Tag Archives: Addiction

Left to right: Book - China Room and Author - Sunjeev Sahota

Sunjeev Sahota’s China Room Reclaims Family Generations Later

After reading Sunjeev Sahota‘s new minimalistic book, China Room, visions of the story and his writing linger and invite revisiting. Not having read his two previous novels—including The Year of the Runaways, which was shortlisted for the Booker Prize—I’m eager to compare them to this engulfing tale built of economical language filled with imagery, pain, and possibilities.

In 1929, while freedom fighters scour the country for new recruits, fifteen-year-old Mehar is married, one of three brides to three brothers. She, not her family, or the other brides know which of the brothers is whose husband. The girls, mostly sequestered, live and work in the “china room,” a small, suffocating place with their mother-in-law’s unused dowry on display. Mehar thinks she’ll be clever when her husband comes to her for sex in a different small, pitch-dark chamber. During their allowed times together as authorized by the groom’s mother, Mehar listens to the few but gentle words he speaks and maps the feel of his hands.

One day, after her husband tells her that pearls under her pillow will help her become pregnant, she fails to see when he gives the pearls to his youngest brother to present to their mother. She does see, from a distance, the youngest brother holding the pearls and believes him to be her husband. A dangerous scenario follows, and eventually, her curiosity and assumption lead to grave consequences.

Alternately, it’s 2019. A young man whose name we only know as S- reminisces about 20 years earlier when he seeks to escape the ever-present racism in his northern England town and the demons of his addiction. On his family’s near-crumbling farm in rural Punjab, he wonders about the barred windows on the property.

Living alone on the farm, he self-detoxes, the night stars acting as his silent witnesses. With various new acquaintances, he pours his waking energy into cleaning and painting the farm’s buildings and regains his self-esteem. He comes to learn about his great-grandmother, Mehar Kaur, and her fate through stories told by those who remembered her, knew of her, or had heard the legends about her.

I confess I felt contempt as I read, but not for the author whose writing was simple on its face and complex on a deeper level. Was it contempt for the mother-in-law who “hired” female children as nothing more than workhorses and broodmares? For the men who accepted such treatment of their young wives? The bullies who terrorized S-‘s family? In the end, it was angry grief I felt for Mehar, her sister-brides, and later, for S-.

Each of the characters in the story is imprisoned by someone or something. Sahota never promises a happy ending despite similes and metaphors so substantial you can touch them. Nevertheless, Mehar’s great-grandson returning 70 years after and telling his story 20 years later offers a spark of wonder that holds great promise for all that carefully remains untold.

Both Mehar and her great-grandson live and breathe the same small truths of their lives, tormented, and trapped until each decides to do something to foment change. How that change endures is unspoken. In some measure inspired by Sahota’s own family, China Room is a heartbreakingly quiet, sensitive, and beautifully written story of what one life means in the present and how it impacts other lives generations into the future.

Jeanne E. Fredriksen lives in both Carolinas and is a long-time contributor to India Currents, a Books for Youth reviewer for Booklist magazine/American Library Association, and a member of WCPE-FM The Classical Station’s Music Education Fund committee. 

 

An Unseen Epidemic: Indian Americans & the Opioid Crisis

On 5th July 2020, Ikonkar Manmohan Singh Sandhu, a young 23-year-old boy, died from an opioid overdose in Michigan just months before he was to be married. He is by no means an isolated case in the Indian American community.

A small group of doctors are sounding the alarm on the nation’s opioid crisis. Dr. Arun Gupta is one of those who is urging health authorities to wake up to this catastrophe, which is ripping through communities with scant regard for race, gender, educational level, or financial standing.

To be fair, before COVID-19 ravaged the country, the growing opioid addiction was giving the nation’s health officials sleepless nights. The pandemic put this issue on the back burner and while more Americans are dying from the virus, it can be just as deadly if left unchecked.

Opioid overdoses have killed more than 70,000 young people annually between the ages of 18-54 for the past five years. In 2011, the CDC reported that overdose deaths superseded auto accident deaths for the first time in 32 states This is now true for all 50 states. The organization also reported that more than 700,000 young Americans have died between 1999- 2017 from polydrug overdose. That number is expected to be as high as one million by the end of 2020. The report further states that “preventable disease & retroactive analysis show that most of these deaths were unintentional.”  Isolation, stress, and the depression, that came in the wake of the pandemic are shooting cases through the roof.

Dr. Arun Gupta

“Parents are burying their children and children are burying their parents,” says Dr. Gupta. 

Dr. Gupta is quick to rid you of the rosy view that Indo American families have been unaffected by this affliction. It is a growing trend in the community, he says, largely due to parents’ unrealistic expectations for their children and the reality of facing conflicting cultures. What worsens it, is that many are either in denial or wary of seeking professional help for fear of being stigmatized or shunned. These are lives that could have easily been saved, he laments, much like the case of a distant relative who died because the family hesitated to reach out for help or were unaware of the problem.

A physician for 34 years, of which 14 are as a doctor of addiction management, Dr. Gupta has seen enough to be worried. He has been charting the surge in cases throughout the nation for the past decade and is seeing it played out at his doorstep – the rural region of Monroe, Michigan where he runs his private practice.

For 11 years, Dr. Gupta was the local prison doctor where he saw the interplay of drugs and death up close and the ineffectiveness of the administration’s efforts to curb it. This pushed him to change tracks from being a general physician to addiction management. Rural communities, he observes, are more prone to opioid addiction than urban areas where the population is better educated and have higher-paying jobs. The problem is compounded when there is family instability, lack of education, poverty,  physical, mental and sexual abuse in childhood, mental illness, or addiction both in the family and the patient. 

So why are addictive opioids prescribed in the first place and how do they hook us? About 25 years ago, pharma company Purdue, manufacturers of the painkiller Oxycodone, pushed the government to sanction prescribing painkillers for non-cancer-related pain. The American Pain Society also classified pain as the fifth vital sign after blood pressure, pulse, temperature, and weight. Statistically, 40% of the country’s population is in chronic pain and many require pain medication to carry out their daily activities or even go into work.

Addiction starts innocuously enough with a prescription for a painkiller to treat post-surgery or chronic pain as in instances of back pain. Consuming these painkillers diminishes the pain but also brings on a euphoric feeling as it raises dopamine – the brain’s pleasure hormone. Celebrities like Michael Jackson were known to use them before a performance, a term referred to as, “spotlight euphoria.” Additionally, it changes the perception of reality for those dealing with psychological issues such as an inferiority complex or anxiety,  these people now start “liking themselves and feeling good.” This altered reality quickly spirals into an emotional and social need followed by dependence and cravings for the painkiller.

The signs of addiction are evident in drastic mood changes, lethargy, or impaired decision-making, among others. Discontinuing the painkillers could lead to a host of withdrawal symptoms such as chills, tremors, body aches, bone pain, vomiting, diarrhea, or irregular respiration. However, Dr. Gupta clarifies that not everyone gets addicted to painkillers and the risk of addiction is only about 10%.

Soon, Oxycodone grew so popular that it began to have, “street value.” When prescriptions ran out, users turned to the streets where it could be obtained illegally. Hustlers began faking health issues to procure and sell these painkillers giving rise to the term “pill-mill.” The cost of one milligram of Oxycontin is one dollar so someone using 1000mg was spending $1000 a day. While insurance took care of legitimate prescriptions, those who were addicted were shelling out their own money. This, of course, was done in connivance with “some doctors who played the game.” Dr. Gupta estimates that about 1000 doctors have been apprehended so far for violating this practice and have “tarnished the image of doctors.”

There is an obvious connection between mental disorders and addictive disorders and its consequences can sometimes be life-threatening. Doctors, however, are required by law to treat pain with painkillers even if there is a sense/awareness that this medication could become addictive to the patient. On the other hand, if doctors practice caution in prescribing pain medication, they risk a bad review on their practice, something every doctor understandably wants to avoid. 

In 1999, the Center for Disease Control went on record for the first time and shared its report of 4000 young Americans who died from drugs. The government scrutinized the problem and rolled out the Drug Addiction Treatment Act of 2000. For the first time, this law allowed practicing doctors to learn and treat addiction with an FDA approved drug. The law also stipulated that any practicing doctor could complete an addiction program and receive an X DEA license which would allow them to treat 30 patients per month for a year. If the doctor’s records are found in order, they could treat 100 patients per month. Past President Barack Obama signed a law that would allow some doctors with specific credentials to treat 275 patients a month. This number was controlled to prevent its misuse but sometimes the best-intentioned laws have unintended consequences.

This one did. 

Only 4300 doctors in the US can treat 275 patients a month and Dr. Gupta is one of them. It’s a drop in the ocean for the estimated 20-40 million people who need help overcoming their addiction. There are more than 100,000 healthcare providers in the country that include doctors, nurses, and physician assistants who have the necessary X- DEA credentials to treat opioid use disorders. But less than 20,000 are actively involved in dealing with the growing opioid epidemic in the country. This lack of access to a healthcare provider aggravates the problem leading to more deaths than recoveries. Meanwhile, the pandemic has not made things easier. There is excessive stress and limited counseling due to the shutdowns and prescriptions cannot be given on the phone without the necessary drug testing. This explains the rise in overdose deaths and addiction cases in the past nine months.

Apart from flawed policy, the American Society of Addiction states that every doctor who graduates from medical school is required to study addiction management. There are 179 medical schools and approximately 9000 residency programs in the country and not one of them teaches this course.  Moreover, addiction management is not considered on par with other areas of medical specialization and neither do insurance companies view addiction like other chronic diseases such as blood pressure or diabetes.

In 2002, the drug Buprenorphine was approved for addiction treatment and ten years later another drug Zubsolv made it to treatment plans. These drugs block the opioid receptors in the brain and reduce a person’s craving for the painkiller. Another ingredient in the drug, naloxone, reverses the effects of opioids. Together, they prevent withdrawal symptoms and deter the abuser from snorting or injecting it. Dr. Gupta pairs medication with counseling, and non-addictive medication in cases of insomnia or anxiety. Recovery takes anywhere from six weeks to six months depending on the severity of the addiction, but the struggle to remain clean continues for the rest of their lives.

With death rates from opioid misuse surging, more than 500 laws were enacted in the last 10 years against doctors, pill mills, and pharmaceutical companies to curb the problem but this has only exacerbated the issue. Addicts are now forced to go to the streets instead of visiting a doctor for treatment. Dr. Gupta notes that national autopsy results over the last 5 years consistently show that fentanyl, heroin, and cocaine are the first three drugs in more than 55% of the people with drug overdose deaths as opposed to prescription medication.

Over the past few years, Dr. Gupta has presented more than 150 talks to schools, doctors, healthcare systems, and social organizations like Rotary clubs and the Kiwanis Club to highlight the gravity of the problem and his message that addiction can be cured. He is talking to elected officials to leverage their influence and galvanize the government to rethink the limit of patients and allow greater access to people who want to overcome their addiction. 

Addiction, he warns, has become synonymous with a death sentence in this country.

Manu Shah is a freelance writer covering Indo American news.

What Makes Things Addictive?

“The three most harmful addictions are heroin, carbohydrates, and a monthly salary.” Nassim Nicholas Taleb

‘Addiction’ is a dirty word. It’s a word that carries heavy connotations of drugs, sex, violence, and criminality. However, addiction is not as clear cut as it used to be perceived. In eras gone by, one could only really be addicted to drugs, whether that be alcohol, opium, and so on. However, in the industrial-modern age, one could now be said to be ‘addicted to’ activities (typically ones that were deemed sinful or anti-establishment) such as sex, pornography, or gambling.

Yet now we see an emergence of new kinds of addiction. Teenagers are ‘addicted to’ their phones, people are becoming ‘addicted to’ fast food, and so on. In the modern age, where almost anything can be had at the tap of a screen, or the click of a button, addiction permeates every pore of life. And so, the age-old question returns: what is addiction? How does it work? And how can it be harnessed?

“Not everybody is comfortable with the idea that politics is a guilty addiction. But it is.” Hunter S. Thompson

Now, I won’t pretend that I’m going to crack the case of addiction in this one article, but what I want to highlight is the philosophical nature that the topic of addiction harbours. First, let’s examine what we mean by addiction.

To me, addiction is the self-compulsion, physically or mentally, to partake in a particular activity (whether that be as simple as cracking one’s knuckles, or as dangerous as illegal drugs). I say physically or mentally because this compulsion can come in two ways: either it physically makes us want to partake in the said activity more (nicotine has this effect for example), or mentally it can cause the same thing (I feel as though I cannot do activity y without first doing x, even when there is no correlation between the two).

Now, physical addiction, although still present in the modern age, is not what I want to focus on. Instead, the concept of being mentally addicted to something fascinates me much more, as one cannot resolve it by pointing out the biochemical reaction in the body that causes such addiction (as with physical addiction).

My hypothesis is this: mental addiction is, by definition, mind-dependent, and occurs when individuals require a crutch or a supplement in their daily lives. It is, in essence, the body attempting to discover and cling to a coping mechanism. Philosophically, this is intriguing: what in life makes people addicted to certain things? There are evidently trends in addiction – so what is it about modern life that makes groups of people ‘addicted to’ the same things?

“You must suffer me to go my own dark way.” [from] The Strange Case of Dr. Jekyll and Mr. Hyde

Let us take a contemporary example, a craze that has swept the nations of the world: ‘Fortnite’. Now, I know this seems flippant, but hear me out. For those who have not heard of this phenomenon, Fortnite is a video game where 100 players go head-to-head and battle it out until there is only one player left standing. The game has over 250 million users registered and has massive publicity online, where gamers upload videos of their matches.

However, in recent months, there has been a surge of people claiming that the game has addictive properties, and that children and adults alike are becoming ‘addicted’, so much so it causes relationship degradation between children and their parents, and between spouses. Individuals are playing the game non-stop for several hours a day: approximately 5% of individuals in the US have self-reported that they play 24 hours’ worth of the game per week.

I have not indulged in the game myself, and I am sure it is terrifically good – but there must be something else about the game that causes this kind of interaction. People are genuinely putting their lives on hold, destroying relationships, and ignoring their body’s natural needs in order to continuously play this game – there is no doubt that some individuals are addicted to this game, and the numbers look to be growing.

To find an answer as to why people look to this game, I posit that we must flip back in time and re-read a bit of Plato and Socrates (I never thought I would see the words Plato, Socrates, and Fortnite, in the same piece of text). According to Plato, in The Republic, the soul is formed of three parts (also corroborated in the Phaedrus dialogue):

1. Reason – one could imagine this as the mind/brain.

2. Spirit – one could imagine this as the heart.

3. Appetite – one could imagine this as the stomach.

So, imagine each of us has a soul, and that soul is a chariot. The chariot is driven through life by three horses, which just so happen to be the three parts listed above. All three horses must ride at equal pace and in the same direction – if one horse goes off kilter, the chariot will swerve, go in the wrong direction, and/or crash. In essence, for our lives to be safe, happy, and healthy, we must operate with equal amounts of reason (good thinking ability/rationality), spirit (energy and fortitude), and appetite (physical desires and raw emotion).

This kind of idea has ingrained itself in human thought – live a balanced life. Keep this in mind as we now flip forward to the present day.

“Technological progress has merely provided us with more efficient means for going backwards.” Aldous Huxley

Johann Hari gives a fantastic Ted Talk discussing addiction. In the talk, he talks about a study conducted on rats, which was orchestrated to find out what caused addiction, and what addiction was like. I won’t go into the details of the talk (although I highly recommend you watch it), but he points out that another study was conducted where the rats were given the same choices as the former study, but were also given ‘rat park’.

This park was heaven for rats – it was filled with slides, toys, activities, and other rats (so they could have sex, and make friends). In the second study, no rats became addicted to the heroin water they were supplied with, whereas in the first study, all the rats became addicted and overdosed.

Now, let’s bring ‘rat park’ and Plato’s soul theory together. In the first rat study, the rats had nothing to do. Their soul was out of balance, which meant they had to look for a crutch or a coping mechanism to get through the awful and boring life. However, in the second study, the rats were all happy – their lives were fulfilled, and they had no need for a coping mechanism or crutch.

Okay, so we can now see that addiction or this mental compulsion to repeat an activity comes about when one has an unfulfilled life, or when one’s internal mechanisms are out of balance. Let’s transpose this analysis to Fortnite. Let’s see what Fornite provides. It provides entertainment, connection with others, community, a sense of purpose/a goal, and a common ground between other people. Not to mention such things are easy to access, and can be accessed without even getting up out of bed.

It is a fact of life that younger people (whom the game attracts) have less face-to-face interaction with their peers. This is not because young people don’t want to meet their friends, but it is much more convenient to text, FaceTime, or interact via games, than to get dressed and leave the house. However, humans are social creatures, and we are biologically wired to require social interaction in person.

Yet such needs are subconscious, and when ignored, the body looks for a coping mechanism – and it appears that such games provide a little bit of what the body desires (although it is no substitute for the real thing). People don’t get face-to-face interaction, so they look for a coping mechanism; such a mechanism is playing games or texting, etc., so they get less face-to-face interaction, and the cycle continues, eventually forming this mental addiction and compulsion.

“Cell phone: a private convenience that has become a public nuisance.” Richard E. Turner

Modern day mental addiction is less about something being so deliciously insatiable, and more about the individual consumer having something lacking in their quotidian lives. Humans are wonderfully adaptive creatures, which means that we can adapt and alter our own lives and routines without us actually realising we’re doing it. When we become dependent on a ritual, habit, or activity, it is actually just us trying to cope with a deficit of some kind. The key is to notice such a trend in behaviour and find the locus of the problem before the ‘addiction’ and its effects become too damaging. Addiction is a key part of the philosophy surrounding how to live a ‘good life’, and as such has stakes in topics such as ethics, politics, economics, and more.

So, at the very least, this modern age mental addiction is not some unconquerable beast, but rather can be overcome with a healthy dose of introspective philosophy, and a support network (yes, this is a drastic oversimplification, but I think such will suffice for a Fortnite addiction). Often, with modern age quandaries, people always ask about the what, when, who, and how – but they almost always forget the ‘why?’; and this is where Philosophy can really shine and provide, if not the answer, then a few pointers in the right direction.

Neville is currently studying BA Philosophy at Warwick University..Neville has entered the Times Advocacy Competition three times, and each time was shortlisted into the top ~20 candidates in the country. In his free time he writes his own scripts, as well as other fictional and non-fictional works.