This Is Running for Your Life (25 page)

Copresenter Ken Rosenberg opened with his own definition of addiction—“a failure to bond”—and the announcement that we are now dealing with behaviors that didn't exist in 1991. Rosenberg's beat was sex, and he was sorry to tell us that he has seen the future sitting in his office, and it's hairy as all hell. “We have a tsunami coming,” Rosenberg said, citing statistics about eleven-year-olds switching between homework and online porn as a matter of course and warning of the addictive neuro-pathways that kind of behavior creates.

As the gap between the kids' learning how to control their impulses and the guardians' trying to figure them out widens, the idea of what's normal threatens to find a new level inside it. Can we stop that from happening? Should we? “We as a profession cannot duck it,” Rosenberg said of the coming wave of misfits, if not the culture creating them. Yet treating apparently “new” emotional and behavioral disturbances like biological events would seem to be another evasion of a problem the 12-step program makes plain. It feels significant that the first thing someone seeking that program's help does is walk into a room filled with other people.

Another
DSM-5
revision seeks to collapse “alcohol dependence” and “alcohol abuse,” two separate diagnoses, into “alcohol use disorder.” Where
DSM-III
defined addiction in terms of dependence (clearing the whiff of conversion and transience that surrounds
alcoholism
and
alcoholic
),
alcohol use disorder
reconceives addiction more explicitly as a brain disease, even as it spreads open a diagnostic spectrum. If it feels like the culmination of a blame-conscious trend in the nomenclature, the fine-tuning of alcohol use disorder's criteria is potentially infinite. On the table now is the removal of alcohol-related legal trouble from the checklist (since state laws differ about things like drunk driving, it is seen as an unreliable marker) and adding alcohol craving. Consensus on what constitutes “craving” is already proving elusive, which might indicate why it was left off the list for so long. An Australian study published in
Addiction
, a scientific journal, and presented at the conference suggested that adopting this new classification would lead to a 60 percent increase in diagnoses; in the United States that number has been estimated at up to twenty million newly diagnosed addicts.

Because a second
DSM
diagnosis often accompanies their addiction problem, substance abusers offer a stark example of how close psychiatry remains to its predicament of a century ago, where symptoms and diseases refuse to separate and assume their proper order. Did the anorexic stop eating because she was depressed, or did malnutrition cause her mood to plummet? Was depression a response to stress or molecular mutation? Was a gene marker for compulsion turned on by circumstance?

The Greek idea that personal identity derives from what we do and how we are perceived has been adjusted for an inward-facing culture: you are what you have, and you have what you do. Instead of reckoning with the world, reckoning with your illness is the path to self-discovery. But what if
owning
your ADHD and responsibly re-upping your Adderall scrips is actually hindering the passage into self? What if we are masking the mysterious cause of so much spiritual and emotional suffering by calling it a psychiatric disease? What if we never stopped being what we do, and that's the better part of the problem?

Separating symptoms from disorders—those who feel depressed from those who
are
depressed or
have
depression—according to a keenly intuitive discretion is the clinician's job. As waves of psychiatrists forsake traditional forms of talk therapy in favor of the lucrative prescription-writing business, the issue of causality recedes from “a philosophical problem with no defined answer,” as one conference presenter put it, to an afterthought defined by default, once a drug treatment is found to suggest that a mental illness is based in bio-pathology. But psychiatry's sibling worship of science is critically flawed: the biological basis of disease is self-evident; it doesn't need to be proven. At stake is the cause—of diabetes, of heart disease, of lupus. Only by understanding a cause can cures be determined and vaccines developed. It's why cancer treatments are so brutal and imprecise. It's why my thirty-six-year-old uncle, an immunologist, died of a heart attack after sloppy radiation treatments for lymphoma weakened his brachial artery. We still don't understand cancer's causes, so we do battle with its effects. By turning to science to prove the existence of sadnesses, compulsions, darkened or deluded minds, and disordered behavior our own experience has already confirmed, we are denying a complexity of self that only language and the continuum of lived experience can contain.

Allen Frances thinks money and hubris have corrupted the APA, that it can no longer be trusted to define the terms of mental health. “They overvalue what they think they know,” he told me. “There's a certain lack of humility for the great unknown, particularly with the impact of this new neuroscience.” Frances doesn't believe there's a new wave of reactive pathologies and takes a question about that possibility as an opportunity to reiterate that the one thing that hasn't changed in the last twenty years is clinical psychiatry—certainly not based on anything brain scans have turned up so far. So why change its handbook?

“Once you write the book, it can be easily distorted,” Frances said, “and you have no control over it. We had every reason to think that autism would
not
become an epidemic, that ADHD would
not
become an epidemic, because we did cautious—fairly cautious things. And that thing blew out of control.” He paused. “These suggestions, they slope the curve of normality.”

When I told Frances that post–
DSM-IV
autism numbers have altered my thinking about having children of my own, his answer was immediate: “I don't think you should have children for other reasons, but autism isn't one of them.” He looked away. “The world's too crowded.”

*   *   *

It was fixing to rain on Waikiki. Having checked out of my hotel and blown off the conference's final-afternoon dregs, I had eight hours and nothing but beach until my flight back to Los Angeles.

It was like breathing wet T-shirt on the strip, so I headed into one of the nearby outlets—a Billabong, if you must know—with nothing in particular in mind. This used to be a fairly safe option. The part of the retail world not geared toward my concrete desires, which were finite and never extended far beyond food, travel, and clothing, was busy proposing possible aspirations, which were infinite, and involved things like hair extensions, handbags, and expanding every part of my physiognomy I wasn't obsessed with shrinking. No part of it was not interested in some present or future part of me. We existed in a kind of mutually reinforcing harmony that way.

Inside the store, carefully curated indie-punk-ska fusion droned from corner speakers and a backwash of sand covered the floor. The salespeople appeared as polished preadolescents, and within a minute two of them had addressed me as
ma'am.
Except for the sand, which I may have imagined, all of these things have happened before. At some point, though, while moving between rack after rack of what suddenly looked to me like clothing designed for sub-life-size sculptures made by intelligent aliens working from rumors of the human form, I realized what was happening. Determined to drop myself from this thing's greatest height, I pulled a fitted, many-pouched jacket and what looked to be a reasonable pair of cargo pants from their hangers and headed for the changing room.

I can't really describe what happened next, except to say that I faced the inconceivable, and it was
not cool
.

*   *   *

I took the only retail job I've ever had during a summer at home in Toronto, after my first year in New York City ended with what I came to describe as a nervous breakdown.

I had always been curious about that phrase. It sounded both mysterious and meaningless—the refuge of Victorian romantics, maybe, or the girls at my grade school who went around, to my voluble scorn, proudly announcing their PMS. And yet there was nothing else to call it, and no way to leave it unnamed. Symptoms: incapacitating loneliness, exhaustion; extreme susceptibility to common viruses, anemic chest pains. Onset: sequoia slow, then all at once.

A couple of times a week that summer I walked over to the high-end boutique where a friend of a friend had offered me a twelve-dollar-an-hour gig doing inventory and stocking shelves. The boutique, since deceased, exemplified a new kind of retail: the concept of the old general store rarefied to scale. They sold their parent company's boot-cut jeans and plush peacoats alongside towels in unexpected colors and designer stemware; Italian kitchen implements mingled with seasonal-print pajama bottoms.

I had asked to stay mostly in the back, where I stacked seat covers and reorganized shelving units filled with scented candles and camisoles. Too much time in public, with people I didn't know, felt dangerous. There was this hideous fragility. An incident in a sandwich shop had left me in a heap on the bathroom floor. For weeks, even small unkindnesses spelled chaos. I appreciated the calm of the stockroom, where I could bring order to the merchandise, stepping onto the floor now and then to watch the show. I was grateful for a place to go.

Cracking up meant asking for help. Deciding that I had, in fact, cracked up was liberating in this regard. Dreading my own company, all summer I followed family and friends from room to room, auditing weekend trips and errands to the hardware store as though they might save my life. I tried therapy, briefly, but it was too late for that. It was too late for a thumbs-up in the dike.

At its core it was a problem of context. Flailing around inside my own poorly defined limits, I had lost my place. The rituals of youth no longer mark our passages with any authority. We reach maturity any number of times—biologically, religiously, legally, academically, socially—before the age of twenty-one, but the imputation rarely sticks. The world will not be informed of your various arrivals, the world informs you. It probably always did, though multiplexity means better hiding places, more ways for the contingencies of time to splinter into crisis. It seems obvious to me now that tribal coming-of-age rituals are often designed to be searingly painful so they won't leave any doubt. Because cut as many ribbons, engrave as much parchment, pound all the Jäger shots you like, the long and largely spouseless, childless, asset-free stretch of one's twenties and thirties is not the ordered march into adulthood it has been.

And so, at some point, the options are made plain. The longer you wait to address them, the more basic they become. The world informs you and then you must decide. Slowly, sometimes moment by moment, small choices about whom and how to be beget bigger ones—shading in background, scaling out the continuum; striking out villains, fleshing in the overlooked—until the story begins to tell itself, with a fully fledged hero at its center. Here's the gist: at twenty-nine, I broke down and became a woman.

Because the boutique was near a cluster of office buildings and a grocery complex, at lunchtime it teemed with working women. Wearing bright pedicures and the face of drift, they moved absently about the floor. It's one of the most private rituals you will see a woman conduct in public: eye contact is discouraged and conegotiation strictly peripheral. Crossing domains—kitchen to bathroom, beauty to fashion, work to home—the women reached out blindly, caressing a crystal decanter, briefly adjudging a mandoline, letting the synthetic but reasonably silklike fabric of a peach-colored blouse slip through their fingers as they passed.

“They don't know what they want,” the store manager shrugged one afternoon, after I remarked on her deft brokering of the sale of a three-hundred-dollar leather jacket. “You just have to tell them.”

I think of that summer in the stockroom when I see those women now—when I see us—arms outstretched, passing through the material world in a waking trance. I wish I could tell her what she wants. I wish I knew.

*   *   *

The sky was pouring as I hurried out of Billabong, youth officially over, and ran toward an open, sheltered structure on the beach. I sat at the third of its seven stone picnic tables, where one muttering woman was quickly replaced by another—a Hawaiian for a blonde. At the next table five men were playing bridge. The blond woman pulled a woven mat from the green milk cart fastened to a set of wheels and spread it out on the ground behind me.

“You gotta be in by nine, out after six,” said the bald, mustached man with the Carolina accent. “New house rules.” The men murmured. “But you know what? I'm gonna break 'em.” He giggled like a Nick Ray delinquent, a real juvie. The blond woman in the pink floral dress pulled white wool and needles from the pink-and-black plastic suitcase beside her crate and began crocheting an infant's skullcap. The chess game at a far table had attracted a crowd.

A gaunt, shirtless guy in orange shorts changed tables every fifteen minutes, bicycle in tow. The Hawaiian with the dangling cigarette and
HANG LOOSE
trucker hat had placed a blue cushion between his butt and the stone slab. A stringy blond hustler blew through the shelter, talking up a designer-sneaker windfall. The bridge club ignored him and he skittered away, sorry for their loss. The Hawaiian snorted, “Wasn't he the one with the coffee yesterday?”

I had been sitting there for about an hour when a shoeless man with bursting-blue eyes and a badly scabbed face and hands took a seat directly across from me. His thick head of eggshell-white hair was well combed with pomade on one side, but mussy and crusted with bird shit on the other. He was small and shambling with bright, vaudevillian features and hid a minibottle of vodka in his right hand. We looked at each other for a second or two.