In “Neurochemical Selves” Nikolas Rose traces the historical development of the fields of neurology, psychiatry, and psychopharmacology from a focus on mental illness as a “sickness of the soul” to the “flattened” discourse of today that seeks to explain every aspect of our personalities and behavior at the neurochemical/molecular level, thereby affecting the very foundation of how we understand ourselves as human beings (198). According to Rose, these days “ new truths about ourselves arise, not from philosophy, it seems, but from research” (190). This new model of understanding purports to offer more control to the patient/consumer through education and the development of a new class of psychopharmaceuticals. Like the drivers on the highway in the image above, we are the masters of our own destiny. We can choose which exit to take. Will it be Interstate 95 to Zoloft? Perhaps we will choose to continue along the turnpike to Prozac. But the very analogy of the interstate illuminates the degree to which we are forced to choose and what the stakes of that “choice” are. At some point we will have to exit. We cannot simply keep driving forever. The interstate, like the new discourses of neurology and psychiatry, is a man-made construction designed to get people places. But who decides which places are worth getting to? What if we take the wrong exit? What if we get lost?
As this discussion most likely makes evident, I am curious about the ways in which, far from empowering individuals, we might see the neurochemical discourse as controlling, as providing the means for society to police and quiet those citizens whose beliefs and behavior it finds inconvenient or threatening. What if, instead of enabling “individuals to cope with life in the community,” the new psychopharmaceuticals actually serve to enable the community to cope better with the individual by dulling down all the “symptoms” that make that individual unpalatable (210)? This begs the question: what is the rationale of intervention when it comes to mental illness? As Rose writes, “for these processes were not merely processes of discovery, but of intervention--the neurochemical brain becomes known in the very same process that creates interventions to manipulate its functioning” (200). This new “knowledge” about the organic and molecular causes of mental illness creates a social and political agenda for eradicating these illnesses. As Eli Lilly’s tagline puts it, they are providing “answers that matter.” These answers matter not only because of what they can supposedly tell us about ourselves but because they help to facilitate systems of social control. Rose addresses this point when he references the newest DSM’s investigative premise, which includes asking “ whether disease, illness, and disorder are scientific and biomedical concepts or sociopolitical terms that necessarily involve a value judgment” (207). Are the very ways that we define these terms “ tied to depersonalizing, uncaring, degrading, and repressive strategies for governing those with mental health problems?” (218).
But what is the threat of schizophrenia or depression or ADHD to social order and cohesion? Is it that being around depressed people bums everyone else out? Another possible answer involves a Marxist analysis: those afflicted with these disorders cannot properly contribute to society through capitalist production. If we help the depressed person feel happier or the ADHD worker focus better, then they can once again add value to society. Yet, as Rose points out, the psychopharmaceutical industry has discovered “vital opportunities for the creation of private profit and national economic growth. Indeed the profit to be made from promising effective treatment has become a prime motive in generating what counts for our knowledge of mental disorders” (209). But I think that there is something deeper yet than the profiteering motives of the pharmaceutical companies. When we see the man on the street talking to himself do we really think about what the experience is like for him (can we even conceive of the possibility that this might be just ‘who he is’ or that he might be making it work?) or do we think of the inconvenience and discomfort that coming in contact with him entails for us? What idea of ourselves does his existence threaten? I am certainly not suggesting that we should just leave him alone. The high incidence of schizophrenia among the homeless points to our desire not to see certain aberrations. But how we engage and seek to “help” him may say as much about our neuroses as his.
The very appeal of these drugs to make us “feel like ourselves” again draws on the naturalist conception of an essential eternal self. While we have made much of the existence of this essential self, we have not said a lot about the character traits of that self. I would like to propose that what the schizophrenic man threatens is our idea of ourselves as beings made in the image of God. Schizophrenia or any number of the more “severe” disorders show us what happens when creation happens imperfectly. And if it can happen imperfectly for him, what does that say about the possibility that we might also be imperfect? As much as modern biomedical science seeks to throw off the cloak of superstition and religion, is it not inextricably linked to it? Is it possible that biomedicine is contending with some voices in its own metaphorical head? As Rose writes, “the drugs themselves embody and incite particular forms of life in which the ‘real me’ is both ‘natural’ and to be produced” (222). So modern neurology, psychiatry, and pharmacology seem to be conflicted: on the one hand, they have boiled the diversity of humanity down to specific molecules and genetic sequences, but, at the same time they hold out the promise of transcending our base fates (almost like magic!). Can both stories really coexist?
The invocation of God brings me back to a discourse of control. Rose writes, “Of course, psychiatric drugs are undoubtedly used, now as previously, in all manner of coercive situations and institutions to normalize conduct and to manage inmates. Similarly they are undoubtedly part of control strategies for patients ‘in the community.’ In these situations, those who take them often do so under explicit or implicit duress” (210-211). It is not only in these extreme cases where duress may be involved. Rose details a case from the Amen Clinic for Behavioral Medicine in which a psychiatrist uses SPECT scans to convince a patient who had stopped taking Prozac to start taking it again based on “abnormal” brain activity (197). The psychiatrist notes: "Leigh Anne still didn’t want to believe that anything was ‘wrong’ with her, so she was still resistant to going back on the medication. After I ordered a brain study to evaluate her deep limbic system, I was able to point out to her the marked increase in activity in that area of her brain. It provided me with the evidence needed to convince her to go back on Prozac for a while longer " (ibid).
This example brings in the specter of patient compliance. What if the patient resists or alters the course of treatment prescribed by their physician? Does this make them "non-compliant?" What is the punishment for non-compliance? In the second picture above we see a group of pillhead doctors surrounding and threatening a presumed patient. Their faces may be smiley, but their fists are disproportionately large and looming. Similarly in the cartoon below we see God himself, the ultimate authority figure, offering Moses some Prozac. We certainly did some things to make Him pretty pissed at several key junctures (my biblical chronology is admittedly not the best), and He could have any number of reasons for wanting to quiet us down and get a little peace.
Rose references Gilles Deleuze as suggesting “that contemporary societies are no longer disciplinary, in the sense identified by Foucault; they are societies of control” (223). In our society this sense of control comes from without and within. Doctors, pharmaceutical companies, patient lobbying groups, the police, the courts, and governmental agencies all have something to say about what is appropriate, legal, and “sane” behavior. But we are also being taught to police ourselves. Rose writes: "The person, educated by disease awareness campaigns, understanding him- or herself at least in part in neurochemical terms, in conscientious alliance with health care professionals, and by means of niche-marketed pharmaceuticals, is to take control of these modulations in the name of maximizing his or her potential, recovering his or her self, shaping the self in fashioning a life" (ibid).
In this way, we are being taught what it means to be good neurochemical citizens.
Finally, I would like to ask: if it is possible to set aside the issue of control for a moment, what is lost in this new neurochemical vision of ourselves? Where do art, beauty and the irrepressible wonder of the human spirit fit into this story? Would van Gogh’s self-portraits have been as moving if he had lived a happy, carefree, two-eared life? Would Beethoven’s music stir us so had there been a pharmaceutical he could have taken to perhaps deal with some of the frustration his deafness caused him (of course now he could have gotten a cochlear implant, but I do not know how well it would translate musical notes)? Sadness, difficulty, and, yes, even death are a part of the richness of life. What happens to that richness when we are reduced to mere neurochemical citizens?
Works Cited
Rose, Nikolas, 2007. “Neurochemical Selves” in The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. Princeton: Princeton University Press. Pp. 187-223.
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