The symbolic constitution of addiction: Language,alienation,ambivalence

Introduction

The second half of the 20th century has seen an explosion in the problems known as addictions. It has also been marked by a major change in emphasis in philosophy towards a study of language and its crucial role in knowledge and subjectivity. This so-called ‘linguistic turn’ went in many directions but shared one essential feature, language was not an arbitrary bystander on the way to truth. Language itself contributes to truth. Bringing these two developments together, this article will explore the extent to which the contemporary phenomenon of ‘addiction’ is determined symbolically. I want to define the symbolic more broadly than just language and include the sedimented beliefs and practices, retained and elaborated via language, that persist in western culture. In other words the symbolic is partly sociological. The symbolic is nothing other than the persistence, through time, of a meaning set, embodied as spoken words and actions, which help determine the behaviour of the members of a particular group. For the purposes of this article that group is addicts in western culture at the turn of the millennium.

This article will explore the degree to which addiction is symbolically constituted however, it is worth noting that a complete phenomenological description of addiction is not possible here. The symbolic constitution of addiction is but one dimension of a comprehensive phenomenology. Elsewhere I have been working towards such a description, based on the lived-experience of temporality (Kemp, 2009b), embodiment (Kemp, 2009a), intersubjectivity (Kemp, 2009c) and ‘worlding’ (Kemp, in press). Also, throughout this article, I use the term ‘addiction’ and ‘the addict’ without a critical analysis of whether such terms are adequate or in fact constitute a substantial entity worthy of study. These terms are not adopted arbitrarily and are not intended as a language of denigration. Without falling into the use of unwieldy concepts such as ‘the subject of addiction’ or ‘so-called-addiction’, I have chosen to use the simpler terms ‘addict’ and ‘addiction’, acknowledging it is possible to deconstruct these terms. To some degree this article is itself a critical genealogy of these terms and how these significations can become uncritically embodied by those who suffer as addicts or who discourse, as experts, on addiction.

To explore this dimension the analysis will be primarily within the field of existential-phenomenology, particularly the theory of Heidegger. But to this will be added, perhaps surprisingly, the psychoanalysis of Jacques Lacan. This will be attempted so as to provide a grounded description of how the addict lives in relation to the symbolic structures, which partly determine their existence. I will begin by exploring how existential- phenomenology understands the phenomenon of language. Lacan’s work will deepen the analysis, while an uncovering of the etymologies of the actual words, which haunt the world of addiction, will be added. The sociology of contemporary consumption and addiction will be briefly outlined, before a description of the symbolic constitution of addiction is attempted. Finally the implications for the clinical treatment of addiction will be briefly explored.

This article has a dual focus, partly clinical, but also with an aim to challenge the common conceptions used to consider addiction. In describing addiction as at least partially constituted by symbolic forces, outside the subject’s own creation, it is hoped that addiction could be opened up for a broader analysis, which escapes the easy route of demonizing those that suffer this condition. So both the practising clinician and the social scientist may benefit from considering addiction as constituted by sedimented language and practices. My entry into this area is via my engagement with addiction in the context of UK National Health Service (NHS). Both my own individual practice, as a clinical psychologist, and in my role as part of a larger system of treatment provision, have highlighted the need to seek constantly to find fresh angles to bring to the condition of addiction. Although much of what I will describe below will be drawn from my clinical practice, the implications for social theory more broadly, should be apparent.

The phenomenology of language and the structuring of the symbolic

Existential-phenomenology, although a diverse discipline, is united in asserting that the subject is grounded, as a being-in-the-world. As such, the human subject is constituted, in part, by the world in which they exist. This ‘world’ is not just a geographical place, but is a field of meaning, which the subject has no option but to engage with (Heidegger, 1962 [1927]; Kwant, 1965). ‘The symbolic’ is to some extent this ‘field of meaning’. Meaning is not only known cognitively, but is also embodied and lived as a practical ability to function in the world (Merleau-Ponty, 1962). However for meaning to be reflectively grasped it must be articulated by language, even if silently via thought. Language consequently has a structuring effect on knowledge and praxis.

Language is clearly also a way to communicate. However, as many philosophers and social scientists have now noted, it is also the repository of sedimented truths and fictions. It is the conduit through which our history, knowledge and myths are perpetuated. It is no neutral medium. Our task here is to explore how language may have sedimented our notions of addiction, allowing and hindering our access to this complex phenomenon. Before drawing any conclusions, I shall explore some of the major theorists in the existential-phenomenology tradition starting with Heidegger.

While there is an appreciation of language throughout the work of Heidegger, this expands and becomes a major focus in his latter works. Heidegger is concerned to bring the meaning of Being to prominence in philosophy again. In his latter works he argues that it is only through poetic discourse that humanity can approach the subtlety that is Being. Language allows the Being of beings to be revealed or dis-closed. Language thus not only opens an access to beings, but also to Being, as that which allows beings to appear. Language is thus a route to truth. Not any sort of truth, but truth as aleithia, as unconcealment (Heidegger, 1961, 1962 [1927]). Therefore truth is a moment, an opening, in which Being and beings gradually emerge. Language is the power, the light, which allows for this meaningful dis-closure.

While language has the capacity to bring about this dis-closure or this un-concealment, it is not a power, which is owned by the human subject. Rather the subject is a conduit through which language comes to presence, reveals or opens. The subject must ‘let’ this happen and it can be resisted. This negative characteristic is inherent to language and to Being. This is why Heidegger uses words for the process of truth, which overcome a negative connotation, such as un-concealment, dis-closure and re-veal. The subject can side with the negative, thus hiding, repressing, veiling or closing. Equally the subject can side with the truth, which re-veals, dis-closes, un-conceals and opens. Consequently there is a complex relationship, which exists between the subject and truth or untruth. To some degree it is both active and also passive:

Unconcealment occurs only when it is achieved by work: the work of the word in poetry, the work of stone in temple and statue, the work of word in thought, the work of the polis as the historical place in which all this is grounded and preserved … [and] this struggle for unconcealment, which even in itself is continuous conflict, is at the same time a combat against concealment, disguise, false appearance. (Heidegger, 1961: 160)

Heidegger continually emphasizes the contrasting nature of Being, and of language, as perpetually revealing–concealing. Later Heidegger would emphasize a process of Gelassenheit, or letting-be-ness (Heidegger, 1966). There is also a sense that through this ‘letting-be’, the human subject is transformed. The subject here can claim, appropriate or own, the otherness, which surrounds them and paradoxically already constitutes them. It is in some sense the moment when the relational quality of existence is fully lived (Stambaugh, 1972). This includes the appreciation of how language opens up a world and also how the subject inhabits language. And it is a dwelling, Heidegger (1993: 262) going so far as to call language ‘the house of being’. In the latter stage of his work, Heidegger rarely used the word Being, instead he chose to use various metaphors including ‘the source’, ‘Saying’, ‘the It’, ‘Logos’ and simply language. While it is possible to explore all these metaphors, for the purposes of this article it is more important to note the poetic quality of these devices. For Heidegger it is only possible truly to open up to Being, to the truth, via a poetic sensibility.

Turning now to Merleau-Ponty, an account of language that is not substantially different from Heidegger is found. For purposes of brevity, I will restrict myself to the earlier work, particularly Phenomenology of Perception. For Merleau-Ponty (1962) language is not an exclusive dimension and is embodied alongside other dimensions of the lived-body. Language is therefore a capacity for meaningful existence. It is also the fundamental aspect of our being-with others, not as something that makes this possible, but as the actual connection itself (Kwant, 1963). The word makes something present, and is thus implicated in the ‘presence’ of things, be they available or absent. A thing may be thought, remembered or even worked on, if it can be brought to presence via language. Thought is not separate from language, but neither is it wholly dependent on it. There is pre-verbal form of thought, which accounts for practical action. However both verbal and pre-verbal thought open up a world and are never anything but our constitution as being-in-the-world. Kwant (1963) uses the metaphor of ‘light’ to illustrate the power of language to unveil. However, whenever we reflect on ‘the soil’ from which this light is born a mystery arises. Language is therefore a ‘light rooted in a dark soil’ (Kwant, 1963: 55). Not everything is say-able, so some darkness always adheres to language, no matter how precise we try to be. This adds to the ambiguity, which is inherent to the being of the body-subject. Another way to express this would be to say that it makes ‘the unconscious’ possible. This process of articulation by language thus has the potential for closing, as well as opening. Merleau-Ponty (1962: 196) refers to the ‘density of being’ against which language struggles, never fully accomplishing a complete openness. However, whether or not this complete opening is achieved, even if fleeting, meaning is the product. Meaning is consequently given in the constant struggling dialogue of the subject with themselves (as body-subject) and the world, and language is the insufficient mediator of this dialogue.

Sartre’s position on language appears to be consistent with both Heidegger and Merleau-Ponty. He writes in Being and Nothingness that language is intrinsically intersubjective: ‘Language is not a phenomenon added on to being-for-others. It is originally being-for-others’ (Sartre, 2003 [1956]: 394). Any attempt at expression is an ‘incomplete flight’ outside of conscious control. Meaning therefore transcends whatever I may have been trying to convey. Language is always, whether reflectively realized or not, addressed to the human other. The other always forms and constitutes the subject for Sartre, meaning that the subject is de facto alienated. Language is consequently another layer of this alienating process. The subject is first alienated by realizing their being via the other, then is unable to constitute this relation via an unreliable medium that is language.

The analysis of language as a constituent of our being, will now be deepened by considering the work of Jacques Lacan. In fact in my choice of the term ‘the symbolic’, I am explicitly calling the French psychoanalyst to mind. Lacan is not a natural adjunct to phenomenology, although he was deeply steeped in Heidegger and was a close friend of Merleau-Ponty. However, to this researcher’s mind, Lacan brings together several notions to bear on our theme, which are extremely useful. For Lacan, the symbolic is one of the three registers, which structure the subject. It is never an exclusive structuring agent with both the imaginary and the real always acting in concert. Lacan’s ideas owe much to Levi-Strauss where the symbolic also includes societal laws, kinship structures and the exchange of gifts. Lacan started out maintaining that the unconscious is structured like a language, but later more straightforwardly stated that the ‘unconscious is language’ (Lacan, 2006: 736). I take this to mean, at least partly, that our capacities to live out our potentialities are marked by a structural hindrance (the unconscious), which is created by the revealing–concealing nature of language itself. Of course phenomenological psychology has made many attempts to find a way to account for the unconscious, which is more existentially palatable than Freud’s (and Lacan’s) explanations. The most convincing are those based on Heidegger’s notion of finitude (Richardson, 1965) and Merleau-Ponty’s notion of the lived body (Brooke, 1986; Romanyshyn, 1977). It would take us too far afield to explore these accounts here.

For Lacan the subject is spoken through by a discourse, which is not their own. In other words, a certain discourse is created, propagated and dispersed. It finds its voice, as it were, through the speaking subject. In this sense, Lacan is close to Heidegger. The speaking subject cannot, therefore, realize their own desire because they are subject to a set of signifiers, which transcends them:

the unconscious is the discourse of the other. This discourse of the other is not the discourse of the abstract other, of the other in the dyad, of my correspondent, nor even of my slave, it is the discourse of the circuit in which I am integrated. I am one of its links. (Lacan, 1988: 89–90)

For Lacan, at least one way the subject finds emancipation is through finding access to their unconscious desire. This is achieved by adopting a different language, or at least a differing speech. A new relation to the structuring effect of the symbolic can thus be achieved. A particular discourse regarding addiction has arisen over the past 200 years. This discourse, which shall be explored shortly, marks a particular place for the addict in the symbolic universe (society, culture, knowledge, etc.). Without being aware of it the subject of addiction takes up this discourse as their own. The Lacanian psychoanalyst attempts, for the most part, to alter the relation of the subject to the symbolic via free association and interpretation (Parker, 2011). Psychoanalysts are consequently ‘practitioners of the symbolic function’ (Lacan, 2006: 235).

In summary the subject can be described as profoundly structured by the language and discourse, which pervades their existence. This structuring also includes symbolized structures, such as societal laws, structured practices and ‘accepted’ mores and attitudes. It creates a field of pre-structured meanings. We are less free to think, speak and act than we imagine. However there is some scope for freedom, especially if the subject can realize their position in the symbolic and adopt another signifying ‘place’. It is a matter of dispute whether the subject must reflectively adopt such a move. Could the subject adopt another discourse unconsciously and still achieve liberation? Lacanian theory seems to point to this as a possibility.

The language of addiction

Exploring the etymology of words is somewhat controversial. It implies that words themselves have a history, but not a history that is dead, but one that lives on in these words. It implies that words have a soul and that this soul effects us today, through some subtle pre-reflective process. If this is true then it matters what words we use. It also matters what words are drawn into a discourse that surrounds a particular subject and its connected practices. So I shall rather rapidly explore the most pertinent words which populate addiction. Unless otherwise referenced, these etymologies are from Klein (1967).

The word addiction itself derives from Latin to ‘assign, award or devote’ and is linked to the word diction. Ad-diction is a restriction of this capacity. Diction implies the possibility of ongoing saying, talking and communication. Ad-diction implies a structural constriction of possible expression (Lenson, 1995; Loose, 2002), both through speech and action. There is thus a connection to language, via expression, at the very heart of addiction. Junky, a common word for an addict, could refer to a Chinese boat, or to bulrushes, but most likely it is connected to ‘old cable or old cordage’ from Latin juncus. It would therefore imply a tying up or tying down. Dependence, a more modern phrase, derives from the Latin dependere ‘to hang from, hang down’. Again this implies cable but the connotation is more precarious, because now the subject is hanging and depends on this connection. Abuse is another commonly used word, with a more recent history, which derives from ‘use’, implying that these substances and practices are not always problematic, and can just be used. There is also the implication that there is a function to this use.

Moving onto the substances most commonly abused, alcohol probably derives from the Arabic kuhl, which is ‘antimony’ or a fine powder. Spirits was a common word for alcohol, and still is to some respect, which derives from the Latin spiritus meaning breathing, breath, soul, mind and courage. It also has connections with ‘to blow’ and ‘to pipe’ and ‘to play on the flute’. The same route has connections with aspire, expire, inspire and obviously spirited. This derivation reveals the way alcohol was positively viewed until the 19th century (Levine, 1978). Opium is from the Greek for poppy juice, while heroin was coined by Dreser, who probably derived it from the Greek for ‘hero’. Hero in turn has connections to ‘defender, protector and preserve’. Narcotic as narcotique was introduced into French in 1314, derives from the Greek for ‘benumbing’ and has old English connections to snare and narrow. It also has connections to sleeping. Gambling derives from medieval and old English meaning ‘to play’.

Various words are used to describe the effect of using substances. Drunk is derived from ‘drink’, literally to be intoxicated by drink. Intoxicated is from the Latin intoxicare ‘to dip into poison’. Sober is from medieval English sobre, French sobrius, meaning literally ‘not drunk’. Abstinence is from Latin abstinentem meaning ‘to refrain from’. Hooked and clean are so transparent I shall not expand on them although their pejorative connotation is palpable. Recovery, now a very vogue term, is probably from old French meaning ‘to get back’ or from Latin recuperare, to recuperate.

William White (2001), a major figure in the New Recovery Movement, argues that for the recovery movement to have a sustained future it must reclaim the language it uses. He believes that some terms, such as ‘untreated alcoholic’, ‘abuse’ and ‘consumer’ need to be abandoned, while others need to be debated. This latter group includes words such as ‘disease’, ‘enable’, ‘relapse’ and even ‘addict’ and ‘alcoholic’. To go still further, and perhaps more radically, there is a place, he argues, for the adoption of a whole new rhetoric for recovery. That rhetoric cannot be predetermined or imposed, but will appear organically from within the recovery movement itself. It must be a language true to the heritage of addiction, but which frees it of the pejorative and medical shackles, which still bind the movement.

What emerges from these etymologies is an inherent ambivalence. There is a reliance, while also a binding; life is given (spiritus) while also poisoned; hero and junk; life enhancing while also numbing; play while restricted; use and abuse. There is a bivalent potential here and, while this is lived out in addiction, it is also living in the very words we use to express our relation to addiction. It can also be recalled that the ambivalent nature of pharmacia (meaning medicine, cure and poison) has been extensively explored by Derrida (2004). Perhaps this ambivalence exists in the drugs themselves (Ronell, 1992); some are ‘uppers’ (stimulants) while others are ‘downers’ (depressants and tranquilizers). It should, therefore, be no surprise that the nature of the mythical figure Dionysus, the god of wine, intoxication and ecstasy, is also deeply contrasting:

Dionysus brought forth again the chaotic subterranean powers and shook the Olympian order. The very essence of the deity was highly chaotic. Dionysus is marked by contrasting features of lightness and darkness, of life and death, of creation and destruction. (Vycinas, 1961: 202)

In Dionysus is summarized and embodied the ambivalent nature of addiction and addictive substances, both to improve life and to destruct it; to be a force for creation and for chaos.

The place of the addict in society

It would be difficult to argue that there is a lower place in society than being an addict. Moreover when this is coupled with the fact that many addicts are also the poorest members of society, often from minority ethnic communities, a total marginalization is nearly complete. Addicts are not unaware of this situation. Almost without fail, addicts entering treatment enquire about whether their treatment will appear on their official records. There are often questions about the existence of an ‘addicts register’ kept by the Government. Who would we talk to? What are the rules of confidentiality? Do their families need to be involved? What about social services? In the face of almost complete bodily, mental and social breakdown, some choose to walk away from treatment because of the ‘place’ that will be marked for them by acquiring the signification ‘addict’.

I recall hearing a radio show in which the issue of benefits was being debated. A right-wing contributor, feeling under pressure, was called on to say that benefits were fine for those seeking employment, but he really objected to those ‘who lay in the gutter with needles in their arms’. In the final instance the addict is the subject who refuses work, refuses to take up a place of responsibility and lives off society like some sort of parasite. Addiction (most often drug addiction) is also usually the only specific medical category named in British political debates. This is because the addict traverses several political domains. These are crime, justice, health and social cohesion. The addict functions almost as a societal symptom, which would be foreclosed, but for the fact that it continues to haunt and hinder the illusion of social tranquillity.

Of course the signifier, addict, has not always existed. There is some controversy about when the designation was first used. But certainly it came into use somewhere between early 17th century and the end of the 18th century (Levine, 1978; Warner, 1994). However the medical claiming of addiction only took hold mid-way through the 20th century (Room, 2003). This medicalizing was first established with alcohol, then drugs and finally gambling. But just prior to the creation of the medical discourse of addiction, was the creation of 12-step fellowship discourse. Applied first to ‘alcoholics’, it soon spread to a number of other addictions. Two very powerful discourses were thus created and found strange support from the dominant market forces. Gerda Reith (2004a) has analysed the sociology of addiction and how this is paralleled with the rise of industrial capitalism and consumer culture. The creation of pathological identities allows the alcohol and gambling industries to legitimize their expansion by designating those who are harmed by this expansion as ‘pathological gamblers’ or ‘alcoholics’ (Reith, 2007). What these industries produce is consequently designated as harmless, only those who are ‘sick’ are unable to partake of these products. So by the end of the last century the addict was not only a social pariah, but also ‘sick’.

Reith (2007) argues that there has been a movement in western society from a work ethic, to a production ethic and now to a consumption ethic. The growth of an ethic of consumption is an ideology which suggests that the more the subject consumes, the more fulfilled they will be. To some extent it does not matter what is consumed. Of course this becomes problematic, both for the subject and society, when that consumption goes out of control. Addiction is quite literally a process of consumption without limits. So the addict is the embodiment of this ideology, excessively and endlessly consuming and yet finding no satisfaction. Yet the ideology promises no fulfilment in the outcome of consumption, only in the act of consumption itself. Yet it does assume some control, some ability to set limits. The addict does not however consume with control. Therefore the addict is either bad (criminal) or sad (sick).

Of course within the ideology of consumption is the notion of choice and freedom. However this freedom is not a pleasure but an obligation, and functions as a form of governance (Reith, 2004b). The contemporary subject is expected to regulate themselves in freedom, through their freedom. Perhaps however, this is overwhelming for the subject. How many different types of toothpaste are really needed? How many different types of cell phones? Addiction becomes a way to counter this freedom by truncating choice. In addiction freedom is not removed, as is argued by some commentators, but is restricted, with choices seemingly very limited. This is the limited expression, of ad-diction, already noted above. The addicted subject consequently finds some peace of mind, within a limited predefined space of choice. Capitalist choice is held back, resisted, even as its consumption effects decimate the addict.

The modern subject cannot however escape capitalism. While the addict is regularly depicted as a hedonistic subject, wrongly perhaps, hedonism and instant gratification are themselves inherent to capitalism (Bell, 1976). What is therefore so problematic about addiction, is inherent to our economic system. Consumption is driven by the system, while pleasure is obligatory. However, it is not just that these processes are encouraged. In modern capitalism these processes lead to self-fulfilment, and are then later elevated to the level of a right (Reith, 2004a). The addict takes these ‘rights’ of pleasure and consumption and attempts to test them at an extreme level. Nevertheless no self-fulfilment is forthcoming. Only two outcomes are possible: suffering and breakdown, or more consumption. In addiction, the subject is consumed by consumption (Reith, 2004a).

In summary, this brief sociological sojourn reveals the addict as marked within contemporary culture as alienated, partly as outcast, partly as sick and yet to some extent the epitome of the modern subject. The addict is the embodiment of the ideology of consumption. Driven to pleasure and greater consumption, addicts seek refuge in their addiction, which is a particular type of constriction within excess. Perhaps this partly explains why we are, as a culture, so interested in celebrity addicts. They are us, just in extremis.

The lived symbolic constitution of addiction

What then is the lived-experience of being symbolically structured as an ‘addict’ and how is this lived-out? To ground this exploration consider the following clinical vignettes which are drawn from my work as a clinical psychologist in the UK National Health Service:

Harry told me straight away in our first session that he was ‘working the steps’. He described how much AA had helped him to get his life ‘back in order’. He valued the meetings and his sponsor. Yet, when I probed his understanding a little, Harry became angry. He argued back at me. I was not convinced by his conviction, but undoubtedly by his anger. I asked why he was seeking therapy. He said that his psychiatrist had referred him, because of depression, and that was why he was attending. Harry spoke almost exclusively using AA jargon and sayings. I tried my best to convey my thoughts using the same metaphors, but he never responded well to this attempt. I remember feeling very uneasy at the end of that first session, as if I had had to hold on to the session. Was Harry ‘holding on’ too? Or was he being held by his strong AA convictions?

Matt let me know early in our sessions that he was not an ‘alcoholic’. His parents had both been heavy drinkers and he felt that he was born with the problem, it was in his ‘genes’. Matt accepted that he had a problem but somehow would not turn this into an identity. Much later he realized that being my ‘patient’ (his word) was an identity. Matt was more comfortable with the language of science and medicine. He did however manage to hold these terms lightly. His language progressed and changed as we worked together.

Each of these individuals was spoken through by a discourse, one medical, one AA. Each had their own unique story, recast via the structuring metaphors of these discourses. However, the quality of this talking was different and this seemed to affect their capacity to modify and language their therapeutic experience. This is not to critique these discourses. They disclose as much as they conceal. There is no such thing as a ‘pure’ discourse. However a more or less authentic appropriation of different discourses is possible. And different discourses may be limited. The language that is available to particular subjects, is the language which ‘speaks’. So it matters less which discourse is adopted than how that discourse is adopted.

Are these subjects fully aware of their role as a ‘place’ for this articulation? Certainly not in these cases. Perhaps what is clear is that these discourses can be taken up more or less authentically. It could perhaps be argued that there are a limited set of discourses, which course through any subject at any one time. Our claim here is that there are three essential unavoidable discourses, which constitute the addicted subject:

These discourses, particularly societal (2) and addiction (3), have been described earlier. To some extent the family or individual discourse is also a product of the discourses of that culture, but this time filtered through particular family drama and history. Also each subject is affected by these discourses in a unique way, which can never be clearly forecasted.

The etymologies reveal discourses, which suggest being tied down, constricted, perhaps even trapped. This level of discourse is undoubtedly visible in the way addicts speak of their condition. They often report being unable to escape, being caught and yet very much needing their ‘drugs’. A being ‘caught’ yet also a ‘needing’. This ‘needing’ is not dependency in the usual sense, but a need to cope with emotions, relieve pain, find sleep and overcome interpersonal challenges. Yet almost all ‘drugs’ make these aspects of life more problematic, not less. It is a relationship, which is consequently, deeply ambivalent.

While the academic discipline of sociology may suggest that the addict is alienated, an outcast, the individual addict is very much sensitive to this. This often explains why addicts return to so-called ‘using friends’ after periods of abstinence. In this group they belong, have a place and are ‘in’. These groups often develop an internal language, which takes time to learn (Lenson, 1995). These groups try to foster their own discourse, in rejection of the broader societal discourse. But this just fosters greater alienation. This social alienation also goes some way to explaining the shame, which characterizes so many addicts (Wurmser, 1978). This is shame, not for individual transgressions, but for the transgression of just being an addict. Perhaps recovery is finding a new language, a new diction?

Implications for the clinic

If it has been established so far that there exists a particular discourse, which permeates and is addiction, it remains unclear how deeply this social discourse has permeated into the practice of the clinic. Has the domain of the clinic responded to this discourse and language? And perhaps more importantly, how should individual clinicians respond to these discourses to which they are themselves subject? First it should be noted that there is more to clinical interactions than language. There are levels that are interpersonal, emotional and embodied. Brevity prevents us expanding on these dimensions here.

In the most banal sense clinicians should and do become acutely aware of their own discourse. What language do I bring to the treatment dialogue? Does this language continue or undo the symbolic structuring, which the addict undergoes? However, it is impossible to step outside discourse and consequently some ideology will always find expression whenever and however I choose to speak. Of course language is the basis of the therapeutic dialogue, which is at the heart of all ‘talking’ therapies (Frie, 1999). This dialogue allows for the establishment of an interpersonal relationship, which is at the core of therapeutic healing. But surely there is more to language that needs considering.

From our earlier argument, the psychotherapist should attend to the three types of discourse, which pass through the subject. It may, or may not be possible, to analyse in any depth these discourses. Perhaps the most obvious clinical consequence of our argument is to move the treatment beyond the personal and into the field of the symbolic. This ‘beyond’ may be general or specific, but allows the subject of treatment to realize their place as a symbolized subject. Do they discourse as individuals, or as ‘bad’ or ‘sick’? It has always amazed me that when I ask addicts what title they prefer, they most commonly choose ‘patient’. Is this an embodiment of a discourse of sickness? Is it an avoidance of responsibility?

Recall that for Lacan, language, as the symbolic, was the primary determining element of subjectivity. Determined by the symbolic, the subject also finds relief through a different relation to the symbolic. This is not a conscious determining however. For Lacan, the subject does not choose the discourse to which they are subject. Rather, they are the product of this discourse and symbolic structuring. Nevertheless Lacanian psychoanalysts contest that there is some healing, however partial, to be gained by being in psychoanalysis. The Lacanian psychoanalyst listens to the discourse presented via free association and directs, through various interventions, the discourse into other directions and avenues. Over time this restructures the relation of the subject to their language and to their place in the symbolic (Parker, 2011).

While psychoanalysis can be applied to many problems, there are several therapies which are aimed primarily at the condition of addiction itself. Motivational interviewing (MI) is an evidenced-based approach to addiction treatment, which also emphasizes the role of speech in recovery (Miller and Rollnick, 2002). MI attempts to resolve the ambivalence at the heart of addiction: namely whether to change or to stay the same. Therefore MI attends to this ambivalence in the speech of the addict. Attention is given to both sides of the ambivalence, but then using the interactional dynamics of the relationship the therapist directs the conversation towards change and the speech, which exemplifies this. MI distinguishes several forms of speech. There is ‘resistance’ and its more subtle sister ‘sustain talk’. There is ‘change talk’ and crucial ‘commitment’ statements. The therapist learns to recognize these forms of speech, allow them their place, but then steers towards change and commitment talk. As far as I am aware MI has not, however, made the connection argued here: ambivalence is not just in the addict, it is inherent to the language of addiction itself.

While MI is widely used, perhaps the most dominant approach to addiction treatment throughout the world is the 12-step fellowships of Alcoholics Anonymous, Narcotics Anonymous and so on. While it is not possible to explore this approach in detail here, it is fair to say that there are various ways to understand how these fellowships work. Overtly the argument is that it is a spiritual cure (Alcoholics Anonymous, 2001), but perhaps also it is group therapy (Weegmann, 2004), or a therapeutic community (Weegmann, 2009). More recently O’Halloran (2005, 2008) has researched AA meetings and has concluded that the effective element of the process is a change in the way members of the fellowship relate and especially talk. Through various subtle mechanisms members are encouraged to talk about themselves, their addictions and their recoveries using a particular language. This language de-emphasizes individuality, separation and self-sufficiency while emphasizing surrender, mutuality and narration itself. AA members are encouraged to relate their story repeatedly, learning over time to tell the story in an increasingly AA congruent manner. Also the structural dynamics of the AA process also embodies their overt emphasis on mutuality and spirituality. Through rituals, conventions and turn-taking, members of AA learn to practise a sociology, which refuses the modern individualized subject. The sociological structure of AA overcomes this societal alienation. AA discourse, embodied in its various texts, is thus fully consonant with its practice in meetings.

Towards a conclusion

How might addiction now be considered? The argument here is that addiction is constituted, at least in part, outside of the subject. It is constituted by a discourse and set of practices, which are ‘other’. ‘Other’ in the sense that this form of the symbolic originates and flows from a field of meaning, which precedes the existence of the modern subject. However much these discourses originate outside the subject, these discourses find their most explicit expression through the person who is ‘the addict’. So, while addiction is most commonly defined in terms of behaviour (in taking, drinking, doing certain things, etc.) it is constituted equally as a flow of language which finds its articulation in identity and as an identity. This identity is drenched in alienation and ambivalence. Stuck in ambivalence the addict hesitates, and continues to consume. The addict feels alien, unsure and yet wholly committed to finding satisfaction in and through their repetition. The ideology of consumption is fully embodied and realized.

Addiction can thus be constituted as much as a certain language, ideology and place in society as it can as a certain set of behaviours. And these structural components of the discourse of addiction are in fact dealt with via two major approaches to treating addiction. It would be fair to say that these clinical approaches brought language into treatment not as a deliberate component, but perhaps as an intuitive response to the embodied presentation of addiction itself. This can now, however, be articulated more clearly. Treatment approaches and philosophies however alter from time to time. There is a current move towards recovery and abstinence in the UK, eclipsing the era of harm reduction. These changes testify to the political dimension inherent in the symbolic constitution of addiction. However the social implications of a consumption culture, the role of poverty, overly medicalized discourse and the denigration of addicts as a social ill are not often reflected on by those with political power. A capacity to reflect critically on the morphology of treatment practices, via their symbolic articulation, would be a major step forward. This needs to be done simultaneously at an individual clinician level, as well as at the level of social policy.

Equally so, it remains a major challenge for society to recognize themselves in the addict. While I have articulated here how our current technocratic, consumption centred society finds ultimate embodiment in the practice of addiction, it is perhaps not the only place. Certainly society is obsessed with many celebrity addicts. Is there a variety of vicarious alienation occurring here? Certainly these individuals are encountered ambivalently, as objects of fascination, yet of pity and also of derision. The way we discuss and consider these individuals is instructive. Yet perhaps society is comfortable for an unlucky few to suffer for its collective ways of being, while the rest benefit and enjoy the fruits of technology and consumption.