p. 230 Reading Nyswander today is still inspiring. Her fierce optimism and respect for the dignity of her patients shine off the page – including recognition of the diversity of psychological and social factors that influence drug use. Casting aside psychoanalytic stereotypes that would reduce all addicts to "masochists" or people seeking a "crude substitute for masturbation," she instead speaks evocatively about the depth and variety of her patients' motivation for using drugs, describing how drug use can serve perfectly understandable functions: "a way of keeping alive whatever life and joy they can feel," or even "a way into a mystical experience," "a clarity of felling and oneness of perception."
p. 266 A fundamental shift in our thinking would be the best way to help people like Josie – letting go of the ideal of a "drug-free" world and instead prioritizing policies and treatments that accept the fact that drug use and addiction are facts of life, unlikely to leave us anytime soon.
p. 281 It is not that addiction is or is not a brain disease, or a social malady, or a universal response to suffering – it's all of these things and none of them at the same time, because each level has something to add but cannot possibly tell the whole story.... [Mental] disorders, in other words, are not ground truths about reality, like chemical elements on the periodic table. Jellinek's word was a good one: they are more like "species" with a general family resemblance – biological species in nature have fuzzy boundaries, and the members of those species are not all the same. We must still make psychiatric diagnoses in order to do research, advocate for insurance payments, or otherwise translate our diagnostic thinking into the real world, but these labels should not be confused with an enduring, unitary, and discrete essence.
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