Both Matthews and I see addiction as the outcome of developmental processes that arrive at diverse levels of dysfunction for different individuals at different stages. Matthews characterizes "late-stage" addiction in terms of lost control and extreme automaticity, a degree of dysfunction he calls a "disorder" and compares to another disorder -- depersonalization. I don't mind the label "disorder." Yet addiction is no more like depersonalization than it is like other conditions, most notably obsessive-compulsive disorder. Automaticity is never pure or total. (...) My dual focus on the phenomenology and neuroscience of addiction has helped me capture these critical details and differences. In fact, I think we've had enough of comparing, classifying, and defining addiction. It's time to recognize addiction as a thing in itself, unlike anything else. (shrink)

Although I reject neuronormativity -- an idea central to the Brain Disease Model of Addiction -- Henden and Gjelsvik argue that the disease definition might refer to normativity in nonneural domains. They profess that a cognitive dysfunction, or a mismatch of evolutionary intentions, could also qualify as norm violations, thus legitimizing the disease label. The need for dividing lines is questioned as well. I rebut these criticisms in turn, but I must admit they are thought provoking.

Mental disorder (earlier entitled “illness” or “disease”) is ascribed to deviations from normal thoughts, reasoning, feelings, attitudes, and actions that are considered socially or personally dysfunctional and apt for treatment. Schizophrenia, depression, and bipolar disorder are core examples. The concept of mental disorder plays a role in many domains, including medicine, social sciences such as psychology and anthropology, and the humanities, including literature and philosophy. Philosophical discussions are the primary focus of the present entry, which differs from the entry on (...) Philosophy of Psychiatry in noting several different approaches—not only those of the philosophy of science and mind, but also those arising from phenomenology and social theory. -/- Mental disorder is a widely contested concept and there are longstanding debates on whether disorders are biological or social in nature. Even uncontroversial disorders, such as those listed above, were not always regarded as disorders in the past (Porter 2002). Moreover, the status of mental disorder has frequently indicated ethical, as much as other deficiency (Irwin 2013). Such reminders direct our attention to contemporary medical psychiatry’s sometimes uncompromisingly neurobiological, and avowedly value-free “medical model”, with its incumbent analogies and assumptions, and to the general question of how the taxa of psychiatric classifications are to be viewed as objects of natural science. This model has received intensive philosophical scrutiny, including arguments that deny these conditions are deficiencies at all. Along with issues arising from cognitive psychology and the neurosciences, such foundational matters make up much of the following entry. Because of their focus on issues central to the philosophy of mind and ethics (e.g., the mind-body problem, moral responsibility, agency and identity), analyses of mental disorder have extensive implications for those fields. As clinical phenomena, they also reflect an inescapable, everyday, social reality, giving theoretical inquiries additionally urgent practical, moral, and legal implications. (shrink)

Flanagan asserts that my model of addiction would apply as well to sonnet writing. Yet his most interesting point is that “addiction” is an imprecise label for a cluster of distinct phenomena. I agree with him that we need to examine these distinctions, but that doesn’t negate their shared features. Neuroscience can play an important role in advancing our understanding of both commonalities and distinctions within the phenomena of addiction.

In this introduction we set out some salient themes that will help structure understanding of a complex set of intersecting issues discussed in this special issue on the work of Marc Lewis: conceptual foundations of the disease model, tolerating the disease model given socio-political environments, and A third wave: refining conceptualization of addiction in the light of Lewis’s model.

I applaud Fenton and Wiers' attempt to find a demarcation point between cases of addiction that fall within the range of normal function and those that may count as disease. However, I argue that continua don't offer demarcation points, the mechanisms involved are not demonstrably different, and trying to pin down subjectivity doesn't help.

Berridge's nuanced approach to the conceptualization of addiction as a disease is easier for me to accept than most others. In fact, Berridge and I agree on many core features of addiction, but still not on how to label it. When competing definitions reach a standoff on intellectual grounds, we should look at the clinical utility of each. And here I think that Berridge misses a critical insight. Yet, we end by agreeing to keep listening to each other.