A Time of Hope and Trepidation in the State of the Art

February 21, 2021
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On Las Meninas by Velasqez, Foucault writes, “In appearance, this locus is a simple one; a matter of pure reciprocity: we are looking at a picture in which the painter is in turn looking out at us. A mere confrontation, eyes catching one another’s glance, direct looks superimposing themselves upon one another as they cross. And yet this slender line of reciprocal visibility embraces a whole complex network of uncertainties, exchanges, and feints. The painter is turning his eyes towards us only in so far as we happen to occupy the same position as his subject. We, the spectators, are an additional factor. Though greeted by that gaze, we are also dismissed by it, replaced by that which was always there before we were: the model itself. But, inversely, the painter’s gaze, addressed to the void confronting him outside the picture, accepts as many models as there are spectators; in this precise but neutral place, the observer and the observed take part in a ceaseless exchange. No gaze is stable, or rather in the neutral furrow of the gaze piercing at a right angle through the canvas, subject and object, the spectator and the model, reverse their roles to infinity. (Foucault, 2005 [1966]: pg.5) Highlights by Acervado: https://beatrizacevedoart.wordpress.com/2014/08/08/foucault-and-painting-las-meninas-by-velazquez/


Why begin with Foucault’s opening on Las Meninas in The Order of Things? Quite simply because this article is both a reflection of myself, and perhaps one of you as well. This piece is also a moment of pause where I (and maybe you too), can consider where we are, how we came here, and where we are going. We are both the subject and object of our field in many ways, particularly those of us in recovery who find a situated form of knowledge embodied not just in ourselves but in those we study. We relate, strike an accord, hum an affinity, between our lives, experiences, and the work we do. We exist in multiplicity, historically, though free-floating at times in lofty balloons of “objectivity” we can instantly return duplicitously into the skin, heart, and mind of our subjects. We can possess them as we possess ourselves in ways that are not possible for many scientists in other fields. Our humanity give our brushstrokes a certain technique that is unassailable, while at the same time the colors we use may be dangerously close to real life, risking all claims to the empirical. We can reverse the roles to infinity, and this offers us insights we should share, as I will do now.

In recent years, I have expanded my education beyond the clinical and human services field into more extensive areas of social sciences such as geography, history, economics, and philosophy. Stepping outside of the SUD and recovery field has allowed me to rearticulate and renegotiate my thoughts, hopes, and ideas regarding the state of the art.

Nationally, as new money in the forms of grants and funding has flowed in to the science of recovery, along with a whole host of new faces, names, and ideas, a tremendous amount of ground has been covered in a short time. Driven by the opioid crisis, the renewed money and interest have spurred innovations, new organizations, data collection, and an avalanche of research. In 2014, I decided to pursue and promote a vision for a new science of recovery. At the time, it took me only a few months to read all the existing research on recovery (something that today would take far, far longer). In 2014, the stock of research on addiction far outweighed any discussion of recovery, hope, or community. I committed myself to changing what I saw as a gross imbalance in the science regarding the field.

A handful of legendary researchers whose names we all know had carried the entire recovery science vision between themselves, often with little money, no lab space, or awkwardly positioned within medical and clinical departments and programs. To me, these scientists were the real heroes of the field. It was so much easier to get millions of dollars to drug rats and dissect their brains than to get money to study how real people recovered from addiction en vivo.

If nothing else, the years since the mid-2010s have demonstrated a rapid and appreciable shift toward a focus on recovery dynamics as a distinct and worthy scientific endeavor. Recovery science requires a stand-alone research space, ethos, and focus. The study of recovery necessitates unique instruments, theory, definitions, models, and scientific training.

But the most crucial advancement has been the recognition and promotion of lived experience as an intractable ingredient to science, clinical design, and advocacy overtures. We must never lose our reliance on survivors as our most trusted and reliable source of knowledge.

Despite the advancements, I still have vast amounts of trepidation. Knowledge production is funded through institutional forms of political and ideological control. These forms of power are not always in our interests. We are not unlike robotics researchers who take defense money to study things that may have future military applications. In particular, federal funding has a way of pushing the field toward “acceptable” (profitable) forms of knowledge production. As we see with the COVID-19 vaccine– decades of publicly funded research, powered by idealistic scientists, grad students, and basic researchers are often just handed over, lock, stock, and barrel to private interests. I think of all the insights, late nights, coffee, donuts, failed experiments, frustrations, and ultimately that glorious feeling of laboratory success that brought us mRNA technology. I imagine the quiet egghead celebrations in cramped breakrooms of biology labs that each of those breakthroughs must have brought! Cake, drinks in paper cups, and cheers to the dedication, late nights, and good work of the team.

The story of mRNA technology and the vaccine’s evolution is quite beautiful, as is the scientific discovery process in general. In many ways, the story of mRNA vaccines reflects why most of us got into research and science. All of us working in human science research are fueled by a genuine belief in the goodness of science and the fundamental premise that persistence, applied knowledge, technique, and synthesis, can yield discoveries that can save lives, facilitate social connection, heal broken bodies, and soothe inflamed minds. To be sure, the private sector is working hard in manufacturing these vaccines, breaking through boundaries of their own, and smashing speed records in bringing COVID vaccines to market. Still, I wonder what is lost in this complete handover to the private sector. What do we lose when well-intentioned science becomes a commodity?

Any of us who have worked in the field long enough know the struggle—the balance and the challenge that exist when seeking funding and mainstream intellectual acceptance of our ideas. We risk losing control of those ideas, and we risk losing control of how these ideas are applied to the world. Sometimes, the intent is lost altogether. It is so easy for a good idea to be co-opted, stripped of its purpose, and sold as a market product enriching many except the people who thought it up, believed it to be fair and who proved such an idea was worthy of being called scientific. Sometimes good ideas are commodified in such a way that they never even reach the people they were designed to help.

As a field, we are somewhere between the days of pioneering legacy, radical experimentation, and mainstream establishment. This moment calls for a more “hack and slash” mentality—distribution, collection, analysis: deployment, incremental adjustment, redeployment— in short, a time of trial and error– one that will require significant resources and endurance.

This time is also where we begin to see the fundamental flaws of systemic knowledge production and the challenging translational application of such ideas in the real world, from funding to politics: we are beginning to see how the limitations wrought by institutions, biases, class, race, culture, methods, history, power, money, and the boundaries of established fields can delimit and negate one another. We see how forms of knowledge and power conflict, disrupt, occlude, merge, and neutralize with one another. We see the diffusion of both ideas and intentions, and we see the dispersion of will and force. We open the hood of society and see the complex machinations churning away beneath. We also witness how sometimes only parts of ideas are mainstreamed, while more comprehensive, humane, and otherwise, better parts of our concepts are discarded without a second glance by the world and its systems. We see how some ideas and specific findings have a covalent bonding potential that attracts similar ideas while repelling others. Different ideas come to rest in different places and under myriad guises, applications, and operations. We see the kinetics of social science come alive and in full detail.

We see the rise of well-intentioned medical experts and clinicians claiming territory and decrying the historical absence of their tools and expertise. And we see cultures and communities that do not necessarily need or want scientists and doctors, well-intentioned or not, treading on their space. We see the death grip of insurance companies, profiteers, and shady business promoters who have fed themselves on the blood of desperate families struggling with addiction for decades. Under the slightest scrutiny, they bare their fangs when we come promoting science and dignity as they shame their clients into submission. We lurch back in disgust and wonder how such creatures have escaped the light of day.

Most importantly, we see how the historical abandonment of all people with addiction issues has painfully and dangerously given birth to some of the most beautiful, potent, and vibrant forms of mutual-aid and community outreach that have ever existed in human history, all driven by forms of spiritual altruism, humanistic compassion, and the search for basic human dignity, rights, and the promotion of health.

And finally, we see a whole generation of newly minted researchers eager to step into freshly formed departments of recovery science popping up at institutions across the country. Recovery has in many ways moved from a social novelty into a scientific focus.

The Future:Tense

As challenges, limitations, and tensions arise, we see the age-old philosophical questions emerge about ethics, knowledge, empiricism, evidence, and morality. We cannot and should not shy away from these contradictions, disputes, and limits. There is no perfect world where money will be limitless, where all lives are saved, everyone with previous addiction issues flourishes, and everyone gets a pat on the back for collectively ending the problem of addiction in society. If you haven’t already accepted this fact, you should. Our political economy alone forbids such utopias, even if they are possible in some ways. This acceptance, however, should spur you towards something else, something more extensive and more urgent. Personally, these small challenges we face as scientists have pushed me well beyond my “own lane” into concerns about the state of science, ecology, and the future of humanity.

If you work in this field long enough, you will notice there is an invisible wall or ceiling you can’t quite seem to grasp that begins to hamper your every move. Like a mime, you feel along the invisible surface, hand over hand, seeking some edge, some way around, or through this hidden field. And hand over hand, you begin to realize the enormity of this barrier. You begin to sense how this invisible barrier isn’t just your problem. You notice that virtually everyone bumps into it and staggers away, dazed and confused, wondering what happened. As a scientist, you feel the pull of curiosity. What is this force that is holding us all back? Why can’t we seem to get the stuff that people need into their outstretched hands, even when we have proof that this is the answer?

Versions of that question can and should plague every moment of your career. And if your eyes are open, you will seek an explanation and a solution. Particularly as we move forward as a country, as one slow-rolling crisis bleeds into the next, you will begin to see that your frustration regarding the field of recovery is not unique– your frustration is part of a connected set of larger systems of power. These prompt larger questions we should all be asking.

What is state of the art today? Recovery science is taking its rightful place within the annals of science. But with that emerging development, recovery science faces the same dangers, temptations, ambiguities, and contradictions that all humanitarian endeavors face. Once desperate for funding, we see that we might be pushed in directions we did not intend now that we are flushed with cash. We see corruption abounds in equal measure to good intentions. We see tools that may help can also restrain and injure. We see our scientific jargon and beliefs can be just as dogmatic and equally misunderstood as folk knowledge and tradition. We see politicians who appear friendly, who shake our hands and congratulates us, only to cut funding the minute budgets are tight. We see institutions, organizations, and departments that are in an equal measure responsible for, and to, the forces that oppress and subjugate the populations for whom we toil. Whole areas of western thought, we realize, can be historically problematic and inhumane. We watch colleagues take up causes for the sheer profit of self-promotion. Books are written, and careers heralded in ways that make a simplistic mockery of the complexity we see growing day by day in our research.

We see and feel resistance to what we do in various ways, but we are beginning to recognize that the resistance we feel isn’t just because of what we do or who we are seeking to help. We are beginning to see how reductive our awareness has been. It isn’t just stigma. It isn’t just puritanism. It isn’t limited resources or poor management, and it isn’t just racism, sexism, or inequality that holds back the forces we are seeking to elucidate and expand in the name of good.

In short, we are beginning to outgrow our ignorance of the larger social forces that delineate what we do, how we do it, and what use is made of the things we discover, like a social worker who suddenly realizes that poverty can’t be counseled out their client, that neither mental health nor poor choices are responsible for this kind of poverty. The troubles their client is facing are instead part of a vast system of forces of which poverty is but one outcome.

We should embrace and welcome this new and growing sense of enormity and challenge. Our burgeoning awareness should be a source of strength, wisdom, curiosity, and hope. As scientists, we are some of the most powerful minds on the planet. Those of us in recovery are some of the greatest humanitarians to walk the earth presently. We should question all that holds back the efforts to alleviate pain and suffering in this world– Systematically, methodologically, forcefully, and definitively– we will advance, not just for the sake of facilitating recovery, but for the sake of society itself. And this brings us full circle folks.

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