Serving’ the Self-Actualizing Subject in Global Culture
Antidepressants and their lack of efficacy in regards to mild to moderate depression has garnered much media attention in recent months. These studies have shown that antidepressants demonstrate the same level of improvement with treatment as placebos for individuals in forty-seven controlled trials1. This is the most recent scandal about serotonin selective reuptake inhibitors (SSRIs) and their prescribed use for mild to moderate depression. In 2005, media attention focused upon how SSRIs were likely to increase suicidal ideation in individuals after they have commenced treatment with these psychotropic prescriptions2. Although these scandals did receive a large amount of media fanfare, the popularized understandings that SSRIs offer pharmaceutical correction for chemical imbalances, which are involved in mood disorders and compulsive behaviour, has not been challenged. Neuroscientific theorizations for behaviour remain prevalent in popular culture even though there is no scientific evidence for the serotonin hypothesis of depression3. Moreover, popularized scientific descriptions of how the neurotransmitter system operates within the brain are being capitalized by the pharmaceutical companies for an increasing array of disorders.
On July 29, 2004 Campral was approved by the U.S. Food and Drug Administration (FDA) for patients suffering from alcohol dependence in the maintenance of abstinence from alcohol4. This was the first drug in ten years of intense research that had finally been approved for nation-wide use for alcohol abstinence, and it is available by prescription. Alcoholism had long been condition of interest for bio-medicalization by medical practitioners, neuroscientists and pharmaceutical companies5. This was the first time that a pharmaceutical product in conjunction with recent neuroscientific explanations of this ‘disorder of desire’6 had become available that was hailed as a new innovation for the rehabilitation of individuals afflicted with this dependency. Previously, alcoholism had been considered a ‘disease of the will,’ as described by the organization Alcoholics Anonymous, which had gained further popularity in the 1980s with the proliferation of a multitude of twelve step programs (AA, Al-Anon, Alateen, Overeaters Anonymous, Narcotics Anonymous).
This understanding of such a complex bio-socio-psychological condition as alcoholism exhibits a much larger trend of how we have begun come to think of ourselves and our subjectivity in terms of neuroscientific discourses. This is one particular tangent of discussion in a broader analysis of how the self is represented and understood in contemporary Western societies. It does indicate a very crucial transition in terms of how ‘psy’ knowledge networks have re-legitimized their authority in terms of the production of ‘truth’ about the individual and his/her behaviour.
Nikolas Rose has written extensively on this subject78; however, his accounts of the rise of neurochemical subjectivity in Western societies do not incorporate a discussion of the development of the culture of ‘therapism’ as described by Hoff Sommer and Satel9 that helped to facilitate the popular acceptance of neuroscientific discourses. The culture of ‘therapism’ arose from the emerging self-help literature market, which was to a large extent based on the writing of specialists (mental health professionals, addictions counselors and even individuals afflicted with these conditions). Moreover, the influence of this emerging market (and the discourses proliferating from it) into mainstream culture was one of the major factors that prompted the biological focus of psychiatry that started to become fashionable in the late 1980s.
Rose describes how contemporary psychiatry is enthralled with new developments in neuroscience that explain variations in mood, cognitive state, affective reflexes and behaviour in terms of anomalies in the brain – specifically malfunctions in the neurotransmitter system. One example of this is how the condition of depression that may be diagnosed as the result of an anomaly in “just one of the many subtypes of one of the seven sub-families of receptors for the neurotransmitter serotonin.”10 Rose depicts that even though this hypothesis had obvious scientific inadequacies, it still became the basis of pharmaceutical drug development and the inspiration for the SSRIs. Prozac became the ‘prescription’ for the treatment of depression not due to “its greater efficacy in treating clinical depression, than from the belief that it was the first “smart drug,” in which a molecule was designed with a shape that would enable it specifically to lock into identified receptor sites in the serotonin system-hence affecting only the specific symptoms being targeted and having a low “side effect profile.”11
Rose argues that in the psychiatric/psychological knowledge networks the trend in discourses towards biological reductionism is most evident. Behaviour is reduced to biological determinism, in the ‘neurochemical’ account of personhood. Rose does argue that this transition was in part due to neo-liberal discourses that were infiltrating civil society. For example, he does mention the public health Defeat Depression campaign in the United Kingdom as a prominent source of information and the best selling books Prozac Nation12 by Elizabeth Wurtzel and Listening to Prozac13 by Larry Kramer. Certainly, the success of these texts and campaign illustrated the very point when the ‘tipping point’ had been reached and neuroscientific theories about depression had become popular14. The success of these bestsellers, and the UK public health initiative were not the sole factors in the establishment of the serotonin hypothesis of depression as popularized notions. Moreover, many sociology of medicine texts utilize a Foucaultian conception of biopolitics that was applicable to disciplinary societies. Biopolitics conceptualized in this manner lacks a discussion of the media environments proceeding these particular texts and campaigns in both the United Kingdom and North America. Both psychology and psychiatry were largely predicated upon psychoanalytic theories before this period15, and the transition from psychoanalysis was occurring not only in these disciplines; it was transpiring on a larger cultural scale within western societies. In large part, Rose simply subsumes this discussion under the rubric of the rise and proliferation of neoliberalism. By omitting these very crucial threads of discussion in his research, the account developed by Rose lacks a comprehensive explanation as to the new emerging logic in the ‘psy’ knowledge networks. In particular, the very transformations in logic required for the acceptance of the flattening of the multitude of factors contributing to depression, to the biological.
This presentation addresses the emergence of neuroscientific discourses concerning ‘disorders of desire’, which include alcoholism, obesity and depression and their bio-medicalization in global biopolitics. Many scientific studies tend to frame all three conditions as stemming from the same set of genes, and that it is the actual variations in gene sequencing that causes the resulting different forms of expression16. Historically speaking, these conditions have been contemplated in conjunction as described in the archival research by Marianna Valverde. Valverde describes how previous theories depicted the connections between melancholia and inebriety and argued that the biological bases for both of these conditions were similar. Specifically, Valverde outlines how in both British and French medical practices in the early 1900s there were similar approaches taken that included nutritional therapies combined with fresh air and rest, which were supposedly useful for the restoration of equilibrium in the nervous system17. Moreover, all three conditions receive extensive media coverage. In particular, depression and obesity are considered major epidemics in post-industrialized countries as described in the World Health Organizational Reports18. This discussion will focus on developing a more comprehensive socio-historical explanation for the emergence of the serotonin hypothesis of depression within a broader analysis of other mediated discourses within global networks by utilizing the philosophical thinking of Deleuze, Guattari, Heidiegger, Lazzarato and Walby. In particular, emphasis will be placed upon illustrating the connections between the discourses emerging from self-help literature with the trends in the biologization of psychiatry and the promotion of neurochemical accounts of ‘disorders of desire’ in global capitalism. Moreover, by following and unpacking these threads of analysis it is possible to further explore what Martin Heidegger termed the ‘will to technology’19 within late modernity and develop a critique of the arguments that underpin the very basis for the continued popularity of the serotonin hypothesis.
Contemporary labour as described in the work of Lazzarato has also evolved in our post-Fordist economy from a materialist foundation to becoming a combination of immaterial labour (specifically in First World nations) and material labour (generally Third World). This transformation has also intensified the deployment of biopolitical strategies from concerns about physical health in disciplinary societies to the entire subjectivity of workers in societies of control. As the lines of consumption and production have blurred, the processes of generation and implementation have also been blurred in the intellectual enterprises of the information age. Global capitalism now demands both the affective and communicative capacities of workers20. Specifically, these conditions can be seen in the expanding service industry related positions that comprise the majority of new job openings in a myriad of international settings. As countries industrialize, particular classes of individuals that comprise these nations are incorporated into the intellectual proletariat and become integrated into the communications networks of the global economy. As part of the corporatization of global culture, gender, ethnicity, sexual preference and disability are no longer considered liabilities in the workforce; however, the inability to socialize and become part of the organization as a result of not embodying certain required personality traits is considered justifiable cause for dismissal. These characteristics are assumed to be possible for all individuals to develop, no matter what subjective positioning that they may occupy within the diverse social networks and publics that they may inhabit. In global capitalist culture, individuals are encouraged to seek the ‘truth’ from specialists in order to optimize all facets of their lives. In this manner, the subject is encouraged to think of all structural impediments (such as corporate culture and their own subjective positioning) as simply obstacles that the victorious self-actualized individual may counter and overcome with the ‘secrets’ of success. At the same time, the contemporary individual, which has in part been interpellated by the very discourses of techniques of the self, is also more likely to be susceptible to ‘status anxiety’21. The success that the individual achieves on a number of levels is not considered comparable to his/her peers and there is always a lack of fulfillment, which allows for the intensification of desire. The self-actualizing subject22 is a further extension of the Entrepreneurial23 subject that has been described by Deborah Lupton and Alan Petersen (or the ‘homo economius’24 as depicted by Michel Foucault).
Biopolitics has moved beyond simply ensuring norms of behaviour to the privileging of personality traits that are considered necessary for achievement with an implicit directive that self-awareness, reflexivity and pharmaceutical enhancement can result in redefining the self. This is one crucial aspect of the very process of the interiorization of the individual in global capitalism as described by Gilles Deleuze in ‘Postscript on the Societies of Control’ in which he extends Foucault’s concept of biopolitics and adapts it for the emergence of global capitalism. Techniques of the self in contemporary society, although operationalized on an individual level are more insidious than the regulatory disciplinary societies that emanated from particular institutions as Foucault had described. Deleuze and Guattari developed the concept of the rhizome25, which they depict as being like an interconnected system of trees, roots, tubers. This concept does offer an image as to how discourses within contemporary mediated networks operate synergistically and even though they emerge from completely different fields of knowledge are, indeed, part of the same system of logic that the contemporary subject is predicated upon.
The contemporary subject in global capitalistic culture is expected to self-regulate and not to transgress prescribed pathways of desire. An inability to self-monitor and self-adapt to the discourses of medico-moralization results in distress, and the responsible individual will submit him/herself to medical diagnosis and intervention when s/he believes that his/her suffers from an inability to ‘control’ desires. We are presently witnessing the extension of the ‘will to health’26, as described by Deborah Lupton that arose in the 1970s, with the global psychiatric logic of neurochemical ‘correction’ (and the trend of ‘prevention'[diagnosis]) for ‘anomalies of the will’. In this manner, the self-actualizing subject is encouraged to seek intervention from a variety of specialists (self-help texts, mental health counselors, psychiatrists, etc) to ensure optimal performance in their own vision of the pursuit of success. The optimization of performance has also been surpassed in which the lines for treatment, prevention and even enhancement have been blurred.27 For example, the WHO program that has been developed for the prevention of depression is actually about the diagnosis and treatment for depression and negates the possible social factors that may precipitate the condition28. In this manner, the variables that are influencing the development of this disorder are flattened to simply one factor – biological susceptibility. Information reductionism in this fashion collapses biological susceptibility into biological destiny as these discourses proliferate into the media and are translated from systems biology to an audience that is not versed in the this discipline of knowledge.
The very techniques for the construction of the ‘self’ in global capitalist culture also make immanent sense to the consumer in the consumption of pharmaceutical products for the treatment of ‘disorders of desire’ due to the embedded logic about choice within the construction of identity. With ‘psy’ knowledges esteemed as the authorities of the ‘truth’ about subjectivity, the promotion of the unitary self has now surpassed the film screen29 and is dominant in the bombardment of mediated messages that we encounter in our day to day lives with either a basis in psychology (or to a large extent – the pop psychology that is also infused into brand marketing).
Specifically, the consumer is supposedly making ‘informed’ choices that in many ways are not only about the consumption of products such as an anti-depressants; but, also incorporate westernized understandings of the self (through the educational process that accompanies both the medical diagnosis and treatment involved in distributing pharmaceutical innovations). In large part, the concept of biopolitics of Foucault must be extended in order to account for the mediated environment of the contemporary consumer in global capitalism. In an interview, Maurizio Lazzarato describes the concept of publics and how these publics are one element of analysis that need to be considered with respect to biopolitics30. Specifically, in the age of mass media, information technologies and the influence of the contents of these mediums in the formation of not only publics but also the affects inspired in individuals do need to be incorporated into the analysis of how strategies of self-regulation become interiorized. Memory for the individual in contemporary society is based on seduction, pleasure, consumption, communication and information that is derived on the semiotics presented in the multitude of venues that we encounter in day-to-day living. At the same time, our responses to this information are not based on our alliances with these publics but our individual desires that are inspired by belonging to these publics. Most importantly, this extension in logic requires that that consumption is not simply seen as a passive activity, but is in fact viewed as being active.
With respect to consumption and informed decision making in regards to self- regulation of the contemporary subject, it becomes paramount to address how scientific discourses about the body are popularized and dissect the productions of truth. Foucault described anatomy as the oldest ‘science of Man’, and this science as the beginning of understanding the body in relation to different forms of technological writing. Catherine Walby describes the Visible Human Project in her work and describes how “the body has been made accessible to some of the kinds of intelligibility and navigability particular to the book and the computer, and the book and the computer have been able to embody the human. At the same time this interramification undermines any attempt to position the human body as pretechnical, natural point of origin for science’s accounts of it.”31 Understandings and their depictions of the body with respect to their very creation do need to be included into any discussion as to how the body is theorized. Moreover, Walby describes the cybernatural and how this concept is:
…generated out of the history of the interpenetration of living organisms with information systems, where the terms ‘life’ and ‘information’ act as synonyms. This history involves the exchange of information between the cybersciences’…the constellation of technoscientific disciplines like cybernetics, systems analysis, communications engineering, operations research and computer science…and molecular biology research…Since the establishment of these respective fields, molecular and development biologists and computer scientists have drawn extensively upon each other for formulations about system, organism, code, feedback, and transmission32
This exchange of information allows for the ‘biomedical imaginary’ to envision new theoretical ideas in the life sciences. Therefore, the ‘biomedical imaginary’ describes those “aspects of medical ideas which derive their impetus from the fictitious, the connotative and from desire.”33
Even conceptualizations of the body have changed so that the body is no longer envisioned as having an organic stability that it may depart from in sickness, but is instead in perpetual flow as depicted in the notion of ‘hyper-complexity’. Therefore, technical interventions in this framework of ‘hyper-complexity’ are viewed “not simply as mechanical additions or rational subtractions but rather as another element in the complex production of uncertain outcomes.”34Furthermore, scientific theoretical innovations do not simply occur in the lab as may be commonly assumed. Walby describes how:
Science requires a multiplicity of specialist and nonspecialist audiences, and has developed textual and visual practices which both solicit such audiences and compelassent to particular interpretations of its products and activities. To secure such audiences, medicine actively participates in the migration of its images out of the clinical domain and into the media of public visual culture. …Such practices of dissemination and popularisation seek to constitute an imagined community to legitimate and validate experiments and to assimilate the nonspecialist gaze to the medical gaze, an assimilation which depends on a wide acceptance of the scientific medical interpretation of the phenomena under consideration. 35
In large part, visual representations of the brain are becoming extremely powerful in the promotion and persuasiveness of neuroscientific narratives. Contemporary western culture is a visual culture and trust in knowledge is highly predicated on what we can actually see. The images that neuroimaging scanners do offer with respect to brain activity are of course mediated through the interpretation of experts. Yet, such interpretations are compelling as can be evidenced in how they are beginning to be utilized in terms of the development of individualized pharmaceutical treatment options and how they are marketed36. In part, this confidence in the progression of applicable knowledge in the discipline of systems biology will supposedly counter the fears of possible negative side effects that individuals may experience from prescription drugs. This notion of specificity is extremely compelling and offers a solution to the concerns of the side effects for the plethora of new pharmaceutical drugs available. In addition, it also challenges the critique embedded in arguments about over-prescription and the pathologization of otherwise healthy individuals. Yet, at the same time it is extremely important to highlight that this confidence is not predicated upon pharmaceutical innovations available in the present, but the products that will supposedly be available in the future. Moreover, images of increased brain activity might be associated with specific moods and behaviours, yet what such associations really mean is actually filtered through the theoretical perspective utilized in interpretation. Simply because the components of the brain have been identified and we have been able to isolate particular neurotransmitters and enzymes and are beginning to understand how neurons are interconnected, does not in any manner suggest that we actually understand how they operate in tandem in order to form consciousness37. This is one particular disconnect between actual theory production and recent scientific discoveries and their simplistic and sensationalistic38 portrayal in the media. Advancements in neuroscience are actually toted as being answers when more often, than not, they are in fact the beginning of new questions for this discipline.
Returning to the previous discussions about biopolitics in global capitalism, a few glaring paradoxes are readily apparent that do require some exploration. As the populations of post-industrialized countries have been increasingly bombarded with public health campaigns (among a multitude of mediated messages) with respect to eating, nutrition and lifestyle choices, how and why is it that obesity has become such an epidemic? Why are the rates of depression in rapidly industrializing countries beginning to reach the same epic proportions as post-industrialized nations? 39 Why do rates of alcohol abuse in rapidly industrialized countries often reach and even surpass the rates of post-industrialized nations?40 Logically, if increasing population health41 is the intention of public health campaigns, how is it that rates of diagnosis and treatment are actually rising rather than falling for these conditions? Responses to such questions could actually be directed to dissecting how these figures might be the result of under-diagnosis, pathologization of healthy individuals based on susceptibilities rather than actual illness, and the over-prescription of pharmaceutical products. For the purpose of my argument, I would like to continue on the tangent that these disorders are epidemics of global capitalism. What is it about global capitalistic culture that might be facilitating the very social conditions for the emergence of these epidemics?
The works of Martin Heidigger have once again become in vogue and his discussions about the ‘will to technology’ are often referred to in many cultural studies texts. Although, he is generally cited in combination with some very alarmist visions of our post-human future, his warnings might be more useful in terms of thinking through our trust in science and technological progress. Specifically in terms of what might be used in the present, rather than being seduced by the possibilities of future technologies. Heidegger describes how culture in modernity incites boredom. One component of this incitement to boredom that specifically applies to global capitalism is the mistaken belief that science is able to and has discovered all ‘truth’. We that live in the late industrialized societies are hyperconnected, and we do have access to massive amount of data at our fingertips through the Internet, databases and on-line libraries. On a certain level, this does lead to the illusion that there is nothing new to discover and that we have access to all knowledge. These sentiments leach the wonder out of life, and the world that surrounds us. With our trust in science for answers to all of our life questions, it is little wonder that The Secret42 by Rhonda Byrne with its pseudo-scientific descriptions of ‘the laws of attraction’ became such an astounding success in 2006.
My preliminary discourse analysis of self-help literature from the mid-1980s reveals common themes in the individual narratives of dealing with these disorders. As a synopsis, there are two major ideas that I would like to discuss with respect to this presentation. First, many persons describe what might be termed a ‘loss of meaning’ in their lives during which a period of depression, drinking or overeating had overtaken their lives. Relating back to Heidegger’s concept of the ‘will to technology’, a worldview dominated by science and technology in which all is calculable and known does not contain hope. Hope requires a trust in the unknown and uncertain, and faith in an outcome beyond our control. Secondly, the ‘loss of control’ typified by alcoholics, overeaters and depressives with respect to their moods and compulsive behaviours was described by them as being beyond their control. As the life stories of alcoholics and individuals suffering from addiction became popular stories in the 1980s, the paradox of addiction surfaced in which individuals that were in fact ‘strong willed’ also suffered from these dependencies. The particular ‘will’ of such individuals afflicted was not lacking. In fact, for an alcoholic to continue drinking even when s/he has already vomited, no longer has any of his/her belongings and barely has the strength to physically continue indicates a very ‘strong’ will. This very paradox illustrates the complexity of such disorders and is one of the very reasons that biological explanations for ‘disorders of desire’ seem extremely plausible. If the ‘will’ involved in cognition is not capable of subsuming ‘control’ over mood and/or behaviour than it does sound very probable that the condition is in fact biologically based and similar to animal instinct – hardwired and driven.
Elizabeth Wurtzel in her best-selling novel describes how her treatment with Prozac was able to restore her authentic self. Narratives such as hers are excellent in for the promotion of pharmaceutical products. Identification with such narratives is one of the most compelling marketing tools in recent pharmaceutical direct to consumer advertising. Although, in this particular case the pharmaceutical companies were not the genesis of this promotion they certainly do make use of it. Moreover, in our contemporary culture we are constantly self-monitoring and self-regulating on both conscious and unconscious levels as a result of the constant bombardment of biopolitical mediated messages. Symptoms of anxiety, insecurity or confusion are certainly common for everyone in Western societies, and pharmaceutical ads do tend to play on these very feelings in the promotion of their products. It is easy to understand how symptoms become disconnected from social context even in the process of self-monitoring since it 43requires that we observe ourselves as both subject and object.
In summation, neuroscientific discourses are extremely appealing for their ability to explain the complexity involved in human moods and behaviours. As outlined in this presentation, on a multitude of levels such explanations do merit further critical examination since they are disconnected from the sociality of human beings and their interconnections to not only each other, but to complex networks and information systems. The logical underpinnings that have supported the popularization of the serotonin hypothesis are difficult to counter since the notion, that low serotonin levels are the basis for depression, has become ‘common sense’. At the same time, by unpacking the various threads that have been involved in the production of this assumption, it is possible to challenge the information reductionism upon which it is based. On a final note, I would like to state that I am not arguing against the use of psychotropic prescription drugs in the medical treatment of these disorders. However, such potent pharmaceutical innovations should be used in a more carefully regulated manner. Moreover, patients do need to be fully informed that the long-term effects of these relatively new pharmaceutical products are unknown and that the very theory upon which they have been based, has never actually been scientifically proven.
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1 CBC News. Antidepressants may only be useful for the severely depressed: study. February 27, 2008. Retrieved from the CBC News Website on March 29, 2008. http://www.cbc.ca/health/story/2008/02/26/antidepressant-study.html
2 CBC News. Antidepressants increase risk of suicidal behaviour: study
February 18, 2005. Retrieved from the CBC News Website on March 29, 2008. <http://www.cbc.ca/health/story/2005/02/18/SSRI-suicide050218.html>
3 Lacasse JR, Leo J. “Serotonin and depression: A Disconnect between the advertisements and the scientific literature”. PLoS Med 2005. 2(12): e392.
4 Charles Triano, Charles. “First new treatment for alcoholism in 10 years, now Campral(R) (acamprosate calcium)”Medical News Today. January 12. 2005 <http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=18794>
5Midanik, Lorraine T. Biomedicalization of Alcohol Studies: Ideological Shifts and Institutional Challenges. (New Brunswick: Transaction Publishers. 2006).
6 Valverde, Mariana. “Targeted Governance and the Problem of Desire.” In Risk and Morality. Edited by Richard V. Ericson and Aaron Doyle. (Toronto: University of Toronto. 2003), 438-458.
7Rose, Nikolas. The Politics of Life Itself: Biomedicine, Power and Subjectivity in the Twenty-First Century. (Princeton: Princeton University Press. 2007).
8 Hoff Sommer, Christina and Sally Satel. One Nation Under Therapy: How the Helping Culture is Eroding Self-Reliance. (New York: St. Martin’s Griffin. 2005).
11Wurtzel, Elizabeth. Prozac Nation: Young and Depressed in America. (New York: Penguin Books. 1994).
14Blazer, Dan G. The Age of Melancholy: “Major Depression” and its Social Origins. (New York: Routledge. 2005).
15Stunkard, Albert J, Faith, Myles S and Kelly C. Allison. “Depression and Obesity” Biological Psychiatry (54) 3, August (2003)1: 330-337
Sookoian, Silvia, Carolina Gemma, Silvia I. Garcia, Tomas Fernandez Gianotti, Guillermo Dieuziede, Adriana Roussos, Miriam Tonietti, Liliana Trifone, Diego Kanevsky, Claudio D. Gonzalez and Carlos J. Pirola. “Short Allele of Serotonin Transporter Gene Promoter is a Risk Factor for Obesity in Adolescents.” Obesity Research. The North American Association for the Study of Obesity. (2007)15:271-276.
16Valverde, Mariana. Diseases of the Will: Alcohol and the Dilemmas of Freedom. (New York: Cambridge University Press. 1998).
17World Health Organization. “Depression” Retrieved March 29, 2008 from <http://www.who.int/mental_health/management/depression/definition/en/>
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