Pro et Contra - Clinique & Critique
We must distinguish first of all between a syndrome and an illness.
A syndrome is a cluster of phenomena which together present us with a particular assemblage of symptoms or “clinical picture” (Krankheitsbild); an illness is the effect of a particular cause. One expresses a conjunctive relation, the other a causal relation. An illness answers to the question “What is it?” A syndrome answers to the twin questions “What does it do and how does it work?”
Ordinary language use makes it difficult to see this distinction. “What’s wrong with him?” we ask; “He’s got the flu” and “He’s an alcoholic” are both conversationally adequate responses to this question. But addiction is not a cause, it is a syndrome. The answer to the question “What’s wrong with him?” can be equally well answered with “He’s got the flu” and “His body is infected with a particular strain of influenza virus.” On the other hand, in causal terms the answer to the question “Why is he staggering around like that?” is never originally “He’s an alcoholic”; the first few times it happens, the answer is “He’s had too much to drink.” The answer does not become “He’s an alcoholic” until the effect in question has presented itself a good number of times. In other words, even if the sole, exclusive symptom of alcoholism was excessive drinking, “alcoholism” is not a single thing but rather a cluster of phenomena or events that can be much less clearly expressed as “every time he’s had too much too drink and every problem and complication those times have caused him and every problem and complication those times have caused everyone else around him.”
To begin with, then, an addiction is always a multiplicity. It is a collective designation for a cluster of phenomena. And like every conceptual multiplicity, understanding addiction requires two separate cognitive movements: What are its elements? and What kind of effect do these elements produce in constellation? In other words, analysis of a syndrome, unlike causal identification of an illness, has two necessary stages: descriptive and evaluative.
In the case of addiction, the descriptive and the evaluative correspond to the quantitative and the qualitative. In the example of alcoholism, the first question is, “Does he drink significantly more than an average person?” (The term “average” here is always a relatively arbitrary mean). This is the quantitative description (“a lot or a little?”). The second question is, “Does this quantity of drinking produce a detrimental effect given this particular person’s circumstantial conditions?” This is the qualitative evaluation (“good or bad?”).
The reason this double question is necessary is, quite simply, that evaluation is always circumstantial or contingent (we recall Nietzsche’s aphorism: “There are no moral phenomena, only moral evaluations of phenomena”). Another way to put this is that “a lot” and “a little” describe an abstract relation, while “healthy” and “unhealthy” evaluate a specific relation. More bluntly - different people can handle different quantities of drugs, not only physically but also contextually.
Let me give an example from my errant youth. When I was young, I was famous in my circle of friends for being able to chug vodka. I was stick-thin, had a lightning-fast metabolism and genetically high alcohol tolerance that runs in my father’s family, and I could drink a bottle of Absolut in about 45 minutes without passing out, throwing up, falling over, or otherwise making an ass of myself. Over the years, though, I’ve started going out much less frequently, drinking less and less frequently, and my metabolism has slowed down. If I tried to drink a bottle of Absolut by myself in 45 minutes, the results would be sad at best and disastrous at worst. Descriptively, drinking a bottle of Absolut in 45 minutes represents a greater-than-average consumption of alcohol by any measure. But evaluatively, we see that the “goodness” or “badness” of the phenomenon is contextual, not absolute: the same person performs the same action in two moments or contexts, and their value is drastically different.
In other words, one again we come back to the basic link between ethical evaluation and utility. As was the case with exercise in this earlier post, we cannot ask “Is it healthy?” without implicitly asking “Is it healthy for…?” Marijuana use is another example. You don’t necessarily want your cardio surgeon taking a bong hit before performing heart surgery on you. But it’s much less disturbing to think of your favorite musician taking a bong hit before laying down some tracks. So that even one of the broadest criteria that experts use to evaluate whether substance consumption constitutes addiction - the extent to which it interferes with your job and your everyday life - is entirely contextual, that is, particular. This becomes most clear if we evaluate addiction based on “quality of life.” For a broke graduate student, spending $150 a month on marijuana might represent a significant decline on their quality of life, due to financial constraints, while a millionaire my be able to spend $10,000 a month on cocaine without their quality of life being significantly impacted. The quantitative relation (a lot or a little) doesn’t acquire a qualitative meaning (good or bad) except in and through its immanent context.
Another way to say all this is to say that the difference between description and evaluation is the difference between “a lot” and “too much.” As Deleuze writes in “Two Questions on Drugs”: “The second question would be: How do we account for a ‘turning point’ in drugs, how do we determine at what moment this turning point occurs?…Why and how is this experience, even when self-destructive, but still vital, transformed into a deadly enterprise of generalized, unilinear dependence?…If there is a precise point, that is where therapy should intervene.”