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The Dishcast with Andrew Sullivan
Sally Satel On Drug Addiction And Personal Agency

Sally Satel On Drug Addiction And Personal Agency

Sally Satel, the author of many books, is a psychiatrist and journalist who just came back after spending a year with opioid addicts in Ironton, Ohio. She writes about that experience, and her views on addiction — that it’s not as simple as a “brain disease” — for the journal, Liberties. We also discuss depression, mental illness, and modernity.

You can listen to the episode right away in the audio player embedded above, or right below it you can click “Listen in podcast app” — which will connect you to the Dishcast feed. To hear two excerpts from my conversation with Sally — on the compelling story of how Nixon got Vietnam vets off heroin; and on the tragic impact that meth has had on too many gay men — head over to our YouTube page.

Looking back to last week, a reader loved our episode with Glenn Greenwald:

Do you have any idea how refreshing that was?! One and a half hours of bullshit-free thinking out loud! As much of his stuff I’ve read, I had never heard Greenwald interviewed in depth or even heard his voice.  

I was just so impressed with this man’s courage. He exemplifies intellectual honesty and integrity, to the point that he puts his body on the line. The dude has big brass balls and I admire the hell out of him even more having heard you two chat.  

Another reader digs up a YouTube recording from 2013:

I finished your podcast with Glenn this morning and went to find and watch the marriage debate in Idaho that you mentioned in the episode:

I’m just sending this note to let you know how moving you were in the debate. I don’t cry, but I do let my eyes swell, and over the course of those two hours you made so many statements that moved me to the point of my eyes swelling. Really appreciate your work and everything else.

Another reader criticizes my work:

Greetings from Afghanistan. I’ve read your work on and off since your days at The New Republic. I credit you for changing my mind on gay marriage, so thank you for that alone. Although we have different views — I’m a Never Trumper, somewhere between Kevin Williamson and George Will — I respect your willingness to debate people who hold different views.

I must admit, however, that I vociferously disagree with your thoughts on Iraq/Afghanistan/and the wider war on terrorism. I’m currently on my sixth deployment and I’ve spent nearly five years in Iraq and Afghanistan. I will fully admit that I’m probably biased on this subject. I’ve shed a lot of blood here. I’ve lost so many friends — both Afghan/Iraqi and American — so when I hear you and Mr. Greenwald roll your eyes at the thought of staying put in either country, it certainly boils my blood.

I’m aware we’ve made egregious errors. I’ve railed against the machine myself, tilting at the proverbial windmills. Nevertheless, I’m quite reluctant to quit (lose) and see hundreds of my Afghan friends get slaughtered, like our South Vietnamese allies did in re-education camps.

These wars are just talking points for so many — another cudgel to hit the neo-cons with or put that war-monger W in his place. But for thousands of my brothers and sister-in-arms, it has been our lives’ work. 

I didn’t intend to be in any respect glib about that. I’m in awe of the way so many service-members have given their lives to this endless war, and it’s impossible to express my respect and admiration for those not in armchairs debating policy. The question is whether to keep this kind of sacrifice going indefinitely, or to end it, however grueling an admission of defeat might be.

Another reader sizes up the rapidly shifting mediascape from his vantage point in Boston:

Thank you for the wonderful conversation with Glenn Greenwald. I was struck by your mentioning the recent media obsession with violence toward Asian Americans. You are correct — in none of the stories have I seen a word said about the perpetrators. We are supposed to assume that this is collateral damage from Trump’s xenophobic reign, but it appears to me that many of those committing these heinous acts are young black men. For the media to acknowledge that would sort of make the simplistic narrative surrounding BLM that we’ve been spoon fed these past several months a bit more complicated, so therefore we are left with just the storyline that’s there’s been “escalating violence” against Asians.

Your attitude towards the New York Times mirrors mine toward the Boston Globe. The Globe was a staple on my morning doorstep throughout my life — I guess I’m a true classic Liberal deep down as well — but I no longer have faith in the paper. Conversely, The Manchester Union Leader has always been my local paper — but growing up gay and reading anti-gay bigotry on its editorial pages throughout my life did little for my self acceptance.

A funny thing happened during the Trump era. The Globe ran story after front-page story as part of “the resistance”, and the op-eds all had the same punchline: Trump is evil. (I did not vote for him either time.) The Union Leader did not support Trump; he’s really not a “ conservative, they said, nor a Republican at heart.

Long story short, I no longer subscribe to the Globe — way too woke and only dishing out what hyper-elite progressives want to read. I find the once intolerant far-right Union Leader actually publishes more moderate and Liberal op-eds these days than the Globe does with moderates and conservatives. So much for “diversity”.

Another reader looks back to our episode with Mara Keisling:

I’ve followed your thoughts on the trans debate a great deal, and I very much appreciate your perspective. But it seems to me that your writing, and your episode, miss one particular point a bit (one which I believe J.K. Rowling was making): Allowing people who declare themselves to be trans into women-only spaces merely on the basis of that declaration introduces a risk to women from abusive cis men, not from trans people.

An example. In one company I worked for, with around 5K employees, the bathrooms were set to automatically lock overnight. People who worked late could still get into them by using the employee ID cards, which were key-coded to only let you into the bathroom of your gender. This was meant as a safety mechanism for women who worked late in the office to have a place to retreat to if a man started acting in a threatening way and no one else was around.

The risk with some of the proposed legal changes, as Rowling seemed to be pushing back on, is that a straight male predator could declare himself a woman legally, mandate the company honor this by changing the coding of his ID card, and use this as a way to attack a woman in exactly the place our society set aside for her to retreat to.

The knee-jerk reaction of some people is to say no cis man would do this, but I’d suggest that those people are not considering seriously the lengths to which teenage boys will go for a laugh, and the lengths to which male predators regularly can and do go to against women.

There must, of course, be a balancing act in this. There are clearly ways our society should change to be more welcoming and supportive of trans people. But it seems reasonable to ensure that those changes don’t inadvertently dismantle safety mechanisms for women designed to protect them from cis men — or at least have an honest debate about where that balance might be, and how to minimize the cost.

Another wrinkle in the trans debate from a reader:

In our corner of northwest London, we have a large population of Muslim families who we struggled to engage in girls’ sports. Many of them are already nervous about allowing their girls to participate in mixed classes for swimming and after-school sports. Any whiff of shared changing rooms or physical contact (judo/soccer, etc) with a biological boy and they would be out for sure. 

Emails keep coming in over that episode with Mara, which is probably our most popular yet, in terms of downloads. Here’s another:

Reading your column celebrating gender non-conformity, and listening to your conversation with Ms. Keisling, it occurred to me that some on the left are simply flatly denying the validity of any kind of statistical analysis.

I work as a scientist at a biotech startup, and I’m used to thinking of things in statistical terms. Nature manifests many phenomena, particularly biological phenomena, as probability distributions. This is true of organismal properties like body size, genome content, immunological responses, and more socially relevant phenomena in human beings like expression of sex/gender and ancestry/race.

Leftist political thinkers, immersed in postmodernist theory, take these probability distributions and use them to justify statements like “race simply doesn’t exist” or “sex-based binaries are meaningless”, which is, it seems to me, fairly absurd. Statistical analysis is about clusters of data, correlation, grouping things together based on shared characteristics, and these analyses (like the bimodal probability distribution of “male” and “female” characteristics you spoke to Ms. Keisling about) often don’t perfectly fit the entirety of an individual. But they are still often incredibly useful in making predictions about many individuals, and policy making, by nature of its broad strokes approach, must necessarily concern itself with the statistic.

To recognize an individual as just that — an individual, with their own private life and idiosyncrasies and beliefs — is appropriate and just and moral and compassionate. In most day-to-day interactions, it’s not necessary to collect data to understand someone; we simply need to have a dialogue with them to come to appreciate their personality and traits. We can observe patterns without being prejudicial. We can be rational and kind at the same time. Indeed, we need to be.

But it’s ridiculous to deny that probabilities and correlations aren’t useful in policy analysis. Biological males are more often physically stronger and faster than biological females. The fact that Sara Sigmundsdóttir exists doesn’t negate that. Ms. Keisling seemed to deny, for instance, that one can say on average a trans woman should be presumed to have a biologically based advantage over a cis woman in an athletic competition, despite that fact that one of the primary reasons androgen levels spike in males is to increase muscle and bone mass. To be frank, that was an astonishing rejection of simple reality.

The more leftists rely on non sequiturs and sophistry to attempt to secure what they believe is the moral high ground, the more the foaming-at-the-mouth reactionary right will point to these irrationalisms and denounce the entire progressive framework.

As an aside, as a lover of Impressionism, I thought your father’s painting was gorgeous, and it’s a shame he couldn’t devote more of his life to what seems to have been a remarkable talent.

Lastly, from a reader who just listened to the episode with Michael Anton:

Everybody loves a non-falsifiable argument these days. “Given all the irregularities, there could obviously be fraud and you don’t know how much and so why wouldn’t you commit fraud?” Or “if the same situation happened after the 2016 election, Hillary would behaved in much the same way!” Or “if the Capitol riot was actually a BLM protest, the cops would have massacred the protestors and that proves racism exists!” These are all bullshit arguments and they are everywhere, and it's distracting and utterly exhausting.

I believe that it is quite obvious that the elections were free and fair because I have some basic understanding about how democracy is supposed to function!  But, of course, I can’t directly PROVE that the elections were free and fair, because the systems are manifold and complex.  

In the same way I believe peer-reviewed science to produce conclusions that are provably correct, I believe that a functional democracy will produce elections that are provably fair. And when the majority of a political party is insistent on casting doubt on a systemic process that is so utterly fundamental ... we have serious problems!

One thing I would love to see produced by news media is a legitimate, detailed case-study / audit of election process. Examine every aspect of election process in various states (not just contested ones, because obviously the focus there is because of the results, not because of the imagined fraud). I want to know every step of how elections work — from registration to the hiring of poll volunteers to the selection of polling sites to the operation of voting machines to the tabulation of ballots.  

And then also an honest, categorical interrogation of the fraud allegations. Can “dead people” actually vote? If that's possible, why is it possible, and what is State X doing to ensure it doesn’t happen? If it is happening, what’s the frequency, and what’s the impact? How is identity verified at the polls? How is it verified for mail-in voting? How are votes actually tabulated, and how do we know that they count?  How do we know that the software on voting machines is secure and accurate in its reporting? Can individuals know that their vote was tabulated correctly, and if so, how?

Is each flavor of theoretical fraud actually possible? What prevents it? How likely is it that the scale of such fraud could be done in a way that is impactful and undetectable?  

For all I know, this has been done by mainstream press. Sounds like something the New York Times would produce. But then you have an entire half of the political spectrum that is prepared to dismiss such reporting out of hand.

It’s just fucking easier to say “The system works and it’s obvious” or “The election was rigged and it’s obvious” than to break anything down and actually examine things and it's so troubling, and this is why I enjoy your podcast, which I found through Sam Harris’s podcast, which I also very much enjoy, even when — or maybe especially when — I disagree with the arguments.

Spoken like a true Dish reader.

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