Editorial Comment 6/23/2020: History of addiction medicine – converging paths

ACAAM, the association of program directors in addiction medicine, thoughtfully provided certificates of acknowledgment to all of the recent fellowship graduates on June 4^th. The acknowledgments included photographs of those about to graduate, and while this is a pretty mundane observation, I was seized by how youthful at least half of the faces appeared to be. This is a not inconsequential observation, because it follows on the lengthy development of a field whose history the graduates might well not know.

The second, converging path was an invitation to be the guest lecturer at the West Virginia University School of Medicine Psychiatric Grand Rounds, on the same topic, A History of Addiction Medicine.  The audience was gracious and good; they kindly put up with one of my digressions, inclusion of Shakespeare’s 119^th sonnet.  I probably would not have been so patient as they, 40 years ago. But the beauty of web-based platforms is that they allow the attendees to stroll off and get coffee, take a catnap, etc., perks of which I hope they availed themselves. 

So, my digressions lead to a digression, sorry.  Back on track. Here is the poem:

What potions have I drunk of Siren tears,
Distilled from limbecks foul as hell within,
Applying fears to hopes, and hopes to fears,
Still losing when I saw myself to win!
What wretched errors hath my heart committed,
Whilst it hath thought itself so blessed never!
How have mine eyes out of their spheres been fitted,
In the distraction of this madding fever!
O benefit of ill! now I find true
That better is by evil still made better;
And ruined love, when it is built anew,
Grows fairer than at first, more strong, far greater.
   So I return rebuked to my content,
   And gain by ills thrice more than I have spent.

On the face of it, the poem is about deviating from a journey with someone beloved in favor of more immediate pleasures, evil pleasures, only to return to the abandoned object of love and discover new intensity.  But it is also about ambivalence. And it is noteworthy that the object of the new passion is never identified as being a person. This is as much about obsession, even addiction; and the new construction of something better than had ever existed before, upon the author’s return.  Who among our patients has not heard the Sirens’ call, craving, that causes them to wreck their boat upon the rocks? 

And who among them would have believed that in recovery they might find something more beautiful, more satisfying, a greater gain than they had experienced even before the Sirens’ call?

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(Unrelated: I wish that all will be able to celebrate Father's Day, while understanding the ambivalence that many of our patients’ families will experience, about fathers and fatherhood.)

- W. Haning, MD, DFASAM, DFAPA