Abstract

In lieu of an abstract, here is a brief excerpt of the content:Surrender Versus Control:How Best Not to DrinkMark D. Rego (bio)Keywordsaddiction, Alcoholics Anonymous, will, St. AugustineI recall as a teenager noticing that some people modified nouns in, what sounded to me, a peculiar way. A friend's mother who was taking an automotive repair course said, " We're going to learn to fix the brakes next week." The same folks would also use the possessive for common nouns in phrases like: "I'll be ready after I take my shower." Although not incorrect, I believe this type of usage reflected a different attitude about brakes, showers, and other things. These tended to be more hands-on people and thus, in my understanding at least, had a more particular relationship with things in their world than others for whom objects were examples of types of things.This brief vignette serves as an introduction to my qualified enthusiasm for the project taken up by Allison Mitchell in her paper, "Taking Mentality Seriously: A Philosophical Inquiry into the Language of Addiction and Recovery" (Mitchell, 2006). Indeed, as a practicing psychiatrist I would be hard pressed not to endorse the use of language as a key to deeper aspects of experience.My following remarks are mostly contra Mitchell's hypothesis, but before beginning I name one more reason I think this project is worthwhile. In spite of much research and recitations of the motto "treatment works," we do not presently have a reliable treatment for addiction. The linguistic portrait painted by Mitchell allows us to view our treatments in vivo and reflect upon what we see. (For the purpose of this commentary, I consider alcoholism and Alcoholics Anonymous [AA] as a general example of addiction and treatment.)Medication treatment remains almost inconsequential except when applied for comorbid psychiatric disorders rather than the primary addiction. Even then it rarely serves to undo some form of self-medication, but instead only offers an important leg up in battling the addiction.Research and much experience has shown AA to be the single best treatment for alcoholism (Vaillant and Hiller-Sturmhofel 1996). Some investigators have proposed underlying mechanisms for its efficacy (some, like "creating dependency" run very counter to Mitchell) (Vaillant 2005). AA's success is highly dependent upon attendance (McCrady et al. 2004), which can of course be a marker for getting better in the first place and not solely a cause of improvement (i.e., people who are doing better attend more meetings not vice- versa). Even within AA, the dropout rate is quite high (Martin et al. 1996). Workers in this area [End Page 223] have raised questions about AA's approach and have proposed other avenues to sobriety, including interpersonal, cognitive–behavioral, and relapse prevention programs (Witkiewitz and Marlatt 2005, 2004; O'Dwyer 2006). Lamentably, some very large studies failed to show any effective ability to match up alcoholics with a particular treatment modality (Church 2004; Read 2004).Given the lack of clarity with which we still work, I think an approach like Mitchell's is a welcome call for serious reflection. The limitations of a linguistic analysis place an unfortunate constriction on implications to be drawn.Mitchell's chief concern is that the language of recovery, as reflected in twelve-step programs, betrays and even fosters a degree of passivity, which leaves the addict without an adequate sense of agency and autonomy with which to combat addiction. From a more philosophical perspective, Mitchell believes this is due to an incomplete philosophical materialism; one that lacks "mentality" (i.e., the sense that part of our physical being is made up of mental activities such as emotions, motivations, beliefs, etc.). This attitude is manifest in a "pretheoretic conception of the self" that leaves the addict with a dearth of self-awareness as a mental agent of action and change.In place of the standard recovery model in use today, Mitchell suggests cultivating a sense of self that values and fosters engaged agency that is both capable of self-control and responsive to external obligations.A Few ConcernsFirst, I will offer a few concerns about premises at work within the paper. Then, I outline an attempt to make sense of the...