Another great essay Claudio. But I must take you up on a point of disagreement. I hate the word 'dependence', not because it is wrong, but because it medicalizes behavior and puts it under the purview and control of public health. I think of my lifetime use of nicotine as a habit: not because it is something distinct and different to dependence, but because habit is an ordinary description of behavior that sits outside of public health purview and control.
Vaping - along with many other behaviors - will never escape the control of public health until such time as we resist and reject the medicalization of our lives.
Paul, thank you very much for the excellent comment. I share your resistance to the term "dependence" not because it lacks precision in certain contexts, but because of what it does rhetorically: it displaces the term into a clinical register and, in doing so, introduces a presumption of specific jurisdiction.
Indeed, it might be necessary to adjust our language to using "habit" as the default descriptor and reserving "dependence" only for explicit clinical criteria, while highlighting the institutional implications the term carries beyond mere description.
However, there is a point we cannot ignore: the economic gears that benefit from this distinction. On the one hand, an industry profits by turning repetition into predictable revenue. On the other hand, the public health apparatus and (under) the pharmaceutical industry system find a business model in medicalization.
We know that transforming a "habit" into a "pathology" creates a vast market for treatments and therapies, alongside a self-perpetuating bureaucracy of control. In the end, the individual finds themselves hemmed in by two major interests: one seeking to capture their behavior as consumption and the other seeking to capture it as a diagnosis.
The question that arises now for me is: how can we recognize harms where they exist without granting "public health" an open-ended mandate to define what counts as an acceptable life?
In other words, what would a non-medicalized approach to everyday habits look like, one that still takes responsibility seriously without being swallowed by either aggressive marketing or clinical tutelage?
One hypothesis: perhaps the path lies more in "risk literacy" than in institutional compliance; less "prescription" and more technical information as a tool for individuals to calibrate their own choices. A model of "responsible habit" could be sustained by social norms of etiquette, mutual care, and self-regulation, rather than coercion as the default.
Do you think it is viable, in practice, to envision communities of users defining their own standards of safety and ethics and functioning as sovereign spaces of support in relation to both corporations and traditional agencies?
"one seeking to capture their behavior as consumption and the other seeking to capture it as a diagnosis."
I am not concerned with either attempt at capture. Businesses do not have the power to capture my consumption, at best they can capture my loyalty to the brand.
The medical profession is likewise powerless to capture me in diagnosis. I can simply avoid visiting my doctor. When I do visit my doctor I am implicitly giving my consent to the diagnosis. But without my consent they are powerless to capture me.
It is when business and/or public health captures the power of government and the media that my resistance arises. It is fully within my power to resist the diagnosis of my doctor, so long as that diagnosis is not aligned with the power of the government to compel it.
"Do you think it is viable, in practice, to envision communities of users defining their own standards of safety and ethics and functioning as sovereign spaces of support in relation to both corporations and traditional agencies?"
Envision? Yes, it is called democracy and all that it entails: for example, individual rights to self determine. In 'practice', the problem arises when special interests capture the media and government.
"perhaps the path lies more in "risk literacy" than in institutional compliance; less "prescription" and more technical information as a tool for individuals to calibrate their own choices."
The path lies in the past. It is the path that has been lost and corrupted by the special interests of public health. When the harms of smoking were first discovered, public health understood its duty as no more than educating the public and leaving the individual to determine their choices. Millions gave up as a consequence. But to stop there left nothing else for public health to do. Their interests lie in having something to do: but beyond educating, they are powerless to do so without capturing, at first the media, and then government. As an old fart, I can well remember this process starting with capture of media interests (for gaining attention), followed by the government responding to that attention.
How did they do this? By falsely redefining an individual problem as a population level problem.
When those in harm reduction use the diagnosis of dependence, it is just a more reasonable and medically justified diagnosis of habit as opposed to addiction. I am resistant to all such medical diagnosis without my consent. To say it again, when I seek help from a medical professional I am implicitly giving my consent to a medical diagnosis.
To those in harm reduction who might be listening, when it comes to my lifetime habit of using nicotine, I am not seeking a medical diagnosis. I am seeking to recover my independence and autonomy from any and all such medical diagnosis without my consent.
Another great essay Claudio. But I must take you up on a point of disagreement. I hate the word 'dependence', not because it is wrong, but because it medicalizes behavior and puts it under the purview and control of public health. I think of my lifetime use of nicotine as a habit: not because it is something distinct and different to dependence, but because habit is an ordinary description of behavior that sits outside of public health purview and control.
Vaping - along with many other behaviors - will never escape the control of public health until such time as we resist and reject the medicalization of our lives.
Paul, thank you very much for the excellent comment. I share your resistance to the term "dependence" not because it lacks precision in certain contexts, but because of what it does rhetorically: it displaces the term into a clinical register and, in doing so, introduces a presumption of specific jurisdiction.
Indeed, it might be necessary to adjust our language to using "habit" as the default descriptor and reserving "dependence" only for explicit clinical criteria, while highlighting the institutional implications the term carries beyond mere description.
However, there is a point we cannot ignore: the economic gears that benefit from this distinction. On the one hand, an industry profits by turning repetition into predictable revenue. On the other hand, the public health apparatus and (under) the pharmaceutical industry system find a business model in medicalization.
We know that transforming a "habit" into a "pathology" creates a vast market for treatments and therapies, alongside a self-perpetuating bureaucracy of control. In the end, the individual finds themselves hemmed in by two major interests: one seeking to capture their behavior as consumption and the other seeking to capture it as a diagnosis.
The question that arises now for me is: how can we recognize harms where they exist without granting "public health" an open-ended mandate to define what counts as an acceptable life?
In other words, what would a non-medicalized approach to everyday habits look like, one that still takes responsibility seriously without being swallowed by either aggressive marketing or clinical tutelage?
One hypothesis: perhaps the path lies more in "risk literacy" than in institutional compliance; less "prescription" and more technical information as a tool for individuals to calibrate their own choices. A model of "responsible habit" could be sustained by social norms of etiquette, mutual care, and self-regulation, rather than coercion as the default.
Do you think it is viable, in practice, to envision communities of users defining their own standards of safety and ethics and functioning as sovereign spaces of support in relation to both corporations and traditional agencies?
"one seeking to capture their behavior as consumption and the other seeking to capture it as a diagnosis."
I am not concerned with either attempt at capture. Businesses do not have the power to capture my consumption, at best they can capture my loyalty to the brand.
The medical profession is likewise powerless to capture me in diagnosis. I can simply avoid visiting my doctor. When I do visit my doctor I am implicitly giving my consent to the diagnosis. But without my consent they are powerless to capture me.
It is when business and/or public health captures the power of government and the media that my resistance arises. It is fully within my power to resist the diagnosis of my doctor, so long as that diagnosis is not aligned with the power of the government to compel it.
"Do you think it is viable, in practice, to envision communities of users defining their own standards of safety and ethics and functioning as sovereign spaces of support in relation to both corporations and traditional agencies?"
Envision? Yes, it is called democracy and all that it entails: for example, individual rights to self determine. In 'practice', the problem arises when special interests capture the media and government.
"perhaps the path lies more in "risk literacy" than in institutional compliance; less "prescription" and more technical information as a tool for individuals to calibrate their own choices."
The path lies in the past. It is the path that has been lost and corrupted by the special interests of public health. When the harms of smoking were first discovered, public health understood its duty as no more than educating the public and leaving the individual to determine their choices. Millions gave up as a consequence. But to stop there left nothing else for public health to do. Their interests lie in having something to do: but beyond educating, they are powerless to do so without capturing, at first the media, and then government. As an old fart, I can well remember this process starting with capture of media interests (for gaining attention), followed by the government responding to that attention.
How did they do this? By falsely redefining an individual problem as a population level problem.
When those in harm reduction use the diagnosis of dependence, it is just a more reasonable and medically justified diagnosis of habit as opposed to addiction. I am resistant to all such medical diagnosis without my consent. To say it again, when I seek help from a medical professional I am implicitly giving my consent to a medical diagnosis.
To those in harm reduction who might be listening, when it comes to my lifetime habit of using nicotine, I am not seeking a medical diagnosis. I am seeking to recover my independence and autonomy from any and all such medical diagnosis without my consent.