September 2, 2011
(A comment on my last blog entry got me thinking more about the relationship between drugs, politics and free will. This post is my first sustained response to that comment.)
Historically, we have been deeply ambivalent towards psychotropic drugs, wondering what (if any) role they should have in society. I would even argue that drugs are at the heart of all political philosophy. Indeed, you already know the politics behind the following questions: Are drugs ‘themselves’ dangerous (are they like guns)? Is drug use truly the activity of a free, rational, autonomous individual? Or, does one not truly act ‘voluntarily’ if they are under the influence of drugs, essentially making them less able to make ‘free choices’? What, then, should be the status of drug users’ civil liberties?
John Stuart Mill, whose nineteenth-century political philosophy was the direct precursor to modern-day libertarianism, emphasized that, “Over himself, over his own body and mind, the individual is sovereign.” Mill address the question of drugs specifically, arguing that any self-harm that comes from drug use should be punishable only insofar as it directly affects others (his example is being drunk while performing soldierly duties). That is to say, members of society should be held criminally responsible only for those behaviors that harm others. Do not criminalize the use of drugs; criminalize the resultant actions that may harm others.
Of course, the case for a paternalistic drug policy can be made on the argument that the notion of true self liberty is a complete fiction. Harming oneself inevitably affects others, whether in the form of a drain on public medical services (health problems), or a drain on social services (family neglect), or on social security (unemployment). Mill’s solution was simply to disregard these cases, defining harm to others as narrowly as possible, for instance as defraudment or physical violence. “Indirect” effects like the eventual use of social services did not count in his framework.
I am definitely attracted to the social ideal behind Mill’s proto-libertarian political philosophy, which was that we should live in a society that enables “experiments of living.” In On Liberty, he writes:
The majority, being satisfied with the ways of mankind as they now are (for it is they who make them what they are), cannot comprehend why those ways should not be good enough for everybody; and what is more, spontaneity forms no part of the ideal of the majority of moral and social reformers, but is rather looked on with jealousy, as a troublesome and perhaps rebellious obstruction to the general acceptance of what these reformers, in their own judgment, think would be best for mankind. (1859, Ch.3)
Mill emphasizes the development of one’s own individuality as a hallmark of a free, democratic society. Essentially saying: “get yo’ freak on!” He warns against the kind of paternalistic government that would essentially predetermine what kinds of lives, personalities and characters are socially valuable, and therefore individually permissible. So drugs may ruin our lives, but it’s of paramount importance that we live in a society that allows us to include them in our individual “experiments of living” — which, of course, could very well turn out disastrously.
But still, one argument against drug-taking is that it is essentially an irrational act, antithetical to the civil ideal of a society made up of rational, autonomous citizens. (Therefore, if drug-taking is not truly a free act, the government should be paternalistic and prevent us from possessing them). This argument can be applied to the decision to take drugs in the first place, or to whether the citizen-on-drugs is a ‘fully rational’ participant in a civil society. That is, either drugs are inherently without value, and pursuing them in the first place is irrational; or, consuming drugs incapacitates or debilitates individuals to the point of making them less rational, less autonomous, and essentially less capable of participating in a ‘free society.’ But I think both boil down to a fundamental confusion between personal freedom and political liberty. And I would argue that, c’est la vie, the integrity of civil liberties risks the compromise of personal freedom. It’s easy to see how an individual’s drug use might made them ‘less free,’ in the sense that they may become unhealthy, irresponsible, destitute, miserable. Their personal, everyday experience of freedom would then become compromised. Yet their civil liberties would have remained intact, since (hypothetically) they ‘freely’ made a decision — albeit a poor one — for themselves. And isn’t this the more important social ideal? [I put ‘freely’ in scare quotes because, of course, there’s no absolute freedom, as if we lived in social vacuums and as if our individual decisions weren’t overdetermined socially and culturally. But I’ll bracket this discussion (addressing behavorial economics, too) for a later post …]
As to the question of whether drugs have ‘inherent’ value, I hasten to mention that public debates about drug policy almost always avoid discussing positive effects of illicit drugs. As Bakalar & Grinspoon put it in their book Drug Control in a Free Society, “Permitting drug use is often defended in the name of individual freedom but rarely on the ground that there is any good in it.” (1984:16) This is another challenge to personal freedom and political liberty, but from a different angle: Nevermind whether drug use makes an individual less free; if drugs are inherently without value, then trying to obtain them in the first place is irrational, and should be prevented by the government. But we already know how contentious and ultimately wrong-headed this claim is. The fact that we now have the phrase “medical marijuana” speaks to the political compromises that simultaneously belie and reveal how this drug has positive effects. But the politics here is that marijuana’s positive effects have to be framed as social (“medical”), not personal.
Of course, there would seem to be numerous other demonstrable social boons from drug use. The historical connections between drugs and art and music certainly jump to mind, which are perhaps most visible in part because of the counter-culture posturing that has been a core component of artists’ and musicians’ collective identity (drugs as badges of anti-authoritarianism). At the same time, where artists and musicians have not flaunted their drug use, mainstream media has all too often stepped in to create their own mythologies-cum-scandals about such behavior. Check out this nice clip of a young Paul McCartney calling out the media for creating and bloating the very scandals about his acid use that they claim to have merely identified and reported on:
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Keith Richards also comes to mind, as the iconic drugged-out, infinitely parodied how-the-fuck-is-he-still-alive rock star. But read his autobiography. Jesus, this guy is articulate [yes, I realize the book is co-authored with a bonafide journalist], funny, and can recall his life with an extraordinary level of detail that puts my 35-year-old brain to shame (as he snipes in the book’s inscription: “Believe it or not, I remember everything”). Moreover, while Richards fully admits to near-constant drug use for his whole career, if we are to believe his narrative, he has never been in serious medical trouble because of it (his legal and political problems have been another story).
Many of us are familiar with how figures like Mark Twain, Sigmund Freud, Baudelaire, Jean Cocteau all used drugs to some extent. But also, some of our most prominent contemporary scientists and engineers credit their revolutionary developments in part to their experimentation with drugs. Kary Mullis, Nobel Laureate who invented the polymerase chain reaction (PCR) as a technique to make copies of DNA fragments, says he learned to visualize DNA because of his experiences on LSD. Similarly, Microsoft co-founder Bob Wallace claims that the birth of early Silicon Valley technologies was influenced by psychedelic drugs, crediting his own invention of shareware–which transformed software distribution–with his experiences with psychedelics. In a documentary on the use of LSD in scientific experiments Wallace says, “I think psychedelics help you in general go beyond the normal way of doing things, and to really open up your mind to more possibilities that maybe seem obvious in retrospect but that you never think of if you’re going along the normal way of doing things.”
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I do not intend these examples as a naively one-sided celebration of drugs that most certainly have the potential to damage or kill us. I intend them as counter-examples to policy-level debates about decriminalization that ignore the very questions of whether and how drugs can have positive effects.
In the middle there is always this:
Drugs are bad. But psychopharmaceuticals, on the other hand …
Some of my ethnographic research around psychopharmaceutical advertising has been to explore what drug companies say beyond the FDA-mandated package insert information. As I discussed in my last blog entry, the discourse of psychopharmaceutical advertising is that antidepressants and antipsychotics realize a return to self (never a way to “explore” or “transcend” the self, which is outside of our normative sociomedical discourse). In terms of civil liberties, it would seem that, so long as you are taking licit psychopharmaceuticals, your free, rational autonomy is guaranteed. So much so, in fact, that the drug companies combine the pharmacological return to self with the consumerist discourse of self-empowerment (You know what’s wrong with you / You should talk to your doctor / You should ‘take control’ of your symptoms). All this is fine and good — and distinctly libertarian-sounding, incidentally — but of course the end-game here is profit maximization for the drug industry, whose “Be Yourself, Take Antidepressants” insinuation is isomorphic to every other advertising slogan that gets hurled at us.
On the other hand, occasionally the drug companies slip up in what their ads reveal about an ideal, fantasized relationship to psychopharmaceuticals. Just days after 9-11, Pfizer released a public relations spot, basically patting themselves on the back for donating to the American Red Cross. But check out this line from the ad’s voiceover: “We wish we could make a medicine that could take away the heartache. Until we can …” This ad aired only very briefly, but luckily my dissertation advisor Joe Dumit was able to record it. I have since posted it on YouTube, with the following description: “In their rush to broadcast a touching bit of PR immediately after the World Trade Center attacks, Pfizer said what it wanted to say (we make medicines, we perform acts of social good). But they ended up promising much, much more (we will make drugs that cure heartache). The pharmaceutical vision of goodwill here is that of a company who eradicates the collective emotional response to a national tragedy.”
In terms of political philosophy and the question of free will, the Pfizer ad lets slip the idea that it’s perfectly permissible for a giant corporation to be in the business of selling drugs that chemically manage citizens’ emotional processing of geopolitical trauma. For the record, I do not actually think this should be illegal. HOWEVER, I think it is highly hypocritical of our society to allow such widescale psychotropic drug-mongering on the one hand, while criminalizing our personal decisions to make our own chemical “experiments in living.”
I’ll end this post with a spot-on Chris Rock clip. He says, “The government doesn’t want you to use your drugs, they want you use their drugs. So every night on TV, you see a weird-ass drug commercial trying to get you hooked on some legal shit. And they just keep naming symptoms until they get one that you fucking got.”
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August 22, 2011
“Be a philosopher, be a mummy … and away, above all with the body, that pitiable idée fixe of the senses! Infected with every error of logic there is, refuted, impossible even, notwithstanding it is impudent enough to behave as if it actually existed!”
Here Friedrich Nietszche mocks the longstanding Western philosophical tradition that exalts something called ‘Reason’ over the perpetually unreliable, fallible and deceitful ‘senses.’ Nietszche indicts Plato, Christian theology, and uber-positivist scientists alike of buying into and disseminating a giant moralistic LIE that there is a ‘true world’ that we can access, if only we can unshackle ourselves from our inferior / sinful / inaccurate bodies.
Pharmaceutical marketing is one of today’s ultimate snake-oil philosopher kings. Remember the television and magazine ads for Pfizer’s “antidepressant” Zoloft?
The putative “chemical imbalance” of these ubiquitous ads updates Nietzsche’s complaint about moralistic, arrogant-yet-idle philosophizing as a modern-day capitalist ideology: The ad’s refrain condescends, “When you know more about what’s wrong, you can help make it right.” This is paternalistic philosophizing, too, albeit one that hands over a deeply personal, social and culturally complicated construct like “depression” to a literally cartoonish scientific expertise, whose ultimate end-game is profit maximization.
Profit, indeed. We’re talking BILLIONS of dollars (according to industry tracker IMS Health, antidepressant sales alone brought in $9b in 2009). In just over a decade, what was once a relatively unknown illness has turned into a mammoth global industry that, in a nutso Orwellian turn, has had so many people taking antidepressants that these drugs have literally ended up in our water supply.
Crazy. And a big reason for why antidepressants have become so commonplace is because of the massive marketing campaigns that the pharmaceutical industry has launched over the past decade, which have relied heavily on the rhetorical sway of neuroscientific language and imagery in these ads.
With this in mind, here’s my critique of the psychopharmaceutical industry, in a nutshell (yes, it dawns on me that I should start using “nutshell” to refer to antidepressant pills themselves):
(1) Whether antidepressants ‘work’ at all is completely up for grabs
Through the Freedom of Information Act, analyses of ALL the antidepressant clinical trial data that drug companies have conducted (and not just the ones submitted to the FDA) suggest that antidepressants do not work significantly better than placebos. (For a nice review of this predicament, see Steve Silberman’s 2009 Wired article.) Of course, this is a real slap to the face of the notion that antidepressants work because they target biochemically-deficient disease states. Which brings us to:
(2) Drug companies propagate mainstream, scientific explanations of how antidepressants work that are part of a contemporary capitalist ideology
That was kind of a nerdy way to put it, BUT: Do patients/consumers feel relief because their antidepressant has worked on an underlying disease pathology, as the drug ads would have us believe?
Or, do antidepressants actually induce psychoactive states, like sedation or stimulation or altered sense perception?
This not a straightforward ‘objective,’ ‘scientific’ question. This is a question about the kind of language we choose to describe what a drug does. Correcting a “chemical imbalance” sounds squarely medical and socially appropriate. “Altered sense perception” sounds too much like how we are used to talking about illicit or illegal drugs, as if their psychopharmacology were a completely different animal than what Big Pharma peddles. Of course, it’s absolutely crucial that the pharmaceutical industry sounds like it is in the business of generating health and normality, not pleasure and dependency. For instance, one of the first direct-to-consumer pamphlets for Prozac claimed that, “Prozac doesn’t artificially alter your mood and it is not addictive. It can only make you feel more like yourself by treating the imbalance that causes depression.” What strange and preemptively defensive language … and what grandiose philosophical and epistemological claims about such a poorly-understood chemical!
Contrast how the National Institute of Drug Abuse (NIDA) describes MDMA (Ecstasy), whose pharmacology is quite similar to that of Prozac and Zoloft: “MDMA produces feelings of increased energy, euphoria, emotional warmth, and distortions in time, perception, and tactile experiences.” Can we imagine Pfizer making the same claims about Zoloft? And yet, this is what individuals sometimes actually report experiencing.
Part of what makes such psychopharmaceutical claims part of a capitalist ideology is their relationship to a distinctly Western-style of consumption in which we seek out and buy commodities to fashion our own unique personal identities. We buy things to become who we were always meant to be. (For critical theory buffs, start with Jean-Paul Baudrillard’s analysis of how, over the past few decades, capitalism has started to focus on the consumer — and not just the laborer — as a key site of exploitation.) Psychopharms are no different. Note the language of the above Prozac pamphlet: “It can only make you feel more like yourself …” Whereas users of illicit drugs like MDMA and LSD hail them as ways to go beyond oneself, or to explore oneself, the drug industry offers us psychopharmaceuticals as a return to our true selves. To the point, the tagline for Paxil advertisements used to be, “With the help of Paxil you can see someone you haven’t seen in awhile – yourself. Hey, I remember you.”
So, in this society, we consume antidepressants to fulfill our roles as outstanding consumer-citizens. But we consume marijuana or Ecstasy and become aberrant, unproductive drains on society. Which brings us to:
(3) We live in a hypocritical society that denies non-prescription self-medication while simultaneously encouraging a behemoth pharmatocracy
(First, this claim reminds us that the pharmaceutical industry does not exist in a vacuum. These companies are easy targets — and should most definitely be targeted — but we need to keep in mind that our contemporary experiences with drugs emerge from a complicated nexus of relationships between Big Pharma, government regulatory agencies, physicians, consumer groups, and beyond …)
On the one hand, the U.S. government denies individuals rights to grow, synthesize or consume psychotropic substances, whether it’s marijuana, opium, LSD, or methamphetamine. (This is a topic that I will give special attention to in later blogs.) On the other hand, psychotropic drug-taking has become a cornerstone of global capitalism, as corporate pharmaceutical paternalism takes over under the guise of “health” as a cultural imperative (so much so that the drugs are ending up in the water, remember?) The very facts — or, more properly, factoids — that the State-cum-pharmaceutical-industry propagates about mental health are circular: The notion that there is a high prevalence of depression in the United States is largely based on antidepressant prescription rates. So, the more people taking antidepressants = the more people counted as suffering from depression. “Depression” becomes reified as a bonafide epidemiological entity, and the pharmaceutical industry touts growing antidepressant rates as mere evidence that they are unearthing an “undertreated” (!) illness.
The capitalist, expansionist logic of this medical system is scary. Antidepressants do not work very well; their prevalence bloats the pharmaceutical companies’ and physicians’ profits; and their commercial success gets reinterpreted as a medical rationale for why we should consume more and more of them.