A Million Little Pieces

I am in the process of reading "A million little pieces" by James Frey the second time around. This book, this wonderful work of art, is about the author's struggle as a drug addict and his struggle in a rehab center and how he befriends the other recovering inmates of the center and their individual stories (to a much smaller extent)

The author was criticized by the keeper of our collective world conscience,Oprah Winfrey in 2006 (not sure about the year), when it was revealed that he had manipulated certain elements of his true life story into something more dramatic and readable. As a person who has worked in De-addiction Psychiatry, let me be the first to tell you that the lives of these people are anything but readable. They are powerless over a crippling addiction, their families despise them for who they've become, and they are alienated by society in general. And they are angry at the world for looking at them with unsympathetic eyes. Yes, it is also true that they lie, they cheat others and they steal in the process of them becoming dependent on the substance they very often wish they could do without.

While Frey may well have manipulated certain aspects of the book, the book is in itself a haunting portrayal of one man's reluctance to seek help, his anger and defiance while in rehab, and his coming to terms with his own problem. And it should be read by anyone who is interested in addiction, or who has a substance use problem, or thinks they might have a substance use problem. In short, it is a masterpiece.

The author has publicly gone on to say that he thinks addiction is not a medical illness and that the element of free will involved in the process of becoming dependent is not present in most of the other medical disorders in current literature.

While I do agree that the environment plays a key role in any illness, let's look at this from a different angle. Is it possible to choose that you keep on drinking daily and consistently until you wake up every morning with trembling hands? Is it not possible to make a conscious decision to stop when you feel that things are going out of control?

I feel that it takes something far more than personal choice in order to make a person want to drink repeatedly and repeatedly. It might be easy for us to say that it is an illness caused due to a lack of will power. Aside from James Frey, I have not come across a person who has overcome the illness who feels that it was something of their own making. The responsibility to seek help for their illness is their own, but whether or not they choose became a habitual, problematic drinker or not is something I am not truly convinced about.

Personally, it was very hard for me to identify with many things that these people were going through, until I realized that there may be something more than a lack of pure will power involved here. The external manifestations, or phenotype as it is called in genetic language, is such that these people often have a history of cheating, stealing, lying to everyone-including the treating team, that makes it very difficult for a clinician to feel sympathy for them. However, once things are seen from a biological perspective, I think our outlook on these people will change.

Alcohol Dependence is the classical bio-psycho-social disorder, meaning that the person's biological constitution, environment and social milieu are all to blame for the illness. I think it's time we spent more effort in hoping to unravel the biological mechanism behind this illness while promoting social therapies like self help groups as a cornerstone for the treatment, or maintenance of this illness.