Drug Consumption, Psychiatry, and Social Memory

The experience of psycho-pharmaceutical drugs as a circulating commodity at the global scale has been documented by journalists, but it is an area not widely explored by anthropologists. Most anthropology (see Sue Estroff) has ethnographically assessed psychiatric wards and other sites of medical care in the United States and Western world, but aside from the work of Arthur Kleinman in China, it seems that most psychological anthropology addresses cross-cultural emotion states (Unni Wikan, just to name one example).

I was recently reading an special issue in Culture, Medicine and Psychiatry (Issue 36, 2012) that observed the dearth of research performed on people's experiences of psychotropic drugs from an anthropological perspective. Allison Schlosser and Kristi Ninneman from Case Western Reserve University note that this is a largely unexplored area of research that must be probed through the question of pharmaceutical efficacy and how these drugs are interpreted in the everyday lives of patients. After reviewing some of this literature, I feel as if the gaps in information could be partially filled by the work of Neil Thin of the University of Edinburgh, who studies well-being and happiness. In his book, Social Happiness, Thin notes that

"Inflationary prescription of anti-depressant drugs continues, despite clear empirical evidence that for most patients the benefits, if any, are largely due to placebo effects that could be achieved more cheaply, sustainably, and effectively by psychotherapy and/or social therapy" (Thin 2012:11).

Thin's astute observation of this fact has led him to devise a policy-driven scheme guided by the observation of happiness, which is aligned with some of the work by Economist Richard Layard of the LSE, who writes widely on these issues. However, I would propose: could it be that happiness is a cultural artifact of a broader social memory with regard to Western conceptions of well-being? After reading Paul Connerton's How Societies Remember, it is clear that personal memory claims, in which we can configure ourselves as interpolating our pasts, also contain elements of unconscious manipulation, as provoked by the process of recalling particular events in the social sphere.

With this being said, which is more 'sticky' in our brain: the memory of negative, traumatic personal memories OR those of which create positive transformations? How does our mind negotiate this? It is clear that memory has great relevance to traumatic experience and the study of Post-Traumatic Stress Disorder (PTSD), however, the European memory of the Great War, an example cited by Connerton, as well as the American memory of President John F. Kennedy's assassination reflect negative events. However, the autobiographical construction of these events, which is seemingly an intentionally-driven process, is abstracted in the sense that there is a conditioning process, partially influenced by the histories that are learned in school.

What kinds of medical pathologies are learned and constitute an essential part of our remembered experiences of illness? The first that comes to mind is the Red Cross, an international organization that played an integral role in providing medical intervention in the midst of several World Wars. However, governments also intentionally create this 'remembered' medicalized past in which there was once a time in which vaccines, pills, and doctors were either scarce, less effective, or non-existent. This is a persistent trend throughout the history of medicine, which is projected as 'evolving' throughout time with advancements in technologies that undergird it. Yet, has the field of medicine advanced in the realm of mental health? Why are these drugs considered so problematic at large and if they cause such negative side effects, why are they still prescribed? What makes them so salient culturally and in the field of medicine? When was this field established and what kinds of sociocultural and historical trends arose in conjunction with the rise of psychiatric medicine and treatment? Can this be an extension of our learned, social memory?

I ask this complex set of questions in order to better refine my own ideas, however, I hope to engage others in this debate. I have read some historical accounts of this rise, such as Happy Pills in America, but there seems to be little anthropological assessment of some of these inimical issues within the field of medicine.

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Comment by Nathan Dobson on March 21, 2012 at 4:15pm

I particularly like this question in the second to last paragraph: "What makes them so salient culturally and in the field of medicine?" - There must be more drugs that seem to grow on us, that do the job better. A new set of packaging. "Hit pain where it hurts" - as opposed to all the other places. So why choose anti-depressants?

And in the last paragraph by "inimical" do you mean that they threaten status quo?

Comment by Keith Hart on March 17, 2012 at 11:49pm

This is indeed a great set of questions and anthropological interests, Chelsea. I hope you find interlocutors for the debate you seek. I once spent quite a while looking into the idea of happiness as a political virtue. It was in the context of editing C.L.R. James's American Civilization (1993) with Anna Grimshaw. Here is what we wrote about the concept in our Introduction:

“We initially hoped to call the book, which was a text written in 1950,The Struggle For Happiness. We contend that James, like Saint-Just in France in 1794, brought to the world from America the idea of happiness as a revolutionary goal to be added the European legacy of freedom (bourgeoisie) and equality (peasants/workers). Happiness became a word which appeared repeatedly in James’s later writing, from his assertion that Marx and Hegel “believed that man is destined for freedom and happiness”, to his lengthy exposition, in a letter to a literary critic on the centrality of happiness to American society and culture, in contrast to Europe with its sense of the tragic. The notion of happiness lay too at the heart of his volume Modern Politics [1960], but there James called it “the good life”.

“Conventionally, ‘happiness’ has been understood as a trivial thing, as a moment of pleasure which is necessarily fleeting. As James himself recognized, the notion was often reduced to mean simply material satisfaction. He took his lead, however, from the conceptions of the eighteenth century, where the pursuit of happiness in this life was contrasted with religious passivity in the face of earthly suffering. Although he nowhere defined the concept closely, the idea permeated American Civilization; for he held happiness to be as essential to the human experience as the desire for freedom and equality. It was the desire of the modern age, “what people want”, expressive of complex and deeply rooted needs of human beings for integration, to become whole, to live in harmony with society.

“For James then, happiness had two facets, the freedom to be a fully developed, creative, individual personality and to be part of a community based on principles conducive to that aim. This was the unity of private interest and public spirit which de Tocqueville had found in the early American democracy and which James believed was still the palpable goal of the American people in the twentieth century. It is significant in this respect that James used “The Struggle For Happiness” as the title for the chapter on the industrial workers. As he makes clear in the text, the integration of individuals in modern society would require a fundamental reorganization of the way people experience work. America contributed the idea of happiness to our understanding of civilization itself. Today it has become a universal goal; and with the emergence of the people of Eastern Europe, Latin America, Asia and Africa as the potent symbols of the collective force of humanity in its opposition to the forces of oppression, we are reminded again that happiness is inseparable from the active struggle for its attainment.”

Another angle which does not detract at all from the one that interests you.

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