On Desire And Disease

When does desire become disease?

That’s just the question I found myself pondering after coming across, in the midst of research for a recent piece about how medication assisted treatment can reduce the unpleasant symptoms associated with withdrawal, the description of opiate addiction as “characterized by the strong desire to obtain and take opioids despite negative consequences.”

It’s a phrasing that particularly piqued my interest given my recent viewing of the series Dopesick and the two reflective pieces I wrote in response. Even characters who had started the drug for legitimate medical reasons eventually became intensely, physically overcome by their “desires” for it, so much so that they would sacrifice their livelihoods, values, and most meaningful relationships to the drugs’ endless pursuit. 

I’ve never abused opiates, and remember them having little psychological impact on me when I was prescribed some after a dental surgery a few years back. But, as we all do, I think I do know something of desire, and maybe even saw something uncomfortably familiar in watching Dopesick’s desperate characters frantically stave off withdrawal.

In this, I’m less referring to my relatively low-key dalliances with drugs and alcohol than to the years I spent flitting wildly between periods of self-starvation and rebounds into out-of-control binge eating. Eventually, it got to the point that I would fast for most of each week only to binge on each subsequent weekend. 

It was a level of deprivation that was profoundly disorienting, if not as physically harmful as it may have been if I had stayed at one extreme or the other. I struggle, though, to describe the complete illogic and detachment of whatever strange place I was suspended in, the one where the resistance or pursuit of food were the only endeavors that still held meaning. 

In acting on your desire for some ersatz ideal, you step into the mirror and only then find that it’s a passage to nowhere, that you’ve picked up the script for a play nobody wants to see. All the lines mean nothing, but the lines are the only thing you remember because now you’ve forgotten your life offstage. You are a painting with no audience, a puppet spinning for an empty room—you may as well be nothing at all. 

How can I explain that?

Being nothing at all?

How can you talk about hunger: that desperate, down to the bottom of you hunger? That deranged down to the bottom of you fear. How things can become pure need, pure terror, pure sensation. How you can fall out of your body and die alive, then think a barren ghost-world is the place you’ve always lived. 

But words, in the end, can only ever approximate; a map is always different than a terrain. Maybe I can’t describe the feeling of enslavement to one desire that eclipses all others— and maybe you can’t either, whatever may have been your particular vice. Not really, not how it felt, how it changed you, or killed you, or broke you down.

And not how there was a long period in which I was aware that obsessively focusing on my weight was not actually satisfying me and that my attempts at restriction were more likely to result in an eventual binge than in weight loss, it felt as if I couldn’t simply “stop” the cycle, despite the fact that its negative consequences on my mental health were readily apparent.

I feared the void of uncertainty and aimlessness that might open up without my preoccupation, and actions that had begun as “decisions” had somehow come to feel irrevocably entrenched. What had begun as a grasp at control became something I had entirely lost control over— to the point that I would characterize an eating disorder as something I ever “had” than as something I was driven mad by desire for.

—

Why do we desire the things we desire?

At least physically, much of the answer seems to lie in dopamine, a reward chemical that is released in response to the administration of just about every addictive drug.  This fabled neurotransmitter is often called the chemical of pleasure, but it’s also often said that that isn’t the whole story. No, it seems that dopamine is something harsher: the chemical of desire. 

But it still, often, puts the cognitive “wants” of our higher selves at odds with our primitive, dopamine-based desires for whatever our brain thinks will help us survive. No one would ever say that they “want” to destroy their lives by becoming drug addicts—but because their desire for their drug of choice is so strong, they choose the temporary relief of satisfying their craving, either without realizing or without caring about the long-term consequences that could result.

And since the approach behavior mediated by our biological reward system is the foundation that everything else is built on—our attention, our cognition, even our movements—untangling an obsessive desire for anything from the rest of our psyche can be an exceedingly complex task. 

 Yet the network dopamine controls is a sophisticated one, and one that eventually learns to respond to all kinds of secondary rewards, which allows for higher order activities like setting goals as well as for addictions to things other than psychoactive substances.

For example, one corrupt Purdue sales rep in Dopesick refers to himself as “addicted” to the money his toxic trade is bringing him. Money, of course, is not something you can get physically “high” on,  but, by virtue of what it represents, it can foster an overwhelming desire that in turn fosters a series of beliefs: this thing (drug, body, person, sex, money, cheesecake, etc) is what I need to be happy—or what I need to survive. 

As I have previously pondered, there are both pros and cons to thinking of addiction as a “disease.” But I will suggest that if some desire has overtaken your mind and heart to the extent that you believe you will not be happy or functional unless you have that thing, it is not necessarily a sign of any fundamentally “diseased” thinking for someone to behave in extreme ways in order to pursue said thing at the expense of all else, however absurd, dangerous, or damaging that extreme behavior may be. 

—

To the extent that the Sackler family, who misleadingly marketed opiate painkillers on a massive scale, are guilty of causing disease, they are guilty of the crime of inciting desire; of opening a Pandora’s box by offering, through their peddled poisoned pills, an illusory short-lived satisfaction of the yearning that lies at the heart of every human psyche. And while the burden of physical cravings can often be lessened with medication, there is no completely eliminating the more emotional desires that my drive our drug use.

However, desire itself is neither good nor evil but simply a part of how all human beings move through the world. Thus, perhaps it makes sense to conceptualize recovery not as a conquering of desire or a surrender to a life of dissatisfaction but as a process of shifting your desires.

Sometimes, this shift comes about due to a realization of just how much you have lost or may lose yet, or it might be brought about by an external wakeup call or the pure exhaustion of a life dedicated to chasing an ever-elusive high.

Some combination of these factors are responsible for my own shift away from obsessive dieting over time, with lower and lower percentages of my brainspace being taken up by worries about weight and body image and more “normal” habits eventually becoming more comfortable. Long story short: I found other, more meaningful pursuits and causes I wanted to be able to devote my full attention to; I found more important things to want. 

Desire, at its worst, can make us into self-serving monsters, but desire can also inspire action, and inspire change. Desire for a better life can inspire us to conquer the countless obstacles that we will face in breaking free of addiction, and desire can inspire us to become better, fuller versions of ourselves, both for ourselves and because of what positive impact our recovery might have on others. 

As powerful as desire can be, no desire is irresistible, and with enough determination and the right professional help, you can reshape your mind’s landscape into one that allows your desire to propel you towards growth instead of towards destruction.

It’s never too late to get back on the path towards a brighter future: to rewire your brain and remake your world. To learn more about how Reco Intensive’s comprehensive treatment program can help you or a loved one begin to conquer their addictions’ underpinnings and set the stage for a lasting recovery, feel free to contact us anytime online here or at (561) 464-6533.