Agency lost and recovered: A social constructionist approach to smoking addiction and recovery

Abstract

Deterministic, disease models of addiction assume human agency is co-opted by a biologically-driven compulsion to engage in the addictive behaviour. A central tenet of counselling, on the other hand, is that clients are agents of their own change [Beatch, R., Bedi, R.P., Cave, D., Domene, J.F., Harris, G.E., Haverkamp, B.E., & Mikhail, A.-M. 2009. Counselling psychology in a Canadian context: Report from the executive committee for a Canadian understanding of counselling psychology. Ottawa, Ontario: Counselling Psychology Section of the Canadian Psychological Association. Retrieved from http://www.cpa.ca/cpasite/userfiles/Documents/sections/counselling/CPA-CNPSY-Report-Final%20nov%2009.pdf]. Our essay explores this agency divide between theory and practice, and proposes that attention to agentic language [Davies, J.B. (1997). Drugspeak: The analysis of drug discourse. London: Informa Health Care; Wittgenstein, L. (1968). Notes for lectures on “private experience” and “sense data”. The Philosophical Review, 77, 275–320; Zidjaly, N. (2009). Agency as an interactive achievement. Language in Society, 38, 177–200] and use of discursive therapy techniques (e.g. narrative therapy, [White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York, NY: W.W. Norton]) from a social constructionist perspective [Burr, V. (2003). Social constructionism (2nd ed.). New York, NY: Routledge; Burr, V. (1995). An introduction to social constructionism. London: Routledge; Gergen, K.J. (1994). Realities and relationships: Soundings in social constructionism. Cambridge, MA: Harvard University Press]) can help reconcile the agency divide. Agency is conditionally defined as the biologically and socio-culturally-mediated capacity to act [Ahearn, L.M. (2001). Why agency now? Annual Review of Anthropology, 30, 109–137]. Furthermore, all human action has a reciprocal relationship in shaping, enacting and responding to our biological substrates and socio-cultural context. Brief narratives from smokers are presented and analysed within the anti-smoking policy environment where they live. Smokers claim agency for themselves as they make personal meaning of their smoking, and disclaim agency as they submit to dominant explanations of smoking as an addiction or a disease. These agentic turns can be found in how the smokers talk about addiction. This spectrum of responsible agency appears to be mediated by social expectations and context. The smokers’ narratives are used as a springboard to (1) further explicate a social constructionist approach to the agency paradox in addiction and (2) to show how counsellors may listen for agentic language and use discursive therapeutic approaches in treating addiction.

• Addiction
• agency
• counselling
• smoking
• discursive therapy
• social constructionism

Notes

1. This was a pilot study funded by the Canadian Institutes of Health Research and led by Dr Kirsten Bell. It broadly explored smokers’ experiences in relation to tobacco control policies in Vancouver, Canada. Twenty-five semi-structured interviews were conducted with smokers (21) and recently quit smokers (four) over a 7-month period between September 2008 and March 2009. Many smokers talked about feelings of social exclusion, discrimination, self-reproach and powerlessness in quitting (Bell, McCullough, et al., 2010; Bell, Salmon, et al., 2010; Bell et al., 2012).

2. O’Connor (2000) was interested in agentic language in the context of prison life, as well as narratives describing the crimes they had committed. We felt that given that smokers in Vancouver are excluded through denormalization policies, and pursue smoking behaviours under highly restricted conditions, they may struggle with similar issues of responsibility towards their actions.

3. Turkel has also used O’Connor's agentic language framework from a Contextual Action Theory perspective (Young & Valach, 2000, 2004; Young, Valach, & Collin, 1996, 2002) to analyse the language of agency in parent-adolescent conversations about career (thesis title). Turkel and O’Connor's works were used as exemplars to guide this analysis.

4. A label or diagnosis implies judgement, and carries the implicit notion of value (Hacking, 1999; Ross, 2005). The values of being called an addict permeate the label, contributing to a collective meaning of addiction taken up by the majority, and contributing to what Hacking calls ‘the looping effect’ (Hacking, 1999) of addict self and identity. According to Hacking, people embody their classifications, taking on their diagnoses and labels in an effort to conform; to further become textbook cases of such classifications. Interestingly, the looping effect as defined posits that, although people will conform in order to better fit classifications, they are themselves in constant flux; therefore, the institutions used to label and diagnose are revised to accommodate these changes (see also Rødner, 2005).