August 2011


This is a small, rough something I put together while I was at BIOS (LSE) during June. It’s really half a paper, kind of – and quite rough along with it – and part of where I want to go next is to ask about the, well, unhappy recipients of US military violence, and why, exactly, they don’t quite show up on the radars of those writing articles about therapeutic forgetting. And about the role propranolol could play in exacerbating the asymmetry of trauma produced in wars with Western countries who have easy access to pharmaceuticals.

The rise of happiness discourse in the last few decades has been remarkable. Although the Declaration of Independence codified the pursuit of happiness as a key element of freedom for US politics, happiness talk has spread far and wide. There are mildly critical public and popular discourses – such as Alain de Botton’s Affluenza – but these mostly critique assumptions about what it is that will make us happy. The goal of happiness remains a pervasive influence, especially on contemporary understandings of freedom. Indeed, as more and more is ‘discovered’ about happiness, it has become less a lucky accident, as Sara Ahmed points out the word’s etymological root in ‘hap’ might suggest, and more something earned through labour, something worked towards, a telos which shapes lives.

As Carl Elliott has shown, however, happiness is increasingly both over-determined and difficult to know: a Wittgensteinian beetle-in-the-box, he claims. Wittgenstein writes “Suppose everyone had a box with something in it: we call it a ‘beetle’… No one can look into anyone else’s box, and everyone says he knows what a beetle is by looking only at his beetle” (Wittgenstein, cited in Elliott, 2004, p. 301). Elliott suggests that it is this radical internality to happiness which makes it so susceptible to the production of anxiety and uncertainty which is leveraged by pharmaceutical companies, particularly in the US’s context of aggressive marketing. Elliott writes:

Wittgenstein’s beetle box game makes an important point about the words we use to describe our inner lives – words such as ‘pain,’ ‘depression,’ ‘anxiety,’ ‘fulfilment,’ and so on… Because nobody can look into the box of another player, nobody has any way to compare his or her ‘beetle’ to that of another player…. So they begin to worry. How does my ‘beetle’ measure up. Is my ‘beetle’ healthy? Would I be happier with a different ‘beetle’…. And this is precisely the reason it is possible to market successfully so many ways of improving psychic well-being, from psychoactive drugs and cosmetic surgery to self-help books and advice columns. If I never know for certain whether the quality of my experience matches up to yours, I am always susceptible to the suggestion that it could be improved (Elliott, 2004, pp. 301-302).

Of course, this idea of the radical internality of psychic states is already suspect from a Foucauldian perspective. This sense of a concealed inner self is, for him, a fiction produced by the recurrence of the repressive hypothesis. It grants legitimising truth effects to individuality and individualism, in turn concealing processes of subjectivation, and the implication of those radically internal experiences in much larger political structures. Although Foucault’s distrust of existential and phenomenological concepts of subjectivity led him to avoid discussion of ‘how people feel,’ numerous scholars working with even a partially Foucauldian frame are concerned with precisely this: the politics of how individuals feel.

The subjectivating technology of being ‘obliged to be free,’ (Rose, 1999, p. 87) as Nikolas Rose calls it, which brings with it both biopolitical (population administration) and anatomopolitical (individual discipline) effects, is modulated through ideas, ideals, and experiences of happiness. Elliott cites a French surrealist painter, Phillipe Soupault, who claimed, ‘one is always in danger of entrapment by what appears on the surface to be a happy civilisation. There is a sort of obligation to be happy’ (Soupault, cited in Elliott, 2004, p. 303). Even as happiness is not straightforwardly equivalent with freedom – the persistence of ideas of ‘false consciousness,’ ‘happy slaves,’ and perhaps even ‘happy housewives,’ demonstrates this – freedom is predominantly oriented toward, and justified by, happiness. As Lauren Berlant argues, commenting on contemporary American political culture, the shared fantasy about politics is that ‘[t]he object of the nation and the law… is to eradicate systemic social pain, the absence of which becomes the definition of freedom’ (Berlant, 2000, p. 35). In eradicating social pain, freedom is achieved, and the pursuit of happiness made possible. Foucault’s account of the ‘normalizing society’ (Foucault, 2003, p. 252)  where freedom is a key dimension of power, cannot be unbound from the experiences of happiness and suffering in contemporary neoliberalism. Where Foucault argued that ‘there is one element that will circulate between the disciplinary and the regulatory… [:] the norm’ (Foucault, 2003, pp. 252-253), Sara Ahmed’s account in The Promise of Happiness manages both to share his concern to demonstrate the relation between ‘macro’ and ‘micro’ technologies of power, yet demonstrate the normative significance of feelings:

[H]appiness involves a way of being aligned with others, of facing the right way. The points of alignment become points of happiness. The family, for example, is a happy object, one that binds and is binding. We hear the term ‘happy families’ and we register the connection of these words in the familiarity of their affective resonance. Happy families: a card game, a title of a children’s book, a government discourse; a promise, a hope, a dream, an aspiration. The happy family is both a myth of happiness, of where and how happiness takes place, and a powerful legislative device, a way of distributing time, energy and resources. The family is also an inheritance. To inherit the family can be to acquire an orientation toward some things and not others as the cause of happiness. In other words, it is not just that groups cohere around happy objects; we are asked to reproduce what we inherit by being affected in the right way by the right things (Ahmed, 2010, p. 45).

The pursuit of happiness, then, for all that it is fantasised by liberalism as the site of free, individual creativity, is profoundly political. The teleological orientation towards happiness is not simply about achieving the right emotional state, but also about feeling the right feelings in relation to the correct objects: a form of individual, communal, national and international alignment through which the alignment is maintained.

Therapeutic Forgetting

It is in this context, then, that I want to think through the politics of recent developments in the use of propranolol in terms of happiness and suffering. Propranolol is a remarkably efficient drug. It is used to reduce anxiety, to regularise heartbeats, to reduce the tissue damage in burn victims, amongst a range of other uses and the many new ones in development (including as an aid to quitting smoking, and perhaps even for enhancing cosmetic surgery patient’s satisfaction with the results of their surgery). Recently, however, it has been found that propranolol has an unusual effect on memories of trauma. In reducing the release of stress hormones in response to trauma, propranolol modulates three elements of memory, according to Elise Donovan:

[the] formation, acquisition, and encoding of the memory; emotional response to and consolidation of the memory; and reconsolidation, reinstatement, and retrieval of the memory, which includes recall and the emotional responses triggered by later stimuli. (Elise Donovan, 2010, p. 63)

Much of the discussion of propranolol as a tool for ‘therapeutic forgetting’ has been about its effect on the second element, the consolidation of the memory (). If administered within 6 hours after a traumatic incident, propranolol affects the consolidation of the memory. Rather than being ‘overconsolidated,’ as some commentators describe the ‘pathological’ memories that produce PTSD, the memories are consolidated in a ‘normal’ fashion (Bell, 2007; Henry, Fishman, & Youngner, 2007). There is, however, probably currently more scientific research on the effect of propranolol on the final element of memory, in the recall and reconsolidation, because, if as effective as it is hoped, this will enable the treatment of those already living with PTSD. In both cases, however, the benefit here is meant to be that the ‘emotional’ or ‘affective’ part of the memory is stripped out, whilst the ‘facts’ remain, although there is some uncertainty about whether stress hormones also assist in producing particularly clear or detailed ‘factual’ memory (Kolber, 2006).

The usefulness of the capacity of propranolol in ‘therapeutic forgetting’ was already explicitly tied to questions of happiness in one of the earliest sources of commentary on it, the US President’s Council on Bioethics’ report, Beyond Therapy: Biotechnology and the Pursuit of Happiness, released in 2003. This may, in fact, be where the somewhat misleading name ‘therapeutic forgetting’ arose. Although numerous anxieties about the effects of therapeutic forgetting were given in this report (which was widely acknowledged to be quite conservative!), the majority of the concerns expressed had to do with ‘authentic’ personhood, with the (especially moral) value of diverse experiences of happiness and suffering, and, somewhat awkwardly, the social and political importance of memories of suffering. They end with this claim about a propranolol-using future:

Nothing would trouble us, but we would probably be shallow people, never falling to the depths of despair because we have little interest in the heights of human happiness or in the complicated lives of those around us. In the end, to have only happy memories is not to be happy in a truly human way. It is simply to be free of misery—an understandable desire given the many troubles of life, but a low aspiration for those who seek a truly human happiness. (President’s Council on Bioethics, 2003, p. 264)

The resistance expressed in this report is grounded fairly clearly in a commitment to ideas about normal human being, ideas which those from the ‘transhumanist’ side of the tracks suggest indulge in a naturalistic fallacy, assuming that what (already) is is all that ought to be. However, whilst much academic and bioethical commentary in the aftermath of the report resisted this conservatism (especially in the American Journal of Bioethics target article and set of responses published in 2007), I want to suggest that there remains an implicit commitment to particular ‘alignments’ towards suffering and happiness. It is this commitment to the apparent dovetailing of happiness, an absence of pain, and individual freedom which has produced both the numerous positive arguments for propranolol, and a neglect of larger concerns.

Ethics, Politics, and Suffering

Propranolol is hard to argue against. The reduction of suffering is an important ethical imperative, one which crosses, I would suggest, both the rigorously systematised conceptions of ethics that bioethics is committed to, and other more critical frameworks such as those offered by Emmanuel Levinas, or Jacques Derrida. The reduction of suffering is imagined as core not only to political structures, as the Berlant quote I cited above indicates, but also to medicine; even if and where we might critique that image of such institutions, at least some aspect of their legitimacy and significance may be said to arise from it. Liberating individuals from their suffering so that they may pursue happiness is such a simple good.

Yet the consequences of liberating individuals through the use of propranolol also reveals that suffering plays a key motivating role in producing normal, happy, free people: people oriented correctly towards their own optimisation, towards a happiness that is not merely their own end, but also others. There is an example given by Elise Donovan of a case in which she believes propranolol could not and should not be denied:

Take… the case of a 30-year-old veteran who has completed a tour in Kosovo in addition to three tours in Iraq. Upon walking past a cemetery on the way to a 4th of July BBQ, he is overtaken by grief at the sight of veterans’ graves decorated for the holiday. The grief, guilt, and memories triggered by this sight result in his spending over an hour sobbing uncontrollably in the cemetery on the grave of a deceased veteran, while sounds of civilians enjoying their holiday can be heard in the distance (Elise Donovan, 2010, p. 72).

Without minimising one iota the suffering experienced by this young veteran, it is also interesting that Donovan selects an event – Independence Day – which is meant to be taken as a site of happiness. The decorations, the promise of the BBQ and the sounds of civilians, are all proper alignments to happiness: they render Independence Day and the creation of the United States as happy objects, sites around which happiness is supposed to coalesce.

I have suggested that happiness is attributed to certain objects that circulate as social goods. When we feel pleasure from such objects, we are aligned; we are facing the right way. We become alienated – out of line with an affective community – when we do not experience pleasure from proximity to objects that are attributed as being good. The gap between the affective value of an object and how we experience an object can involve a range of affects, which are directed by the modes of explanation we offer to fill this gap (Ahmed, 2010, p. 41).

The weeping veteran’s suffering, then, is explicitly situated as a misalignment: a failure to be made happy by what ought to make one happy, and thus a failure to participate in recreating the object of the nation as a happy one. Ahmed elsewhere discusses the ways that alienated subjects, such as unhappy migrants, can become ‘bad objects’ for social projects, such as multiculturalism, because the alienated subject’s unhappiness is supposed to result from an individual misalignment with the happy social project, rather than from, for example, the implicit racism that can characterise much multiculturalism. Yet the case of the unhappy veteran produces a more complex and troubling dynamic for this politics of happiness than the unhappy migrant. In this case, PTSD becomes the unhappy object, not the individual, partly because the willingness to fight ‘for one’s country’ is so clearly a happy orientation towards a happy object. The suffering is thus understood as an injustice, because it is assumed that the veteran would and will be happily aligned, given that this suffering is the result of his or her commitment to the military protection of the happiness of this happy object of the nation. The happiness of the military veteran – who is the go-to example throughout many of the papers on propranolol – appears as good, and right, and properly aligned: a straightforward good thing.

There is, of course, a continual problem with suffering veterans in this politics of happiness. The evidence of his or her participation in the happy alignment to the happy object of the nation is given by suffering, a paradox in this fantasy about good political institutions. This is where the politics of propranolol becomes particularly problematic. “Treating trauma” like this inevitably produces it as a pathology. Arguably the creation of PTSD already did this but as sociologists such as Peter Conrad has underlined, the capacity to treat is part of what produces a particular state of being as pathological (Conrad, 2005). It renders the problem of PTSD a medical problem, and, more than this, a medical problem experienced by the survivor. This narrows the clinical and societal focus to the survivor, and the aftermath, responsibilising her or him as an individual. As with other examples of neoliberal responsibilisation, this functions to obscure the situation that produced the suffering that is now being ameliorated (Kelly, 2010). Whilst this tendency may be slightly less in the case of veterans because in such robust evidence of their “happy alignments,” holding them entirely responsible for their suffering is clearly problematic, the approach to their ‘PTSD’ means it is, nonetheless, present.

The problem here is that the veteran’s PTSD is one of the few sites of trouble for the happy object of the nation. The suffering of those on “the other side” of whatever conflict the veteran was involved in not only does not trouble the state, but affirms it: these people who suffer suffer because they are/were incorrectly aligned (they were terrorists, is perhaps one of the more familiar examples) and thus their suffering works only to affirm the happiness of the happy object. Thus, the problem in the case of propranolol is that what is being obscured is what Ahmed calls the ‘scene of wounding’ (Ahmed, 2004, p. 33), a scene and a wounding in which the happy object of the nation is implicated. After all, it is the nation that sends soldiers off into combat, knowing they will probably experience trauma. The nation, this happy object, supposed to guarantee freedom, sends soldiers to kill others. In fact, in military training, the capacity to resist the trauma attached to killing is bound to achievement, such that succumbing to it is coded as failure. Similarly, military training encourages the development of incredibly close ties between soldiers, which both enhance safety in combat zones, and increase the likelihood of trauma arising from watching friends die.

In this sense, the suffering of veterans is testimony to the failures of the happy object of the nation. In this context, then, the politics of propranolol is intensely problematic: it covers over the scenes of wounding, enabling realignment. That realignment might be a happy one, for the individual – indeed, according to Ahmed’s argument, it is no accident that that alignment toward the happy object is happy – but it is happy, too, for the legitimating fantasies of those political structures which are meant to guarantee happiness. Given that the vast majority of major political changes have arisen in and through the insistent testifying to suffering – whether that suffering arises from colonisation, racism, war, sexism, homophobia, ableism or any one of a range of responses to ‘bad objects’ – the forgetting of that suffering, even when it does not obscure the ‘facts’ of the memory, has ramifications for progressive social change.

Conclusion

In this context, I think that it is premature to jump to a ‘yes’ or ‘no’ about propranolol, despite the number of academics willing to do so. I would suggest, instead, that this kind of critical appraisal of the politics of propranolol underscores that such biomedical developments have a politics which arises not straightforwardly from the drug itself, nor from the solution it offers to a particular form of suffering. Rather, the politics of propranolol arises from the political significance of memory, suffering, happiness and freedom, such that attending solely to the veteran suffering from PTSD can obscure far larger problems, problems which are implicated in the reproduction of suffering. The extreme antagonism between the ethical imperative to reduce this individual person’s suffering, and the political means to address the occurrence of suffering in the first place, indicates a profound problem with contemporary political structures that requires thorough consideration. As Erik Parens puts it,

[w]ork on our bodies instead of our environments may incline us to ignore the complex social roots of the suffering of individuals. And the easier it is to change our bodies to relieve our suffering, the less inclined we may be to try to change the complex social conditions that produce that suffering (Parens, 1998, S7).

Without such a negotiation, the ethical imperative to relieve suffering becomes part of biopower in a way that continues to conceal the violence that lies in the gap between legitimating fiction and experiential reality, a gap that biopower produces and sustains.

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Over at New APPS, Catarina links to and comments on a New Scientist article about fMRIs and female sexuality. When my comment grew to be so unwieldy (sigh), I decided to post it over here instead…

Mmm, interesting post – thanks Catarina! And Mark, you’re entirely right… but I think this point has more to say in this context…

Whilst I understand and also reject the Freudian model of understanding ‘mature’ female sexual pleasure (a thesis shocking in its persistent) as lying in being a ‘lodging place for the penis’ (as Irigaray puts it), I’m also hesitant about suggesting that female sexual pleasure arises primarily from the clitoris and that this is unsurprising because it is the homologue with the penis. Again this seems to centre a very particular masculine imagining of sexual pleasure (one, I might add, not necessarily experienced by all men), with feminine versions then imagined as a mirror image. I understand not wanting to buy into a Freudian model, but as Irigaray points out, challenging Freud lies not just in saying ‘my sex is not nothing’, nor ‘my sex is one’, but in elaborating a feminine experience of multiple sites of pleasure, sites which are both distinct and unable to be fully distinguished. The acknowledgement that nipples might also activate ‘genital regions’ (it wasn’t clear to me whether this meant the apparently clearly distinct vaginal or clitoral areas) seems to me to appeal interestingly to such ideas.

Part of the reason I find Irigaray’s focus on the multiple interesting is because it also helps do justice to the voices of other women, who are often treated as if they – like all those immature women out there failing to have vaginal orgasms! – must be, as Mark put it in comments on Catarina’s post, lying. One example is those women who have experienced some form of genital cutting, as Catarina alludes to in the post linked to above. There are a thousand different elements to the debate about female genital cutting, but voices claiming sexual pleasure, like those of the women in this study,  are often dismissed (see also Njambi’s assessment of the how and why these debates often play out this way). There are lots of ways of considering how sexual pleasure can occur in these situations – and the authors focus on the way that, as Catarina pointed out, clitoral tissue is ‘iceberg-like’, spread far further below the surface than most acknowledge. This is legitimate and even expected from scientific types, but it is also probably worth analysing how the experience of erogenousness might be modified by changes to the body.  ( I’ll note that ‘activation’ in the fMRI linked to above can’t really, as far as I understand, be equated with ‘being turned on’ except through the subjective experience of the individual woman – the ones whose accounts, it would seem, may not be able to be fully trusted unlike the Truthiness of the colourful scans – but this is an ongoing issue with fMRI studies, as far as I can tell).

But I also think that the experiences of those with spinal cord injuries have something to contribute here. There’s some evidence [pdf] that orgasmic stimulation does not necessarily, in all cases, require direct contact with the genitals: other parts of the body, such as the skin above the site of spinal cord injury may become intensely erogenous, even to the point of producing orgasm; and in certain cases, women can experience ‘thought orgasms’ with no physical stimulation whatever. Such orgasms are only sometimes experienced as ‘connected’ to genitalia (in much the same way as the nipple example above, I think?) but the fMRI, despite the initial dubiousness of the neuroscientists – because let’s not just actually believe people when they tell you what they experience, amirite? – demonstrates very few differences between those experiencing orgasm through direct vaginal/clitoral contact (they squoosh these two in together, which is clearly a problem) and those having ‘thought-orgasms’.

The point of this is that many of those theorising accounts of sexuality and eroticism which don’t match ‘common sense’ – such as those of BDSM practitioners, trans people and people with spinal cord injury – via contemporary theories of the body talk about ‘remapping’ erogenous zones.  Often, though not always, they’re building on Foucault’s argument about pleasure in relation to sadomasochism, which que(e)ries the ‘virilisation’ of pleasure, that is, questioning the account of sexuality not just the focussed on the genitals, although this is part of it, but focussed on the penis-king. In this sense, Foucault’s account shares some terrain with Irigaray’s, undermining Freud’s focus on the penis and its speculuum-sheath, but also helping to make eroticism and pleasure flexible and multiple, that is, understanding pleasure as capable of modification. He particularly discusses fisting and the role/power-play aspects of sadomasochism, but his point is really: there are pleasures to be produced that exceed heteronormative common sense.

As far as I can see, the accounts offered by these studies of fMRI (well, and their popular representations, which are probably the real site of the problem) would do well to maintain a level of complexity in negotiating with the Truthiness of their studies. Not only do they need to be circumspect in the claims they make about the relationship between the brain and experience (the key difficulty with this kind of neuroscience, I think) but they also need to be more thoroughly aware of the specific embodiment of sexuality of those they are ‘testing,’ and the role that this is playing in a supposedly generalisable ‘neuroscience of sexuality’ (and – sigh – we’re back to Ogg and Gaddam territory). In taking a particular cohort as potentially universalisable, not only are alternative experiences of sexuality excluded or rendered derivative or ‘unnatural’, but the contingency of those dominant, ‘common-sense’-compatible experiences of sexuality are obscured – for example, perhaps the connection between the activation of nipples and genitals is related to the sexualisation of breasts and genitals in contemporary Western culture; and perhaps the continued activation of ‘genital’ areas of the brain in people with SCIs says more about the lingering effects of genitocentric sexuality than about a necessary nerve connection to the genitals (the Vagus nerve really came into its own in the Komisaruk and Whipple paper!) . And, as Foucault seemed profoundly concerned to elaborate, the denial of this contingency, when it becomes truth, also works to deny everyone the proliferating possiblities of pleasures (and the political challenge that that brings – but that’s another chapter in this story, to be told another day).