In the last issue of Addiction and the Humanities, we reviewed a story of one man’s addiction to gambling as an example of a behavioral expression of addiction that fit Shaffer et al.’s (2004) syndrome model. Recall that Shaffer et al.’s (2004) model suggests that psychosocial and neurobiological elements predispose individuals to develop addictive behaviors. This week, in a review of Taylor Hackford’s film Ray, we explore how the model can explain the development and course of chemically expressed addiction. The film Ray chronicles the life of the legendary musician Ray Charles giving the viewer stunning insight into Charles’ inner struggle with multiple factors that might have led to his addiction to heroin and his emotional journey to confront these issues. Jamie Foxx’s brilliant performance helps us to understand the life of Ray Charles and the fierce independence and emotional suffering that are at the core of Charles’ creative genius. The seamless integration of music throughout the film enhances both the emotional drama and the viewer’s appreciation of Charles’ artistic output.
The film suggests several primary vulnerability factors for Charles’ heroin addiction: including poverty, childhood trauma and consequent posttraumatic stress disorder (PTSD)-like symptoms. Poverty that Charles experienced as during his childhood and young adulthood might have increased his vulnerability to engaging in drug-related behavior (Boardman, Finch, Ellison, Williams, & Jackson, 2001). Similarly, scientific literature has shown that PTSD is highly prevalent among patients with substance abuse disorders (Ouimette, Brown, & Najavits, 1998). Patients with dual diagnoses of PTSD and substance abuse disorder are a particularly difficult subpopulation to treat and exhibit worse symptom and functioning levels than patients with either disorder alone (Najavits, 2002).
Charles was born in Atlanta, Georgia during 1930, within a climate of racism and segregation, and became blind at the age of seven. At around the age of five, Charles witnessed his younger brother, George, die by drowning in a laundry pail after a fall. This traumatic event was one of Charles’ last visual memories before losing his sight. The guilt he felt for not saving George haunted Charles throughout his adulthood. Several sequences in the film show Charles having flashbacks to this traumatic childhood event and re-experiencing the helplessness he felt at the time of the incident. For example, there’s a scene in the film where Charles hallucinates water filling up in front of him and a young boy’s hand reaching out for help. These film sequences are particularly psychologically jolting because Charles screams out for help and the people around him do not console him or understand the horror he is experiencing.
Vulnerability to addiction, however, does not ensure the development of addictive behavior. Within the syndrome model, exposure to a chemical or behavior is essential to the development of specific expressions of addiction (Shaffer et al., 2004). The film shows that as public appreciation for Charles’ musical talent grows, Charles goes “on the road” to perform. During his travels, he is exposed to the illicit drug use that was common among jazz musicians of his era. Furthermore, the film Ray dramatizes Charles’ PTSD-like symptoms preceding his drug experimentation and eventual abuse and dependence. Charles’ decision to take drugs was likely an attempt to numb his emotional pain. This is consistent with Khantzian’s self-medication hypothesis (Khantzian, 1997). His repeated heroin use leads him to develop what the syndrome model refers to as premorbid addiction syndrome (See Figure 1, The WAGER Vol. 10(1)).
Scenes in the film show Charles experiencing some of the shared manifestations of the addiction syndrome (See Figure 1, The WAGER Vol. 10(1)) such as the destruction of meaningful relationships with people in his life (Shaffer et al., 2004). When Charles’ wife confronts him about the effect his heroin addiction and arrests have had on his family, Charles illustrates his focus on his own needs rather than his family’s needs by saying “When I walk out that door I walk out alone in the dark…I can’t do it if I’m alone everywhere I go.” Despite pleas from his friends and family to quit, Charles did not enter treatment until federal officials arrested him and left him with no other choice.
A sequence at the end of the film shows symbolically the treatment that Charles received. Charles returns to his childhood, opens up his eyes and sees his mother and brother appear in front of him. His mother tells him that although he has kept his promise not to let his blindness cripple him, he has allowed his heroin addiction to cripple him. His brother says to him “it’s not your fault” referring to his accidental drowning. This sequence draws a connection between the trauma he experienced as a child and the development of his addiction, inferring that he must address emotional issues pertaining to the trauma to recover from his addiction.
Although this symbolism illustrates the complex interaction of co-morbidities in Shaffer et al.’s (2004) syndrome model, it is an oversimplification of the treatment process and leaves the viewer with unanswered questions: What type of treatment did he receive? Which treatments were most helpful? Did he relapse after leaving the treatment facility? How did his relationships with family and friends change during the recovery process? How were his creative process and his ability to perform affected? What parts of the film are a realistic portrayal of Charles’ life and what parts are “Hollywood”? A deeper look at these questions would help to shed light on Charles’ recovery process and provide insight on ways to improve treatment programs for other people struggling with these types of emotional issues. Nonetheless, Ray is a movie that sensitively portrays the development and manifestation of Charles’ addiction to heroin and how his inner struggle with the addiction is expressed through his music.
What do you think? Comments can be addressed to Allyson Peller.
Boardman, J. D., Finch, B. K., Ellison, C. G., Williams, D. R., & Jackson, J. S. (2001). Neighborhood disadvantage, stress, and drug use among adults. Journal of Health and Social Behavior, 42(2), 151-165.
Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231-244.
Najavits, L. M. (2002). Clinicians' views on treating posttraumatic stress disorder and substance use disorder. Journal of Substance Abuse Treatment, 22(2), 79-85.
Ouimette, P. C., Brown, P. J., & Najavits, L. M. (1998). Course and treatment of patients with both substance use and posttraumatic stress disorders. Addictive Behaviors, 23(6), 785-795.
Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A., & Stanton, M. V. (2004). Toward a syndrome model of addiction: Multiple manifestations, common etiology. Harvard Review of Psychiatry, 12(6), 367-374.