User-driven standards in a mutual help context: The co-emergence of subjects and standards

Standards and subjects

At a time of fervent rise in governance by standards, not least in approaches to addiction, 12-step fellowships immediately impress as an obvious, yet strangely paradoxical, case in point. If one regards, defines, or reshapes the fellowships as instrumental in “treatment,” one is amazed by how an immense political and public goodwill coexists with consistently meager evidence of effect beyond that of any other method (Pedersen & Hesse, 2012). If this is a standardized, evidence-based treatment or rehabilitation program, it is certainly not a standard case of it. The play of absolutes seems to provide a logical shield in the shape of the tautology: it only “works if you work it,” as the motto has it. Yet, clearly the notion lingers on, that 12-step fellowships, typically by derivate proxies, should be either praised or dismissed as treatment programs.

At the same time, as mentioned, the fellowships are globally standardized to the extent that we, writing this article, could count on a shared, taken-for-granted knowledge taken from Hollywood as well as from extremely diverse local instantiations (in Brazil, Tokyo, or Moscow). And of course, the relevance of this article cannot but imply that very standard, even as it wrestles to escape it or transform it; similarly, when Mäkelä et al. (1996) stress the local variability of AA (arguing the relevance of their “study in eight societies”), they also presuppose the immutability which secured the global distribution of their book.

Such descriptions and paradoxes appear striking, as they push us back and forth between the universal and the particular. But our use of the concept of standards has a deeper purpose and a bolder ambition.

Within the two studies discussed here, we consider standards as material and/or discursive models of and for practice. Standards serve to stabilize and connect sites; they coordinate and render things, places, practices, and people comparable (Latour, 2005, p. 230). In connecting practices, standards highlight certain properties at the expense of others, forming provisional or stable wholes across the different sites they connect (Latour, 2005, p. 243). Standards direct attention such that they prompt or even enforce a confirmation of their own relevance. A critical reflection of standards, by contrast, emphasizes how, in the concrete practices of everyday life, there is an ongoing creation, transformation, negotiation, and handling of standards (see, for instance, Mol, 2008b; Yates-Doerr, 2012); or other standards may be attributed as immanent to practices in dialogic or dialectic opposition (Nissen, 2016). Thus standards perform an abstract fixation and coordination of certain aspects of the sites they connect, but going beyond their abstraction means rendering them dynamically as units that both produce and are produced through practice. When thus reflected, standards imply a dialectics as they inherently move between habits of the living body, structures of (model) artifacts, and social (power) relations, incessantly interchanging closure with unsettling, structure with process, and deconstructing rigid oppositions of determinism versus voluntarism. Further, with this broad approach, standards can be seen as embodied in prototypes: artifacts that serve as exemplars retaining a complex, situated historicity and a precarious, mutable relevance, perhaps mediated in narrative or aesthetic formats (Jensen, 1987; Nissen, 2009, 2014).

Viewed in relation to standards, subjects can all too easily be thought of as either the agents of establishing or using standards, or as their imprint—perhaps then as opposed to some non-subjective affectivity flowing outside of this rational-and-preformed intentionality (e.g., Thrift, 2008). Our deeper engagement with the concept of standard matches a more cultural-historical, contradictory subject; a subject that submits, suffers, engages, creates, transcends, and transforms; a self-constituting and self-overcoming subject; a subject recognizing and recognized by herself and others; a subject identifying and participating; a subject thus incessantly emerging. In our view, this is a richer approach to subjectivity, which can be articulated with such seemingly adverse traditions as the Foucauldian (especially if referring to late Foucault, e.g., 1990; Rose, 2007), narrative anthropology (e.g., Mattingly, 2010), the performative ontology emphasized in some science studies (Martin, 2007; Mol, 2002), or the cultural-historical branch of critical psychology (Wertsch, 1991; Zittoun, 2012); see also Nissen (2012).

In the 12-step fellowships, we come across such subjects as the implied or articulated “I”s and “We”s in their evolving indexical interplay with those who imply or articulate them, and in the ways that they relate to us, as we meet them on various levels.

Data

As mentioned, we use data from two recent studies of 12-step fellowships, Narcotics Anonymous (NA) and Overeaters Anonymous (OA). The study of NA draws on the available literature by and about NA; on speaks, which are personal stories from NA participants, often recorded at meetings or conventions and made publicly available online; on 3 pilot interviews with long-term participants in NA; and on participant observations from 5 NA meetings in Copenhagen; the primary emphasis is on NA’s own literature and speaks (Keis, 2014). The study of OA covers available literature by and about OA, participant-observation studies from 10 OA meetings in Copenhagen, speaks available online, and 3 semi-structured interviews with OA participants. In the OA-study, the emphasis was on the interviews (Nymann Nielsen, 2014).

A few points should be made regarding our empirical material. The use of personal stories is common in research on 12-step fellowships (e.g., Cain, 1991; Rafalovich, 1999; Valverde & White-Mair, 1999). These stories are often generated through the reading of fellowships-approved literature and through semi-structured research interviews. Speaks are a less-used resource for researchers. Speaks are extemporaneous and often contain a telling of parts of the speaker’s life story as well as stories about their participation in the 12-step fellowship. They exemplify the central procedural standard of sharing one’s story and one’s experiences, speakers only speaking on behalf of themselves, since no single person is allowed to represent the fellowships (cf. the 12 traditions). Another important point is that these speaks take place inside the fellowship and are addressed to other participants in the fellowship. Therefore these speaks can be treated as examples of participation, and not just as stories about participation, as would be the case if we relied solely on semi-structured research interviews.

These diverse empirical materials can be regarded as representing different kinds of textual layers, ranging from the most general (fellowship-approved literature), over speaks generated at meetings, and to the more personal life stories generated through research interviews. Represented like this, the materials appear to form a continuum from the most abstract-social standards found in the literature to the concrete-personal stories and interpretations of standards found in speaks and interviews. But our analyses revealed a more complex distribution. When attending meetings, listening to speaks, and talking with participants, we were struck by the way in which 12-step slogans, references to what other participants say, and citations from the 12-step literature constantly figure as references. As will be exemplified below, it was often apparent how interacting with standards allows the participant to create, stabilize, and maintain a certain stance or perspective. In this respect, qualitative interviews have something important to contribute, because they can serve as a naturalistic experiment with how standards interact with the subjectivity of the participants.

Through thus relying on several empirical sources, the 12-step fellowships are constructed as a complex case (Mol, 2008a, p. 32). This helps preserve the recalcitrance (Latour, 2004; Stengers, 2005) of the phenomenon. Along this line, constructing a case in which NA and OA serve as two prototypical examples of 12-step fellowships does not entail a comparative aim; instead we want to explore some of the differences, displacements, and negotiations of central standards in the 12-step program as they travel between different 12-step fellowships and are connected to different kinds of problems of addiction.

Another point concerns the question of genre; the types of material we are working with can be seen mainly as examples of what Foucault calls “prescriptive” and “practical” texts: texts whose main function is to offer opinions, advice, and rules of conduct, and which are themselves objects of a “practice” in the sense that they are made to be reflected upon and tested out in the conduct of everyday life (Foucault, 1990, p. 12). With Annemarie Mol’s (2008a) metaphor, prescriptive texts invite us into a subject position that is closer to an eater than a reader: we are invited to see how the individual’s consumption of texts, practices, and advices transforms the “foods” eaten.

Finally, we should note, however, that we have not sought out people who refused to eat or who failed to digest: voices that reject the 12 steps, or present narratives to prove their failure. That, too, seems an obvious route to follow, even though in this landscape of absolutes, it would be no easy task to find ways to mediate their stories with those of the “eaters.” Since our basic ambition is to encourage and cultivate dialogue, we hope for that to become possible at a later stage.

The positive ethics of disease

The 12-step fellowships are founded on a particular understanding of addiction, namely that addiction must be regarded as a disease. This assumption is probably one of the most discussed and widely criticized aspects of the 12-step program and the 12-step fellowships (e.g., Alexander, 2008; Keane, 2002; Peele, 1995). But what is “disease,” precisely, in the 12-step fellowships?

In NA, addiction is defined as “a physical, mental and spiritual disease that affects every area of our lives” (NA, 2008, p. 20), and which is progressive, incurable, and fatal (NA, 2008, p. 23). The disease is characterized by a loss of control of one’s use of drugs, which makes controlled use impossible and abstinence absolutely vital. It is seen as a chronic condition, which must be continuously and actively handled and addressed (NA, 1992, 2008). This allows for the important distinction between active addiction, where the addicted person is still using drugs, and addiction in recovery, where the addicted person abstains from using drugs and deals with the other aspects of his or her addiction.

This looks fairly simple. At first glance, what we have is a popularized medical object, echoing the “loss of control” which is key to diagnosing dependence in WHO’s ICD (and in the DSM), and with a notion of “spirituality” as a folkloristic add-on. But if one looks more deeply into it, it becomes something quite different. For one thing, despite its constitutional status, it appears to be the object of ongoing negotiations.

In the NA “Basic Text,” it is admitted:

There are probably as many definitions of addiction as there are ways of thinking, based on both research and personal experience. It is not surprising that there are many areas of honest disagreement in the definitions that we hear. Some seem to fit the observed and known facts for some groups better than for others. (NA, 1992, p. 9)

One might expect these sentences to warm up to “the NA definition” of its title concept. But the text turns around:

If we can accept this as a fact, then perhaps another viewpoint ought to be examined, in the hope that we can discover a way more basic to all addictions and more valid in establishing communication among all of us. If we can find greater agreement on what addiction is not, then perhaps what it is may appear with greater clarity. (NA, 1992, p. 9)

In continuation, four negative definitions of addiction are offered: Addiction is not freedom, addiction is not personal growth, addiction is not goodwill, and addiction is not a way of life (NA, 1992). These negative definitions then form the basis for the positive goals for recovery: freedom, goodwill, creative action, and personal growth (NA, 1992). The four abstract goals are articulated as both the antithesis to active addiction and as the more general ideals or standards for the way of life of an addict in recovery. This is important because it leads us to the somewhat surprising suggestion that “disease” in the 12-step fellowships—contrary to the standard medical approach—is anchored in a positive ethic; it is connected explicitly to questions and assumptions about how one should live. ²

The question of the origin of the disease is generally left unanswered, often by treating it as commonplace: “because I’ve had this disease ever since I was a little girl, and I’m not going to try to explain how I got it, and blah-blah-blah, because you all know all about it” (Danish female NA speaker). ³

It is characteristic of NA and other 12-step fellowships that they do not ask their participants to accept a particular ontology or etiology of their addiction, other than the overall idea that addiction is a chronic disease (Rafalovich, 1999; Valverde, 1998). This seems to remain sufficiently vague to enable the co-existence of different and potentially opposing explanations of the origin of the disease within the fellowships. Thus, the practiced epistemology is pragmatic and ethical: what matters is what you can do with it, and how you can live—not just survive—with it, and this appears to render further explanations of the cause or origin of this disease superfluous.

The kind of knowledge privileged in 12-step fellowships is personal experience. 12-step fellowships can be seen as representing a non-professionalized form of expertise, which is experiential, and which differs markedly from a medical approach (Bailey, 2005, p. 541; Valverde, 1998, p. 122). It is repeatedly stated and written that the power to define someone as an addict is solely placed with the addicted subjects themselves. No expert can diagnose anyone as an addict; instead, the self-diagnosis, which takes place through participation in the 12-step fellowships, performs the subjective experience of being an addict—an experience that is furthered by the descriptions of addiction as a certain way of being, which can be found in fellowship literature, in speaks, and at meetings. However, this does not reproduce the radical opposition of objectivity and subjectivity pervasive in the medical approach (and confirmed in Arthur Kleinman’s famous distinction between disease and illness, 1988). The 12 steps’ disease concept organizes both a communal and personal ethics; it offers a generalized and objectified experience which is to be interpreted by the individual yet nevertheless asserts a truth against subjective delusions and moral faults engendered by the disease itself. Its idiosyncratic grounding precludes issues of universal validity; yet it still provides a “boundary object” (Star & Griesemer, 1989), at once marking a dominion independent of medicine and connecting different communities, perspectives, and experiential contexts, including scientists, professionals, sufferers, and relatives.

On the Overeaters Anonymous homepage, you can select the header “Is OA For You” to reveal 15 questions to ask yourself in order to establish whether you recognize yourself as an overeater. ⁴ Here are three of the questions: (a) Do I have feelings of guilt, shame or embarrassment about my weight or the way I eat, (b) do I eat sensibly in front of others and then make up for it when I am alone, and (c) is my eating affecting my health or the way I live?

The questions come with the suggestion that a “yes” to several of them may indicate that you either have, or are well on your way to having, a compulsive eating or overeating problem. However, the questions are so broad it seems hard to imagine a late-modern Westerner who would not occasionally have these experiences. In this way, we all become potential subjects for a fellowship such as OA, in so far as we all may recognize ourselves in the diagnostic criteria.

Thus on one level, the conception of addiction as a self-diagnosed disease seems in line with the bio-politics described by Nikolas Rose, in which growing areas of everyday life become sites for personal entrepreneurship and self-invention mediated by (pseudo-) medical or biological concepts (2007, 2010). But if tendencies of pathologization resonate within 12-step fellowships, they do so explicitly by distancing themselves from the otherwise implied appeal to individual health responsibility (cf. Galvin, 2002; Mol, 2008b). This becomes obvious from the very first step of the 12-step fellowships (NA, 2008; OA, 2002, p. 1), in which the participant admits her or his powerlessness over the substance in question. Admitting one’s powerlessness may seem the antithesis to agency; but not within 12-step fellowships. Rather than setting up an ideal of individual sovereignty, defining addiction as a disease to be accepted and chronically managed represents an opening up to the world and to help from others. Powerlessness becomes a permanent feature of the self “in recovery” (Valverde, 1998, pp. 128–129)—an agentive self, re-defined as participatory, constituted as incomplete unless reaching out to others: “An addict alone is in bad company” (NA, 2008, p. 52).

Addiction is produced as a narrative prototype, a shared condition and a shared experience among the 12-step participants. This performs subjects that are not only—as immediately obvious—prompted to self-diagnosis and self-care, but also—perhaps less obviously—constituted as incomplete and dependent on others. ⁵

“Clean” but far from clean-cut

Another central 12-step standard is that of abstaining from the defining substance. In NA, this means a “complete abstinence from all drugs” (NA, 2008, p. 9). The chronic disease implies that no control method works; for an addict it is not possible to use in moderation or to only use certain drugs (NA, 2008, p. 78). “Once we use, we are under the control of our disease. … The first thing to do is to stay clean. This makes the other stages of our recovery possible” (NA, 2008, p. 84).

This is also reflected in the central message of the NA—that “an addict, any addict, can stop using drugs, lose the desire to use, and find a new way to live” (NA, 2008, p. 68). The ideal of abstinence functions both as a performance standard (a goal) and as a practice standard (a means). Notably, it is more than not using drugs; recovery is a wider ethical principle: “Recovery as experienced through our Twelve Steps is our goal, not mere physical abstinence” (NA, 2008, p. 78).

Still, the standard of being clean is objectified as measured in time without the substance, as exemplified by the existence of “clean time” calculators online or as apps, and in the celebration of clean time anniversaries at meetings, where coins and key chains are handed out as rewards.

With this standard of abstinence, a certain formatting of the addict’s body and its relation to drugs are established. The addict’s body is affixed with a particular sensitivity to drugs, sometimes described as an allergic condition (NA, 2008, p. 5). Being-on-drugs is articulated as a pathological form of existence for the addict, for whom using drugs will lead to “jails, institutions, dereliction and death” (NA, 2008, p. 7). Importantly, this is not a universal demonization of drugs; it is the underlying disease of addiction that makes the relationships between the addict and the drugs problematic, not the drugs themselves, whatever their effects may be. Hereby NA circumvents the entire discussion about the addictive properties of different drugs; but they are left with another issue: What counts as a drug?

In NA’s Basic Text, it is stated that an addict cannot use “any mind-altering or mood-changing substance, including marijuana and alcohol, successfully” (NA, 2008, p. 4). This very broad definition of drugs also makes the question of medicine precarious:

Our experience has shown that no drugs are risk-free for us. Any medication may unleash the craving and the compulsion that haunted us while we were using. Nonprescription drugs can be as dangerous as those prescribed by a physician. (NA, 2010, p. 15)

On this background, the increasing use of substitution medicine (such as methadone) poses an acute challenge, and is the object of ongoing negotiations within the local groups in the fellowship. This is the point of clash between two radically opposed ways of performing the body in the drug field. In 12-step programs, the body primarily serves to anchor the defining disease as a given entity, an essence, and not as a platform or tissue for technical intervention; in substitution treatment, the body is configured as a central site of pharmaceutical intervention (Gomart, 2004). The two approaches imply very different assumptions about the relationship between the use of drugs and the user’s subjectivity, as well as different assumptions of how to create the possibility of resistance to the grip of addiction: abstinence programs promote users’ agency in proportion to the distance they maintain from the drug, whereas substitution programs reconstitute agency by inserting drugs into the body.

This also directs our attention to a more general point concerning drugs, namely their fundamentally ambivalent character, to which Derrida (2003, p. 25) refers with the concept of pharmakon: both as antidote and as poison; a cause of illness as well as of cure. The status of certain drugs as either medicine or poison is continuously negotiated in concrete practices and arrangements, and it is through these negotiations that the drug’s status becomes stabilized in relation to particular forms of practice and particular subjects. Despite the unambiguous standard of abstinence, these negotiations can also be found within the 12-step fellowships. Given the soaring modern culture of not only directly pharmaceutical commodities, but also an ever-increasing variety of other substances thought or meant to effect changes in metabolism or mood—energy bars or drinks, coffee, herbal tea, etc.—complete abstinence is not as simple as it may sound. Pharmaceutical developments are often accompanied by gliding standards, whether or not directly as part of the wave of medicalization. Thus, even though the NA arrived at a firm stance against normalizing methadone as a drug similar to insulin, new questions are posed by users of anti-depressants and ADHD medicine, who often think of their use in similar ways, heavily backed by an overwhelming alliance of professionals and lay public:

The medical team said I was severely depressed and schizophrenic, and prescribed medication. But I refused to take the meds, because I didn’t want a mood-altering drug in me. (NA, 2008, p. 257)

The confusion I felt inside was mirrored by how others responded to me. Some told me that I wasn’t clean because I was taking meds. (NA, 2008, p. 258)

Although alcohol is a fairly well-defined substance, the issue was already problematic in AA, for instance in the form of differences between contexts dominated by cultures of alcohol abstinence (e.g., some Muslim areas), Nordic drinking cultures (general abstinence interrupted by binges), and “wet” cultures (daily, but moderate drinking), or as various interactions with temperance movements. Still, it becomes more precarious with NA’s generalization of the substance from “alcohol” to “drugs.” And the question is even more pressing when we turn our attention to OA: How can an addict become abstinent when the substance in question is food? Abstinence altogether is not a viable option for the overeater; instead, abstinence from specific types of food that the particular person recognizes as her specific addictive trigger is promoted. In this way, OA may be said to promote rigid and restrictive relationships with food, rather than the flexibility that others associate with healthy eating habits (Kahn, 2009; Keane, 2002; Russel-Mayhew, von Ranson, & Masson, 2010). It is indeed possible, like Malins (2004, p. 99), to see this as a case of how 12-step fellowships reinforce reductive stratifications.

However, it is also possible to see another logic at work. Keane has pointed out that it is the qualitative difference between “normies” and overeaters that legitimizes the restrictive eating patterns that OA promotes (Keane, 2002, p. 129). When OA parallels overeating with diabetes, it is not a rhetoric of normalization, as in the methadone debate, but one of care: in the community of overeaters, the chronic condition demands constant care and attention. Care must sometimes overrule the ideal of freedom and autonomy often championed within health discourse; as Mol (2008b, p. 30) argues, life with a chronic disease is by definition a life of dependence on others. The OA disease concept demarcates the field of operation for a communal and public practice, in which a local sense is made of the meticulous dietary regimen.

In general, the seemingly rigid standards of complete abstinence or restricted diet should be contextualized by the broader ethics and communities of the fellowships. However, as we shall return to below, this still leaves open a question of whether more productive standards could be developed by envisaging bodies cultivated also by taste, beauty, and pleasure, rather than only—however locally defined—ascesis.

A shift from self-control to communal care

While 12-step fellowships can be articulated as examples of the prevailing neoliberal appeals to consumer choice and personal self-invention, we have argued that this does not imply a subject of independence. Admitting powerlessness in the face of an incurable disease seems to propel the individual in the direction of others. In this way, the conception of the subject as sovereign and self-controlling gives way to decentered forms of subjectivity, which may be both susceptible and semi-permeable (Blackman, 2012; Mol, 2008b). The addict in the 12-step fellowships is a subject who is constantly traversed by different forces and desires. Her focus on how to handle and balance diverse affects through her everyday conduct of life does not depend on a strong will or a centered control. It is a matter of distributed coordination both inside and outside the skin, and a cultivation of participation in collective practices (Mol, 2008b). Unilateral control gives way to relational and reciprocal forms of subjectivity within 12-step fellowships. In this sense, the “logic” ⁶ practiced within the 12-step fellowships can be articulated as one of care:

The logic of choice is concerned with individuals who wish to be free. The individuals who figure in the logic of care would die if they were left alone. They owe their very ability to act to others. (Mol, 2008b, p. 72)

One strong force that opens the 12-step subject to her caring community is the instant and recurrent recognition that is given with identifying as addict. This can be viewed as a self-stigmatizing categorization; but it can also be regarded as a mode of community building. Much as in a late modern couple, an unconditional and eternal sympathy is declared, which may not be entirely justified in an empirical sense, but still works as an interaction premise, and is repeatedly confirmed as such.

As most of us know from almost every Hollywood rendering, many exchanges at 12-step meetings begin with “My name is Morten and I’m an addict,” followed by the ritual reply from the audience: “Hi Morten.” The trope of ritual conformation of identity is ubiquitous. In a Danish NA speak, Anne Grete offers: Anne Grete:

“Damn, there are so many beautiful addicts!”

The caring Other always-already knows me, sees through me, and understands how I feel. In her speak, Anne Grete invokes the caring community as embodied by her audience, who intermittently replies by ritually confirming. As in classic Greek tragedy, the chorus is the anonymous generalized Other, but in a very particular version, designed to recognize and hail a recovering addict. What they see at first sight is the subject; the addict category mediates as a framing device to bracket any conditionality, granting agency and moral intentionality despite all the wrongdoings that are only to be expected and probably no worse than those of others, of ourselves. The gaze is one that specializes in articulating and helping along ethical potential through and as participation.

The creation of stances in interaction

In the dialogical flow of interviews, different standards (rendered as slogans, citations from others or from the literature, etc.) figure as different voices within the discourse of the subject. What is striking is that even when they are not in consonance with each other, participants are able to mediate between these voices, whereby meanings seem to be propelled forward into a making of local sense, enabling a personal stance (Dreier, 2008) in regard to a specific topic discussed within an interview. This takes place through different kinds of semiotic mediation (Valsiner, 2000; Wertsch, 1991; Zittoun, 2012), for instance through the use of repetitions, paraphrases, and switches in personal pronouns and modalities.

Asger discusses food plans with the OA-participant, “Ida”:

(1) A: Yeah, yeah, so sometimes it’s just about moving on…?

(2) I: Yeah, at least for me it is.

(3) A: Yeah. And now to something more, like, concrete. In OA, you… they talk about that food plan, and then I thought, is that something you use more? It’s perhaps more concrete than the spiritual stuff?

(4) I: Well, it varies a lot, I think. Because it depends on what period I’m in. Because sometimes I’m like: “What the hell and fuck it all” and stuff, other times it’s more like: “Now we are going to do like this, and then it’s all taken care of.” And now I’m more at a point, where it’s actually a bad thing for me.

(5) A: To have a food plan?

(6) I: Yes.

(7) A: Okay.

(8) I: Because it actually triggers me.

(9) A: It reinforces in some way or another?

(10) I: Yeah, all of a sudden it just triggers.

(11) A: How is it triggering?

(12) I: It’s something about, that if you walk around for a long time denying yourself something – then all of a sudden, one gets very much like – then one just throws in the towel. Some of the biggest binges I ever had have come when I live with a lot of structure.

(13) A: Okay, but is it then somehow connected to the abstinence? That you choose something you are supposed to be abstinent from, and then it’s fucking hard in the last instance, or?

(14) I: It’s because, yeah but it’s because, things always end up as some kind of diet, so you are starving your body, right? And at some point, you can’t live with that any more.

(15) A: And the food plan ends that way as well?

(16) I: It doesn’t have to, you know, it’s very much your own call – whether you choose to keep something abstinent or whether you choose to say: “I only eat this,” and you know, some people have – well, my sponsor for instance, she makes packed lunches, that’s the only thing she is allowed to eat aside from. Where I’m like… Yeah well it worked for me for a certain time period, but it doesn’t work for me now – it doesn’t make me happy.

When discussing what has worked for her, versus what is more problematic, Ida consistently makes use of a moderator, typically “at least for me,” as in (2). If we consider meaning-making as a collaborative process happening from the intersection of voices within and between persons, it becomes understandable how Asger in (3) is in doubt whether to address a “they” or a “you.” Using the moderator, Ida has somehow established a distance between herself and the others, and Asger seems to respond to this. The pronoun confusion is not taken up in (4); instead, she distances herself explicitly from the food plan, a common element within OA’s tools of recovery (OA, 2011). As Asger asks about this in (11), the distancing seems to become accentuated. In (12) she moves through the personal pronouns of “you,” “one,” and “I”. Using “you” she first establishes a relation between herself and Asger as two persons who recognize each other in viewing the food plan as problematic. Having established a dialogue of recognition, she moves on to use the more impersonal “one,” which in the context of the utterance seems like an effort to generalize, legitimize, or normalize her subjective experience, which Asger and she, by virtue of the “you,” now have in common. Having used “one,” she follows this up using “I,” which seems to affirm the food plan as problematic: “Some of the biggest binges I ever had have come when I live with a lot of structure.” The shifting configurations of pronouns make it possible to see how distancing from the food plan is a relational event. Her description in (10) “all of a sudden it just triggers” demands explanation if Asger is to understand it. This understanding is brought about by her first establishing a recognizing relation through the “you,” which is then made an objective fact through the “one,” which finally makes it possible for the “I” to break through, explaining how the food plan may be a trigger. In this fashion, Ida’s subjectivity is neither there all along as an a priori stance taken prior to the dialogue, nor is it produced through the canonical material of the OA-fellowship. Rather, a dialectical process within the dialogical situation seems to produce a subject both different and the same. When Ida says: “Some of the biggest binges I have ever had come when I live with a lot of structure,” she is no longer the same subject as she was when she initially distanced herself from the food plan. The subject becomes consolidated through an intersubjective relation in which her statement is recognized and made a common fact. The analysis is supported by (13) in which Asger uses the word “fucking”; the swearing may be seen as his active display of his effort to recognize what she previously said.

The dialogical production of subjectivity evolves further in (14) where Ida again switches to using “you” rather than “I.” On a linguistic level, it thus becomes apparent how Ida is striving to forge a relationship between herself and Asger, which legitimizes her perspective as one she is sharing with others. This is also visible when she says: “so, you are starving your body, right?” where the “you” instead of the more impersonal “one,” together with “right,” seem to reduce the dialogical distance between her and Asger. When Asger in (15) asks whether the food plan becomes a diet as well, it is noticeable how she in fact contradicts herself by saying it doesn’t have to be, making reference to her sponsor’s solution. In regard to the pronouns, the neat sequentiality, characteristic of the beginning of the sequence, here gives way to a polyphony of different voices. She moves through “you,” “I,” “some people,” “my sponsor, she,” to “I,” “me,” and again, “I”. As with (16) she expresses how food plans don’t necessarily have to be a bad thing, the simultaneous presence of different personal pronouns seems to reinforce this point. Within the whole sequence, the polyphony makes it possible to see how a dialectical development is at play. The statements that the food plan can be good for some and bad for others exist side by side, as do the different pronouns. This makes for a synthesis in which the perspective of the other becomes incorporated without the subject having to completely abandon the stance towards the food plan present at the beginning of the sequence.

In this way, participation seems to convey submission, but in contrast to the logic of choice, this doesn’t entail a subject of repression or submission. Rather, submission seems to consolidate individual agency in a participatory form, as a synthetic stance towards specific questions, relationally defined both within the interview dialogue and within the local community.

Conclusion: Cultivating the ethics of recovery

By focusing on how standards and subjectivities are recreated in local collective practices, we have tried to suggest a way of articulating 12-step fellowships that goes beyond the dichotomy of agency that dominates the field—between totalizing discourse and (naïve or cynical) pragmatics. We have proposed a middle ground, or rather, made use of a mediating third term: standards as practiced.

This made it possible to articulate a practiced relativity of the multiple absolutes, which otherwise tend to make it hard to discuss the fellowships, not only for outsiders, but also for members. Part of this practiced relativity could be seen to unfold as ongoing reconstitutions of collectivities and participant subjects, through the genres of text and rituals performed, and through the continuous sense-making which is all the time prompted and shaped as dialogical and relation-forming in the public space of the fellowship. Yet, the sequence from a discourse of absolute standards fixed in texts and rituals onto a floating relativity of situated sense-making, vital as it is, is counteracted by a production of meaning. The stories in the standard 12-steps literature, the online speaks, and the ritualized performances should be taken seriously, not as more or less perfect realizations of pre-given templates, but as prototypical narratives (Nissen, 2015): narratives of personal experience, which retain singularity and circumstance, yet are cultivated and objectified as generalizing substantiations of the contradictory but meaningful standards by which the fellowships are defined.

At the same time, the approach highlighted the practiced positivity of the ethics that is articulated collectively and individually. Although the fellowships present as “disease-oriented,” that discursive negativity is left open, and, in turn, itself negatively defined, resulting in a positive ethics, which, granted, is typically articulated in vague generalities or quasi-religious terms, but which is continuously anchored in the mutual-help concern as care. In other words, even as the disease is omnipresent, it is the hope of health that structures the instantiation and handling of disease; etiology and diagnosis are left to personal preference, while “the good life” is subject to ongoing and public ethical problematizations and practices—quite the opposite to mainstream health discourse.

It is in this regard that we can move from a recognizing articulation into one which is visibly critical (although basically, these are two aspects of articulation that presuppose each other). In a first move, we can point to the limitations of standards built around abstinence, the idea of a clean body. Without denying the experience of millions of 12-step addicts, we can note two problems with abstinence: for one thing, in an increasingly pharmaceutical culture, 12-step fellowships are already moving beyond this standard. Just as the 12-step subject is generally permeated and relationally defined, so it can no longer think of itself as coextensive with a pure body. With Mol’s (2013) concept the “onto-norms” of the embodied 12-step subject go against mindless consumerist instrumentalism, but they need a better anchorage than the traditional image of purity can provide. This was most clearly expressed in OA, where abstinence is reconstructed as the communal maintenance of personally defined dietary regimes.

And this already points to the second problem: the tabooing of pleasure. Abstinence could still, until fairly recently, be conceived as a positive concept of health—continuous with a long Protestant (or Muslim, etc.) tradition—but when it morphs into self-defined regulatory regimes, the ubiquitous cultural monster of self-control easily appears as the “natural” alternative to addiction (just as, in Co-Dependents Anonymous, the individualism of therapeutic culture can be said to replace the original communal ethics, cf. Rice, 1998). The spontaneous replacements for ascesis, the bodily expression of recovery that was inherited from religious ancestors, seem to be standards that lead back to square one.

Given the capacities to handle paradoxes that we have witnessed, and the insistence on a take-it-or-leave-it organizational premise, it is likely that these problems will not be recognized and discussed within the 12-step fellowships. Still, since we articulate 12-step fellowships around their positive ethics, it would not seem altogether impossible to suggest a recognition of desire and pleasure as elements of new fellowships that may branch off from those we know at present. The positive cultivation of desire and pleasure may prove more solid as discursive and experiential references for the fellowships’ ethics of care, even as these maintain a reference also to the destructive “allergy” of the “disease”—rather like when some dietitians recommend cultivating taste and cooking as a way to overcome obesity (cf. Mol, 2013).

But, one might reasonably ask, who are we to make such a suggestion, in a professional journal of state-sponsored professors and psychologists? Our reply is our final critique. The smooth coexistence of choice and surrender fits well into the culture of civil society—parallel to how the customer meets the drugstore or the smart-phone brand. In the words of Marx’s 10th “Thesis on Feuerbach,” if we accept the “12 traditions” premise of an absolute distinction between the self-chosen membership of a free association and the alienation resulting from state coercion and professional expertise—as most scholars do—then we assume the “standpoint of civil society” (Marx, 1845/2014). The implication of that standpoint would be to pragmatically accept 12-step fellowship standards as curious plants grown in the wild forest of modern social life, perhaps with the half-hearted endorsement that they seem to “work” for those who “work it.” Yet, today’s social reality is not only heterogeneous, but pervasively hybrid. This hybridity is already present in the “boundary object” workings of the 12-steps disease—even as “free” mutual help groups, the fellowships in fact maintain a lively dialogue with the medicalized mainstream culture and its power-knowledge. But as the fellowships have expanded, this hybridity has, too. As the 12-step standard is applied in increasing numbers of state-financed and professional institutions—rightly or wrongly—those professionals also attend the groups when off duty. The recognition of 12-step fellowships implies institutional demands and expectations on members to attend (e.g., as conditions of parole). These are perhaps “external” to the groups, but they are nevertheless crucial to members’ participation. It is getting hard to maintain the image of a pure civil society association, which would anyway render the present considerations superfluous.

The alternative, which governs the imagined relevance of this text, is taking 12-step fellowships seriously. This implies that it is, after all, possible to learn from them as a complex case that works as a prototype—not only at the theoretical level for understanding the co-constitution of subjects and standards, but even at a more practical level for cultivating user-driven standards in the fields of health, social work, and education, where, with current forms of management and organization, similar clashes of absolutes are increasingly encountered. It also implies that we—and this “we” includes the 12-step members—embrace the possibility that the fellowships might be open to dialogue, and perhaps consider adding a 13th step and a 13th tradition the next time they regroup to form a not-quite-as-anonymous fellowship.