drugs


So it’s been a while since I’ve been back here to update you all on where things are at, and now here I am on the third day of my new postdoc, feeling guilty for letting you all be misled for all this time! I’m actually not in Austria. Around August or September last year, I applied for a postdoc in a Psychology department (I know, whut?) at a university in the Netherlands. After a far swifter process than I’ve encountered with any other postdoctoral position, I was offered a two year position, with a teensy bit of teaching, to work on the therapeutic forgetting project.

So here I am, having uprooted myself from the easy spaces of Sydney and, more lately, Canberra, and transplanted myself into a small Dutch town with an abundance of bikes and (comparatively) cold weather. I have a new house, with stairs so steep they barely deserve the name, and French doors which at the moment are mostly used for watching something fall from the sky while I try to decide if it’s snow or sleet or hail or rain. I have an office, which is ridiculously exciting for me, who didn’t even have a dedicated university computer during my PhD.  I have some new colleagues who, even if they think I’m a trifle odd for having the diverse interests I do, have been remarkably, and unusually, welcoming. We had a dinner in my honour. Everyone has lunch together each day. It’s collegiality gone wild! 😉

But I’m also hovering at the beginning of a new project, with all the future-taming that seems to entail (I love the way that futures hover, unmanageably big, beautiful and slightly out of reach, like a kite, but inevitably there’s the process of trying to catch at it, to tug down a string to let it become at least mildly real). Of course there’s the reading (I’m trying to work out whether my new colleagues will hold it against me if I do what I always did in my PhD years, which is go to a cafe and read for hours, instead of sitting in my office in front of a computer), and there’s the thinking about a new set of papers, but it always feels like there’s something more I should be doing to prepare myself for, y’know, actually doing it. This could be a delaying tactic (which has worked sadly too well for the book-of-the-thesis, which I’m still trying to grapple with, getting sadder as I go) or it could be the perfectly reasonable marinating stage. We’ll see.

So far, I’ve been copying files to my office computer, printing out things and signing myself into Dutch bureaucracy. I have printed out CFPs and stuck them on the wall, applied for the Feminist Theory Workshop at Duke (now that I have an institution to cover some of the funding, everything feels a lot more within reach, not to mention certain geographical proximities which seem to hold such promise just now) and I pulled out a notebook and pen to do my usual beginning-thing of handwriting a plan with numbers and cross-outs and lines that lead to ‘minor’ thoughts that scrawl into importance as they head for the margin. And then I thought of my fallow-lying blog, and thought I’d share some of this process with you…

So, would you like to see what I promised I’d try and do? This is an excerpt from the ‘Letter of Motivation’ (I’d never written one before and really had no idea what I was doing!) that I sent to my new colleagues…

My project is entitled ‘Therapeutic Forgetting: Happiness, Suffering and the Politics of Medical Innovation.’ It seeks to provide a critical engagement with the developing pharmaceutical practice of ‘memory dampening’, particularly the potentials of the betablocker propranolol. I will explore the issue of therapeutic forgetting in ways that intervene in or critique ‘common sense’ or dominant understandings of it, specifically by considering the often-neglected intersections between embodied subjectivity, memory, suffering and happiness. Using the methodological tools of feminist theories of the body, queer theory, critical race and whiteness studies, critical disability studies, phenomenology, bioethics and poststructuralism (which one can see at work in my doctoral thesis, attached), I will offer a postconventional analysis of the ethical and political issues around therapeutic forgetting, as well as consider the way that propranolol is likely to affect individual subjects, given contemporary structures of subjectivity and embodiment. I propose to analyse the following key issues:

  • the role of memory in the construction of the contemporary embodied subject, and the subject’s vulnerabilities to suffering;
  • the contemporary imagining of medical innovation in relation to the happiness/suffering distinction, and conceptions of ‘enhancement’;
  • the issue of how propranolol is both differentiated from and related to other ‘treatments’ for trauma, in terms of both the lived experience of them, and their ethical, social and legal significance;
  • the way that ‘memory dampening’ interacts with contemporary forms of subjectivity—such as the lived experience of a mind/body or brain/body split—and current constructions of suffering, for example as damaging, as enabling, or as useless;
  • the effect of ‘memory dampening’ on contemporary conceptions of ethics, politics and justice, given their reliance on the liberal humanist understanding of the subject, of trauma, and of memory.

Also, just as an aside, I’m thinking about using that paper (the one in the post below) as a way of kick-starting my thinking about this. And I think I want to spend a bit more time considering the likely military use of propranolol, and the way that it exacerbates the question of whose trauma can be forgotten, and for whom…

Oh, and I’ve been using the word ‘trauma’ because it’s used a lot in the stuff on propranolol, but I’m not sure I really want to go there. Does anyone have any thoughts about the use of the T word? It feels awfully freighted with the weight of the psy sciences, with that whole PTSD thing (which is a troubling enough ‘disorder’ in itself), and with the attempt, then, to make-expert the knowledge of suffering, to swipe it out of the everyday land of suffering and into, well, a whole grid of intelligibility more invested in knowing than in, well, ethics. Sorry, my psy-invested kids, is that mean??

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So, this is a copy of the paper I gave at the AWGSA conference just a couple of weeks ago. It’s not spectacular – it was primarily written late at night and early that morning, due to a somewhat ridiculous schedule – but I’m hoping it will give a sense of where, at least, I’m starting out in thinking about law and therapeutic forgetting. I didn’t get into much theory, really, because this was really a sketch of a research area, rather than a fully rigorous paper. Bah, caveating aside, here’s the goods:

Medical innovation is something that we are all becoming, more and less, accustomed to dealing with. Whilst the effects of such technologies for the individual–not only straightforward safety, but the risks of potential side-effects and pharmaceutical interactions, for example–are considered a key part of the research required in advance of permitting sale of a product, or allowing a surgical technique to become standard procedure, the effects which extend beyond the individual concerned remain, for the most part, irrelevant. Bioethics, for example, which one would be forgiven for assuming considers the ethics of medical and biological research, turns out to be primarily concerned with enumerating the rights and responsibilities of the liberal humanist individual in relation to medicine. But as scholars such as Margrit Shildrick have pointed out, such bioethical analyses tend to presume the very subject that these medical and pharmaceutical developments query, or change, or throw into question. Obviously, however, it is not only bioethics that presumes a liberal, humanist subject, the conception of which is shaped by a history of the subordination of women, by colonisation and racism, by rampant and continuing ableism and eugenics, and by class asymmetries. This subject lies at the heart of numerous social and political institutions; of central concern today is our legal system.

If we turn to John Stuart Mill’s On Liberty, we can see the central ideals of liberalism which are so key to understanding such institutions, perhaps summed up as follows:

‘The only freedom which deserve the name, is that of pursuing our own good in our own way, so long as we do not attempt to deprive others of theirs, or impede their efforts to obtain it.’

The deprivation of freedom has been configured as a ‘harm.’ At least theoretically, then, according to liberalism, whenever harm occurs, some kind of intervention is warranted. This is thought to be the place for the law, and, perhaps more importantly, the justification of it: it is meant to intervene where someone transgresses on another’s capacity to be free, to ensure that justice is done, say through prevention, compensation, punishment and/or deterrence. Yet, of course, what counts as harm has never been entirely clarified, even though there are many liberal philosophers who have attempted to describe it. I would add that the selectivity of what counts as harm is one of the key ways in which the white, straight masculinity of the liberal humanist subject is both privileged and protected. That is, only certain forms of harm are subject to legislation or court decisions.

The very use of the word ‘harm’ in liberalism is, I think, telling: where we could use words like ‘suffering’ or ‘hurt’, we use ‘harm’, an apparently objectively given standard. And this objectively given standard is adjudicated, often, by law, before which we are all, allegedly, equal… or perhaps ‘the same’ is a better description. Thus, looking closely at what the legal system protects helps us to understand what kind of a subject the law seeks to protect, or more specifically, what vulnerabilities the law assumes its subjects have, that must be protected to ensure that justice is done, helps us to understand how and why social asymmetries are reiterated through law. As Moira Gatens points out, the legal system is produced to protect those whose bodies match the body politic, whilst laws relevant to minorities such as women are fragments, set around the edges. This discussion might seem a little distant from medical innovation, but the key point is that our legal systems function with a particular model of subjectivity in mind. Whilst that subject may have always been something of a fantasy, nonetheless the issue of what happens when contemporary subjects change through medical intervention requires some analysis. The question I am interested in asking, then, is how medicine and law intersect in the context of existing oppressions and social assymetries, given first that they tend to bow to each other’s expertise, and second that they share a mutually reinforcing conception of the subject. In this particular case, I want to talk about therapeutic forgetting, or, as it is also known, memory dampening.

The pharmaceutical at the heart of this set of questions is a beta-blocker, one of a set of drugs which help to stop the visible manifestation of anxiety. They are mostly used by performers, to keep them from perspiring excessively, and to steady their hands. Propranolol, however, has been discovered to have another, rather astonishing effect: if taken in the immediate aftermath of a traumatic event, it can, it would seem, reduce the ‘traumatic weight’ of the memory of the event. This practice is called ‘therapeutic forgetting’ or ‘memory dampening’, and although it isn’t yet a common part of the treatment of trauma, it seems likely that, if the initial tests go forward into proper clinical trials, it could become part of the toolkit used to negotiate with trauma, alongside, say, anti-depressants, counselling, anti-anxiety medications and debriefing. There are many questions still outstanding about the use of propranolol in the prevention of trauma–for example, it’s not clear from the tests which have taken place so far whether the reduction of trauma also affects the clarity of the memory of the events– but in the end, the promise of being able to contain trauma to the immediate aftermath of an event, rather than something that takes months, years, perhaps decades to deal with, is probably going to be too sweet a possibility to refuse.

What does it mean, to be able to reduce the traumatic significance of a memory? Those closely involved in its testing see only what they call a positive outcome: the prevention of PTSD. Yet our memories are not simply the ‘content’ added to the ‘container’ of who we are: they are part of us; in fact, there are those who suggest that we are nothing more than the narrativisation of our memories, that our subjectivity is shaped that profoundly by our experiences. In terms of traumatic memory, it is not only the memory of the traumatic event that reshapes a subject, but the memory of the memory, the practices of remembering that develop over time, as we ‘deal with’ or ‘fail to deal with’ whatever trauma we have experienced.

The memory of rape can and often is, precisely that significant in someone’s life, a memory that for a long time can produce suffering, in the recollection of suffering. Suffering is, obviously, understood as a prima facie bad thing, claims about post-traumatic growth notwithstanding. On the one hand, this might mean that we cheerfully hand over propranolol to all those who might be traumatised, as medicine would seem to recommend. And it is incredibly difficult to imagine how it could be ethical to refuse a rape survivor access to a drug that might reduce her suffering, a suffering which is part of the reiteration of women’s oppression, a suffering which, lest it need to be repeated, she did not deserve, or earn.* Surely the relief or reduction of suffering can only be an ethical aim?

On the other hand, what effect might this have on the law? If law is shaped, ideally, by the trauma experienced by liberal individuals, then what happens to legal understandings of crimes when trauma is reduced? If a woman is raped, for example, and takes propranolol, thereby reducing the longevity of her trauma, or the ‘traumatic weight’ of her memories, does that reduce the significance of the crime? Or, more to the point, if propranolol became standard ‘treatment’ for the trauma of rape, might it, over time, reduce or at least reconfigure the significance of rape, not only for the individuals involved–as the drug is intended to do–but for the legal system and for society more generally? And would this be a bad thing, in any simple sense?

For the individual concerned, perhaps not. But if this pharmaceutical reduction in trauma became that widely used, which would seem quite likely if the adoption of, for example, anti-depressants is any indicator, what happens to the individual woman who might choose to not take propranolol after someone rapes her? Our society has a plethora of discursive techniques for holding women responsible for rape–from having had sex once, to wearing skinny jeans, to getting drunk–and in this context, it seems likely that such a discursive construction would shape social responses to the use of propranolol. For a woman to choose to not take propranolol in the aftermath of rape thus risks becomes freighted with the language of responsibility for trauma. What precisely might it mean to ‘choose your own trauma’ in this way?

Preventing ‘bad’ experiences from shaping who we are–perhaps this is a simple straightforward good thing. We often assume it is. But it also places us in the position of making decisions about who we want to be. Obviously we already make these negotiations, but the question of whether we, both individually and as a society, have the wherewithal to make more and more and more decisions about who we want to be, remains a live one. The alleged equation of more choice = more freedom has clearly been a seductive one, but there are increasing numbers of questions being asked about whether those choices are liberating, or risk becoming another facet of oppression or even trauma. For rape survivors, the effects of propranolol in terms of the pathologisation of bad memories and the potential to erase trauma have just this potential.

Similarly, some commentators such as Bell, Chatterjee and Lindberg and Siao,  have pointed out that propranolol risks pathologising bad memories; making memories that are difficult appear as disease, in the limited lexicon of medical science. It is a well-established problem for medical innovation that having the capacity to ‘treat’ something situates that ‘something’ as pathological. Memories of rape are already socially coded as sites of shame, partly because they tap back into existing and conservative ideas about gender dynamics which render women allegedly ‘unrapeable’. To expand this investment in memories of rape into the pathological would seem to add a problematic discursive weight to the aftermath of rape, making negotiating the entire experience far more complicated. I have already suggested that our practices of remembering–how we remember what we do, and how those rememberings reshape the memory itself–are particularly at stake here, and it seems that propranolol may produce a peculiar new way of remembering memories, one which risks carrying the extra weight of pathologisation. The effect of propranolol on our socially shared styles of memory and remembering, then, bears with it the potential to undo its own positive effects. Between the question of who becomes responsible for the trauma arising from rape when ‘she could have just taken a pill’, and the issue of further stigmatisation of rape survivors and rape memories through the pathologisation of such memories, this drug, which has so much potential, may simply become another complicated and contradictory space that a rape survivor must negotiate.

It also opens up the question of the significance of the memory of rape beyond the individual. Contemporary Western culture is extremely good at erasing the memory of rape from public knowledge. Whether the erasure takes place when survivors are shamed into silence, or when police officers refuse to take reports, when physical examinations are not done, or are inconclusive, or when prosecutors decide a case is too hard to win, or when judges lead or affirm juries in thinking that rape is not rape because of drunkenness or skinny jeans or whatever, the point is that rape is too easily rendered solely a private matter. A memory delimited to a single embodied subject. One of the only spaces for publicly marking and remembering the trauma of rape is the legal system, and the effect of propranolol on this role is thus a key part of the questions I want to ask. Reducing the trauma of rape could either reduce or increase the number of rape survivors prepared to testify: perhaps, with the reduction of the trauma attached to the memory, testifying in court might become a less re-traumatising experience and thus become a process that survivors are more willing to go through; or again, reducing the trauma may mean that whatever psychological ‘closure’ is offered by testifying, and the promise of conviction, becomes an unnecessary part of negotiating with trauma. Both possibilities are fairly damning about the contemporary system of justice, however, suggesting that the contemporary legal system is inadequate to deal with the trauma of rape, and that the liberal promise of this institution is never fully borne out. More than this, they require that harm, suffering and trauma be experienced somewhere, and by someone, before intervention of any kind if warranted. Someone needs to be traumatised in order for the legal system to step in.

This is why, I would suggest, that the philosopher of ethics, Emmanuel Levinas, is so damning of the question of justice. He argues that ethics–our responsibility to an other who is always unknowable and unknown–must be acknowledged as coming ‘before’ justice. Ethics is about responding to the suffering of the unique other before me, whilst justice always sets the ethical demands of two others in competition with each other, even as their demands are incomprable. For Levinas, any attempt to talk about the ‘positive outcomes’ of suffering is intensely unethical, and in fact winds up being a justification of the unjustifiable, a defense of the indefensible, a form of what he calls secular theodicy. In these discourses, he includes three claims that are raised in the literature about therapeutic forgetting: first, the claim that suffering is character-building, or second, that it is a natural part of life, or third, that it acts as an indicator for society about where injustice is occurring. He argues that this turns suffering, which is fundamentally useless, fundamentally meaningless, into something that is useful, and in so doing establishes grounds upon which suffering becomes justified. Justifying suffering seeks to delimit that which cannot be ethically constrained: our infinite responsibility to the other.

It is worth attending to where and how these examples of ‘secular theodicy’ occur. Problematically, of course, this is precisely how liberalism works. Liberalism can only respond to injustices such as rape. Harm, trauma or suffering must occur first, must indicate where society has ‘gone wrong’. Suffering must occur first before the correction to social structures is even perceived as necessary. Someone must bear the physical and traumatic memory of injustice before justice may–and it may not!–be done. This style of justice is, according to Levinas, profoundly unethical, yet it is predominantly minorities of various kinds whose vulnerabilities become the site at which these issues with liberalism’s ethical inadequacy is played out.

Therapeutic forgetting, then, is not simply about forgetting harm, suffering, or trauma, about the individual’s experiences of these. Rather, in dampening trauma, it functions to forget this inadequacy, to forget the injustice of a liberalism that claims to protect freedoms from harm. It functions to obscure that liberalism cannot deal with ‘vulnerable others’. In a system of law and politics that is clearly so troublingly unresponsive to the vulnerabilities of its subjects, then, medicine is offering a stop-gap, a means of reducing those vulnerabilities, or rather, a means of producing ideal subjects whose vulnerabilities to trauma lie only in those spaces that liberalism protects. In this context, the question of whether a rape survivor is actually the subject of therapeutic forgetting or not, remains a live question. If, as I suggested at the beginning, medical innovation is transforming embodied subjects as we know them, the question I want to ask is what is it turning them into, and why? Medicine might seek to prevent suffering, but it does so by transforming the other into something less vulnerable, something more isomorphic, as Moira Gatens suggested, with the body politic. In this sense, medical innovation needs to be carefully analysed, perhaps especially where it reduces suffering, because it can too easily forget that suffering is not a naturally occurring experience, but the result of a very particular social and cultural context; and because that forgetting is often weighted with the forgetting of difference.

* I refer to ‘women’ throughout not because I think that men are not raped, because they are, though at far, far lesser rates than women, but because I go on to discuss the specificities attached to women-as-survivors-of-rape, particularly the discourses used to discredit them.

SPOILERS again… Consider yourself warned…

Warned..

They’re coming!…

Warned…

Look out!

Sicko: After all of that, I’m not going to say much about this movie, because, you know, the entire world has. And I’m not simply anti Mike Moore. He’s not simply right, but he’s very far from being George Bush and, y’know, that kinda appeals! But there’s something interesting that seems to characterise the whole thing: and that’s a sense of competition. Yeah. Competition. I understand why he continually, throughout the movie, pointed out the mismatch between the richness of America and the healthcare and mortality rates etc, but doing it with reference to those supposedly terrible and terribly poor countries—Cuba, El Salvador and Serbia come to mind—in there alongside richer but still terrible in some way (according to the US) countries including France and England, feels to me like an entrenching of nationalism. “We’re not measuring up,” could have been the catch-cry of this movie. It might be to a ‘good’ end, but I can’t help but be a little bit horrified by his willingness to reinstate what is already problematic about America (and American foreign policy more particularly, perhaps) in order to achieve his ends. In the end, it felt a little too much about what America and Americans ‘deserved’ (as if there really might be people out there who didn’t deserve health care!).

This was particularly bile-inducing when ‘the best’ of America—ill 9/11 rescue workers—were set up against Guantanamo Bay ‘detainees’. The overt astonishment-bordering-on-disapproval that Moore expressed about the medical facilities at Gitmo was pretty awful, and the rhetoric of ‘look what we’ll do for terrorists and murderers!’ made me a little sick, along with the shots of an orange-clad detainee apparently cheerfully kicking a ball around contrasted with the depressed sick American citizens. As my companion pointed out, there was no reference to the fact that part of the reason that such high level medical facilities are required might be because torture’s on the cards. And the implication, whether or not Moore intended it, was that when resources are spread so thin, we need to decide who deserves it… and we all know how America would make such decisions, given a choice between terrorists and citizens. As if it were ever quite so simple.

I think this was what bothered me the most, in the end: instead of just saying ‘we have the resources, let’s universalise health care!’ his comparisons wound up implying that ‘oh my god, the rest of the world and even the baddies who try to kill us, and the people we disapprove of, get a better deal than we do!’ And that, I humbly submit, attempts to use capitalist market competition to motivate universalising health care. If this is the premise upon which the USA were to actually ‘universalise’ it, how long do you think it could maintain actual ‘universality’? Perhaps for as long as the competition lasts?

And one last point: I’ve seen a lot of people expressing disgust at the American single mother who traveled to Canada to attempt to get free health care. Wow, the vitriol really surprised me; I can’t help thinking it was partly because she didn’t demonstrate her poverty in nice, obvious ways. Yeah, she doesn’t pay taxes in Canada, that’s true. But I’m not sure that I’d be happy to argue that the only people who deserve health care are those who pay for it… hmm, coz hang on, that seemed to be the problem in the first place! Besides, the richness of Western countries, for example, is guaranteed by the poverty of poorer countries, and I wouldn’t want to suggest, therefore, that health care should be only a national responsibility; if exploitation gets to be trans-national, why not justice? (:-)) I get that that’s how the system works now, and that an argument could be made that the nation’s first responsibility is to its own folks , but to me it feels like disapproving of a woman making decisions like these only reinforces the way the system works: that you need to be, or potentially be, a contributing citizen (read tax-payer). Health care on the basis of exchange for money/contribution to society? Hm. Would we want to deny all comers from other countries access to health care, especially given that their ill health may not be as unbound from the richness of Western countries as we might like?! If not, then I’m not sure why we would be so very grumpy at a single mother whose vulnerable situation might send her across the border. I guess in some sense I think that hiding behind the idea/l of a nation-state is just a bit disingenuous, given that the West cheerfully crosses all kinds of borders in seeking, say, cheap labour. I’m not positive about my stance on this, so forgive the rant-y-ness, but I was taken aback by the willingness of so many to attack her. Consider this my knight-in-shining-armour-leap-to-defense!

I‘VE been sick. V sick. And in recovery. Me sorry 😦

(In case you haven’t noticed, I’m sticking by the Aussie… well, Britsky spelling of words with ‘-ised’ in them. My tiny stand against crazy American-iSAtion of spelling. Yeah.)

So this evening I attended a seminar given by Kane Race at Sydney Uni. I really like Kane’s stuff—I’ve seen him present before, talking about the way that discourse about drugs (both prescription and not) never really gets around to paying attention to the pleasures of such activities. His book, which is eagerly awaited (by me, amongst others), almost finished (by him) and published by Duke, is going to be called Pleasure Consuming Medicine which as you can no doubt tell, is one of those clever meaning-play titles that contains the entire thesis. Keep your eyes peeled for it.

So: to the seminar. Today Kane talked about pleasure in relation to illicit drug use, from a paper to be published in I think the International Journal of Drug Policy. As one can imagine, those from the ‘abstinence’ camp simply deny the pleasures of drug use, in order to try to undermine the attractiveness of them (well, that’s a simplification, of course, but that’s the gist). In fact, most public health campaigns based on the whole ‘abstinence’ thing fail miserably, because first of all, the experiences of drugs expressed doesn’t match those of the users (who oddly enough tend to claim it’s pleasurable), and second, the denial of pleasure just winds up making any of that authoritarian ‘advice’ seem stupid and out of touch. The other, more Foucauldian observation about abstinence campaigns is that they operate through pathologisation, where ‘bad’ behaviour is taken to be indicative of a deviant individual. For those who don’t know Foucault all that well, this is from the History of Sexuality Volume 1, and in that context, it is taken to apply to sexuality. The sudden emergence of scientific and psychologistic observations, cataloguing and theorising about sexuality in the Victorian period enabled the development of sexual identities: that is, although there were doubtless people who engaged in what we would now call homosexual sex prior to this period, they were not previously defined by these behaviours; after the development of these catalogues, identities such as ‘the invert’ and ‘the homosexual’ became possible (alongside the ‘heterosexual’, of course). These kinds of identities operated through poles of normal and abnormal. The same kinds of pathologising moves, Race was arguing, occur in relation to drug use.

In an echo of Foucault, who distinguished pathologised and medicalised ‘desire’ from ‘pleasure’ which was less framed by normalising discourse, Race suggests that paying attention to where and how pleasure comes to operate in relation to drug use has the possibility of moving away from the moralistic tendencies of pathologising drug users. In the first place, as harm minimisation methods have long argued, the shift from policing an identity to developing safer behaviours is less (though probably not completely free of) moralising. In the second place, and here we hit a contentious spot in Foucault, Race argues that pleasure is socially and culturally shaped material less constituted (in comparison to, say, desire) in and through a logic of the individual normalising subject. The contention here is that some have argued that at this moment, Foucault alludes to a pre-cultural body; Race explicitly disagrees with such a reading, and in relation to drug use draws on a 1970s (or is it 1950s??) article entitled ‘Becoming a Marihuana User’ by Becker. In this article, Becker suggests that there are three steps to becoming a marijuana user: “1)… learn… to smoke it in a way that will produce real effects, 2) learn… to recognise the effects and connect them with the drug use and 3) learn… to enjoy the sensations he [sic] perceives.” Race argues that the processes by which these three steps take place are socially mediated rather than developed through normalising and scientific discourses. Often, these social interactions also involve a negotiation of risks and some consideration of safety in amongst the development of particular pleasures. Yet in denying that which goes into the production of pleasure, as abstinence and even some harm minimisation methods do, public health campaigns tend to fail to recognise the often very successful negotiation of ‘safety.’

Okay, forgive the haziness of this; my notes are bad and I’m very tired (and still in sickness-recovery!). The general point, though, is that tapping into these processes of pleasure-constitution and risk-negotiation enables a non-moralising, or at any rate much less moralising and normalising engagement with users. I agree with this, particularly in this instance, but I still have questions about the extent to which social interaction can really be considered to be, or, better, be relied upon to be non-normalising. I think of the amount of policing that occurs in and around social interaction, and the ways that that policing is (sometimes explicitly, often not) moralising and normalising. Samantha Murray, for example (sorry, I can’t find a reference, this was at a conference; will post later if I find it), critiques Foucault’s ‘care of the self’ ethics (actually Kane talked a lot about this, but I skipped that stuff out… sorry!) on the basis that the very terms by which such a negotiation of selfhood might happen are not neutral. Foucault takes this ‘care of the self’ ethics from an analysis of Greek and Roman ways of being, and whilst he doesn’t simply want us to go back to a golden era, he does think that the reflective elements of care of the self as it was done then could be applied to now. However, he recommends the value of ‘moderation’ in relation to developing a care of the self, and here Murray offers her challenge. She uses the example of the fat body to demonstrate that this ‘moderation’ dovetails all too neatly with the pathologisation of particular bodies, particular ways of being, and in ways that often shape social interactions of various kinds, rather than being shaped by them. In other words, the current set of aesthetics which engender the desire for a thin body cannot help but be part and parcel of the kinds of ‘care’ we try to take of ourselves (though this doesn’t necessarily mean that we’re simply bearing out power’s program, either).

I suppose in the end, my concern with Kane’s thesis is that whilst there are and will always these kinds of social interactions that allow for the productions of pleasures not fully bound to the normal liberal humanist subject, this doesn’t mean that they are not, or will not become normalising, especially if the infiltration of medicalised knowledge into everyday social interactions continues at the rate it is. Whilst, then, I agree that social interaction may well permit some of these pleasures to occur, this same social interaction is also part of the diffuse operation of power. I can’t remember who it was who suggested that while the images of women’s bodies in, say, women’s magazines may well have a negative effect on girls’ body image, part of the ways that they become so effective is in and through the kinds of group policing that girls are involved in. In relation to drug use, we need to be aware that there are other kinds of normalising going on in around and perhaps even through the kinds of social interaction that Race demonstrates is key to pleasure and to the negotiation of safety. Perhaps the most obvious form might be the ‘I can do what I want with my body,’ a justification which although absolutely understandable nonetheless reiterates a liberal humanist and Cartesian subjectivity. But more disturbingly (I thought, as I made dinner tonight) is the possibility that an awareness of these communal productions of pleasures and the concommitant negotiations of risk could in fact be used in some ways to inform an abstinence program, and may even be already understood in this way. For example, the absence of information about safer strategies for drug use in the public sphere means that only some communities are capable of this kind of pleasure-production-and-risk-negotiation-sharing. Abstinence campaigns, then, seek to use their moralising tools to dismantle the possibilities for pleasure, for example by disallowing or reducing the circulation of techniques for pleasure. With the knowledge granted by analyses like Race’s, how much more repressive and targeted might abstinence campaigns become? (Okay, a lil hysterical there, but it’s a legit worry, I think).

In some sense, here, though, I wonder again about Foucault’s ‘repressive hypothesis,’ which suggests that that which is supposedly being repressed is in fact produced in and through the repression. That is, as power claims (I’m personifying power, which is theoretically a naughty move, but it’s just shorthand) that sex is so bad it mustn’t happen, it ensures that sex happens in ways that feel naughty and in the ways it (power) describes. The distinction between desire (repressed) and pleasure (not so much) seems a little hazy here. In translating this across to the drug use case, I wonder whether abstinence campaigns come to produce precisely what they supposedly repress: dangerous drug use, pleasurable, deviant and risky. How much, though, is the pleasure involved partially the result of this construction?

Or, in a larger concern, if drug use, for all its pleasurable undermining of individualistic liberal humanist subjectivity, is justified or simply thought of as part of the function of that liberal humanist subjectivity (I do it coz I wanna, even though (read, because) it’s bad and they tell me not to do it like this) how resistant is this pleasure? Can it be understood as normalising, perhaps even moralising, just not in the ways we expect?

This is too crude a formulation, because it appears now that I’m denying Race’s point, and I’m really not. It’s incredibly important to acknowledge the ways that communities work to develop resistant pleasures and even risk negotiations; and for a harm minimisation approach, this kind of theoretical consideration is incredibly useful for developing strategies that actually might work. Yet it must be acknowledged that the context within which such strategies function is not neutral (not that I think that there’s some wondrous place beyond power which is ‘value-neutral’), and that the reiteration of the liberal humanist and ‘healthy‘ individual in and through even harm minimisation techniques isn’t innocent, and does have effects on the ways that certain groups are conceptualised and treated in relation to drug use. And that the harm minimisation attempt to tap into the social interactions Race identifies may have unintended moralising, normalising and thus rather problematic effects.

I’m going to leave it on that clumsy note because I’m tired and can’t even be bothered proof-reading (I am an evil blogger, to do this to you, I know). Further and hopefully more nuanced thoughts soon, especially about the absence of the other in Foucault (in amongst the Derrida post I’ve been working on that explains how sick I’ve been and makes other such excuses!) Bona nox!