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Feature Article

Nikolas Rose
ow did we become neurochemical selves? .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? How did we come to experience our worries at home and at work as "generalized anxiety disorder" alsocaused by a chemical imbalance which can be corrected by drugs? How did w e - - o r at least those of us who live in the United States-come to code children's inattentiveness, difficulties with organizing tasks, fidgetiness, squirming, excessive talkativity and noisiness, impatience and the like as Attention Deficit Hyperactivity Disorder (ADHD) treatable by amphetamines? How did some of us come tounderstand changes in mood in the last week of the menstrual cycle--depressed mood, anxiety, emotional lability and decreased interest in activities--as premenstrual dysphoric disorder, treatable with a smaller dose of the very same drug that has become so popular in the treatment of "depression"--fluoxetine hydrochloride? Perhaps some names give a clue. Depression: not so much fluoxetinehydrochloride as Prozac. G e n e r a l i z e d A n x i e t y Disorder: not so m u c h paroxetine as Paxil. ADHD: not methylphenidate or amphetamine/dextroamphetamine but Ritalin and Adderall. Premenstrual dysphoric disorder: not so much fluoxetine hydrochloride (again) but Sarafem. And some more names: Prozac and Sarafem: Eli Lilley. Paxil: GlaxoSmithKline. Ritalin: Novartis (Ciba Geigy). Adderall:Shire-Richmond. In this essay I want to explore the linkages 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. These do not just reshape our ways of thinking about and acting upon disorders of thought, mood and conduct. Of course, they have enormous consequences forpsychiatry as it is practiced in the psychiatric hospital, for the "community psychiatric patient," and in the doctors" surgery. But they


have also had an impact on the workplace and the school, the family and the prison--not to mention the bedroom and the sports field. And this recoding of everyday affects and conducts in terms of their neurochemistry is only one element of a morewidespread mutation in which we in the West, most especially in the United States, have come to understand our minds and selves in terms of our brains and bodies. I have started with neurochemistry: the belief that variations in neurochemistry underlie variations in thought, mood and behavior, and that these can be modulated with drugs. I might have started with brain imaging: the belief that it is nowpossible to visualize the activities of the living brain as it thinks, desires, feels happy or sad, loves and fears, and hence to distinguish normality from abnormality at the level of patterns of brain activity. Or I might have started with genomics: claims to have mapped precise sequences of bases in specific chromosomal regions that affect our variations in mood, capacity to control ourimpulses, the types of mental illness we are susceptible to and our personality. But here, I want to start with the pharmaceuticals themselves.

Psychopharmacological Societies
Over the last half of the twentieth century, health care practices in developed, liberal, and democratic societies, notably Europe and the United States, became increasingly dependent on commercially produced pharmaceuticals.This is especially true in relation to psychiatry and mental health. 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...
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