Popular and neurobiological accounts of addiction tend to treat it as a form of compulsion. This contrasts with personality disorder, where most problematic behaviours are treated as voluntary. But high levels of co-morbidity, overlapping diagnostic traits, and the effectiveness of a range of comparable clinical interventions for addiction and personality disorder suggest that this difference in treatment is unjustified. Drawing on this range of clinical interventions, we argue that addiction is not a form of compulsion. Rather, the misuse of drugs (...) and alcohol is like many of the problematic behaviours associated with personality disorder: it is typically a way of coping with psychological distress. We suggest that a satisfying explanation of why many addicts struggle to control their use can be given without departing from concepts employed in our basic folk psychological understanding of agency. In particular, we appeal to five rough-and-ready folk psychological factors to explain addiction: (i) strength of desire and habit; (ii) willpower; (iii) motivation; (iv) functional role; and (v) decision and resolve. (shrink)

The development and publication of Diagnostic and Statistical Manual of Mental Disorders, fifth edition produced a peak in mainstream media interest in psychiatry, and a large and generally critical set of scientific commentaries. The coverage has focused mainly on the expansion of some categories, and loosening of some criteria, which together may lead to more people receiving diagnoses, and accompanying accusations of the medicalisation of normal living. Instructions given to members of DSM-5 work groups appear to have encouraged this.1 This (...) has not been the only source of disquiet. The influence of the pharmaceutical industry on the members of the appointees to DSM diagnostic work groups, which constructed the new rubrics, has caused concern,2 as remuneration and insurance coverage in the USA depends partly on DSM diagnosis, and the pharmaceutical industry has been accused of encouraging the development of new diagnoses as a way to increase profitability.3 Societal impact has been an explicit part of the development of DSM-5, as outlined in the article in this issue.4 Reasons for decisions by DSM-5 workgroups have included enabling sufferers to receive treatment which would not be available without a DSM diagnosis , or …. (shrink)

I was delighted to be asked to comment on Peter Zachar’s paper, partly because he presents an elegant proposal for how personality disorders (PD) might be considered to fit into a broadly medical conception of disorder, but also because the overlap between moral and clinical elements of disorder, and more broadly moral and clinical psychiatric kinds, seems to me to be a question central to the theory and practice of psychiatry. The moral context of diagnosis and treatment is a question (...) not just in the PD field (Pearce and Pickard 2009, 2010). The fact that over half of prisoners in the United Kingdom have a PD and a similar number can be diagnosed with a neurotic disorder (Singleton, Meltzer, and Gatward 1998) .. (shrink)

continent. 2.1 (2012): 22–28. Jeroen Mettes burst onto the Dutch poetry scene twice. First, in 2005, when he became a strong presence on the nascent Dutch poetry blogosphere overnight as he embarked on his critical project Dichtersalfabet (Poet’s Alphabet). And again in 2011, when to great critical acclaim (and some bafflement) his complete writings were published – almost five years after his far too early death. 2005 was the year in which Dutch poetry blogging exploded. That year saw the foundation (...) of the influential, polemical, and populistically inclined weblog De Contrabas (The Double Bass), which became a strong force for internet poetry in Dutch in the years to follow. In the summer of that year, a lively debate raged in the aftermath of Bas Belleman’s article “ Doet poëzie er nu eindelijk toe ?” (“Does poetry finally matter now?”), on a blog specifically devoted to this question. Up to that point, the poetical debate in the Netherlands had largely been confined to literary reviews (which were often subsidized), having become mostly marginalized in more mainstream media, where poetry could be covered by only a small number of so-called authorities. As a result, literary debate had acquired a rather placid quality. Though a variety of camps with different aesthetics could be discerned, most poetical positions shared a general acceptance of poetry as a form of art somewhat apart from fundamental political concerns. Late modernists would pursue subtlety and density of reference. Others would insist poetry was best understood as a form of entertainment that should ideally be accessible and work well on the stage. Still others would insist that poetry is mostly a play with forms. Linguistically disruptive strategies were valued highly by some, but mostly for their aesthetic effect. Values of disinterested playfulness reigned supreme everywhere. Any idea that poetry could be a field in which one confronts politics and the world was decidedly marginal. This led to a climate in which most attempts at polemics were DOA, often based on far too superficial positioning and analysis. The greatest polemical debates were revolving around the question of whether poetry should be difficult or easy, with both camps defining their ideas of difficulty and accessibility in ways that were so utterly shallow as to make the entire point moot. Debates were performed, rather than engaged with. It was a postmodern hell of underarticulated poetics. Half-consciously, people were yearning for new forms of criticism that could put the oomph back into poetry. Weblogs provided for ways to explore debate directly outside of the clotted older channels of the reviews and the newspapers. Belleman’s essay and the resulting online activity had shown that there was a widespread eagerness to take poetry more seriously as a social art form. It was in this environment that Mettes started his remarkable project Dichtersalfabet . At that moment, Mettes was active mostly in academic circles, having become noted at Leiden University as a particularly gifted student of literary theory. Within the Netherlands, the field of literary theory has a very odd relationship to literature as it is practiced in the country. Academic theory tends to have a mostly international view and engage with international debates of cultural criticism, literary theory, and philosophy, with academics often publishing in English and attending conferences around the world. Literature itself however is much more concerned with domestic traditions. Consequently, in the Netherlands, there exists a language gap between academic theoretical practice (as it is studied in the literary theory departments) and literary practice (which, academically, gets studied in specialized departments of Dutch literature). The Dichtersalfabet can be seen as Mettes’s attempt to close this gap. It is also an attempt to bridge the divide between theory and practice, in which he could apply his theoretical knowledge in a very unorthodox and unacademic critical mode that moreover could reach far beyond the domain of conventional criticism. Mettes’s goal was to trace a diagonal through Dutch poetic culture, to “strangle” what he perceived to be its dominant oppressive traditions of agreeable irrelevance, in order to see whatever might be able to survive his critical assaults. But he could only do so by means of a very serious engagement with poetry itself. To this end, he would go systematically through the poetry bookshelf of the Verwijs bookshop (part of a mainstream chain of booksellers) in The Hague, buying one publication per blog item, starting from A and working his way through the alphabet, reading whatever he might encounter that way in the restaurant of the HEMA store (another big commercial chain in the country). He would subsequently write down his reading experiences, refraining however from trying to write a nuanced book review. Rather, he would write about anything that caught his attention and sparked his critical interest. This way of working would yield vast, at times somewhat rambling, dense, lively, and generally brilliant essays, in which he held no punches. He never hesitated to pull out his entire arsenal of concepts from the international theory traditions, while never degenerating into mere academic exercise and pointless intertextualities. The attempt was rather to live the poetry that he read, and to engage it with the full range of political, academic, cultural, and personal references that he had at his disposal—all that composed the individual named Jeroen Mettes as a reader. Often what he wrote would not be according to the standards of what we usually think of as a critical review of a book of poetry. Sometimes he would even be a little sloppy in his judgments of poets or representations of the books he read, for example by basing an entire essay on the blurb of a book rather than its poetry content. But what he did was always brilliant writing nonetheless—virtuoso riffs on poetic fragments randomly found within capitalist society, exposing an incisive and insistent poetical sensibility. Mettes read poetry for political reasons, to see whether poetry could offer him a way to deal with a political world he detested. The right-wing horrors of the Bush years, the Iraq war, and the turn of Dutch public opinion towards ever more conservative, narrow-minded, and xenophobic views alongside a complete failure of the political left to present any credible alternative, were weighing heavily on the times in which Mettes reported on his reading. Poetry was to measure this world, diagram it, to lay bare its inconsistencies and faults, to indicate where lines of flight might be found. Amid the ruins of a world wrecked by imperialist policies, corporate capitalism, and doctrinal neoliberalism it would have to show the possibility of a new community. And it was, through its rhythmical workings, to release the reading subject from his confinement to ideologically conditioned individuality and lead him into the immanent paradise of reading. The stakes were high. Much higher than anything Dutch poetry had seen for many years. Mettes’s blog was widely read from the start. His posts sparked lively debates. Some of these subsequently led to the publication of extensive essays on a few key poets in some literary journals, particularly Parmentier and the Flemish journal yang , for which Mettes would become a member of the editorial board, a few months after starting the Dichtersalfabet . This could have been the start of a brilliant career, but this was not to be. The initial manic energy that fueled the blog gradually subsided. The Alfabet was updated less and less regularly. Mettes sometimes just disappeared for many weeks, then suddenly returning with a brilliant essay. Until, on September 21, 2006, he posted his final blogpost, consisting of no text whatsoever. That night I learned from his mentor at Leiden University that he had committed suicide. Mettes and I had had some fruitful exchanges on poetry, rhythm, music, and form, mostly on the blogs, but also by email. Three weeks before his death was the last time I heard from him: a very sudden, uncharacteristically curt note saying “My old new sentence epic.” Attached to that message I found a DOC-file of a work so major that I felt intimidated. This was N30 , a text he had been working on for over five years. After his death, it took me a long time before I dared to read it in its entirety. In the meantime, the work of preparing the manuscript for publication was entrusted by his relatives to his colleagues at yang magazine. It took them a few years to brush up the text and to edit the Dichtersalfabet -blog (which, apart from the Alphabet project itself, incorporated many other fragments of political, polemical, and theoretical writing) into book form along with the essays. The result of this labor was finally published in 2011 as a two-book set, and Mettes burst onto the Dutch poetry scene for the second time. The work was widely reviewed, on blogs, in journals, magazines, and newspapers. Many critics who had not followed the blogs in 2005 showed themselves surprised, baffled even, by the intensity of Mettes’s critical writing. But for those who had read the blog, the main surprise was in the poetry. During Mettes’s lifetime, some of his poems had already been published in Parmentier . Although these were strong texts by themselves, in no way did they prepare readers for N30 . Nothing like it had been written in Dutch before. Instead, N30 explicitly follows the American tradition of Language Writing, directly referencing Ron Silliman and his concept of The New Sentence. However, it would seem that much of the poetical thinking around his use of this technique puts him closer to a writer such as Bruce Andrews. For Mettes, using non sequiturs as a unit of poetic construction was not only a way of reinventing formal textual construction, but it was another way of finding the fault lines in the social fabric. From the perspective of the Language tradition, one may put N30 somewhere between Silliman and Andrews. N30 shares an autobiographical element with Silliman’s New Sentence projects, and as in Andrews, there is a concern for mapping out social totality within text—what Mettes refers to as a “textual world civil war.” Again this shows a formal textual strategy for allowing the person “Jeroen Mettes” to be absorbed by the world, which here appears as a whirlwind of demotic and demonic chatter, full of violence, humor, intensity, beauty, disgust, sex, commerce, and strife. Influenced as it may by American precursors, Mettes’s tone and form end up quite different from his American counterparts, consistently referencing a world that is Dutch, all too Dutch, taking on the oppressive orderliness of Dutch society with its endemic penchant for consensus by introducing chaos into its daily life and laying bare its implicit aggressions. The work’s 31 chapters each have a different feel and rhythmical outline, but none of them follow a predetermined pattern. Rather, Mettes would consistently edit and reedit the text, randomly rewriting parts of it, as he explains in his poetical creed Politieke Poëzie (Political Poetry). N30 – referring to the 1999 antiglobalist protest in Seattle – was to be the first text of a trilogy. The work itself was written “in the mode of the present.” A second text was to be written in the mode of the future, and a third one, in the mode of the past, was going to be an epic poem about the Paris Commune, and to form an alternative poetic constitution for the European project. I still deeply regret that Jeroen Mettes never got to complete those projects, just as I would be very keen on knowing what he might have had to say about more recent political developments. Instead, in 2006, he remained stuck in the horrors of the present, that ended up consuming him completely. He left Dutch literature with some of its most piercing criticism and its most profoundly moving, exciting and powerful poetry. Excerpts from N30 Translated by Vincent W.J. van Gerven Oei from Jeroen Mettes. "N30." In N30+ . Amsterdam: De wereldbibliotheek, 2011. Published with permission of Uitgeverij Wereldbibliotheek, Amsterdam. Chapter 1 1999. A day is a space too. And another man, who had chained himself, had his ribs crushed, and a motor has driven over somebody’s legs. Dutch health care system spends ±145 million guilders per year on worriers. A spiderweb vibrates as I pass by. Randstad renovating. She slaps her bag against her ass: “Hurry up!” OPINION IS TRUE FRIENDSHIP Your skin. It doesn’t express anything. “But the use of the sword, that’s what I learned, and you’ll need nothing more for the moment.” Just try to interrogate a guy like that. Gullit in Sierra Leone. Codes silently lying all around. But that’s simply what belongs to “that it’s just allowed”: that sigh of “world” (a word expressing that the trees are now standing along the water like black men with white bags in their hair); that’s nothing else right? And you see how everything has to move, and first of all what cannot do so. Without Elysium and without savings, barbarians lashing out, horny for an enemy, staring across the water, staring into the air—staring to get out of it. “You’ve never showed me more than the mall,” she said. All those “dreams” in the end—and now? It was lying on the stairway, so I picked it up and took it upstairs. Chapter 3 “You know what?” Telecommunication. For love… I don’t really like that cheap cultural pessimism, but… The holy city is on pilgrimage in the earthly bodies of the faithful until the time of the heavenly kingdom has come. The end of an exhausting autumn day behind the computer, my eyes filled with tears of fatigue. KITCHEN / INSTALLATION / SPECIALIST. Network integration. In the sun, stretched out on a sheet. (…) I don’t believe what I’m reading, because I want to believe something else. An illusion? Suits me. There’s a variety of shapes and tastes… “So what?” you may think. 102 dalmatians can’t be wrong. But I want more, dear… A feel good movie. I’m smashing the burned body. So what? We continue to save the European civilization. What’s there to win? Plato with poets = Stalin without gulag? Ball against the crossbar. No wonder. She comes straight to her point. She’s standing in the kitchen eating an apple. (…) The godless Napoleon had used her as a stable and wanted to have her taken down. “Our” Rutger Hauer. Ready or not here I come. Psst… are you also wearing a string? Nobody understands our desire. Cliffs breaking the waves and shattering the sunset. I used to be a real romantic (as a poet). A typical fantasy used to be the one in which I brutally raped mother and daughter Seaver from the sitcom Growing Pains . Nevertheless you only contain bad words. Eyelashes. Automatic or manual? That your skin always in the afternoon. Integration. The air is empty. Too bad! Hand in hand on their lonely way. Alaska! Chapter 12 May 5, 2001 [10:00-10:30] A dust cloud on a hill. Globe. Indian (British) (tie) / pope. Damascus. Rape. We’re carrying the ayatollah’s portrait through the streets. At the moment the girl is mostly suede jacket with white ribbons on her sleeves. A small explosion flares up/impact. Camouflage. Close up. We’re analyzing the situation. He’s dead right? Dead dead. Dead. Everything without, these, and only with the body. Indices signal death. Dollar bills are printed in factories. Holes. Light patch. Globe in a box. Microphone. What’s the situation? Grey impact on a green hill (field?). The water is blue. He has no lips. Interns on the background with skirts that are too long. This is an example of a sonnet. An Islamic woman pushes against the door of an electronics shop. Arrows (percentages (prices)). Is this what awaits the American? Touch screen interface. The word, an island, can only be a sign in that situation. We pull up a chair, join in on the fun. On the shelves only books about computers. One glance in the distance is enough to lighten up a luna park in the distance. She’s really desperate, especially when she laughs. Click. Ah. Next. And now it’s raining, but that’s ok. Yellow stains sliding over the south. Shallow caves light: clothes, boots, electrical equipment. 45. 22:10. Nothing gives you the right to eat more than people starving to death. The Hague. Slam dunk. Traffic light. Two H’s, one L (standing for the L (little prick)). We’re happy to say something. Clouds, small suns, temperatures, cities. The truth is never an excuse. Yellow. Yellow. Green. Yellow. Yellow. Yellow. Yellow. Green. Green. Yellow. Will you email me? Skeleton: “No.” Ex-nerds in brand-new and brightly red sport cars. $$$. I love. Shihab. Hooves in the sand. Skinny senior with over-sized sunglasses; old jockey (cap, trophy) smiling in slow motion. And there I am again, flashback, crying with my head in between my hands. Sometimes I’ve got the feeling that cannibals. Eyes: blue. Cancer. Why would I wait until tomorrow? Golden beams protruding from the lifted/lit earth. May 5, 2001 [11:30-12:45] You’ll remember this for the rest of your life. Graphs, diagrams. Bu$ine$$. Blue shirt, white collar, no neck (porn star). A name lights up. I’m hysteric. Will you join us? Letters falling in their words. Fingers set up a tent and start to dance. Young entrepreneurs from poor neighborhoods (read: black) guided by Microsoft. Kinda makes me happy, that sort of kitsch. A sense of exhaustion/impotence to see anything but the present. (…) Wouldn’t you like to? Orange explosion in an industrial zone. YOU’RE DOING THIS FOR AMNESTY INTERNATIONAL. Would you. A familiar face. Clouds and blossom. Sunflowers. Supermodels. Mountainous area in a rectangle: shades of brown, from dark to beige, more green toward the south. Tents and next to them (it’s all a blur) people. Plane. Stadium. Geometrical block of people. No, I ain’t crying. I don’t speak no more. I just want. Quote + photo. (Positive:) screaming crowd. Three-piece suit, seen from the back, before entering the arena. On the back: “Daddy abused me.” Oh, bummer. State of emergency has been declared and everyone has to cooperate. She’s cut her wrists. What we do know (…) is that there’s never been a unique word, an imperative name, nor will there ever be. [Click here for work that suits you.] Barefooted children are watching it (coherent pieces revelation of what’s lying below). Who knows how she’s changed during those two years. “Everything used to be better” + sigh. And here we are. An empty field of parquet. A city lying behind it. Explosion. Blue. A rain drop falling in my coffee. May 5, 2001 [14:30-15:30] A young Arafat on video speaking with raised finger. “I’m calling from my convertible.” Names on walls, victims, numbers… Tourists. Yellow. Yellow. “Your own child! Really, what kind of human are you?” I don’t want to hear it no more. A woman jumping out of the water in a yellow bikini against a background of fireworks and the Cheops pyramid. Thy sorrow shall become good fortune, thy complaints laudation. All planets will float and wander. Wo die Welt zum Bild wird, kommt das System (…) zur Herrschaft. It is something, but is it? May 5, 2001 [18:30-19:00] Iris. Leaves. NASDAQ. Open / and white and. For the one who’s doing nothing, just waiting. (…) NO DEFEAT is made entirely up of defeat -- since / the world it opens is always a place / formerly / unsuspected. October 2002. “Jeroen, I’m leaving for the cemetery, byeeee.” The rise of the middle class. My entire oeuvre is an ode to the. My entire head is a fight against the. God always demands what you cannot sacrifice. You may take that the easy way, but… “The state hasn’t made us, but we make the state” (Hitler). A stork exits the elevator. Skeletons of. Moscow. Helsinki. Palermo. Paris. Chapter 30 Like your paradises: nothing. United Desire, as only remaining superpower. And even though the sea is now calmer and the wind is blowing pleasantly in my face… Heart! Who determines whether a tradition is “alive”? The yellow leaf or the white branch? Mars. This sentence is a typical example. Most Dutch people are happy. No consolation. When I see a girl sitting at a table with a book, a notepad, a pen, a bottle of mineral water, her hand writing in the light—then I consider that one thing. “Presents,” “poetry,” “classics.” We are what we cannot make from ourselves. “Left”: mendicant orders, missionaries. Saint-Just: “A republic is founded on the destruction of its enemies.” She crosses the street with a banana peel between her fingers. (…) We chose our own wardens, torturers, it was us who called all this insanity upon ourselves, we created this nightmare… But “no”? Girl (just like a beach ball) talking rapid Spanish (Portuguese?) in a mobile phone. Do I have a chance now that her boyfriend is getting bold? CLIO, horny bitch. What else do you want? An old woman, between the doors of the C1000, is suddenly unable to go on; her husband stretches out his hand, speaking a few encouraging words. Selection from. Der Führer schenkt den Jüden ein Stadt. How can it reach us if we haven’t been already reached somehow? It doesn’t “speak.” No problem. Each word she uses is a small miracle, as if she doesn’t belong to it, to language, but wanders around with a pocket light looking for the exit; she’s never desperate (maybe a little nervous), lighting up heavy words from the inside. But indeed, we’re free. But the predicate is not an attribute, but an event, and the subject is not a subject, but a shell. That’s why also samurai, knights, and warriors raised the blossom as emblem: they knew how to die. Locked up in a baby carriage with a McDonald’s balloon. Blue helicopter, the blue sky. Whether you want to refer? The point is. How / Motherfucker can I sing a sad song / When I remember Zion? You’ll feel so miserable and worthless that you think: “If only I were dead!,” or: “Just put an end to it!” “So you’re an economist?” Her card—two little birds building a nest, her handwriting shaking—is still on the mantelpiece. Guevara: “No, a communist.” A straw fire, such was our life: rapidly it flared up, rapidly it passed. I’m fleeing, coming from nowhere. (…) Eazy-E drinking coffee with the American president. If I’d scream, would that be an event? Drown it: the cleaner it will rise up from the depths. No! The night, so fast… As if there’s something opened up in that face. Come on, we may not curse life. He shows me his methadone: “If you drink that all at once, you’ll die instantly.” The last one dictates how we should behave to deserve happiness. One shine / above the earth. “I want to go to Bosnia,” I said bluntly. I don’t even know the name of the current mayor. Let’s despise our success! “There is no future; this is the future. Hope is a weakness that we've overcome. We have found happiness!” Sun. Sushi. Volvo. I feel like a bomb about to explode at any moment. Makes a difference for the reconstruction right? The decor moves forward. Daughter of Nereus, you nymphs of the sea, and you Thetis, you should have kept his tired head above the waves! Alas! This sentence has been written wearing a green cap. I receive my orders from the future. A frog jumps into it. Her husband has turned the Intifada, which he follows daily on CCN, into his hobby, “to forget that he doesn’t have his driver’s license yet." Suddenly the sun slides over the crosswalk. Her (his?) foot is playing with the slipper under the table. Is this how I’m writing this book now? I’m not a fellow man. I hate you and I want to hurt you. These are my people. Their screaming doesn’t rise above the constantly wailing sirens which we've learned to ignore. My whole body became warm and suddenly started to tremble. Unfortunate is he who is standing on the threshold of the most beautiful time, but awaits a better one. Arafat’s “removal” is contrary to American interests. Jeep drives into boy. What you can do alone, you should do alone. A food gift from the people of the United States of America. Two seagulls. [...]. (shrink)