social inequality : the poor simply cannot afford to get well - it costs too much. I don’t eat high on the hog , and my monthly outlay comes in at more than $300 per month ; the average food-stamp allotment is around $200. One obstacle to a low cost /low carb regimen is in the hold sweeteners have on me and most people - the sugar or honey I simply must have in my coffee and tea. Southeast Asians , for example , ate plenty of rice and noodles without getting fat , for the simple reason that , prior to modernization , their consumption of sugar had been on par with what we had consumed in the 19thc : not much at all. Sticking to a budget - hell, coming up with one - might mitigate the difficulty facing the poor , but they face an uphill battle , not just with their appetite for comfort foods , but with a medical establishment bankrolled by the pill industry , and a government bureaucracy mired in outmoded certainties as to what causes obesity.

For the last five years I’ve been a substitute teacher in public schools with about 90% Chinese-American students. Almost none of them are overweight . Chinese civilization is one of the oldest , and its dietary culture is perhaps the one that non-Chinese are most aware of , even if only in the slightly skewed representations of it available in Chinese restaurants. If desserts do figure in the typical menu , they are very few. Cooking as a domestic art represents a cultural value so deep that it is easy to ignore : it’s just there - anodyne and banal. But consider this : if you were making your own lemony iced -tea , would you add 10+ teaspoons of sugar to every 12 ounces ? Probably not. This is what happens when you abandon yourself to commercially engineered foods in lieu of making your own.

To rejoin our Chinese-American kids , it has been hard to exactly predict which of the pre-cooked , packaged meals they will reject , but from my own years supervising snack-time I can attest to their love of hamburgers and hot-dogs. Kids love meat. Humans love meat. Our brains and muscles love the concentrated protein it provides , and the graduated energy level - not the sugar-spike - it provides. But there has arrived a reluctance to admit of such a preference ; as early as the mid ‘70s “ Diet For A Small Planet” brought sustainability front and center , at least among the counter-culture , and this issue has surged once again with the vogue for meatless meat , which , last time I looked , cost twice as much as the meat it seeks to replace. (Here we must recognize something weird : where I shop , at my local Safeway , I regularly stock up on pork when it’s on sale at $2 a pound or so. Even on sale a pound of quality wholewheat bread costs more than $4. What gives ?)

Lurking behind the sustainability argument is one that is moral in nature : killing animals for our own consumption is bad. It’s murder : messy and unsanitary. In short we’d all be better off as vegetarians. Aren’t they healthier ? The anti-meat folks have hit on a perfect line-up of villainy : the injustice , disease , industrial agriculture and red-meat politics brought on by the carnivores among us. It’s a spiritual pitch oddly devoid of any mention of God , sin or forgiveness. They are bumping up against an irreducible element in human existence : that we must kill in order to survive. But there’s killing and then there’s rapine ; the former atones , the latter wantonly glories in its own dominance ; the hunter abhors waste , the glutton lays waste. Karen Armstrong , in her “Fields of Blood “ , recalls the poetic evidence of early humankind’s uneasiness in its position atop the food-chain : the poignant and awed depiction of animals in the caves of Lascaux can be seen as testimony to how early humans grappled with this moral conundrum. In the secular world where this moral drama plays out , however, there is no sin , thus no forgiveness , only a nit-picking observance of ‘ethical behavior ‘ , which , when applied to something as basic as eating , cannot help but prove beside the point. We eat , basically , to survive , an instinct notably resistant to ethical imperatives. The doctor , the lawyer , the educator - all are trained to live up to ethical standards , and when they don’t it is cause for concern. Ethical behavior is proper to such roles. Your stomach has no such radar.(Ask someone suffering from hunger …) Those who pretend otherwise are promoting something very much different from ethics : privilege , of the sort conditioned both by entitlements and a sere moral landscape. Positioning oneself on the right side of sustainability stings a bit less when you’ve got the means to pay extra ; the very notion of buying your way to righteousness is inane ; are we to tax the under-paid with unethical consumption because they don’t bust their budget on organic foods ? Those unsettled by such an idea might reconsider what avenues to moral action are actually open to them. The binary structure of the digital world - ones or zeros - has stealthily undermined the actual nature of moral action by positing an either/or model of ethical behavior. Doing the right thing obliges the kind of struggle one doesn’t meet up with in the world of clicks and likes : you may be alone , without the instant approval of the like-minded ; you may entertain doubt ; you may even fail. But in the giant on-line mall we now inhabit there reigns a paucity of moral agency : a parched landscape of ’choice’ from which the needy have been banished.

A ‘cognitive elite’ , one that for a generation or two has benefited from the meritocratic opening of university education , now sets the tone for discussions of public policy and individual responsibility. Around dinner-tables where political loyalties are taken for granted , where religious faith counts for little more than an eccentricity , and where sex is reduced to questions of ‘safety’ , food comes to the rescue as a subject sure to offend no one. But the human faculty for moral choice will not be stilled , and so one is privy to self-serving bromides promoting sustainability , local sourcing , exotic elixirs , and the latest ‘miracle foods’ conducive to enhanced cognition. To the well-educated the epidemic of obesity is taking place off-stage , where the poor and the minimally educated are left to fend for themselves , the hapless victims of a massive public - health failure that doesn’t admit of economic factors. It's as if the ancestral squeezing of the peasantry had morphed into the contemporary bloating of the poor ; who the hell is going to eat all that crap filling up half of Safeway ? This exploitation goes back a ways .

Karen Armstrong has advanced the idea that it was agriculture , not religion , that brought on the violence-prone hierarchies in society that , at the end of the day , enabled progress in human affairs : without an agricultural surplus , obtained by beneficent nature , or by squeezing the peasantry , humankind would be stagnant : egalitarian in their hunting and gathering , but mired in stasis. The surplus allowed for priests , technicians , armies , bodies that resist seasonal adjustments of their entitlements . When the East Indian Company obtained the role of tax-collection the usual leniency in time of drought was abandoned .Peasants in revolt usually destroyed the records of their indebtedness as a matter of course ; and hunger as a political tool of gruesome efficiency saw duty in both the Nazi and Soviet regimes. From the exploitation of Egyptian fellaheen to the grinding poverty of the share-cropper , this double-faced goddess of agriculture , both feeder of millions and tool of the elite , has structured human society. But who , in America , are the exploited peasants of today ? We seem to have outgrown the rank exploitation of agriculturalists upon which the birth and development of the arts and sciences relied. If I am honest , even with my paltry income I am among the tiny minority , world-wide , who live in a nominally democratic nation , sheltered from violence , with clean and abundant water , an exemplary public library , health care , union membership , and free speech. Up until the industrial revolution a peasant in India and one in the West led lives of comparable (dis)comfort , but as the West surged , disparities between the mechanized nations and those still powered only by human and animal labor soon made any parity risible. If globalism means anything , it obliges us to an inventory of our real assets , ie , libraries , bridges , air , water etc , and to jettison the rest , if we are to play a serious role in reversing 'development' and mitigating the storms that have already arrived .

You can't have it all . This conceit undergirds the growth model whereby the need for re-distribution of wealth disappears as the 'pie ' gets bigger . But the concept of infinite growth hasn't much going for it , and one can see in the sacrosanct status of US corn production the exploitation of human hunger in the provision of cheap , and toxic , calories in soft drinks sweetened with corn syrup.

One could argue that it is the earth itself that is the exploited party : the forests and wetlands that ensure the diversity upon which evolution depends are in the crosshairs of development , itself the ravenous offspring of a humanist credo that can’t see past its own nose. Calls to ‘save the planet’ are myopic in the extreme . We will go and the planet will survive just fine without us . Just as with the reformist parties of Tsarist Russia , the proponents of ecological reform are more symptom than remedy for a long-term reckoning with a force heedless of human concerns: Nature . Problem is , we can't reduce consumption: our status depends on it .

When my fiance took a year in France to complete her MA in literature I tagged along and cobbled together a course of study at a suburban branch of the Universite de Paris at St Denis. A survey of French history ? Nah , too many dumb Americans. The course offerings , c 1988 , were quaintly taped to the office doors. One of them , "L'Alimentation a l’Europe 14th-18thc ", caught my eye and I signed up. The professor , Jean-Louis Flandrin , I was to learn , was a highly respected writer of the Annalien school - those who investigated the history of private life. In his course , What did people eat , and why ? What records were kept , and how reliable were they ? A sailing ship’s manifest might reveal some bottom-line dietary necessities of the age , but the ship’s quarter-master , he in charge of the vittles , might have cheated , to line his own pockets. Did people spice up their meat dishes to hide the rot ? Maybe , but most meat was slaughtered and cooked on the same day , and the (French)meat market was under strict regulation as early as the 1200s. Turns out that spices- read pepper- cost a lot back then , and only the upper crust could afford them ; as soon as the nascent bourgeoisie got their hands on the spices , around the 17th c , the aristos developed a taste for ‘simply prepared dishes ‘. Spices were for wannabes. Food , it turns out , is a major status-marker , to the point where even the onset of gout among the well-to-do of the 19thc barely dented their appetite for rich foods , in an era where plumpness was sexy.

As a ‘hippie’ in the ‘70s I found dietary distinction a piece of cake : get with the honey and the whole-wheat and you were done ! White sugar - eewh ! White bread , ditto. My own present refusal of status concerns doesn’t deny them - it’s just too expensive. With top-shelf , ‘fair-trade’ coffees at $17 a pound , and organic brown rice at a whopping $5 , the spiritual and political stakes are decidedly secondary in importance. Besides , sometimes hipness is what it ain't.

-----------------------------------------------------------------------------------------------------------------------------------------------------------------

When I got sober I started to gain weight. At a physical, towards the end of my first year sober , the nurse taking my vitals informed me I weighed 185 lbs , a full 20 lbs. over the weight I had maintained since college. I offered that she must be mistaken ; it wasn’t possible. How could I have put on these pounds without knowing it ? Of course , I had other fish to fry at the moment. At a follow-up soon after , the number remained the same. I had to admit it : without any great change in diet -save the booze, mainly wine , that I had foregone - or exercise , I had gained weight. Four years later , coming in at 205 , I shared my concern with my primary care physician , someo

ne I respected. We shared a laugh over my aversion to ‘blue (skim) milk’: His rueful ‘You can get used to anything ‘ seemed funny at the time. And he sent me on my way with the food pyramid devised under the Carter administration , which counseled reducing fats and sugars , and increasing grains. Nothing happened. I was on my way to being a blimp : 240 was in sight if nothing changed.

Then one fine day I happened to be tuned in to NPR and heard a presentation on obesity by a science-writer and researcher. Gary Taubes convinced me that calories-in , calories -out was a myth ; that fat doesn’t make us fat ; and that it was a disruption in the body’s metabolic rate that brought on obesity. I looked at his YouTube video , took notes , bought the book , took more notes , and then changed my diet accordingly.

Bacon and eggs , salads and meat , yogurt and cheese , and a few crackers to assuage the bread lover in me.

So , not only did I stop gaining weight , I actually lost 10 lbs , and my vitals today are fine , especially my blood-glucose levels. Another video I watched , one featuring some altogether serious nutritionists , demolished the relevance of cholesterol levels to physical well-being , as well as that of statins routinely prescribed to lower one’s cholesterol. When I told my new doctor I was discontinuing the statin regimen I had retained -hedging my bets , as it were - she didn’t argue the point , not at all , and it became clear to me that an uneasy complicity of MDs might be at work : some of them knew what a crock it might prove to be , but were justifiably wary of going on record. This is just one reason why charlatans might get the ear of patients. In the case of statins a lot of money is involved , given the automatic enlistment of even those with an outside chance of developing heart disease.

One anti-carb researcher noted that , until the 1960s , every British housewife knew that the way to slim down was to banish bread from the diet. People with skin in the game , those whose appearance determined their livelihood or performance - models , wrestlers , etc - were equally sold on the no/low-carb diet. It worked. Its chief proponent , Dr Atkins , was dismissed by establishment dieticians as a quack.

My food budget increased by at least 50% , for the simple reason that chicken costs more than pasta , sausage and bacon more than toast , and salmon considerably more than rice. For a good while demographers have noted the correlation of poverty with obesity , but who among them have been willing to go the extra mile and suggest that one is fat because one is poor : this would suggest that obesity is not the result of individual choice but of social inequality : the poor simply cannot afford to get well - it costs too much. I don’t eat high on the hog , and my monthly outlay comes in at more than $300 per month ; the average food-stamp allotment is around $200. One obstacle to a low cost /low carb regimen is in the hold sweeteners have on me and most people - the sugar or honey I simply must have in my coffee and tea. Southeast Asians , for example , ate plenty of rice and noodles without getting fat , for the simple reason that , prior to modernization , their consumption of sugar had been on par with what we had consumed in the 19thc : not much at all. Sticking to a budget - hell, coming up with one - might mitigate the difficulty facing the poor , but they face an uphill battle , not just with their appetite for comfort foods , but with a medical establishment bankrolled by the pill industry , and a government bureaucracy mired in outmoded certainties as to what causes obesity.

For the last five years I’ve been a substitute teacher in public schools with about 90% Chinese-American students. Almost none of them are overweight . Chinese civilization is one of the oldest , and its dietary culture is perhaps the one that non-Chinese are most aware of , even if only in the slightly skewed representations of it available in Chinese restaurants. If desserts do figure in the typical menu , they are very few. Cooking as a domestic art represents a cultural value so deep that it is easy to ignore : it’s just there - anodyne and banal. But consider this : if you were making your own lemony iced -tea , would you add 10+ teaspoons of sugar to every 12 ounces ? Probably not. This is what happens when you abandon yourself to commercially engineered foods in lieu of making your own.

To rejoin our Chinese-American kids , it has been hard to exactly predict which of the pre-cooked , packaged meals they will reject , but from my own years supervising snack-time I can vow that they love hamburgers and hot-dogs. Kids love meat. Humans love meat. Our brains and muscles love the concentrated protein it provides , and the graduated energy -level - not the sugar-spike - it provides. But there has arrived a reluctance to admit of such a preference ; as early as the mid ‘70s “ Diet For A Small Planet” brought sustainability front and center , at least among the counter-culture , and this issue has surged once again with the vogue for meatless meat , which , last time I looked , cost twice as much as the meat it seeks to replace. (Here we must recognize something weird : where I shop , at my local Safeway , I regularly stock up on pork when it’s on sale at $2 a pound or so. Even on sale a pound of quality wholewheat bread costs more than $4. What gives ?)

Lurking behind the sustainability argument is one that is moral in nature : killing animals for our own consumption is bad. It’s murder : messy and unsanitary. In short we’d all be better off as vegetarians. Aren’t they healthier ? The anti-meat folks have hit on a perfect line-up of villainy : the injustice , disease , industrial agriculture and red-meat politics brought on by the carnivores among us. It’s a spiritual pitch oddly devoid of any mention of God , sin or forgiveness. They are bumping up against an irreducible element in human existence : that we must kill in order to survive. But there’s killing and then there’s rapine ; the former atones , the latter wantonly glories in its own dominance ; the hunter abhors waste , the glutton lays waste. Karen Armstrong , in her “Fields of Blood “ , recalls the poetic evidence of early humankind’s uneasiness in its position atop the food-chain : the poignant and awed depiction of animals in the caves of Lascaux can be seen as testimony to how early humans grappled with this moral conundrum. In the secular world where this moral drama plays out , however, there is no sin , thus no forgiveness , only a nit-picking observance of ‘ethical behavior ‘ , which , when applied to something as basic as eating , cannot help but prove beside the point. We eat , basically , to survive , an instinct notably resistant to ethical imperatives. The doctor , the lawyer , the educator - all are trained to live up to ethical standards , and when they don’t it is cause for concern. Ethical behavior is proper to such roles. Your stomach has no such radar.(Ask someone suffering from hunger …) Those who pretend otherwise are promoting something very much different from ethics : privilege , of the sort conditioned both by entitlements and a sere moral landscape. Positioning oneself on the right side of sustainability stings a bit less when you’ve got the means to pay extra ; the very notion of buying your way to righteousness is inane ; are we to tax the under-paid with unethical consumption because they don’t bust their budget on organic foods ? Those unsettled by such an idea might reconsider what avenues to moral action are actually open to them. The binary structure of the digital world - ones or zeros - has stealthily undermined the actual nature of moral action by positing an either/or model of ethical behavior. Doing the right thing obliges the kind of struggle one doesn’t meet up with in the world of clicks and likes : you may be alone , without the instant approval of the like-minded ; you may entertain doubt ; you may even fail. But in the giant on-line mall we now inhabit there reigns a paucity of moral agency : a parched landscape of ’choice’ from which the needy have been banished.

A ‘cognitive elite’ , one that for a generation or two has benefited from the meritocratic opening of university education , now sets the tone for discussions of public policy and individual responsibility. Around dinner-tables where political loyalties are taken for granted , religious faith little more than an eccentricity , and sex reduced to questions of ‘safety’ , food comes to the rescue as a subject sure to offend no one. But the human faculty for moral choice will not be stilled , and so one is privy to self-serving bromides promoting sustainability , local sourcing , exotic elixirs , and the latest ‘miracle foods’ conducive to enhanced cognition. To the well-educated the epidemic of obesity is taking place off-stage , where the poor and the minimally educated are left to fend for themselves , the hapless victims of a massive public - health failure that doesn’t admit of economic factors.

Karen Armstrong has advanced the idea that it was agriculture , not religion , that brought on the violence-prone hierarchies in society that , at the end of the day , enabled progress in human affairs : without an agricultural surplus , obtained by beneficent nature , or by squeezing the peasantry , humankind would be stagnant : egalitarian in their hunting and gathering , but mired in stasis. Peasants in revolt usually destroyed the records of their indebtedness as a matter of course ; and hunger as a political tool of gruesome efficiency saw duty in both the Nazi and Soviet regimes. From the exploitation of Egyptian fellaheen to the grinding poverty of the share-cropper , this double-faced goddess of agriculture , both feeder of millions and tool of the elite , has structured human society. But who , in America , are the exploited peasants of today ? We seem to have outgrown the rank exploitation of agriculturalists upon which the birth and development of the arts and sciences relied. If I am honest , even with my paltry income I am among the tiny minority , world-wide , who live in a nominally democratic nation , sheltered from violence , with clean and abundant water , an exemplary public library , health care , union membership , and free speech. Up until the industrial revolution a peasant in India and one in the West had lives of comparable (dis)comfort , but as the West surged , disparities between the mechanized nations and those still powered only by human and animal labor soon made any parity risible. One could argue that it is the earth itself that is the exploited party : the forests and wetlands that ensure the diversity upon which evolution depends are in the crosshairs of development , itself the ravenous offspring of a humanist credo that can’t see past its own nose. Calls to ‘save the planet’ are myopic in the extreme Just as with the reformist parties of Tsarist Russia , the proponents of ecological reform are more symptom than remedy , for a long-term reckoning with nature , a force heedless of human concerns.

When my fiance took a year in France to complete her MA in literature I tagged along and cobbled together a course of study at a suburban branch of the Universite de Paris at St Denis. A survey of French history ? Nah , too many dumb Americans. The course offerings , c 1988 , were taped to the office doors. One of them , Alimentation a l’Europe 14th-18thc , caught my eye and I signed up. The professor , Jean-Louis Flandrin , I was to learn , was a highly respected writer of the Annalien school - those who investigated the history of private life. What did people eat , and why ? What records were kept , and how reliable were they ? A sailing ship’s manifest might reveal some bottom-line dietary necessities of the age , but the ship’s quarter-master , he in charge of the vittles , might have cheated , to line his own pockets. Did people spice up their meat dishes to hide the rot ? Maybe , but most meat was slaughtered and cooked on the same day , and the (French)meat market was under strict regulation as early as the 1200s. Turns out that spices- read pepper- cost a lot back then , and only the upper crust could afford them ; as soon as the nascent bourgeoisie got their hands on the spices , around the 17th c , the aristos developed a taste for ‘simply prepared dishes ‘. Spices were for wannabes. Food , it turns out , is a major status-marker , to the point where even the onset of gout among the well-to-do of the 19thc barely dented their appetite for rich foods , in an era where plumpness was sexy.

As a ‘hippie’ in the ‘70s I found dietary distinction a piece of cake : get with the honey and the whole-wheat and you were done ! White sugar - eewh ! White bread , ditto. My own present refusal of status concerns doesn’t deny them - it’s just too expensive. With top-shelf , ‘fair-trade’ coffees at $17 a pound , and organic brown rice at a whopping $5 , the spiritual and political stakes are decidedly secondary in importance. Besides , sometimes hipness is what it ain’t.

Diet

When I got sober I started to gain weight. At a physical, towards the end of my first year sober , the nurse taking my vitals informed me I weighed 185 lbs , a full 20 lbs. over the weight I had maintained since college. I offered that she must be mistaken ; it wasn’t possible. How could I have put on these pounds without knowing it ? Of course , I had other fish to fry at the moment. At a follow-up soon after , the number remained the same. I had to admit it : without any great change in diet -save the booze, mainly wine , that I had foregone - or exercise , I had gained weight. Four years later , coming in at 205 , I shared my concern with my primary care physician , someone I respected. We shared a laugh over my aversion to ‘blue (skim) milk’: His rueful ‘You can get used to anything ‘ seemed funny at the time. And he sent me on my way with the food pyramid devised under the Carter administration , which counseled reducing fats and sugars , and increasing grains. Nothing happened. I was on my way to being a blimp : 240 was in sight if nothing changed.

Then one fine day I happened to be tuned in to NPR and heard a presentation on obesity by a science-writer and researcher. Gary Taubes convinced me that calories-in , calories -out was a myth ; that fat doesn’t make us fat ; and that it was a disruption in the body’s metabolic rate that brought on obesity. I looked at his YouTube video , took notes , bought the book , took more notes , and then changed my diet accordingly.

Bacon and eggs , salads and meat , yogurt and cheese , and a few crackers to assuage the bread lover in me. But no rice , pasta , potatoes , or , most arrestingly , fruit. Anything with sugar , anything sweet , anything that quickly turned to sugar in the blood was off-limits. For a few months there was no change , then , at a VA hospital where I was chairing an AA meeting , I checked my weight on one of the digital scales : 195 ! I was on the right track , without counting calories , without exercising beyond the daily 45 minute walks I’d always favored. This is where I’ve stayed ever since , except for during a period of dental work which obliged me to eat soft foods , when I allowed myself jam , ice cream , puddings and plenty of mashed potatoes , and my weight shot up to the previous warning level of 205 : a confirmation of the ketogenic theory , in fact. A few weeks after I resumed the low-carb diet my weight went back down.

So , not only did I stop gaining weight , I actually lost 10 lbs , and my vitals today are fine , especially my blood-glucose levels. Another video I watched , one featuring some altogether serious nutritionists , demolished the relevance of cholesterol levels to physical well-being , as well as that of statins routinely prescribed to lower one’s cholesterol. When I told my new doctor I was discontinuing the statin regimen I had retained -hedging my bets , as it were - she didn’t argue the point , not at all , and it became clear to me that an uneasy complicity of MDs might be at work : some of them knew what a crock it might prove to be , but were justifiably wary of going on record. This is just one reason why charlatans might get the ear of patients. In the case of statins a lot of money is involved , given the automatic enlistment of even those with an outside chance of developing heart disease.

One anti-carb researcher noted that , until the 1960s , every British housewife knew that the way to slim down was to banish bread from the diet. People with skin in the game , those whose appearance determined their livelihood or performance - models , wrestlers , etc - were equally sold on the no/low-carb diet. It worked. Its chief proponent , Dr Atkins , was dismissed by establishment dieticians as a quack.

My food budget increased by at least 50% , for the simple reason that chicken costs more than pasta , sausage and bacon more than toast , and salmon considerably more than rice. For a good while demographers have noted the correlation of poverty with obesity , but who among them have been willing to go the extra mile and suggest that one is fat because one is poor : this would suggest that obesity is not the result of individual choice but of social inequality : the poor simply cannot afford to get well - it costs too much. I don’t eat high on the hog , and my monthly outlay comes in at more than $300 per month ; the average food-stamp allotment is around $200. One obstacle to a low cost /low carb regimen is in the hold sweeteners have on me and most people - the sugar or honey I simply must have in my coffee and tea. Southeast Asians , for example , ate plenty of rice and noodles without getting fat , for the simple reason that , prior to modernization , their consumption of sugar had been on par with what we had consumed in the 19thc : not much at all. Sticking to a budget - hell, coming up with one - might mitigate the difficulty facing the poor , but they face an uphill battle , not just with their appetite for comfort foods , but with a medical establishment bankrolled by the pill industry , and a government bureaucracy mired in outmoded certainties as to what causes obesity.

For the last five years I’ve been a substitute teacher in public schools with about 90% Chinese-American students. Almost none of them are overweight . Chinese civilization is one of the oldest , and its dietary culture is perhaps the one that non-Chinese are most aware of , even if only in the slightly skewed representations of it available in Chinese restaurants. If desserts do figure in the typical menu , they are very few. Cooking as a domestic art represents a cultural value so deep that it is easy to ignore : it’s just there - anodyne and banal. But consider this : if you were making your own lemony iced -tea , would you add 10+ teaspoons of sugar to every 12 ounces ? Probably not. This is what happens when you abandon yourself to commercially engineered foods in lieu of making your own.

To rejoin our Chinese-American kids , it has been hard to exactly predict which of the pre-cooked , packaged meals they will reject , but from my own years supervising snack-time I can vow that they love hamburgers and hot-dogs. Kids love meat. Humans love meat. Our brains and muscles love the concentrated protein it provides , and the graduated energy -level - not the sugar-spike - it provides. But there has arrived a reluctance to admit of such a preference ; as early as the mid ‘70s “ Diet For A Small Planet” brought sustainability front and center , at least among the counter-culture , and this issue has surged once again with the vogue for meatless meat , which , last time I looked , cost twice as much as the meat it seeks to replace. (Here we must recognize something weird : where I shop , at my local Safeway , I regularly stock up on pork when it’s on sale at $2 a pound or so. Even on sale a pound of quality wholewheat bread costs more than $4. What gives ?)

Lurking behind the sustainability argument is one that is moral in nature : killing animals for our own consumption is bad. It’s murder : messy and unsanitary. In short we’d all be better off as vegetarians. Aren’t they healthier ? The anti-meat folks have hit on a perfect line-up of villainy : the injustice , disease , industrial agriculture and red-meat politics brought on by the carnivores among us. It’s a spiritual pitch oddly devoid of any mention of God , sin or forgiveness. They are bumping up against an irreducible element in human existence : that we must kill in order to survive. But there’s killing and then there’s rapine ; the former atones , the latter wantonly glories in its own dominance ; the hunter abhors waste , the glutton lays waste. Karen Armstrong , in her “Fields of Blood “ , recalls the poetic evidence of early humankind’s uneasiness in its position atop the food-chain : the poignant and awed depiction of animals in the caves of Lascaux can be seen as testimony to how early humans grappled with this moral conundrum. In the secular world where this moral drama plays out , however, there is no sin , thus no forgiveness , only a nit-picking observance of ‘ethical behavior ‘ , which , when applied to something as basic as eating , cannot help but prove beside the point. We eat , basically , to survive , an instinct notably resistant to ethical imperatives. The doctor , the lawyer , the educator - all are trained to live up to ethical standards , and when they don’t it is cause for concern. Ethical behavior is proper to such roles. Your stomach has no such radar.(Ask someone suffering from hunger …) Those who pretend otherwise are promoting something very much different from ethics : privilege , of the sort conditioned both by entitlements and a sere moral landscape. Positioning oneself on the right side of sustainability stings a bit less when you’ve got the means to pay extra ; the very notion of buying your way to righteousness is inane ; are we to tax the under-paid with unethical consumption because they don’t bust their budget on organic foods ? Those unsettled by such an idea might reconsider what avenues to moral action are actually open to them. The binary structure of the digital world - ones or zeros - has stealthily undermined the actual nature of moral action by positing an either/or model of ethical behavior. Doing the right thing obliges the kind of struggle one doesn’t meet up with in the world of clicks and likes : you may be alone , without the instant approval of the like-minded ; you may entertain doubt ; you may even fail. But in the giant on-line mall we now inhabit there reigns a paucity of moral agency : a parched landscape of ’choice’ from which the needy have been banished.

A ‘cognitive elite’ , one that for a generation or two has benefited from the meritocratic opening of university education , now sets the tone for discussions of public policy and individual responsibility. Around dinner-tables where political loyalties are taken for granted , religious faith little more than an eccentricity , and sex reduced to questions of ‘safety’ , food comes to the rescue as a subject sure to offend no one. But the human faculty for moral choice will not be stilled , and so one is privy to self-serving bromides promoting sustainability , local sourcing , exotic elixirs , and the latest ‘miracle foods’ conducive to enhanced cognition. To the well-educated the epidemic of obesity is taking place off-stage , where the poor and the minimally educated are left to fend for themselves , the hapless victims of a massive public - health failure that doesn’t admit of economic factors.

Karen Armstrong has advanced the idea that it was agriculture , not religion , that brought on the violence-prone hierarchies in society that , at the end of the day , enabled progress in human affairs : without an agricultural surplus , obtained by beneficent nature , or by squeezing the peasantry , humankind would be stagnant : egalitarian in their hunting and gathering , but mired in stasis. Peasants in revolt usually destroyed the records of their indebtedness as a matter of course ; and hunger as a political tool of gruesome efficiency saw duty in both the Nazi and Soviet regimes. From the exploitation of Egyptian fellaheen to the grinding poverty of the share-cropper , this double-faced goddess of agriculture , both feeder of millions and tool of the elite , has structured human society. But who , in America , are the exploited peasants of today ? We seem to have outgrown the rank exploitation of agriculturalists upon which the birth and development of the arts and sciences relied. If I am honest , even with my paltry income I am among the tiny minority , world-wide , who live in a nominally democratic nation , sheltered from violence , with clean and abundant water , an exemplary public library , health care , union membership , and free speech. Up until the industrial revolution a peasant in India and one in the West had lives of comparable (dis)comfort , but as the West surged , disparities between the mechanized nations and those still powered only by human and animal labor soon made any parity risible. One could argue that it is the earth itself that is the exploited party : the forests and wetlands that ensure the diversity upon which evolution depends are in the crosshairs of development , itself the ravenous offspring of a humanist credo that can’t see past its own nose. Calls to ‘save the planet’ are myopic in the extreme Just as with the reformist parties of Tsarist Russia , the proponents of ecological reform are more symptom than remedy , for a long-term reckoning with nature , a force heedless of human concerns.

When my fiance took a year in France to complete her MA in literature I tagged along and cobbled together a course of study at a suburban branch of the Universite de Paris at St Denis. A survey of French history ? Nah , too many dumb Americans. The course offerings , c 1988 , were taped to the office doors. One of them , Alimentation a l’Europe 14th-18thc , caught my eye and I signed up. The professor , Jean-Louis Flandrin , I was to learn , was a highly respected writer of the Annalien school - those who investigated the history of private life. What did people eat , and why ? What records were kept , and how reliable were they ? A sailing ship’s manifest might reveal some bottom-line dietary necessities of the age , but the ship’s quarter-master , he in charge of the vittles , might have cheated , to line his own pockets. Did people spice up their meat dishes to hide the rot ? Maybe , but most meat was slaughtered and cooked on the same day , and the (French)meat market was under strict regulation as early as the 1200s. Turns out that spices- read pepper- cost a lot back then , and only the upper crust could afford them ; as soon as the nascent bourgeoisie got their hands on the spices , around the 17th c , the aristos developed a taste for ‘simply prepared dishes ‘. Spices were for wannabes. Food , it turns out , is a major status-marker , to the point where even the onset of gout among the well-to-do of the 19thc barely dented their appetite for rich foods , in an era where plumpness was sexy.

As a ‘hippie’ in the ‘70s I found dietary distinction a piece of cake : get with the honey and the whole-wheat and you were done ! White sugar - eewh ! White bread , ditto. My own present refusal of status concerns doesn’t deny them - it’s just too expensive. With top-shelf , ‘fair-trade’ coffees at $17 a pound , and organic brown rice at a whopping $5 , the spiritual and political stakes are decidedly secondary in importance. Besides , sometimes hipness is what it ain’t.

Diet

When I got sober I started to gain weight. At a physical, towards the end of my first year sober , the nurse taking my vitals informed me I weighed 185 lbs , a full 20 lbs. over the weight I had maintained since college. I offered that she must be mistaken ; it wasn’t possible. How could I have put on these pounds without knowing it ? Of course , I had other fish to fry at the moment. At a follow-up soon after , the number remained the same. I had to admit it : without any great change in diet -save the booze, mainly wine , that I had foregone - or exercise , I had gained weight. Four years later , coming in at 205 , I shared my concern with my primary care physician , someone I respected. We shared a laugh over my aversion to ‘blue (skim) milk’: His rueful ‘You can get used to anything ‘ seemed funny at the time. And he sent me on my way with the food pyramid devised under the Carter administration , which counseled reducing fats and sugars , and increasing grains. Nothing happened. I was on my way to being a blimp : 240 was in sight if nothing changed.

Then one fine day I happened to be tuned in to NPR and heard a presentation on obesity by a science-writer and researcher. Gary Taubes convinced me that calories-in , calories -out was a myth ; that fat doesn’t make us fat ; and that it was a disruption in the body’s metabolic rate that brought on obesity. I looked at his YouTube video , took notes , bought the book , took more notes , and then changed my diet accordingly.

Bacon and eggs , salads and meat , yogurt and cheese , and a few crackers to assuage the bread lover in me. But no rice , pasta , potatoes , or , most arrestingly , fruit. Anything with sugar , anything sweet , anything that quickly turned to sugar in the blood was off-limits. For a few months there was no change , then , at a VA hospital where I was chairing an AA meeting , I checked my weight on one of the digital scales : 195 ! I was on the right track , without counting calories , without exercising beyond the daily 45 minute walks I’d always favored. This is where I’ve stayed ever since , except for during a period of dental work which obliged me to eat soft foods , when I allowed myself jam , ice cream , puddings and plenty of mashed potatoes , and my weight shot up to the previous warning level of 205 : a confirmation of the ketogenic theory , in fact. A few weeks after I resumed the low-carb diet my weight went back down.

So , not only did I stop gaining weight , I actually lost 10 lbs , and my vitals today are fine , especially my blood-glucose levels. Another video I watched , one featuring some altogether serious nutritionists , demolished the relevance of cholesterol levels to physical well-being , as well as that of statins routinely prescribed to lower one’s cholesterol. When I told my new doctor I was discontinuing the statin regimen I had retained -hedging my bets , as it were - she didn’t argue the point , not at all , and it became clear to me that an uneasy complicity of MDs might be at work : some of them knew what a crock it might prove to be , but were justifiably wary of going on record. This is just one reason why charlatans might get the ear of patients. In the case of statins a lot of money is involved , given the automatic enlistment of even those with an outside chance of developing heart disease.

One anti-carb researcher noted that , until the 1960s , every British housewife knew that the way to slim down was to banish bread from the diet. People with skin in the game , those whose appearance determined their livelihood or performance - models , wrestlers , etc - were equally sold on the no/low-carb diet. It worked. Its chief proponent , Dr Atkins , was dismissed by establishment dieticians as a quack.

My food budget increased by at least 50% , for the simple reason that chicken costs more than pasta , sausage and bacon more than toast , and salmon considerably more than rice. For a good while demographers have noted the correlation of poverty with obesity , but who among them have been willing to go the extra mile and suggest that one is fat because one is poor : this would suggest that obesity is not the result of individual choice but of social inequality : the poor simply cannot afford to get well - it costs too much. I don’t eat high on the hog , and my monthly outlay comes in at more than $300 per month ; the average food-stamp allotment is around $200. One obstacle to a low cost /low carb regimen is in the hold sweeteners have on me and most people - the sugar or honey I simply must have in my coffee and tea. Southeast Asians , for example , ate plenty of rice and noodles without getting fat , for the simple reason that , prior to modernization , their consumption of sugar had been on par with what we had consumed in the 19thc : not much at all. Sticking to a budget - hell, coming up with one - might mitigate the difficulty facing the poor , but they face an uphill battle , not just with their appetite for comfort foods , but with a medical establishment bankrolled by the pill industry , and a government bureaucracy mired in outmoded certainties as to what causes obesity.

For the last five years I’ve been a substitute teacher in public schools with about 90% Chinese-American students. Almost none of them are overweight . Chinese civilization is one of the oldest , and its dietary culture is perhaps the one that non-Chinese are most aware of , even if only in the slightly skewed representations of it available in Chinese restaurants. If desserts do figure in the typical menu , they are very few. Cooking as a domestic art represents a cultural value so deep that it is easy to ignore : it’s just there - anodyne and banal. But consider this : if you were making your own lemony iced -tea , would you add 10+ teaspoons of sugar to every 12 ounces ? Probably not. This is what happens when you abandon yourself to commercially engineered foods in lieu of making your own.

To rejoin our Chinese-American kids , it has been hard to exactly predict which of the pre-cooked , packaged meals they will reject , but from my own years supervising snack-time I can vow that they love hamburgers and hot-dogs. Kids love meat. Humans love meat. Our brains and muscles love the concentrated protein it provides , and the graduated energy -level - not the sugar-spike - it provides. But there has arrived a reluctance to admit of such a preference ; as early as the mid ‘70s “ Diet For A Small Planet” brought sustainability front and center , at least among the counter-culture , and this issue has surged once again with the vogue for meatless meat , which , last time I looked , cost twice as much as the meat it seeks to replace. (Here we must recognize something weird : where I shop , at my local Safeway , I regularly stock up on pork when it’s on sale at $2 a pound or so. Even on sale a pound of quality wholewheat bread costs more than $4. What gives ?)

Lurking behind the sustainability argument is one that is moral in nature : killing animals for our own consumption is bad. It’s murder : messy and unsanitary. In short we’d all be better off as vegetarians. Aren’t they healthier ? The anti-meat folks have hit on a perfect line-up of villainy : the injustice , disease , industrial agriculture and red-meat politics brought on by the carnivores among us. It’s a spiritual pitch oddly devoid of any mention of God , sin or forgiveness. They are bumping up against an irreducible element in human existence : that we must kill in order to survive. But there’s killing and then there’s rapine ; the former atones , the latter wantonly glories in its own dominance ; the hunter abhors waste , the glutton lays waste. Karen Armstrong , in her “Fields of Blood “ , recalls the poetic evidence of early humankind’s uneasiness in its position atop the food-chain : the poignant and awed depiction of animals in the caves of Lascaux can be seen as testimony to how early humans grappled with this moral conundrum. In the secular world where this moral drama plays out , however, there is no sin , thus no forgiveness , only a nit-picking observance of ‘ethical behavior ‘ , which , when applied to something as basic as eating , cannot help but prove beside the point. We eat , basically , to survive , an instinct notably resistant to ethical imperatives. The doctor , the lawyer , the educator - all are trained to live up to ethical standards , and when they don’t it is cause for concern. Ethical behavior is proper to such roles. Your stomach has no such radar.(Ask someone suffering from hunger …) Those who pretend otherwise are promoting something very much different from ethics : privilege , of the sort conditioned both by entitlements and a sere moral landscape. Positioning oneself on the right side of sustainability stings a bit less when you’ve got the means to pay extra ; the very notion of buying your way to righteousness is inane ; are we to tax the under-paid with unethical consumption because they don’t bust their budget on organic foods ? Those unsettled by such an idea might reconsider what avenues to moral action are actually open to them. The binary structure of the digital world - ones or zeros - has stealthily undermined the actual nature of moral action by positing an either/or model of ethical behavior. Doing the right thing obliges the kind of struggle one doesn’t meet up with in the world of clicks and likes : you may be alone , without the instant approval of the like-minded ; you may entertain doubt ; you may even fail. But in the giant on-line mall we now inhabit there reigns a paucity of moral agency : a parched landscape of ’choice’ from which the needy have been banished.

A ‘cognitive elite’ , one that for a generation or two has benefited from the meritocratic opening of university education , now sets the tone for discussions of public policy and individual responsibility. Around dinner-tables where political loyalties are taken for granted , religious faith little more than an eccentricity , and sex reduced to questions of ‘safety’ , food comes to the rescue as a subject sure to offend no one. But the human faculty for moral choice will not be stilled , and so one is privy to self-serving bromides promoting sustainability , local sourcing , exotic elixirs , and the latest ‘miracle foods’ conducive to enhanced cognition. To the well-educated the epidemic of obesity is taking place off-stage , where the poor and the minimally educated are left to fend for themselves , the hapless victims of a massive public - health failure that doesn’t admit of economic factors.

Karen Armstrong has advanced the idea that it was agriculture , not religion , that brought on the violence-prone hierarchies in society that , at the end of the day , enabled progress in human affairs : without an agricultural surplus , obtained by beneficent nature , or by squeezing the peasantry , humankind would be stagnant : egalitarian in their hunting and gathering , but mired in stasis. Peasants in revolt usually destroyed the records of their indebtedness as a matter of course ; and hunger as a political tool of gruesome efficiency saw duty in both the Nazi and Soviet regimes. From the exploitation of Egyptian fellaheen to the grinding poverty of the share-cropper , this double-faced goddess of agriculture , both feeder of millions and tool of the elite , has structured human society. But who , in America , are the exploited peasants of today ? We seem to have outgrown the rank exploitation of agriculturalists upon which the birth and development of the arts and sciences relied. If I am honest , even with my paltry income I am among the tiny minority , world-wide , who live in a nominally democratic nation , sheltered from violence , with clean and abundant water , an exemplary public library , health care , union membership , and free speech. Up until the industrial revolution a peasant in India and one in the West had lives of comparable (dis)comfort , but as the West surged , disparities between the mechanized nations and those still powered only by human and animal labor soon made any parity risible. One could argue that it is the earth itself that is the exploited party : the forests and wetlands that ensure the diversity upon which evolution depends are in the crosshairs of development , itself the ravenous offspring of a humanist credo that can’t see past its own nose. Calls to ‘save the planet’ are myopic in the extreme Just as with the reformist parties of Tsarist Russia , the proponents of ecological reform are more symptom than remedy , for a long-term reckoning with nature , a force heedless of human concerns.

When my fiance took a year in France to complete her MA in literature I tagged along and cobbled together a course of study at a suburban branch of the Universite de Paris at St Denis. A survey of French history ? Nah , too many dumb Americans. The course offerings , c 1988 , were taped to the office doors. One of them , Alimentation a l’Europe 14th-18thc , caught my eye and I signed up. The professor , Jean-Louis Flandrin , I was to learn , was a highly respected writer of the Annalien school - those who investigated the history of private life. What did people eat , and why ? What records were kept , and how reliable were they ? A sailing ship’s manifest might reveal some bottom-line dietary necessities of the age , but the ship’s quarter-master , he in charge of the vittles , might have cheated , to line his own pockets. Did people spice up their meat dishes to hide the rot ? Maybe , but most meat was slaughtered and cooked on the same day , and the (French)meat market was under strict regulation as early as the 1200s. Turns out that spices- read pepper- cost a lot back then , and only the upper crust could afford them ; as soon as the nascent bourgeoisie got their hands on the spices , around the 17th c , the aristos developed a taste for ‘simply prepared dishes ‘. Spices were for wannabes. Food , it turns out , is a major status-marker , to the point where even the onset of gout among the well-to-do of the 19thc barely dented their appetite for rich foods , in an era where plumpness was sexy.

As a ‘hippie’ in the ‘70s I found dietary distinction a piece of cake : get with the honey and the whole-wheat and you were done ! White sugar - eewh ! White bread , ditto. My own present refusal of status concerns doesn’t deny them - it’s just too expensive. With top-shelf , ‘fair-trade’ coffees at $17 a pound , and organic brown rice at a whopping $5 , the spiritual and political stakes are decidedly secondary in importance. Besides , sometimes hipness is what it ain’t.

Diet

When I got sober I started to gain weight. At a physical, towards the end of my first year sober , the nurse taking my vitals informed me I weighed 185 lbs , a full 20 lbs. over the weight I had maintained since college. I offered that she must be mistaken ; it wasn’t possible. How could I have put on these pounds without knowing it ? Of course , I had other fish to fry at the moment. At a follow-up soon after , the number remained the same. I had to admit it : without any great change in diet -save the booze, mainly wine , that I had foregone - or exercise , I had gained weight. Four years later , coming in at 205 , I shared my concern with my primary care physician , someone I respected. We shared a laugh over my aversion to ‘blue (skim) milk’: His rueful ‘You can get used to anything ‘ seemed funny at the time. And he sent me on my way with the food pyramid devised under the Carter administration , which counseled reducing fats and sugars , and increasing grains. Nothing happened. I was on my way to being a blimp : 240 was in sight if nothing changed.

Then one fine day I happened to be tuned in to NPR and heard a presentation on obesity by a science-writer and researcher. Gary Taubes convinced me that calories-in , calories -out was a myth ; that fat doesn’t make us fat ; and that it was a disruption in the body’s metabolic rate that brought on obesity. I looked at his YouTube video , took notes , bought the book , took more notes , and then changed my diet accordingly.

Bacon and eggs , salads and meat , yogurt and cheese , and a few crackers to assuage the bread lover in me. But no rice , pasta , potatoes , or , most arrestingly , fruit. Anything with sugar , anything sweet , anything that quickly turned to sugar in the blood was off-limits. For a few months there was no change , then , at a VA hospital where I was chairing an AA meeting , I checked my weight on one of the digital scales : 195 ! I was on the right track , without counting calories , without exercising beyond the daily 45 minute walks I’d always favored. This is where I’ve stayed ever since , except for during a period of dental work which obliged me to eat soft foods , when I allowed myself jam , ice cream , puddings and plenty of mashed potatoes , and my weight shot up to the previous warning level of 205 : a confirmation of the ketogenic theory , in fact. A few weeks after I resumed the low-carb diet my weight went back down.

So , not only did I stop gaining weight , I actually lost 10 lbs , and my vitals today are fine , especially my blood-glucose levels. Another video I watched , one featuring some altogether serious nutritionists , demolished the relevance of cholesterol levels to physical well-being , as well as that of statins routinely prescribed to lower one’s cholesterol. When I told my new doctor I was discontinuing the statin regimen I had retained -hedging my bets , as it were - she didn’t argue the point , not at all , and it became clear to me that an uneasy complicity of MDs might be at work : some of them knew what a crock it might prove to be , but were justifiably wary of going on record. This is just one reason why charlatans might get the ear of patients. In the case of statins a lot of money is involved , given the automatic enlistment of even those with an outside chance of developing heart disease.

One anti-carb researcher noted that , until the 1960s , every British housewife knew that the way to slim down was to banish bread from the diet. People with skin in the game , those whose appearance determined their livelihood or performance - models , wrestlers , etc - were equally sold on the no/low-carb diet. It worked. Its chief proponent , Dr Atkins , was dismissed by establishment dieticians as a quack.

My food budget increased by at least 50% , for the simple reason that chicken costs more than pasta , sausage and bacon more than toast , and salmon considerably more than rice. For a good while demographers have noted the correlation of poverty with obesity , but who among them have been willing to go the extra mile and suggest that one is fat because one is poor : this would suggest that obesity is not the result of individual choice but of social inequality : the poor simply cannot afford to get well - it costs too much. I don’t eat high on the hog , and my monthly outlay comes in at more than $300 per month ; the average food-stamp allotment is around $200. One obstacle to a low cost /low carb regimen is in the hold sweeteners have on me and most people - the sugar or honey I simply must have in my coffee and tea. Southeast Asians , for example , ate plenty of rice and noodles without getting fat , for the simple reason that , prior to modernization , their consumption of sugar had been on par with what we had consumed in the 19thc : not much at all. Sticking to a budget - hell, coming up with one - might mitigate the difficulty facing the poor , but they face an uphill battle , not just with their appetite for comfort foods , but with a medical establishment bankrolled by the pill industry , and a government bureaucracy mired in outmoded certainties as to what causes obesity.

For the last five years I’ve been a substitute teacher in public schools with about 90% Chinese-American students. Almost none of them are overweight . Chinese civilization is one of the oldest , and its dietary culture is perhaps the one that non-Chinese are most aware of , even if only in the slightly skewed representations of it available in Chinese restaurants. If desserts do figure in the typical menu , they are very few. Cooking as a domestic art represents a cultural value so deep that it is easy to ignore : it’s just there - anodyne and banal. But consider this : if you were making your own lemony iced -tea , would you add 10+ teaspoons of sugar to every 12 ounces ? Probably not. This is what happens when you abandon yourself to commercially engineered foods in lieu of making your own.

To rejoin our Chinese-American kids , it has been hard to exactly predict which of the pre-cooked , packaged meals they will reject , but from my own years supervising snack-time I can vow that they love hamburgers and hot-dogs. Kids love meat. Humans love meat. Our brains and muscles love the concentrated protein it provides , and the graduated energy -level - not the sugar-spike - it provides. But there has arrived a reluctance to admit of such a preference ; as early as the mid ‘70s “ Diet For A Small Planet” brought sustainability front and center , at least among the counter-culture , and this issue has surged once again with the vogue for meatless meat , which , last time I looked , cost twice as much as the meat it seeks to replace. (Here we must recognize something weird : where I shop , at my local Safeway , I regularly stock up on pork when it’s on sale at $2 a pound or so. Even on sale a pound of quality wholewheat bread costs more than $4. What gives ?)

Lurking behind the sustainability argument is one that is moral in nature : killing animals for our own consumption is bad. It’s murder : messy and unsanitary. In short we’d all be better off as vegetarians. Aren’t they healthier ? The anti-meat folks have hit on a perfect line-up of villainy : the injustice , disease , industrial agriculture and red-meat politics brought on by the carnivores among us. It’s a spiritual pitch oddly devoid of any mention of God , sin or forgiveness. They are bumping up against an irreducible element in human existence : that we must kill in order to survive. But there’s killing and then there’s rapine ; the former atones , the latter wantonly glories in its own dominance ; the hunter abhors waste , the glutton lays waste. Karen Armstrong , in her “Fields of Blood “ , recalls the poetic evidence of early humankind’s uneasiness in its position atop the food-chain : the poignant and awed depiction of animals in the caves of Lascaux can be seen as testimony to how early humans grappled with this moral conundrum. In the secular world where this moral drama plays out , however, there is no sin , thus no forgiveness , only a nit-picking observance of ‘ethical behavior ‘ , which , when applied to something as basic as eating , cannot help but prove beside the point. We eat , basically , to survive , an instinct notably resistant to ethical imperatives. The doctor , the lawyer , the educator - all are trained to live up to ethical standards , and when they don’t it is cause for concern. Ethical behavior is proper to such roles. Your stomach has no such radar.(Ask someone suffering from hunger …) Those who pretend otherwise are promoting something very much different from ethics : privilege , of the sort conditioned both by entitlements and a sere moral landscape. Positioning oneself on the right side of sustainability stings a bit less when you’ve got the means to pay extra ; the very notion of buying your way to righteousness is inane ; are we to tax the under-paid with unethical consumption because they don’t bust their budget on organic foods ? Those unsettled by such an idea might reconsider what avenues to moral action are actually open to them. The binary structure of the digital world - ones or zeros - has stealthily undermined the actual nature of moral action by positing an either/or model of ethical behavior. Doing the right thing obliges the kind of struggle one doesn’t meet up with in the world of clicks and likes : you may be alone , without the instant approval of the like-minded ; you may entertain doubt ; you may even fail. But in the giant on-line mall we now inhabit there reigns a paucity of moral agency : a parched landscape of ’choice’ from which the needy have been banished.

A ‘cognitive elite’ , one that for a generation or two has benefited from the meritocratic opening of university education , now sets the tone for discussions of public policy and individual responsibility. Around dinner-tables where political loyalties are taken for granted , religious faith little more than an eccentricity , and sex reduced to questions of ‘safety’ , food comes to the rescue as a subject sure to offend no one. But the human faculty for moral choice will not be stilled , and so one is privy to self-serving bromides promoting sustainability , local sourcing , exotic elixirs , and the latest ‘miracle foods’ conducive to enhanced cognition. To the well-educated the epidemic of obesity is taking place off-stage , where the poor and the minimally educated are left to fend for themselves , the hapless victims of a massive public - health failure that doesn’t admit of economic factors.

Karen Armstrong has advanced the idea that it was agriculture , not religion , that brought on the violence-prone hierarchies in society that , at the end of the day , enabled progress in human affairs : without an agricultural surplus , obtained by beneficent nature , or by squeezing the peasantry , humankind would be stagnant : egalitarian in their hunting and gathering , but mired in stasis. Peasants in revolt usually destroyed the records of their indebtedness as a matter of course ; and hunger as a political tool of gruesome efficiency saw duty in both the Nazi and Soviet regimes. From the exploitation of Egyptian fellaheen to the grinding poverty of the share-cropper , this double-faced goddess of agriculture , both feeder of millions and tool of the elite , has structured human society. But who , in America , are the exploited peasants of today ? We seem to have outgrown the rank exploitation of agriculturalists upon which the birth and development of the arts and sciences relied. If I am honest , even with my paltry income I am among the tiny minority , world-wide , who live in a nominally democratic nation , sheltered from violence , with clean and abundant water , an exemplary public library , health care , union membership , and free speech. Up until the industrial revolution a peasant in India and one in the West had lives of comparable (dis)comfort , but as the West surged , disparities between the mechanized nations and those still powered only by human and animal labor soon made any parity risible. One could argue that it is the earth itself that is the exploited party : the forests and wetlands that ensure the diversity upon which evolution depends are in the crosshairs of development , itself the ravenous offspring of a humanist credo that can’t see past its own nose. Calls to ‘save the planet’ are myopic in the extreme Just as with the reformist parties of Tsarist Russia , the proponents of ecological reform are more symptom than remedy , for a long-term reckoning with nature , a force heedless of human concerns.

When my fiance took a year in France to complete her MA in literature I tagged along and cobbled together a course of study at a suburban branch of the Universite de Paris at St Denis. A survey of French history ? Nah , too many dumb Americans. The course offerings , c 1988 , were taped to the office doors. One of them , Alimentation a l’Europe 14th-18thc , caught my eye and I signed up. The professor , Jean-Louis Flandrin , I was to learn , was a highly respected writer of the Annalien school - those who investigated the history of private life. What did people eat , and why ? What records were kept , and how reliable were they ? A sailing ship’s manifest might reveal some bottom-line dietary necessities of the age , but the ship’s quarter-master , he in charge of the vittles , might have cheated , to line his own pockets. Did people spice up their meat dishes to hide the rot ? Maybe , but most meat was slaughtered and cooked on the same day , and the (French)meat market was under strict regulation as early as the 1200s. Turns out that spices- read pepper- cost a lot back then , and only the upper crust could afford them ; as soon as the nascent bourgeoisie got their hands on the spices , around the 17th c , the aristos developed a taste for ‘simply prepared dishes ‘. Spices were for wannabes. Food , it turns out , is a major status-marker , to the point where even the onset of gout among the well-to-do of the 19thc barely dented their appetite for rich foods , in an era where plumpness was sexy.

As a ‘hippie’ in the ‘70s I found dietary distinction a piece of cake : get with the honey and the whole-wheat and you were done ! White sugar - eewh ! White bread , ditto. My own present refusal of status concerns doesn’t deny them - it’s just too expensive. With top-shelf , ‘fair-trade’ coffees at $17 a pound , and organic brown rice at a whopping $5 , the spiritual and political stakes are decidedly secondary in importance. Besides , sometim