What if, instead of shaming people for their addictions, we embraced the idea that we are all addicts?
That's the question Elizabeth Roberts, medical ethnographer at the University of Michigan, asked after spending years living in working class neighborhoods in Mexico City. Her neighbors there proclaimed themselves addicted to various substances-alcohol, soda, drugs, shopping-and as long as the addiction drew them together, they cherished it. But if a substance drove a person to isolation, they considered them lost to a detrimental vice, not addiction.
Roberts spent years examining this distinction between addiction and vice in context of her own battles with binge eating as well her sister's struggle with alcoholism in the United States. She says this distinction could be used as another kind of harm reduction tool that prevents shaming people with addiction and, in fact, may help them survive.
What led you to think about addiction in this way?
I'm a medical anthropologist, and for the last nearly 15 years, I've been collaborating with environmental health birth cohorts in Mexico City. One of them, called ELEMENT, is based here at the University of Michigan at the School of Public Health. It's a birth cohort that's been running for over 30 years.
Environmental health scientists usually use surveys and collect biomarker data to understand the impact of, say, a single chemical like lead on people's health or developmental outcomes. In 2013, I approached ELEMENT and said, "What if I did ethnographic work in these neighborhoods where a lot of ELEMENT participants live. What if I lived there, and learned more about the participants' everyday lives?" And so in 2014 and 2015, I lived in two neighborhoods that you could think of as working class neighborhoods, or colonia populares.
There, people kept telling me they were addicted to lead, which was weird. I also started noticing that people were talking about addiction all the time, and in really different ways than I was used to coming from the United States. They were telling me that everyone is addicted to something. I explore what seemed like their strange relationship to addiction in my book, "In Praise of Addiction: Or How We Can Learn to Love Dependency in a Damaged World."
How were they talking about addiction?
One of the main findings of the environmental health study is that the primary form of lead exposure in Mexico City is coming from these lead-glazed ceramic dishes. If you've ever been to Mexico or to a Mexican restaurant and you see these shiny terracotta dishes, those probably have been glazed with a lead glaze.
But many people's experience was that lead also makes food sweeter. People talk about the beans being sweeter and the food tastes better. They said they were addicted to lead, that they loved the dishes, that they were devoted to the dishes and they couldn't stop using them, even though they were being instructed by people in this environmental health study to stop using them. They would talk about this addiction in this kind of triumphant, celebratory way. I realized they were also talking positively about addiction to other substances we think of as harmful, like alcohol, soda and drugs.
Can you compare the concept of addiction in Mexico City to ours in the U.S.?
In one of the houses in which I was living and working, the patriarch of this four-generational household, Clemente, came knocking on my window one morning, begging for a drink. It was a very disconcerting experience. I ran across the courtyard to his son's house, and his granddaughter opened the door. I said, "Your grandfather's begging me for a drink and it's seven in the morning-what's going on?" And her mother said, "Oh, just give him a drink."
Later that day his wife, who was my landlady, told me Clemente has a vice. She said we are all addicts, all alcoholics, but he has a vice. I asked her what I should do if Clemente came begging again, and she said to just give him a drink. I thought, "On what planet is this OK?" But she was telling me that there was a distinction between addiction and a vice.
Over time, I started to see that this was a really common distinction, and that addiction was something to be celebrated because it held people together-that it is the single most important thing in these communities in Mexico City. What binds you with others is what you want to continue to foster, even if, from our point of view, it's something that might damage your individual health. That is less important than something that binds people together, and anything that takes you away, no matter what it is, is a vice.
Alcohol bound most of my landlady's family together, so it was an addiction, but for Clemente, alcohol was a vice, since when he drank, he isolated himself. For his family, the problem was not his drinking but his isolation.
Were their addictions that we would consider destructive by U.S. standards?
One of the main things I describe in my book is people who don't pathologize addiction or pathologize dependency. Their baseline assumption is that we should all try to cultivate as many dependencies as possible. So if you're dependent on alcohol, and it's connecting you to other people, that's a positive thing.
In the United States, on the other hand, we're so sure that dependency in general is pathological-that we need to grow up and become independent. We need to be individuals. When we are dependent on a substance, we're sure that's wrong. This starts a cascade of judgment that becomes deadly in the United States, because we end up more isolated.
What does a better approach look like?
I'm going to connect my response to the harm reduction movement which seeks to prevent the harm of substance use. In the U.S., much of the harm of substance use comes from the harm of the War on Drugs, the harm of criminality and the harm of shaming people for their dependencies, which, in the case of drugs like opioids, leads to isolation and death by overdose. A better approach would be decriminalizing drugs, and also examining our commitments to independence. Could we start celebrating what binds us together, instead of shaming others and ourselves for our addictions?
