SOME BOOKS LODGE themselves in your consciousness, threatening significance, before you’ve even read them. The sense that they might be of enormous personal value creates a combination of excitement and something like dread. Such was the case for me with Tove Ditlevsen’s Dependency, the third volume in a recently republished memoir trilogy that also includes Childhood and Youth. The books were published together by FSG to relative fanfare earlier this year and written about in all the major venues.

Childhood and Youth, published in 1969 and translated by Tiina Nunnally, cover Ditlevsen’s early years in a working-class neighborhood of Copenhagen. But Dependency (the title, “Gift” in Danish, can mean “poison” or “married”), published in 1971 and translated by Michael Favala Goldman, was the one I was holding out for. It focuses on Ditlevsen’s romantic relationships and her romance with the opioid Demerol.

When I first heard of Ditlevsen, I was at work on my own memoir about opioid addiction in my family and, in particular, one long, harrowing romantic relationship with a man periodically lost to heroin and crack. I have long been an avid reader of the literature of addiction and few entries written by women exist in English prior to the memoir boom of the 1990s. A literary volume about becoming a writer and a mother, sustaining codependent relationships, and weathering addiction to a pharmaceutical painkiller written 50 years ago by a woman who chose not to fictionalize her experiences felt like gold to me.

Dependency is largely about the years Ditlevsen spent married to Ebbe Munk, an economics student and alcoholic with whom she had a daughter, and about her affair and subsequent marriage to a student doctor, Carl Ryberg. Ditlevsen has few romantic feelings for Carl until she finds herself pregnant (it could be Ebbe’s or Carl’s) and seeks him out to perform an abortion. (“I don’t want anything to happen to me that I don’t want,” she says dispassionately about the pregnancy.) To perform the procedure, Carl shoots her up with Demerol, and Ditlevsen experiences euphoria. “The room expands to a radiant hall,” she writes, “and I feel completely relaxed, lazy, and happy as never before.” “I’m in love with you,” she tells Carl then, but it’s the Demerol she’s talking to.

What follows is a ravaging period of addiction that arguably ruins a portion or the remainder of her short life. (Ditlevsen died by suicide in 1976 at age 58.) It is narrated, somewhat disconcertingly, the same way as the other volumes, with that magisterial Scandinavian blend of emotional acuity and coolness bordering on impassivity.

Reviews of The Copenhagen Trilogy heap unqualified praise on the first two volumes and the knowing but detached view Ditlevsen takes on her hometown and its lively characters. Yet Dependency seems to have been judged by another set of metrics. The same quality of writing induces an altogether different, more physical, reaction.

In The New York Times, Megan O’Grady writes, “So unsparingly abject is her rendering of addiction — I frequently found myself having to pause, finger in book, and take a breath.”

“During the worst of it, I found myself throwing down my copy of the book to get up and pace furiously,” writes Constance Grady in Vox, “desperate to get out of that head, that mental space where agony was being observed and recorded with such a clear-eyed lack of sentiment.”

Of the pages that follow Ditlevsen’s first Demerol high, which she describes as blissful, Deborah Eisenberg writes in the New York Review of Books, “No horror movie I’ve ever seen — however potent its imagery or metaphor — has come near the rest of the book for sheer terror.”

Sentiments like these may be meant to convey sensitivity and show how heartrending readers find scenes of drug use, but they have the opposite of their desired effect, revealing instead a pearl-clutching squeamishness about addiction. They lay bare the division that remains in our society — albeit one ever-weakened by the continued proliferation of elephant-grade opioids — between those who know this disease and those who do not. Still, their shock seems gratuitous, considering we have been living for years through an epidemic that looks a lot like this, that claims the dreams and lives of human beings every day. Have none of these people known anyone addicted to an opiate? I found myself thinking with surprise as I took in the collective gasp.

And why do readers feel such horror when the descriptions of Ditlevsen’s drug use are not even particularly grisly? Her relationship with Carl is darkly codependent: manipulative, transactional, and unstable. And Ditlevsen’s single-mindedness about drugs, the way the aperture of life closes in around highs, is of course bleak. Gone are time’s recognizable units: “An hour could be a year and a year could be an hour,” she writes. For Ditlevsen, life takes place almost entirely in her bedroom. She is unfit to be anything to anyone, and it’s bitterly sad.

But as in the first two volumes, Ditlevsen writes with restraint. And besides, as happens with slow-moving crises, for a time, life goes on. She hides her track marks with a long-sleeved dress. She finds she can still write well on methadone. She takes in a child fathered by Carl who will otherwise be put up for adoption, vowing to raise it as her own, and has another baby herself. “That summer was relatively happy,” she writes. “We had created a civilized frame around our life, a dream that I had always harbored deep down.”

Perhaps this is actually what reviewers are reacting to: the fact that Ditlevsen calls this life “civilized” at all. She does not include guilty asides, musings on her failures, shame about either her abandonment of her children (they are raised by Jabbe, the dutiful nanny) or the abdication of her roles as daughter, sister, or friend. Most notable for contemporary memoirists, she does not append that now-requisite final chapter striking a note of fanatical gratitude for her newfound sobriety, extolling the crisp gifts of asceticism, the simple pleasure in a cup of a coffee or a pretty sunrise. (I caved to that pressure; my book has one.) She refuses the kind of interiority and self-flagellation we demand of women’s addiction stories, and so is read as pure horror, as monstrous.

It’s worth noting that a blithe normalization of addiction is something we’ve grown accustomed to in men’s memoirs. In stark comparison to the deep breathing and pacing brought on by Ditlevsen, reviews of addiction books by male authors often read like a catalog of roguish antics. “Joshua Mohr is not a regretful man,” begins a New York Times review of Mohr’s recent memoir, Model Citizen.

He doesn’t regret the time he mugged a stranger for a couple hundred dollars, or the time he cracked the bathroom sink in a fancy restaurant by attempting to have sex on it, or all the times he dropped acid, snorted cocaine, smoked heroin, shot Special K or guzzled Fernet like water. He isn’t proud, per se, but these misdeeds — or, in some cases, actual crimes — have provided him the perspective necessary to appreciate how he’s aged into a stable, sober, married father who doesn’t do any of that, and hasn’t in a very long time.

But a different kind of judgment is reserved for women. Describing Ditlevsen’s post-rehab encounter with the man who will become her fourth husband, Eisenberg writes in NYRB,

Within a matter of minutes they’ve vowed never to separate, sent the children out to buy candy, and fallen into bed: “What about your wife?” I asked. ‘We have the law of love on our side,” he said. “That law, I said, kissing him, gives us the right to hurt other people.” Excuse me?

Eisenberg asks (italics hers). “Am I the only reader who clutched her head here?”

There is a peculiar will here to believe Ditlevsen doesn’t see what she’s doing. But that strikes me as naïve. Might she in fact know exactly how this line will sound to weary readers? Might she be delivering a moment of dramatic irony? In choosing to evaluate scenes like these merely as life events, rather than as crafted, curated pages of literature, these reviews subtly reinforce the paternalistic idea that a memoir is like a woman’s diary, a faithful, perhaps even unedited recording of things that took place. And this common slippage perpetuates the notion that a contribution to the genre is primarily an invitation to judge that person’s (that woman’s) life choices.

I, too, wondered how Ditlevsen really felt about certain neglected relationships, especially with her children. But I also wanted to shake her hand for denying me a view on her shame, for challenging my belief that it was something to which I was entitled.

But it’s not all clutching. Other reviewers elide addiction in other ways. “Ditlevsen has a dependency not only on Demerol but on the question of what it means to be a wife while also a lovesick daughter and an artist,” Hilton Als writes in The New Yorker, a strangely romanticizing line considering that for a time, these other tensions fall entirely away and Demerol is all there is. “In a way, being a junkie is her most selfless role,” he continues provocatively, because “one of the reasons you get high is to forget who you are and concentrate on how you feel as the world melts away.” He can’t possibly mean selfless in the sense of self-sacrificing; while deep in her addiction, Ditlevsen (like everyone else) is wildly selfish. Als must mean selfless in the sense of being without a self. But then who is it concentrating on feeling the world melt away?

In Harper’s, Lauren Oyler questions focusing on addiction at all. She challenges the inclusion of Ditlevsen’s four marriages, addiction, and suicide in the short bio accompanying advance copies of The Copenhagen Trilogy, for the ways it “glamorizes hardship” and shifts our focus away from the author’s aesthetic investments. I agree with the latter point, but what exactly about the mention of Ditlevsen’s life-defining addiction glamorizes it? In my view, the idea of removing addiction from her biography comes off as an act of erasure, not a gesture of respect.

Oyler’s concern is that Ditlevsen’s work invites misinterpretation because she’s been packaged as yet another “rediscovered” literary woman from history. “The ‘sad girls in Europe’ have become a marketing cliché,” she writes. But Ditlevsen was celebrated, not overlooked, in her native Denmark, as Oyler notes. While I agree that we would do well not to lump her into any facile grouping of “sad girls,” rendering her as less sad, less tormented, is not the answer.

I see Dependency as a rare, early entry to the literature of addiction — as such, it is thrilling — but it seems reviewers are loath to view it this way. They don’t want to reduce Ditlevsen’s work to the genre of “addiction lit” because it would be condescending. I imagine it’s also because addiction lit is considered lowbrow. These reviewers do not say as much, but they don’t have to. Under the false flag of a defense of the aesthetic, the notion that addiction lit is trash is quietly smuggled in.

Toward the end of the book, Tove falls deeper and deeper into her addiction. She finally gets clean during a long, voluntary stint in a rehabilitation facility, and Carl — who it turns out is quite mentally ill — is banished to an asylum. Ditlevsen quickly finds love again with Victor Andreasen, the man she would spend two decades with. But she is marked, dogged by cravings, captivated by the lights of the pharmacy. In photographs from her later life, she has the steely, rueful gaze of the recovering addict, for whom the “shadow of the old longing” will “never disappear completely for as long as I live.” Those lines are the last in the book, a reminder that it is Ditlevsen herself who demands we foreground this part of her biography. In her own telling of her life, she reserved more than an entire third — 141 of 370 pages — for her struggles with love and drugs. That was a radical act for a woman, anywhere on the globe, in 1971. I believe we ought to consider that math in our appraisal of her work.

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Nina Renata Aron is a writer and editor living in Oakland, California. Her work has appeared in The New Republic, The Rumpus, The Millions, and elsewhere.