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This chapter compares typical experiences and practices of identification and anonymity in the state-run Addiction Hospital and the House of Recovery. “Identification” can refer both to the determination or recognition of “what a thing or a person is” and to “the becoming or making oneself one with another, in feeling, interest, or action.” This chapter focuses on both meanings and their relationship with one another. It begins with the Addiction Hospital, describing the institution and then shifts to the House of Recovery. In each case, it examines how the possibilities for self-identification were opened up or foreclosed by ascriptions of identity made by interlocutors, and how such opening up or foreclosure in turn shaped the mutual potential for identification with one another. Finally, it concludes with a brief consideration of identification and anonymity within ethnographic practices.

One of the most obvious social changes over the second half of the 20th century was the increase in the proportion of young people using alcohol and different kinds of drugs. Recreational use of illegal substances has increased and is now a conspicuous part of the social landscape. We know that using substances is associated with a range of poor outcomes. The UK has a high level of adolescent alcohol consumption and problem use. What are the implications? The literature is rarely focused on the more specifically developmental aspects of use in adolescence, and preliminary evidence suggests that indeed there may be links between the rising trends in both substance use and mental health outcomes.

Sometime in the middle of May in 2017—at the height of summer in India—a grainy mobile phone video began to make its way across the country. The recording rocketed from phone to phone, first in the eastern state of Jharkhand and then nationally, circulating among groups on WhatsApp. The video was shot in portrait, showing a man beaten and bloodied, crumpled up on a patch of barren earth. His white undershirt was rolled up to his chest and drenched in blood. Encircling him was a small mob of men armed with cane sticks. Several appeared to be filming the proceedings on their phones. “You son of a bitch,” someone screamed. “Motherfucker! We’ll kill you!” A cacophony of abuse was under way. The man was pleading for his life, but his cries were drowned out by a rising tide of expletives and fury. The mob continued to beat the man. The video cut to black. The subject, Sheikh Haleem, was killed. He was only twenty-eight. Six others were killed as well, across two separate vigilante attacks. It was as if a cloud of rage had suddenly descended on a small part of Jharkhand, propelling village men to embark on extrajudicial murder sprees. It turned out that a rumor had spread that a group of strangers was abducting children from nearby villages. The rumor made its way onto WhatsApp; the rumor morphed into “news”; the news, circulating from phone to phone, villager to villager, was weaponized; a group of locals decided to act. The rest happened very quickly. A mob was formed. Strangers were produced, beaten up, and murdered. Justice was delivered. The recordings of the killings were duly sent back out into the ether of WhatsApp, completing the cycle of horror. Jharkhand’s police were befuddled. There had been no reported cases of child abductions. The rumor was completely unfounded. “Rumors have always flourished in India,” says Pratik Sinha, the founder of a myth-busting website, AltNews.in. “But it’s become exponentially dangerous because of the internet.”

Albert Schweitzer called pain “a more terrible lord of mankind than even death.” Thus, it is not surprising that humans have from the earliest times attempted to identify plants which might provide pain relief. The Odyssey by Homer provides a mythic account of the use of one such agent. . . . Then Helen, daughter of Zeus, took other counsel. Straightaway she cast into the wine of which they were drinking a drug to quit all pain and strife, and bring forgetfulness of every ill. Whoso should drink this down, when it is mingled in the bowl, would not in the course of that day let a tear fall down over his cheeks, no, not though his mother and father should lie there dead . . . Such cunning drugs had the daughter of Zeus, drugs of healing, which Polydamna, the wife of Thor, had given her, a woman of Egypt, for there the earth, the giver of grain, bears the greatest store of drugs . . . . . . More than a century ago, it was suggested by Oswald Schmiedeberg, a German scientist regarded by many as the father of modern pharmacology, that the drug to which Homer refers is opium for “no other natural product on the whole earth calls forth in man such a psychical blunting as the one described.” When today, in the fields of Afghanistan or Turkey or India, the seed capsule of the opium poppy, Papaver somniferum, is pierced, a milky fluid oozes from it which, when dried, is opium. Virginia Berridge, in her elegant history of opium in England, tells us that the effects of opium on the human mind have probably been known for about 6,000 years and that opium had an honored place in Greek, Roman, and Arabic medicine. I will not dwell on that ancient history but will instead jump ahead to the 17th century by which time opium had gained wide use in European medicine.

Pain has been defined as ‘‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’’ (Lindblom et al., 1986). Table 5–1 contains definitions of terms commonly used to describe pain sensations (Merskey et al., 1986). Pain is the most common reason a patient presents to a physician for evaluation. The U.S. Center for Health Statistics found that 32.8% of the general population suffers from chronic pain symptoms (Magni et al., 1993). Many factors can influence patients’ reports of pain, including medical and psychiatric disorders, social circumstances, disease states, personality traits, memory of past pain experiences, and personal interpretations of the meaning of pain (Clark and Treisman, 2004). There is no simple algorithm for determining whether the cause of pain is psychologic or neurologic (Clark and Chodynicki, 2005). The clinical evaluation of patients complaining of pain should be comprehensive and incorporate the patient’s descriptions of pain (ie, location, intensity, duration, precipitants, ameliorators); observations of pain-related behaviors (eg, limping, guarding, moaning); descriptions of problems performing activities; and neurologic and psychiatric examinations (Clark and Cox, 2002). Post-herpetic neuralgia (PHN) is defined as pain persisting or recurring at the site of shingles at least 3 months after the onset of the acute varicella zoster viral rash. PHN occurs in about 10% of patients with acute herpes zoster. More than 50% of patients older than 65 years of age with shingles develop PHN, and it is more likely to occur in patients with cancer, diabetes mellitus, and immunosuppression. During the acute episode of shingles, characteristics such as more severe pain and rash, presence of sensory impairment, and higher levels of emotional distress are associated with developing PHN (Schmader, 2002). Most cases gradually improve, with only about 25% of patients with PHN experiencing pain 1 year after diagnosis. Approximately 15% of patients referred to pain clinics suffer from PHN. Early treatment of varicella zoster with low-dose amitriptyline (25–100mg QD) can reduce the prevalence of pain at 6 months by 50% (Bowsher, 1997).

We discuss how the complexities of conducting neuroscience research on addiction limit its application to the criminal law. Individual addicts vary enormously, and the general findings of neuroscientists do not always describe particular cases. Moreover, the neuroscience of addiction may not be relevant to the criminal law because addiction itself may not be relevant. We examine several ways in which it might be thought that addiction is relevant to the penal law before identifying the single respect in which its significance is likely to be greatest. Some jurisdictions have created specialty drug courts that make addiction a necessary condition for eligibility, so evidence from neuroscience is potentially helpful to ensure that defendants would benefit from these diversionary programs. With respect to criminal liability itself, however, we believe that neuroscience turns out to be of limited value at the present time as well as in the foreseeable future.

Whatever their particular causes, environmental problems all share one fundamental trait: with rare exceptions they are unintended, unforeseen, and sometimes ironic side effects of actions arising from other intentions. We intend one thing and sooner or later get something very different. We intended merely to be prosperous and healthy but have inadvertently triggered a mass extinction of other species, spread pollution throughout the world, and triggered climatic change—all of which undermines our prosperity and health. Environmental problems, then, are mostly the result of a miscalibration between human intentions and ecological results, which is to say that they are a kind of design failure. The possibility that ecological problems are design failures is perhaps bad news because it may signal inherent flaws in our perceptual and mental abilities. On the other hand, it may be good news. If our problems are, to a great extent, the result of design failures, the obvious solution is better design, by which I mean a closer fit between human intentions and the ecological systems where the results of our intentions are ultimately played out. The perennial problem of human ecology is how different cultures provision themselves with food, shelter, energy, and the means of livelihood by extracting energy and materials from their surroundings (Smil 1994). Ecological design describes the ensemble of technologies and strategies by which societies use the natural world to construct culture and meet their needs. Because the natural world is continually modified by human actions, culture and ecology are shifting parts of an equation that can never be solved. Nor can there be one correct design strategy. Hunter-gatherers lived on current solar income. Feudal barons extracted wealth from sunlight by exploiting serfs who farmed the land. We provision ourselves by mining ancient sunlight stored as fossil fuels. The choice is not whether or not human societies have a design strategy, but whether that strategy works ecologically and can be sustained within the regenerative capacity of the particular ecosystem. The problem of ecological design has become more difficult as the human population has grown and technology has multiplied. It is now the overriding problem of our time, affecting virtually all other issues on the human agenda.

Dopamine is a neurotransmitter critical for reward processing and is elevated by most addicting drugs. The effect of THC and other CB₁ agonists moderately elevate dopamine in reward related regions of the rodent brain; however, there is less consistent evidence in humans for marijuana-induced changes in dopamine release or for morphological changes in brain reward areas. In humans, cannabis use disorder has been identified, which shows similar features of other substance use disorders, but not in the same extremes as opiates, psychostimulants or alcohol. This chapter discusses the interaction between cannabis and other drugs in relapse to drugs use, with a special case for the interaction between cannabinoids and opiates. Finally, the relationship between cannabinoid effects on men and women in sexual behaviour is discussed.

While dopaminergic neurotransmission has largely been implicated in reinforcement learning and model-based versus model-free decision making, serotonergic neurotransmission has been implicated in encoding aversive outcomes. Accordingly, serotonin dysfunction has been observed in disorders characterized by negative affect including depression, anxiety and addiction. Serotonin dysfunction in these mental disorders is described and its association with negative affect is discussed.

Chapter five charts how and why the medical profession developed and popularized the view that heavy habitual drinking constitutes an incurable physiological disease. In public lectures, journals, and speeches, physicians detailed the catalogue of destruction wreaked by alcohol, publicizing a new pathology of intemperance. Through vivid description and illustration, physicians asserted that the drunkard’s compulsion to drink derived from a diseased stomach. While heightening public fear, however, physicians had little inclination to attempt to develop a cure for the condition. Promising therapies emerged in the 1820s which physicians actively discouraged people from using. By mid century, finally spurred on by patient demand, physicians experimented with treating inebriates in hospitals and asylums, but their efforts remained scattered and experimental. This chapter argues that by heightening public fear, but failing to develop therapies, physicians encouraged the popularity of the Washingtonians, who promised to cure drunkards. As Washingtonians exerted an ever-greater influence on popular culture, sensational accounts of delirium tremens proliferated. The medical impulse to pathologize habitual drinking thus led to a popular lurid fascination with the drunkard’s struggle with the cravings for drink.

The context of forced displacement in chapter 7 is what we know as chronic homelessness in the United States. Here we explore the risk to interhuman relationship that is its result. Published narratives of persons without home and those in a transitional housing facility put a practical face on homelessness and help shed light on some of its most complicating factors.These elements, not surprisingly, include the state of affordable housing, addiction, mental illness, incarceration, and other “nontraditional” circumstances. Forced displacement in the form of homelessness most often results in the objectification—whether as objects of need or objects of distain—that leads to overwhelming social exclusion. This threatens relationship in the form of a just community and rejects the moral obligation to care for the displaced other.

This book’s conclusion epitomizes this book’s claims with an analysis of Lisa Cholodenko’s High Art (1998), a film falling under New Queer Cinema’s non-redemptive, underground narratives of queerness. Ugliness as the negative operates as both literal and conceptual. It refers to an inherent erotic tangibility in older media processes of photographic documentation—the use of negatives—and it describes the ways that lesbian desire becomes defined through heroin addiction. This chapter shows how queer erotics communicates as a photographic negative, that is, a desire paradigm without the ability to be properly “developed.” The deeply counterintuitive possibilities of ugliness here reinforce the book’s larger argument about the importance of nondominant expressions of difference that queer female sexuality requires.

American bioethics affords extraordinary respect to the values of personal autonomy and patient self-determination. Many would argue that the most significant achievement deriving from bioethics in the past 40 years has been to replace a paternalistic model of health provider–patient relationships with one that sees patient self-determination as the normative foundation for practice. This shift away from paternalism towards respect for self-determination has been on going in behavioral and mental health as well, especially as it is reflected in the ‘recovery movement’. As a result of the emphasis placed on patient autonomy, arguments in favor of mandatory treatment are rare and often half-hearted. Can a case be made which acknowledges the centrality and importance of autonomy but which would still deem ethical mandatory treatment for addicts? I think it can.

Incentive salience (‘wanting’) normally provides an ‘oomph’ that spurs attention to and motivation for objects of desire. But when amplified excessively by brain mesolimbic sensitization, a set of neurobiological changes that increase the reactivity of dopamine-related brain systems, ‘wanting’ can have pathological intensity, leading to the kind of compulsive ‘wanting’ associated with impulse control disorders, such as addiction. A stimulus attributed with excessive incentive salience may trigger an overwhelming urge to consume its related reward. Sensitization of its underlying neural systems can make rewards and their cues powerful triggers of craving and instigate seeking behavior, and similar changes in the brain may possibly occur spontaneously in certain binge-eating disorders and in some other compulsive pursuits of incentives. Selective surges in ‘wanting’ spurred on by environmental triggers can explain why, under these conditions, rewards can be ‘wanted’ much more than they are ‘liked’. The incentive sensitization theory provides an explanation for the compulsive pursuit and over-consumption of addictive incentives