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Nikolas Rose “Neurochemical Selves”

Rose, Nikolas 2003. Neurochemical Selves. Society 41(1): 46-59

We could term these “psychopharmacological” societies. They are societies where the modification of thought, mood and conduct by pharmacological means has become more or less routine. In such societies, in many different contexts, in different ways, in relation to a variety of problems, by doctors, psychiatrists, parents and by ourselves, human subjective capacities have come to be routinely re-shaped by psychiatric drugs. (46)

This is a point that should be born in mind: the increasing worldwide dependence of health services on commercial pharmaceuticals is not restricted to psychiatric drugs and much of the growth in this sector is in line with that in drugs used for other conditions. (48)

But despite the law suits, anti-psychotic drugs had become central to the rationale of deinstitutionalization in the United States by the midsixties and to the management of the decarcerated or never incarcerated-population. The gradual acceptance of the reality of tardive dyskinesia, of its prevalence, and of its causation by drug treatment could not reverse the policy or the use of the drugs. A dual strategy took shape. On the one hand, the pharmaceutical industry met with FDA to discuss how to label the propensity of their compounds to cause tardive dyskinesia. On the other hand, the search began for alternative drugs that would not produce such damaging side effects. This track would eventually lead to the marketing of the socalled “atypical neuroleptics.” But it also underpinned other attempts to engineer so-called “smart drugs” which could be said to directly target the neurochemical bases of the illness, or at least the symptoms, with the minimum of collateral damage. (50)

In this context, drug treatment outside hospital becomes the treatment of choice, although short-term, focused, behavioral or cognitive therapy may also be funded, designed to ensure that the patient has the insight to recognize that he or she is suffering from an illness, and hence to increase the likelihood of compliance with medication. (51)

The epidemic of prescribing for ADHD in the United States seems a pretty clear example of a “culture bound syndrome.” (52)

But other factors also need to be addressed. First, no doubt, these developments are related to the increasing salience of health to the aspirations and ethics of the wealthy West, the readiness of those who live in such cultures to define their problems and their solutions in terms of health and illness, and the tendency for contemporary understandings of health and illness to be posed largely in terms of treatable bodily malfunctions. Second, they are undoubtedly linked to a more profound transformation in personhood. The sense of ourselves as “psychological” individuals that developed across the twentieth century-beings inhabited by a deep internal space shaped by biography and experience, the source of our individuality and the locus of our discontents-is being supplemented or displaced by what I have termed “somatic individuality.” By somatic individuality, I mean the tendency to define key aspects of one’s individuality in bodily terms, that is to say to think of oneself as „embodied,” and to understand that body in the language of contemporary biomedicine. To be a “somatic” individual, in this sense, is to code one’s hopes and fears in terms of this biomedical body, and to try to reform, cure or improve oneself by acting on that body. At one end of the spectrum this involved reshaping the visible body, through diet, exercise, and tattooing. At the other end, it involves understanding troubles and desires in terms of the interior “organic” functioning of the body, and seeking to reshape that – usually by pharmacological interventions. While discontents might previously have been mapped onto a psychological space-the space of neurosis, repression, psychological trauma-they are now mapped upon the body itself, or one particular organ of the body-the brain. (54)

In this way of thinking, all explanations of mental pathology must “pass through” the brain and its neurochemistry – neurones, synapses, membranes, receptors, ion channels, neurotransmitters, enzymes, etc. Diagnosis is now thought to be most accurate when it can link symptoms to anomalies in one or more of these elements. And the fabrication and action of psychiatric drugs is conceived in these terms. Not that biographical effects are ruled out, but biography-family stress, sexual abuse-has effects through its impact on this brain. Environment plays its part, but unemployment, poverty and the like have their effects only through their impact upon this brain. And experiences play their part substance abuse or trauma for example-but once again, through their impact on this neurochemical brain. A few decades ago, such claims would have seemed extraordinarily bold-for many medicopsychiatric researchers and practitioners, they now seem “only common sense.” (57)

Where Foucault analyzed biopolitics, we now must analyze bioeconomics and bioethics, for human capital is now to be understood in a rather literal sense-in terms of the new linkages between the politics,  economics and ethics of life itself. (58)

We have seen that, in certain key respects, the most widely prescribed of the new generation of psychiatric drugs treat conditions whose borders are fuzzy, whose coherence and very existence as illness or disorders are matters of dispute, and which are not so much intended to “cure”-to produce a specific transformation from a pathological to a normal state-as to modify the ways in which vicissitudes in the life of the recipient are experienced, lived and understood. (58)

So the capitalisation of the power to treat intensifies the redefinition of that which is amenable to correction or modification. This is not simply blurring the borders between normality and pathology, or widening the net of pathology. We are seeing an enhancement in our capacities to adjust and readjust our somatic existence according to the exigencies of the life to which we aspire. (58)

The new neurochemical self is flexible and can be reconfigured in a way that blurs the boundaries between cure, normalization, and the enhancement of capacities. And these pharmaceuticals offer the promise of the calculated modification and augmentation of specific aspects of self-hood through acts of choice. (59)

An ethics is engineered into the molecular make up of these drugs, and the drugs themselves embody and incite particular forms of life in which the “real me” is both “natural” and to be produced. (59)

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