Updated: Aug 30
I recently had the pleasure of speaking with Randolph Nesse about the evolutionary origins of addiction – Nesse is perhaps the leading expert on the evolutionary basis of disease and immunity, and in 1997 he wrote an influential article on drug use in evolutionary perspective. The conversation got me thinking about the relevance of contemporary scientific claims about the causes of addiction to the art and craft of writing history, and it led me to return to a paper that I first presented back at the 2008 meeting of the American Association for the History of Medicine. It occurred to me that this blog would be an interesting place to have a conversation about the relationship between what scientists do and what historians do, and perhaps also to get some feedback on the arguments I’m trying to make in the paper itself. So, please consider what follows very much a “work in progress.” I’d certainly appreciate feedback, either in the comments of through email, but I’m also interested in hearing what you think about these sorts of issues. Do scientists and historians have anything useful to say to one another? And if so, what?
I want to begin by briefly telling you the story of a woman named Annie C. Meyers. Born in 1858 to a highly religious family, Meyers married as a young woman into a prominent Chicago family and lived the life of a socialite. “I was considered a woman of some beauty, refinement and intelligence,” she once recalled. “I was a typical woman of society in those days.” One day in 1894, while suffering from a severe cold, Meyers began using a patent medicine for her sinuses that contained cocaine. She soon developed a habit for the drug, with horrifying results: “From a well-balanced Christian woman, I became a haggard and wretched physical and mental wreck,” she wrote. “My thoughts were only for more of that accursed poison, cocaine, that was dragging me down to destruction.” In 1902 Meyers published an account of her descent into cocaine addiction, which she called Eight Years in Cocaine Hell: It tells a terrifying story of her journey downward into poverty, moral depravity, sickness, and insanity. “I became a wandering vagabond on the earth… I very soon found myself with no will power left and I sank lower and lower. I was firmly bound in the slavery of this awful monster.”
What are we to make of this story? As historians, how should we explain to our readers the transformation that Meyers describes? Some argue that we should draw on contemporary scientific insights in order to explain behavior like this. Howard Kushner, for example, has suggested that historians of addiction should begin to take scientific claims about the biological basis of addiction seriously. As Kushner points out, over the past two decades historians of addiction have made great progress in contextualizing the political, social, and cultural meanings of addiction, yet “evidence pointing to the social construction of previous medical and scientific claims has made them skeptical of current claims,” and as a result, they “have felt liberated from engaging current neurobiological, neuropharmacological, and genetic claims about addiction.” In response, Kushner suggests that it is time for historians of addiction to directly engage the work of contemporary scientists and begin to integrate findings into their narratives. His goal is a practical one: “Integrating these histories into wider collaborative drug research can make important contributions for prevention, treatment, and policy toward addictions. Such collaborations will require, of course, that addiction researchers acknowledge and engage the findings of historians. In turn, this obliges historians to pay as much attention to the contemporary biology of addiction as they have to historicizing it.”
My question is this: What does it mean to engage the contemporary science of addiction in the context of writing history? What does it mean to try to integrate social and cultural analysis with current scientific claims about the biological basis of addiction into our historical narratives? What does it mean to use the language of dopamine, brain chemistry, and neurotransmitters to explain the life of Annie C. Meyers?
Kushner’s critique of social-constructivist approaches to the history of addiction points to an intellectual tradition dating back more than fifty years, one that rejects what sociologists Craig Reinarman and Harry Levine have termed “pharmacological determinism” – the idea that consuming specific drugs inevitably leads to specific forms of behavior. Drugs, as Reinarman and Levine put it, are “more than molecules,” and any explanation of addict behavior must be found in “the psychological, social, and cultural factors shaping the users’ motives, experiences, and behaviors.” What is interesting here is precisely the point that Kushner suggests: the absence of the biological in these narratives. Although often framed as integrating the social, the cultural, and the biological, these types of work in fact often do the reverse: they read biology out of the equation, reducing addict behavior to social and cultural forces.
Kushner suggests that historians that adopt this type of approach to the history of addiction are skeptical of current scientific claims because of their success in contextualizing scientific claims in the past. Yet he also warns us that this success should not lead us to ignore scientific claims made in the present. The implication, I think, is that contemporary scientific claims made about the biology of addiction transcend the social and cultural context in which they are made, and are therefore able to contribute to an understanding of people’s behaviors in different times and places. This is, I think, a fair assumption when approaching the topic of addiction from a scientific perspective. For example, in a well-known article published in 1997, Alan Leshner, the director of the National Institute on Drug Abuse at the time, argued that “scientific advances over the past 20 years have shown that drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain.” Leshner is careful to suggest that addiction is a brain disease, but not just a brain disease: it also has social and cultural components, and as a result treatment options will be most effective when combined with behavioral interventions. Despite this, there is an unsurprising assumption in his work that biological changes in the brain should be given primary theoretical weight when explaining addict behavior. Thus, as Leshner puts it, “addiction is, at its core, a consequence of fundamental changes in brain function[.]” Addiction is, at its heart, a biological process, and as such scientific claims about addiction now can be used to better understand addiction in the past.
This does not, of course, imply that addiction is somehow “outside” of the historical process in which addict behavior takes place. But it does, I think, imply that contemporary scientific claims about the biological workings of the body are equally valid when applied to different times and cultures. It also implies that these claims can be the basis of successful historical narratives – and indeed they can. In Forces of Habit, for example, David Courtwright suggests that a “psychoactive revolution” in the eighteenth and nineteenth centuries led to the widespread proliferation of various types of drugs and that our brains are biologically unequipped to successfully respond to the use of these commodities. For Courtwright, the problem of addiction thus fundamentally grows out of the impact of powerful drug technologies on the brain; as he notes, “addiction is the hijacking of the body’s natural reinforcement mechanisms…Addiction is a chronic, relapsing brain disease.” For Courtwright, as for Leshner, addiction is a brain disease but not just a brain disease: it is a brain disease that occurs within a certain social and cultural context that impacts both the way the disease is arrived at and the way it is expressed; as Courtwright puts it, “culture shapes drug use” and “drugs also shape culture.” Still, exposure “is the critical precondition” to addiction in that it is exposure that leads to the triggering of the brain reward system, and thus to the initial cravings that are mediated through social and cultural forces. The biological impact of drugs on the brain, in other words, is – I think – theoretically prior to the social and cultural forces in which this chronic, relapsing brain disease is expressed, and addiction is thus positioned as an important causal factor in the process of historical change. For Courtwright, and presumably for Leshner, contemporary scientific claims about addiction are thus assumed to carry equal weight when applied to the present and to the past; such claims, in other words, point to universal truths that exist outside of the social and linguistic contexts in which they are articulated.
This is a persuasive narrative strategy. However, it does not follow that historians of addiction working in a social-constructionist vein should necessarily adopt the claims currently being made by scientists uncritically. There is, after all, a large body of literature that analyzes contemporary scientific discourse in terms that that are similar to those that historians who write in a social-constructionists mode bring to the study of the past. In other words, the issue here is not one of historical scholarship written in a social or cultural vein versus claims made by contemporary scientists that somehow need to be integrated together, since current scientific work itself can be contextualized as easily as can scientific claims made in the past. Instead, the issue centers on the incompatibility of scientific claims which isolate the primary cause of human behavior in phenomena at the biological level and that, as a result, are assumed to be the same across time and space with methodological approaches to understanding human behavior that give primary weight to the social and cultural context in which such behavior occurs. Indeed, the very point of social-constructionist approaches to human behavior is to undermine the types of claims Kushner encourages historians of addiction to adopt.
The matter is made even more complicated by the fact that there is a significant amount of evidence from contemporary scientific research that challenges the idea that drug effects on the body can be understood as theoretically prior to the social and cultural contexts in which they occur. As a result, it is not at all clear that incorporating the science of addiction into one’s narrative necessarily leads in the direction that Kushner wants it to. For example, take Richard De Grandpre’s book, The Cult of Pharmacology. The book is a highly critical history of the idea that drug effects can be understood independent of the social and cultural context in which they occur; as DeGrandpre puts it, the book describes how “drug dependence and drug addiction involving illegal drugs were effectively encapsulated within a black box of biology that excluded nearly all external factors, whether individual or cultural – the very factors central to acute drug effects and long-term outcomes, as demonstrated by numerous sociologists and behavioral pharmacologists[.]” DeGrandpre draws on a significant amount of scientific evidence to make his argument, yet this scientific evidence leads him to the exact opposite perspective that Courtwright has reached. For DeGrandpre, addiction is not a chronic, relapsing brain disease: it is a socially and politically created category of behavior, one that clearly has negative consequences for individuals but which is not linked to the molecular properties of particular substances.
What is interesting here is not who is right and who is wrong in this debate. Rather, it is the intractable nature of the debate itself. For most historians, even those who work at the level of social and cultural analysis, there is an assumed biological basis to addiction, since ingesting certain drugs is assumed to cause addiction and thus lead to a host of negative, and predictable, consequences. Occasionally, such as in Courtwright’s work, this assumption is made explicit and given clear theoretical weight by linking it to contemporary scientific claims. For a smaller group of historians, social and cultural analysis gains theoretical priority and the biological recedes as the primary explanatory frame for addict behavior. As DeGrandpre’s work demonstrates, however, the binary between the two approaches is not reducible to the question of whether one incorporates contemporary scientific research into one’s historical narrative or not: the contemporary scientific literature itself can be used to fashion multiple, and contradictory, historical narratives. The turn towards science that Kushner advocates thus offers no real solution to the question of how to take biology seriously in our narratives; or, rather, it offers one potential solution for how to do so, as demonstrated by Courtwright, but also, simultaneously, offers an avenue for doing the opposite, as illustrated by DeGrandpre. In other words, science no more implies that we take biology “seriously” as a force in past addict behavior than does cultural analysis, at least not in the way that Kushner implies.
What I am suggesting here is that incorporating contemporary scientific work on the biological aspects of addiction into our historical narratives is not going to help us overcome the gap between social-constructionist approaches and biological reductionist approaches to addiction, since the contested nature of scientific work on the topic is itself part of what this debate is about. Certainly, as historians we are free to adopt Courtwright’s approach in our historical narratives: it is an important, useful, and interesting approach, and one that produces good history. Yet I think we should be cautious about assuming that doing so somehow brings us closer to the truth of addiction than do other approaches. Given the fact that scientific discourse can be deployed in different ways to reach different conclusions on the topic, incorporating universal claims about the role of biology in addiction into our narratives does not mean that we are bridging the gap between a social-constructionist approach and a biologically reductionist approach. It means that we are reproducing it.
So, how can we write narratives of the past that take biology seriously yet avoid the endless debates between social-constructionism on the one hand and biological reductionism on the other? In his essay, Kushner suggests that we conceptualize addiction not as a disease but rather as a syndrome – as a diagnostic category based not on the identification of a pathogen, lesion, or other biological event but rather on the presence of a set of signs and symptoms, some of which are typically assumed to be social and cultural in origin and others which are typically assumed to be biological in origin. For Kushner, this approach allows one to “bring together seemingly contradictory social-constructionist and biologically reductionist claims,” but it also requires “engagement with the accumulating evidence from recent research that substance dependence… alters brain reward mechanisms, including brain architecture and neurochemistry[.]” Perhaps. But, perhaps, it also allows us to do exactly the opposite. If we read addiction as a syndrome rather than a disease, and thus shift our frame of reference from supposedly underlying causes, whether biological or social, to the presence of symptoms and signs, the insistent demand to prioritize the biological over the cultural, or vice versa, disappears. We are thus authorized to craft our narrative through reference to the textual representations that we find in our sources, rather than through reference to a theoretical model, such as changes in brain function, that we find only indirect evidence for. By approaching addiction as a collection of symptoms and signs, whether biological or cultural in origin, or some combination, we give ourselves permission to write narratives about the past that resist engagement in the protracted, and at times vitriolic, debate between proponents of social-constructionism and biological reductionism.
This returns me to the story of Annie C. Meyers. Framing our narratives around the first-person experience of users is a particularly effective way of bring the language of the body, as expressed in the symptoms and signs that users recorded of their suffering, into our stories of the past. It allows us to integrate the biological into our narratives in that we are authorized to take seriously the claims that users have left us about their cravings, visual and tactile experiences, and other bodily sensations. Yet it does not oblige us to explain these signs or symptoms in terms of some underlying cause. Doing so thus allows us to write history that, while taking biology seriously, does not reproduce the binary which Kusher’s call to action seeks to overcome.