Neuro-chemical Selves: Constructing and Deconstructing Neuro-chemical selfhood

1. Neuro-chemical Selves: Constructing and Deconstructing Neuro-chemical selfhood

2. This lecture will explore how pharmaceutical companies shape our understandings of what it means to be a person, affecting and reframing how we speak about and account for ourselves. It will focus on how we have come to think of medication as the answer to distress and what the implications of this are for how psychologists understand and work with people. This lecture will centre on writings by Nikolas Rose and David Healy. It will work through some of their ideas and the implications of their work for psychology; and personality, self and identity.

3. Video about depression http://www.youtube.com/watch?v=IeZCmqePLzM

4. Nikolas Rose How have we come to understand our distress, sadness and ultimately ourselves through the language of neurochemistry? ‘How did we come to think about our sadness as a condition called ‘depression’ caused by a chemical imbalance in the brain and amenable to treatment by drugs that would ‘rebalance’ these chemicals?’ (Nikolas Rose, 2003, p1) To begin to answer these questions we need to explore the links between the reframing of the self, the emergence of these conditions, the development of these drugs, the marketing of these brands and the strategies of the pharmaceutical companies.

5. ‘Depression is not fully understood, but a growing amount of evidence supports the view that people with depression have an imbalance of the brain’s neurotransmitters, the chemicals that allow nerve cells in the brain to communicate with each other. Many scientists believe that an imbalance in serotonin may be an important factor in the development and severity of depression.’ (The following comments can be found on the Eli Lilly website http://www.prozac.com/how_prozac/how_it_works.jsp?reqNavId¼2.2, cited in Moncrieff, 2006)

6. The language of adverts suggest that depression is a biological or neurochemical problem in the brain but there is actually no evidence to support the monoamine theory of depression and there is no evidence of serotonin deficiency in depression (Moncrieff, 2007: p121).

7. Advertising ‘psychobabble is rapidly being replaced by a biobabble that equally has pervasive consequences for the ways we view and experience ourselves and not just for the labels we give to our discontents.’ (David Healy, 2004: p10 ) David Healy – adverts for anti-depressants don’t just market anti-depressants, they market depression itself • Adverts for anti-depressants appeared in British Medical Journal, as early as 1961 (Moncrieff, 2007).

8. ‘The range of psychotropic pharmaceutical merchandise is breathtaking’… ‘It is not uncommon to find friends and colleagues drinking from a Zoloft mug, writing with a Seroquel pen, squeezing a Paxil sponge ball-brain, relaxing to a Prozac waterfall, eating popcorn and Pop-Tarts in Resperdal packaging, wiping away tears with Librium tissues, or telling time from a Geodon clock’ (Rubin, 2005: p380)

9. Direct to Consumer Advertising (DTCA) Prohibited at UN convention 1971, then allowed by FDA in 1997, in the USA. Not currently legal in the UK. ‘In the four-year period following the FDA’s removal of restrictions on DTCA, national spending on pharmaceutical promotion rose from $791 million to $2.4 billion (Kreling, Motta, and Wiederholt, 2001:p 31). • Example- video of Pristiq advert http://www.youtube.com/watch?v=9-ZNcjtxNbY • Pristiq commercial - Creepy Wind-Up Doll.asf

10. Recent research suggests that ‘‘patients who request particular brands of drugs after seeing advertisements are nearly nine times more likely to get what they ask for than those who simply seek a doctor’s advice’’’ (Rubin, 2004:p379) In 2001, in the USA, $16.4 billion was spent on drug promotion, $2.6 billion of which went into DTCA (Rubin, 2004:p378) Each year, almost 70 million prescriptions are written for Paxil, Prozac, and Zoloft alone in 2000 (Kreling, Motta and Wiederholt, cited in Rubin, 2004).

11. Video of seroquel xr advert: http://www.youtube.com/watch?v=8bf2LA1ScVA Seroquel XR Commercial2.asf

13. ‘see themselves in the ad’ After doing a ton of research, Saatchi & Saatchi realized that people dealing with bipolar depression feel like they are spectators in their own lives. They said they were literally "consumed" by their condition. The S&S team struck upon the notion that people feel as though they are fading into the background. At first, this was just a phrase to inspire them, but it soon became actual content with an ad campaign depicting people melding into the background of their everyday lives.Bipolar depression is a new term for the consumer audience, so the campaign had to be as much about education as it was about medication.The ad team did a stunning job setting a tone and mood that made viewers turn to the TV and say "That's me, that's what I feel like, and now it has it's name."When the phrase "bipolar depression" was put in front of patients in testing there was an immediate head nod. "We didn't just want to tell people that depression hurts, and that it hurts others.We wanted consumers to literally feel the fading and see themselves in the ad," says Helayne Spivak, chief creative officer. However, the television ads remain respectful to the patient population. The players in the commercial are simply going through their daily routine as portions of their body turn opaque and blend into whatever is behind them, be it a couch, bus seat, or grocery stand. The result is a powerful segment thatresonates with sufferers and regular viewers alike. • (A Solid Choice, Saatchi & Saatchi, BRAND Seroquel XR CLIENT AstraZeneca) • (Saatchi&Saatchi,Mar1,2010,PharmaceuticalExecutive)

14. A new ethics of the self • Adverts don’t just sell anti-depressants, they market depression itself – as a medical condition (see Moncrieff, 2007; Healy, 2005). • Adverts blur the boundaries between normal and pathological experiences of sadness and depression (Rubin, 2004) • So, more people come to understand their unhappiness or distress as depression, and doctors are encouraged to diagnose more people with depression, and use anti-depressants to treat them. • How psychiatric drugs effect and reshape how we understand and interpret our world and our selves. • Creating the widespread belief that taking pills for life’s ills is fine – what Rose (2004) calls ‘the neurochemical re-shaping of personhood’. • Rose discusses this in ref to how biomedicine forms new relations to the self, calls for new forms of recognitions, new rights, new responsibilities, new ways of understanding and acting on selves, a new ethics of the self. • And new ways of talking about our experiences, our sadness, distress etc in ‘biologically colored’ language (Rose, 2007:140-146; also see Kurt Danziger, 1997, ‘Naming the Mind: How Psychology found its language’).

15. ‘One afternoon recently … Pat burst in the door, having come straight from a frustrating faculty meeting. "She said, 'Paul, don't speak to me, my serotonin levels have hit bottom, my brain is awash in glucocorticoids, my blood vessels are full of adrenaline, and if it weren't for my endogenous opiates I'd have driven the car into a tree on the way home. My dopamine levels need lifting. Pour me a Chardonnay, and I'll be down in a minute”'. (New Yorker, 9th Feb, 2007)http://www.portifex.com/BSPages/FridayFronts/H0209.htm

16. ‘I mean in all my episodes it's been drugs that have helped me, not just drugs, but drugs have been the safety net. I've no problem about taking drugs, never have. I'm still taking them. I can't, I won't, I don't, I can't imagine coming off them at the moment. I don't feel safe enough to come off them, I don't really worry about taking them. I'm certainly not one of these people who thinks, "Oh God, some kind of poison in my body.'" It's like no, it makes me feel better…. you know I'm quite, you know I'm quite happy to admit there's something screwed up about my brain chemistry, you know. But you know, some people are diabetic, they take drugs, you know.And I…know people say, "Oh, it's not the same.'"But I'm afraid it bloody well is. It's just, you know, you're trying to undo several hundred years of cultural difference between the brain and every other organ. But you know, some people are just not built the same way, a lot of people actually. You know I wear glasses, I'm short sighted, I take anti depressants, I get depressed you know. [taking medication has] never been something that's bothered me. That might be partly family as well, my family has never been sort of anti taking things to make you feel better. And when people say to me, "Oh I'd be worried about the long term," well alright let's say Seroxat is more likely to make me…. I don't know. Let's say, or even to take five years off the end of my life. I'd say well it's better than feeling fucking awful now. Which is, you know, I can honestly say antidepressants work, work well’. http://www.healthtalkonline.org/mental_health/Depression/Topic/1499/

17. Biosociality • People increasingly say things about having a hereditary predisposition to schizophrenia, talk about low dopamine levels in relation to their unhappiness and about their unhappiness as depression etc • This biologically coloured language is used by people to make judgements about how they should act, the kinds of lives they should live • This focus on the brain marks a shift in human ontology, it changes the kinds of persons we take ourselves to be. This means new ways of seeing, understanding, judging and acting upon what we take as normality and abnormality. It creates new ‘problem’ populations – those who refuse to understand and act on themselves through neurochemistry • This entails us to be governed in new ways, and to govern ourselves in new ways. (Rose, 2007:192).

18. Pharmaceutical colonisation and medicalisation of people’s everyday lives is particularly worrying because the huge commercial incentive to construct particular experiences as ‘mental illness’ changes our view of what it means to be a person, and ultimately to be human. Anti-depressants are entangled with certain conceptions of what people should be like; norms and judgments are internalized in the molecular makeup of these drugs (Rose, 2006).

19. Frames of seeing / hearing Pharmaceutical marketing regulates what we can see and hear about depression, meaning we continue to believe the evidence for a biological cause is there . David Healy points out that pharmaceutical companies also restrict what information we can find out about depression, especially around the link between anti-depressants and suicide. Medical trials of some anti-depressants have shown increased suicidality in patients, yet this information is not made public (Healy, 2005; and see www.healyprozac.com for further papers on this issue)

20. Before the introduction of anti-depressants depression was almost unrecognized, 50-100 people per million were thought to experience it (or melancholia as it was called). Now, its estimated that 100,000 people per million are affected. This is a thousand-fold increase since the discovery and marketing of anti-depressants. (Healy, 2004: p2). Between 1992 and 2002, prescription rates for anti-depressants increased by 235%,from 9.9. Million to 23.3 million (National Institute for Clinical Excellence, 2004). In the USA 11% of women and 5% of men now take anti-depressants (Stagnitti, 2005). ‘By 1996, the World Health Organisation had reported that depression was the second greatest source of disability on the planet’ (Murray and Lopez 1996)

22. Implications - Decontextualization Critics of psychiatry have long pointed out that locating the source of problems in individual biology – ‘blaming the brain’ – impedes exploration of social and political issues. It prevents serious consideration of the way in which economic imperatives, such as the need to tolerate poor working conditions and the discipline of the school system, help to define certain behaviours as pathological. It also obscures the effects of social factors, such as overwork and increased competition, on mental well-being. (Moncreiff, 2006) By localizing pathology within the person rather than in the external factors that give rise to them, decontextualization ‘‘serves to reinforce and legitimize social attitudes and relations [such as sexism and alienating working conditions] which may actually contribute to the problems these [medical] products target’’ (Kleinman and Cohen, p873, cited in Moncreiff, 2006). Through minimising the influence of the social, our culture has fostered a climate where the internal world of the individual has become the site where the problems of society are raised and where it is perceived they need to be resolved. (Furedi, 2006: p. 1)

23. ‘the seductive advertisements implicitly undermine self-help, alternative forms of treatment, and the need to remedy the inequities, injustices, and discomforts that gave rise to the problem in the first place’ (Rubin, 2004: p376)

24. ‘we now compulsorily detain three times more patients than were detained before modern psychotropic drugs were first developed, that we admit fifteen times more patients than were admitted before the present psychotropic era began, and patients now on average spend more time in the course of a psychiatric career in a hospital than they did before modern drugs came on stream’ (Healy et al 2001:p 26-27)

25. Further reading / resources ‘The Creation of Psychopharmacology’ by David Healy, 2002 (most of it on google books) ‘Let them eat Prozac’ by David Healy, 2004 http://www.healyprozac.com/ This website explores threats to public safety and academic freedom surrounding the SSRI group of drugs – Prozac, Zoloft (Lustral), Paxil (Seroxat/Aropax). It makes available trial transcripts in 3 major cases involving SSRIs and suicide and homicide. It also makes available correspondence surrounding issues to do with ghost writing, efforts to draw attention to the hazards of these drugs and the dramatic changes taking place in academia as an increasing proportion of clinical research is privatised.

26. Rose, Nikolas. (2006) The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. (especially see chapters 5 and 7) Rose, Nikolas. (1998). Inventing ourselves: power, psychology and personhood • Abi-Rached, Joelle M. and Rose, Nikolas (2010) The birth of the neuromolecular gaze.History of the human sciences, 23 (1). pp. 11-26.

27. Moncreiff, J. The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. Whitaker, R. (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Crown.

28. Further resources • Robert Whittaker article on psychiatric drugs http://www.naturalnews.com/011353.html • PLoS Medicine's April 2006 series of articles on disease mongering - brilliant articles on different ‘disorders’ by Healy, Moynihan etc http://www.ploscollections.org/article/browseIssue.action?issue=info%3Adoi%2F10.1371%2Fissue.pcol.v07.i02 • Look on Youtube for pharmaceutical adverts; http://www.youtube.com/watch?v=8bf2LA1ScVA • www.youtube.com/watch?v=9-ZNcjtxNbY Asylum – magazine for democratic psychiatry http://www.asylumonline.net/index.htm

29. Assignment Critically assess the value of the construct 'personality' with reference to one specified theory of 'personality' in psychology These lectures look at the construct 'personality' in the practical sense in which it operates (in, for example, diagnostic systems). Could draw on this material to critique the mainstream notions of personality in psychology. Broad understanding of ‘personality’, as ‘self’ / ‘identity’ / ‘personhood’ Could use theorists such as Nikolas Rose, Kurt Danziger, Judith Butler and Ian Hacking to critique mainstream psychological constructions / theories of personality; and/or as alternative theories as to how the ‘self’ or the personality is formed through power relations and techniques of classification and government.

30. Critically assess the value of the construct 'personality' with reference to one specified theory of 'personality' in psychology Here are some points of clarification which also provide the specific criteria that will be used by the Personality II course team to mark the essay. 1. We know this is a difficult question, and we have deliberately asked a question for which a ready-made answer could not be copied or downloaded, giving you the task of thinking this through. 2. You need to draw on what you know from other areas of the degree to answer this, and we expect you to show initiative in answering the question demonstrating that broader understanding of debates in psychology. 3. You need to be clear what you mean by ‘construct’ as a presupposition or conceptual framework (and you may find it useful to think, for example, about ‘hypothetical constructs’ and ‘social constructionism’). 4. You need to step back and think critically about the advantages and disadvantages of the term ‘personality’ to describe what individuals have in common and how they differ from each other. 5. Choose ONE theory of personality in psychology (we put ‘personality’ in scare quotes because we are asking you to step back and think about that notion) to answer the question (which could be one we cover in the course). 6. You should define what you mean by a ‘theory’ (taking, for example, ‘humanistic’ or ‘social learning’ or ‘psychodynamic’ OR being more specific and referring to, for example, the theory of Rogers or Bandura or Freud). 7. Do NOT just describe the theory (you will fail) or just assess the theory (we have not asked you to do that), think about how the theory in relation to the question (with the theory you choose as an example to answer the question). 8. Remember that this is asking you to ‘critically assess’, and so you should weigh up advantages and disadvantages (of the value of the notion of ‘personality’) in the course of your answer. 9. Structure your answer so that you briefly say what you are going to do, set out the steps in the argument (referring to the theory you have chosen) and end with a conclusion, summing up what your answer to this question is. 10. You can write in first person but, as with all other pieces of work for the degree, you must make clear that you are basing your argument on your reading, and you should reference the reading you refer to at the end of the essay (in BPS format).

31. If you need to contact me, here’s my email: china.t.mills@gmail.com Thanks for listening