September 26, 2016
We’re performing at the Berklee Performance Center Monday October 3. It will be epic. Marching band epic. Like, there will be a marching band on stage with us. You can get tix here: https://www.berklee.edu/events/bury-me-standing
September 22, 2015
March 24, 2015
“Facts, Fantasies, and New Online Sociopolitical Interpassivity” (in Fast Capitalism)
March 9, 2015
I believe that, in a truly democratic society, all “content” (still a dumb word) must be free to all. It’s the public library model, but for everything: books, records, films, newspapers, academic journals — anything that can be digitized and put online. Of course this leaves us to figure out how the “content creators” will make their living.
I think the current crowdfunding paradigm still splits the world into have’s and have-not’s. Those who can afford art shall experience it. Those who can afford more art shall experience more of it. Those who can afford limitless art shall get into the artist’s “inner circle.” I don’t know, it just seems like the postmodern version of paying to get into museums, paying more for special exhibitions, and paying much more to go to swanky events and maybe even get a wing of the museum named after you. Cha-ching!
The Big Picture solution is that every citizen should receive a living stipend and free health care. Remember this nice foundational ideal about being guaranteed “the pursuit of happiness”? You want to go make art? Go ahead. You will likely live quite modestly, but at least you’ll live. The problem of how to fund artists is just a microcosm of what plagues this blatantly plutocratic country: wild economic inequities, no grand safety net, a demoralizing ideology that blames the individual for her failure to succeed, ET CETERA.
But alas, sigh, woe is me, DRAT … there is no stipend-for-all-citizens proposal on the table (because blatant plutocracy, w00t!) So everybody’s got to make due, all the while trying to #changethesystem or something. Clearly I am a stubborn idealist and, despite the crazy list of degrees after my name, I’ve never been good at making money. Worse, I am deep within the precariat class. But I acknowledge that we do live in a wonderfully chaotic time for experimenting with how “content creators” can make a living, especially by leveraging social media.
In my tiny corner of the world, I’ve launched a patreon campaign to help fund my writing, music, comedy, and independent scholarship. I realize that I am essentially asking people to give me the stipend I believe We the People should be providing to everybody. Which is weird. But it feels better than encouraging small circles of patrons to have tiered, exclusive access to my stuff. Everything I create, I try to put out into the world for free.
That said, my patrons will have a more direct line to what I’m making. I happily provide them with a monthly letter to let them know what I’m up to, what’s brewing, what I’m planning — just a little window into the Hieronymous Bosch painting that is my noggin. But the eventual “content” I create must belong to everybody (because democratic ideals and stubborn idealism!)
So here’s where I get my Sally Struthers on and say that, for less than the price of a cup of coffee (that’s PER MONTH, mind you), you can contribute to my s̶t̶u̶b̶b̶o̶r̶n̶n̶e̶s̶s̶ efforts to put some delightful writing and music and lectures and who-knows-what-else out into the world. Seriously, if 1,000 people threw in two bucks each per month, that’d have a pretty huge impact on what I’d be able to generate. Of course, you need to believe that such content is worth experiencing in the first place.
So, with maybe too much detail, I’ve described my artistic goals, background, and current projects on my patreon page.
Please do check it out and see if this is something you’d like to support.
We’ll figure this out, folks, with or without the radical new social contract.
January 16, 2015
I have just launched a campaign via patreon.com to help fund my independent research, writing, and myriad creative endeavors. Please check it out and consider becoming a patron of my many shenanigans.
As historian of science Anne Harrington dramatized in the introduction to her 1997 edited volume The Placebo Effect, “Placebos are the ghosts that haunt our house of biomedical objectivity, the creatures that rise up from the dark and expose the paradoxes and fissures in our own self-created definitions of the real and active factors in treatment” (p.1). It’s hard to hear this and not think of Marx’s introduction to The Communist Manifesto: “A spectre is haunting Europe — the spectre of communism. All the powers of Europe have entered into a holy alliance to exorcise this spectre …” Marx went on to declare that communism was a finally acknowledged formidable sociopolitical power and that the world was overdue a manifesto penned in its name. Similarly, within the pharmaceutical industry, the placebo effect is seen as a threat to be controlled—pretty literally, it would seem, the power of (the) people to heal themselves.
This article does not pretend to be a manifesto for the placebo, but it argues that the “problems” that the placebo effect has created for the pharmaceutical industry in fact suggest ways past a dominant cultural system in which our endogenous capacity for health is exploited for capital.
The pragmatic if not panicked title of a 2011 article in the journal Schizophrenia Bulletin sounds the alarm: “What Is Causing the Reduced Drug-Placebo Difference in Recent Schizophrenia Clinical Trials and What Can be Done About It?” (Kemp et al.) The article was the outcome of an international meeting of psychiatrists and researchers trying to understand why in clinical trials for new antipsychotic medications since the mid-1990s the placebo effect has been steadily increasing while the drug effect has been steadily decreasing. They wondered, do these newer studies have design flaws? Have the patient populations changed? Has the disease itself changed? Are the new antipsychotics simply less effective than earlier ones? They even considered the rise of so-called “‘professional’ research participants” who have financial motives to remain enrolled in clinical trials and who might therefore exhibit “an apparent eagerness to please the investigators.” The paper’s authors did not arrive at any firm conclusions. But their flailing about for answers suggests that the placebo effect is like an epistemological whack-a-mole: As soon as one confounding factor is explained or controlled for it’s just a matter of time before another pops up.
The authors specifically lamented the dearth of raw clinical trial data that is readily available for re-analysis. However, pharmaceutical companies do not openly share clinical trial data. On the contrary, they “protect” it, firstly by often not publishing unsuccessful trials. But why? On the one hand, it’s perplexing that raw clinical trial data would be kept a secret. So long as the data has not been fraudulently altered, what’s to hide? On the other hand, the entirety of clinical trial data might make a drug look less efficacious than reported in individually successful trials (a mere two of which is what the FDA requires to approve a new drug). Biased publications have characterized the psychiatric drug literature in particular.
Marx offers one explanation: “Political economy conceals the estrangement inherent in the nature of labor by not considering the direct relationship between the worker (labor) and production” (1964, 109-110). The “direct relationship” in the case of the clinical trial would include the participant’s ability—not to generate objective health for capital, but subjective health for its own sake, i.e. the experience of health over and above what is assumed to be given by the therapeutic agent (e.g. pills) directly. Problematized as the placebo effect, this ‘extra’ form of health cannot exploited like surplus labor, for it does not add value to the pill; rather, it is discarded altogether as that which cannot be commodified. (In fact, the placebo effect comes at literal expense to drug companies insofar as it contributes to the failure of clinical trials, whose costs subtract from the eventual surplus value of the drug.)
As a wily form of health, the placebo effect is nonetheless a kind of “estrangement inherent in the nature of labor.” Rather than estrangement that takes the form of a worker putting their labor into producing an object that ultimately cannot be theirs, in the case of the placebo effect it takes the form of an endogenous capacity to produce health that gets disavowed as not-real. This kind of “spontaneously” produced health is rejected because it cannot be objectified as the true “signal” of the drug—a prerequisite for commodification: “High placebo response rates hamper efforts to detect signals of efficacy for new antidepressant medications, contributing to trial failures and delaying the delivery of new treatments to market” (Rutherford & Roose, 2013).
So the clinical trial participant whose improved health is explained away as “only” because of the placebo effect would still seem to be in the very state of alienation Marx described for the worker: “[L]abor is external to the worker, i.e. it does not belong to his essential being; that in his work, therefore, he does not affirm himself but denies himself …” (1964, 110). Clinical trial participants become estranged to their own labor (i.e. the work of producing health) and thus, as Marx would have it, become alienated from themselves. Hence the patient’s self-reproach: “It’s all in my head.”
Pharmaceutical companies hide the majority of these “failed” clinical trial data from the public. As a consequence, most of the clinical trial participant labor that has gone into producing pills-as-commodities is hidden from the consumer, who nonetheless is later invited into a relationship with the FDA-approved (i.e. legitimated) drug as the imminent objectification of their own health.
This is a particularly egregious form of commodity fetishism. As exemplified in the case of antidepressants, the drug becomes an illusion that masks the reality of the clinical trial, namely that the consumer likely does not need the drug to become healthy.
Commodifying the placebo effect via consumerism
Capitalism is remarkable for its ability to assimilate—i.e. commodify—material that might seem outwardly subversive to it (for example, a bestselling book that critiques consumerism). In the case of pharmaceuticals, this has meant devising clever ways to profit from the placebo effect, despite that researchers lament it as increasingly subversive to the clinical trial. But while endogenous self-healing cannot be commodified at the level of the clinical trial, it can be commodified once the drugs have entered the marketplace. One strategy is to exorcise the placebo effect as the ghost of the real, by invoking neuroscience as a kind of biological reductionism.
Interviewed by the industry journal Pharmaceutical Executive, the lead researcher of a study showing that the brain could release endorphins in response to a placebo painkiller claimed, “Placebo effects are physiology, not just psychology,” adding that, “physicians could maximize the impact of real drugs by using the mechanisms of the placebo effect to encourage their patient’s brains to provide additional relief” (Metzler, 2005). Here the placebo effect, while not legitimized to be as “real” as the drug itself, is nonetheless objectified as a market opportunity to become more real than what is accounted for in the clinical trial. The just-psychology of “it’s all in my head” is then redeemed, but only insofar as it can be pressed into the service of the effects of the real-drugs (“maximizing their input”).
The consumer’s endogenous health is finally abstracted and commodified as a kind of labor that equates to the value of the drug. It has become surplus value, since it is health generated over and above what the drug supposedly delivers alone.
The sense in which the placebo effect is rendered “real” through neuroscience is an example of how science can be deployed as ideology in the service of pharmaceutical capitalism. As economist and historian Robert Heilbroner noted:
Science is not ideological in the sense of an avowal of social values, or an overt partisanship for social interests. Its ideological aspect lies rather in the function played by its deepest conception—an indifferent and inert matter as the ultimate stuff of reality. It this provides a world view compatible with, and needed by, that required for the limitless invasion of the world for the purpose of surplus accumulation (1985, 135).
Neuroscience is used to tame the placebo effect (“the ghosts that haunt our house of biomedical objectivity”) as inert in precisely this sense of encouraging surplus accumulation.
The placebo effect can also be commodified after the clinical trial through advertising. Drug marketers in fact have defended the direct-to-consumer advertising of prescription drugs in terms of the placebo effect, which, they argue, could lead to better drug compliance:
These advertising strategies not only create consumer demand for the advertised products, but may also create the emotionally conditioned responses and expectancies instrumental to enhancing a placebo effect that occurs when the medication is taken. This conditioned response may increase the effectiveness of medications beyond that which is expected from their purely biological mechanisms (Almasi et al., 2006).
Note that in this quote it’s not “emotions” (or imagination or mind) that are themselves efficacious, but that they can only enhance the effectiveness of the drug alone. That is, they add value to the drug.
It is striking that the clinical trial—which is what the FDA demands of pharmaceutical companies to connect their drugs to specific illness and to prove that their drugs work as advertised—does not account for marketing itself. Clinical trial participants are not told brand names. They are not shown advertisements. But once in the marketplace, the consumer becomes a producer; endogenous health is appropriated to boost the signal of the drug. So pharmaceutical capitalism wants it both ways, minimizing the placebo effect in clinical trials whose goal is to show a drug’s signal, and maximizing the placebo effect after the drug has entered the marketplace.
It is perhaps ironic that the clinical trial participant whose endogenous production of health was disavowed would then confront it in an externalized (alienated) form in the marketplace as a drug to be purchased. But pharmaceutical capitalism is a cultural institution that disavows our endogenous health, selling it back to us as an objectified commodity.
The industry journal Pharmaceutical Executive has defined the very purpose of the drug marketer as discovering how to make consumers feel discomfort with their own choices and experiences:
[O]ur job as marketers is to change customers’ perceptions, preferences, and behaviors towards our products or services. Our job is to make people uncomfortable enough to change their current behavior. Their comfort is not in our best interest. Left to their own devices, our target customers would choose to stay in their comfort zones, which means they wouldn’t use or even try the product or service we’re offering (Topin, 2013).
That is to say, an individual’s satisfaction is antithetical to contemporary capitalism. They must be kept alienated from it in order to keep returning to the marketplace in a perpetual attempt to regain it.
In a recent study published in the prestigious Proceedings of the National Academy of Sciences, the objective fetishism of neuroscience has met up with the psychological life of drug advertising:
Our results suggest that a commercial phenomenon, television advertising, may be an important trigger for psychologically mediated physiological effects of a drug. Our findings also inform economic theories of advertising. They suggest that, at least in the context of new consumers of pharmaceutical products, advertisements can have a large impact on the efficacy of a drug (Kamenica et al., 2013).
The curious phrase “psychologically mediated physiological effects” implies that the mind or imagination is a passive conduit of the “real” workings of biology. Moreover, the study’s authors are directly cognizant of how their research (especially couched in this framework of biological reductionism) is already at the service of “economic theories of advertising”—that is, the science of the placebo effect is a deliberate strategy on behalf of the political economy of pharmaceutical capitalism.
Sorcery and relentless expansion
In pharmaceutical capitalism, commodity fetishism intersects with what anthropologist Claude Lévi-Strauss called the “effectiveness of symbols”—the social network of belief necessary to elicit the experience of healing, whether in psychoanalysis or in shamanistic magic. Lévi-Strauss enumerated the components of symbolic efficacy as: “First, the sorcerer’s belief in the effectiveness of his techniques; second, the patient’s or victim’s belief in the sorcerer’s power; and, finally, the faith and expectations of the group, which constantly acts as a sort of gravitational field within which the relationship between sorcerer and bewitched is located and defined” (1972 ). In the case of the placebo effect, the capacity to produce endogenous health is similarly born out of social relationships. This might mean seeking authority in a doctor; or seeking paternal or maternal understanding from a therapist; or seeking “exotic” alternative understandings of bodies, health, and illness. In these various cases, the would-be patient seeks out an authoritative and empathetic knowledge about themselves that is assumed to be possessed by somebody else (“the patient’s belief in the sorcerer’s power”).
At the same time, the placebo effect works on drug researchers. It is now well-established in scientific placebo literature that doctor or researcher expectations influences the placebo effect just as well as patient or participant expectations (“the sorcerer’s belief in the effectiveness of his techniques”).
In addition to a unique doctor-patient dyad being a locus of the placebo effect, it also makes sense to talk about cultural zeitgeist as originating it (“the faith and expectations of the group”). That is, if the placebo effect is based in part on individual expectations, and if those expectations are given culturally (e.g. when antidepressants graced the covers of mainstream magazines and were hailed as miracle drugs), then our individual biological relationship to medications can be mediated by culture.
And, as noted in the beginning of this article, that relationship can change over time. The placebo effect has increased in recent decades the U.S., suggesting that it is under the influence of cultural changes. Statisticians have even invoked “the publication year effect” to describe growing rates of placebo response in antidepressant clinical trials specifically. That is, the more recent the date of a study’s publication, the more likely it is to exhibit a higher placebo response rate (Mora et al., 2011).
From the perspective of the capitalist, this is a problem of overproduction. That is to say, via an increasing placebo effect clinical trial participants produce too much health—but not the kind that can be measured as a drug’s signal. Not only are those participants then confronted with a fraction of their labor in the marketplace as FDA-approved psychiatric drugs to be purchased, but those drugs have seemingly become less and less effective over time. And yet pharmaceutical profits have risen while the effectiveness of pharmaceuticals has fallen (Chalabi, 2013). We are therefore faced with a strange situation analogous to how Marx described the capitalist paradox of overproduction in which workers are forced to live below their means (i.e. not being compensated with adequate medication) because they have produced too much.
The “overproduction” of the placebo response is part of a new global political economy of the pharmaceutical industry to search out so-called “treatment naive” populations. Clinical trial managers have had an increasingly difficult time finding such populations within the U.S., in part because so many Americans consume prescription pharmaceuticals, which leads to confounding drug interactions in the clinical trial. In practice this has also meant identifying populations who are enticed into the clinical trial (including the placebo arm) as a form of health unto itself.
Arif Khan, a psychiatrist who has led hundreds of clinical trials for pharmaceutical companies, provides an ethical justification for placebo-centric healthcare in underdeveloped countries: “The quality of care that placebo patients get in trials is far superior to the best insurance you get in America … It’s basically luxury care” (Silberman, 2009). However, the endgame of a clinical trial is a new therapeutic designed to treat whatever illness those clinical trial participants suffer from in the first place—regardless of whether they are receiving relatively improved interim healthcare as part of a placebo arm. And the exploitative reality is that many of these outsourced clinical trials develop drugs for common chronic diseases that are sold back in wealthy countries—not in the countries whose populations were used in those clinical trials, despite their interim “luxury” care (Glickman et al., 2009).
Anthropologist Adriana Petryna has called this kind of logic “ethical variability,” or how drug companies rationalize providing ultimately substandard medical care compared to what would be offered in more developed countries. These scenarios of globalized pharmaceutical capitalism echo the opprobrious Tuskegee syphilis study, a long-term “experiment” conducted between 1932 and 1972 by the U.S. Public Health Service to examine the “natural” progression of untreated syphilis in rural African American men—continued for decades even after effective treatments had been developed in the mid-1940s. Tuskegee researchers defended withholding active treatments by claiming that the general level of medical care within the study was much higher than the community standard.
On the one hand the globalization of the pharmaceutical industry follows the logic of expanding capital in which cheap labor is seemingly inevitably sought overseas. This is not quite capitalism expanding to find new markets, however, so much as capitalism expanding a still-colonialist version of labor power and seeking out additional “natural resources” (i.e. treatment-naive bodies) to saturate a single (Western, often American) market.
On the other hand the ethical variability of the globalized clinical trial has found its way back inside of the U.S. In an age of rapid-paced managed care, the clinical trial has become a site of longer, potentially more empathetic care. As one research article on the antidepressants acknowledged: “[B]eing assigned to placebo in an antidepressant trial is far from ‘no treatment,’ since it entails intensive contact with health care staff that greatly exceeds what is delivered in standard community treatment.”
Perhaps placebo-as-treatment has reached one logical extreme in a recent unblinded placebo study, which showed that placebos can be experienced as more efficacious compared to no treatment—even if participants and researchers are both aware that a placebo is being administered. It’s important to note, though, that the researchers told these participants that placebos are known to activate one’s own healing responses (Kaptchuk et al., 2010). The study suggests that the “effectiveness of the symbol” does not require deception in the traditional sense of the blinded randomized control trial, although it would seem that medical authority in the form of knowledge about the placebos is still at play (both as “the patient’s belief in the sorcerer’s power” and “the sorcerer’s belief in the effectiveness of his techniques”).
From signal to perturbation
Pharmaceutical researchers are hurriedly trying to deconstruct the placebo effect as the numerous non-pharmacological ways in which we interact with drugs (“psychological,” “cultural,” and so on). This perhaps represents an inadvertent throwback to some of the basic tenants of psychodynamic psychiatry—historically, the dominant form of American outpatient psychiatry when the first generations of psychopharmaceuticals were introduced. Psychodynamic psychiatrists did not worry about the placebo effect as a “ghost that haunts our house of biomedical objectivity”; rather, they assumed that individuals engage with psychiatric medication first and foremost at the level of meaning.
Today’s psychodynamic psychiatrists still insist that, while antidepressants may have “real biochemical effects,” there’s no guarantee that individuals won’t resist, amplify, or invent these effects to express or address psychological needs. Glen Gabbard, Director of the Baylor Psychiatric Clinic, claims that even the very notion of a “chemical imbalance” can become part of a patient’s defensive armature against the psychological work required of talk therapy, precisely by strengthening stubborn pathogenic fantasies about oneself.
Belief in invisible neurologic damage may become part of the effectiveness of the symbol that facilitates healing. But whereas pharmaceutical companies hope that the reductionist biological explanations within antidepressant advertising will bolster the placebo effect (by impressing upon consumers that their suffering is “real”), psychodynamic psychiatrists might skeptically pronounce such an experience of a drug as a “flight into health” (conversely to how Freud described neurotic symptoms as flights into illness—i.e. somaticized escapes from unconscious fears or desires).
Psychiatrist David Mann similarly discusses antidepressants not as simple medical interventions for a clearly-defined, objective underlying pathology, but rather as “perturbations” in a patient’s subjective experience of themselves:
Medication is for people who believe there’s something organically wrong with them, and they want to experience the perturbation … [It’s] also for individuals who are stuck, who wouldn’t otherwise return to therapy. It’s a means of engaging them. They won’t explore their symptoms on the level of meaning yet. They just want to be relieved of these feelings. They want something from me, and we may engage on the level of the symptoms (personal interview).
Within psychodynamic psychiatry there is no ‘true drug response,’ which of course is what the clinical trial demands, and which is what the drug marketer promises. In a sense we are all fundamentally placebo responders within this framework, because consuming an antidepressant starts with a kind of meaning-making that is embodied as much as “just psychological.”
Individual symbolic engagement with psychopharmaceuticals also thwarts the notion of the placebo effect as a generalized, measurable category of experience. Gabbard explains the psychodynamic framework as antithetical to the contemporary clinical trial model:
And going back to your original question – ‘What does psychoanalysis have to contribute [to the development of antidepressants]?’ – it’s that each person is unique, so that you’re always tailoring treatments to an understanding of the individual. And that goes completely against the psychopharmacological way of looking at – everybody we hang into groups, and we’ll give them the same treatment because they all have the same diagnosis (personal interview).
Of course, there is no such thing as a clinical trial with an n of 1. The FDA requires that pharmaceutical companies demonstrate that a given compound is effective not on a particular person but on a particular illness (as defined by an orthodox allopathic medical institution, like the AMA or APA). And as there are no biomarkers for mood disorders, determining whether the compound work entails comparing participants’ subjective reports before and after treatment. Whereas the psychodynamic psychiatrist would be interested in why a unique person had a unique set of experiences on an antidepressant, the pharmaceutical company only cares that the aggregate of individuals’ experiences can be boiled down to a signal for the drug itself.
While we should beware romanticizing the psychodynamic framework of antidepressants, its basic tenets do provide an alternative understanding of how endogenous health involves personal and cultural meaning-making. Moreover, historically psychoanalytic theory has included a socially progressive strand of thought by acknowledging fundamental antagonism between individuals and the culture they find themselves within.
The philosopher Herbert Marcuse praised psychoanalysis both as a therapeutic praxis and as a metapsychological critique of society in this sense. He claimed that psychoanalysis recognizes that ontogenetically sick individuals are really caused by phylogenetically sick societies, and that, beyond personal “health,” the goal of analysis is both to get individuals to see how society is sick, and to get them to function with society “without surrendering to it altogether.”
Symptoms are not mere suffering to be medicated away; they might be signs that some desire (often sexual in nature) has been denied, diverted as a form of anguish for the sake of preserving cultural norms. Symptoms are therefore jumping off points to discuss why an individual suffers, both in terms of their personal history and in terms of how society might be set up so has to deny them self-expression.
The apparent next revolution in psychiatric medication is also a return to an old revolution—the therapeutic use of psychedelic plants and fungi (and compounds synthesized from them, like LSD). Before psychedelics were criminalized for sociopolitical reasons in the late 1960s, they were a part of a dramatic new experimental psychopharmacology. Initially CIA experimentalists turned to LSD as a new form of psychological warfare that could be used during interrogations or to disorient enemy soldiers en masse. But they were repeatedly thwarted by the directionality of LSD experiences. It seemed to work like a truth serum on some subjects; it seemed to work like a “lie serum” on others, making them paranoid and uncooperative (Lee & Shlain, 1985, 16). Some subjects experienced overwhelming anxiety; others felt themselves to become omnipotent. At the end of the day, the effects of LSD were simply too wily for the CIA to find strategic usefulness in it.
But such experiential wiliness fit the work of a number of psychiatrists who found LSD elucidative to the work of psychodynamic therapy. Indeed, it was within the psychodynamic context that psychedelics were seen as the ultimate perturbations. Whereas the subsequent generations of psychopharmaceuticals would be intended to control symptoms, psychedelics were intended to generate unique experiences and induce profound personal insight directly. Also unlike psychopharmaceuticals, psychedelics did not have to be taken continuously and indefinitely; a finite number of psychedelic sessions could bring dramatic resolution to a number of malaises including depression and anxiety (Grob et al., 2011) and alcoholism (Hoffer, 1966).
In addition to narrow clinical goals, early psychedelic researchers like Humphry Osmond and Stanislav Grof ruminated on the potential of these substances to change how we understand the very nature of mind (Dyck, 2008). Their writings were as much philosophical treatises on the human mind as clinical accounting of how psychedelics can affect behavioral problems, addiction, or doctor-patient rapport in psychotherapy sessions. Grof, for instance, described psychedelics as revolutionary prods to any serious science of the human: “Many observations from psychedelic research are of such fundamental importance and are so revolutionary in nature that they should not be ignored by any serious scientific interested in the human mind. They indicate an urgent need for drastic revision of some of our theoretical concepts and even the basic scientific paradigms” (1980,10).
We should count among these scientific paradigms the placebo-controlled clinical trial. Indeed, psychedelics fundamentally challenge the role of the placebo effect in psychiatric medicine. After all, what does it mean to pit a placebo against substances that produce intense perceptual distortions including hallucinations and synesthesia, or sudden and rapturous personal insight? The small handful of recent psychedelic studies conducted under the aegis of evidence-based medicine have used “active placebos” including a much smaller dose of the psychedelic compound which might be vaguely detected by the participant but whose effects are not as profound as those brought on by the higher doses given to the experimental groups.
There is an important sense in which psychedelics transcend medical and scientific truth claims. Is a patient’s Prozac working (is there a signal)? Perhaps. But there’s no conclusive way to tell. (After all, maybe it’s “just in their heads.”) But is a patient’s psilocybin or LSD working? Without question. Compared to psychopharmaceuticals, experiences of psychedelics are indubitable.
The fact that we even debate the efficacy of antidepressants points to the heart of the problem. There is no debating that psychedelic experiences can profoundly affect individuals (of course, the content of those altered states of consciousness is shaped by culture and personal histories). But it’s precisely in the epistemological gray area of uncertainty over how well psychopharmaceuticals work where politics and capital insert themselves. Hence the burgeoning marketing literature devoted to exploiting the placebo effect for pharmaceutical profit.
Psychedelics, however, would seem to have the potential to divorce our health from pharmaceutical capitalism. As if their wily nature wasn’t already impractical enough to be commodified as “signal,” the most potent psychedelics are either naturally-occurring plants that cannot be patented, or, in the case of LSD, a semi-synthetic substance whose patent expired in 1963.
Psychedelic truth to pharmaceutical power?
Since the time of Marx’s writing, we have seen increased direct involvement of the state to protect capitalists. This helps us understand the continued repression of psychedelic drugs in Western societies. Pharmaceutical companies are threatened by psychedelics, which cannot be obviously commodified. The state protects their profits from psychopharmaceuticals by refusing to decriminalize psychedelics. That is, the state protects capital at the expense of the people’s health (endogenous health as the people’s inherent capacity to work for themselves).
There is deeper sociopolitical ideology at play here, too, insofar as the history of psychedelics in the U.S. is the history of their being associated with anti-war, “counter-culture” youths whose experiences of psilocybin and LSD were often phrased in terms of “opening the mind” and seeing through the bullshit of political power structures. As Marcuse wrote in 1969: “Today’s rebels want to see, hear, feel new things in a new way: they link liberation with the dissolution of ordinary and orderly perception. The ‘trip’ involves the dissolution of the ego shaped by the established society …” (1969). To the New Left movements of the 1960s, cognitive and perceptual revolution was a prerequisite for true, lasting political revolution.
The ethnobotanist and psychonaut Terence McKenna would revisit this notion in the 1990s:
It doesn’t matter whether you’re a Hasid, a communist apparatchik, a rainforest shaman, if you take psychedelics you will question your first premises; and that is a business that all governments—right, left, middle—are in the business of repressing. They don’t want to have to explain why things are done as they are. But if we don’t begin asking for that explanation, they’re going to run this planet right into ruin.
It is a tantalizing idea that a drug itself could induce politically subversive thought. We certainly don’t talk that way about psychopharmaceuticals. On the contrary, the history of antidepressant and anxiolytic advertising gets repeatedly critiqued for how it has reinforced sexist or otherwise repressively normative social roles (see Greenslit, 2006, and Metzl, 2003).
Some have even argued that the very word “drug” is a misnomer when it comes to psychedelic plants and fungi. McKenna, for instance, was insistent that substances like psilocybin-containing mushrooms and DMT-containing ayahuasca were not drugs, but “events.” They did not treat symptoms; they imparted experiences that could change one’s understanding of their role in the world. Moreover the language of “drugs” invokes the work of manufacturing, licensing, and medical gatekeeping—all state-protected enterprises that arguably do not—and should not—apply to plants or fungi.
As the comedian Bill Hicks once quipped, “Doesn’t the idea of making nature illegal seem a little … unnatural to you?” This plaint echoes Marx’s observation about the separation of labor from land. On the one hand this meant subordinating the land to capitalist exploitation. On the other hand, in the case of natural psychedelics like shrooms or yagé, this has meant preventing access to nature altogether. But as pharmaceutical capitalists need to own the means of production of health, so too do they need to prevent the people from acquiring their own means to produce the same.
In light of the grip of pharmaceutical capitalism, one strategy to reintroduce psychedelics into mainstream American culture has been to medicalize them. Organizations like MAPS (the Multidisciplinary Association for Psychedelic Studies) have been receiving DEA approval for small clinical trials that are demonstrating what researchers in the 1950s and 1960s already knew: Psychedelic substances can alleviate anxiety and depression, and can increase people’s general sense of spiritual well-being (for lack of better description).
MAPS’s contemporary strategy, though, is to push psychedelics through the culturally sanctioned institution of evidence-based clinical medicine, eventually to get them approved by the FDA as prescription drugs. As its founder and spokesperson Rick Doblin said optimistically of the process: “The FDA really does respond to attempts to alleviate suffering and to promote healing in patients. Their primary mission is not to support the war on drugs, their primary is to work to develop medicines to treat patients” (Doblin, 2001).
The question is whether this will end up trading sociopolitical control in form of criminalization for control in the form of medical gatekeeping and perpetuated pharmaceutical capitalism. Psychedelics seem inherently less amenable to the sorceries of belief that characterize the political economy of today’s psychopharmaceuticals, including the strange relationship between the placebo effect and the extraction of value from the drug.
Following Lévi-Strauss, the placebo effect—the “effective symbol”—hinges on belief. But culturally perhaps we need to push past belief-in-pharmaceuticals to the more indomitable experiential knowledge that psychedelics would seem to enable, namely trading symptom relief for therapeutic insight into oneself and one’s society. Because belief in this case teeters dangerously close to the capitalist ideology of “drugs for life” (Dumit, 2012) that sustains the cultural hegemony of the pharmaceutical industry.
This is not a naïve clarion call to an idyllic or nostalgic psychedelic free-for-all. Rather it’s a call to challenge the ideology of pharmaceutical capitalism, to replace our dependency on technocratic expertise and medical gatekeeping with revitalized community-based traditions in which knowledge of psychedelics is shared and openly transmitted to future generations. As the pharmaceutical industry has grown exponentially exploitative during the 35 years since Stanislav Grof wrote about the need to revamp the basic premises of psychology, it’s high time we finally acted on that sense of urgency. Pharmaceutical-centric psychology has failed to offer us a way to save ourselves. And most psychedelic substances are illegal in the U.S. But if we can rebalance our relationships to drugs, perhaps we can change the world. We face the hopeful chance that a return to plant-based psychedelic medicine will unravel major socioeconomic problems associated with the “war on drugs,” from the global militaristic offenses against “terror,” to rising incarceration rates, to exacerbated race and class disparities.
At the very least a new turn to psychedelic healing might offer us a way out of the forms of state-supported capitalism that are depriving us of basic human rights to generate our own health and explore our own minds—without paying for the privilege to do so.
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June 18, 2014
It’s called “How Neuroscience Reinforces Racist Drug Policy”: http://www.theatlantic.com/health/archive/2014/06/how-bad-neuroscience-reinforces-racist-drug-policy/371378/
May 15, 2014
My band Bury Me Standing has been recording new songs with our new singer / violinist Yasmine Azaiez. Here’s a sampling: