Quinten Clarke is a 2nd year medical student at McMaster University.

 

At once a memoir and critical exploration of the narratives around addiction and addiction recovery, Leslie Jamison’s 2018 non-fiction work The Recovering: Intoxication and its Aftermath works to personalize addiction using the lens of the author’s own experience.

Unlike her previous work in The Empathy Exams that used personal narrative to explore understandings of empathy as manifested through human behaviour, The Recovering uses contemporary understandings of addiction to explore her own personal narrative. The narrative structure that oscillates between Jamison’s own experiences, the history of addiction treatment, and the interplay between famous depictions of addiction and the artists who produced them, functions as a reflection on her attempts to avoid the reality of her addiction. Drawing from works as diverse as David Foster Wallace’s Infinite Jest to Charles Jackson’s Lost Weekend, The Recovering creates a comprehensive review of literature pertaining to addictions and intertwines these depictions with Jamison’s own experiences.

The Recovering is successful in encompassing, explaining, and exploring the biopsychosocial model of addiction in a personalized form. The self-deceit and, at times, self-defeating behaviours of individuals with addictions are recognized by Jamison in her own experience and analyzed without irony, stigma, or self-deprecation. For that reason, The Recovering reads as unflinching in its deconstruction of the recovery process.

Jamison spends a substantive portion of her book exploring her experiences with Alcoholics Anonymous. Her exploration elucidates the social connections and peer support which are major tenets of these programs and considered some of the most important benefits of these programs. In her words, “[at] three days sober, you can tell someone on her first day what the second day was like for you.” As such the program’s egalitarian approach to peer support is recognized and valued throughout this work.

Further, Jamison explores the limitation of her anticipation of what sobriety can offer and the freedom stemming from avoiding that reality. In her words, “[contract] logic involved its own tyrannical authorial impulse – I will write the script, and God will make it come true – but sobriety didn’t dutifully deliver on its end of the contracts I’d written. It did the opposite: offered relief from my own plotline.” As such she offers a salient perspective that should be shared with trainees working in this environment: practically, it may take multiple attempts for patients to become sober and it may not look like what they envisioned.

Additionally, Jamison effectively highlights contemporary issues regarding the DSM-5 criteria for substance use disorder: “When the American Psychiatric Association released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, in 2013, and officially changed its definition of ‘Substance use disorder’ from a category to a spectrum, many scientists were afraid that its broadened criteria would effectively produce too many addicts – that it would, in essence, make everyone who had ever drunk recklessly an addict, and destroy a vital distinction between dysfunction and disease.

What do I think? That its important not to lose our grip on the notion of disease or its physical mechanisms by defining it too broadly, but it’s also true that everyone has longed for something that harms her. I wish we could invoke that universality not to render the boundaries of addiction utterly porous, but to humanize those under its thrall.” Measured and well-considered, her willingness to explore contentious issues within the psychiatric and medical community is admirable.

While lengthy, The Recovering is a valuable read for trainees or established healthcare providers working with individuals with additions issues. Its exploration of the experience of living with addiction, and addiction treatment provide contemporary perspectives on ongoing societal and healthcare concerns.