Dr. Carl Erik Fisher’s impressive debut tackles the cultural history of addiction, offering a nuanced, personal perspective on a health crisis that remains stigmatized and misunderstood. In The Urge, Fisher weaves together history, psychology, neuroscience, sociology, philosophy and medicine to construct a holistic, humane portrait of a condition that has baffled experts for centuries.
Fisher, an addiction specialist and assistant professor of clinical psychiatry at Columbia University, begins with his and his family’s history with alcoholism and addiction. As a psychiatry resident at Columbia, he checked himself into treatment after he realized he was addicted to alcohol. During his time in rehab, he asked himself a simple but profound question: Why is this so hard?
Looking to history for answers, Fisher found that the earliest references to the concept of addiction were from great ancient thinkers. Aristotle, Augustine and Teng Cen, the Chinese poet from the Song dynasty, all described a compulsion to do something against one’s will. As an addiction specialist, Fisher sees this same compulsion in his patients: a strong desire to stop harmful behavior and an inability to do so.
There’s a strong American perspective in The Urge, since most of the contemporary world’s ideas of addiction come from work started in the United States—from groups like Alcoholics Anonymous to movements like Prohibition and the war on drugs. Our current view of addiction is as a mental disorder or disease that exists on a spectrum, but as Fisher explains, that wasn’t always the case. Rather than a medical condition, it was considered a crime, and until recently, there was no treatment.
Fisher’s personal experience in rehab informed his view of addiction. He knew that he received excellent, humane care because he was a doctor, and he also knew that most people who seek help for their addictions don’t receive the same quality of care. He examines why effective treatment for addiction is not only hard to come by but also, Fisher argues, unequally and unfairly administered.
The Urge is several excellent books in one: a complete and sweeping history of addiction, a compassionate doctor’s approach to treating people with addictions, and a blistering critique of outdated, draconian government policies around drug use and addiction.