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Thursday Review: “Does Addiction Have A Subject? Desire in Contemporary U.S. Culture”

Desire and wanting is so important to storytelling that it’s entered popular culture as a kind of parody. The cartoonishly egocentric actor whining, “But what’s my motivation!?” is an extreme form of a very real analytical tool for the humanities. Knowing what a character desires and how they go about getting what they want is the linchpin of any kind of narrative.

This is also the primary touchpoint between the humanities and psychology and medicine: addiction is desire driven to a diagnosable pathology. The psychological and biomedical view of addiction, then, is a window into how we currently understand what desire is, how it’s formed, and how that drives us into action.

Writing in The Journal of Medical Humanities, Jaeyoon Park discusses the history of addiction from the standpoint of desire. Park also illustrates how shifts in our understanding of addiction mirror cultural shifts in our more mundane wanting.

At the end of the paper, Park writes that the changes the article discusses are ongoing, and that is surely one central reason why attending to developments in medical science holds a vital importance for humanistic inquiry today. That is itself a summary of the importance of the medical humanities: that our understanding of our medical selves, psychological selves, and our cultural lives all move together.

The last forty years have seen a shift in our understanding of addiction from a developmental or moral regression give way to a much more medicalized, external model. Park cites a physician speaking in a 1983 PBS documentary about how an addict is 18 going on 15 or 23 going on 16 in terms of their emotional, social, and intellectual development.1

Park then contrasts this understanding of addiction as regressive psychological states to the more recent work on addiction according to “incentive salience attribution:”

In other words, when an object stimulates the [brain’s] mesolimbic circuits, its status for the subject shifts: no longer an ordinary stimulus, it becomes a salient stimulus, which means […] a stimulus that “grabs” the subject’s attention and that “elicits” the subject’s approach. It is as if the object becomes highlighted—or in one of Berridge’s favorite metaphors, magnetic—within the experiential field of the subject. It is not that the object is associated with pleasure, or that the subject attaches a conscious or unconscious promise to the wanted object. Rather, what occurs is a transformation of the landscape that the subject inhabits in which the stimulating object grows bigger, more obvious, and more weighty, exerting a kind of gravitational pull on the subject.

Park goes into some detail about this shift, that desire has moved from an essentially Freudian notion to a historical, external one. Previously , desire and addiction were a kind of hidden, secret, bedrock part of the self that society must tame. We (chiefly) now consider desire to be a natural, developmental part of a person interacting with the world around them. Incentive salience attribution is not only about addiction, it is crucial to normal reward learning.2

Addiction, in our current understanding, is not some regression of the psyche. Addiction is an extreme form of the normal ways we learn to want things. Incentive salience attribution understands addiction as a pattern of behavior.

Park summarizes this shift by saying that since about the 1990s onward, we understand both the formation of desire and addiction as

  1. depersonalized,
  2. object-oriented, and
  3. measurable.

This shift in the psychological and biomedical view of addiction is mirrored in culture, and Park charts this shift in some surprising, and some expected domains.

A shift in addiction science would understandably be mirrored in psychotherapy. The depersonalized view of how desire forms has its analogy in the almost total dominance of cognitive behavioral therapy (CBT), in which there’s no spelunking to find the true and hidden id, ego, and superego. CBT refers back to certain underlying beliefs or axioms that distort a patient’s experience of reality.3

The other two ways Park charts the shift in our understanding of desire aren’t directly from the field of psychology. Because this formation of desire is fundamentally about the individual’s interaction with objects they find attractive, and not about the individual alone, Park discusses the ubiquitous use of ratings as a measure of value. Since our current understanding of desire is not about personal identity, but about action in the external world, the self is fundamentally knowable by means of tracking. If what a person really wants is measured by their activity, their desire is capturable by [quantitative] metrics and not only, indeed not well, by the medium of expressive language.

Park never goes as far as making value judgements about this shift in our understanding of desire. The change, though, contributes to a more human and more personal, nuanced understanding of addiction. Instead of informing an addict that there is something fundamentally wrong with who they are, the focus is on helping an addict correct their behavior.

As for storytelling, this itself is a shift: the desire of an addict in recovery becomes to do what’s necessary to change their habits, instead of the almost unsolvably complex notion that in the deepest, hidden self, there is something flawed.

This shift points back to theater, as well. It might not change how an actor prepares a role, but it’s a reminder that the only way an audience has to judge the desires of a character is what is actually observed in a performance.


The article reviewed: Park, Jaeyoon. “Does Addiction Have A Subject?: Desire in Contemporary U.S. Culture.” Journal of Medical Humanities 42, no. 3 (September 1, 2021): 435–52.

1Kaiser, Lloyd. The Chemical People Book. QED Enterprises Pittsburgh, 1983.

2Berridge, Kent C. “Reward Learning: Reinforcement, Incentives, and Expectations.” In Psychology of Learning and Motivation, 40:223–78. Academic Press, 2000.

3Ellis, Albert. Reason and Emotion in Psychotherapy. Secaucus, NJ: Lyle Stuart, 1962.

Featured Image: “Delicious dopamine” photo by Flickr user Quinn Dombrowski, used under a CC BY-SA 2.0 license.