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 Synaptic Connections By CHRISTOPHER GARY CANNING A dissertation submitted to the Department of Sociology in conformity with the requirements for the degree of Doctor of Philosophy Queen’s University Kingston, Ontario, Canada May 2010 Copyright © Christopher G. Canning, 2010 Abstract This project critically evaluates sociological and biological epistemological approaches to the study of mental health and illness, such as anti‐psychiatry, social constructivism, Actor Network Theory, neuroscience, and epigenetics, and addresses implications for establishing theoretical links between these domains of scholarship. How, for example, can neuroscience and epigenetics contribute to contemporary accounts of the embodiment of mental illness in the social sciences? What can the sociology of mental health contribute to contemporary biological accounts of behaviour? How might an integrative approach to the study of mental illness help better the lives of women and men living with mental illnesses? In order to address these questions, this project traces shifting sociological and natural scientific trajectories from the 1960s to present, and theorizes a more nuanced alignment between social and biological research in mental health. This dissertation is situated within a growing science studies tradition, one which examines the relationality between human and nonhuman processes, and which investigates how mental illness might be viewed as a constitutive state of relations between somatic (internal) and social (external) environments. ii
Acknowledgements There are many people to whom I owe enormous thanks. First, thank you to my school buds who each, in some way or another, took me away from my work at appropriate times to do what PhD students do. Thank you to Dr. Martin F., Dr. Simon K., Robert L., Marcel N., Serena R., Dr. Erin B., Brian D., Paul H., Melissa H., Nick H., Dr. Jason P., Dr. Scott U., Erica S. and the rest of The Tavern folks, the English Department crew, my Boundless Adventures buds, and my long lost Calgary friends, for all the great times over the last few years. In particular, thank you to my very best friend, Dr. Enda Brophy, who, in his own awe‐inspiring (albeit at times frustratingly honest) way, helped me through this process as he has done for so many of our friends. I owe infinite thanks to my supervisor, Dr. Myra Hird, for her intellectual, academic, and financial support over the last four years. She flew me to conferences to help with the development of my ideas (and CV), employed me when times were tough, and pushed me harder academically than I ever imagined possible. While it may not seem like all of those pushes were appreciated, I can say with absolute certainty that I would not have written my dissertation without her guidance and careful, critical edits on all drafts and individual chapters. For everything, Myra, I thank you so very kindly. Thank you also to my two remaining committee members. Since taking a course in science and technology studies with Dr. Vincent Mosco in my first year as a PhD student, a course in which the ideas for my thesis were originally formed, him and I have iii
shared many great conversations about Latour, epigenetics, and science studies. Thank you, Vinny, for your support, guidance and critical comments on my work. Thank you to Dr. Roberta Hamilton, who, after retiring during the final year of my studies from a tremendously successful academic career, continues to offer me encouraging words and academic guidance whenever we see each other around campus and the Kingston area (usually on the Wolfe Island Ferry). I’d like to offer a special thank you to my entire committee for the help and feedback during the particularly bumpy and challenging last few months of this project. Finally, thank you to my external examiner, Dr. Aryn Martin of the Department of Sociology at York University, and my internal‐external examiner, Dr. Jackie Duffin (Queen’s Medicine/Philosophy/History), for their careful and critical reading of my work. Your challenging questions and comments will no doubt impact the future direction of this work. To Len Canning, my father, who is probably still pinching himself from the realization that one of his sons actually finished a PhD, I thank you for your support. I felt your encouraging and proud words despite our geographical separation. Thank you to my brothers, Colin, Shawn, and Derek, for motivating me to finish by telling me that I chose the wrong career path. To Norma Canning, my mother, the strongest person I know on the planet, thank you for inspiring my work. The longer you fight, the more you help me understand the world. You define what I do. iv
To Laura McGavin, my partner (and, at the time of writing, my fiancée), the love of my life, my editor, my confidant, my coffee buddy, an essential member of our bike parade, I thank you for everything (Wunderbar, Seoul, and the countless edits, most especially). Understatement of ’09‐‘10: this project was completed because of you. You are brilliant. Thank you. v
Table of Contents Abstract .............................................................................................................................. ii Acknowledgements ........................................................................................................... iii Table of Contents .............................................................................................................. vi Preface..............................................................................................................................viii Chapter 1: Introduction ...................................................................................................... 1 Aim and Project Summary .............................................................................................. 1 Neuroscience and Mental Health ................................................................................... 7 Anti‐Psychiatry and Social Constructivism.................................................................... 11 Actor Network Theory and Realist Approaches to Science .......................................... 14 Ontological, Epistemological, and Methodological Assumptions................................. 17 Chapter Summary......................................................................................................... 21 Chapter 2: Psychiatric Survivors and Embodied Epistemological Approaches to Mental Health and Illness ............................................................................................................. 25 Introduction.................................................................................................................. 25 R.D. Laing and the Politics of Anti‐Psychiatry ............................................................... 29 Emotions and Embodiment: The Politics of Voice and Survivor Testimonials.............. 36 Conclusion .................................................................................................................... 46 Chapter 3: The Sociology of Mental Health...................................................................... 51 Introduction.................................................................................................................. 51 The Postmodern Turn................................................................................................... 55 Contemporary Social Constructivist Approaches to Mental Health and Illness in Sociology....................................................................................................................... 65 Realist and Bioethical Approaches to the Study of Mental Health and Illness............. 79 Conclusion .................................................................................................................... 94 vi
Chapter 4: Bruno Latour and Actor Network Theory ....................................................... 97 Introduction.................................................................................................................. 97 Ontology, Epistemology, and Metaphysics................................................................. 108 Nature/Culture ........................................................................................................... 113 The Circulatory System of Science.............................................................................. 116 A Latourian Methodology: ANT .................................................................................. 120 Limitations of a Latourian Approach to Mental Health .............................................. 121 Conclusion .................................................................................................................. 126 Chapter 5: Neuroscience, Matter and Mental Health .................................................... 127 Introduction................................................................................................................ 127 Mental Illness in the Age of the Neurosciences ......................................................... 132 Elizabeth Wilson, Neuroscience, and Mental Health.................................................. 144 Epigenetics: A Latourian Actor‐Network? .................................................................. 155 Conclusion .................................................................................................................. 169 Chapter 6: Conclusion..................................................................................................... 172 Introduction................................................................................................................ 172 R.D. Laing .................................................................................................................... 173 Bruno Latour............................................................................................................... 177 Elizabeth Wilson ......................................................................................................... 180 Conclusion .................................................................................................................. 185 Future Research Questions......................................................................................... 187 References ...................................................................................................................... 189 vii
Preface The impetus for my critical investigation into mental health studies occurred in the summer of 1997, when I first started a job leading multi‐day canoe, hiking, and horseback trips at an outdoor centre nestled in the foothills of the Canadian Rockies. It was there that I was first exposed to the creativity and imagination of “at‐risk” boys and girls diagnosed with Attention Deficit Hyperactive Disorder (AD/HD), many of whom were sent to the out‐of‐doors to help them become—in whatever way possible, according to their parents—“better children.” After working with this population of youth for several years, I began to question the label “AD/HD,” mostly because I found it to be ironic that the more youth were forced to comply with the increasing standardization of public education and testing, the more they were diagnosed as being “hyperactive.” I was troubled by the idea that, as youth were increasingly asked to sit still in desks, usually at the expense of active learning in physical education programs, the more their so‐called “abnormal,” “hyperactive” behaviour became a pathology with largely unquestioned normative and disciplinary consequences. I also found it to be interesting that many of these “hyperactive” youth, who, apparently, could not pay attention in classroom learning, pay perfect attention to tasks in outdoor learning. This phase in my thinking about mental health was also a result of my reading Foucault and other post‐structuralist theorists, as I had also just started an undergraduate degree in sociology and philosophy at the University of Lethbridge. It was then I first became viii
interested in studying mental illness. I would often ask myself: is AD/HD just a label? Surely, I thought, there must be physiological differences between bodies influencing some youth to be more active over others? Many years later, and just after I started my PhD in 2005, I spent two summers working at another outdoor centre in south‐central Ontario. This program is designed to offer experiential, outdoor‐based therapeutic possibilities for youth and adults diagnosed with schizophrenia, depression, bi‐polar disorder, and other mental illnesses. At this centre, I started thinking about how bodies‐in‐the‐world interact differently in changing social and environmental contexts, and how this interaction influences and changes one’s physiology and psychological well‐being. With the help of the outdoor community, I saw many youth diagnosed with depression transform in different environmental contexts. I witnessed women and men with severe cases of schizophrenia, while still highly medicated, become more open, more social, and always more “expressive” and “affective.” The clients told me repeatedly that the out‐of‐doors, and the supportive community at this centre, transformed them into thinking and feeling differently—mostly for the better. They were not “cured” of schizophrenia or depression by these experiences, but most of the women, men, and youth did confidently say that something was both socially and physiologically better about being in supportive, highly caring, active, and creative environments. These experiences profoundly shaped my interest in tracing how different epistemologies, including the “hard sciences,” have come to understand mental illness ix
over the last few decades. What influence did the postmodern turn have on sociological understandings of health and illness more broadly? Why do some activists and theorists so radically reject psychiatric labels? How has sociology theorized the body, illness, the brain, DNA, and “the environment,” especially in the context of mental health? How are sociologists theorizing how one’s physiology might change in different social environments, as I saw in the youth and adults transformed in outdoor spaces? Lastly, what are scientists saying about mental illness in the age of the neurosciences, and how might they work alongside sociologists, and sociologists alongside them, to understand the lived experiences of women, men, and youth diagnosed with mental illnesses? My interest in supportive and caring communities for youth and adults with mental illnesses underscores this project, as does my academic interest in anti‐
psychiatry, the sociology of mental health, science studies, philosophy and sociology of science, and emerging theories in biology concerning the complex interaction between physiological processes and environmental contexts. I am indebted to the conversations I had with distinguished psychiatrists and neuroscientists during the early stages of this project. In particular, I would like to thank Dr. Beninger, Dr. Arboleda‐Flórez, Dr. Delva, Dr. Owen, and Dr. Kelley in the Department of Psychiatry at Queen’s University, and Dr. Petronis in the Department of Psychiatry at the University of Toronto and the Centre for Addiction and Mental Health (CAMH). I dedicate this project to the many women, men, and youth fighting to be understood and cared for in a world where mental illness is still largely, if not entirely, x
stigmatized. Most importantly, I would like to dedicate this project to my mother, who has suffered from severe depression—on top of two successful battles against breast cancer—for close to fifteen years. Yet, remarkably, she is the most caring, thoughtful, and supportive person I know. xi
Chapter 1: Introduction The doctor is not on the side of health, possessing all the knowledge about the illness; and the patient is not on the side of illness, ignorant of everything about it, including its very existence. The patient recognizes his [sic] anomaly and it gives him [sic], at least, the sense of an irreducible difference separating him from the world and the consciousness of others …The way in which he [sic] interprets it and gives signification to its most absurd forms constitutes one of the essential dimensions of the illness. (Foucault, 1962: 47) From the birth of modern science, methodological reductionism has proved a powerful and effective lever with which to move the world. We owe to it many of the most penetrating insights into mechanisms in every field of science, including biology. But, especially in biology, complexity and dynamics, open rather than closed systems are norms, rather than exceptions, and the methodology of reductionism, however powerful, has difficulty dealing with this complexity—indeed, it may be positively misleading. (S. Rose, 2003: 295) Aim and Project Summary Fifty years ago, C.P. Snow noted a polarizing dichotomy between the natural sciences and the social sciences and humanities, an epistemological separation that he claimed had done little for advancing a collective understanding of social issues (Snow, 1959). As Brockman points out, while much work has led to alignments between the social and natural sciences since Snow’s The Two Cultures lecture, the “gulf‐gap‐chasm” between disciplines is still a significant one (Brockman, 1995). My dissertation aims to advance communication between sociology and the natural sciences, domains of research that have had important but seemingly disparate insights concerning the care of women and 1
men living with mental illnesses. This is not to suggest that sociology and the natural sciences are monolithic entities, nor that all sociological and/or scientific studies of mental health have elided the other in order to advance research in direct opposition. Rather, my project investigates and complicates ontological and epistemological assumptions that underscore social and biological studies of mental illness, while creating new “synaptic connections” by highlighting ways in which these domains of knowledge are already entangled. In order to make a novel intervention into sociological and science studies literature, my research deploys an empirical method that analyzes, through close reading, several bodies of sociological and scientific literature pertaining to mental illness from the early 1960s to present. My expressed goal, in this regard, is to find an accord between sociological and scientific reductionist perspectives by exploring and complicating the value dimensions of the biological sciences, an approach that has, to date, been a point of contention throughout the development of science studies (Bloor, 1976; Bloor, 1999; Latour, 1999b). More recent feminist science studies approaches (c.f. Barad, 2008, Wilson, 2008) suggest that sociologists are not only in a position to neutrally explore the novelties of scientific practices (Bloor, 1976), but are also bound to the broader social, political, ethical, and pragmatic implications of scientific claims to knowledge (Wolfe, 1998). As such, my project makes an original contribution to this debate by theoretically exploring how a science studies approach to mental health can be both an empirical investigation of scientific literature on mental health, as well as 2
one of engaging with the ontological and ethical entanglement of human and nonhuman bodies and processes (Barad, 2008; Hird, 2009). One of the central considerations of my project is that contemporary sociological studies of mental health and illness, while “irreducibly political” (Wilson, 1998), have often reified an epistemological separation between biology and sociology. Many contemporary social studies of mental health regard biological psychiatry as either an objective site of knowledge production or an oppressive form of social control, which leaves many studies at a distance from understanding the complexity of the molecular processes of the biological body (Wilson, 1998, 2008). Similarly, many biological studies of mental health and illness operate within a fixed positivist framework, one that influences deterministic1 epistemological positions and elides an engagement with the social sciences’ emphasis on patient subjectivity and wellness. My project investigates the epistemological assumptions that define social and biological studies of mental illness, and theorizes potential pathways that link sociology with the natural sciences (Wilson, 1998, 2006, 2008; Cromby, 2004a, 2007; Barad, 2008; Szyf et al., 2008; Hird, 2009). This investigation is by no means exhaustive. Throughout my project, I make particular political and ethical insertions into social and natural scientific literature from 1
Throughout the dissertation, I borrow from S. Rose et al. their comprehensive definition of determinism. As they write, “Ultimately, [determinism claims that] all human behaviour – hence all human society – is governed by a chain of determinants that runs from the gene to the individual to the sum of their behavious of all individuals” (S. Rose et al., 1984: 6). 3
the 1960s to present, focusing on exemplary aspects of how various disciplines have approached the study of schizophrenia and depression. Undoubtedly, there are other sociological, philosophical, and scientific perspectives that have been omitted from this project, both unintentionally because of the expansiveness of each discipline, but also intentionally given the necessary purview of a project this size. Nevertheless, this dissertation explores and theorizes specific examples in order to address the following guiding research questions: How have sociological, philosophical, and biological epistemologies from the 1960s to present approached the study of mental health and illness? How might sociologists of science complicate and contribute to these positions without dismissing important contributions from other domains of scholarship? What are the underlying ontological assumptions behind various claims to knowledge in contemporary understandings of mental health? How might sociology, philosophy, and neuroscience each contribute to a more nuanced, collaborative dialogue between the social and natural sciences for future studies in mental health? The title of this dissertation, “Synaptic Connections,” serves as both a literal and metaphorical starting point for this dialogue. As molecular biologists and neuroscientists have come to demonstrate, behaviour, “abnormal” or otherwise, can be, in part, understood by chemical and electrical processes between nerve cells, or synaptic connections. Yet, as many social and natural scientists have also come to argue, the brain does not act in isolation from the social world, nor does the social world exist in opposition to—in reverse reductionist terms—molecular processes of the human body 4
(Damasio, 1994; Kandel, 1998; Thagard, 2006; Cromby, 2007; S. Rose, 2009). The phrase “synaptic connections,” then, first indicates my interest in sociologically engaging with the materiality of brain processes, especially to theorize, in non‐reductive and literal terms, how molecular and neurological processes are implicated in current understandings of schizophrenia and depression. Used metaphorically, the image of chemical and molecular communication in the brain becomes a way to promote an ongoing dialogue between sociology and the neurosciences. Dialogues of this sort challenge what Henningsen and Kirmayer call the “localization fallacy” in neuroscience and psychiatry, the assumption that specific neuronal circuits or genes are computational determinants dictating human behaviours such as schizophrenia and depression (2000: 477; see also S. Rose et al., 1984; S. Rose, 1998). The determinism of the localization fallacy, while no longer reigning in recent neurobiology and cognitive neuroscience, has historically made many social scientists cautious of data emerging from scientific laboratories (Cromby, 2007). Yet, as neurobiologist S. Rose points out in Lifelines: Life Beyond the Gene (2003), many biologists are now offering alternate versions of living systems, non‐reductionist epistemologies that “recognize the power and role of genes without subscribing to genetic determinism, and which [recapture] an understanding of living organisms and their trajectories through time and space” (S. Rose, 2003: 7). As S. Rose’s research suggests, “Humans are not empty organisms, free spirits constrained only by the limits of our imagination,” but neither are humans “machines for the replication of our DNA” (2003: 6). Humans are, he contends, 5
“products of the constant dialectic between ‘the biological’ and ‘the social’ through which humans have evolved” (2003: 6). Placing this dialectic at the centre of a study about mental health does not mean simply celebrating the work of genetic or neuroscientific research. As Foucault points out in Mental Illness and Psychology (1962), mental health patients create and construct important meanings from experiences of being ill. While Foucault remains largely dubious of scientific epistemologies, his notion of the patient‐as‐knower is a starting point in my attempt to demonstrate how biological and sociological views of mental health are, in fact, already in productive conversations with one another. How, for example, has Foucault’s insistence that “the patient recognizes his [sic] anomaly” (1962: 47) served as a starting point for sociological engagements with non‐reductionist epistemologies in neuroscience and psychiatry? Conversely, how might neurobiologists such as S. Rose contribute to sociological understandings of mental illness, such as the role of the patient in contextualizing and giving meaning to mental illness, the construction of deterministic scientific claims to truth, and the bio‐political production of pathologized identities? Before addressing how these questions will come to frame this dissertation, I will give an overview of the epistemological approaches that are central to this project. This overview will only offer brief insights into each field, as I return to each of them in the chapters to follow. For now, I examine the development of scientific epistemologies such as neuroscientific and molecular biological approaches to mental health, the anti‐psychiatry movement’s response to these fields and its influence 6
on social constructivism and the sociology of mental health, and variations of realist responses to constructivism and scientific reductionism. Following this overview, I outline the ontological, epistemological, and methodological assumptions underscoring my own science studies approach to mental health and illness, and then detail the dissertation’s objectives by giving a chapter summary of the project as a whole. Neuroscience and Mental Health Until the early twentieth century, neurosurgery, neurology, and psychiatry were often non‐communicative scientific disciplines competing to define a particular patient base for the diagnosis and treatment of mental illness, despite the fact that some scientists at the time collaborated in research and publications (Valenstein, 1973, 1986; Porter, 1985; Pressman, 1998; Starks and Braslow, 2005). After the 1930s, the American Psychiatric Association (APA)—the united field of medical disciplines researching mental illnesses—gained political and medical influence in North America, and the previously disparate fields of neurosurgery, neurology, and psychiatry began collaborating in the therapeutic treatment of psychiatric illnesses (including psychotherapies and private, industry‐based pharmaceutical and neuro‐pharmacological research) (Shorter, 1997: 145 ‐ 180). This unification in biological psychiatry was justified because many researchers within the neurosciences argued that neurology and psychoanalysis were dependent upon non‐verifiable, philosophical concepts, especially in the case of psychoanalysis (Valenstein, 1986: 21 – 22; Kotowicz, 1997). During the 1950s, 7
neuroscientists and biological psychiatrists argued that psychiatric illness should be studied at the molecular level, and did not accept psychoanalytic arguments that psychoses, or other related illnesses, are caused exclusively by adverse life experiences, despite the strength of post‐WWII psychoanalytic psychiatry in the 1950s and 1960s (Grob, 1991; Valenstein, 1986). As neuroscience established itself as a discipline that encompassed a variety of fields in the biological sciences,2 and as new technologies were developed to diagnose and treat mental illnesses, the research focus shifted dramatically to genetic origins of mental illness (Kandel, 1989; McGuffin et. al, 1991; Plomin and Rende, 1991). Contemporary studies of neurological and genetic origins of mental illness developed as a branch of biological psychiatry, largely as a result of its success in capturing the public imagination (Conrad, 1997; Caspi and Moffitt, 2006; Rose, 2007). Aided by the merging of psychiatry with genetics, the 1990s, in particular, saw a rise in genetic studies of mental illness (Kandel, 1989; Kandel et al., 1995; Martin and Ashcroft, 2005), such that neuroscientists began to examine molecular mechanisms conferring long‐term effects on gene expression in the brain (Andreasen, 2001: 197‐199; Fox Keller, 2002: 123 – 147). Throughout the 1990s and continuing to present, scientists within the fields of neuroscience, neurogenetics, and psychiatry argue that mental illnesses can be treated 2
Subspecialties of neuroscience now include neurophysiology, which studies the detailed electrical activity of neurons and other neuronal structure; neurobiology, which focuses on the molecular and cellular understanding of the nervous system; and cognitive neuroscience, which studies correlations between cognitive phenomena and biological patterns (Racine et al., 2001: 124). 8
through clinical procedures, aided by advancements in genetic studies of mental illness (Kandel, 1989; Insel and Collins, 2003; McGuffin, 2005; Caspi and Moffitt, 2006). Neuroscientific studies in the area of psychiatric illness engage with the question of how genes and “the environment”3 shape distinctions between health and illness, treatment and enhancement, normality and pathology (Wilson, 1998; Rose, 2001; Martin and Ashcroft, 2005: 2). In particular, many neurotechnologies, such as imaging, are attempting to locate genetic origins of psychiatric illnesses through DNA sequencing, which is combined with computer programs to analyze the molecular basis for pharmacological therapy and treatment (Andreasen, 2001; Cowen et al, 2002: 1 – 4; Fox Keller, 2002; Rose, S., 2006). As a result of these technological developments in neuroimaging and molecular genetics (Kendel et al., 1995; Andreasen, 2001), mental illnesses are now scientifically defined as neurological and genetic diseases, as encompassed within biological psychiatry’s broad definition. A Public Health Agency of Canada document, for example, 3
Throughout my dissertation, “the environment” refers to external environments, such as depressive states, nutrition, psychological harm, and somatic environments, such as processes in the cell influencing gene expression, or the synaptic communication between different nerve cells (Laughlin and Sejnowski, 2003; Caspi and Moffitt, 2006). These somatic environments are also “human” environments in that they are contained within human bodies (although they are not limited to humans) (Wilson, 2008). As I point out later in the dissertation, the concept of “the environment” remains ambiguous and is often used reductively across the social and biological sciences. The environment is central to sociological understandings of mental health, and can include human speech and interaction, as well as the discourses and practices of psychiatric science (Fee, 2000). To date, however, theorizing or discerning exactly what sociologists, philosophers, and biologists mean by “the environment” remains a difficult task, especially as the term becomes so ubiquitous in gene‐environment studies and epigenetics, both of which have, to some extent, supplanted genetic determinism(s) (Rose et al., 1984; Hedgecoe, 2001; Caspi and Moffitt, 2006; Rose, 2007; Pickersgill, 2009). 9
notes that mental illnesses are defined broadly as resulting from “changes in the chemistry of the brain, changes in the structure of the brain, and genetic factors” (PHAC, 1991: 2). According to this document, functional magnetic resonance imaging (fMRI) techniques have demonstrated structural abnormalities in the brains of people diagnosed with schizophrenia, including enlarged lateral ventricles, enlarged third ventricles, and asymmetries and cortical atrophy (PHAC, 1991; McGuffin, 2005: 22, 2001: 116 – 120). Most recent studies of schizophrenia suggest that these abnormalities are present from the earliest stages of the illness, and may be related to symptoms of “cognitive dysfunction” such as impaired motivation, socialization, and complex problem solving (Weinberger et al., 2001; Cowen et al., 2002; McGuffin, 2005; Raines, 2002; Harvey, 2008). Physical symptoms of schizophrenia are usually characterized as social and occupational dysfunctions and social disturbances, catatonic states, and what is called “schizoaffective disorder,” a delusional state of little to no “emotional” response to treatment and care (Maxmen and Ward, 1995). As neuroimaging and other brain sciences continue to define and locate abnormal functioning in the brain, specifically neurogenetic and cognitive neuroscientific studies of brain mechanisms (Andreasen, 2001; Tandom and McGuffin 2002; Insel and Collins, 2003; McGuffin, 2005), social and political studies of neuroscience and biological psychiatry simultaneously challenge the reading of normal and abnormal brain functioning as a cultural and political tool for social control. Even some neuroscientists argue that certain aspects of scientific research and treatment 10
have gone too far in controlling what are seemingly “normal” behaviors, especially in children (Cohen, 1988; Breggin, 1991; S. Rose, 2003, 2006). Anti‐Psychiatry and Social Constructivism The most radical challenges to psychiatric science originated during the 1960s anti‐
psychiatry movement (Cooper, 1967, 1978; Cohen, 1988; Crossley, 1998; Cresswell, 2005; Deleuze and Guattari, 2003 [1977], 2003 [1987]). Ranging in its critique of biological and psychoanalytical etiologies of mental illness, anti‐psychiatry is a grass‐
roots social movement that philosophically challenges both psychoanalysis and biological psychiatry (Laing, 1961, 1967; Cooper, 1967; Kotowicz, 1997; Crossley, 1998; Cresswell, 2005). Following from his work on the phenomenology of madness, which attempts to understand ways in which mental illnesses are lived and experienced by patients (Kotowicz, 1997), R. D. Laing’s major criticism of psychiatry shifted to what he called the “technical language of science” in order to demonstrate how mental illness is constructed by a “scientific world” that necessarily alienated patients (Laing, 1967). Laing argued that the diagnosis of individuals as mentally ill is a “social prescription that rationalizes a set of social actions whereby the labeled person is annexed by others, who are legally sanctioned, medically empowered, and morally obliged, to become responsible for the labeled person” (Laing and Esterson, 1964: 18). While abnormal social behaviors appear to be a result of the illness, Laing argues that such behaviors may be closely related to larger political, economic, and social factors that are 11
internalized by the diagnosed individual (Laing, 1961; Cooper, 1967, 1978; Boyers, 1971; Burstow and Weitz, 1988; Breggin, 1991; Burstow, 2005; Kotowicz, 1997). The psychiatric survivor movement—the most recent manifestation of 1960s anti‐psychiatry—can be defined as forms of activism advocating for more supportive medical and living communities and for psychiatric survivor rights (Breggin, 1991; Cohen, 1988; Burstow, 2004: 143; Cresswell, 2005; Crossley, 1998; Shimrat, 1997). Often working outside academic environments, but allied to some degree with academics, the psychiatric survivor movement provides community‐based alternatives to mainstream treatment, critical psychotherapies, drop‐in centres for psychiatric patients, and on‐the‐street protests and direct action casework (Burstow and Weitz, 1988; Burstow, 2004; Breggin, 1991; Shimrat, 1997). Important to the anti‐psychiatry movement and contemporary forms of survivor advocacy work is the distinction between “mental illness” and “madness,” the former linked to the historical pathologization of “abnormal” behaviors, the latter largely influenced by the existential philosophy of Laing and Cooper, as well as the post‐structuralist theories of Deleuze, Guattari, and Foucault. “Being mad,” according to contemporary anti‐psychiatry and survivor activism, is defined broadly as the political reclamation of an identity that was historically degraded by psychiatry, neuroscience, and genetics (Laing, 1961, 1967; Cooper, 1978; Burstow, 2004). While Laing has been criticized by Marxists (Sedgwick, 1973) and feminists (Jacoby, 1975), the implications of his philosophy are experiencing a resurgence within 12
the academy. The historical significance of Laing’s activist work, which demonstrated the possibility of non‐hospital settings for living with mental illness in supportive community settings,4 as well as his theoretical, existential analysis of madness, has re‐
defined and re‐created contemporary, critical perspectives in mental health studies. Most importantly, Laing’s work offered psychiatric patients the opportunity to speak and be heard while living through mental distress, an insight that has been broadened and re‐deployed in contemporary social constructivist approaches to mental health and illness.5 Laing’s philosophy and activist work has also influenced contemporary sociological approaches to mental illness, which often challenge what is commonly referred to as the “biomedical model” (Wheaton, 2001; Burstow, 2004; Westerbeek and Mutsaers, 2008; Warner, 2009). According to some sociologists of mental health, neurological or biological theories of mental illness ignore “felt experiences” and 4
In 1972, Peter Robinson released a documentary, titled Asylum, about Laing’s involvement in Kingsley Hall, a house in eastern London set up to offer a safe living space for women and men with schizophrenia, depression, and related mental illnesses. The documentary showcases Laing’s interpretation and politicization of what he calls “mad discourses” during the time that he lived with and supported women and men with mental illnesses in a non‐medical setting. Throughout the film, Laing suggests that “freedom” for mental health patients can only happen outside of medical discourses, influencing more recent constructivist readings of psychiatric science (Robinson, 1972). 5
Throughout my dissertation, I define social constructivism as the epistemological approach that interprets psychiatric knowledge as contingent upon, and defined by, social and cultural forces, including theories of embodiment. Common to both the anti‐psychiatry approach and social constructivism’s reading of mental illness is the assumption that scientific facts are not discovered, but socially constructed by the material‐discursive dimensions of psychiatric science (Busfield, 2001). 13
emotions as they shape and are shaped by one’s embodied experiences living through mental illness (Laing, 1961, Cooper, 1967; Breggin, 1991; Parr, 2000; Williams, 2000; Guattari, 2005 [1976]). The focus on survivor‐driven knowledge revealed through illness narratives, most recently theorized in the context of the sociology of mental health and emotional testimony, explicitly counters dominant biomedical accounts of mental illness that are circulated, for example, in public health material and the DSM‐IV, and which suggest that depression and schizophrenia are solely “biologically‐based conditions” (Foucault, 1962; Breggin, 1991; American Psychiatric Association, 1994; Lewis, 2000; Williams, 2000; Knopp, 2004; Burstow, 2004; Cresswell, 2005). For example, sociologists such as Turner et al. critique biological psychiatry’s dissemination of information that pathologizes psychiatric symptoms at the expense of the “social locations” and “social causes” of ill mental health, factors such as gender, race, family relationships, and socio‐
economic status (1995: 104; Pilgrim et al., 2009; Warner, 2009). This position, like others to which I will return, does not explicitly dispute the etiological significance of biological factors of mental illness, but epistemologically “sets [its] influence to the side, held in reserve to account for individual differences” (Swartz, 2002: 227). Actor Network Theory and Realist Approaches to Science While Latour does not discuss mental health and illness explicitly in his work, he responds to social constructivist epistemologies by advancing a realist, science studies methodology, which he calls Actor Network Theory (ANT). In Pandora’s Hope (1999a), 14
for example, Latour argues that one goal of science studies might be to bridge realism and constructivism by revealing a posteriori work scientists and social scientists “have to do to become so bound together” (Latour, 1999a: 99). Science and society have always co‐existed, Latour suggests, making it all the more important to expose what he calls the “circulatory system of science” (1999a: 99 – 101). Science studies can look to merge what he calls dictum (scientific facts and matter) and modus (situations, people, and judgments); moreover, he contends that the study of one or the other, either in constructivism or reductionist science, has traditionally reinforced the matter/culture dualistic split (Latour, 1999a: 214, 2005). Latour also suggests that there have been two misunderstandings that have influenced social constructivist readings of scientific practices. The first is the belief that sociology seeks only social explanations of scientific facts, and the second is the belief that social studies of science deal only with discourse and rhetoric, while eliding the agency of human, nonhuman, and artifactual “actants” (Latour, 1999a: 12). Actants, in Latour’s work, are human and nonhuman “things” defined through their relations‐by‐association, some of which are human, some of which are nonhuman, and all of which are actualized, or made “real,” through what Latour calls “trials of strength” (Latour, 1988). ANT’s epistemology includes the study of nonhumans because, like Haraway and others, Latour does not ontologically privilege the human (Haraway, 2004 [1985], 2007; Cromby, 2004a; Wilson, 2004; Barad, 2007, 2008; Hird, 2009). How science studies scholars know what they know, Latour contends, cannot be distinguished from the 15
world of things because reality is defined through infinite “gradients of resistance” (Latour, 1988: 166). Harman summarizes this as follows: Actants are stronger or weaker not by virtue of an inherent strength or weakness lying in their private essence. Actants gain strength only through their alliances. As long as no one reads Mendel’s papers, his breakthroughs in genetics remain weak. An airplane crashes if a few hydrolic lines malfunction, but the resistance of these lines is weakened if they are discovered in time and exiled to the garbage dump. For Latour, an object is neither a substance nor an essence, but an actor trying to adjust or inflict its forces. (Harman, 2009: 13‐14) Actants, therefore, both exist and gather to produce meaning; meaning is not inherent to actant, but is defined by the strength of its relationships, associations, alliances, gatherings, and companionships to other actants. Science studies scholars, Latour contends, must empirically follow these relationships, of which humans are only sometimes a part, so as not to impose a predetermined sociological or cultural order (Latour, 2005). Latour’s contribution to science studies, from this perspective, is the idea that “society” has to be “made up, constructed, established, maintained, and assembled. It is no longer to be taken as the hidden source of causality” because, as Latour concludes, “an interest in the social does not lead to society as a source of explanation” (Latour, 2000: 110). Later in the dissertation, I explore social and natural science perspectives in the field of mental health that ostensibly advance what Latour 16
sets forth: a “reassembling of the social” through the empirical tracing of human and nonhuman actants (Latour, 2005). Ontological, Epistemological, and Methodological Assumptions Building from Latour’s “sociology of associations,” my project is situated within a growing science studies tradition, one that examines the relationality between, and mutual constitution of, human and nonhuman actants (Wilson, 1998; Cromby, 2004a; Latour, 2005; Harman, 2007, 2009; Hird, 2009). This emerging science studies tradition ontologically, epistemologically, and methodologically challenges the matter/culture bifurcation,6 as seen in Wilson’s work in neuroscience, cognition, and connectionism (1998, 2008); Barad’s research in feminist theory, quantum physics, “agential realism,” and “intra‐action” (2007, 2008); Cromby’s “socio‐neural” account of depression (Cromby, 2004b, 2007); Hird’s research concerning the “micro‐ontology” of bacteria (2009); Latour’s ongoing research in science studies (1988, 1993a, 1999a, 2005); and Harman’s metaphysical philosophy of objects (Harman, 2007, 2009). 6
There are many bifurcations challenged in the science studies literature, such as matter/culture, nature/nurture, subject/object, inside/outside, nature/culture, and so on (Latour, 1993; Wilson, 1998, 2008; Bloor, 1999; Haraway, 2004 [1985]; Barad, 2008; Hird, 2009). Throughout this dissertation, however, I focus on the matter/culture bifurcation specifically because of its centrality to sociological and biological accounts of mental health and illness. By centrality I mean that many sociological studies of mental illness continue to exclusively examine social or cultural determinants of health; neuroscientists, conversely, often speak mostly of matter and little about culture, despite, for example, the increased focus on how social and cultural environments influence gene expression in complex illnesses. 17
Barad’s concept of intra‐action is central to the ontological and epistemological orientation of this dissertation. In place of what she calls “representationalism,” a philosophical and sociological approach to science that “separates the world into the ontologically disjoined domains of words and things” (2008: 130; see also Harman, 2009), Barad advances what she calls “agential realism,” which studies how “phenomena do not merely mark the epistemological separability of ‘observer’ and ‘observed’; rather, phenomena are the ontological inseperability of agentially intra‐
acting ‘components’” (2008: 133). In an agential realist account, Barad argues, “matter is substance in its intra‐active becoming—not a thing but a doing, a congealing of agency. Matter is a stabilizing and destabilizing process of interactive intra‐activity” (2007: 151). In The Origins of Sociable Life: Evolution After Science Studies (2009), Hird expands on Barad’s thesis by pinpointing an ontological meeting place between “natural” and “social” forces, traditionally understood as distinct ontological entities in sociological and biological epistemologies. Hird writes: “Barad’s term ‘intra‐action’ refers to the ontological inseparability (in the Bohrian sense) of all ‘words’ (culture) and all ‘things’ (nature), contrasted against the term ‘interaction’ predicated upon (ontologically) individuated entities that subsequently interact. By considering ‘words’ and ‘things’ as ontologically (as opposed to only epistemologically) entangled, Barad’s theory avoids the problem that representation seeks analogies and homogies between separate entities” (2009: 23). Barad’s realism, therefore, makes what she calls “agential cuts,” which constitute a “reworking of the traditional notion of causality” (Barad, 2007: 18
133). By challenging the assumption that relationality is distinct from a science studies scholar’s attempt to understand “relata‐in‐phenomena,” agential cuts trace what Barad calls “local determinate structures” of both the agency of matter and the measuring of objects (2007: 133). She writes: “a phenomenon is a dynamic relationality that is locally determinate in its matter and meaning as mutually determined (within a particular phenomenon) through specific intra‐actions” (2007: 138). Towards the latter half of the dissertation, I survey this ontological and epistemological approach as other science studies scholars understand it, and then seek to explicate it through my own discussion of how the social and natural sciences might advance a more communicative dialogue in the field of mental health and illness. By tracing ontological and epistemological assumptions underscoring natural scientific approaches to mental health, my dissertation both informs and is informed by the social scientific community, which has often elided biological matter in order to foreground social and cultural understandings of mental health and illness, but which also contributes significantly to contemporary understandings of patient subjectivity and well‐being (Mirowsky and Ross, 1995, 2002; Conrad, 1997; Lewis, 2000; Swartz, 2002; Kecmanovic, 2009; Warner, 2009). My dissertation further engages with the work of the natural scientific community by interrogating the occasionally reductionist question‐asking that can frame the types of psychiatric research being conducted in laboratories and beyond (Weinberger et al., 2001; Harvey, 2008). As Fox Keller points out in her studies of genomics research, “…to understand how gene talk has affected 19
the course of biological research, we need to examine the particular ways in which terms like gene, gene action, genetic program, have participated in shaping the biological landscape of the scientists doing the work” (2002: 139). Fox Keller’s realism challenges reductionist, neo‐Darwinian7 readings of evolutionary theory often found in socio‐biology (Hird, 2005) by demonstrating the molecular basis of DNA repair and cooperation, a material and social understanding of how genes are far from selfish agents (Fox Keller, 2002: 145). The ontological, epistemological, and methodological assumptions underscoring my project, therefore, promote ways to theorize, investigate, and complicate the epistemic cultures of natural scientific research, including the neurosciences, genetics, and epigenetics, as well as a way of sociologically engaging with the variation, contingency, and materiality of biological matter such as DNA and neurotransmitters (S. Rose, 2003, 2009; Wilson, 1998, 2006, 2008). Although my project does not explore laboratory life (Latour and Woolgar, 1979), I contend that science studies scholars are well situated to study the far‐reaching epistemological implications of natural scientific research (Vicedo, 2000). 7
Throughout my dissertation, I remain sympathetic to Fox Keller’s reading and definition of neo‐
Darwinian genetics. Fox Keller defines neo‐Darwinian genetics as a scientific practice that characterizes biological species as “survival machines,” “lumbering robots,” and “engines of self‐
preservation,” which is methodologically flawed for its “atomic individualism,” and is especially troubling for its erasure of how genes exist in relations to environmental conditions (Fox Keller, 1996: 154‐156). According to Fox Keller, contemporary evolutionary genetics working within this hyper‐individualized framework, a framework tied to neo‐liberal politics of the responsibilization of the individual, “supports the characterization of the biological individual as somehow ‘intrinsically’ competitive, as if autonomy and competition were semantically equivalent, collapsed into one by that fundamentally ambiguous concept, self‐interest” (Fox Keller, 1996: 156). 20
In order to comment on the implications of natural scientific research beyond the laboratory, my methodological approach follows from that of other science studies scholars such as Latour, Wilson, Hird, Barad, Cromby, and Fox Keller, approaches that take seriously the agency and relationality of human and non‐human actants (Latour, 1988, 2005; Wilson, 1998; Haraway, [1985] 2004; DeLanda, 2002; Fox Keller, 2002; Cromby, 2004a, 2004b, 2007; Hird, 2005). Several actants merge and co‐mingle throughout this project: psychiatric survivors, neuroscientists, neurons, synapses, the brain, and genes, all of which—in a Latourian sense—I choose to situate as “matters of concern” in contemporary understandings of the mental health system (Latour, 2008). As I discuss in Chapter 5, this project makes particular insertions into social and biological literature that are by no means exhaustive, and seeks to promote a theoretical conversation that involves tracing selective relations between social and somatic environments. Chapter Summary In Chapter 2, I explore how psychiatric survivor testimonials have been read as an epistemological “way of knowing” in anti‐psychiatry, and discuss the politics of the psychiatric survivor movement and the sociology of mental health more broadly (Cresswell, 2005). Central to these anti‐psychiatric positions are affective and/or emotional testimonials, which respond to the practices of psychiatry, and which are currently being promoted as politicized, identity‐based positions against what many see 21
as oppressive forms of psychiatric, bio‐political control (Laing, 1961, 1967; N. Rose, 2007). In Chapter 3, I explore sociological positions that situate—following Foucault, Lyotard, and the linguistic turn in general—material‐discursive dimensions of psychiatry and neuroscience as the ontological starting place from which to understand how women and men are implicated in the mental health system and beyond. In particular, I discuss theoretical developments in constructivist and postmodern sociological thought, ones largely influenced by the anti‐psychiatry movement, which share an oppositional position against distinctions between the normal and the pathological, and seek to highlight the discursive ways in which mental illnesses are tied to this dichotomy. I conclude Chapter 3 by exploring realist epistemological approaches to the neurosciences, which are, in part, advancing new ways of comprehending the relations between the social and biological sciences. Sympathetic to Foucauldian readings of bio‐
power and the political economy of neuropharmacological research and funding, these realist sociological positions are seeking to align social, political, economic, and biological approaches to neuroscience and genetics by engaging in interdisciplinary studies with natural scientists. In Chapter 4, I foreground Latour’s research concerning the nature/culture distinction that underscores human‐centered philosophies. Through a thematic discussion of Latour’s major publications—The Pasteurization of France (1988), We Have Never Been Modern (1993a), Pandora’s Hope (1999a), and Reassembling the Social 22
(2005)—I show that Latour conducts what might be categorized as an anti‐essentialist empiricism, one that investigates human and nonhuman actants existing in relations‐by‐
association. In order to critique the nature/culture bifurcation, Latour argues that science studies might investigate the intersectionality and relationality between, and mutual constitution of, human and nonhuman actants (Latour, 1993a). Throughout Chapter 4, I chart what I see as important elements of a Latourian realist ontology and epistemology, and then theorize how sociology might advance what Harman sympathetically calls an “object‐oriented metaphysics” (Harman, 2002 2009). In Harman’s view, the troubled ontological relationship between humans and nonhumans in the social and natural sciences has been perpetuated by what he calls “defamatory realism,” which “continues to write its hands … over the gap between human and the world” (2002: 123). How sociologists might complicate this human‐centered approach is a major focus of Chapter 4, and becomes a recurring theme throughout the remainder of my project. Chapter 5 turns to three examples of scientific and social scientific research in mental health that engage meaningfully with the dynamic relationality between social and molecular environments. Here, I explore social and natural scientific approaches to the neuroscience of mental health, emotion, and cognition; Wilson’s research concerning embodiment, neuronal networks, and synaptic communications between the brain and the gut; and emerging theories in epigenetics concerning the complexity of the relations between somatic and social environments. Epigenetics, I suggest, not 23
only challenges the central dogma of genetic determinism that has captured the public imagination since the 1980s and 1990s, but also has the potential to disrupt the matter/culture bifurcation because of its increased focus on the intra‐action between genomic material, such as DNA and proteins, and social environments, such as malnutrition, stress, and psychological harm (Burbano, 2006; Szyf et al., 2008). An Actor Network approach to epigenetics, I point out, strives to empirically trace the relationship between the genome and its “energetic interaction” with spatial and temporal contexts, or “the environment” (Wilson, 2008; Petronis, 2004; Szyf et al., 2008; Barad, 2008). In the conclusion, I propose a hypothetical discussion between Laing, Latour, and Wilson in order to advance a dialogue between the theoretical and epistemological trajectories I trace throughout this dissertation. The conclusion describes ways in which a more integrative approach to the study of neuroscience, epigenetics, and mental health might be advanced in order to animate important theoretical contributions made to the field of mental health by anti‐psychiatry, social constructivism, ANT, and anti‐
reductive approaches in the neurosciences. 24
Chapter 2: Psychiatric Survivors and Embodied Epistemological Approaches to Mental Health and Illness Schizophrenia needs to be defined in positive terms. “Dissociation,” “autism,” and “loss of reality” are convenient terms for those who wish to silence schizophrenics...”loss of reality” – how can we say this about someone who lives in an almost unbearable proximity to the real? (Deleuze, 2006: 27) Introduction Throughout this chapter, I trace ways in which theorists who are influenced by the anti‐
psychiatry movement understand and strategically deploy the embodiment of emotion as a meaningful, acted, political, and lived epistemological position with respect to mental health. To do so, I examine the field of anti‐psychiatry, which stages political challenges to psychiatric practices and knowledge from the epistemological position of what I will call testimony‐as‐politics (Haraway, 2004 [1997]; Larsen, 2004; Roberts, 2004). By outlining Laing’s work during the changing political climate of the 1960s and its subsequent influence on the sociology of embodiment, emotions and mental health (Crossley, 2006), I will highlight how survivor testimony‐as‐politics, formed largely through Laing’s phenomenological approach to “embodied ways of living through mental illness” (Kotowicz, 1997: 19‐20), has been read as a politicized way of knowing in the broader postmodern approach to mental health studies (Burstow, 2004; 25
Westerbeek and Mutsaers, 2008).8 This tradition promotes the situated knowledge(s) of psychiatric survivors9 as a way to challenge the exclusion of women and men from what anti‐psychiatry deems to be the mechanistic practices of psychiatric science (Haraway, 2004 [1997]: 224; Larsen, 2004). Moreover, contemporary anti‐psychiatric scholarship promotes the embodied experiences of survivors as important “non‐science” positions within the broader psychiatric survivor social movement (Burstow and Weitz, 1988; Weitz, 1997; Kotowicz, 1997; Crossley, 1998; Burstow, 2004). For example, Chamberlin, a psychiatric survivor, promotes survivor knowledge as a form of political empowerment, because, as she writes, “…whether ‘madness’ is explained by religious authorities (i.e. as demonic possession), by secular authorities (as disturbance of the public order), or by medical authorities (as ‘mental illness’), the mad themselves have remained largely voiceless” (1990: 323). By tracing the development of anti‐psychiatric epistemology, I acknowledge ways in which Laing and subsequent theorists of 8
Laing’s phenomenological approach, which was largely influenced by Sartre, Heidegger and Merleau‐Ponty (Kotowicz, 1997: 19), is defined most clearly in Self and Others (1961). In this text, he examines the subjective feeling of madness by analyzing the “content of experience” as defined by schizophrenic patients (1961: 38). Important to Laing’s phenomenological position is his reading of experience over existence, the former being his primary focus concerning how women and men live through mental illness, and how the “world” of the psychiatric patient is largely misunderstood, or “mis‐experienced,” as Laing suggests, by “normal” experiences (Laing, 1961). He refers to his reading of the experiences of madness as social phenomenology (Laing, 1961, 1967). This, as I demonstrate, underscores and defines current anti‐psychiatry and psychiatric survivor approaches to, and definitions of, embodiment (Williams, 2000). 9
Throughout this chapter, I use the term survivor as it is commonly used in contemporary activist and sociological circles (Burstow, 2005). Cresswell in particular defines the survivor as a politicized identity defined in opposition to the psychiatric system, which, as he argues, has done little to help many women and men (Cresswell, 2005; see also Campbell, 1992, 1999). 26
emotion,10 embodiment, and testimony advocate for the situated knowledge(s) of mental health survivors. Psychiatric survivor activists and postmodern sociologists of mental health often claim embodied experiences—conflated with emotional experiences—as being central to the study and understanding of depression and schizophrenia (Shimrat, 1997; Stoppard, 1998; Parr, 2000; Busfield, 2001; Burstow, 2004; Larsen, 2004; Philo, 2005). As Williams argues, the expression of emotional experiences in journaling, poetry, novels, legal testimony, and oral histories (Gruber and Kring, 2008; Westerbeek and Mutsaers, 2008), “pave the way for an inter‐subjective and inter‐corporeal approach to social life” (Williams, 2000: 562). Knopp (2004) takes a more political position with respect to embodiment and emotion, suggesting that personal “journeys” of illness and identity, which can be expressed in critical yet painful ways, reflect both the social and material ways in which ill bodies are constituted. The act of speaking about such journeys is what Knopp calls an epistemological “framework for the exercise of power” that has otherwise been removed by a normalized medicalization and/or pathologization process (Knopp, 2004). Furthermore, according to phenomenological and postmodern approaches to embodiment and testimony, situated knowledge is seen to be generated from the telling of “somatic stories”—that is, stories which address intersections between 10
In this chapter, I deal specifically with sociologists of emotion, but will return to the discussion of emotion and neuroscience in Chapter 5. 27
subjectivity and the body—from a particular, often oppressed position (Bracken, 2003: 674‐675). As Westerbeek and Mutsaers suggest, an approach to mental health and illness that emphasizes the centrality of embodied testimony is defined by Foucault’s “oeuvre,” which situates the self not as the cause but the “effect of a new identity generated through narration” (2008: 28). In social constructivist understandings of psychiatric survivor testimony, the term “narration” is used to describe mental illness as a lived story. As opposed to the dominant narration of mental illness—where “dominant” is defined as originating from psychiatric or scientific explanations and treatments—Foucault, for instance, suggests that anti‐psychiatry should aim to give “the individual the right to take his [sic] madness to the limit, to see it through, in an experience to which others may contribute, but never in the name of power that would be conferred on them by their reason or normality; detaching the behaviors, the suffering, the desires from the medical status that had been conferred on them, freeing them from a diagnosis and a symptomatology that had not simply a value of classification but also one of decision and decree” (1994: 49). Larsen supports this claim, one which is both postmodern in its insistence on the discursive construction of “madness,” and also ironically humanist in its reclamation of a coherent or originating selfhood (2004; see also Lewis, 2000: 80‐82). As he suggests, “there is a need to consider the mentally ill as persons, that is, as agents within individual life processes” (Larsen, 2004: 447). Testimonial illness narratives, in this respect, are prioritized “system[s] of explanation” in understanding how women and men negotiate the world as subjects of medical knowledge (Larsen, 2004). 28
In the following section, in order to historically contextualize anti‐psychiatric epistemology and its influence on the sociology of mental health, I give a background to Laing’s philosophical contributions to an understanding of madness. In outlining approaches to mental health studies, it is important to begin with Laing’s anti‐
psychiatric activism because of his subsequent influence on contemporary approaches to the politics of survivor knowledge. As Roberts summarizes, Laing's rejection of biological etiologies of mental illness “so eloquently criticized in The Divided Self [1960] is the starting point for his contemporary relevance for postmodern theory. Here, Laing recognized that the human condition, in whatever circumstances, is not reducible to a depersonalized natural scientific formulation” (Roberts, 2004). In his own words, Laing situates affective dimensions of mental illness outside the purview of the biological sciences, along with “love and hate, joy and sorrow, misery and happiness, pleasure and pain, right and wrong, purpose, meaning, hope, courage, despair, God, heaven and hell, damnation, enlightenment, wisdom, compassion, evil, envy, malice, generosity, camaraderie and everything, in fact, that makes life worth living” (1982: 18). R.D. Laing and the Politics of Anti‐Psychiatry The classic critique of biological and psychoanalytic psychiatry, which continues at the time of writing in social constructivist studies of mental illness (Conrad and Schneider, 1992; James and James, 2004; Busfield, 2001; Kihn, 2001), is largely defined by R.D. 29
Laing’s philosophy and by his activism at Kingsley Hall. A therapeutic community in the east end of London, Kingsley Hall was set up in 1965 in an “attempt to create conditions in which people going through a psychotic breakdown could overcome it in a non‐
medical environment” (Kotowicz, 1997: 3). Kotowicz has researched the significance of Kingsley Hall in the broader anti‐psychiatry movement, especially to highlight Laing’s willingness to live temporarily and spontaneously in a community of “mad” people. As he notes of the place, There is something special about [Kingsley Hall], although it has to be viewed on the ‘small is beautiful’ scale. What marks out Kingsley Hall is that it was conceived of as a project where the madwoman and madman could be met on their terrain, where some form of genuine dialogue with Unreason could happen. Perhaps this was the only project where such a thing could really take place, even if only sporadically. (Kotowicz, 1997: 87) From this perspective, the anti‐psychiatric epistemological position is defined in opposition to what Laing calls the “rational, scientific terrain of [psychiatric] knowledge,” one that manages only a cursory mention of the daily lives of psychiatric survivors (Laing, 1960: 16‐20; Larsen, 2004; O’Brien and Fullagar, 2008). As Read and Reynolds contend, Laing is the key philosophical and activist figure defining the anti‐
30
psychiatry movement, even more so than Cooper,11 despite the latter’s more radical rejection of psychiatric practices and knowledge. According to Read and Reynolds, [Laing] was instrumental in bringing the user movement into being, by providing a platform for, and by giving a voice to, a group, which until then had been effectively silenced by both theory and practice. In effect he helped create the conditions for a radical sea change in the nature of discourse on mental health and illness. This may yet come to be seen as a turning point in the history of ideas, setting in motion an inexorable decline in the medicalised view of madness. (1996) Laing argues that a person defined within the diagnostic criteria of psychiatry is not able to “experience himself [sic] ‘together with’ others or ‘at home in’ the world, but, on the contrary, … experiences himself [sic] in despairing aloneness and isolation” (1960: 17). 11
Cooper coined the term “anti‐psychiatry” although Laing is commonly said to be the founder of both the term and social movement (Cooper, 1967; see also Kotowicz, 1997). Cooper wrote criticisms of both psychoanalytic and biological psychiatry, suggesting that all forms of psychiatric treatment were a result of what he called the “causal epistemological model” (Cooper, 1978: 154). According to Cooper, all pathological “labels” are applied to “a person who ceases to conform sufficiently with social conventions” (Cooper, 1978: 154‐155). Influenced by the work of Laing, Cooper was by far the most radical in his dismissal of all forms of treatment by psychiatric professionals, calling them “psycho‐police agents of [the] final phase of capitalist society,” motivated by a “mind‐imperialism” (Cooper, 1978: 18/157). Cooper similarly challenged biological and psychoanalytic psychiatry during the 1960s, suggesting that the psychiatric sciences (as a monolithic entity) “[reduce] the normal verbal state of expression with all its disformities [sic] (including academic discourse in all the scientific disciplines that begin to become truly speculative, wondering about and doubting themselves) to the expression of earlier states of expressive being” (Cooper, 1978: 21). He continues with a critique of “mad discourses,” which, according to him, is “an important and specific nothing that is created precisely in the measure that it is not destroyed by the normalizing techniques of the society” (Cooper, 1978: 21). Cooper’s reading of madness as a “specific nothing” was influenced by economic and social changes in the 1960s, during which time the rejection of biological psychiatry became commonplace in academic and activist circles alike (Laing, 1961; Cooper, 1978; Crossley, 2005). 31
This isolation, to Laing, directly results, in part, from “technical” language of clinical psychiatry, which in fact need not limit the “schizoid person” from experiencing “his world and himself [sic]” (Laing, 1960: 17). Rather, psychosis is considered by Laing to be “a particular way of being where all the interactions take the forms of splits – splits between the real and false self, between the real self and the body, which becomes part of the false self, between the false self and others” (Kotowicz, 1997: 19).12 As Kotowicz argues, Laing rejects the science of psychiatry as a necessarily oppressive practice, an “ideology, and attitude and, most of all, … a language which shapes the reality it claims to describe” (1997: 12; see also Chamberlin, 1975). Roberts similarly summarizes Laing’s view of madness‐as‐discursive construct: “[To Laing,] sanity and madness exist only as linguistic conventions, which express particular relations of power, in a society which requires the social regulation of people who are deemed troublesome by virtue of their conduct or experience” (Roberts, 2004). In a 1967 address to the First International Congress of Social Psychiatry, Laing argued that schizophrenia is a social and political label, and is defined solely to impose linguistic definitions with medicalized consequences on the labeled person (1967: 64). Highlighting the inconclusiveness of genetic causes of schizophrenia in his address to the Congress, Laing vehemently rejected any and all biological explanations of mental illness. He argued that “the present position can be stated to be that recent critiques of 12
This notion of the true/false self greatly influenced later contemporary understandings of testimony and politics of the patient’s voice (Westerbeek and Mutsaers, 2008), a point to which I return. 32
the work on genetics, and the most recent empirical genetic studies, have alike brought all the apparent advances in [the field of mental health] back to square zero, while biochemical research is still inconclusive” (1967: 64). He furthered this point in a 1976 article in which he critiques Kallmann and Slater’s work in the genetics of schizophrenia. Here, he suggests that diagnosis of mental illness “is a completely unsubstantiated hypothesis. It cannot be converted into a ‘fact’ in order to substantiate another completely unsubstantiated hypothesis (of genetic etiology), which is in turn converted into a ‘fact’ in order to substantiate the [biological] hypothesis” (Laing, in Evans 1976: 102). As Laing saw reality as being defined in and through the operations and use of technical and mechanistic language, he argued that forms of biological psychiatry and psychoanalysis perpetuate the notion that the inner self, or what he called the “speaking subject,” is not able to share her‐ or himself with a world that is perceived to be more accurately interpreted by medical professionals (Laing, 1967). Laing summarizes this as such: A feature of the interplay between psychiatrist and patient is that if the patient’s part is taken out of context, as is done in the clinical description, it might seem very odd. The psychiatrist’s part, however, is taken as the very touchstone for our common‐
sense view of normality. The psychiatrist, as ipso facto sane, shows that the patient is out of contact with him [sic]. The fact that he is out of contact with the patient shows that there is 33
something wrong with the patient, but not with the psychiatrist. (1967: 89 – 90) Conversely, speaking from a particular subject position—be it schizophrenic or originating from multiple forms of psychiatric “oppression”—calls for the necessity of creating, as Laing argues, a “self‐advocating politics” (Laing, 1967). Ultimately, according to Laing, “Psychiatrists have paid very little attention to the experience of the patient. Even in psychoanalysis there is an abiding tendency to suppose that the schizophrenic’s experiences are somehow unreal or invalid” (Laing, 1967: 90). In the words of Laing and Esterson, the diagnosis of individuals as mentally ill is a “social prescription that rationalizes a set of social actions whereby the labeled person is annexed by others, who are legally sanctioned, medically empowered, and morally obliged, to become responsible for the person labeled” (1964: 18). That is, while “abnormal” social behaviors appear to be a result of an illness, such behaviors may be more closely related to larger political, economic, and social factors that are internalized by the individual diagnosed as ill (Laing and Esterson, 1964). Laing influenced the emergence and development of postmodern conceptions of depression and schizophrenia by posing the following radical questions.13 How can 13
As Lewis contends, Laing played a major, albeit unintentional role in the development of postmodern readings of mental illness. Postmodern conceptions of mental illness, owing to Laing in particular, understand that “what is accepted as knowledge is always bound up with the interests of who gets to speak. As such, any psychiatric knowledge base that excluded patients’ perspectives would be suspect, and postmodern psychiatric knowledge would be created as much by patients as it was by clinicians” (2000: 82). Double also notes how Laing contributed greatly to post‐modern conceptions and critiques of psychiatry, which he summarizes as follows: 34
mental illness be taken out of its clinical context? Is the clinical biology that attempts to derive concepts of what it means to be mentally “ill” from within multiplicities of human behaviour more harmful than that which treats persons suffering from other kinds of illnesses? Does psychiatric knowledge and treatment harm people more than help them? What role do women and men have in defining their own path to treatment and care? According to Laing, in the clinic, individuals diagnosed with mental illnesses are not only treated as being sick and in need of a cure, but are also themselves invalidated by medical practices and knowledge (Laing and Esterson, 1964; Burstow, 2004). He argues that it is important to consider ways in which psychiatry places a “hypothetical” disease of unknown etiology and undiscovered pathology onto individuals by reading what he deems to be questionable symptoms. Deleuze, sympathetic to the anti‐
psychiatry movement, sums up Laing’s position this way, or as follows: “…the very nature of [psychiatric] symptoms makes them difficult to systematize, to combine in a coherent and readily localizable entity. They come apart at the seams. Schizophrenia is a syndrome in disarray at every point, ceaselessly retreating from itself” (2006: 22). Laing and Esterson, in a similar vein, argue that the problem with psychiatry, biological and psychoanalytical, is found in the notion that patients are in need of a cure, yet their “1) Faith in the meta‐narratives of science is fading; 2) This creates particular problems in psychiatry, which has struggled over the twentieth century to define itself as a credible and reliable science; 3) Psychiatry as a ‘modernist’ project must engage with psychiatric survivors themselves in order to understand how best to provide services; 4) Social and cultural contexts of illness come before technology or the biological sciences, and “works to minimize medical control of coercive interventions” (2002: 902). 35
experiences matter little in the definition and lived experiences of being ill (Laing and Esterson, 1964; Laing, 1967). Emotions and Embodiment: The Politics of Voice and Survivor Testimonials Following from my overview of Laingian epistemology, I will now discuss ways in which psychiatric survivor testimonials—an emphasis on which comprises a significant contemporary current of the anti‐psychiatry movement, as well as a postmodern sociology of mental health—have been promoted as politicized challenges to the medical model of biological psychiatry. Psychiatric survivorhood, from this perspective, is understood to be an embodied position from which one speaks about treatment, stigma, labeling, prejudice, and the experiences of living through what many consider to be an alienating treatment process (Westerbeek and Mutsaers, 2008: 26; see also Busfield, 2001; Kihn, 2001; Burstow, 2004; Moses, 2009). Therefore, in what remains of this chapter, I elucidate contemporary sociological approaches to mental health that situate emotions as political challenges to scientific practices and knowledge (Burstow and Weitz, 1988; Parr, 2000; Burstow, 2004; Cresswell, 2005). Here, I show that post‐
Laingian mental health activists and sociologists currently describe and promote the phenomenological world of the patient, especially as he or she is situated socially and politically situated as “Other,” in order to privilege emotional survivor‐based 36
experiences as a model of knowing (Laing, 1961; Burstow and Weitz, 1988; Kotowicz, 1997; Crossley, 1998; Williams, 2000; Burstow, 2004).14 A main feature of what anti‐psychiatric sociologists describe as the disciplinary or controlling features of psychiatric knowledge can be summed up by what N. Rose describes as the “expertise of subjectivity” (as cited in Lupton, 1998: 93). Within supposedly dominant forms of medical knowledge, according to this line of argument, emotional responses—even though they have been read as “blunted” in the DSM—are considered to be aspects of the self that need improvement (American Psychiatric Association, 1994).15 For example, a primary symptom of schizophrenia is what Canada’s Schizophrenia: A Handbook for Families describes as “blunted feelings” or “blunted 14
This strict division between two kinds of experts—the survivor, whose testimonial, “grassroots” knowledge is always situated in opposition to knowledge produced and promoted by the medical psychiatric expert—has, to some extent, led to an increased bifurcation between the social and natural sciences, one that is only now being addressed in the sociology of mental health literature (Williams, 2000; Cresswell, 2005). As Lyon argues, knowledge emerging from the experience of being ill “confronts how the social realm itself is embodied, a notion which can give form to the relationship between the social structural milieu in which humans live, their subjective experiences, and the flesh through which that experience is lived” (Lyon, 1996: 69). I will continue to address this bifurcation in the following chapters of this dissertation. 15
As Suslow et al. suggest, both Bleuler and Kraepelin “conceptualized diminished emotional experience as a fundamental symptom of schizophrenia” (2003: 303). However, not all symptoms of schizophrenia and depression are tied to the pathologization of emotion. Breggin writes: “emotional or psychological suffering,” which are sometimes symptoms of mental illness linked to schizophrenia and depression in the DSM‐IV (American Psychiatric Association, 1994), is poorly understood in biopsychiatry, or what he calls a “simple‐minded speculation” that is “doomed to failure” (Breggin, 2003: 45). He maintains that psychiatrists have very little evidence for the “supposed genetic or biological factors [of emotional dysfunction], the capacity of drugs to improve these deficits, or the risks entailed” (Breggin, 2003: 46). Breggin’s contribution to both anti‐psychiatry and the sociology of mental health can be summarized by his view that emotions “tell us about our physical and psychological condition,” but are not necessarily symptoms of a psychiatric illness of an unknown etiology (Breggin, 2003: 41). 37
affect” (1991: 4).16 This so‐called “blunted affect,” reflected in the DSM‐IV, is the flattening of emotions: Because facial expressions and hand gestures may be limited or nonexistent, the ill individual seems unable to feel or show any emotion at all. This does not mean that the individual does not feel emotions and is not receptive to kindness and consideration. He or she may be feeling very emotional but cannot express it outwardly. Blunted affect may become a stronger symptom as the disease progresses. (1991: 4) Here, Breggin intervenes to suggest that this document ignores how women and men with schizophrenia understand their own agency by experiencing an array of emotional responses to the harmful effects of the medicalization process; in other words, emotions, negative or otherwise (joy, sadness, anger, regret, surprise, contempt, shame, guilt; see Suslow et al., 2003: 307), may not be symptoms of illness, but a necessary and 16
In particular, as Gur et al. (2006) argue, “impaired emotional functioning in schizophrenia is a prominent clinical feature that manifests primarily as flat affect [anhedonia]” (279). So‐called “flat affect,” they contend, is a cognitive impairment, one that adversely affects facial emotion processing tasks, which “required identification of happy and sad emotions and another that required differentiating among intensities within these emotions” (2006: 284). The clinical application of their study, they argue, is the need to further link cognitive impairments, such as memory loss tied to psychological harm, to “flat affect,” the latter a result of “temporolimbic dysfunction” (in the left hemisphere of the brain) in patients with schizophrenia (2006: 285; see also Meyer and Kurtz, 2009; Suslow et al., 2003: 307‐309). I return to this discussion concerning cognition, emotion, and the neurosciences and its limitations and possible importance for the sociology of mental health in Chapter 5. There I point out that cognition, emotion, and behaviour are now understood to be more than just “neurological events,” challenging the reductionist claims, like those made in the PHAC document, that emotional dysfunction (as a symptom of schizophrenia) is necessarily a cognitive disorder located in the brain (Thagard, 2008: 349). 38
important response to the effects of modern psychiatry (Suslow et al., 2003). Further, Breggin argues that patients’ apparent lack of resistance or docility do not automatically indicate that they are “ill.” He suggests that blunted affect can be regarded as a necessary response to the “controlling” practices and processes of biological psychiatry (Breggin, 1991).17 Williams argues that providing a space within which testimonial knowledge can emerge in opposition to biological/medical forms of knowledge “(i) avoid[s] the somewhat `medicalised' ring of mental health, restoring emotions to the meaningful, intersubjective, intercorporeal domains of everyday life and communicative praxes; (ii) put minds back into bodies, bodies back into society and society back into the body, and (iii) brings emotions to the fore in all discussions of health, including the `afflictions' of inequality” (2000: 574). In Gruber and Kring’s most recent study, they found that, despite ongoing claims that schizophrenic patients experience a so‐called flattening of emotion, or “flat affect” (PHAC, 1991), women and men with mental health histories “report experiencing similar or greater amounts of negative emotions compared with healthy controls” (2008: 520). The narration of these emotional experiences, they 17
Westerbeek and Mutsaers (2008) similarly suggest that biological psychiatry, and the mechanistic, “controlling” language of the DSM, represents a “problem oriented system,” one that, by definition, ignores psychiatric survivor as a speaking and knowing “self.” As they contend, “The current, dominant medical‐biological way of thinking in psychiatry, with the DSM as a diagnostic instrument, also represents the problem‐oriented position, although quite different in its theoretical orientation. In this view, everything is directed toward making the right symptom‐related diagnosis and prescribing the right symptom treatment. The self does not appear” (2008: 28; American Psychiatric Association, 1994). 39
contend, “enables individuals to not only refer to their emotions, but also to explore and evaluate their significance” (2008: 520). The narration of one’s experience with schizophrenia, they conclude, allows women and men to convey stories “about emotional events that [are] socially embedded, personable, and draw from an emotion‐
ladden vocabulary,” despite so‐called “flat‐affect” being a defining symptom of schizophrenia (Gruber and Kring, 2008: 531; see also Suslow et al., 2003: 308‐309). According to current studies in the psychiatric survivor movement, for embodied knowledge to be an accepted way of knowing and experiencing illness, it is important to understand that women and men living with mental illnesses can, at times, act as experts of their own experiences, which scientific knowledge can only partially explain. As healing and good mental health have been commodified, individualized, and characterized within the mind/body distinction, embodied knowledge challenges political, economic, and social conditions in which patients experience mental illness through the body.18 This epistemological position does not suggest that experiences of illness can expose an essential category which define a single identity, nor that a “true”’ healthy self can be revealed in later stages of material conditions or discursive practices. On the contrary, because emotions have historically been pathologized (Williams, 2000), the political force of situated knowledge, according to Westerbeek and Mutsaers, exists 18
For a good example of the (neo‐liberal) individualization of mental health, see: Quality of Life Measurement Among Persons With Chronic Mental Illness: A Critique of Measures and Methods (1996). This Health Canada document highlights, among other things, scales for the measurement of social and individual “emotional functioning” whereby emotions are reduced to quantifiable data. 40
in the ability to emotionally contextualize fields of knowledge and material living conditions that psychiatric survivors experience daily (2008: 25‐28). In this formulation, situated knowledges—which emerge through testimony—can be seen as the interplay between space and emotion (Worthman, 1999). As Parr similarly argues, access to “the world” is never impartial; embodiment affects the outcome of women and men’s interaction in and of the world (Parr, 2000). Furthermore, Freund suggests that emotions provide the basis for embodied knowledges because feelings can be linked to material and social conditions, such as the way women and men are treated or resisted by others, or by the way they might be abandoned or stigmatized as a result of a mental illness (Freund, 1990; Fee, 2000a; Ussher, 2000; Williams, 2000; see also chart on Page 80 of this dissertation). This relationship highlights “different modes of emotional being [that] are, in effect, different felt ways of feeling empowered and disempowered” (Freund, as cited in Williams and Bendelon, 1998: 143). Testimonial responses to psychiatry, in this respect, offer a particular agency in the act of speaking that necessarily links emotion and bodily being(s)‐in‐the‐world with social relations (Freund, 1990). Psychiatric survivor testimony most often takes one of two forms: 1) stories that address negative experiences of the mental health world, through which emotional and situated responses to “legends” of oppression emerge; and 2) stories that promote positive alternatives to these negative experiences by demonstrating how survivors are in effect “experts” in their own treatment and well‐being, and sometimes even more so 41
than medical professionals (Cresswell, 2005; see also Chamberlin, 1975, 1990; Burstow and Weitz, 1988; Shimrat, 1997; Burstow, 2005). In a report to the 2005 Psychiatric Drugs Panel in Toronto, Burstow details the reasons for considering survivor testimony when planning the delivery of psychiatric treatment and care. As she notes, survivor knowledge gives voice to and validates survivors’ experiences; reduces survivors’ sense of isolation and alienation resulting from drug treatment and hospitalization; provides case stories and information to the broader public about psychiatric diagnosis and treatment, including psychtropic drugs and electro‐shock treatments; and provides direction for health legislation, services, and advocacy work for women and men who have been on psychiatric drugs and for those in potential risk of being medicalized or hospitalized in the future (Burstow, 2005: 2; see also Breggin, 2003). Cresswell similarly situates narrative testimony as ritualized “discourse[s] in which the speaking, suffering subject is also the subject of the statement” (2005: 1674). Testimonial responses become “performance as survival, distress, and direct experience” with illness (Cresswell, 2005: 1674). The testimony‐as‐expert‐position, according to Larsen, is a political stance from which psychiatric survivors understanding the “nature, cause, and course of mental illness” (2004: 450). Cresswell summarizes why testimony is a “productive feature of resistance” to the practices and processes of psychiatric science (2005: 1669). He outlines the distinction between patients and survivors of psychiatry, the latter representing individuals who have survived negative experiences within a supposedly helping system. He argues that the psychiatric system often works to 42
oppress and/or highlight existing inequalities without addressing social, cultural, and economic factors that lead to and perpetuate marginalization (Burstow, 2004; Cresswell, 2005). As a form of resistance, Cresswell continues, the telling of one’s direct experience with psychiatric treatment (such as pharmaceutical or electroshock treatments) promotes important “truth claims,” which might otherwise be summarized as political actions that situate spoken, written, or acted testimony as a form of “survival in a non‐
pathological sense” (Cresswell, 2005: 1670; see also Weitz, 1997). Burstow further highlights the role of the silenced survivor in the context of the over‐representation of medical expertise. “Therapeutic hegemony,” as Burstow calls it, operates such that “the opinions of survivors are generally under‐represented and often downright dismissed” (Burstow, 2004: 49). Friedenberg furthers Burstow’s point that conventional biological psychiatry treats patients assuming that they are hampered by defects in perception, which are measured by objective or mechanistic assessment (Friedenberg, 1973). As he writes, “The seriousness of the patient’s illness is to be judged by the depth and extent of the discrepancy between his [sic] subjective view of his life situation and the objective correct assessment” (1973: 61). Testimony, in these accounts, is positioned as an embodied engagement with psychiatric care providers, wherein survivors organize and lead the planning and delivery of a process through which suffering is relieved (Burstow, 2004). Burstow argues that recognizing suffering happens through the creation of ethically and politically aligned networks of survivors, advocates, and progressive mental health care 43
professionals (Bursow, 2004; see also Breggin, 1991). A good example of this, in practice, is the Ontario Recovers Campaign (ORC), organized out of Street Health in downtown Toronto. Recovery is contextualized at the ORC not as the cure for a “diseased brain,” but as a conscious process with practical steps individuals take in order to “speak through recovery,” forms of which will vary from survivor to survivor. This process relies on essential material support, including adequate income, housing, and resources to be informed about treatment options (Mental Health Rights Coalition, 2008). Pinfold similarly argues that personalized, emotional perspectives in mental health studies can contribute to an understanding of how women and men experience mental illness in community care facilities. She argues that offering a space for women and men to speak or write about their illness experiences is an important process when working with survivors (Westerbeek and Mutsaers, 2000). Although she prefers “consumer” to “survivor,” Pinfold highlights how the voices of those suffering with depression or schizophrenia have been censored within dominant, scientific forms of knowledge (Pinfold, 2000). In a specifically Canadian context, Burstow, whose activist work includes anti‐
poverty and anti‐psychiatry work in Toronto and beyond,19 has written extensively since 19
At the time of writing, Burstow is the primary organizer of the May 2010 conference, PsychOUT: A Conference for Organizing Resistance Against Psychiatry. Organized out of the University of Toronto, this conference aims to: “foster networking and coalition building across different social movement; clarify key goals in the struggle against psychiatric profession; address feminist, anti‐racist, and queer resistance against psychiatry; address intersections between poverty and mental health; and develop long‐term strategies to meet anti‐psychiatry abolitionist goals” (PsychOUT, 2010). 44
the 1980s about why a shared critique of institutional psychiatry is important as an epistemological “way of knowing” that challenges biological readings of illness (Burstow and Wietz, 1988; Burstow, 2004, 2005). Burstow and Weitz’s collection of survivor testimonials from the late 1980s suggests that spoken and written psychiatrized experiences are an important avenue through which oppressions can be highlighted. Their anthology, according to Burstow and Wietz, “is a creative and liberating response to the ‘treatments,’ which robbed many of us of our creativity, individuality, and freedom” (1988: 31). Burstow and Weitz offer this anthologized collection of written testimony in order to show that allowing a space for survivors to speak fills the need to recognize many de‐humanizing aspects of the psychiatric system, including ways in which medication can, at times, be harmful, and ways that psychiatry is largely “obsessed with conformity and social control” (Burstow and Weitz, 1988: 30 – 33). While etiologies of mental illness range from biological, neurological, and/or psychoanalytical origins, a shared critique of psychiatry, Burstow contends, opens up a space for the “psychiatrized other” to speak for self‐determination (Burstow, 2004; see also Larsen, 2004). Burstow and Cresswell both argue that it is precisely because dominant forms of psychiatric diagnosis and treatment have been made incompatible with emotional responses that the act of speaking against, or writing one’s experience about, the psychiatric system is powerful and re‐empowering (Burstow, 2004; Cresswell, 2005). 45
Conclusion I have demonstrated in this chapter how psychiatric survivor testimony‐as‐politics has been understood as an epistemological way of knowing, one that was largely influenced by Laing’s phenomenological approach to, and recognition of, “mad experiences,” and one which has since influenced more radical rejections of psychiatric science in contemporary currents of the psychiatric survivor movement. This position, however, is not without its criticisms. As Sedgwick points out in his often‐scathing critique of Laing’s work, both anti‐psychiatry and social constructivist readings of mental health relegate all categories of mental illness to a “control‐process,” the sole product of a “labeling world” (Sedgwick, 1973: 20; see also Murphy, 1976). Sedgwick argues that Laing and other authors of anti‐psychiatry literature, such as Szasz, Goffman and to some extent Foucault, construct and simultaneously reject the natural sciences as a controlling enemy against an otherwise autonomous, non‐medicalized space free from diagnosis, treatment, and disease‐like “labels” (1973: 20‐2).20 Sedgwick elaborates on this point in his critique of Laing’s work. He writes: “In seizing on the 20
Although I have not represented sociological theories of labeling and mental illness in this chapter, I do not mean to suggest that studies concerning the labeling of women, men and youth as mentally ill are not important. Indeed, Moses’ most recent empirical study on the internalization of mental pathologies by youth is quite important. For instance, as Moses points out, “youth put a lot of stock in formal diagnostic models,” many of which go unquestioned by themselves and their peers (2009: 571). Moses develops what is now called the “Modified Labeling Theory” in the sociology of mental health, which examines “the self as constructed by others through communication and interaction” (2009: 571). Even though many youth remain ambivalent to psychiatric labels (Moses, 2009: 575), understanding how youth negotiate their early lives labeled as “mentally ill” remains an important goal in the sociology of mental health (see also Kihn, 2001). 46
value‐laden, subjective, ‘political’ elements of psychiatric diagnosis and treatment, [Laing and others] have implicitly – and sometimes, indeed, explicitly – conceded the value‐free, political, and ‘objective’ character of medicine in general; their dismissal of positivism in psychiatry is founded on a contrast [with] non‐psychiatric medicine which actually depends on the acceptance of positivism as a possible method in vital areas of human decision‐making” (1973: 27‐8). While Sedgwick points out that anti‐psychiatry often assumes the solidity of the hard sciences through an outright rejection of scientific positivism, he also admits that “mental illness is a social construction,” and that Laing and others have “shown convincingly that both diagnosis and treatment measures in psychiatry are founded on ethical judgments and social demands whose content is sometimes reactionary, often controversial, and nearly always left unstated” (1973: 27). Perhaps Laing’s most lasting contribution to the study of mental illness has been to radically position madness as a socially and culturally determined object of critical analysis. Kotowicz summarizes this point in Laing’s work: Whatever scientific value there might be in psychiatry’s findings, they suffer from a fundamental flaw – they study the patient outside the context of his [sic] life in general, and outside the context of the psychiatrist‐patient relationship in particular. Every psychiatric description, Laing…[goes] on to argue, is not a statement of fact but an interpretation, and the interpretations we find in the psychiatric textbooks are determined in advance by the 47
categories of the theoretical stance and by the language. (1997: 14‐5) While I believe that Laing was correct in describing the alienating power of psychiatric discourse and practices, his position also tends to reify a falsely unified natural scientific epistemology, which, as many social and natural scientists have now argued, elides the complexity of the culture of science (see also Vicedo 2000; Fox Keller, 2000; Hird, 2004, 2009; Wilson, 1998, 2004, 2008). As I elucidate further in the following chapter, this social constructivist approach suggests that depression and schizophrenia are categories and labels constituted by discourse(s) and by material‐discursive relations, where the material is defined by social, cultural, and economic forces acting on the body, rather than biological processes contained within the body (Yardley, 1996; Wilson, 1998; Carolan, 2005). Laing’s influence on this field of sociology was in championing an awareness of lived, existential worlds of women and men living with mental illness. Interestingly, however, as Carolan contends, unwillingness on the part of anti‐psychiatry to engage with biological processes of the body may not necessarily be an anti‐
biologism, as Wilson (1998, 1999, 2006, 2007) suggests, but a result of a “bio‐ and eco‐
illiteracy” (2005: 12). Williams concurs, calling this “illiterate” schism between sociology and the biological sciences “socio‐historical baggage,” which has left the sociology of mental health epistemologically favouring “social‐cultural aspects of health and illness” over biological etiologies, and the biological sciences to privilege neurological or genetic factors over social or cultural ones (Williams, 2000: 565; see N. Rose, 2006, 2006a). 48
Since the 1960s, the psychiatric survivor movement has been through multiple transformations and struggles, and has ranged in critiques of both the biological and psychoanalytical models of psychiatry (Laing, 1961; Cooper, 1967, 1978; Deleuze and Guattari, 1987; Crossley, 1998, 2006; Deleuze, 2006). While it is beyond the current scope of this chapter to discuss the climate of “the movement,”21 suffice it to say that, in Canada, many continue to view psychiatry as problematic and are committed to combating its problems. Testimonial responses to the practices of psychiatry highlight the need to build more affective and caring communities, to support the telling and publishing of personal stories (Burstow and Weitz, 1988; Shimrat, 1997), and to lobby for survivors’ rights22 (Cohen, 1988; Breggin, 1991; Caponi, 1992, 1997; Burstow, 2004: 143; Cresswell, 2009). The significance of the movement, according to Burstow and others, is the interconnection of values and political commitments. I demonstrate later 21
I use scare quotes here to highlight that the psychiatric survivor social movement varies across regions of the world. In spite of this variation, however, the movement does share international common goals of addressing forms of inequality within the diagnosis and treatment of all mental illnesses. See Crossley (1998, 2006) and European Network of (ex)Users and Survivors of Psychiatry (ENUSP) (2010). 22
The concept of “survivor rights” is becoming much more important in the sociology of mental health, as seen in a recent journal issue dedicated to this topic (Cresswell, 2009; see also Burstow, 2004). In Cresswell’s words, which echo Laing’s phenomenological approach from The Divided Self (1960) and Self and Others (1961), “madness‐experience” must be understood to help with the politicization of the field of mental health studies, and, more importantly, to create a dialogue between survivors and critical legal practitioners (Cresswell, 2009). Because survivors are often traumatized by the provision of state services, and/or the lack thereof, an “experiential rights” discourse provides a double demand. The European Network of (ex)Users and Survivors of Psychiatry (ENUSP) has recently announced what it is calling a “rights monitor” across Europe, one that documents incidents of harm(s) associated with or without state‐
supported mental health services. The ENUSP in particular is calling for protection for psychiatric survivors—on an international level—under treaties such as the UN Convention for the Protection of the Rights of People with Disabilities (ENUSP, 2010). 49
in the dissertation how the significance of survivor affect and experiential aspects of treatment might be considered in an interconnected fashion alongside non‐reductionist biological approaches to mental health. While Burstow argues, for example, that the emotional voices of survivors demonstrate the interconnection of values and political commitments, many science studies scholars maintain that this political orientation can be extended to matter—or somatic environments—as well (Henningsen and Kirmayer, 2000; Cromby, 2004a, 2004b, 2007). 50
Chapter 3: The Sociology of Mental Health Introduction As I discussed in the previous chapter, anti‐psychiatric engagements that critique mental health delivery are largely indebted to philosophical challenges to the “epistemological profiles” of psychiatric science during the 1960s and 1970s.23 Building from the previous chapter, this chapter examines contemporary sociological positions influenced by the anti‐psychiatry movement and the postmodern turn, and especially by what Sofoulis calls the “corporeal turn” of 1960s and 1970s activism and scholarship, such as Laing and others’ understanding of embodiment and the discursive dimensions of psychiatric science (Sofoulis, 2009; see also Gillett, 1999). My goal in this chapter is to discuss the ontological and epistemological assumptions surrounding social constructivist readings of genetics, neuroscience, and psychiatry, and how these readings contribute to sociological understandings of how mental illness is not just a lived, embodied subject position, but also one constituted by material and discursive forms of power relations (Foucault, 1975, 1976; Stoppard, 1998; Ussher, 2000, 2005; N. Rose, 2007; N. Rose, 23
The term epistemological profile was, to my knowledge, first used in an interview with Foucault in Truth and Power (1980) in reference to what he calls the “dubious” practices of psychiatry (Foucault, 1980: 108). In this interview, he discusses how the epistemology of psychiatric science, for example, is linked to institutions, economic requirements and social/political regulation. For Foucault, the important question is how knowledge systems are enmeshed within social structures, and how these structures produce truth claims or rule statements that are regarded as scientifically acceptable (Foucault, 1980). 51
2007; Federman et al., 2008). In the latter half of this chapter, I point to recent realist work in the sociology of mental health that highlights the complexity of the relationship between the social and biological, especially in the field of bio‐ethics, which is attempting to re‐open the biology‐society debate that scholars suggest was closed off following the constructivist turn in sociological theory (Williams, 2000; Martin and Ashcroft, 2005). For the most part, the positions I outline in this chapter deploy what Yardley calls a “discursive‐materialist” epistemological approach to the study of mental illness, one that follows from the work of Butler (1993) and Foucault (1990 [1976]),24 and that which might be characterized as a “non‐skin‐encapsulated” sociology of mental health (Barad, 2007: 155; see also Stoppard, 1998; Ussher, 2000, 2005; Pilgrim et al., 2009).25 The material, according to these epistemologies, is generally defined as forces “acting” 24
Here I am thinking specifically about Butler’s reading of the regulation and production of subjectivity in material‐discursive relations (Butler, 1993). Butler warns that, in order for us to understand identity construction, we must first examine the conceptualization and institutionalization that identities demand. For instance, we might say that mental illness has become an object of analysis within particular practices and truth claims on “abnormal” mental pathological processes (Butler, 1993). Drawing upon the work of Foucault, Butler’s argument takes the form of a discursive materialism, whereby the regulation of madness becomes a function of political economy as much as one involving symbolic systems of normalization (Butler, 1993). 25
The significance of the term “skin‐encapsulated” is tremendously interesting for a meta‐
analysis of the epistemologies of mental health studies, particularly in sociology, and I return to it a number of times throughout the dissertation (see Barad, 2007: 159‐160). There were obvious epistemological boundaries between the “inside” and “outside” of the body in 1960s scholarship with respect to understanding the “situatedness” of bodies in the world (Barad, 2007: 159). The understanding of embodiment as beginning and ending at the skin, Barad contends, was challenged in 1980s and 1990s feminist science studies (c.f. Haraway, 2004 [1985]), and is important for the work I examine in much more detail in the following two chapters. 52
outside the body—that is, forces outside the boundaries of the skin—such as social, political, historical and economic factors negatively influencing the physical features of human lives (family history, violence, alcohol abuse, diet, as well as structural positions such as education, gender, and race) (Ussher, 2000, 2005; see also Stoppard, 1998: 494‐
495; Fee, 2000a, 2000b; N. Rose, 2007). The discursive, in this instance, can be defined as the “socially and linguistically mediated nature of human experience” (Yardley, 1997: 1). This conceptualization of the material and discursive dimensions of mental illness owes a great deal to Laing’s work, which has been updated by psychologists and sociologists of mental health interested in merging “sociocultural formations” with the material experience and constitution of illness in an age where neuroscience and genomics have come to dominate how mental illnesses are defined, understood, and treated (Yardley, 1997; Stoppard, 1998: 85; Andreasen, 2001; N. Rose, 2007). In other words, whereas Laing gave meaning to the “experience” of mental illness in the 1960s and beyond, constructivist sociology borrows from Laing and others to demonstrate ways in which these experiences are both individually embodied and also constituted within the conditions, practices, and knowledge claims made by the biological sciences. I further point out throughout this chapter, however, that some contemporary sociological work in mental health—despite its claims to the contrary—continues to reinforce a matter/culture bifurcation (Wilson, 1998, 2008). There appears to be a lingering skepticism in some sociology of mental health, or in “post‐psychiatry” in particular, that psychiatric science, by definition, is reductionist, deterministic, 53
empirical, and overly rational (Bracken, 2005; Horacio, 2008). As Kecmanovic argues, “Post‐psychiatrists have recognized psychiatrists as the protagonists and defenders of the modern mind, that is, as those who have faith in science, in rationalism, empiricism, in technology and progress, in the possibility of revealing universal truths about the world” (2009: 32).26 I contend that this skepticism towards the study of “skin‐
encapsulated” matter, a skepticism Carolan (2005) might otherwise call an illiteracy towards the biological,27 continues to perpetuate a material (biological)/discursive (sociological) dichotomy in some postmodern sociology of mental health, furthering the subject/object distinction that is common in this scholarship (Ussher, 2000; Schwartz, 2002: 227‐228; O’Brien and Fullagar, 2008; Warner, 2009). Before detailing constructivist approaches, which seek to understand the consequences of “the social” for mental health, I will now give a brief overview of the postmodern turn in sociology, which influenced the development of the sociology of mental health, and contemporary 26
The idea that postmodern sociology has successfully deconstructed the “universal” laws of “modern” science is a common one in the literature (Fee, 2000; Horwitz, 2003). For example, Horwitz argues that the “central task of the methods employed to uncover the biological foundations of mental disorders is to separate the impact of genetic factors from the influence of environmental forces” (2003: 135). However, in his postmodern challenge to the so‐called universal logic of biological psychiatry, which is said to situate the brain “in the natural rather than social world” (2003: 135), Horwitz ironically reinforces the binaries (such as matter/social) he claims to be contesting. 27
Davis concurs with this notion through her reading of Wilson’s work. As she states, “The problem is not that [constructivists] do not address the biological in their work, but that their engagement with it is restricted and conventional. [Wilson’s] claim is that many feminist accounts remain committed to a conceptual separation of the biological from the social; that is, at some level the nature/culture division remains unquestioned in their work” (2008: 70). 54
approaches to, as well as understandings of, social‐environmental “causes” of ill mental health (Horwitz, 2003; Pilgrim et al., 2003). The Postmodern Turn What is characterized as the postmodern turn in sociology began almost contemporaneously to the anti‐psychiatry movement of the 1960s, a time when the study of knowledge shifted from the examination of determining structures to more localized forms of knowledge and the discourses and practices of scientific truth claims (Laing, 1961; Lyotard, 1979; Fee, 2000b; Bracken, 2005; Kecmanovic, 2009). The postmodern shift in knowledge was one away from logical determinist theories to what might be called systems of generalized meanings. During the 1970s, for instance, sociologists of mental health began looking at how subjects are pathologized, and/or how women and men are constituted by discourses of psychiatric science and the material practices of the medicalization process (hospital care; the ordering of bodies; community care; the role of political economy), but not by overarching social structures or ideologies (Chamblerlin, 1975; Smith and David, 1975). The study of discursive and material ways in which women and men with mental illnesses are constituted, however, is not equivalent to contending that subjects are determined by structures. Rather, postmodern sociologists foreground discursivity. It is the use of language, Chamberlin contends, that constitutes “madness” as what she calls 55
an “ordered subjectivity” (Chamberlin, 1975; Butler, 1993; Fee, 2000b; see also Laing, 1961). Postmodernism critiques meta‐narratives, whether of science, reason, structuralism, Marxism, which, as Lyotard argues, claim to guarantee truth, ideology, or any aesthetic narrative that offers normative standards of interpretation (Lyotard, 1979). It was not just the breakdown of structuralism that influenced the development of postmodern sociology, but also the disappearance of—or at least challenge to—
causal explanations, and, as I discussed in the previous chapter, the recognition that embodiment and the narration of lived experiences should be foregrounded as ways of knowing, or being‐in‐the‐world (Laing, 1961; Kotowitz, 1997). In a sense, this epistemological shift revealed the agency of “mad” subjects that structuralism had occluded (Chamberlin, 1975). Subjects are still influenced by structures, but postmodern sociology, and the sociology of mental health in particular, investigates mental illness in a way that is not wholly deterministic, naturalistic, or essentialist (Yardley, 1996; Stoppard, 1998). There are notable differences between postmodernism and post‐structuralist philosophy. I associate post‐structuralism with the philosophical challenge to what might be called closed‐systems, or to the Derridian concepts of the centre, the inside/outside distinction, cause and effect, determination, and/or collapses in order. In Structure, Sign and Play (1978), for instance, Derrida attacks these various closed, structural systems by challenging what might be called “structures of structure.” For Derrida, if systems (sociological) and structure (philosophical, scientific) are broken 56
down, all that remains is play or interpretation, rather than empirical analyses. The theorists’ task, then, is not to deduce the “truth” of the structure, but to point out the manner in which the structure simulates itself as having “structure,” which always involves an attention to how apparent structures are constituted by language. In this formulation, language, as a closed system, is displaced by discourses that always exceed what they attempt to exclude (Derrida, 1978). From this ontological position, the designation “scientific” is always irreducibly discursive, and can never be totalizing. Because science can never be “complete,” and because the (apparent) goal of all science is to empirically “know” the world, Derrida promotes the task of linguistic interpretation, or play, without stopping at the foundations of empirical fact (Derrida, 1978: 291). Derrida’s influence on the sociology of mental health, I would argue, is that this sociology ought to accept a variety of interpretations of “social” realities, to contribute to their development and discussions about these realities, and to accept difference rather than trying to define “sanity” or “health” under a single truth claim.28 In The Postmodern Condition, Jean‐François Lyotard argues that the status of scientific knowledge changed significantly in the post‐industrial age (Lyotard, 1979). Scientific knowledge, according to Lyotard, is a collection of discourses that are grounded, by necessity, in language. The objects of science, such as psychiatric 28
Interestingly, as Wilson accomplishes in her studies of the sciences, deconstruction in particular, and post‐structuralism more generally, can be used productively in realist readings of scientific practices and knowledge (see Wilson, 1998, 2008). I return to this discussion in Chapter 5. 57
classification and/or the materials and matter with which scientists work, are contained in the ways scientific experts speak about the truth of science. Alongside the hegemony of the computerization of knowledge grew what Lyotard calls a reductive logic, or an overall reductionism across the sciences, and therefore a set of prescriptions determining what scientific statements are accepted as claims to truth (Lyotard, 1979). According to Lyotard, because scientific and technical knowledge is cumulative and very rarely questioned by sources outside of itself, it cannot represent a totality; rather, scientific knowledge has always existed in addition to, and in competition and conflict with, what he calls narrative knowledge (Lyotard, 1979). Throughout this text, Lyotard compares scientific and narrative knowledge, suggesting that both are language games with different sets of rules. He writes: “It is therefore impossible to judge the existence or validity of narrative knowledge on the basis of scientific knowledge or vice versa; the relevant criteria are different” (Lyotard, 1979: 26). Lyotard suggests that these two forms of knowledge – scientific and narrative – are incommensurable. Therefore, science and narrative knowledge “play their own games” and each are “incapable of legitimating the other language game” (Lyotard, 1979: 40). Key to Lyotard’s claim is that scientific knowledge is unable to verify itself “as speculation assumed it could,” suggesting that it is merely a discursive game defined by its own rules and criteria, and unable to legitimate itself by anything other than itself (Lyotard, 1979: 40). Viewing science as one narrative among many possible narratives fed (and continues to feed) a strong suspicion in the social sciences towards scientific truth 58
claims (Lyotard, 1979; see also Kuhn, 1962). Of course, Lyotard did not reject scientific knowledge outright. He did, however, argue that science could no longer claim an overarching privilege over other forms of knowledge as it had done throughout the modern philosophical period. This challenge to the meta‐narratives of science had radical political associations with non‐totalizing, local forms of knowledge and their orientation to localized forms of social change (as in Laing’s survivor activism). Owing directly to postmodern theorizations of thinkers like Lyotard, work in the social sciences – and certainly including the sociology of mental health – came to see its role in the 1970s and on as challenging positivist claims in sciences and determinist theories derived from reductionist science. Indeed, Lyotard advocated for a sociology that examined ways in which we are constituted by discourses and practices, not by overarching social structures.29 The use of language in the practices and discourses of science came to be known, therefore, by what constitutes and creates various subjects through a contract constructed by language games (Chamberlin, 1975; Lyotard, 1979; Lewis, 2000: 79‐80). Rather than trying to figure out “truth,” an understanding of subjectivity, behaviour, and history, were to be achieved by engaging sociologically with discourses of knowledge, including the outcomes and effects of these discourses. Most importantly, as Lyotard states in the introduction to the Postmodern Condition, “the 29
Lyotard’s philosophy was not only grounded in his position with respect to science, but also by his rejection of structural Marxisms, such as The Frankfurt School, which he saw as rigid and reductive readings of industrial production at the base of culture (Lyotard, 1979). Lyotard challenges structuralism by “wag[ing] war on totality,” which shifts the sociological focus from base/superstructure (or social structures) to discourse (1979: 81). 59
object of study is the condition of knowledge,” which I argue has informed contemporary constructivism’s main epistemological starting point: discourse (Lyotard, 1979: xxiii). Foucault’s work is extremely influential in the development of material‐
discursive approaches to mental health.30 In one of Foucault’s most important texts, Truth and Power (1980), his basic unit of analysis is the “discursive regime,” or a semiotic system composed not only of Saussurian signs,31 but also of bodies, subjects, and objects.32 What is important about these entities is not what they are in 30
As Pilgrim and Rogers argue, the most “extreme” criticisms of psychiatric science came from Foucault, who, as they argue, calls into question scientific “causal reasoning, truth claims and any confidence in an independent reality, [which] culminate in a focused exploration of ideas, language, and discursive practices” (2005: 230). 31
Saussure defines a sign as a psychological entity with two elements, the signified, or the idea or sound image that the word calls up, and the signifier, or the actual word or concept. These two elements are meaningfully connected, Saussure argues, in that a change in one necessitates a change in the other (1972: 110). Saussure’s influence on post‐structuralism and the linguistic turn concerns how words get their meaning from the interrelation of what they signify. Saussure argues that language is a system of interdependent terms “in which the value of any one element depends on the simultaneous coexistence of all others” (1972: 113). 32
As Pearce and Woodiwiss point out, some of Foucault’s work was often in close proximity to critical realism, and has unfairly been compared to, and often mistakenly measured against, constructivist sociology. For a closer reading of Foucault’s realist tendencies, from The Order of Things to The Archaeology of Knowledge, see Pearce and Woodiwiss (2000: 51‐62). In particular, they argue that Foucault made a number of “linkages between the domain of the human sciences and that of empirical sciences” such that the world is not merely defined through representation, but is an interactive (mutually constitutive) process between psychological, linguistic, economic, and social domains (Pearce and Woodiwiss, 2000: 54). I return to realist readings of the biological sciences in the latter half of this chapter, where I explore positions that pick up on Foucault’s concept of biopower in much more detail with respect to the constitutive relations between sociology, neuroscience, genetics, and mental health, so as to advance a more productive dialogue between the social and biological sciences (Martin and Ashcroft, 2005; Rose, 2007). 60
themselves, but how they are related to one another, and what kinds of regularities they display when viewed as parts of systems and structures. In Truth and Power, Foucault exposes relations of power, which, for him, are moves, strategies, tactics, contending forces and struggles, especially within the human sciences (for example, biology or psychiatry) (Foucault, 1980). For example, according to Foucault, in a psychiatric hospital, doctors are figures of legitimacy that, in both discursive and material ways, are implicated in the various relations of power within governing institutions and practices, the material‐discursive environments in which truth claims are made about mental illness. In Discipline and Punish (1975), Foucault extends his analysis of 19th century sovereign power to what he calls the “acquisition of life” insofar as humans are living beings (Foucault, 1976). That is, Foucault traces relations supplanting state power through the administering of bodies and the calculation of “life itself” (Foucault, 1975; N. Rose, 2007). In the development of disciplinary spaces, Foucault analyzes political and economic practices of the sciences that made governance over “man as species” possible (Foucault, 1976: 138). Where power was once centralized through the sovereign state, bio‐power – or the biological ordering of life – came to operate in the “machinery of production and the adjustment of the phenomena of the population to economic processes” (Foucault, 1975: 141). Bio‐power, broadly defined, involves the “will to categorize, compartmentalize and define life; to treat the human as species, to fragment and create within the biological” (Foucault, 1990 [1976]: 147). According to 61
Foucault, bio‐power is the increasing ordering of subjectivities under the guise of improving the welfare of the individual and the population. To sociologists, therefore, this order reveals itself to be a strategy whose end is the increase of power and order themselves (Dreyfus and Rabinow, 1982; Foucault, 1990 [1976]; May, 1993; Foucault, 2003 [1997]; N. Rose, 2007). Hardt and Negri, who have built upon Foucault’s concept of bio‐power in their book Empire, suggest that “[bio] power is now exercised through the machines that directly organize the brains and bodies toward a state of autonomous alienation from the sense of life and the desire for creativity” (Hardt and Negri, 2000: 23). In The History of Sexuality: Volume One (1976), Foucault further traces material/discursive spaces in which control over life took shape during the 18th and 19th centuries, what N. Rose calls “broadening techniques that organized enclosed spaces making particular subjects and objects of biological analysis” (2001: 22).33 According to Foucault, the discourses and practices of science allowed rational bureaucratic systems to operate through regulatory mechanisms. Deleuze refers to this process as a “control system,” one that works when nothing is left alone and where forms of biological intervention are intended to govern subjects (Deleuze, 1995). According to Foucault, because bio‐power orders and manages bodies through biological means, it makes it difficult for states to apply more spectacular forms of punishment to “abnormal” forms of behaviour. Rather than power operating through 33
While I return to Rose’s reading of Foucault in later in this chapter, he takes from Foucault the idea that “mad” subjects were made aware, through bio‐political production, of their bodies, of their conditions of existence (their “materiality”), which Foucault argued were forces that made subjects ordered “in an optimal manner” (Foucault, 1976: 142). 62
top‐down sovereign state structures, bio‐power shifts control and punishment to more open and seemingly “democratic” strategies. N. Rose and Rabinow (2006) argue, using Foucault, that biopower today is linked to the “collective existence in the name of life and health” (197). According to them, biopolitical strategies are “more democratic” than brutal or forceful forms of treatment or punishment because the management of democratic life is the management of “the health of each and all” (2006: 213). Therefore, biopower today consists of three strategies: “Knowledge of vital life processes, power relations that take humans as living beings as their object, and the modes of subjectification through which subjects work on themselves qua living beings” (2006: 215). It is precisely around this notion that Deleuze furthered Foucault’s analysis of disciplinary spaces into what he termed “societies of control” (Deleuze, 1995). Technologies of bio‐power, according to Deleuze, seek to integrate, modify, and control subjects within disciplinary practices and knowledge (Deleuze, 1995; Foucault, 1976). In the following section, I highlight sociological studies of mental health that use and develop these post‐structuralist and postmodern theoretical approaches in order to understand both the work of psychiatry and the experiences of women and men living with mental illnesses. As I will demonstrate, these positions assert that the lived experiences of psychiatric survivors must be understood epistemologically as a type of “social reality,” one that is discursively constructed and maintained as a form of social 63
control (Ussher, 2000: 223).34 My goal throughout the remainder of this chapter is to complicate this position, or to point out ways in which sociological studies of discursive dimensions of mental illness, defined as being brought into being through language, and material35 dimensions, defined as being subject to social, cultural, and historical structures, have changed significantly since the 1980s. Sofoulis argues, for example, that although there was an increasing focus on “the body” during the 1970s and early 1980s, which to some extent came to supplant “merely discursive” challenges to naturalized categorizes of mental illness found in 1960s anti‐psychiatry, “many felt that [post‐
modernists] were too dependent on discourse and representation and did not sufficiently grapple with ‘the in‐itself of matter’” (2009). Notwithstanding the fact that sociologists rarely examine the physiological properties of mental illness, anti‐psychiatry of the 1960s and more contemporary social constructivism is, as Sofoulis optimistically concludes, “inspirational” for denaturalizing the categories of illness, and for challenging determinist and essentialist assumptions underscoring many biological theories of science in general, and mental illness in particular (Sofoulis, 2009). In what remains of this chapter, then, I trace the epistemological assumptions underscoring constructivist approaches to mental health. I will then demonstrate how constructivism is now being 34
For example, Ussher uses the term mental illness “to refer to the discursively constructed category which effectively defines individuals so categorized as ‘Other’” (2000: 227). 35
Here I make the distinction between “material” as it is commonly used in sociological studies of mental health, that is, the study of bodies in material conditions, and “matter,” which is defined as non‐human things in the world, including skin‐encapsulated material processes such as neurotransmission and drug metabolism. I return to this distinction in the following two chapters as well. 64
challenged by a Foucauldian realist epistemology, one that takes into account multifactoral configurations of sociological, ethical, political, and biological approaches to mental health in particular, and science studies more broadly (Sofoulis, 2009; N. Rose, 2007). N. Rose’s work has been particularly influential in the sociology of mental health for promoting more “socially informed” ways of understanding mental illness in the age of the neurosciences, despite the difficult epistemological history between the social and natural sciences (N. Rose, 2006, 2006a; see also S. Rose, 2009). Contemporary Social Constructivist Approaches to Mental Health and Illness in Sociology As opposed to the claims made by some 1960s anti‐psychiatry activist and scholars,36 few sociologists today reject all biological readings of mental illness outright; most would support the claim that human behaviour is simultaneously social and physiological, cultural and biological. Furthermore, not all sociology of mental health is necessarily constructivist, nor do all sociologists of health and illness necessarily trace their origins to the postmodern turn. Spanning a wide range of topics in what Warner calls a “sub‐sub‐discipline” of sociology (Warner, 2009), the sociology of mental health has a long tradition beginning in the 1970s and 1980s in studies of psychological and/or emotional harm, misogyny and mental illness (Yardley, 1996, 1997; Ussher, 2000, 2005), 36
In particular, see Cooper, 1967, 1978 and Laing, 1961, 1967. 65
and different ways that gender, race,37 and social inequality impact women and men’s mental health (Brown, 2008; Warner, 2009). Central to this diverse sociological field, and one that is often less radical in its challenge to the normalizing discourses of science, is epidemiological sociology, which focuses on mental illnesses at the level of population (Warner, 2009: 634; see also Turner et al., 1995). The “opportunity and stress” model of mental health demonstrates, for example, that people from lower income families “suffer from greater levels of stressful life events and have fewer buffers against adverse experiences, exposing them to an increased risk of developing schizophrenia” (Warner, 2009: 635). The diverse sub‐sub‐field of sociology highlights the wide range of topics within the sociology of health, some of which are rooted in more radical rejections of science beginning in 1960s sociology, some of which embrace a reductive empiricism (Mirowsky and Ross, 2002),38 and all of which continue to raise 37
The study of critical race theory in the context of mental health is an expansive field in the sociology of mental health (Brown, 2008). Unfortunately, it is beyond the current scope of this chapter to explore this important field in a fair and thorough way. However, as Brown argues, incorporating a critical race perspective into the sociology of mental health “draws attention to the ways in which race‐related inequality transforms the conception of psychopathology and causes of mental health problems” (2008: 58). Interestingly, he concludes this article with a nod to post‐psychiatry, influenced chiefly by anti‐psychiatrists such as Laing (Kecmancovic, 2009). As Brown states, if the sociology of mental health were to take critical race theory more seriously, “researchers would begin to practice what Bracken and Thomas label ‘post‐psychiatry’ (or postmodern psychiatry), which means conducting psychiatric research that is attendant to the social context of structured inequality and the harm cause by it” (2008: 58). 38
While critical of “medical explanations” of mental illness, and more likely to study the social determinants of health, Mirowsky and Ross suggest that sociology of mental health should be a “human science,” one that produces “information for the people it studies so that they can better understand and control their lives” (2002: 153). “Without measurement,” they contend, “answers will simply reflect our preconceptions, biases, and ideology” (2002: 152). What they mean by “answers,” however, is far different than what other sociologists of science mean by a non‐reductive empirical approach to understanding the complexity of behaviour, and of social 66
awareness about how stigma, class, race, gender, and other forms of inequality negatively impact the lives of women and men with mental illnesses (Stoppard, 1998; Warner, 2009). However, despite the diversity of the field and increased appreciation for the epistemological practices of the biological sciences, influenced chiefly by the growth of the Sociology of Scientific Knowledge (SSK),39 many sociologists are suspicious of, or relatively ignorant to, the actual biological data emerging from natural science laboratories (Davis, 2008). These sociologists, for the most part, focus primarily on the social, cultural, and historical effects of scientific practices and knowledge (Williams, 2000). This is summarized well in Wilson’s research on feminist theories of depression. According to Wilson, many contemporary social studies of depression “emphasize the cultural motivations for keeping women medicated…are critical of the practices of pharmaceutical companies and doctors that collude with them, and…remain dubious about the efficacy of pharmaceutical treatments for conditions they diagnose as essentially social in origin” (Wilson, 2008: 374, my emphasis). In social studies of and biological causes of illness (Pilgrim and Rogers, 2005; Pilgrim et al., 2009; Warner, 2009). In other words, Mirowsky and Ross appear to be replicating the very scientific, reductive approach to the biological in their revised sociological and epidemiological approach to the social. 39
While I return to this discussion in the following two chapters, I touch on it briefly here because SSK has become an important field that defines itself epistemologically as a “radical social constructivism,” which is often said to take a “realist” approach to the study of science. I explore this radical constructivism in contrast to Latour’s work in the following chapter. 67
biological psychiatry, these social diagnoses40 are sometimes outright rejections of psychiatric knowledge. Pilgrim et al. describe sociology’s role in the study of mental health as follows: “Our summary of the interdisciplinary evidence, which endorses the centrality of relationships in understanding mental health, does not imply the need to reject the role of individual biology. However, it puts skin‐encapsulated factors in a subordinate role” (2009: 247, my emphasis).41 Similarly, O’Brien and Fullagar argue that neuroscience and genetics, conflated as the “biomedical model,” “predominantly [construct] depression as a physical disease” (2008: 8).42 Their study is important for raising awareness about individualizing neo‐liberal policies linked to the recovery model, which often puts blame 40
A recent article by Lawn reflects Wilson’s point that sociologists are more likely to diagnose (or explain) mental illness within the realm of the cultural. Lawn calls such a position “social determinants” of mental illness. She writes: “A social determinants of health view recognizes that a range of economic, environmental, political, and cultural factors influence health beyond the limits of a behavioural, biological, and genetic view of health” (2008: 36). Note here the outright omission of anything biological as even a potential determinant of illness. 41
Here, I emphasize the phrase “skin‐encapsulated” again to show how Pilgrim et al.’s conception of what the sociology of mental health should study excludes internal bodily processes (what they call “individual biology”). 42
Horwitz similarly conflates all biology of mental health as “biological psychiatry.” He writes: “The attempt to separate genetic from environmental impacts on human behaviour is the driving force behind many studies in biological psychiatry” (2003: 136). The assumption that “biological psychiatry” is some sort of unified force out to separate the gene from the environment is factually incorrect (see, for example, Sullivan, 2005; Caspi and Moffitt, 2006; Petronis, 2007; Mill and Petronis, 2007). I return to this discussion a number of times throughout this thesis when I analyze studies that understand the complex relationship between gene and environment (see also Martin and Ashcroft, 2005). While often problematic in their reductive definition of the environment, gene‐environment studies highlight a separation between sociologists of mental health who study biological psychiatry from actual studies emerging from molecular biology laboratories. 68
solely on women recovering from depression. However, they remain cautious of discussing what Pilgrim et al. (2009) call “skin‐encapsulated” matter. For example, they state: “This articulation of depression as primarily a biomedical illness that can be treated via the use of SSRIs has perpetuated the ‘truth’ that recovery can be induced by drugs” (O’Brien and Fullagar, 2008: 8). Here, the “truth” of depression, or the recovery from mental illness, becomes an articulation of material and discursive practice as it is mediated by the discourses of psychiatry. I do not mean to say here that the notion of neo‐liberal self‐responsibility so closely tied to the biomedical model is unproblematic. Indeed, “recovering individuals are positioned as responsible for seeking and adhering to expert advice from physicians that, as virtuous neo‐liberal citizens, they recover their autonomy and ability to be economically and socially productive” (O’Brien and Fullagar, 2008: 8). As I point out throughout this chapter, however, this somewhat flippant response to “the biomedical model” – by virtue of it being biological – continues to steer the sociology of mental health towards an epistemological stalemate between the work of social science and molecular biology and neuroscience (Wilson, 2004, 2008). More sympathetic to a certain type of materialism, Ussher advances what she calls a “material‐discursive‐intrapsychic” approach to mental health, a model that, as she claims, takes seriously the epistemology of the natural sciences. Ussher advocates for this new model because it avoids what she calls the “realist/positivist” epistemology of the natural sciences (2000: 209; see also Ussher, 2005). Without clarifying exactly what is meant by the conflation between realism and positivism (see also Yardley, 1996: 69
503, n.2), she continues by suggesting that both realism and positivism have “refused to engage postmodern and feminist debates, resulting in the standard reductionism and marginalization of historical and cultural factors” (2000: 209). Challenging positivist science on its reductionist tendencies, Ussher continues, means highlighting how the body has become “more real in science” than in psychosocial or postmodern readings of mental health. She writes: “In what is a totally reductionist viewpoint, the body or biology is conceptualized in terms of physical processes – the actions of hormones, neurotransmitters, or ovarian function, considered separately from any meaning or cultural context” (2000: 212). For Ussher, scientific readings of the body are reductionist, where scientific studies of physical processes, by definition, separate bodily matter (for example, neurons and molecules) from their cultural (symbolic) contexts. Here, it seems, Ussher adopts an epistemological distance from (nonhuman) matter itself, one which is influenced by a particular sociological tradition, arguing that the natural sciences separate matter from the cultural by the very act of investigating matter itself (see also Yardley, 1996; Stoppard, 1998). Fee similarly suggests that approaches to the study of matter, such as neurotransmitters, overshadow what he calls “social processes,” which are, according to him, “reduced [in such a study] down to elements or variables within an overall biomedical problem” (Fee, 2000b: 76; see also Horwitz, 2003). Not surprisingly, given this aversion to the technical discourses of science, sociologists tend to study social environmental markers of mental distress, which Fee 70
and Ussher situate in opposition to biomedical accounts of depression and schizophrenia. According to Fee and Ussher, the biomedical model emphasizes the importance of understanding the molecular processes of noradrenaline, 5HT, serotonin, dopamine, and acetetycholine neurotransmitters (Ussher, 2000: 213; see also Fee, 2000b: 76). As Ussher correctly points out, there are many convincing epidemiological studies that suggest environmental stressors contribute largely to the reporting of mental health problems. Such markers include: “marital status, with married women reporting higher rates of problems than single women or married men; caring roles, with women looking after small children or elderly relatives being at higher risk; employment status, with work generally providing a protective factor, particularly for working class women; absence of social support and economic and social power; and gendered role socialization, which leads to depresso‐genic attributional styles” (2000: 213). Interestingly, however, from this position, “the environment” does not include nonhuman matter, and “the social” is barricaded from the sociality of neurotransmission (Wilson, 2004, 2008), wherein “sociologists are resistant to biological theories of human behaviour, and perhaps especially to those that appear to lodge the self in the processes of neurotransmission rather than the social world” (Hewitt et al., 2000: 175). Here, the self is said to exist in a social world independent of the processes of the brain, which are said to belong (ontologically) to the natural world, which is not, from this reading, “social,” the former an object for sociological investigation, the latter a matter for positivist science only. 71
In place of the realist/positivist conflation, one that is seen by default as reductionist, Ussher outlines her own material‐discursive understanding of mental health and illness. Her model can be summarized as follows (adapted from Ussher, 2000: 225, my emphasis in bold): MATERIAL FACTORS DISCURSIVE FACTORS INTRAPSYCHIC FACTORS Physical effects of depression, history of mother’s depression ‘Madness’/’abnormality’ Impact/interpretation of violence Marital violence, alcohol abuse ‘Sickness’/’illness’ Psychological defenses Structural positions and opportunities (race, class, gender, education) ‘Femininity’/’Masculinity’ Mood/well‐being/self‐
esteem Treatment options offered Marital (verbal) violence Attributions Social support, family relationships Heterosexual relationships and gendered expressions of distress Ways of coping Women’s bodies/hormones Insecurities about relationships Certainly, the consequences of these material, discursive, and intrapsychic factors have very real, daily impacts on women and men living with mental health histories (see Chapter 2). Of particular epistemological interest to me, however, is the obvious split between what is considered as “material” and what is considered 72
“discursive” and/or “intrapsychic.” For instance, in the chart above, Ussher makes an interesting distinction between the physical effects of depression, whereas “women’s bodies/hormones” is situated on a discursive plane, in order to indicate the way that scientific discourses speak about hormones in such a way as to define women’s bodies scientifically (see also Stoppard, 1998). In this instance, hormones, rejected previously because bodies are erased culturally by scientific approaches to the real, are divorced from material processes of the body. Observing this separation, however, does not mean that I disagree with the situated, material conditions in which women (and men) find themselves so as to be implicated in the suffering of mental illness. Class, race, gender, the affordability and accessibility of treatment options, and the support women and men receive from family members are all significant and important realities for the lived experiences of mental illness (Ussher, 2005). Epistemologically speaking, however, Ussher relegates sociological terms – “abnormality,” “illness,” “gender,” and so on – to discursive, cultural, and social realms. Ironically, despite the attempt in Ussher’s chart to merge the social, material, and psychic realms into one model, her approach to matter (here, hormones) situates the model firmly in a constructivist epistemology that separates matter from sociality (Ussher, 2000: 209). Ussher’s material approach to the study of mental health is similarly reflected in Orr’s reading of biological and molecular mechanisms of the body. As she writes, “Of particular historical interest to me are the somewhat hysterical features of the ‘real’, empirically based diseases named by the new science of psychiatry and its data‐driven 73
methods” (2000: 63). Echoing Ussher’s concern that psychiatry is driven by its desire to represent “the real,” Orr summarizes her concern with psychiatric science’s “command‐
control‐communication” of anything not human. She writes: This dream of understanding and materializing – in the metal [sic], not the flesh, and with a powerful desire for their abstract equivalence – a certain perception of mind‐body connection grounded in the image of mind as a command‐control‐
communication center and the body as its systems parameters is repeated, perhaps compulsively, in the conceptual framing of the action of psychotropic drugs as a reconfiguration of the neurotransmission, or the message centers, in the brain to correct for the deviant signals which constitute mental disorder. (Orr, 2000: 68‐69) Here, Orr argues that any understanding of the materiality of the brain is a conceptual process of naming, one that aims to “correct for the deviant signals” of neurotransmission (2000: 69). That is, scientific discourse contributes to the computerization of the body through the naming of molecular mechanisms of (technological) neuronal agency (Orr, 2000; see also Wilson, 1998). While she does not reference Lyotard specifically, her approach to mental health is markedly similar to his approach to science. In particular, Orr is critical of the language of diagnosis, or what she calls “the rules and rhetoric of the scientific method” that use a “rational language” (Orr, 2000: 61). Her intention is to expose the language of psychiatry and diagnosis, and to complicate the methods for naming illness, which she says are carved out of 74
“intensely historical stories created from complexly knotted desires for scientific certainty and slippery methodological stagings for ‘real’ objects and simulated stand‐
ins” (Orr, 2000: 65, my emphasis). Reflecting a similar position to Orr, Fee invokes a literary, dramaturgical metaphor for socially diagnosing depression, which is seen as a narrative, one that is created and perpetuated by science‐as‐drama: “Depression can thus be seen as constructed by ‘true’ stories within a larger historical drama that puts human agency in a new role within a previously circumscribed and mystified arena of individual mental pathology” (2000: 96). If depression is one narrative among many, Fee suggests, “no instance of depression, reflexive or non‐reflexive, is any more or less ‘real’ than another” (Fee, 2000b: 95). Ontologically, the “real” is defined in Fee’s work as a material‐discursive construct, which is left open to a relativist interpretation of mental‐
illness‐as‐story. Fee suggests: “Whatever biological or purely psychological strata might exist, it still holds that the more we discuss what depression is and how it affects our lives – in an effort to understand ‘it,’ to develop a relationship to ‘it,’ to combat ‘it’ – the more we add to its discursive life…depression, then, as a powerful story, must be taken as seriously as other aspects or dimensions of the condition” (2000: 75‐76). Seemingly sympathetic to the material‐discursive‐intrapsychic approach put forth by Ussher, Fee sees depression as a lived, material condition, but also one that is governed by discourse, including the way we speak daily about depression as an abnormal pathological illness. Because the rules of scientific statements are immanent in the 75
narration of scientific knowledge by experts, the social truth of depression is established within the bounds of (and the discursive dimensions beyond) the scientific debate, or what Fee argues is the consensus extended to illness by experts (Fee, 2000a). Indeed, Bowers constructivist position supports Fee’s approach to science. As Bowers argues, “perhaps the most important way that mental illness can be said to be socially constructed is that it is identified and determined by social criteria” (Bowers, 2000: 191, my emphasis). As Fee argues in defense of the social constructivist position, which he notes is “beholden to anti‐psychiatry” (2000: 11), the meaning of experience is open to any interpretation by survivors themselves. He argues that “The conceptual strength of social constructivism is precisely its postmodern‐allied anti‐foundational approach to meaning and linguistic boundaries which allows modes of interpretation and rendering of knowledges that collapse naturalized dichotomies between subject and object and knower and known” (Fee, 2000a: 4).43 In this respect, the social constructivist approach to reality is one that negotiates, interprets, and understands the language of biology and psychiatric science in order to expose “how bodies and minds are immersed within economic, political, and biological struggles” (Fee, 2000a: 2). While it is certainly interesting that Fee points to biological struggles as well as social and political ones, he does not expand on the former. Instead, he argues that sociology should pay more 43
Ironically, this position does anything but collapse the subject/object distinction. Scientific knowledge, according to Fee, becomes an object of critique from a sociological perspective (subject), the latter ontologically barricaded from the former. 76
attention to the “sociolinguistic and therefore fluid quality of psychoscientific knowledge” (2000: 11). Language is seen here as being more fluid than biological matter,44 thus situating constructivist sociology in an epistemological position from which to view the discursive nature of psychiatric science through a Foucauldian lens: “The human is produced within discourse – within technologies of health – and is not presumed a priori. In other words, we become certain kinds of subjects through institutions, and, capable of reflexive agency, are not merely coerced by them in a purely external or determined fashion” (Fee, 2000a: 12). According to Fee, a sociology of mental health means abandoning causal or deterministic reasoning, a position that culminates in an exploration of the discursive practices and language of psychiatric and neuroscientific knowledge (Fee, 2000a; Lewis, 2000, 2006). Walker echoes this interpretive, social constructivist epistemological position: “From a postmodern point of view there are no absolute or essential truths; instead all we have is interpretation. Furthermore, there can exist multiple valid interpretations – multiple descriptions” (Walker, 2006: 84). The destabilization of “truth claims” is aimed at increasing the understanding of the experiences of madness, and exposing the narratives and stories emerging from psychiatrized positions (Burstow, 2004; Cresswell, 2005). 44
See Hird (2004, 2009) and Wilson (1998, 2008) for sociological approaches to the fluidity (and sociality) of nonhuman matter. In the sociology of mental illness, language is commonly regarded as the only object that is fluid, and therefore open to deconstructive techniques (Wilson, 1998). Hird and Wilson challenge the assumption that language is necessarily more fluid than nonhuman matter, the former through her study of bacteria, the latter through her study of neurons, pharmacological drugs, and the gut. I return to this discussion in much more detail in Chapter 5. 77
Longino, in this respect, intervenes to challenge the assumption that all science is out to unearth (and/or explain) the “truth” of the world. As she argues, It is tempting to think that scientific knowledge is like ordinary knowledge except better. But scientists are not (or not just) better observers and more careful reasoners [sic] than the rest of us; they do something different. The purpose of scientific inquiry is not only to describe and catalog, or even explain, that which is present to everyday experience, but to facilitate prediction, intervention, control, and other forms of action on and among the objects in nature. Description and classification are in service to these more overarching purposes, which move the focus of inquiry away from what is present to us to the principles, processes, and mechanisms that produce or underlie what is present to us. (1999: 271) As Vicedo similarly suggests, sociological analyses of the epistemology, methodology, and ontology of science “should pay careful attention not only to what scientists say, but also to what they do and how they do it” (2000: 15). In her view, this transdisciplinary, and respectful engagement, would dispel the myth that laboratories—
through their investigation of matter in the world—are in some way distinct or separate from the social world, or that natural scientists do not appreciate the complex interplay between discourse and objects, or the social and material (2000: 215; see also Fox Keller, 2002). It is precisely here where more recent work in the sociology of mental health and science studies of psychiatry, neuroscience, and genetics engages with 78
scientists themselves so as to advance what they claim can be a novel way forward in bettering the lives of women and men living with mental illnesses. Realist and Bioethical Approaches to the Study of Mental Health and Illness In the second half of this chapter, I highlight recent work in the sociology of neuroscience, genetics, psychiatry, and mental health,45 which is situated within an epistemological realism, one that is often critical of—but also builds upon—the type of “bio‐illiterate” constructivism I outlined in the first half of this chapter. This is especially the case in the emerging field of bio‐ethics, or what N. Rose calls “somatic ethics,” which attempts to integrate sociology with the neurosciences, and neurosciences with the social sciences (N. Rose, 2006a, 2007; see also Hedgecoe, 2001; N. Rose, 2007; Martin and Ashcroft, 2005). According to N. Rose, somatic ethics is a politics of “life itself,” which he defines as “the sense that all human beings on this planet are, after all, biological creatures, and that each creature exercises a demand on each other simply by being a creature of this sort. Perhaps this ‘biological reductionism’ should not be cause for critique but the grounds for a certain optimism” (N. Rose, 2007: 255, my emphasis). 45
In this chapter, I examine sociological readings of neuroscience, genetics, and mental health, but will return to a much more detailed discussion of these fields in Chapter 5. There I will focus more specifically on the science literature in these areas, as well as other realist sociological responses to a wide range of topics within the biological sciences that pertain specifically to mental health, such as neuronal communication, molecular approaches to the nervous and enteric systems, and the correlations between cognitive functions and biological patterns (S. Rose, 1998, 2009; Racine et al., 2006). 79
For N. Rose, then, somatic ethics means a questioning but respectful engagement with contemporary, biopolitical constructions of the molecular/biological citizen. Of particular concern for N. Rose, as influenced by his Foucauldian roots and critical position with respect to psychiatric science, is the “emergence of the biological body as a key site for the government of individuals, as the contemporary locus for so much of our unease and discontents, [and] as the site for potential overcoming” (2007: 255, my emphasis). He continues: “If our ethics have become, in key respects, somatic, this is in part because it is our ‘soma’ – or corporeal existence – that is given salience and problematized – to some extent at least, our genome, our neurotransmitters – our ‘biology’” (N. Rose, 2007: 257). This Foucauldian ethics, as it might be called, informs N. Rose’s work, as I will demonstrate, and similarly influences other Foucauldian realists in the field of bio‐/neuro‐ethics, such as Hedgecoe (2001). N. Rose further defines a bioethical approach to mental health as one that encompasses sociological, philosophical and biological understandings of brain imaging and genomic scanning, and the potential impacts these technologies have on women and men with mental health histories (N. Rose, 2006b, 2007). With the intention of mapping out a possible epistemological way forward that might merge the social and biological sciences, Martin and Ashcroft similarly argue that both “sides” (social/biological) have unfairly criticized each other without actually engaging with the other discipline: sociology often rejects biology as being determinist (especially in post‐
psychiatry, as I mentioned previously), whereas the biological sciences often dismiss the 80
social sciences due to their apparent grounding in relativist, constructivist epistemologies46 (Martin and Ashcroft, 2005). This lack of transdisciplinary communication has done little in the way of resolving the debates surrounding behavioural enhancement, coercive drug therapies, policy‐making and issues of treatment and consent, and the social and psychological well‐being of young children in particular (Martin and Ashcroft, 2005: 4‐6).47 As they argue, this impasse has also done little in the way of allowing sociology to engage with, and ultimately understand, the “appraisal and ends of scientific research” from within the actual sites in which neuroscientific and genetic research takes place (Martin and Ashcroft, 2005: 9; Lock, 2005). Notwithstanding their denouncement of this epistemological stalemate, Martin and Ashcroft’s research is motivated by an optimism that points to recent collaboration between sociologists and biologists in gene‐environment studies and social science 46
See Canning, Hird, and Smith (forthcoming) for a more detailed analysis of this point. In this article, we argue that scientists often unfairly designate all sociologists as constructivists who remain impartial to, or outright reject the agency of, nonhuman matter. However, as we argue, realist epistemologies in the social sciences are ideally situated to engage with scientists because of an appreciation for the mutually constitutive relationship between the material and the social (Latour, 2005). However, until realist epistemologies are recognized in transdisciplinary projects by biological and social scientists, communication between disciplines will remain a difficult task. 47
There are obviously many more ethical issues surrounding genetic and neuroscientific research. Martin and Ashcroft outline a few more tied closely to the rise of genomic scanning and fMRI studies, such as: “The interpretation and findings in behavioural genetics or imaging studies into the basis of traits such as criminality, risk‐seeking, intelligence, racial, sexual or gender difference, and the ability or otherwise to publish findings adverse to the interest of one’s research sponsor, especially in government or commercially‐funded research” (2005: 12). 81
studies of embodiment and illness (see Caspi and Moffitt, 2006). Caspi and Moffit’s research, for example, admits to a complexity concerning the “origins” of schizophrenia and depression, and attempts to move beyond determinist claims so common in gene‐
illness correlation studies. For example, they examine environmental markers (which they troublingly call “pathogens”) interaction with candidate genes, such as DNA markers on the neurotransmitter 5‐HTT, to show the mutually constitutive ways in which the gene and environment interact with each other (2006: 585). I remain cautious of their claims, as I discuss further in the following chapter on epigenetics, because of their tautological or even reductionist use of the term “the environment” to refer to any potential “pathogen.” According to their definition, “Environmental risk factors for mental disorders discovered to date include (but are not limited to) maternal stress during pregnancy, maternal substance abuse during pregnancy, low birth rate, birth complications, deprivation of normal parental care during infancy, childhood physical maltreatment, childhood neglect, premature parental loss, etc.” (2006: 584).48 Martin and Ashcroft agree, suggesting that the gene‐illness correlation has not been shown conclusively with respect to schizophrenia and depression. They ask how environmental markers inform and or shape health status, and what direct biological evidence can help support the mutual ways the environment impacts pathology. For instance, the organization and structure of the pre‐frontal cortex, according to Martin and Ashcroft, 48
Despite this collaboration between sociologists and gene/environment studies, such as Caspi and Moffitt’s work, little has been questioned about the use of the term “environmental pathogens.” In other words, this list suggests that mental illnesses are caused by potential environmental factors, which have yet to (if ever) be correlated with specific genes. 82
changes with respect to different social environments, such as stress, psychological harm, and so forth (Martin and Ashcroft, 2005). Approaching this constitutive relationship between the brain and its external environment enables sociology to develop what Martin calls an embodied sociology, a new materialist approach that challenges behavioural, neo‐Darwinian genetics and its reductionism, as well as sociology’s conception that the social world is somehow distinct from genetic and neurological matter and the plasticity of brains and genes. A “common ground” – and thus an ethical approach to the science of life – means building (and challenging) models of normality and abnormality that incorporates social, environmental, and biological factors (Martin and Ashcroft, 2005). Throughout their work, Martin and Ashcroft succinctly summarize the potential ethical problems of causal models tied to the rise of biotechnologies, such as genomic scanning and fMRI studies of schizophrenia, depression, ADHD, personality disorders, and so on (2005; N. Rose, 2006a, 2006b, 2007).49 For example, the increased geneticization of mental pathologies (Hedgecoe, 2001), now defined through claims of susceptibility, is creating what Martin and Ashcroft call “new models of human kind” that will have serious implications for the ways in which mental illnesses are defined and treated. They highlight these main areas of sociological interest: 1) The idea that genetic 49
S. Rose highlights an ongoing problem with fMRI studies. He writes: “Even if an area ‘lights up’ in a particular fMRI experiment it does not mean that that area is ‘the site’ of the attribute being studied in the experiment; it could be a transient region of passage, for instance, through which neurons in one region are ‘passing on’ information to another as many brain areas become dynamically and briefly engaged in a task” (S. Rose, 2009: 10). 83
and biological accounts undermine personal responsibility,50 and therefore that our sense of freedom can lead to a “genetic fatalism,” and in doing so pose a threat to human dignity; 2) Further medicalization of behaviour; 3) Possibility of new forms of stigma; 4) Creation of new categories of individuals who are seen to be “at risk,” and are subject to surveillance and medical intervention; 5) Pressure to introduce genetic screening programme[s] to select particular traits and characteristics (Martin and Ashcroft, 2005: 18). To summarize Martin and Ashcroft, a sociological approach to the neurosciences means engaging with philosophical questions about the consequences of emerging discoveries, and the ways in which the modification of behaviour through pharmacological treatment might change the biopolitical nature of what defines us as subjects of scientific knowledge (Martin and Ashcroft, 2005). Echoing a Foucauldian material‐discursive approach to the study of genetics, Hedgecoe’s work demonstrates how neurogeneticists continue to prioritize genetic explanations of mental illness over social ones (2001). According to Hedgecoe, a bioethical approach to genetics means engaging critically with the framing of genetics research, especially ways in which geneticists challenge “hard‐line” genetic determinism with nuanced references to gene‐environment interaction (2001: 876). Hedgecoe writes: “I suggest that there is far more to the narrative of enlightened geneticization 50
This is an especially interesting and somewhat ironic point, especially if contrasted to Foucault’s analysis of the “responsibilization” of the individual in disciplinary societies (Foucault, 1991). If, for example, genetic and biological accounts of behaviour undermine personal responsibility, and neo‐liberal governmentality has placed more pressure on individuals to be “personally responsible,” we arrive at somewhat of a paradox with respect to subjectivity (Foucault, 1991; Martin and Ashcroft, 2005). 84
than simply calling schizophrenia a ‘genetic disease’ and proposing a ‘gene for’ schizophrenia with little role for environmental influence” (2001: 884). What Hedgecoe points out here is that, although the search for one gene that causes one illness takes place in some neuroscience laboratories, the failed narration of genetic determinism is being heard and dealt with by some scientists (Caspi and Moffitt, 2006; S. Rose, 2009). The understanding of environmental markers and their interaction with genes is itself a dominant discourse that, in usurping gene‐centric research, “presents a complex multifactoral vision of schizophrenia with a role for environmental influence” (Hedgecoe, 2001: 885). Interestingly, however, Hedgecoe’s research focuses specifically on a sociological/ethical approach to the emerging, complex features of what he calls an “enlightened geneticization,” ignoring his last point that the environment plays an important role in and for gene expression. Sociology, he contends, should study the following aspects of the geneticization of schizophrenia and depression: 1) the use of history in emerging gene‐environment studies, or the ways in which neuroscientists build upon and expand twin studies, many of which are dependent upon deterministic claims; 2) genetic modeling, or the ways in which neuroscientists still prioritize genetic explanation despite the increased focus on the role of the environment; 3) responsibility and caution, or ways in which neuroscientists and geneticists accept the mistakes of the past and remain circumspect about the power of new molecular studies of mental illness; 4) the schizophrenia spectrum, which includes 85
borderline features of an illness, including diagnosis and treatment (Hedgecoe, 2001: 885‐886). Most importantly, Hedgecoe argues that sociology can no longer claim from a distance that neuroscientists and genetics are determinist simply because they make claims to the genetic causes of illness. He states: “To suggest that there is no single gene ‘for’ schizophrenia in the belief that this undermines molecular approaches is to miss the point that genetic researchers are the first to admit this” (2001: 902). For Hedgecoe, then, “sociologists of science can expand the focus away from simply debating the merits of particular technologies, and increase awareness of how ethicists need to consider the process of scientific investigation” (2001: 903‐904). This “critical bioethics” means engaging with the “ways in which genetic explanations are constructed” (Hedgecoe, 2001: 903) so as to understand the ethical, political, and social consequences of the complex narration of scientific discourses, especially as they are tied to a “biology of control” and “form[s] of capital, biocapital, and with the capitalization of life itself” (N. Rose, 2007: 258). N. Rose argues that neurobiological studies of mental illness have created new ways of governing human conduct that reach far beyond the material‐discursive dimensions of the clinic, prison, and psychiatric hospital (N. Rose, 2007). Referring to the biological control of “soma,” N. Rose argues that the “psychiatric gaze is no longer 86
molar but molecular” (N. Rose, 2007: 199).51 What this means is that the classification of mental disorders over the last half‐century has shifted towards the molecular structures of the brain, and that therapeutic intervention is now mediated by the profitable market of psychopharmacology (N. Rose, 2007: 199‐202; Masters and McGuire, 1994).52 The rise of predictive neurological and genetic studies, however, continues to be critiqued as deterministic, especially because of the explanatory failure of genetic predisposition studies and the selective, individualized approach so common in the brain sciences (N. Rose, 2007: 130; see also S. Rose et al., 1984; Hird, 2004; Wilson, 2004; S. Rose, 2003). The advent of visual simulations of molecular brain processes has solidified the position in the biological sciences that the communication between nerve cells is largely chemical, and involves neurotransmitter molecules such as monoamine, dopamine, norepinephrine, epinephrine, acetylcholine, and serotonin (Andreassen, 2001: 207‐210; see also Masters and McGuire, 1994). Tied closely to research on psychiatric drugs, the molecular origins of mental pathologies are now “assigned to an anomaly in a particular 51
N. Rose elaborates on this by suggesting that through the growth of proteomics (the coding of the functional properties of proteins), and the rise of molecular neuroscience such as the visualization of enzyme activities and transporter genes, a new “ontology of life” is linked to what calls the “molecular gaze” (N. Rose, 2007: 199, 2006, 2006a). Vitality, he argues, now becomes a resource to be engineered, capitalized, commercialized, and, ultimately, controlled by “somatic experts” (N. Rose, 2006, 2006a, 2007). 52
Lakoff’s work is important in this area. He explores the ways in which a “reason” or rationale surrounding drug development and treatment in biological psychiatry attempts to “restore the subject to a normal condition of cognition, affect, or volition” (2006: 7). Even more troubling, as Lakoff points out, is the structuring of market valuation around biological innovation, which is “a novel way to rationally manage the population’s well being” (2006: 170; see also Rose, 2006, 2006a, 2007). 87
neurotransmitter system, and pharmaceutical companies [seek] to isolate the compounds whose specific molecular structure enable[s] them to target, modify, or rectify that anomaly” (N. Rose, 2007: 199). What makes this position so compelling, according to N. Rose, is the “matter‐of‐fact materiality” represented in molecular models, and the iconic “molecular specificity” of different types of disorders reported in medical journals and disseminated in the popular press (N. Rose, 2007: 200). N. Rose summarizes this iconic (and often reductive) representation that has so easily captured the public imagination since the rise of the visualization of molecular mechanisms of the body as follows: “Depression can be visualized as a depletion of neurotransmitters – a visual version of the famously oversimplified ‘serotonin hypothesis of depression’ that understands depressed mood in terms of an abnormally low concentration of this neurotransmitter in the synapses in particular regions of the brain” (N. Rose, 2007: 201). In studies of schizophrenia in particular, N. Rose (2007) contends that the “schizophrenic brain” is now represented as having an over‐activity of dopamine neurons in the mesolimbic dopamine pathway, which is now made visible with “a moving image of a synapse with dopamine molecules jumping across it” (N. Rose, 2007: 201). As N. Rose points out, this vastly simplistic, deterministic representation has captured the public imagination because the “excess” of dopamine supposedly represents “broken” molecular pathways said to “cause” schizophrenia (N. Rose, 2007: 200‐202). 88
The specificity and selectivity of much of the neurosciences has been a part of what N. Rose calls the “fabrication process” so closely tied to the development and testing of pharmaceutical drugs. He writes: “Indeed there is considerable evidence that so called specific drugs actually have a wide spectrum of action, and the claims for specificity often arise from the forms of evaluation use – for example, a focus on the reduction of a score on a scale supposed to measure depression or psychosis – or the dismissal of some phenomena as ‘side effects’” (N. Rose, 2007: 203). The “fabrication process” refers to ways that the explanatory structure of neuropharmacology, since the 1950s, has “fabricated” the benefits of drug therapy, and continues to deny the non‐
specificity of site‐specific (single neurotransmitter) drug therapies (N. Rose, 2007: 203). Unfortunately, N. Rose does not expand on how the drugs are metabolized in the body if they are not site specific (as, for example, what he calls side effects), and what in fact pharmaceutical treatments (might) do in the body (see also Moncrieff and Cohen, 2006). Wilson picks up and elaborates on this point, which I will discuss in more detail in Chapter 5. Contemporary neurogenetic approaches to mental illness are now being called “pathologies of susceptibility” (N. Rose, 2007: 204‐205). While, in some instances, forms of genetic determinism are reported in science journals, many of which claim to know a causal pathway between one gene and one “abnormal” phenotype,53 the more nuanced 53
For a more nuanced exploration of genetic determinism in the field of behavioural genetics and neuroscience, see Looren de Jong (2000) and S. Rose (2003). 89
claim is that genetic mutations can be found on certain loci of base sequences, which “control the synthesis of proteins involved in the production and transportation of neurotransmitters, receptors, enzymes, cell membranes or ion channels regulating the activity of neurons” (N. Rose, 2007: 204). In other words, neurogeneticists are now searching for multiple gene systems (and the focus is shifting to proteins and the cytoplasm, for example) that result in a susceptibility to mental disorders (N. Rose, 2007). N. Rose provides a particular example of the way in which genetic determinism, in some instances, is being supplanted by a logic of genetic susceptibility: [Schizophrenia is linked] to a variation in a single base in the gene for an enzyme called catechol‐O‐methyl‐transferase (COMT). This gene has been located on Chromosome 22q11 and sequenced. The variation is a transition from G (guanine) – A (adenine) in the DNA sequence. It leads to valine being substituted for methoionine in codon 158 of the enzyme. This enzyme has been shown to be involved in the breakdown of certain neurotransmitters. So an error in the makeup of the enzyme will disrupt this breakdown process, leading to more or less of the neurotransmitter in question being present in the synapse in particular regions of the brain. (N. Rose, 2007: 205) According to N. Rose, genetic susceptibility studies are more philosophically nuanced (and economically beneficial) than single‐gene studies. N. Rose’s position is that even 90
though the polymorphism on Chromosome 22q11 might be said to increase one’s susceptibility to schizophrenia or depression, it may not necessarily cause it, making this reductionism an object of sociological investigation (N. Rose, 2007). Neurogeneticists, according to N. Rose, are now in the position to claim that because polymorphisms might lead to mental illness, in some cases and inn some environmental contexts, genetic screening can focus on the pre‐symptoms of mental distress. He argues that “Psychiatric researchers [express] optimism about the implications for patients and their search for susceptibility genes and presymptomatic diagnostic tests, enthusiastically supported by those who have long argued that there is a genetic basis for mental disorder” (N. Rose, 2007: 206). Obviously, the market for women and men susceptible to mental illness is potentially boundless, which leaves sociologists like N. Rose understandably uneasy. N. Rose writes: “Biotech companies…launched a depression and anxiety gene discovery program…with an eye on the potential market for new medications” (N. Rose, 2007: 206). The focus on predictive and/or preventative medicine, which is largely based in pre‐symptomatic speculation of potential genetic polymorphisms, leaves sociology in a necessary position to ethically engage with neurobiological theories of uncertainty (N. Rose, 2007: 207). According to N. Rose, psychiatry has little grounding in neurobiology despite an academic (and financial) collusion dating almost a century, and “has thus far failed to identify a single neurobiological phenotypic marker or gene that is useful in making a diagnosis of a major psychiatric disorder or for predicting response to 91
psychopharmacologic treatment” (N. Rose, 2007: 207). As N. Rose argues, biological psychiatry is aware of the limits of biological markers for diagnosis and treatment, yet remains optimistic about the future possibilities of genetic screening. It is now time, N. Rose continues, to focus on a new hope: “To generate a research agenda that will, in the decades to come, lead to a diagnostic and classificatory system based directly in these molecular brain states” (N. Rose, 2007: 207). N. Rose, however, who demonstrates inconsistencies in the molecular approach to genetic susceptibility from a Foucauldian understanding of the material/discursive practices giving rise to what he calls the “biological citizen,” remains at somewhat of an epistemological distance from approaches that examine the mutually constitutive ways in which matter and sociality intra‐act (Barad, 2008; see also Latour, 1988; N. Rose, 2007: 130‐132; Wilson, 2008; Hird, 2009). Throughout his work, N. Rose values ways in which genetic and neuroscientific research provides potential “valuable resource[s] for the generation of intellectual property rights, for biotechnological innovation, and for the creation of biovalue,” but does not theorize the sociality or agency of matter itself, especially its potential significance in providing new understandings of schizophrenia and depression (2007: 133). As I demonstrate in the following chapters, science studies scholars, and Wilson in particular, manage to address the ontology of “matter” where N. Rose does not. In his latest work, N. Rose does acknowledge that a sociological understanding of 92
ontology is important (2007: 130).54 As he argues: “I suggest that contemporary genetics is beginning to operate in a ‘flattened’ world, a world of surfaces rather than depths…the genetic code is no longer thought of as a deep structure that causes or determines, but rather as only one set of relays in complex, ramifying, and nonhierarchical networks, filiations, and connections” (N. Rose, 2007: 130). In this reading of the non‐causal power of genes (see also Fox Keller, 2000), N. Rose argues that an ontology of genetics is important; yet, I should note that he does so without elaborating on the complexity of DNA itself, except to say that our understanding of genes is more complex than determinate. This he situates as it relates to personhood: “Perhaps,” he writes, “we need to analyze the way that genetics and genetic risk might figure in the forms of personhood associated with a post‐ontological conception of life, a vitality not of depths and determinations but of surfaces and associations” (N. Rose, 2007: 130). Here, Rose stops at person(human)hood without discussing the ontology of the nonhuman, especially DNA. In his article on the neuroscience of Antisocial Personality Disorder (APD), itself a problematic pathologization, Pickersgill similarly makes a case for ontology in the sociology of science, arguing that “a critical sociology of ontology remains acute” insofar 54
As Dean contends, N. Rose’s ontology, or what he calls a “critical ontology of our[selves]” is one that aims to “understand how human beings came to be thought of characterized as having a certain psychological interiority in which the determination of culture could be inscribed, organized and shaped into a distinctive personality or character” (1996: 220). This reading of ontology, of course, only includes humans, whose “psychological interiority” is governed by scientific practices and knowledge, which are culturally inscribed (Dean, 1996). 93
as “biopsychosocial understandings potentially legitimate category expansion and controversial techniques for the governance of risky individuals” (2009: 58, my emphasis). From this perspective, which echoes N. Rose’s work, Pickersgill defines ontology as the ambiguity in the classification of APD, because scientists themselves remain ambivalent with respect to the diagnosis of the disease (Pickersgill, 2009: 57‐58). He writes: “These ambivalences draw attention to, first, the oscillation between different kinds of disease concepts structuring theory and research into personality disorder, and thus the lack of consensus regarding its ontology, and, second, the ‘kind‐
making’ scientific investigation achieves even as ontological uncertainty endures” (Pickersgill, 2009: 57‐58). Again, Pickersgill defines the ontology of disease by the ambiguity in classification nosologies used by scientists (such as the DSM‐IV), a position that stops short of accounting for the agency and relationality of somatic processes in their materialization (Barad, 2007). Conclusion In the first half of this chapter, I outlined approaches to understanding mental health that situate material‐discursive dimensions of mental illness (linguistic, social, political, and historical aspects) as a sociological object of study. Epistemologically, this subfield of sociology takes the experiences of psychiatric survivors as the basis from which we can understand, interpret, and, to a more political extent, challenge the ways in which discourses of science produce or constitute mental illness as an abnormal genetic or 94
neurological pathology (Foucault, 1961; Burstow, 2004). While not explicitly anti‐
science, many of these social constructivist approaches see the discourses of psychiatric science as a naming process widely accepted by scientific consensus (Hewitt et al., 2000; Lewis, 2000, 2006; Kecmanovic, 2009).55 Cautious of scientific data because of its often reductive techniques, Hewitt et al. argue that, while it is important to study the rise of anti‐depressants such as SSRIs (selective serotonin reuptake inhibitors), an “account of how [anti‐depressants] affect the neurotransmission process is beyond the scope [of sociology], and in many respects quite beside the point” (2000: 163). This epistemological tradition, emerging as it did from the 1960s postmodern turn in the sociology of mental health, demonstrates that sociology might still be in the midst of a fractured ontological debate between “the real” and “the social,” the latter the primary focus for social scientists, the former for biologists only (Wilson, 1998; Hird, 2004; Davis, 2008). 55
It is also important to note here that, as Ahmed points out, “realists” (such as Davis, Barad, Hird, Wilson, as Ahmed suggests) have unfairly criticized constructivists as not being concerned with materiality or the biological, yet provide few examples in their own critique (a point against which I disagree with Ahmed). Her argument is that there has been a “’routinization’ of the gesture of pointing towards the anti‐biologism or constructionism of others, whereby this anti‐
biologism itself functions as a form of bad faith” (Ahmed, 2008: 25). While I take her point that it is important to offer specific examples of how constructivism might actually be anti‐science or anti‐biological, her work often misses the ontological significance of what Davis calls the “entanglement of biology with sociality” (Davis, 2008: 79; see also Barad, 2007, 2008). I argue that despite the important work coming out of the sociology of mental illness, all of which raises essential points about the social significance of psychiatry, genetics, neuroscience, etc, this does not deal with the ontological entanglement between biological and sociality. Is this entanglement an issue for sociology? I raise these questions again in Chapters 5 and the Conclusion where I discuss emerging epistemological bridges between sociologists and molecular biologists in neuroscience and epigenetics (Cromby, 2004a). 95
In the second half of this chapter, therefore, I explored positions that are attempting to bridge this schism by engaging with the biological sciences through what might be characterized as a Foucauldian realism, that is, a study of ways in which social, economic, political, and biological processes are implicated in constitutive relations. Even though some sociologists engage with “data” or biological matter in a perfunctory way, and often avoid theorizing the “materialization” of matter itself, these positions, as I discussed, promisingly and optimistically seek to create new epistemological alliances with the sciences by avoiding “straw‐person” analytical techniques still lingering in both the social and biological sciences (Martin and Ashrcroft, 2005; Canning et al., forthcoming). In particular, this sociology of mental health is collaborating in inter‐
/transdisciplinary ways with scientists to understand the complex interaction between genes and the environment, theories of the plasticity of brains in different environments, and how non‐reductive and reflexive neurological/genetic theories of mental illness might contribute to sociological understandings of the lived, embodied experiences of women and men (Cromby, 2004a). In what remains of this dissertation, I pick up from this development in science studies in order to demonstrate how other sociologists of science, such as Latour and Wilson, emphasize the social/discursive alongside the agency of biological matter so as to collapse the subject/object and matter/social bifurcation that I argue is common in both the social and biological studies of mental health (Wilson, 1998, 2004, 2008; Harman, 2007, 2009; Davis, 2008; Barad, 2008; Hird, 2009). It is now to Latour’s work that I turn as a theoretical model. 96
Chapter 4: Bruno Latour and Actor Network Theory Modernists claim to purify natural things by filtering out arbitrary perspectives, fetishes, and gullible credos, approaching ever more closely to the objective structure in the world. But at the same time, they try to liberate the free dignified choice of humans from all the supposed alienations stemming either from barbaric superstition, or from capitalist consumer society. Yet some purifications are impossible, since there were never two opposed zones in the first place. There is nothing but a cosmic hailstorm of individual actants, none of them inherently natural or cultural, and all of them simply acting in their own way. (Harman, 2009: 73) Introduction In this chapter, I outline a science studies approach that is attempting to bridge the subject/object and matter/culture distinctions by embracing an object‐oriented56 metaphysics, as advanced by Latour and Harman.57 This chapter’s orientation to mental 56
Latour argues that sociology has had a hard time coming to grips with objects because, as he suggests, “to become a social scientist is to realize that the inner properties of objects do not count, that they are mere receptacles for human categories” (Latour, 1993: 52). Later, in Pandora’s Hope, he clarifies this position further: “The name of the game as not to extend subjectivity to things, to treat humans like objects, to take machines for social actors, but to avoid using the subject‐object distinction at all in order to talk about the folding of humans and non‐humans. What the new picture seeks to capture are the moves by which any given collective extends its social fabric to other entities” (Latour, 1999a: 193‐194). 57
I am indebted to Dr. Harman for sending me the manuscript of his most recent book, Prince of Networks: Bruno Latour and Metaphysics (2009), months before it was being sent to press. Without his generous support of my project, supplying me with his extremely informative book about Latour, an entire chapter on Latour may not have appeared in this dissertation. Since the writing of this chapter, the book has been published by re.press as Open Access. All pages in this chapter correspond to Harman’s draft manuscript, not the most recent online or printed version. 97
health, through Latour, means challenging the notion that mental illness is a stabilized set of affairs, a place where actants such as brains, genes, diagnostic manuals, and psychiatric survivors are reduced to linguistic, social, or political explanations (Harman, 2009). Latour reminds us that ontology and epistemology have never been distinct entities.58 Instead, they have become bifurcated within a Cartesian, modernist framework dominating both social and biological accounts of the world of words and objects (Latour, 1999a; see also Haraway, 2004 [1985]; Hird, 2009). In this chapter, I trace Latour’s critique of constructivism (and scientific positivism and reductionism)59 by demonstrating ways in which his epistemology, Actor Network Theory (ANT), lays the groundwork for a science studies approach to sociological and biological accounts of schizophrenia and its cognate mental illnesses. This chapter further highlights how this field of science studies is challenging the assumption that social and biological worlds are in some way ontologically or epistemologically distinct (Latour, 1993). ANT’s commitment to the mutual constitution 58
Breaking down the dualisms of Western metaphysics and the epistemological and ontological commitments of a traditional disembodied science studies, for Latour, is about “granting ontology back to non‐human entities, [so that] we [can] then begin to tackle the major question at issue in the science wars: the modernist Enlightenment” (Latour, 1999a: 287). 59
Through his own critique of social constructivism, Latour challenges reductionism found in the natural sciences, as well as in social science methodologies mimicking (positivist) scientific methods. For example, Latour calls into question ways in which quantitative sociology “[produces] a science of humans as hard as that of natural objects” (2000: 112). Latour continues: “Unfortunately, although it tastes and smells like hard science, those all‐terrain ‘scientific methodologies’ are a sham and a cheap imitation for a reason that has become clear if we go back to the definition of objectivity” (2000: 115). As I mention in Chapter 3, the search for an objective sociological methodology is common in epidemiological studies of mental health (Turner et al., 1995; Mirowsky and Ross, 2002; Warner, 2009). 98
between human and nonhuman actants—in the case of mental illness, these actants might include genes, neurons, synapses, laboratories, psychiatric survivors, geneticists, and others—is the ontological basis from which my current project originates. In Chapter 5, therefore, I engage with a number of actants that are entangled within one of the gatherings surrounding neuroscientific, genetic, and sociological knowledge and the human/nonhuman forces “acting” therein. According to Latour, the world is made up of myriad human and nonhuman actants, each existing in relational networks with other actants. While multiple definitions of the actant appear throughout all of Latour’s work, beginning with his discussion of microorganisms, laboratories and scientists in Science in Action (Latour, 1987: 83‐90), Harman provides a succinct, if creative, definition: [T]he world is made up of actors or actants (which I also call ‘objects’). Atoms and molecules are actants, as are children, raindrops, bullet trains, politicians, and numerals. All entities are on exactly the same footing. An atom is no more real than Deutsche Bank or the 1976 Winter Olympics, even if one is likely to endure much longer than the others. (2009: 12) In Pandora’s Hope (1999a), Latour offers a definition of his own: “Since in English ‘actor’ is often limited to humans, the word ‘actant,’ borrowed from semiotics, is sometimes used to include nonhumans in the definition” (1999a: 303). The most important point to take from Latour’s ongoing definition, and Harman’s reading of Latour, is that actants are forces, associations, collisions, or gatherings between humans and nonhumans; they 99
are not objects or subjects; they “are not specters hovering before the human mind” (Harman, 2009: 4); they are not monads, noumenon or things‐in‐themselves (Harman, 2007); they exist through resistance; actants are, in a positive sense, relational forces defined by their gathering with other forces (Latour, 1988). Actants exist through resistance because, as Harman argues, an object is “neither a substance nor an essence, but an actor trying to adjust or inflict its forces” (Harman, 2009: 13‐14). In other words, “[w]e call ‘true’ whatever has attached itself to something more durable, less vulnerable to the resistance of other actants” (Harman, 2009: 23). In this chapter, I borrow the term “gathering” from Latour to designate my own understanding and critique of what he calls associations or alliances between actants (Latour, 2007: 140; Latour, 2008). Because alliances denote cooperation, and certainly some associations are not entirely cooperative, “gathering” implies that some actants can also be associated in a negative sense.60 For example, a psychiatric survivor is 60
This statement might further sum up what I see as a limitation of Latour’s epistemology, wherein all reality is relational, but not all reality is symmetrical. Latour writes on numerous occasions that what makes actants real are their relations, and that no actant is more important ontologically than the next; humans and nonhumans are in constant mutual negotiation and coproduction. As Harman summarizes, “Pasteur brings microbes into focus from the dubious grey matter and various symptoms by which they are announced; in turn, microbes bring Pasteur into focus as a genius and national hero. Pasteur and the microbes need one another” (2009: 160). However, even though human and nonhuman actors co‐produce one another, as in the case of Pasteur and the microbes, other co‐productions may not necessarily be as symmetrical or reciprocal, despite being as “real” as Pasteur and his microbial allies. For example, a pharmaceutical corporation exists in relations to the women and men consuming their products, but a psychiatric survivor living in poverty by no means affects the corporation symmetrically. To criticize the corporation as only a source of abstract power, or to critique it as “constructing” mental illness, is to ignore what Wolfe calls the relations producing epistemological “rules of knowledge” for a given practice—in this case, pharmaceutical treatment (Wolfe, 1998: 50). The tracing of any Latourian network first demands a praxis 100
associated with the pharmaceutical industry and with biotechnologies, but the relationship might not be in alliance. Yet, psychiatric survivors and biotechnologies exist, in some way or another, in a gathering. I suggest that the strength of actants’ associations does not necessarily require cooperation, as Latour commonly describes, but rather the gathering of actants in a particular network that can be positive or negative or both. As Harman notes, DeLanda calls this plane “actualism,” or concrete entities existing through relations (Harman, 2009: 14). If there is a central thesis to all of Latour’s work, it is that an actant is its relations, which are specific associations with non‐essential alliances, or events without essence (Harman, 2009: 15‐17; see also Latour, 2005). The ontological commitment to actant as relations separates Latour from social constructivism and what he sees as outdated realism(s) (Harman, 2009; see also Latour, 1993a, 1999a). How to grasp (empirically verify) the relations between material objects is the metaphysical question that separates Latour from his counterparts in the Sociology of Scientific Knowledge (hereafter SSK). As an offshoot of Durkheimian sociology, SSK typically investigates how practices and knowledge of the natural sciences shape, and are shaped by, what is broadly referred to as “society,” “social order,” “social practice,” “social dimension,” and/or “social structure” (Latour, 2005: 3; see also Latour, 1993a: concerning which actants we take to be “matters of concern” (Latour, 2005: 260‐261; Latour, 2008). I return to this discussion at the end of this chapter. 101
54‐55; Latour 1999b; Bloor 1999). Proponents of SSK are concerned mainly with the social, cultural, historical, and political implications of natural scientific projects, and how science studies scholars access and interpret the social consequences of scientific knowledge (Bloor, 1992, 1999; Lynch, 2002). This entry point, commonly associated with the “Strong Programme” (Lynch, 1992: 219‐220; Bloor, 1999; Latour, 1999b; Seguin, 2000), assumes that the natural sciences, and the objects of the natural world they study, are in some way ontologically barricaded from the social; “society,” in this sense, becomes a singular, predefined, stabilized noun in which scientific knowledge and natural (nonhuman) scientific objects are contained (Latour, 2005). As Latour contends, SSK provides science studies scholars with a social explanation of the world, without going beyond the “boundary of the social in order to grasp natural and material objects” (Latour, 2000: 109). However, according to Feher, who defends the Strong Programme from ongoing Latourian criticisms, Bloor and others do not necessarily reject the existence of material objects in the world. Instead, as she suggests, it is not SSK’s position to investigate the meaning of nonhuman matter because these objects remain objects‐in‐themselves in science: “For [Bloor], to put it simply, there are no external clear cut objects (entities, events), given in Nature for us to refer to as such. There are no metaphysically given Xs in reality, just there in order for us to merely recognize and identify them. This does not mean, however, the denial of the existence of external reality” (Feher, 2007: 237). In other words, even though there might be objects in the world studied by scientists, we 102
cannot fully know these objects, and thus it is not in SSK’s interest to enter these debates. This approach has been termed methodological relativism, which, according to Lynch, is one that investigates “the conditions [that] bring about belief or states of knowledge” but remain “impartial with respect to truth and falsity, rationality or irrationality, successes or failures” of scientific truth claims concerning objects in the world (Lynch, 1992: 219).61 As Harman points out, Latour’s approach to science studies has placed him in a paradoxical position between constructivism and realism. Harman writes: “For mainstream defenders of science, [Latour] is just another soft French relativist; for disciples of Bloor and Bourdieu [SSK], his commerce with non‐humans makes him a sellout to a fossilized realism” (Harman, 2009, 4). In other words, Latour has been charged by the Strong Programme as being “too” realist, often defined as a “tin man tainted by realism, a compromised figure who pulls up short of explaining science by social factors” (Harman, 2009: 9; see also Bloor, 1999; Latour, 1999b). He has also been banished from the “hard” sciences for his so‐called relativism, “tautological parlor tricks,” and deep rejection of scientific realism (Gross and Levitt in Lynch, 1996: 248‐
249). This paradox is highlighted in Pandora’s Hope, where Latour looks to displace the subject/object distinction in crude forms of social constructivism and realism 61
According to Slezak, SSK’s focus on the contingent, historical nature of scientific theories only, and whose proponents such as Bloor remain impartial to external objects yet continue to call themselves realists, are firmly constructivist because they assume that “rational” scientists are out to discover the “nature” of an independent reality, which is often not the case in science (see Slezak, 2000: 10‐12). 103
respectively, replacing it instead with “factish,” a potential meeting place for the gathering of realism and constructivism (Latour, 1999a). Instead of asking whether things are socially constructed or exist “in themselves,” Latour asks how we might come to terms with fact versus fabrication. He asks, When a fact is fabricated, who is doing the fabrication? The scientist? The thing? If you answer ‘the thing,’ then you are an outdated realist. If you answer ‘the scientist,’ then you are a constructivist. If you answer ‘both,’ then you are doing one of those repair jobs known as the dialectic, which seem to patch up the dichotomy for a while…allowing it to fester at a deeper level by turning it into a contradiction that has to be resolved and overcome. (Latour, 1999a: 281) One of Latour’s most compelling contributions to science studies is his challenge to, and (re)orientation of, the subject/object distinction that has defined science studies to date (Bloor, 1999; Latour, 1999b; Harman, 2009: 11‐12). As I discussed earlier in the dissertation with reference to the specific context of mental health studies, for many social scientists trained in critical social theory, social and natural scientific phenomena are regarded as linguistic events in which “the social” is ontologically privileged (see Bloor, 1999; Latour, 1999b; Barad, 2007). As Harman argues, Western metaphysics permits and encourages sociologists and philosophers to speak about humans and nonhumans as “semiotic tokens,” and “objects of practical manipulation, loci of human power, or flowery literary figures” (Harman, 2002: 105). 104
Sociologists and philosophers, he continues, are often worried about the “encroachment of the sciences on their domain that they have locked themselves away in a linguistic, pragmatic ghetto” (Harman, 2002: 105). Latour certainly accuses some sociology of focusing entirely on human discourse, and/or human power in its relationship with knowledge (Latour, 1993b). According to Latour, even if science studies scholars agree that a nonhuman actant (for example, DNA) exists in the world, this actant is more often regarded as being actualized only by what humans call it, how we engage with it, or how it produces meaning as a social fact or utterance (see Bloor, 1999). In this example, DNA is explained as a social phenomenon because SSK ignores its ontological relations to other actants, many of which are not human (Latour, 2000: 110). Harman goes so far as to suggest that the social sciences and humanities are afraid to fight for, as he calls it, “reality itself” (Harman, 2002; see also Latour, 1999a, 2005; Haraway, 2007). Throughout the development of science studies, this orientation towards a constructivist interpretation of scientific knowledge from the Strong Programme has, according to Latour, deepened the misunderstanding between sociology and the sciences (Latour, 1999a: 115; see also Bloor, 1999; Latour 1999b). Harman calls those maintaining a tendency to privilege language over objects “deflationary realists,” according to whom “the inseparability of reality and context means that there is no coherent way to talk about things in themselves apart from human practices” (Harman, 2002: 122). Latour, Harman, Haraway, Barad and Hird avoid this tendency to quarantine 105
“the cosmos within a network of human significance” (Harman, 2009: 123) through their examination of nonhuman actants, each of which, in its own ontological, democratic way, exists as relations (Latour, 1988, 1993, 1999a, 2005; Barad, 2007, 2008; Hird, 2009). The dangerous, yet persistent assumption in sociology that empiricism is necessarily a reductionist project is a potential barrier to bridging social and biological worlds (Latour, 1993a; May, 1993; Fee, 2000a, 2000b; Burstow, 2004). Latour suggests that, by discarding science, or at best in their discussion of empiricism, Foucault and other poststructuralist theorists are guilty of creating and simultaneously reinforcing what Latour calls “scientism,” 62 an attack against a unified epistemological project in 62
While I disagree with Latour’s wholesale rejection of post‐structuralism, he correctly suggests that there is a lingering “anxiety” in social scientists and philosophers about their relationship to the biological sciences, which are seen as something extraordinary and untouchable (Latour, 1993). Latour also criticizes Feyerabend because he tended to “debunk” science, which “[makes] people believe in the thing being debunked” (Latour, 1993b: 255). Here I am thinking specifically of Feyerabend’s Against Method (1975) in which he challenges the idea that science has a privileged position with respect to truth, echoing Lyotard’s challenge to the metanarratives of science. Kuhnian in many ways, Feyerabend’s critique of science is less concerned with the objects of science than it is a historical examination of the “anarchic” ways in which positivist science operates epistemologically and methodologically to produce statements of truth (Feyerabend, 1975: 158). Latour’s contention with Feyerabend is that focusing primarily on the anarchic methods of science, which are “the preconditions of its progress” (Feyerabend, 1975: 158), he unwittingly reinforces the popular notion that there is a true method against which the existing messiness of science can, by logical extension, be measured (Latour, 1993b). Feyerabend advocates for a science that uses a pluralistic methodology, one that uses a myriad of systems that bring about “a new outlook and considerable contempt for the science of the schools, its methods, its results, and even for its language” (1975: 114). However, Latour disagrees with Feyerabend’s anarchist reading of science. He argues, “Again, it is a debunking strategy, and all debunking makes people believe in the thing being debunked. The attitude of unveiling and denouncing the falseness of the scientific method always reinforces the argument of the scientist, so I think Feyerabend has been rather counterproductive” (1993b: 256). According to Latour, “the attitude of unraveling and denouncing the falseness of [scientific discourses] always reinforces the argument of the scientist” (Latour, 1993b: 255). While 106
laboratories that entails little concrete understanding of the objects that natural scientists study.63 This is summed up in an interview with Latour: [Foucault] slashes knowledge/power, discourse/society, but adding a slash does not solve the question. He raises the problem but hasn’t done the work. His knowledge/power works for the social sciences, but what about the hard ones? My suspicion is that he has retained the typically French attitude – a complete belief in the solidity of the hard sciences. (Latour, 1993b: 252) He continues by noting the tendency to fear the nonhuman within post‐structuralist accounts of science: [French science studies] have been so taken up with [a fight against empiricism] – rediscovering the importance of practices and knowledge, interpretation and theory in the making of science – that when someone asks about the role of nonhumans, they see it as a return to the hated empirical tradition. (Latour, 1993b: 255; see also Wilson, 1998) sympathetic to the criticisms levied against the politics of scientific knowledge and epistemology, Latour is critical of Foucault, Lyotard, and Feyerabend’s approach to science because it reinforces that there is some sort of true, empirical method going on in laboratories, “which makes you believe it is important to find a true method” (Latour, 1993b: 255). Latour’s critique of post‐structuralism, however, does not give fair credence to the work of Lyotard, Foucault, and Feyerabend, who, in many ways, each laid the groundwork for Latour’s own science studies. 63
For a similar critique of the tendency within the social sciences and humanities to engage with “science from a distance” because of a fear of empiricism, see Wilson, 1998: 1‐5. I return to this discussion in the next chapter when I demonstrate Wilson’s largely understudied engagement with gatherings between humans and nonhumans in psychological and neuroscientific studies of mental health and illness. 107
According to Latour, instead of distantly studying science, or outright dismissing empiricism as many post‐structuralist and social constructivist theories have done (Fee, 2000a, 2000b; Ussher, 2000, 2005), science studies must examine inside/outside, subject/object, nature/culture as not binaries but “active categories” with an “active agency created by the actors themselves” (Latour, 1993b: 256; see also Pickering, 1993; Barad, 2007; Davis, 2008). These are binaries that, as Latour highlights in We Have Never Been Modern (1993a), have never been epistemologically distinct (Latour, 1993a: 54‐
55). In the following sections, therefore, I will outline why and how ontology, epistemology, and metaphysics matter to a Latourian approach to science studies. Ontology, Epistemology, and Metaphysics Science studies texts rarely discuss the importance of ontology (Hull, 1988; Pickering, 1992, 1993, 1995; Ross, 1996; Fox Keller and Longino, 1996; Pickersgill, 2009). By default, however, texts written about the sciences are entangled with ontology, that is, with a “description of the basic structural features shared by all objects” (Harman, 2007: 188). While a historical survey of science studies’ relationship to ontology, epistemology, and metaphysics is beyond the purview of this dissertation, in this section I discuss the sociological significance of these terms, and engage with them so as to promote the need for science studies to make explicit our relationship to philosophy. 108
To begin with, I engage with Harman’s object‐oriented philosophy, from which I borrow the idea that ontology can be merged with epistemology and metaphysics, and that metaphysics can become a project for the social sciences and humanities as well (Harman, 2007, 2009). Ontology, according to Harman, is metaphysics64; furthermore, acknowledging the entanglement of ontology and metaphysics allows science studies scholars to “break free of the epistemological deadlock [between what is “human” and “nonhuman”] and reawaken the metaphysical question of what relations mean” (Harman, 2007: 173). For Harman, ontology must rework “the separation of humans and everything else” because being is not only revealed in the human mind, nor do objects act independently of the mind in some pure realist sense (Harman, 2007: 172). Rather than ontology designating “a global war between beings,” Harman shifts the definition of ontology to describe the way in which objects come into contact in the world through relations (Harman, 2007: 172). Hird shares this view of ontology. As she writes, “…ontology does not suppose being as prior to signification (as in classical realism and some cultural feminist theory), 64
In fact, as Harman argues, ontology and metaphysics are not distinct in realist philosophies, because if we take all objects (both human and nonhuman) in the world as having a place in ontology, “there could be a metaphysics of artwork, psyche, and language, and even of restaurants, mammals, planets, teahouses, and sports leagues” (Harman, 2007: 204). In Vicarious Causation (2007), Harman makes a temporary case for the separation of ontology from metaphysics through a discussion of sensual objects. He writes, “sensual objects [could] be confined to a metaphysics of human perception, with no place in an ontology designed to address plastic and sand dunes no less than humans” (2007: 205). However, in defense of realism and the merging of ontology with metaphysics, he goes on to problematize his own point, suggesting that “the confinement of sensuality to the human kingdom must be refused” (2007: 205). It is here where he deploys Latour’s ontology, which does not barricade pencils, bees, rowdy children, bacteria, or neurons from the “human kingdom” (Harman, 2007: 202‐205, 2009). 109
but neither does it understand being as a product of language” (Hird, 2004: 67). Hird furthers her definition of ontology in her latest book, The Origins of Sociable Life (2009), as follows: A microontology would understand humans to be enmeshed in a complex web of co‐domestications…such that natural, social and cultural selection may not be so definitively distinguished. Taking research on bacterial self‐organization, communication, complexity, division of labor, and communities seriously suggests that bacteria are not only social in and of themselves, but also – through symbioses – weave all organisms into cultural and social co‐constructions and co‐evolutions. (Hird, 2009: 87) Following from the work of Latour, Harman, and Hird, therefore, ontology is understood as weaving together of gatherings, “co‐domestications,” or “mangles” between the human and nonhuman, and metaphysics “[signifies] the discussion of the fundamental traits of specific types of entities” and their relations between other entities or actants (Pickering, 1993; Harman, 2007:188; Hird, 2009). In human‐centered philosophies that underscore social constructivism, culture (or society) provides the ontological starting place (Latour, 1999a: 149). For Latour and Harman, however, an empirical study of the association between actants has the potential to dissolve the duality of nature and society, as well as ontology and epistemology, because relations between actants exist independently of human representation through language (Latour, 1999a: 146‐148). In this respect, all actants 110
exist on “exactly the same footing” (Harman, 2009: 12), none more important than the other.65 As Harman writes, If we say that one actant is more important or more significant than any other, we attribute to it, or reduce it to, mere human representation. If, on the other hand, we treat all actants equally, without privileging one over the other, we are able to actually investigate its relationship, its association, to other actants. (Harman, 2009: 41) What this means, to Harman and Latour, is that the relationship between the mind and DNA, for instance, is no different ontologically than the association between DNA and the microscope. According to Latour, then, the task of the researcher is to investigate the association between actants without relegating DNA and the microscope to a realm of linguistic representation, or unwittingly defining them by the outdated realist term of “things in themselves,” which ultimately ignores the relations between them as actants (Latour, 1988). Latour’s metaphysics and object‐oriented sociology were shaped largely in Irreductions (1988), in which he outlines his philosophy in complex aphorisms, each of which builds upon his main thesis: actants exist in their relations or trials of strength (Harman, 2009; Latour, 1988: 158). As Harman suggests in his analysis of Irreductions, 65
I return to this idea at the end of this chapter where I offer a modest critique of Latour’s work. There, I discuss the difference between actants as “ontologically equal,” and actants as “politically (a)symmetrical,” a distinction in Latour’s theory that could use more unpacking. 111
“Actants are mirrors defined by their relations, yet the utter concreteness of these relations make every mirror an island, unable to endure any shift in relations. This paradox is the engine of Latour’s philosophy, and it powers a new style of metaphysics” (Harman, 2009: 6). In Irreductions (1988), Latour discusses ways in which actants become “realized” through their alliance with other actants in temporary relationships, or, more fittingly, irreducible moments: “an actant can gain strength only by associations with others” (Latour, 1988: 159‐160). He returns to this theme throughout his work, calling on sociologists to be rigorous in our empirical investigation of the relationships between actants, human and nonhuman alike (Latour, 1999a, 2005). For Latour, nothing in the world is necessarily ordered in an ontological sense, but exists through “laws”—a term he uses cautiously—of association (Latour, 1988: 161‐164). All actants have the potential to become realized, or actualized, through what Latour calls “grades of resistances” (Latour, 1988: 161). Our job, as sociologists, is to “carefully establish these connections” through arduous and continuous theoretical and empirical labour (see Harman, 2009: 17). In Irreductions (1988), and subsequently in We Have Never Been Modern (1993a), Pandora’s Hope (1999a), and Reassembling the Social (2005), Latour theorizes the agency of actants; “Plague bacteria have strategies as subtle as those of IBM,” he writes (Latour, 1988: 161). Actants’ agency becomes actualized when they are measured against each other. This does not mean, however, that an actant requires a human observer to define or interpret its agency. For example, as Hird points out, bacteria have 112
agency and their own alliances independent of what is said about them: “[T]he biosphere has its own agency, its own liveliness, which far exceeds any human purview: bacterial inventions and interventions defy the healthiest human imagination” (Hird, 2009: 11). As Latour argues, even in science there are only trials of strength: “[Science] is a name that has been pasted onto certain sections of certain networks, associations that are so sparse and fragile that they would have escaped attention altogether if everything had not been attributed to them” (Latour, 1988: 216). Yet, ironically, the idea that actants “do” things independent of the human mind has prevented many science studies scholars (chiefly from within SSK) from empirically understanding, as Hird and Latour attempt to do, the ways bacteria are bound by, and help shape, their own agency and associations outside of the human mind (Latour 1988, 1999a; Hird, 2009). This does not mean that humans cannot study bacteria, but the fact humans might study their relations or “co‐domestications” does not, from this perspective, “turn the world into a matter of human perspective” (Harman, 2009: 24; Hird, 2009: 87). Nature/Culture In We Have Never Been Modern (1993a), Latour argues that all actants exist on the same ontological footing in an epistemological meeting place between Nature and Culture. This does not mean, however, that nature and culture are epistemologically separate, or have been separate in the past, only to be rejoined by Latour’s philosophy (Latour, 1993a; Harman, 2009: 72‐73). Rather, positing a “nonmodern” epistemology against an 113
otherwise modernist (or, conversely, constructivist) one, Latour points to a meeting place between the two extremes. For Latour, reality does not necessarily exist as some sort of combination between nature/culture, which reinforces an epistemological split, nor does it, as Harman argues, exist through some sort of purification, as we have seen in modernist epistemologies (Harman, 2009: 70‐74). Latour’s thesis in We Have Never Been Modern follows as such: “If we consider hybrids, we are dealing only with a mixture of nature and culture; if we consider the work of purification, we confront a total separation between nature and culture. It is the relation between these two tasks that I am seeking to understand” (Latour, 1993a: 30). Harman summarizes this thesis: Modernity tries to purify the world by dissecting it into two utterly opposed realms. On one side we have the human sphere, composed of transparent freedom, ruled by arbitrary and incommensurable perspectives. On the other side we have nature or the external world, made up of hard matters of fact and acting with objective, mechanical precision. As Latour puts it in a later book, a pluralistic multiculturalism is opposed to a homogenous mononaturalism. We are told that nature is one, but that humans have numerous diverse perspectives on it. Not surprisingly, Latour rejects the modern vision. There are not two mutually isolated zones called ‘world’ and ‘human’ that need to be bridged by some sort of magical leap. (Harman, 2009: 72) 114
Latour argues, then, that the hybrid66 is unable to challenge this epistemological dead‐
end because it simultaneously paralyzes scientific realism and constructivism (Latour, 1988), a debate against which he directs many scathing criticisms. He writes: “Hybrids cannot be grasped either by scientific realists, the power‐gamers of sociology, or deconstructionists, because as soon as we are on the trail of some quasi‐object, it appears to use sometimes a thing, sometimes a narrative, sometimes a social bond, without ever being reduced to mere being’” (Latour, as cited in Harman, 2009: 82). According to Latour, reality is also not a mixture of nature and culture, and constructivists and realists will have a difficult time communicating so long as these epistemological boundaries are said to exist (Latour, 1993a). As such, Harman argues that “realists and constructivists will be able to quarrel…for centuries: the former will declare that no one has fabricated this real fact; the latter that our hands alone fashioned this social fact” (Harman, 2009: 74‐75). Latour’s use of the term “hybrid” suggests that reality cannot simply be a mixture of Nature and Culture (Harman, 2009: 80). Determining how to collapse the binary – ontologically, epistemologically, and methodologically – is the difficult task, especially because, to date, science studies scholars have few ways of understanding reality as anything other than a combination of Nature/Culture. 66
Latour discusses at length global warming/climate change as an example of a hybrid as event, which, by extension, is an association between actants – humans, carbon dioxide emissions, melting glaciers, newspapers, etc. (Latour, 1993a). 115
The Circulatory System of Science In Pandora’s Hope (1999a), Latour argues that the “mind‐in‐a‐vat,” his own term for the modernist, rational scientist, has dangerous consequences for distancing oneself from reality (5‐6). Describing what he sees as the historical construction of “paradigm prisons,” he argues that “instead of a mythical Mind giving shape to reality, carving it, cutting it, ordering it, it was now the prejudices, categories, and paradigms of a group of people living together that determined the representations of every one of those people” (Latour, 1999a: 6). That is, to avoid what he terms “mob rule,” positivist epistemologies have become fearful of being overrun by the social world that is branded as opposite to reason: the non‐human or sub‐human (Latour, 1999a: 10‐11). Later in Pandora’s Hope, in an attempt to “reconstruct the whole circulatory system of science,” Latour deploys blood flow as a metaphor for the way scientific facts circulate (1999a: 80). To this end, while noting the importance of the “circulatory system of scientific facts” (Latour, 1999a) to the functioning of the heart, the aim of science studies, according to Latour, is to provide a social explanation of science with a renewed conception of the social, a point to which he returns in Reassembling the Social (2005). Latour’s goal of deploying the circulatory metaphor is to (re)situate the social within an object‐oriented science studies (Harman, 2009); for if we want a “social explanation” of science, then science studies must grant “equal right to existence, regardless of the size [or] complexity” because, as Harman continues, “anything in the world must count as an actant, whether natural or artificial, as long as it has some sort of effect on other things” 116
(Harman, 2009: 16, my emphasis). According to Harman, Latour’s circulatory reference “captures the whole of his metaphysical positions, which replaces the tragic gap of subject and object and a secular plane of countless dueling actors” (Harman, 2009: 92). Latour suggests that there have been two major misunderstandings that have made science studies incomprehensible in mapping the circulatory system of science (Latour, 1999a; Harman, 2009). The first is the belief that science studies can seek a social explanation of scientific facts, and the second is the belief that this deals only with discourse and rhetoric (Latour, 1999a). Science studies, Latour argues, rejects the idea that science is disconnected with the world “out there,” but must not simultaneously fall into mere constructivism (Latour, 1999a). Here, Latour sets up pure science versus pure politics in an attempt to bridge the so‐called “twilight zone” between the two extremes. A tunnel, Latour argues, can fill the empty space between the “meres,” with hopes of “meeting in the middle” (Latour 1999a: 85). At this point, Latour continues, science studies can proceed “without prejudice” and without postulating an incommensurable divide between science and politics (Latour, 1999a). Science studies, as Latour demonstrates in the middle chapters of Pandora’s Hope, will reveal a posteriori (deriving knowledge from experience) work that bounds scientists and politicians irrevocably. Science studies, then, “merely provide[s] a means of tracing this connection between science and society when it exists” (Latour, 1999: 86‐
87). The idea of translation, Latour continues, provides the two teams of scholars, one coming from the side of politics and the other science, towards a circulatory reference 117
(Latour, 1999a). He returns to this idea later in Reassembling the Social, where, instead of rejecting real things as things in themselves (which is naïve realism), “Latour holds that a thing becomes increasingly real the more associations it has” (Harman, 2009: 95, my emphasis). To this end, according to Harman, Latour is neither a constructivist nor scientific realist, because, as he puts it, “uranium and paraffin construct Joliot’s existence every bit as much as French society molds and shapes them in turn” (Harman, 2009: 95). Furthering his metaphor of science studies as circulatory, a position borrowed from his earlier collaborative work with Woolgar (Latour and Woolgar, 1979), Latour argues that science studies must follow leads, nodes, and pathways of inquiry no matter how crooked or unpredictable they may look to traditional philosophers of science. According to Latour, science studies must attend to the following five major aims: (1) to recognize the means by which nonhumans become mobile and available for arguments (Latour 1999a: 99); (2) to convince others of the ways in which a discipline or profession has its own form and criteria of evaluation; (3) to create alliances within science by placing the discipline in a context for others to join, understand or support; (4) to report to the outside world through epistemology; and (5) to recognize the “tight knot” at the center of the net, or the conceptual core that is the container of science, not something to be contained (Latour 1999a: 106). Later in Pandora’s Hope, Latour asks: “how can I convince my scientific friends that by studying the vascularization of scientific facts we gain realism and science gains 118
hardness?” (Latour 1999a: 109). Instead of a continuous path or discursive translation, in order to regain a sense of realism, Latour argues, the study of science must abandon “society” as the primary source of explanation (1999a, 2005). This would have science studies begin to measure misunderstanding between those who say they provide social explanations of science, which Latour sees as being contained within dualist paradigms. He argues: We do indeed alternate between states of social and states of non‐human relations, but this is not the same as alternating between humanity and objectivity. The mistake of the dualist paradigm was its definition of humanity. Even the shape of humans, our very body is composed to a great extent of socio‐technical negotiations and artifacts. To conceive of humanity and technology as polar opposites is, in effect, to wish away humanity: we are socio‐technical animals, and each human interaction is socio‐technical. (Latour, 1999a: 214) Here, Latour ultimately attempts to break down modernist assumptions that continue to perpetuate the nature/culture dichotomy. Pandora’s Hope also offers ways of shifting the focus from the infighting associated with defining science studies (often referred to as the “Science Wars”) to the real point of critique, which is Enlightenment modernism (Latour, 1999a; see also Ross, 1996). Whereas social constructivism, and to some extent phenomenology, has bracketed the world as being descriptive in nature, and positivist science deals with the 119
nonhuman through causation or determinism, Latour avoids this “modernist purification” by challenging both “free human consciousness and mechanical clockwork causation” (Harman, 2009: 100). Instead, Latour proposes a science studies that does not search for scientific essences or linguistic utterances of either the social or biological. Instead, everything has the potential to come together, through alliances, and it is our job to trace the “nature of their union” (Harman, 2009: 106). This is, apparently, not to deny the importance of politics in science, nor is it to put politics at the forefront of any study of the natural sciences, because “For Latour, all reality is political not because human power inextricably shapes the truth, but because truth and reality are assembled through chains of actors in the same way that bills go through Congress” (Harman, 2009: 117‐118). A Latourian Methodology: ANT In Reassembling the Social (2005), Latour outlines the methodology that follows from his philosophical discussion of actants and relationality. ANT, or what he otherwise calls “tracing associations,” is a “methodology” that furthers a promise he made earlier in Pandora’s Hope: to do away with the “useless concept of society” (Latour, 1999a). As a general introduction to ANT, Latour suggests that pure social explanations have become an epistemological dead‐end to a “sociology of the social,” and science studies, particularly, because they are “counter‐productive way[s] to interrupt the movement of associations instead of resuming [them]” (Latour, 2005: 8). The task of ANT, in this 120
regard, is to study (and re‐study ad infinitum) the assemblages of nonhuman and human actants that are formed by and through what Latour calls an empirical “thick description” of the gathering of things, which become, he contends, “matters of concern” (Latour, 2008). In what remains of this dissertation, I highlight neuroscientific and social scientific studies that describe what Latour might call a “thick description,” or a tracing of the association(s) between specific human and nonhuman actants entangled within what we call “mental illness.” As Latour suggests, “The main advantage of dissolving the notion of social force and replacing it either by short‐lived interactions or by new associations is that it’s now possible to distinguish in the composite notion of society what pertains to its durability and what pertains to its substance” (Latour, 2005: 66). ANT, an anti‐reductionist empiricism, is directed toward the tracing of associations within a meeting place between full causality (reductionism) and sheer existence (positivism) (Latour, 2005: 72). Before examining how Latour’s anti‐reductionist empiricism might be helpful for a science studies approach to mental health, however, I will now give a brief overview of a few limitations of, or questions emerging from, his ontology and epistemology. Limitations of a Latourian Approach to Mental Health I begin this section with a few seemingly unanswered questions emerging from Latour’s 121
work. How would a science studies scholar trace her or his own tracings? Put differently, how would the scholar self‐reflexively situate her or his epistemological approach? If science studies scholars are, as Latour advises, to take all actants into account, how can they make an insertion into scientific practices and knowledge without falling into relativism? If, as Latour also advises, “one must practice sociology in such a way that the ingredients making up the collective are regularly refreshed,” what ingredients “matter,” so to speak, for our next insertion (Latour, 2005: 261)? The first step in answering these questions, I contend, is to situate Latour’s work within a pragmatist framework, one advanced convincingly by Wolfe in Postmodern Theory and the Pragmatics of the “Outside” (1998). As Wolfe urges, a science studies approach must seek to comprehend the “specific, material effects of scientific discourse and practice” so as to “forge a more socially and politically responsive pragmatist critique of knowledge” (1998: 52). Finally, then, what are the pragmatic and/or political implications of a Latourian epistemology? To answer the first question—how might the scholar trace her or his own tracings—first demands, as I suggested, a self‐reflexivity on the part of the researcher to make pragmatic insertions determining how certain actants become “matters of concern” (Latour, 2005). A matter of concern, Latour argues, “is what happens to a matter of fact when you add to it its whole scenography, much like you would do by shifting your attention from the stage to the whole machinery of a theatre” (2008: 39). In other words, to challenge statements of fact, sociologists of science should turn their 122
attention to the multiplicity of actants existing through relations, which reveals the “fragile envelopes in which they are housed” (Latour, 2008: 39). To follow Latour’s metaphor, “matters of concern” in the theatre beyond the stage might be electrical circuitry behind the lighting, audience members, the ticket vendor, or the program, each of which, in some way or another, exists through relations. But should, or can, everything be taken into account as an actant in this scenario? Even though matters of concern are disputable, as Latour contends, why is it that I made an insertion to follow the actants I just mentioned over others (Latour, 2008: 39)? Why not the neurons in the brain of the lead actress, the psychological stress of the other actors, or gendered dialogue in the play itself? Latour has a vague and perhaps even moralistic answer to this question: “matters of concern have to be liked” (Latour, 2008: 47). I contend that the “choice” to follow certain actants is undoubtedly a political and epistemological one, and that ANT leaves little room to meta‐analyze or strategically reflect upon how one goes about making the judgment to study one matter of concern over another. As Harman writes about Latourian metaphysics, “If the pragmatism of knowledge becomes a pragmatism of ontology, the very reality of things will be defined as their bundle of effects on other things” (Harman, 2009: 95). And yet, in this collapsing of the pragmatics of epistemology into a pragmatics of ontology, how do we make political claims, even if committed to a Latourian ontology of actants‐as‐relations or as “bundles of effects” (Harman, 2009)? 123
The second question—if scholars are, as Latour advises, to take all actants into account, how does she or he avoid relativism—therefore follows from the first. Latour reminds us that the embeddedness of the nonhuman in politics is as important as the embeddedness of the social and material consequences of scientific knowledge. The task, then, is to be responsible about making epistemological claims, while still maintaining a pragmatist, political commitment to the very matters of concern we first find concerning. Latour writes: “matters of concern…have to be kept up, cared for, accompanied, restored, duplicated, [and] saved” (Latour, 2008: 49). What he does not say about “matters of concern,” however, is how science studies can account for why it chooses to trace particular actants.67 Therefore, to avoid sliding into epistemological relativism, which would suggest that all actants should be taken into consideration, science studies must first make pragmatic, political, and above all ethical insertions about its claims concerning the relations between human and nonhuman things. The envelope is certainly fragile, as Latour admits, but science studies scholars are contained—pragmatically, politically, and ethically—within epistemological envelopes nonetheless. This brings me to my final question: what are the politics of a Latourian epistemology? 67
In the following chapter, I make particular interventions into the neuroscience literature on mental health, taking from it certain “actants” swarming around what we know of as “mental illness,” such as cognition, affect, epigenetics, diagnostic manuals, and psychiatric survivors. It is entirely reasonable to assume that another study of mental illness would reveal to me, or anyone else, a refreshed set of actants, or to follow Latour’s metaphor, new “ingredients making up the collective” (Latour, 2005). 124
Latour considers his epistemology to be thoroughly political (Latour, 2005). Latour argues that to challenge the humanist assumption about the separation of humans and nonhumans is to forge new political possibilities (Latour, 2005; Pickering, 2008). “To raise a political question,” he writes, “often means to reveal behind a given state of affairs the presence of forces hitherto hidden” (Latour, 2005: 260). Revealing forgotten forces is political in nature because it grants democratic agency to human and nonhuman actants previously ignored in critical sociology (Latour, 2005: 259‐261). Wolfe notes that “…if the modernist constitutional separation of human and nonhuman has the practical advantage of allowing the proliferation of networks, it also has the pragmatic drawback…of ill equipping contemporary society to explore in a thoughtful way how its relations to and in hybrid networks should be lived” (Wolfe, 1998: 44, my emphasis). As Haraway suggests, science studies’ politics should be built into epistemology through the making of particular insertions, rather than becoming the result of an epistemology or ontology of reality‐as‐relations (Haraway, 1992). What ANT has tried to do, Latour contends, “is make itself sensitive again to the sheer difficulty of assembling collectives made of so many new members once nature and society have been simultaneously put aside” (Latour, 2005: 259). Yet, Latour’s description of ANT as methodology makes troublingly little commentary on how science studies can engage in politically and ethically motivated conversations about how “matters of concern” present themselves in the first place; and, in “registering the novelty of associations,”68 I 68
In Reassembling the Social (2005), Latour argues that ANT should “register the novelty of 125
contend that ANT must also remain aware of the idea that novelty should not trump ethics (Latour, 2005). In order to effect an analysis, ANT must not let its ontology and epistemology forget its politics. Conclusion In this chapter, I outlined what Latourian ontology and epistemology might look like as the basis for a science studies approaches to mental health. What I see as being most compelling about Latour’s approach to science studies, despite its pragmatic shortcomings, is the way in which Latour seeks a new actant‐based definition of the world through a rigorous empirical examination of both human and nonhuman actants. For the remainder of the dissertation, I investigate how neuroscientists and sociologists are ostensibly attempting to advance what Latour sets forth: to empirically reassemble the relations between human and nonhuman actants so as to arrive at new ways of theorizing mental illness in the age of the neurosciences. associations and explore how to assemble them in a satisfactory way” (Latour, 2005: 261). 126
Chapter 5: Neuroscience, Matter and Mental Health Introduction Returning to and expanding upon themes I initially raised in Chapter 3, particularly surrounding the recent move in sociology to begin collaborating with the natural sciences, and building from a Latourian approach to science studies I outlined in Chapter 4, this chapter is motivated by three main goals. First, I give an overview of how the neurosciences are, in some instances, challenging biological/neurological reductionism by “mangling” the social and the biological, and explore how this emerging epistemological trend might come to bear on social studies of mental health and illness (Pickering, 1993; Cromby, 2004a, 2004b; S. Rose, 2009). Central to this approach is the creation of a more “integrative neuroscience,” one that aims to “transcend older dichotomies between, for instance, cognition and affect, nature and nurture, neurological and psycholog[ical]” (S. Rose, 2009: 4; see also Henningsen and Kirmayer, 2000). Cromby’s important work in this field calls the integrative approach a “socio‐
neural” perspective, one which “challenges the individualizing biomedical accounts that [have] prevail[ed]” in mental health research, but does not abandon an attention to neurological matter (2004a: 17; see also Wilson, 1999). Second, I critically engage with Wilson’s research concerning cognition, psychology, neuroscience, mental health, and feminist theory, which, as I contend, proposes topical and compelling ontological, epistemological, and methodological ways in which the social sciences might engage 127
with neurological matter itself. Whereas, as I outlined in Chapter 3, N. Rose and others argue that a realist account of the configurations between social, cultural, biological, and economic forces is important for sociology of mental illness, Wilson engages equally with both “skin‐encapsulated” matter and with the “cultural milieu” of mental health in order to re‐theorize embodiment (Wilson, 1998). Third, I situate epigenetics, with its increased focus on the relationality between molecular (internal) and social (external) environments, as one practice through which sociologists of science might theorize the intra‐activity between social and biological determinants of health and illness. Building from Chapter 4, the final section of this chapter is therefore based on my reading of how the rapidly expanding sub‐field of molecular biology might contribute to sociological understandings of mental health. S. Rose has been particularly outspoken since the early 1980s about why the social sciences should engage meaningfully with the neurosciences, and visa versa, ultimately avoiding what he calls “cultural and biological determinisms” resulting from disparate approaches to health and illness (S. Rose et al., 1984; S. Rose, 1998, 2003 2009).69 While his work is more specifically oriented to challenging evolutionary psychology and neo‐Darwinian theories of evolution (S. Rose 1998, 2003, 2009; S. Rose 69
In order to avoid what S. Rose calls “cultural determinism,” a reverse claim that mental illnesses are solely a cultural process of labeling (Rose et al., 1984: 75‐81), Rose claims that sociology must also complicate the long lasting nature/nurture dichotomy in its own research (Rose et al., 1984: 76‐7; see also Stevens, 2005: 138). According to Rose et al., “the contrast between biological and cultural determinism is a manifestation of the nature‐culture controversy that has plagued biology, psychology, [and] sociology since the early part of the nineteenth century” (1984: 267). 128
and H. Rose, 2009), S. Rose suggests that a non‐reductive, biochemical account of brain functioning can be a close ally of critical theory. According to S. Rose, social scientists studying the material‐discursive effects of molecular biology are, at times, epistemologically and ontologically naïve because, even if scientists’ work is couched in a logic of genetic susceptibility (N. Rose, 2007), scientists do avoid crude forms of genetic reductionism in their work (Hedgecoe, 2001). As S. Rose argues, [Reductionism] has a number of serious consequences. It hinders us biologists from thinking adequately about the phenomena we wish to understand. But two consequences at least lie in the social and political domain rather than the scientific, and need spelling out briefly here. First, reductionist ideology serves to relocate social problems to the individual, thus “blaming the victim” rather than exploring the societal roots and determinants of the phenomena that concern us…The second immediate social consequence of reductionist ideology is that attention and funding is diverted from the social to the molecular…But for any such phenomenon there is also determining levels of explanation – those that account most clearly for the specificity of the phenomenon, and also indicate potential access points for intervention into it. (S. Rose, 1998: 298‐
299) For S. Rose, it appears, challenging reductionism does not necessarily mean abandoning what he calls “determining levels of explanation,” which might also be described as 129
social and scientific interventions into the myriad of intra‐acting70 factors and relations (biological, social, economic, political) that influence how we understand illness. As he writes, “Good, effective science requires a better recognition of determining explanation, and hence of the determining level at which to intervene” (S. Rose 1998: 98). This does not demand that social and natural scientists search for an absolute causal mechanism of schizophrenia and/or depression, locating this mechanism on a single gene or neurotransmitter. Using determining levels of intervention to comprehend the complex intra‐activity between social and biological worlds (what Latour might call the tracing of associations) potentially disrupts the still prevailing insistence that mental illness is either biologically or socially constructed (see also Hacking, 2000).71 For S. Rose, precisely how sociologists can engage with the materiality of genes, neurons, and their interaction in “the environment” remains unclear. And yet, he argues, the social sciences must remain aware that some neuroscientists are challenging reductive, neo‐liberal, and individualized readings of the brain by showing brain matter to be an “open‐ended network” situated within the “social world,” not barricaded from 70
I discuss the concept of intra‐action, and Barad’s work more broadly, in the introduction. Please see pp. 16‐18. 71
Even though this might seem like an outdated question, I continue to see it asked in sociological circles. For instance, see the most recent call for papers in Social Alternatives, in which a section of this chapter was published. In the call for papers, the editor asked for submissions that address the following question: “Is schizophrenia socially or biologically constructed?” (Palmer, 2008: 3; see also Boyle, 2002). 130
it (S. Rose, 1998; Cromby, 2004a; see also Damasio, 1994). As S. Rose, Lewontin, and Kamin argue, an adequate theory of mental illness must incorporate social and cultural environment(s), without, as they argue, reducing psychological suffering to a “dualistic agnosticism” found in both social and biological determinisms (1984: 231). As Stevens notes, S. Rose’s skepticism of neuroscientific reductionism is significantly influenced by both the anti‐psychiatry movement and the changing political climate of 1960s scholarship, but, epistemologically, does not abandon a study of the materiality the brain, such as molecular mechanisms of DNA (Stevens, 2005). “Developmental plasticity,” S. Rose’s term that challenges popular forms of genetic determinism, can be measured materially, for “[neuronal] systems do not exist in the brain in the abstract; they are called into play by actions, and are as transient and dynamic as the actions themselves” (S. Rose, as cited in Stevens 2005: 144).72 In other words, while no definitive correlation has been found between specific genes or molecules and schizophrenia, social studies of the neurosciences, including critical perspectives on neuroscientific work, can still understand, and politically engage with, these abstract, communicative, and fluid synaptic connections (S. Rose 1998; Wilson 72
Rose also refers to the material process of plasticity as autopoesis, which he defines as a process “shaped by the interplay of specificity and plasticity. In so far as any aspect of life can be said to be ‘in the genes,’ our genes provide the capacity for both specificity – a lifeline relatively impervious to developmental and environmental buffeting – and plasticity – the ability to respond appropriately to unpredictable environmental contingency, that is, to experience” (Rose, 1998: 306). 131
1998).73 It is precisely in response to this point that Wilson’s research attempts to fill a gap between social and biological accounts of mental health and illness (Gergen et al., 1996; Wilson, 1996). Before discussing Wilson’s important work in this area, however, I will give a more detailed overview of both reductive neuroscientific approaches to mental health, and more recent developments that challenge neurological reductionism by comprehending the constitutive relations between the social and biological (S. Rose, 1998, 2009). Mental Illness in the Age of the Neurosciences Coined by George H.W. Bush as the “decade of the brain,” and nominated by the US National Institute of Mental Health (NIMH) as a “promising time to enhance public awareness of the benefits to be derived from brain research” (NIMH, 2000), the 1990s saw an unprecedented rise in studies seeking to trace neurophysiological origins of a wide range of behaviours, such as schizophrenia, depression, AD/HD, and autism, as well as behaviours and traits that were previously thought to be primarily “social” or 73
A synaptic connection is the way in which nerve cells communicate with each other through synaptic input. The thread‐like extensions at the end neurons (dendrites) transmit signals from neurotransmitters, which then pass on certain information between communicating neurons (Laughlin and Sejnowski, 2003). As Laughlin and Sejnowski summarize, “nerve signals are transmitted from cell to cell only via specialized junctions. The transmitting neuron has a slightly swollen terminal point, which houses small vesicles that are filled with neurotransmitters. Upon arrival of a nerve signal, the vesicles spill their content into the narrow space between two cells. The released neurotransmitter molecules flow across the gap to the adjacent nerve cell and bind to specific receptor proteins on the receiving cell's membrane. If the receiving cell is a neuron, the binding of the neurotransmitter will generate an electrical impulse that travels along the length of the cell” (Laughlin and Sejnowski, 2003: 1870). 132
“cultural” in origin, such as criminality, risk‐taking, and racial, sexual, and gender differences74 (Dumit, 2004; McGuffin, 2005; Martin and Ashcroft, 2005; Racine et al., 2006). Central to this development in the neurosciences was the merging of genetics, cognitive neuroscience,75 neurophysiology, and psychiatry, a collusion that was made possible by an equally unprecedented expansion in technological techniques, such as functional magnetic resonance imaging (fMRI) and molecular neuro‐genetics.76 While the cooperation between neuroscience and psychiatry during the 1980s and 1990s was not a new development in the history of medicine,77 the merging of cognitive 74
The list of human behaviours studied by the neurosciences is expansive, including, but not limited to, aggression, happiness, suicide, addiction, love, and social and political values (Gergen, forthcoming). See Wilson (2004) for a more detailed critique of neuroscience reductionism as it relates to sexual difference (2004: 53‐62). 75
Cognitive neuroscience, by itself, was not a new development in the 1990s, but has its origins in the 1950s, a time when computer science and neuroscience began building models to study what many thought were deep computational structures of the human mind (Thagard, 2006). As Thagard summarizes, “according to the computational hypothesis of cognitive science, the mind is a mechanism whose parts are mental representations of various sorts that are organized such that there are computational procedures that operate on them to produce new representations” (2006: 3). However, the computational approach to human thought and action is highly contested (Wilson, 1999; Damasio, 2000; Henningsen and Kirmayer, 2000; Cromby, 2004a; Thagard, 2008; Rose, 2009). 76
As S. Rose concludes, genetic and protein sequencing techniques “enable the structures of individual receptors to be determined, and thus make it possible for pharmaceutical companies to engage in the rational synthesis of molecules designed to interact precisely with specific receptors,” a very profitable outcome of neuro‐genetics and neuropharmacological science (2009: 13). 77
The cooperation between the neurosciences and psychiatry has a long and controversial history, and has been documented by historians such as Grob (1983), Valenstein (1986), Porter (1987), Shorter (1997), Braslow (1997), and Tone (2008), among many others. Important themes from this literature include: the link between cortical function, hallucinations, and schizophrenia, theories for which dominated the 18th and 19th centuries (Grob, 1983); lobotomy as a form of treatment for schizophrenia and depression and the Nobel Prize to Egas Moniz in 1949 (Valenstein (1986); the origins of the DSM‐I in 1952 (Grob, 1983); the rise of 133
neuroscience and molecular genetics with psychiatry was new, boosting the validity of a science profession still marred by decades of challenges to its grounding in science (Kirk and Kutchins, 1992; Shorter, 1996; S. Rose and H. Rose, 2009). As S. Rose and H. Rose argue, “contemporary genomics and neuroscience not only claim to explain how the brain and, hence, the mind work, but also to put psychiatry on a sound scientific basis” (2009: 8).78 However, the synthesis between genetics, cognitive neuroscience and psychiatry is still underscored by determinisms, albeit nuanced ones (Henningsen and Kirmayer, 2000; Hedgecoe, 2001). As S. Rose suggests, this collusion continues to espouse “the prospect of identifying, ascribing causal powers to, and eventually modifying genes which affect brain and behaviour” (S. Rose, 1998: 275‐276). According to Williamson, however, “it has become increasingly obvious to many investigators that [genes for schizophrenia] are not going to be found,” because, he admits, “schizophrenia is not likely a simple genetic disorder nor is it likely accounted for by a few major genes” (2007: 953). psychopharmacology in the 1940s and 1950s, which came to supplant post‐war psychoanalytical theory (Shorter, 1997); randomized control trials and psychiatric treatment (Shorter, 1997; Tone, 2008); and neurodevelopmental factors leading to mental illness (Andreasen, 2001). 78
It is important to note here an emerging and troubling mind‐brain/brain‐mind reductionism in cognitive neuroscience. S. Rose and H. Rose argue, for example, that the decade of the brain has now been supplanted by the “decade of the mind,” because, as seen in computational neuroscience in particular (c.f. Wilson, 2006), the brain “has the mind, but the mind is not the brain because the latter is hard wired to be the mind; you are your brain” (S. Rose and H. Rose, 2009: 14). Not surprisingly, however, even neuroscientists are challenging this reductionism (see S. Rose, 1998, 2009; Damasio, 2000; Thagard, 2006, 2008; S. Rose and H. Rose, 2009). I return to this discussion shortly. 134
While genetic studies linking single nucleotide polymorphisms (SNPs) to complex diseases such as schizophrenia have “not proved helpful” (S. Rose, 2009: 13), recent research focuses on the molecular basis of cognitive impairment (the coding of proteins, for instance) as possible sites of complex diseases (N. Rose, 2007; Petronis, 2007). The field of molecular genetics focuses on the structure of neuronal circuits leading to “cognitive dysfunctions,” the basis from which mental illness can be located, and, ultimately, treated (Andreasen, 2001; Weinberger et al., 2001; Williamson, 2007). In neuroscience literature, “neuronal circuits” generally refer to the function or malfunction of distributed neurons throughout different regions of the brain, including, for example, the prefrontal cortex and temporal lobe (Andreasen, 2001; Weinberger et al., 2001). Weinberger et al. summarize this approach to the study of mental illness as follows: “1) abnormalities of intrinsic prefrontal neuronal circuitry and information processing are core biological aspects of schizophrenia; 2) many of the clinical and biological features associated with schizophrenia are emergent phenomena related to this core biology; and 3) a genetic polymorphism that affects prefrontal information processing is a risk gene for schizophrenia because it interacts with this core biology” (2001: 833). More specifically, Hall et al. argue that, although the etiology of schizophrenia is still unknown, the gene NGR1 on Chromosome 8p is a “promising candidate susceptibility gene for schizophrenia with a range of roles in nervous system and development” (2006: 1477). Changes in the transcription levels of NGR1 can result in 135
“abnormal brain function and psychotic symptoms associated with schizophrenia,” which can lead to “cognitive dysfunctions” traceable to the frontal and temporal lobes of the brain (2006: 1477‐1478; see also Barch, 2005: 878). Williamson’s research is motivated by a similar promissory reductionism, one which suggests that particular neuronal connections in the amygdala (located in the medial temporal lobe, and part of the limbic system, an area of the brain that has been linked to emotion79 and other cognitive behaviours such as memory) are associated with “self‐monitoring and stimulus‐independent thought, referred to as the default network,” and that “networks associated with attention‐demanding tasks, referred to as the task‐related network” could have implications for understanding schizophrenia (2007: 954; see also Gur et al., 2006). In other words, Hall et al. and Williamson’s (2007) research into the molecular basis of schizophrenia attempts to link specific neuronal networks to specific cognitive 79
There is considerable debate within neuroscience literature as to whether emotion is a cognitive trait, or whether it is possible to separate biological substrates from any emotion (see LeDoux, 1996; Damasio, 1999, 2000; Pert, 1999; Wilson, 1999; Lane and Nadel, 2000; Wilson, 2004: 93). The reductive view in cognitive neuroscience is one which presupposes that “errors or biases in reasoning and information processing produce unhelpful attributions, learned helplessness, or a ‘negative cognitive triad.’” In this formulation, “to the extent that feelings or emotions figure at all in such accounts, they play a secondary role, typically appearing as the effects of faulty reasoning or cognitive errors” (Cromby, 2004a: 15). As Wilson summarizes, however, “the traditional notion that psychological capacities are sequestered in specific areas in the brain (emotions down here, cognition up there) is now widely contested” (2004: 94). Following Wilson, then, if emotional and cognitive “worlds” are a “series of interfacing systems,” and not distinctly neurophysiological processes (Damasio, 1994, 2000; LeDoux, 1994), how might we study them sociologically (Wilson, 2004:94; see also Cromby, 2004a)? I return to this discussion shortly. 136
traits, the latter necessary for, and implicated in, the definition and diagnosis of mental illness (Gur et al., 2006).80 Harvey (2008) similarly argues that the genes RELN (Chromosome 7q22), FABP7 (Chromosome 10‐QTL), and CHRNA7 (Chromosome 15q13‐14) all code for proteins that could “underlie certain endophenotypic traits in schizophrenia” (67). RELN, for example, codes for a reelin protein81 regulated in the brains of some women and men with schizophrenia. Harvey speculates that “performance in verbal and visual working memory tests in the nuclear families of the sufferers [of schizophrenia] was greatly decreased” because of variants of this protein (2008: 22‐67). Furthermore, FABP7 codes for the fatty acid‐binding protein 7, which is a single nucleotide polymorphism (SNP) linked to “prepulse inhibition,” or early sensory processing in the brain (Harvey, 2008: 67). Harvey also suggests that the gene CHRNA7 codes for the neuronal nicotinic acetylcholine receptor alpha7 subunit, which is a receptor “known to improve inhibition, pre‐attentive and attentive state[s]” (Harvey, 2008: 68). Important to these inconclusive studies is the underlying assumption that molecular processes are linked to specific cognitive “dysfunctions,” such as loss or hindrance of memory, lower IQ, inhibition, loss 80
In particular, “cognitive symptoms” of schizophrenia in the DSM‐IV include: disorganized thinking, slow thinking, difficulty understanding, poor concentration, poor memory, difficulty expressing thoughts, and difficulty integrating thoughts (American Psychiatric Association, 1994). More specifically, one “negative symptom” of schizophrenia is avolition, or the “reduction, difficulty, or inability to initiate and persist in goal‐oriented behaviour” (American Psychiatric Association, 1994). 81
A reelin protein is one that helps with neuronal movement and positioning in the developing brain (Harvey, 2008). 137
or lack of attention, and flatted or blunted affect (Gur et al., 2006), and can therefore be traced to specific mental illnesses such as schizophrenia, because, conveniently, these cognitive traits serve as diagnostic categories, or endophenotypes, in the DSM‐IV (Weinberger et al., 2001; American Psychiatric Association, 1994). Endophenotype is an important, albeit philosophically slippery term used in more recent genetic studies of mental illness. Understanding the obvious limitations of genotype‐phenotype82 causal connections in complex conditions such schizophrenia and depression, neuroscientists such as Harvey and Caspi and Moffitt have turned to the term “endophenotype” in order to refer to “heritable, neurophysiological, biochemical, endocrinological [biochemistry of hormones], neuroanatomical, or neuropsychological constituents of disorders.” Endophenotypes, therefore, “are assumed to have simpler genetic underpinnings than disorders themselves” (Caspi and Moffitt, 2006: 583). As Caspi and Moffitt write, the search for the genetic basis of an endophenotype is much “easier” than the search for the genetic basis of a phenotype, which ultimately replaces the etiology of an illness with the genetic basis of its diagnostic term (Caspi and Moffitt, 2006: 583). I do not mean to “deconstruct” the DSM‐IV by pointing out this tautological reductionism. What I will demonstrate now, however, is that some neuroscientists are challenging the reductionist claim that “broken” molecular circuitry in the brain, linked 82
Phenotypic traits are the observable characteristics or functions of an organism, such as its physiological properties or behavior. 138
to certain cognitive traits, including blunted affect, necessarily “causes” mental distress. This is not to deny the materialization of molecular processes in the brain and body, nor is to suggest that schizophrenia, for example, is only socially or culturally constructed through diagnostic nosologies. How, though, are neuroscientists using matter’s intra‐
action with cultural milieu in order to debunk the persistent assumption that mental illness emerges from a “disordered mind” caused by the “dysfunction” of neuronal circuitry in the brain (Henningsen and Kirmayer, 2000; S. Rose and H. Rose, 2009)? To begin with, as Martin and Ashcroft summarize, “contemporary work in the neurosciences presents a more fluid and socialized idea of [behaviour], in which many aspects of behaviour are shaped by both biological and social factors” (2005: 27). What might this more “fluid” and/or “socialized” neuroscientific approach to mental illness look like, especially alongside theories of affect, embodiment, and the politics of mental health? Antonio Damasio’s work, like S. Rose’s, has been particularly critical of reductionist claims made in cognitive neuroscience (Damasio, 1994, 2000; see also LeDoux, 1996; Thagard, 2006). Damasio challenges neurological reductionism (what he calls cognitivism) by demonstrating ways in which affect, cognition, the body, and culture act as “interlocking systems” (Damasio, 2000). Damasio rejects a computational approach to human cognition by displacing it from the “isolated brain” and reinstalling what he calls “distributed systems of brain‐body‐world” (Damasio, 1994). Furthermore, he remains dubious of what Protevi highlights as two unexamined presuppositions in 139
cognitive neuroscience: “First, that the unit of analysis in an abstract subject, ‘the’ subject, one that is supposedly not marked in its development by social practices, such as gendering, that influences affective cognition, and, second, that culture is a repository of positive, problem‐solving aids that ‘enable the subject’” (2008: 11). S. Rose and H. Rose summarize Damasio’s important work as such: “…it is not surprising that some of the most detailed attempts by a neuroscientist to come to terms with the complexities of [behaviour] have come from Antonio Damasio…[who] has required not just brain imaging, but listening to…patients suffering from disturbances of will and emotion” (S. Rose and H. Rose, 2009: 15).83 Damasio, then, challenges what he calls “mechanistic medicine” through a “neurodynamics” framework, one that examines the “interaction of firing patterns generated by many neuron circuits, locally, globally, moment by moment, within the brain of the living organism” (1994: 259). This does not mean that Damasio removes brain function from its social or cultural contexts. Rather, he sees it as essential to examine the patient’s “developmental history,” including cultural and social level of analyses (Damasio, 1994: 259‐260). As Cromby argues, with respect to mental health, strictly cognitive accounts of behaviour are problematic because they tend to individualize distress “by treating 83
This is an important link to the work of anti‐psychiatrists and post‐psychiatrists, who, as I mentioned in Chapter 2, have lobbied for decades to have the patient’s voice heard throughout the treatment process. Damasio situates neurological processes (measured empirically in the brain and body) as being equal to one’s psychological well being, and neither exists in opposition to, or in competition and conflict with, the other (Damasio, 2000). Interestingly, this embodied approach to health goes against the common claim in studies of mental health that researchers/health practitioners are guided by a mechanistic approach to the study of illness (see Orr, 2000; Marcum, 2004). 140
people’s acquired response to their inequitable experiences as internal [cognitive] errors” (2004a: 15). Damasio, on the other hand, adds a much “richer understanding of behaviour” (S. Rose, 2009) because of his insistence on the importance of affect, or what he calls the “somatic‐marker hypothesis,” in shaping thought and action, which is not, he insists, purely cultural or biological in nature; rather, this hypothesis is part of bodily/phenomenological, neurological/social “embodied” systems (Damasio, 1994: 247). It is the whole organism, of which the brain and body are parts, that is embodied/embedded or “embrained” in internal and external environments (Damasio, 1994: 224; S. Rose, 2009: 18). To challenge the assumption in cognitive science that affect is separate from cognitive behaviours, Damasio states that “There appears to be a collection of systems in the brain consistently dedicated to the goal‐oriented thinking processes we call reasoning, and to the response selection we call decision making, with a special emphasis on the personal and social domains. This same collection of systems is also involved in emotion and feeling, and is partly dedicated to processing body signals” (1994: 70). In other words, emotions and cognitions are “mechanisms of biological regulation” as much as they are shaped by the conditions of bodies‐in‐the‐
world, or, as sociologists of mental health have long argued, by material‐discursive relations linked to psychiatric practices and knowledge (Damasio, 1994, 2000). Damasio’s work profoundly challenges (but also, in many ways, complements) constructivist approaches that situate affect as distinctly cultural, and also challenges cognitive neuroscience that ascribes causal powers to single genes or molecules 141
(Damasio, 1994; S. Rose, 1998). I return to this discussion shortly when I explore Wilson’s work in more detail. Thagard’s research concerning what he calls the “constituent parts” of mechanisms of mental illness follows from Damasio’s work (Thagard, 2008; see also Henningsen and Kirmayer, 2000). For instance, Thagard argues that “human action” (his term for behaviour) is never a “top down” flow from the social to molecular, nor does it flow from the molecular to the social (2006: 11). Rather, “the enormous complexity” of different, yet ontologically equal “mechanisms” shape behaviour, such as cultural influences (discursive, social, and economic conditions), psychological inferences, neural activity, and the “transformation of the molecular” in synaptic communication (Thagard, 2006; see also Henningsen and Kirmayer, 2000). No mechanism, Thagard argues, is necessarily more important than another in understanding behaviour due to, he contends, the risk of an “ontological reductionism,” which assumes that “changes at each level would have to be explained by the changes at the subordinate level, with all changes ultimately being explained at some lower level” (2006: 11). According to Thagard, there is no “whole‐part hierarchy” which assumes that the social determines the molecular, or that “malfunctions” at the molecular level produce cognitive dysfunction that are said to cause schizophrenia (Thagard, 2006: 10‐12). This does not mean, however, that the study of mental illness is entirely relative, because behaviour is always already social, psychological, neural, and molecular. Rather, Thagard seems to suggest, along the lines of Damasio and S. Rose’s work, that both the social and 142
biological sciences need to be guided by a praxis, one that utilizes “determining levels of explanation” through an empirical tracing of how social and psychological behaviour, including affect and cognitions, influences bodily mechanisms, as well as how molecular mechanisms influence and shape the social (S. Rose, 1998; Thagard, 2006). Doing their work means to engage—albeit critically—with each discipline using various interventions into the understanding of human behaviour: anti‐psychiatry and the sociology of mental health’s focus on affect, the experience of psychiatric survivors, and the material/discursive relations of psychiatry; psychology and its focus on cognition, affect, and embodiment (Wilson, 2004); neuroscience and neuronal communication; and molecular biology’s understanding of synaptic connections throughout the body (Wilson, 2004). Cromby (2004a, 2004b) summarizes how this discussion might be helpful for sociological approaches to mental illness. He provides a realist understanding of embodiment, one that takes into account social inequality, its effect on mental health, and neuronal patterns in order to engender an understanding of mental health through what he calls the “socio‐neural perspective.” Cromby writes: [Depression] is not merely incidental, consequent upon cognitive biases and negative self‐perceptions. Rather, they interact powerfully with overt, rational, cognitive processes, in ways that we might not recognize but which can, in conditions of persistent social inequality, initiate and maintain a downward trajectory the consequences of which is the embodied state psychiatry calls 143
depression. Thus, the inclusion of the socio‐neural perspective…mounts a stronger challenge to the individualizing biomedical accounts that prevail because it not only recognizes the societal origins of distress; it also explains its embodied character. (Cromby, 2004b: 17) Here we can see how Cromby’s research maintains a realist orientation to both matter and sociality so as not to bifurcate them as distinct “worlds.” Wilson’s work is motivated by a similar goal: to understand theories of embodiment through a realist approach to matter and sociality. I now turn to her scholarship in the field of science studies and mental health. Elizabeth Wilson, Neuroscience, and Mental Health Throughout this section, I demonstrate how Wilson’s research concerning feminist theory, affect, cognition, neuroscience, and mental health might be considered emblematic of a Latourian approach to science studies, one that is, as Sofoulis argues, “predicated upon a refusal of the old modern disciplinary divide between human and physical and natural sciences, and a radical redefinition of ‘society’ or ‘the social’ to include the multifarious non‐humans we live with and which sustain us” (2009: 2).84 This 84
Wilson has never called herself a Latourian scholar. During the final writing stages of this chapter, however, an article was published that situates Latour and Wilson in a similar realist science studies tradition along with Barad and others, but does not go so far as to call her Latourian (Sofoulis, 2009). 144
section, therefore, aims to situate Wilson’s work in a science studies of neuroscience and genetics that challenges what she calls the “mind‐brain reductionism” of both psychological (social) and psychiatric (biological) science (Wilson, 1998: 130; Sofoulis, 2009). Rather than critiquing scientific reductionism from a distant sociological or psychological position, Wilson’s research, like Latour’s, engages—and, ultimately, transforms—scientific data so as to arrive at new ways of theorizing how the social sciences might better engage with the biological sciences. Wilson’s research is largely based on her own response to what she sees as “tired criticisms” of big “S” science as essentialist, empirical, or “overly rational” by feminists, psychologists, psychoanalysts, and sociologists, approaches that maintain anti‐biological or anti‐science sentiments, and all of which, she argues, “promote a kind of interpretive eugenics that breeds out the bastard children of any liaison with biological and scientific systems” (Wilson, 1998: 3‐4; see also Wilson, 2004, 2008). 85 Like Latour, Wilson does not reject science based on the idea that scientific epistemologies are, by definition, empirical. She does, however, maintain the belief that most science 85
In Neural Geographies (1998), Wilson contends that feminist psychology has done little in the way of engaging with theories of the brain (Wilson, 1998: 103). In her analysis of the convergence between neurology and cognitive science, a convergence of which she is critical, Wilson uses connectionist models and deconstruction (through Derrida) to trace new interconnections between feminist theory, cognition, psychology, and the computational sciences (Wilson, 1998). Her main conclusion follows as such: “The analysis pursued in this book has been motivated by a sense that critiques premised on a primarily oppositional relation to the sciences or premised on antibiologism, antiessentialism, and antinaturalism are losing their cultural and political purchase – not necessarily because there are wholly mistaken, but because they have relied on, and reauthorized, a separation between the inside and outside, the static and changeable, the natural and the political, the chromosomal and the cultural” (1998: 200). 145
has been guided by a reductive positivism, which should be challenged by both social and natural scientists (Wilson, 2004, 2008). Her scholarship, then, takes a non‐reductive, empirical approach to the understanding of the mutual constitution and intra‐action between matter (inter‐ and extra‐bodily) and human life, but does not, in her words, “[fall] into a naïve celebration of the scientific” (1998: 5). Although she never explicitly states such a theoretical positioning, Wilson uses ANT ontologically, viewing actants as existing in the world through relations, epistemologically through the tracing of neuronal networks and their interaction with the gut, and methodologically using a science studies approach to psychological and neuropharmacological science. Wilson strives to trace intra‐acting networks between human and nonhuman actants (or actants within human bodies, such as serotonin) so as to arrive at a practical approach for the betterment of women and men living with psychiatric conditions (Wilson, 2004). I do not believe her work to be, as others have argued, apolitical (Ahmed, 2008). On the contrary, her work seeks to politicize what she calls an “empirical‐deconstruction,”86 which is a challenge to positivist epistemologies, without falling into a postmodern epistemological position that prioritizes discourse over material processes of the body. As she writes, “[R]ather than negating, excluding, or preventing classical political and epistemological projects, deconstruction is engaged 86
For Wilson, deconstruction, or Derridian play, “is not merely textual” (1998: 89). Instead, she uses deconstruction to focus on the “dynamic nature of biological processes” instead of as an exploration of “the ways in which biological knowledge’s are built with conventional binarized structures” (2008: 391), the latter the primary sociological and methodological uptake of Derridian deconstruction. 146
in an examination of the conditions that make such projects possible and the implications and effects of their operations” (Wilson, 1998: 22; see also Fox Keller, 1998). Furthermore, Wilson argues that actants such as serotonin, the gut, and the central nervous system also have a place in politics. Unlike N. Rose and others in bio‐
/neuro‐ethics who render somatic material distinct from social processes as objects for biopolitical investigation, and often define the ontology of sociality as distinctly human, Wilson attempts to politicize both simultaneously. Wilson argues that an embodied approach to mental illness can be understood by the ways in which biological matter intra‐acts with “the cultural milieu,” which is not, as she argues, defined only as human culture; the body is itself “cultural,” in the Latourian sense, because it metabolizes and communicates the breakdown of drugs independently from what might be said about the body through constructivism or biologically through neurological reductionism (Wilson, 1998, 2008; Sofoulis, 2009). Finally, Wilson’s science studies approach materializes and re‐politicizes the anti‐psychiatry position that I outline in Chapter 2. She asks how bodies intra‐act with affective states (i.e., the environment external to, but implicated in, somatic processes), and how difference and identity could be read through somatic processes, such as neurotransmission and the communication between organs in the body, not in spite of them (Wilson, 1998, 2004, 2008). Wilson provides a concrete example of how the matter/culture dichotomy might be “empirically‐deconstructed” in a science studies approach to mental health (Wilson, 147
2008). She writes: While conventional neuroscientific and psychiatric texts often posit a direct link from the drug to brain, close attention to the details of drug absorption, distribution, metabolism, and excretion (what is called the drug’s pharmacokinetics) shows that the viscera [digestive organs] are also essential to how disorders of mood become instantiated and how they can be treated. Rather than validating a single site of determination for mood (brain), the pharmacokinetics of antidepressant drugs shed light on how depression is distributed, in both organic and psychic registers, all through the body. (Wilson, 2008: 379) Recall here Latour’s argument that actants (in Wilson’s case, the actors involved in drug absorption) are real or actualized if they are associated with other actants collaboratively, wherein “the length of associations, the stability of the connection through various substitutions, and shifts in point of view, make for a great deal of what we mean by existence and reality” (Latour, 1999a: 162). By “exploring the collective” of the mind‐brain‐body intra‐action (Barad, 2008), Wilson follows the events of drug metabolism, but does not make claims as to what “causes” or, conversely, might “cure” mental illness (Latour, 1999a: 162). The association between agents in the gut and other organs, including the brain and the central nervous system, is what “articulates” knowledge about pharmaceutical drugs and embodiment, without reducing either to social constructions or hard facts of the brain sciences (Latour, 1999a: 122‐132). Wilson studies these associations in her empirical approach to the pharmacokinetics of 148
antidepressant drugs and how they are processed in the gastrointestinal (GI) tract, “the site at which the drug is absorbed into the body” (2008: 379). Although symptoms associated with the absorption of pharmaceuticals in the GI tract are commonly regarded as being "side effect[s]" (S. Rose, 2007: 203), drugs are crucially absorbed through the gut first, where “nausea, delayed gastric emptying and constipation” are parts of the metabolizing process (2008: 379‐380). Wilson suggests that “the pathways from the gut to that target site [neurotransmitters] are often circuitous," and, for this reason, "it is these pathways that have attracted [her] critical interest” (2008: 380). Wilson’s close reading of the scientific literature concerning the communicative or “cultural” relationship between the central nervous system (CNS) and the enteric nervous system (ENS)87 has led her to challenge the belief that psychological events, the brain, and somatic processes are in some way distinct “actants” existing in isolation from one another (Wilson, 2004, 2008). She writes: “The influence of psychological events on gastrointestinal disorders appears to be widely recognized, yet this influence is usually kept at a distance from the gut—sequestered in the brain or in the vaguest possible terms attributed to external, social factors such as stress” (2004: 34). Wilson further challenges the assumption that humans are the only actors to possess a sociality, because social factors, such as neurotic or depressive states, she contends, are necessarily implicated in, or intra‐act with, somatic processes and bodily functions such 87
The ENS is defined as the “complex network of nerves that encases and innervates the digestive tract from the esophagus to the anus” (Wilson, 2004: 34). 149
as nausea, abdominal bloating, vomiting, diarrhea, and food intolerance, also commonly disregarded in both social and biological sciences as “side‐effects” from what are otherwise referred to as neuron‐targeted or site‐specific drugs (Wilson, 2004: 36‐39; S. Rose, 2007; Begley, 2003). As Wilson argues, the ENS is extensive, and absolutely vital for the breakdown of so‐called site‐specific pharmaceutical treatments. She notes that when we “Add on the nerve cells of the esophagus, stomach, and large intestine …[we will] find that we have more nerve cells in our bowel than in our spine” (Gershon, as cited in Wilson, 2004: 34). Wilson elaborates on this point more fully in her recent work: A drug like an antidepressant that is intended for the CNS must first pass from the gut lumen into the blood stream. Once it has passed through the gut mucosa, the drug is transported via the portal vein to the liver, where enzymes remove a certain amount of the drug (this is called first‐pass clearance). From the liver, the remaining percentage of the drug moves into the fluid inside and between cells of the body’s tissues and organs. The brain is targeted rapidly, as are the liver, kidneys, and other organs that are well supplied with blood. Eventually (this can take anywhere from several minutes to several hours), muscle tissue, the remaining viscera, the skin, and the body’s fat will also be infused with the drug. (Wilson, 2008: 380) From the ENS, drugs such as SSRIs eventually make their way to the brain, but must first negotiate the “blood‐brain barrier” (BBB). The function of the BBB, according to Begley, 150
is twofold: “Firstly, the internal environment of the brain, the brain interstitial fluid (ISF) and the cerebrospinal fluid (CFS) composition have to be controlled within extremely fine limits…so that neurons can perform their complex functions…Secondly, a major function of the BBB is that of neuroprotection. Over a lifetime, a CNS will be exposed to a wide range of neruotoxic metabolites and acquired xenobiotics, which may cause cell damage and death” (Begley, 2003: 84). What Wilson stresses in this case, however, is that scientific and sociological literature tends to barricade the brain from metabolizing processes throughout the body, in particular, the brain’s synaptic connections with the CNS and ENS (2008: 384). As she argues, neurotransmitters, such as serotonin, require “commerce between the brain and gut and the cultural milieu. The basic building block of serotonin is tryptophan, an amino acid that is small enough to cross the [BBB]” (Wilson, 2008: 384). Wilson summarizes this further: “Serotonin, for example, cannot pass the blood‐brain barrier (it is too large). Even though there are significant reservoirs of serotonin in the rest of the body, the brain must synthesize its own serotonin from other molecules that are able to cross the [BBB]. To put this in quotidian form: it isn’t possible to increase serotonin levels in the brain simply by ingesting more serotonin” (2008: 380‐381). Drugs must move through cells because, as Wilson notes, many molecules are too large to break the BBB, which means that they need assistance from SSRI molecules that are “lipophilic” (lipid‐soluble) to pass across the barrier (Wilson, 2008: 381). The drugs eventually make it to the brain, “where they are thought to increase the amount of serotonin available for neurotransmission (by inhibiting its 151
reuptake in the synapse)” (2008: 381). In this analysis, the “outside” environment supplies amino acids through the digestion of foods, such as bananas, fish, and milk. The intra‐action between the foods we eat and the sociality of the BBB defines Wilson’s embodied approach to the understanding of the relationality between somatic processes, and the relationality between organs and “the outside,” ultimately challenging the matter/culture distinction (Wilson, 2008). Following from this, Wilson argues that if we want to understand “pharmaceutical alleviation,” a reductive focus entirely on the brain does little for understanding “animating effects on the viscera” and the entire embodied experience of mental illness and biological treatment (Wilson, 2008: 381). Wilson’s tracing of the intra‐acting actants involved in the breakdown and absorption of drugs raises two crucial points in science studies. First, Wilson takes from biological data that the brain is not an “autonomous organ” that receives molecules in isolation, a notion that is “common enough in both the scientific and popular imaginary” (Wilson, 2008: 384). Second, Wilson’s work elucidates that the breakdown of drugs in the body is a communicative, intra‐acting, and multiple process involving “social environments” of psychological harm, stress, and depressive states, and bodily environments (CNS, ENS, BBB). In particular, Wilson argues that the relationship between the CNS and ENS is as “social” as is the “human” environment, an intra‐acting process that is not simply an anthropomorphization of somatic states; therefore, the gut can literally be intra‐acting with one’s psychological feeling of anger or depression 152
(Wilson, 2008). She summarizes this as follows: “the liver and gut provide the bioaffective tone of depression: if your depressions are agitated, or soporific, or angry, or anorectic, that is due in no small part to the attitude of the visceral organs” (2008: 382). She further suggests about her empirical method that “As we follow these data, we find that the brain is always necessarily implicated in relations with other organs and extra‐bodily systems,” where extra‐bodily systems are defined as enzymes, amino acids, and the “psychocultural milieu governing diet,” all of which are involved, or intra‐act, in depressive states (Wilson, 2006: 129; Barad, 2007). “Too narrow a focus on the brain as the sole biological source of psychological malady,” Wilson continues, “will obstruct the lines of connection that tie organ to organ and that underpin the biological possibility of recovering” (2008: 385).88 Despite claiming that recovery is a biological process, Wilson understands that it is never solely a biological event. In fact, she criticizes the insulation of psychoanalytic theory, which has been rooted in social and psychological causes of mental illness, from psychopharmacology, which has reduced illness to “broken” molecular pathways by arguing that the body, its organs, and the “outside” are, ontologically, part of the same “bioaffective system” (Wilson, 2008: 387; see also Damasio, 1994). The idea that psychotherapies, or the psychological alleviation of suffering, are somehow ontologically and epistemologically separate from the biological body ignores the fact 88
Recovery here is defined as the effect of “feeling better” (Wilson, 2008). Wilson argues, “The combination of pharmaceutical and psychotherapeutic intervention seems to work better (on average) than treatment with either pharmaceutical or psychotherapy on their own. The effects of one seem to amplify or strengthen the effects of the other” (Wilson, 2008: 387). 153
that, as Wilson discerns, “talk can strengthen organic connection, and drugs can facilitate inter‐subjectivity affinity because the organic and psychic realms share a relational (transreferential) logic” (Wilson, 2008: 389; see also Henningsen and Kirmayer, 2000: 487). I return to this point in the conclusion of the dissertation. As I have argued, Wilson provides a new epistemological position from which to analyze how psychiatry, neuroscience, and molecular biology operate, and how each discipline works by taking into account both the discursive nature of science, and the intra‐action between different “environments” (Wilson, 2008; see also Latour, 1999a: 85, 2005). I contend that Wilson’s research, coupled with ANT, not only collapses the matter/culture distinction, but also promotes a rigorous empiricism from which to understand associations between actants. As Wilson’s work demonstrates, there is only science of the particular; it is therefore sociology’s job to trace the particular’s interaction with other particularities without celebrating a positivist unearthing of the “truth” (Latour, 2005: 31). Taking a realist approach does not mean abandoning the politics of mental health (Ahmed, 2008). Realist epistemologies, including ANT, do not necessarily reject the critical sociological position that identities are implicated in the material‐discursive dimensions of psychiatric knowledge, as outlined in Chapter 3, and/or that mental pathologies continue to be targets in the political economy of neuropharmacological 154
research and funding (Lakoff, 2006; N. Rose, 2007; Tutton, 2008).89 However, as other feminist science scholars have convincingly advanced in other areas of sociological inquiry (see Fox Keller, 1998, 2000, 2002; Wilson, 1998, 2004, 2008; Hird, 2004, 2009; Barad, 2008), Wilson brings neurons and genes90 themselves into the thick of mental health debates—without reinforcing a scientific positivism, or describing mental illnesses as linguistic or cultural representations (Wilson, 1998, 2008; Barad, 2007, 2008). I now turn to epigenetics as a final example of how sociologists of mental health might approach the study of the constitutive relations between social and molecular processes. Epigenetics: A Latourian Actor‐Network? 91 In the final section of this chapter, I first explore how epigenetics, translated as “upon the genes,” exposes additional levels of inheritance factors by examining genetic and 89
Rose terms this the “bioeconomy,” which he defines as the attempt to capture the “latent value in biological processes,” a process that is created by the increased collusion between laboratories and corporations (public‐private‐partnerships) (2006, 2006a, 2007). This is the case, for example, in tissue economics, where tissue becomes mobile, transferable, and manipulated for private economic gain (Rose, 2006, 2006a). 90
According to Pearson, even the concept of the gene, which is so ubiquitous across the molecular biology spectrum (and sociological understandings of molecular biology), is becoming more ambiguous the more ‘it’ is studied by molecular biologists. In fact, “[T]hose at the forefront of genetic research see [the concept of the gene] as increasingly old‐fashioned – a crude approximation that, at best, hides fascinating new complexities and, at worst, blinds its users to useful new paths of enquiry” (Pearson, 2006: 399). 91
A section of the latter half of this chapter was originally published in: Canning, C. 2008. Epigenetics: An Emerging Challenge to Genetic Determinism in Studies of Mental Health and Illness. Social Alternatives 27(4): 14‐21. 155
non‐genetic factors acting upon cells to control gene expression, situating the genome92 in inter‐ and extra‐cellular environmental contexts (Szyf et al., 2008). Through its attention to genetic and environmental factors leading to phenotypic outcomes, epigenetics has the potential to move beyond the bifurcated belief that mental illnesses are either socially or biologically constructed (S. Rose et al., 1984: 75‐7; Wilson, 1998, 2004; Lock, 2005). Therefore, following an overview of this rapidly expanding subfield of molecular biology, I explore how epigenetics might fit within a Latourian approach to science studies, and discuss how this approach might come to bear on sociological understandings of mental health and illness. A term originally coined by C.H. Waddington in the mid 1940s, epigenetics93 is the study of “phenomena that lead to changes in the gene function that are mitotically and/or meiotically94 transmissible without entailing a change in the DNA sequence” (Van 92
The genome is the full genetic material of an organism, or the set of genetic content contained in a haploid set of chromosomes in eukaryotes, in a single chromosome in bacteria, or in the DNA and RNA of a virus. 93
Waddington wrote: “[In 1947] I introduced the word epigenetics, derived from the Aristotelian word epigenesis, which had more or less pass into disuse, as a suitable name for the branch of biology which studies the causal interaction between genes and their products which bring the phenotype into being” (as cited in Jablonka and Lamb, 2002: 85). 94
Mitosis produces two daughter cells, “a process in which each chromosome doubles and then splits longitudinally, with one half going to each of the daughter cells” (Jablonka and Lamb, 2006: 16). Meiosis, on the other hand, produces daughter cells that have one half the number of chromosomes as the parent cell, a process that involves two divisions resulting in four daughter cells (Jablonka and Lamb, 2006: 81). Mitosis and meiosis are related in epigenetics because “epigenetic signals in the somatic cells are inherited during mitotic division” and “There is now an increasing body of evidence suggesting that epigenetic marks of at least some mammalian genes are not completely erased during meiosis and therefore can be transmitted from one generation to another” (Petronis, 2004: 966). 156
de Vijaver et al., 2002: 2; see also Perrin et al., 2007: 1270‐73). Proponents of epigenetics study the complex ways phenotypic traits can be passed on inter‐
generationally independent of DNA, a position that is often, as Morange points out, defined in opposition to mainstream genetics (2002: 56; see also Van de Vijaver et al., 2002: 3; Mill and Petronis, 2007).95 Morange further argues that there is still a reluctance within what he calls the “gene‐centric community” to accept epigenetics because of the complexity and open‐endedness of this emerging science. As he writes, “Faced with the difficulties of [complexity], the main response [from geneticists] too often remains a piecemeal, reductionist approach that focuses on the role of one specific transcription factor: here, indeed, genetics is still ‘old‐fashioned,’ remaining reductionistic [sic] and ‘simple,’ and not yet ready to become epigenetic or new style 95
Support for this notion originates from the Lamarckian understanding of the inheritance of acquired characteristics (Haig, 2007: 423). Lamarck argues that adaptive variations are acquired and can be passed down to offspring, a position, as Haig points out, that has been highly influential in the development of epigenetics (Haig, 2007), and often defined in opposition to neo‐Darwinian theories of evolution (Jablonka and Lamb, 1995). Waddington, for example, objects to neo‐Darwinian evolutionary theory, or “the reigning modern view ... that, in nature, the direction of mutational change is entirely at random, and that adaptation results solely from the natural selection of mutations which happen to give rise to individuals with suitable characteristics” (Waddington, 1953: 151). In short, Jablonka and Lamb’s Lamarckian challenge to neo‐Darwinian theory is twofold: “That the environment and an organism’s activities can influence what is inherited; and that some heritable variation is purposeful rather than random” (Haig, 2007: 425; Jablonka and Lamb, 1995). Neo‐Darwinian theory, conversely, often posits a reductive approach to inheritance: “Genotypes interact with the environment to produce phenotypes and then phenotypes interact with the environment to determine which genotypes are replicated to become the focus for the next round of ‘random’ mutation” (Haig, 2007: 426). Jablonka and Lamb (1995) in particular criticize this position for its central dogma, and similarly critique the selfish gene theory that has emerged from the idea that genetic information flows from DNA to proteins, which ignores the role of the environment in, or at best designates it as secondary to, developmental processes (Haig, 2007). 157
genetics” (Morange, 2002: 58). This “old‐style” genetics assumes a linear, causal relationship between genes and behaviour, and the “goal of this science has been to correlate psychiatric disorders with individual differences in DNA sequence” (Caspi and Moffitt, 2006: 583). Even though a few genes might be implicated in some psychiatric conditions such as schizophrenia and/or depression, replication studies often fail and, as Caspi and Moffitt argue, overall progress in single or multiple gene studies has been slow (2006: 583; see also Hedgecoe, 2001; Weinberger et al., 2001; Walsh et al., 2008). While some suggest that dogmatic forms of genetic determinism are being supplanted by a paradigmatic shift towards complexity, Morange suggests that “old‐style” genetics is still quite common in this literature. As Walsh et al. argue, for example, “The long term goals are to identify all genes with mutations leading to [schizophrenia] and to develop treatment and prevention strategies tailored to the remediation of the altered pathways” (Walsh et al., 2008: 542). As a way of complicating gene‐centric research, epigenetics investigates “social” and “molecular”96 environmental contexts of the genome, or where genes “meet” 96
I scare quote both social and molecular here to suggest that epigenetics has the potential to challenge this bifurcation altogether. In other words, epigenetic mechanisms are simultaneously social and biological, or “intra‐actions,” as Barad claims. She writes, “nature is neither a passive surface awaiting the mark of culture nor the end product of cultural performances” (Barad, 2008: 145). Our job, then, is to make, in Barad’s terms, “agential cuts” to understand the entanglement of matter and sociality. Barad continues: “What the agential cut does provide is a contingent resolution of the ontological inseparability with the phenomena and hence the conditions for objective description: that is, it enables an unambiguous account of marks on bodies, but only within the particular phenomena” (Barad, 2008: 348). Here, Barad’s work echoes Wilson’s focus on the particularities of intra‐activity between somatic and psychic environments, which is similarly highlighted in epigenetic understandings of environmental 158
environmental conditions (Jablonka and Lamb, 1995: 30‐51; Morange, 2002: 51‐6). This was highlighted in a 2002 study by Kaati et al., whose findings suggest that the environmental impact of malnutrition in approximately three hundred women and men in late 19th century Sweden left their grandchildren at a greater risk of developing diabetes and other obesity related illnesses (2002: 686‐687). Similar epigenetic inheritance factors were demonstrated in a 2000 agouti mouse study. By altering a mother’s diet to include methyl‐rich foods, the offspring were born with different phenotypic traits: colour, size, and disease susceptibility – without changing the DNA of the mice (Watters, 2006). These phenotypic changes were then transmitted vertically97 to the next generation. As Watters writes, “The even greater surprise is the recent discovery that epigenetic signals from the environment can be passed on from one generation to the next, sometimes for several generations, without changing a single gene sequence” (Watters, 2006: 2). Beck and Neiwöhner term this form of epigenetic inheritance physiological historicity, which “extends our bio‐graphies beyond our own intra‐action with DNA methylation and histone modifications (Wilson, 1998, 2004, 2006, 2008; Petronis, 2004; Szyf et al., 2008; Oh and Petronis, 2008). 97
Vertical transmission means the transmission from parent to child (Jablonka, 2004: 935). In the Agouti mouse study in particular, different body sizes and colour were transmitted to the offspring without a change to the structure of DNA, a process that Jablonka refers to as “non‐
genetic heredity” (2004: 929). Jablonka provides another specific example of vertical transmission, that is, prion diseases such as bovine spongiform encephalitis (BSE), which can be passed on horizontally (person to person), or vertically (mother to offspring) because they are composed of specific proteins (Jablonka, 2004: 932). In other words, vertical transmission has been shown to be both genetic (aberrant genomic imprinting in Prader‐Willi and Angelman Syndromes) and epigenetic (environmental factors influencing DNA methylation and histone modifications), as Kaati et al. demonstrate (2002; see also Jablonka and Lamb, 1995). 159
birth and death with manifold implications that have so far received little attention in the social sciences and humanities” (2006: 223). According to Peedicayil’s research on the role of epigenetic regulation in schizophrenia, histone modifications lead to heritable changes in genetic expression without any change to the DNA sequence, a material process also referred to as epimutations (2007: 106‐7; see also Fox Keller, 1998: 115‐116). Epigenetic mechanisms play an “active role in the remodeling of chromatin structure” and “regulate various genomic functions that are controlled by heritable but potentially reversible changes in DNA methylation and/or chromosomal function” (Petronis, 2004: 966). Burbano explains this process further: Epigenetic modification of the genome ensures proper gene activation during development and involves: (1) Genomic methylation changes; (2) The assembly of histones and histone variants into nucleosomes; (3) Remodeling of other chromatin‐
associated proteins such as linker histones, polycomb group, nuclear scaffold proteins, and transcription factors (2006: 860). The following figure helps to clarify the previous discussion, and illustrates the two most widely studied epigenetic mechanisms: DNA methylation and histone modification. Figure 1: The Two Main Components of the Epigenetic “Code” 98 98
It is interesting to note the use of the term “code” here, even though epigenetics challenges the assumptions tied to the rhetoric of the “genetic code” so common in gene‐centric research (see Hedgecoe, 2001; Petronis, 2004). 160
(http://universe‐review.ca/F11‐monocell.htm. Consulted 1 April 2008).99 Epigenetics studies DNA sequence (base pair) variants as factors in the etiology of complex psychiatric conditions, but also investigates the regulation of genes and their intra‐action with “the environment,” the latter a major and ongoing focus of the sociological understanding of mental health and illness, as I have discussed throughout this dissertation (Wilson, 1998; Petronis, 2004: 966‐68; Peedicayil, 2007: 105‐07). Driven by the premise that the environment influences epigenetic regulation of gene activity, 99
Written permission not necessary for this image. Please see: http://universe‐
review.ca/FAQ.htm. Accessed 1 May 2008. 161
epigeneticists, and the few social scientists studying epigenetics, stress that the DNA sequence base paradigm is no longer sufficient to explain symptoms that we see in complex psychiatric conditions, such as schizophrenia, depression, autism, or Alzheimer’s (Lock, 2005: s53‐60; Mill and Petronis, 2007: 799‐801; Perrin et al., 2007: 1‐
2; Peedicayil 2007: 105‐06). As Lock argues, epigenetics is an “ontological reversal of genetic determinism and gives priority to dynamic interactions among many variables,” and, ultimately, questions “whether a gene, defined as a DNA sequence, can indeed count as the unity of heredity” (2005: s52‐S53). The emerging goal of epigenetics, in this respect, is to understand the inherited predisposition of complex, non‐Mendelian diseases100 while avoiding the central dogma that DNA sequence variation equals the sole “cause” of complex behavioural traits. As Pearson argues, “[Those] at the forefront of genetic research see [the central dogma] as increasingly old‐fashioned – a crude approximation that, at best, hides fascinating new complexities and, at worst, blinds its users to useful new paths of enquiry” (Pearson, 2006: 399). Petronis, a leading scientist studying epigenetic regulation as it relates to mental health and illness, pointed out in an interview that, traditionally, DNA sequence 100
According to Petronis, Mendelian disorders account for less than 2% of all diseases, including, for example, Huntington’s (a neurodegenerative genetic disorder) (Petronis, 2007). Mendelian diseases can be characterized as single gene mutations in specific loci of the sequence of DNA that influence the expression of heritable phenotypic traits (Petronis, 2007). Non‐Mendelian (or what Petronis calls “complex”) diseases are not single gene disorders; localized DNA sequence variations are not the “cause” of the expression of phenotypic traits such as schizophrenia (Petronis, 2007; see also Botstein and Risch, 2003). 162
variation implies the exclusive role of DNA as the source of mental illness, whereas epigenetics attempts to move beyond this deterministic equation: [The] DNA‐centered paradigm works very well in simple Mendelian disorders, and actually, this is where it is coming from. If we have a simple Mendelian phenotype, there is no doubt that DNA sequence is involved. But what happened, consciously or unconsciously, human geneticists started thinking that the same set of rules, the same strategies, cannot be used in complex, non‐Mendelian disorders. We’re not talking about causal mutations; we’re talking about predisposing polymorphisms. We’re not talking about the exclusive role of DNA sequence variation. We’re saying that DNA is important, but there are also some environmental factors that kind of interact with DNA sequence variants and this is what [could] cause disease. (Petronis, 2007) 101 As Petronis also suggested in the interview, epigenetics is a regulatory mechanism, which makes it much more difficult, as he argues, to “map the complexities of the “epigenome” in a similar way to that of any species’ genome” (Petronis, 2007). Epigenetics is, according to Petronis, an important regulatory aspect because, as his research has shown, if epigenetic regulation is manipulated, various changes to 101
During our discussion of the environment and how it influences epigenetic regulation, Petronis defines “the environment” as being both “external,” including factors leading to psychological harm or stress and “internal” (located in the cell). I would argue that rather than bifurcating these environments by speaking about them as distinct, he actually collapses the distinction, echoing Wilson’s point that so‐called “external” environments play a crucial intra‐
acting role in somatic processes, or so‐called “internal,” “skin‐encapsulated” environments (Wilson, 2004, 2008; Barad, 2007). 163
phenotypes, along identical DNA lines, can and do emerge. How phenotypic traits vary so widely along identical DNA variants is one of the most important and complex questions facing epigenetics research (Petronis, 2007). Petronis also argues that his research does not deny the important headway genetics research has made for understanding Mendelian traits such as eye colour and some diseases such as Huntington’s or Tay‐Sachs Disease, the latter an autosomal recessive genetic disorder (Petronis, 2007). Nonetheless, geneticists are far from understanding the fundamental principles of non‐Mendelian, complex conditions such as schizophrenia (Petronis et al., 2003: 169‐70; Petronis, 2004: 965‐70). R.C. Lewontin’s work has been similarly instrumental in challenging the view that DNA assigns organisms some sort of predetermined destiny, ingrained and unchangeable within our genes (1991: 3‐5). As Lewontin argues, genetic variation is not a causal pathway to determining behaviour or phenotypes, nor can genes be removed from random, stochastic, environmental events. He states: “Genes affect how sensitive one is to environments, and environments affect how relevant one’s genetic differences may be. The interaction between the two is indissoluble” (1991: 30; see also Lewontin, 1999 and Fox Keller, 1998: 115, 2000: 250‐55). Gene studies of monozygotic (MZ) and dizygotic (DZ) twins have made important discoveries concerning the concordance of particular behavioural characteristics 164
(Petronis, 2004: 965‐66).102 Petronis et al. argue, however, that epigenetic regulation is subjected to age‐dependent, environmental markers that potentially lead to the discordance of non‐Mendelian psychiatric conditions (2003: 169‐70). As Bird points out, “What has attracted epigeneticists is that monozygotic twins do not always show the same disease susceptibility, raising the possibility that epigenetic differences that arise during ageing are at work” (Bird, 2007: 397). Schizophrenia, bipolar disorder, and autism are examples of complex traits that, according to Feinberg’s research, all “defy gene identification” because they show high discordance among MZ twins (2007: 438). Thus, epigenetics examines the ways in which DNA sequence variations intra‐act with, or are “epimutated” by, developmental or environmental changes or events (Jablonka and Lamb, 1995: 364‐65; Fox Keller, 1998: 115). 102
As Rose et al. point out, there are three lines of inquiry in genetic studies of schizophrenia and depression (and, of course, other phenotypic traits): family studies, twin studies, and adoption studies (1984: 213). The justification for conducting twin studies for the concordance or discordance of particular traits can be summarized as follows: “The basic logic of twin studies depends upon the fact that while MZ twins are genetically identical [which, as we now know, is not the case. See Bruder, 2008], DZ twins on average share (like ordinary siblings), only half their genes. Thus, if a trait is genetically determined, one would obviously expect MZ to be concordant for that trait more often than DZs” (1984: 214). In their critique of twin studies, Rose et al. argue that while some studies show a higher concordance in MZ than DZ twins, which might, according to Kallman and Slater, suggest that schizophrenia or depression are passed on genetically, they remain cautious of these studies because of the inability to take into account “the enormous importance of environmental factors” (1984: 217). It is interesting to note that these claims were made more than twenty years ago, during which time their challenge to genetic determinism was certainly not common. More recently, Bruder et al. note that twin studies are still used as “a powerful tool for studying various diseases and endophenotypes, evaluating quantitative‐trait loci, estimating heritability, studying difference in gene expression, and testing hypotheses regarding gene‐environment interactions” (2008: 763). 165
Peedicayil highlights specifically what epigenetics might mean for studies of schizophrenia and/or other mental health conditions. As he argues, “Several lines of evidence suggest that epigenetic mechanism in gene expression are involved in mental disorders: the genetic information available in the human genome is insufficient to specify all the neuronal interconnections in the human brain and hence human brain development requires further information in the form of epigenetics in which specific genes within brain cells are activated and modulated during development” (Peedicayil, 2007: 107). While no definitive epigenetic markers have been found, Peedicayil remains optimistic about the possibilities. He writes: “Another epigenetic strategy to identify genes underlying the idiopathic mental disorders involves detecting abnormal gene expression patterns in postmortem brain tissue of patients with these disorders” (2007: 107). He points to studies being conducted by Petronis, who is investigating the “methylation patterns of DNA obtained from lymphocytes at the 5’ regulatory region of the dopamine D2 receptor gene in two pairs of monozygotic twins, one concordant and the other discordant for schizophrenia” (Peedicayil, 2007: 108). The results of this study, while certainly not definitive, suggest the twin from the discordant pair was epigenetically “more similar to the affected concordant twins than to his MZ twin” (2007: 108). Despite not making this claim directly, Petronis’ work in particular echoes a Latourian ANT in that he gestures to environmental events (internal or external to the cell, or external to somatic processes) that are directly intra‐acting with epigenetic 166
regulations. For example, nucleosomal proteins, thought to be a “static packaging device,” are modified by environmental markers such as malnutrition and psychological harm, and intra‐act with what Petronis calls epigenetic regulation, or DNA methylation and/or histone modification (Petronis, 2004: 966; Szyf et al., 2008). Van de Vijaver et al. support this point, suggesting that epigenetics is mainly concerned with the “multi‐
layered contexts surrounding and interacting with the genome” (2002: 2). Although they make a case for interaction between “multi‐layered environments” and the genome, which bifurcates the “social” from “biological,” their summary of epigenetics echoes Barad’s agential realism or Latour’s Actor Network Theory. That is, they strive to empirically trace the relations between the genome and its “energetic interaction” with spatial and temporal contexts, or “the environment” (Wilson, 2008). Understanding what exactly molecular biologists and sociologists mean by “the environment” (cell specific or external to the cell) is still open to sociological, biological, and philosophical investigation, especially as many studies use the term “environmental” monolithically and deterministically (Shimabukuro et al., 2007; Szyf et al., 2008). As Petronis points out, the question of what exactly constitutes “the environment” is still very much in question for molecular biologists themselves. He notes that The question at this stage is that we know that epigenetic [changes] to some extent are inherited and to some extent acquired. We have some inherited predisposition for something 167
that we are bringing through the germ line of our parents. And eventually these epigenetic profiles can be modified by lots of different things: environmental factors, internal environment like hormones, nutrition and diet. They can also be discerned by stochastic events in the cell. So all these different, hundreds and thousands of different [environmental] factors…converge [for] some change in epigenetic regulation. (Petronis, 2007) Although certain external environmental events (psychological harm, for example) are correlated with schizophrenia and other psychiatric conditions (Petronis, 200; Oh and Petronis, 2008; Szyf et al., 2008), there is little evidence that a particular environmental or life event (trauma, psychological harm, diet, malnutrition, stress, etc.) necessarily “causes” specific epimutations. Mill and Petronis write that “[While] exposure to stressful life events and the development of [a mental illness] are almost definitely related, we can conclude relatively little about the causality behind this relationship” (Mill and Petronis, 2007: 802; see also Kaati et al., 2002; Petronis, 2004: 966; Peedicayil, 2007: 106‐07). Epigenetics breaks down the causal equation that DNA determines psychiatric conditions; however, without careful attention to the complex, open‐ended relationship epimutations have with the environment as a non‐monolithic, complex entity, it risks falling into similar determinist equations that have plagued DNA sequence variation studies (Lock, 2005: s53; Mill and Petronis, 2007: 802; S. Rose, 2009). Regardless of the way in which epigenetics promises to challenge genetic determinism and reductionism, I do not claim that it necessarily has, as the media often 168
suggests,103 any revolutionary power to change our current social/biological understanding of complex mental illnesses; as we saw in the reporting of genetics in the 1990s, this promise was largely, if not entirely unsuccessful, and often reinforced forms of inequality and stigma tied to biological citizenship (Foucault, 1976; Conrad, 1997; Petersen and Bunton 2002; Dumit, 2004; N. Rose, 2006a, 2006b, 2007). But epigenetics, as an emerging science still largely unexplored from a sociological position, takes us toward an ethics of complexity and precaution explored previously by other sociologists of science (S. Rose et al., 1984; Wilson, 1998, 2004; Lewontin, 1999; Lock, 2005; N. Rose, 2007). For Beck and Niewöhner, this means the social sciences should conduct research “that symmetrically links empirical investigations of medical and social practice,” what they term somatography, an investigation of “dynamic interactions between different epistemic cultures by empirically tracking pathways” (2006: 224). I describe what a study of these dynamic interactions might look like in the conclusion of the dissertation. Conclusion In this chapter, I have explored emerging science studies perspectives seeking to “mangle” the social and biological, what Pickering might otherwise call tracing “an 103
Some headlines include: “Mechanisms of Epigenetic Inheritance Clarified,” Science Daily 24 April, 2008; “Unlocking the Human Genome,” Marin Independent Journal 3 May 2008; “Unraveling the Link Between Genes and Environment,” Washington Post 5 May 2008; “Epigenetics: Genes’ Chemical Clothes May Underlie the Biology Behind Mental Illness,” Science News 7 May 2008; “Epigenetics Might Provide Clues for Mood Disorders,” ABC News 13 May 2008; “Scientists Unravel Structure of Key Epigenetics Component,” OBBeC 4 September 2008. 169
evolving field of human and material agencies reciprocally engaged in the play of resistance and accommodation” (1993: 567). Used as a noun, mangle here describes relations between humans and nonhuman actants, such as diagnostic manuals, DNA, neurotransmitters, neuroscientists, affective responses, and psychiatric survivors in the coproduction of mental illness. Mangle used as a verb, then, traces the relationality between these actants, without, as Pickering contends, “grasp[ing] the pure essence of material agency” (Pickering, 1993: 577). This chapter has attempted to show, in non‐
reductive terms, some of the many possible ways in which human and nonhumans act in constant coproduction in the field of mental health. In particular, I have examined perspectives in the neuroscience of mental health that empirically demonstrate how affect and molecular processes operate within and alongside the cultural milieu (Damasio, 1994). I have also critically engaged with Wilson’s science studies approach to mental illness, and with studies in the field of epigenetics, to demonstrate how science studies scholars can trace what Latour calls “matters of concern” in the field of mental health. In the following chapter, in order to elucidate further how sociologists might approach future studies of mental health and illness, I advance a dialogue between the fields I have animated throughout this dissertation. How, for example, is the work of Laing and the sociology of mental health important for neuroscientific and epigenetic perspectives on schizophrenia and depression? Do the fields I have outlined in this chapter depend on the work of Laing and others, without fully acknowledging the contributions anti‐psychiatry and social constructivism have made in understanding and theorizing the material‐discursive relations of psychiatric science, and the personal 170
perspectives of psychiatric survivors? What might be the pragmatic outcome of advancing these sorts of dialogues? 171
Chapter 6: Conclusion Introduction I begin this conclusion with a summary of the epistemological positions I examine throughout my dissertation—anti‐psychiatry and its link to social constructivism, and variations of realism deployed in contemporary science studies, such as Actor Network Theory (Wilson, 2008; Barad, 2008; Hird, 2009). Rather than giving an overview of my project as a whole, however, in this conclusion I offer a hypothetical discussion between three sociological/philosophical figures who have influenced my work during the unity of the dissertation, and who were central to the formation of my project—R.D. Laing (constructivism), Bruno Latour (ANT) and Elizabeth Wilson (realism). I envision how each theorist might respond to an important epistemological question with respect to my project, one that has not necessarily been explicitly or adequately addressed: how, exactly, do you define mental illness? As my research on this project draws to a temporary close, an association between Laing, Latour, and Wilson can be traced, which also aids me in offering a summary of the important claims made throughout my dissertation. As I demonstrate throughout my project, each theorist has influenced and defined different epistemological positions with respect to mental health and illness, and science studies more broadly, in dramatically different ways (despite, for example, ontological, epistemological, and methodological similarities between Wilson and 172
Latour) (Latour, 2005; Wilson, 2008). I have contended that all three theorists make important contributions to mental health studies, particularly when situated within science studies approaches to the dynamic relationality between social environments and molecular environments, including DNA methylation and chromatin modifications (Szyf et al., 2008). Although Latour never discusses mental health explicitly, nor does Laing ever discuss the relationality between affective states and somatic environments, I contend that both provide—along with Wilson—important foundations from which we can theorize, and empirically trace, the impact that social environments have on somatic material, and the impact somatic environments have on our social environments (Barchas, 1976; Damasio, 1994; Wilson, 2008). As Wilson demonstrates in her ongoing research, such a realist approach to science demands a “rethinking and re‐
demonstration” of embodiment in order to collapse the matter/culture distinction altogether (Wilson, 1998: 128; Hird, 2009; Harman, 2009). How might this new formulation influence future sociological studies of mental health and illness? R.D. Laing As I outline in Chapter 2, Laing’s most succinct definition of mental illness can be found in his address to the First International Congress of Social Psychiatry in 1967, long after he established himself as a key, yet controversial figure in the anti‐psychiatry movement. In the address, Laing summarizes his constructivist position concisely: “For me, almost the one certain thing about ‘schizophrenia’ is that it is a diagnosis, that is, a 173
clinical label, applied by some people to others. Until recently, this label meant that the labeller [sic] was under the impression that the behaviour of the person he was labeling was symptomatic of some pathological process, itself of unknown nature and origin, going on in the body of the person” (1967: 63). Informing schizophrenia‐as‐label is Laing’s sympathetic reading of both phenomenology and constructivist epistemologies. The former influenced his understanding of how women and men are alienated from the medical world by the highly technical and mechanistic language of diagnosis and treatment, a process that, as I discuss in Chapters 2 and 3, excludes the voices and experiences of those implicated in a biologically‐based system (Laing, 1967). His philosophy also influenced the reading of the (ontological) reality of patients as a material‐discursive construct, whereby bodies are “made” schizophrenic, or pathologized, by psychiatric discourses and material conditions (which is the main focus of Chapter 3). Laing argues that “What we see therefore in some people whom we label and ‘treat’ as schizophrenics are the outer behavioural expressions of an inner experiential drama” (1967: 65). He makes no apologies for his radical and humanist reading of the reality of mental health, which is reflected in this famous quotation: “Persons are not separate objects in space. They are centres of orientation to the world” (1962: 7). While, to him, schizophrenia is made real by language or discursive processes—reflecting his influence on the development of postmodern theory—his definition of mental illness is actually more phenomenological, humanistic, and above all political. 174
Herein lies Laing’s second and more affective response to my question, one that is still popular in contemporary activist and sociological spheres, as I outline in Chapters 2 and 3: mental illness is an internal, embodied affliction or drama, a series of “subjective experiential events” that are subsequently defined by the discourses of science and treated by psychiatrists “in order to be scientific” (1967: 65). According to Laing, science, by definition, ignores emotion, affect, and/or the embodied knowledge of psychiatric patients. This position is reflected in Laing and Estersen’s collaborative work. As they contend, “[Schizophrenia] is an assumption, a theory, a hypothesis, but not a fact that anyone suffers from a condition called 'schizophrenia'...We do not accept 'schizophrenia' as being a biochemical, neurophysiological, psychological fact, and we regard it as palpable error, in the present state of the evidence to take it to be a fact" (1964: 11‐12). Laing continues: “Instead of the ceremonial degradation of psychiatric examination, diagnosis, and prognostication, we need, for those who are ready for it (in psychiatric terminology often those who are about to go into a schizophrenic breakdown) an initiation ceremonial, through which the person will be guided with full social encouragement and sanction into inner space and time, by people who have been there and back again” (1967: 67). To Laing, then, mental illness is a social and cultural construct, but, and perhaps more importantly, madness need not be an alienating, dramatic experience so long as forms of treatment integrate and establish an affective, mutual relationship with patients themselves, or, at the very least, take into account the situated, affective experiences of survivors (Laing, 175
1960, 1962, 1967). This is one of Laing’s most cited contributions to both contemporary postmodern theory and psychiatric survivor activism, or what Roberts calls “postmodern psychiatry” (Roberts, 2004; see also Bracken, 2003, 2005; Lewis, 2006), which seeks to integrate personal perspectives of patients into the practices and processes defining mental illness. However, I would also argue that Laing’s contribution to mental health studies informs Wilson’s understanding of the relationship between affect, psychiatric treatment, and molecular processes of the body, despite her rejection of anti‐psychiatry (Wilson, 1998, 2008). A focus on affect and emotional experiences is important for theorizing ways in which molecular processes are influenced by psychological or social events, as seen in Damasio’s work in neuroscience, cognition, and affect; Wilson’s research concerning psychology, neuroscience and mental illness; and in the emerging field of epigenetics, all of which I explored in Chapter 5 (Szyf et al., 2008). However problematic, Laing’s work and the anti‐psychiatry movement more broadly made emotions “matter,” so to speak, if only to bring affect into the public understanding of how women and men experience mental illness. Wilson’s research, like Damasio’s, expands on Laing’s work in ways that make the materiality of emotions matter (Damasio, 1994; Wilson, 1998, 2004, 2008). I return to this discussion shortly. 176
Bruno Latour Latour adamantly insists throughout his work that ANT is not the “establishment of some absurd symmetry between humans and nonhumans” (2005: 76). Rather, as he discerns, ANT traces biological, social, economic, and political connections by challenging the pre‐defined associations that have been made in the social and natural sciences. He argues that “we have to make sure that [an actant’s] diversity is not prematurely closed by one hegemonic version of one kind of matter of fact claiming to be what is present in experience – and that goes, of course, for ‘power’ and ‘Society’ as well as for ‘matter’ and ‘Nature’” (2005: 118). Actants‐as‐relations can never be predetermined, but emerge from disassembling and then reassembling the taken‐for‐
granted categories that have led to our understanding of the categories themselves (Latour, 1988). ANT, the practice of which I explored in Chapters 4 and 5, empirically traces associations “which [are] categorized by the way [they] gather together into new shapes” (Latour, 2005: 65). ANT begins with the premise that “the social [is] not a special domain of reality principles of connections; that there was no reason to separate the ‘social’ from other associations like biological organisms or even atoms” (Latour, 2005: 13). In this respect, Latour’s answer to my question is much less direct, but nonetheless equally as powerful as Laing’s, and provides an epistemological position to which Wilson’s work contributes: mental illness is a non‐stabilized state of relations between human and nonhuman actants, which collide, even temporarily, to produce 177
meaning through “trials of strength” (Latour, 1988: 160). Within this assemblage, Latour argues, are various layers that articulate the “crossovers through which humans and nonhumans have exchanged their properties. Each of those crossovers results in a dramatic change in the scale of the collective, in its composition, and in the degree to which humans and nonhumans are enmeshed” (1999a: 201). To be more precise, the political economy of pharmaceutical research and funding, the techno‐scientific fusion of science and industry making fMRI devices, psychiatric patients, DNA, neurotransmitters, testimonials, psychiatric discourse, proteins, and psychological stress are some of the actants that “make up” or “assemble” to become what we know of as mental illness (Latour, 1999a: 201‐213). This does not mean, of course, that Latour would deconstruct or scare quote the term “mental illness” in a Derridian sense because he challenges its historical, binary usage in both sociological or scientific contexts (Wilson, 1998, 2008). Rather, the term mental illness might be defined as “points [that] have been linked by paths that were narrow at first and then were broadened and properly paved” (Latour, 1988: 185). Schizophrenia and depression could be characterized as well‐paved paths because they have many intersecting and mutually constituting actants swarming around them. They are not, however, stable states of illness either localizable in the brain or genes or in power/knowledge relations determined through the biopolitical production of pathological behavours (Latour, 1993b; N. Rose, 2006a, 2007). Rather, mental illness, according to Latour, might be a “gathering” defined by the strength of associations or 178
alliances between human and/or nonhuman actants. We, as sociologists, are charged with conducting empirical work in following these relationships, of which we are only sometimes a part, so as not to impose a predetermined sociological conclusion. This empiricism, Latour tells his critics, is political through and through (Latour, 2005). Furthermore, as Latour argues, “trials of strength” are not either things (what he calls primary qualities) or words (secondary qualities), but are actants linked by associations (Latour, 1988, 1993, 2005) or, as Harman puts it, things that “translate into one another” (2009: 92). As Harman observes, Latour “[rejects] the traditional gesture of isolating the real from all its distorting associations; [he] holds that a thing becomes increasingly real the more associations it has” (2009: 95). In other words, from this perspective, mental illness is “real” only insofar as it has many associations, gatherings, or trials of strength between actants (Harman, 2009) that bring about its existence in an ontological meeting place between purely social and biological explanations; it is not socially constructed or biologically based; it is not a symmetry or hybrid of matter and culture; it is its relations (Latour, 1993a, 1999a; Harman, 2009). As Harman summarizes, however, Latour’s epistemology need not be a relativist or individualist one because the world is not simply a “matter of human perspective” (Harman, 2009: 24). In other words, privileging schizophrenia, for example, as a social phenomenon or narration misses the complexity of how it is “constructed by all manner of networks and alliances, including inanimate ones” (Harman, 2009: 31). It is precisely around this notion that 179
Wilson’s research traces alliances between the human and nonhuman to expose the relations between affective and somatic processes (Wilson, 1998, 2004, 2008). Elizabeth Wilson In 1976, Barchas made what probably seemed like a bold and unpopular claim for a social scientist at the time, especially following radical challenges to the epistemic cultures of the natural sciences during the 1960s: “An important set of issues for sociologists,” she wrote, “is the nature of the interaction between sociological processes and biochemical processes in relation to [depression]” (1976: 319). According to Barchas, important research emerged during the 1970s that demonstrated the mutual constitutive relationship between social factors, such as emotional stress or harm, and biological processes, such as neurotransmitter function in the brain (1976: 318‐319). Barchas advocated for collaborative projects between sociologists and biologists to produce a “new and more comprehensive view of [depression], and at the same time illuminate the central problems of how individual biology interacts with social structure” (1976: 319, my emphasis). While Barchas’s notion of social structure might seem problematic in a Latourian sense, and she prefers the term “interaction” (two “worlds” combined; a hybrid) over what Barad calls “intra‐action” (Barad, 2008), her reading of the relations between biological and social processes affecting the outcome of depression and other psychiatric conditions is an important early study anticipating work in the science studies of mental health. 180
To this end, Barchas proposes key questions regarding sociology’s relationship to the biological sciences that remain, to this day, largely understudied in the sociology of mental health. She asks: “How do environmental and behaviour changes interact with neuro‐chemical events that seem to relate to depression? How do the drugs that are effectively used to treat depression alter those events and changes?” (1976: 321). Although she problematically claims that “the biochemical relationships are determined genetically” (Barchas, 1976: 322), Barchas’ questions are reemerging in science studies, as seen in Wilson’s work concerning the relationality between what she terms the “organic and psychic realms” related to depressive behaviours (Wilson, 2008: 389). While Wilson does not cite Barchas directly, her work might be considered a more empirical, realist version of Barchas’ insightful claims and questions made thirty five years ago about the intra‐activity between the “affective” and “social world” and its ontological relationship to somatic processes in the body (Barachs, 1976; Wilson, 2008). Wilson’s research, as I demonstrate in Chapter 5, spans feminist theory, neuroscience, cognition, affect, and mental health studies. Her focus on the relationship between the brain and the gut (2004, 2008) has led her to close readings of neurological processes termed “extra‐cerebral systems,” such as connections between the central nervous system and nerve cells in the enteric nervous system (2006: 129). As she argues, “Notions of the brain as an autonomous, self‐contained organ are common enough in both the scientific and popular imaginary,” making it all the more important to study, as Wilson does, how the brain is “necessarily implicated in relations with other organs and 181
extra‐bodily systems,” and how “the blood‐brain barrier is a particular intensive site for such xenobiotic transmission” (2006: 129). As Wilson demonstrates, affect and emotion are tied closely to biological systems, including pharmaceutical use, because psychoanalytic and drug therapies have been shown to mutually interact and be increasingly beneficial for women and men seeking treatment for depression (Wilson, 2008; see also Henningsen and Kirmayer, 2000).104 As Wilson contends, the choice between psychotherapy and psychopharmaceuticals is “turning out to be less ideologically and medically definitive than we have been led to believe in the post‐war, post‐Freudian, pro‐pharmaceutical years of the twentieth century” (2008: 387). Each approach, she continues, presents “different lines of attack into the same bioaffective system” (2008: 387; see also Henningsen and Kirmayer, 2000). Wilson’s answer to my question, then, might be summarized as follows: mental illness is a bioaffective system constituted by the relations between molecular, neuronal, psychological and emotional events or experiences (2008: 389). Wilson arrives at this answer, I contend, though her careful reading of the relationship between affective systems, or what she terms the social/cultural milieu, such as psychological stress and 104
This is one area of Wilson’s research that could use expansion and clarification. What, exactly, constitutes beneficial treatment, and how is this measured both qualitatively and quantitatively by women and men with psychiatric illnesses? How is this measured by social and natural scientists, or by psychotherapists and biological psychiatrists (Walker, 2006)? At the very least, as Wilson argues, depression is simultaneously a social event shown through an inability to connect with others or lack of appetite, as well as biochemical communicative process between many organs in the body. To understand future forms of mental health treatment, Wilson concludes, we must bring together “psychological, neurological, biochemical, and gastroenterological frameworks” (2004: 47). 182
emotional harm, and somatic systems, such as the blood‐brain barrier and the pharmacokinetic breakdown of pharmaceutical drugs (SSRIs) through the body (Wilson, 2008: 379‐390). She summarizes this position as follows: “The biological disintegration of mood is a breakdown, not of the brain per se, or of the liver or gut, but of the relations among organs” (Wilson, 2008: 385). And yet, mental illness is not only a biological event, for “the brain is always necessarily implicated in relations with other organs and other extra‐bodily systems” (2008: 384‐385; see also Damasio, 1994). What Wilson suggests here is that SSRIs are inextricably linked to psychological conditions and somatic environments, and that our psychic lives are inextricably bound to, and intra‐act with, the sociality and communication between different regions and organs of our bodies. Her approach to therapy follows as such: “effectively administered, SSRIs can promote a profound, long‐lasting, organic empathy” (2006: 130, my emphasis). In this respect, Wilson argues that therapy and recovery should be directed toward understanding the relationality between somatic environments and the “outside” (environmental, psychological environments). She summarizes this well by suggesting that “the successful imbrications of biological and psychological treatments of depression is due to the consanguinity of their methods; both are able to enliven through empathy and thus foster robust organic and emotional connection” (2008: 389). While it might seem as though she still separates the organic from the emotional, Wilson ontologically and epistemologically collapses this split by empirically tracing, as Latour does, relations between human and nonhuman actants. An approach to forms of 183
therapy, she continues, should focus on how the “organic relationality fostered by anti‐
depressant medication (the quality of the relation between, say, brain and gut) resonates with the emotional connection that a strong clinical relationship can provide” (2008: 389, my emphasis). From a political, pragmatic position, Wilson’s research “redirects critical habits” of science studies, sociology, and feminism towards neuroscience and molecular biology in order to locate “greater productivity” in biological data and matter itself (1998: 62). As she contends, an engagement with biological systems and data can offer interesting ways to think about mental illness and future forms of treatment. The “sophisticated systems of organization,” or what I have called intra‐actions between soma and society, she argues, open up ways to empirically trace the associations between SSRIs, the metabolism of serotonin, and the communication between organs in the body and beyond (2008: 390). She does not mean to suggest that mental illness is naturalized by biological systems only, even in their “sophisticated” organization (2008: 389). Rather, both Wilson’s science studies approach, and Laing’s phenomenological focus on affect and emotional testimony as an epistemological way of knowing, suggest that critical projects might now have an important role to play in building new alliances with the biological sciences, for “rather than giving the domains of biochemistry and neurophysiology to these corporate interests as their rightful property, curiosity about the pharmacology of mood can recapture biology for [critical theory]” (Wilson, 2008: 390). 184
Conclusion I have used many terms to pinpoint different ways in which science studies scholars might theorize the relationship between human and nonhuman actants in order to collapse the matter/culture bifurcation, and how an understanding of this relationship might inform new ways of studying mental illnesses such as schizophrenia and depression. For example, “co‐construction” (Sofoulis, 2009), “co‐production” (Pickering, 1993), “co‐domestication” (Tsing, as cited in Hird, 2009), “mutual interaction” (Wilson, 2008), “intra‐action” (Barad, 2007, 2008), “actor‐network” (Latour, 2005), and “relationality” (Wilson, 2008; Harman, 2009) are used to describe a variety of realist epistemological approaches to the study of the relations between, for instance, neuronal and molecular processes and environmental events. As Barad summarizes regarding this type of realist approach to science, “Reality is not composed of things‐in‐
themselves or things‐behind‐phenomena, but “things”‐in‐phenomena” (2008: 135). Barad, therefore, promotes an ontological “meeting place” between constructivism and positivist science (things‐in‐themselves; determinism) through what she calls “agential cuts” (Barad, 2007, 2008). My dissertation, in this respect, concludes by promoting an integrative approach to the sociology of mental health, neuroscience and epigenetics, a practice through which social and natural sciences might collaborate by empirically tracing the relations between social and somatic environments (Cromby, 2004a; Latour, 2005; Beck and 185
Niewöhner, 2006; Barad, 2008; Wilson, 2008). Throughout my project, I survey how the concept of the environment, while key to both social and biological ways of knowing, is defined and used differently across disciplines. I argue that this is due, in part, to competing epistemological claims made by social and natural scientists, as well as to the impact that genetics research has had on public understandings of science and mental health since the early 1990s. A social study of an integrative neuroscience and epigenetics, I suggest, has the potential to borrow from Laing’s focus on emotion, affect, and the perspectives of women and men with mental illnesses (Laing, 1961; Foucault, 1962), the neuroscience of emotion and embodiment (Damasio, 1994), and Latour and Wilson’s understanding of the mutual ways in which somatic and social environments are enmeshed in constitutive relations (Henningsen and Kirmayer, 2000; Wilson, 2008; Szyf et al., 2008). My project, I hope, begins to address this pressing challenge facing contemporary mental health research: “to continue bridging the social environment and our physical DNA – a bridge that is critical for health as well as for our social and physical being” (2009; Szyf, M. et al., 2008; Henningsen and Kirmayer, 2000). In theorizing ways in which social events intra‐act with molecular processes to produce schizophrenic or depressive behaviours, sociologists of mental health now have the radical potential to bridge the ontological and epistemological separation between social and biological claims to what “causes” mental illness. 186
Future Research Questions Building from this project, my future research aims to investigate the following questions in a science studies approach to epigenetics and mental health: 1) How is the term “environment” used and understood in both sociological and biological accounts of mental illness, and what is its historical usage in this context? 2) What intergenerational studies are being conducted to empirically demonstrate how environmental events trigger molecular changes, or how molecular changes impact human behaviour? 3) How is genetic determinism being supplanted by the “dynamic nature of the epigenome,” which has the potential to “unravel the conduits between the environment and our genome” (Szyf et al., 2008: 56)? 4) What epistemological and methodological questions concerning the gene‐
environment relationship are currently being addressed within the social sciences, and how are sociologists of science using this research to bridge the matter/culture bifurcation that is prevalent in health research? 5) What constitutes contemporary sociological understandings of the materiality of molecular environments, and what assumptions underscore sociological readings of the intersection between social determinants of health and molecular processes in the body? Following from these very broad questions, my future research will build upon this dissertation by empirically engaging with what Wilson calls “bioaffective” systems linked to mental distress—systems that are inextricably both biological and affective—in order 187
to consider new therapeutic possibilities for women and men living with mental illnesses. 188
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