Beware the Cure

Diseasing of America: Addiction Treatment out of Control, by Stanton Peele, Lexington, Mass.: Lexington Books, 321 pages, $19.95

In Diseasing of America, Stanton Peele describes an America in which reason, self-reliance, and community are being swept away by a bizarre ideology that defines human problems and excesses as addictive diseases. He suggests that this ideology and the accompanying treatment industry could lead to a medical-religious totalitarianism.

Peele's vision is a social-science counterpart to Margaret Atwood's brilliant novel The Handmaid's Tale. Both Peele and Atwood perceive a real threat in those who seek to heal and purify the American public; both show how the healers mix medical, religious, and psychological ideas into coercive treatment rituals; and both identify a poisonous fear that makes Americans vulnerable to the healers' dogma.

Peele's style is unusual. He draws heavily from the scholarly literature but also from popular television shows and the New York Times. He writes in a casual manner that invites readers to forget that he is a professional scholar. It must be said that he sometimes sacrifices precision for informality, although the underlying analysis is rigorous and compelling. Peele used this casual style in his Love and Addiction to introduce ideas that have enriched the thinking of less adventurous scholars, and I believe he may make as great a contribution with this new book.

As a Canadian, however, I'm not sure whether the situation in the United States is quite as bad as Peele paints it. He leaves the impression that large numbers of Americans who use drugs moderately are being forced into treatment for addiction through urine-testing programs at work and school; that most treatment for addiction in the United States is now involuntary; that such treatment usually forces patients to redefine themselves as having lost control and preaches that they must forever after abstain from all drugs; that a significant number of Americans have been acquitted of crimes as serious as infanticide and spouse murder on the grounds of dubious "diseases" such as postpartum depression, alcoholism, and drug addiction.

Peele also leaves me with the impression that Americans are astonishingly gullible. But do many otherwise sensible Americans really believe that the basic problems of underclass ghettos are caused by crack or other drugs, or, as self-serving experts suggest, that 80 million people (three times the population of Canada) require treatment for either alcoholism, alcoholic codependency, or the effects of being raised in an alcoholic family? Do Peele's horror stories truly reflect an enduring mentality in the United States? Or could these phenomena be just the aberrations of a dark period, a brief nightmare in the long life of a great and intelligent country?

If they are nightmares, then Diseasing of America is a timely wake-up call. But Peele (and Atwood) could be more right than that. What if the United States really is dominated by moral zealots spouting medical-religious-psychological doublethink? In that case, Peele's analysis would be critically important, although it would leave some vital questions unanswered.

The most important unanswered questions concern cause. Why are Americans so receptive to disease theories of just about everything? If the immediate cause is fear, as Peele implies, what causes the fear? What is the root cause of ghetto violence? Surely poverty alone is not a complete explanation. What underlies the widespread incidence of excessive or addictive behavior? The last question could be the most important of all. The ubiquity of personal excess provides an ideal opportunity for the zealots who proclaim the taxonomy of imaginary diseases and peddle their coercive treatments. Peele shows that the tendency to excess is not disease; but what is it?

Here, as I see it, he becomes too informal. He mixes two major ideas together and tosses a few minor ones about as well. One major idea is that excessive people are coping as well as they can with impossibly difficult circumstances, given the limitations of their personalities and abilities. The other is that excessive people are just not trying hard enough, that their problems are a failure of will.

The first of these ideas leads to the humane implications that shattered communities must be restored to normal levels of intimacy and support and that poverty and joblessness must be reduced among the underclasses to provide opportunities for reasonable satisfaction without addictive excess. However, these remedies may be out of reach without some further analysis of the forces that made American society so harsh in the first place.

The second idea, that people who misbehave are simply not trying hard enough to control themselves, seems to me just as dangerous as the idea that they have a disease. Both ways of understanding people—as having chronically weak willpower and as having addictive diseases—imply the need for a technology of control. In one case, the control technology would bolster willpower, and in the other case, it would cure the disease and restore self-control. Peele makes it clear that he sees these two kinds of intervention as fundamentally different, but to me they sound distressingly similar. I will be happy if Peele shows that I am wrong in this fear, but he does not accomplish this task in Diseasing of America.

Leaving aside the still-unanswered questions, I believe that Diseasing of America is important. Stanton Peele has vividly portrayed the anatomy of public folly. His vision is startlingly acute, and his sensitivity to the human condition runs deep.

Bruce Alexander is a professor of psychology at Simon Fraser University in Burnaby, British Columbia, and author of Peaceful Measures: Canada's Alternatives to the War on Drugs (University of Toronto Press).