“I’m twenty-nine years old, writing in my journal in a sloppy felt-tip pen (no ballpoints are allowed), trying to understand how I went from being a newly minted physician in a psychiatry residency program at Columbia University to a psychiatric patient at Bellevue, the city’s notorious public hospital.”
That’s a quote from the first page of Carl Erik Fisher’s The Urge: Our History of Addiction (Penguin Random House, 2022). As he reckons with what has brought him to that point and enters recovery, Carl revisits his own history of alcohol and drug use and comes to pose broader questions. “Why was there a totally separate system for addiction treatment? Why do we treat addiction differently from any other mental disorder? If everyone seems to know that the system is broken, why isn’t anyone changing it?” he writes.
“The Urge” explores these and other questions, offering a history of addiction and medicine and society’s response to it through the ages. Drawing on sociology, anthropology, and theology along with psychology, neuroscience, and of course medicine, Carl’s book is part memoir, part work of popular science. But it’s also something more. That’s why I was so eager to explore it with him.
Carl Erik Fisher is an addiction physician, bioethicist, and person in recovery. He is an assistant professor of clinical psychiatry at Columbia University and maintains a private psychiatry practice focused on complementary and integrative approaches to addiction and recovery. His writing has appeared in The New York Times, The Guardian, Slate, and elsewhere. The Urge was named one of the best books of 2022 by The New Yorker and The Boston Globe. He also is the host of the Flourishing After Addiction podcast, which I highly recommend.
Carl’s work is so compelling to me because it combines his scholarly curiosity with his clinical experience and personal past. It’s one thing to write a history of addiction; it’s quite another to do so while also working with patients who struggle with addiction and who are in recovery while being in recovery yourself. The result is work that I’d describe as integrated, a rich whole that combines the general and the specific, the scientific and the experiential, the analytic and the critical. It’s no exaggeration to say that The Urge helped me see the world around me – both current events and medicine’s particular role in them – as I hadn’t seen it before.
Recorded December 13, 2022
Music: Mr Smith
Art: Jeff Landman
Photo of Carl: copyright Beowulf Sheehan