“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.

Modern-day Dream Theater is just as shitty of an experience ...

Flagellants sure knew how to party

Müller-Lyer's optical illusion: eyes? more like lies!

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.

pharm fresh!

Say wha?

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?

poor little egg! there's a nice bird RIGHT NEXT TO YOU!

where'd the bird go?

BOO-YAH! THERE'S the fucking bird!

Or, do antidepressants actually induce psychoactive states, like sedation or stimulation or altered sense perception?

(from a 2003 MadTV parody using the Zoloft-style ads to promote Ecstasy)

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.

All this makes me feel like Nietzsche looked at the end of his life:


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So let’s start changing the rules of this game.

3 Responses to “Pharmaceutical Paternalism, Part 1: You Don’t Know Your Body / Let Us Help You Find Your Self”

  1. Paul said

    I used to theoretically think that the legalization of all drugs made sense. Working in an emergency room now, I can see the other side of it. If you give people access to unlimited quantities of heroin, their lives are going to get totally screwed up. There’s no way around it.

    Then there’s meth. Should the government outlaw the production of meth? Definitely. Bath Salts? Definitely. It’s a lot less abstract when you see people overdosing on this stuff.

    I don’t disagree regarding anti-depressants, I think they are over prescribed and of dubious benefit (although some people that I know swear by them and I can perceive the “betterness” of their existence on the meds.

    But I think there is a lot of grey and not much room for dogmatism. Pot is not heroin, which is not meth. Which, apparently is not bath salts. They are all weird individual substances that are best thought of that way. Certain things are seriously too dangerous to be available to people. People inevitably make really, really bad decisions.

    Prozac may indeed fuck you up, or, at least, do nothing for you. BUT it’s not going to make you so uncontrollable that it takes 5 nurses to hold down a 95 pound girl which is apparently what’s happening with bath salts.

    P

    • admin said

      Thank you, Paul, for this thoughtful response. You raise the crucial question how personal drug use should be monitored and regulated. There is no doubt that individuals can destroy their lives with drugs (licit or illicit) and, personally, I believe that we should cultivate sociomedical networks that help individuals learn about drugs and how to take them, and that help individuals out of the miserable predicaments that can ensue from drug use. But should these social safeguards take the form of government intervention into personal activity? Is it the government’s role to protect us — not from each other — but from ourselves? We need to reinvigorate this country’s debate over “freedom of choice.” I would argue that, if we take this notion of liberty at face value, then we need to concede that the freedom of choice necessarily entails risk of making the wrong choice (or, in your words, “really, really bad decisions”). I believe that, as a society, we can collectivize to teach ourselves how to be thoughtful and careful with our drug use. I think this can — and should — happen without the government criminalizing cultivation of drugs for personal use.

      Also, my main point about the U.S. being a hypocritical society was to juxtapose how ‘scientific fact’ gets transformed and propagandized, on the one hand to demonize drugs like MDMA, on the other hand to extol drugs like Zoloft and Prozac. This was to demonstrate that science is not out of the realm of ideology. Sides of political / social / medical debates are fact-mongers, through and through. We need to be especially attentive to the rhetorical effects and careful linguistic gnarls that various sides of this debate use to convince us about our brains, bodies, and freewill.

  2. Paul said

    Basically, I think if people want to legalize something that has a really good chance of killing someone, they should have to come to the hospital and explain that idea to the family of someone who has just OD’d on it.

    This is never, ever going to happen with pot. But it happens all the time with heroin.

    I think your argument makes the assumption that people have some basic level of rationality to their actions. That their own decisions, by being theirs, have some basic validity. For many of us I think this is true, but for many, many people, they are going to make the wrong decision every time.

    I honestly can’t even imagine what a shitstorm would be started if heroin was legalized and more freely available than it is now (which I’m finding is pretty freely available). An additional question, if we legalize these drugs, and then people have free access to them, are we, as a society, on the hook for saving the lives of people who OD on them? Because we’re already spending an insane amount of money on that. I’m happy to do everything I can to bring them back to life, in the thoughts that maybe they’ll figure themselves out and try to get clean, but that’s the rare overdose. The vast majority are going to go right back out and use again.

    Again I would say that each drug is different. MDMA seems like a borderline case. I feel like it’s a lot more dangerous than pot, in that, in my limited understanding, it does seriously dehydrate people and can impare their judgement enough to kill them. Not super common but reasonably so. Perhaps no more dangerous than alcohol though.

    I just don’t think a blanket statement “we should be able to do what we want with our own bodies” really holds up unless you attach “and we don’t expect anyone to take care of us when we fuck up”. Currently, for the most part, we have the view in society that if someone does something stupid, we will do our best to bandage them up and get them back to life. I think it’s a privelaged assumption though and one we are barely able to afford. If you turn on the faucet of easily available ways to screw yourself up, are we prepared to deal with the deluge of people who are screwed?

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