Saturday, January 2, 2010

Can You Control Your Cravings?

As long as there have been ethics, thinkers have wondered why people take actions that they know are contrary to their self-interest.

Do our cravings control us to such an extent that they can induce us to will our destruction, even when we know full well the disastrous consequences of our actions?

Is reason powerless when faced with what Freud called the death instinct or what George Loewenstein calls visceral influences on behavior? Link here. Hat tip to Simoleon Sense.

If reason is an uncertain and easily overwhelmed guide to good behavior, does that mean that we should renounce the Enlightenment and, as I have put it, go over to the winning side by giving our viscera more or less free reign?

If a recovering drug addict knows full well what will happen if he relapses, why does he do so? As Loewensteing asks: "The addict knows, in one sense, that taking the drug is the wrong course of action but is unable to translate that belief into action."

Note well the phrase: "in one sense." Is there perhaps another sense in which the addict does not believe that taking the drug is the wrong action?

If an addict takes a drug to self-medicate, does he believe that he is choosing the lesser of two evils? Between persistent and crippling mental anguish and whatever relief the drug provides, which would a rational person choose? Perhaps the issue is not quite as clear-cut as Loewenstein would want it to be.

To Loewenstein, people are perfectly capable of acting against self-interest, while knowing full well that they are doing so.

Our cravings... for food, for sex, for wealth... lead us astray and block the translation of correct belief into correct action.

In his words: "At sufficient levels of intensity, these and other visceral factors cause people to behave contrary to their own self-interest, often with full awareness that they are doing so."

And this: "...many classic patterns of self-destructive behavior, such as overeating, sexual misconduct, and substance abuse, seem to reflect an excessive influence of visceral factors on behavior."

Of course, some people do not yield to the temptations offered by their viscera. To say that people are capable of acting contrary to their own self-interest does not mean that they will always do so or even that they will very often do so.

Doesn't the culture influence the way we process our cravings?

I am hardly in a position to question the science or the mathematics that informs Loewenstein's theory, but I do question the conceptual formulation. Possibility and necessity are not the same thing; allowing us to confuse the two is not a good thing.

Nor is it a good thing to confuse this issue. To illustrate his point about the power of visceral factors on behavior Loewenstein offers the example of people who suffer from phobias.

In his words: "The overriding of rational deliberation by the influence of visceral factors is well illustrated by the behavior of phobics who are typically perfectly aware that the object of their fear is objectively nonthreatening, but are prevented by their own fear by acting on this judgment."

Is this really such a self-evident truth? The dean of cognitive psychology, Aaron Beck wrote a book called "Anxiety Disorders and Phobias" where he demonstrated that phobics fear objects and situations that are, precisely, objectively dangerous.

People are phobic about spiders, snakes, and wolves because these are potentially dangerous. And people are afraid of crowds and heights and germs because these can be objectively threatening. To find snakes fearsome is not irrational; it is adaptational.

Our ability to recognize danger is essential to our survival. The difference with phobics is that they are more acutely attuned to these dangers. More than they need to be, perhaps. More than they should be, true enough.

But this is not the same as saying that phobics are reacting to objects and situations that are not objectively dangerous.

To which you will respond: a man who suffers from arachnophobia cannot even bear to look at a picture of a spider. Surely, this picture is not objectively dangerous.

That much is true, but also misleading. We might also say that he is excessively sensitive to stimuli, thus, that he is excessively well-adapted to avoid this danger.

You might say that it is rational, or you might say that it is excessively rational for a man to adjust his mind so that he will not mistake a dangerous spider for a harmless one.

As opposed to the non-phobic, the phobic individual is much less willing to accept risk. One could say that phobia attempts to eliminate as much risk as is humanly possible.

When it comes to addicts, I believe we should question whether relapsing addicts are merely giving in to a visceral craving. Loewenstein takes exception to Avrum Goldstein's formulation: "Relapse is, of course, always preceded by a decision to use, however vague and inchoate that decision may be. It is an impulsive decision, not a rational one; and it is provoked by craving-- the intense and overwhelming desire to use the drug."

Loewenstein objects to the notion that addicts make a decision to relapse. He feels that this grants them too much moral agency. On this point I agree with Goldstein, not least because if we do not grant the addict moral agency how do we expect him to do what is necessary to avoid the next relapse.

Do you really believe that addicts will be helped if they feel that they have no responsibility for their actions?

Presumably, Loewenstein agrees with Goldstein when he suggests that addicts relapse because an intense and overwhelming craving takes over their minds.

Here again, the evidence does not support this position entirely. Some addicts, as Lowenstein himself notes, begin to relapse without feeling any intense cravings. They do not feel any strong craving and this tells them that they might be able to handle low levels of the drug.

Why do they incur the high level of risk associated with the first drink or the first fix when they know full well how the story ends?
Are their minds simply playing tricks on them?

Maybe so, but there are other factors at play here too. To renounce a drug or alcohol forever you must accept that you are fundamentally too weak to control your intake. You must also accept that you are weaker than those who can have a drink or a toke and take it in stride.

If an alcoholic goes out to dinner with friends and everyone else is drinking, he might well think less of himself. He might believe that he is advertising an inferiority.

Perhaps it is this perception of weakness of will or bad character that propels people to test the waters again and again.

If so, it is not a will to self-destruct that is taking over the mind, but, strangely enough, a need to save face. Is it rational to want to save face, to improve one's self-respect, even given the enormous risk that is posed by that first drink or that first fix?

Human needs, even cravings, involve more than visceral factors. Human beings do not merely have self-interest. They have social identities and character. People have long engaged in highly risky behaviors because their social identities required it or because failing to do so would diminish their character.

The issue, I would say, is more complex than Loewenstein lets on.

For the moment we need to find a better formulation of the problem of addiction than simply to see it in terms of a craving or a visceral influence that overcomes reason.

The mind's calculations are sometimes more complex than our mythologies.

As for addiction and relapse, I would suggest that we do not begin with the addict's psyche, but with the twelve step programs that seem to be the most effective at helping him avoid a relapse.

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