«Kent Academic Repository – Addiction in public health and criminal justice system governance: neuroscience, enhancement and ...»
Nor are all lawful sources of neurochemicals seen as equivalent. Public health’s concern with resource allocation and the consequences of overindulgence in lawful psychoactive substances such as alcohol, nicotine and food has resulted in policies which seek to moderate our access to them. Restrictions upon places where one might smoke, raising taxes on alcohol and the proscription of certain types of food being sold in schools are some recent examples. Criminal justice policies aim to prohibit or to exact retribution for the consumption of unlawful psychoactive substances. Public health and criminal justice system approaches overlap where offenders are directed towards programmes which purport to treat addictions. Here the procedural protections associated with civil liberties within the criminal justice system are typically relaxed. Participants, in effect, are offered the choice of defining themselves as ill or bad, ie as suffering from addiction as a chronic, relapsing disease or as wilfully engaging in prohibited behaviours which damage both themselves and the larger social fabric. In this light, those who complete the therapeutic programmes successfully escape punitive measures such as incarceration, whereas those who fail to complete are subjected to them.48 The neuroscience of addiction traversed above offers supplementary measures of treatment which give rise to concerns over the civil liberties of those offenders who may become subjected to them.
Medications which remove the rewards or stimulate unpleasant side effects when specific psychoactive substances are taken, or vaccinations with similar effect, are potential forms of compulsory treatment for both actual and potential offenders. Thus
individuals with genetic formations associated with a predisposition towards addiction, particularly children, may receive vaccinations, with or without consent, as a preventative measure. Analogies with allegations of the over-prescription of ritalin, tranquillisers and anti-depressants forming part of public health governance are clear.
Compulsory treatment, the use of neuroscientific technologies to identify actual and potential offenders and the compromised capacity of vulnerable offenders and minors to consent to such treatment raise separate ethical issues. As these have been explored elsewhere, they will not be considered further here.49 Hence the definition of addiction as disease, especially when in the context of criminal justice system proscription, gives rise to significant misgivings over compulsory treatments. These acquire additional force from the spectre of relaxed civil liberties protections associated with treatment within the criminal justice system, suggesting prolonged and indefinite liabilities as a very real possibility.50 The reformatory force of public health and criminal justice system measures in this arena are aimed at encouraging those subjected to them to aspire to a model of selfreflexive micro-management where conditions defined as disease are eschewed, socalled cures embraced and experiences of pleasure subsumed within a civic aspiration to health. This model frames happiness as eschewing short-term pleasures and minimising harm to oneself or others. Both public health and criminal justice system governance thus characterise pleasure seeking where psychoactive substances are concerned in terms of curtailment. Finding too much pleasure in ‘excessive’ consumption of lawful substances, or in habitually resorting to those prohibited by the law, is deemed to be inappropriate. Yet, nonetheless, many of us continue to do so. At times, most of us choose pleasure over perfect health and virtuous self-restraint.
Indeed, the proponents of cognitive liberty and human enhancement would argue that we should be free to direct our own choices here.
Models which seek to explain this seemingly irrational behaviour have veered between characterising it as moral weakness or a form of ill-health. Marianna Valverde has traced the historical transformations of alcoholism and other ‘diseases of the will’ in this light.51 Recently, together with Pat O’Malley, she has elucidated how the experience of pleasure has been excluded from public health and criminal justice discursive strategies which seek to restrain our consumption of psychoactive substances via the rubrics of addiction and drug abuse.52 In my view, however, the incorporation of neuroscience into policy discourse and the public imagination has now fostered a simultaneous resurgence and co-optation of pleasure which threatens this strategic deployment of notions of addiction.
Salutogenesis: the obligatory prudential transforming of pleasure
The impetus within public health policy to persuade us to eschew activities which pose risks to our health and espouse those which enhance it is associated with the concept of salutogenesis.53 The opposite of pathogenesis, or the origins of ill-health, salutogenesis aims to delineate the origins of health and the means by which it might be ensured and maintained. Neuroscientific research has contributed to the salutogenic programme by revealing the extent to which pleasure not only enhances our health but forms a basis of our daily life. Endogenous opiates, for example, ensure that we enjoy one another’s company, providing evidence for a postulated human trait of affiliation.54 While the neurocircuits in the brain associated with functional Published version available in ‘Genomics, Society and Policy, 2 (1) pp 92 – 109’
-9Kent Academic Repository – http://kar.kent.ac.uk salutogenic mechanisms that contribute to health via specific beliefs and practices are not yet well understood, associations between certain states of being or beliefs and practices and good health are now accepted. If we feel that life makes sense, that we can deal with its difficulties, and are able to love at least some of our lives, our gods and our fellow men and women, then we will be happier, more likely to be healthy than if we do not, and will recover better from ill-health. Psychoactive substances and practices may enhance or substitute for these factors. Thus, pleasure is good for us because it helps to make us happy and healthy. Lord Layard’s rereading of utilitarianism rests upon this neuroscience of well-being and mood control. Public health and criminal justice systems wishing to draw upon pleasure as a means to promote health or discourage vice must thus move forward from the elision of pleasure from their discursive strategies noted by O’Malley and Valverde.
Hence, in my view, the neuroscience of salutogenesis, Lord Layard’s rereading of utilitarian happiness and recent suggestions that susceptibility to becoming addicted to various substances, such as alcohol, or activities, such as risk-taking, may be associated with particular genetic formations have together supported a reframing of pleasure as the basis of neurochemical algorithms designed to maximise our health. A measure of the degree to which this has become part of popular culture is the daily exhortations in the tabloids to improve our looks and health by engaging in frequent sex with a regular partner,55 to select foods which will maximise our mood enhancing neurochemicals,56 to replace our addictions to obesity inducing serotonin imbued carbohydrates with the non-calorific mood enhancing endorphins to be found in regular cardio-vascular exercise,57 or to log onto a National Health Service affiliated website which will advise us on techniques of sexual pleasure.58 Public health campaigns encourage us to engage in daily rituals wherein subjective experiences of well-being through pleasure are fostered in order to maximise health. Here our pleasures are not inherently to be valued, but become subsumed within a public health imperative mandating self-reflexive salutogenesis as we become responsibilised to engineer and control our moods in order to ensure that we are as healthy as possible.
Rose has drawn attention to the degree to which the daily self-reflexive practices associated with the maintenance of health and the scrutiny of our inner lives constitute contemporary means of governance.59 For our neurochemical selves,60 prudential practices and rational choices associated with the discerning experience of pleasure have become daily obligations as we seek, responsibly, to maximise our health. Public health policy today expects biological citizens to manage their lives reflexively in ways which will maximise their health, longevity and well being.61 Thus, despite genuflections towards the right not to know, we are responsiblised in terms of discovering our risk profiles, altering our lifestyle practices accordingly and attaining prudential mastery of the neurophysiology of mood maintenance. Under the model I have put forward, discourses of pleasure become part of a mandatory programme of self-maintenance which ensures our long-term health and happiness. Pleasure is experienced subjectively as a neurotransmitter symphony we conduct, pumping up the volume of serotonin via sex, carbohydrates or prozac. These prudential practices come under threat when our desires for pleasure are viewed as intemperate. Judicious moderation or modulation of neurochemicals becomes an essential literacy. Foucault’s account of the uses of pleasure in classical Greece has at its centre an allied aesthetic.62 Indeed, this still forms the basis of suggestions that youthful abusers of psychoactive substances might be persuaded to mend their ways by eschewing Published version available in ‘Genomics, Society and Policy, 2 (1) pp 92 – 109’
- 10 Kent Academic Repository – http://kar.kent.ac.uk excess.63 This aesthetics of moderation is threatened by excessive consumption, the location of pleasure in disapproved psychoactive substances and pleasure seeking habits which interfere with our ability to manage our daily life. It is here where public health and criminal justice framings of addiction and substance abuse become salient.
In conclusion, I shall now explore how my portrayal of the discursive strategies over pleasure employed in public health and criminal justice policies may be integrated with recent critical theorising on neo-liberalism, governance and addiction.
Discriminating between pleasures, neo-liberal consumer society and addiction Gerda Reith asserts that neo-liberal consumer society creates a fetishism of addiction as an artifact of discursive conflicts between consumption, freedom and governance.64 In her view, citizens in such societies are responsibilised as self-reflexive consumers who are both constructed by their freedom to choose amongst commodities and constrained by their incapacity to escape the burdens associated with such unending rational choices. In these circumstances, the option of adopting the identity of an addict, whose ability to engage in volitional choices may be accepted as compromised, may prove all too tempting for many. Hence today there is a plethora of people defining themselves as addicted to food, sex, shopping, gambling and so forth.
From this perspective, treatment for addiction becomes a means of returning weakwilled citizens to their self-reflexive responsibilities associated with consumer choice.
The cyclic return of the self-actualising consumer, assuming control over life, is framed as a triumph over ‘the daemonic force of addiction’.65 Those who prove recalcitrant are subjected to the more explicit coercive powers of the criminal justice system.
In Reith’s consumer society, freedom is read as freedom to consume. Hence dependence, or lack of freedom, is peculiarly abhorrent, and must be eschewed and condemned. As she explains, ‘What is new in modern society is not the emphasis on issues of freedom per se, but rather the unprecedented emphasis on freedom as a mode of governance by and through the individual. Innermost states are the medium through which freedom is controlled, as well as the measure of its loss. Today we are governed not against but through our freedom, which is why its loss or vitiation is articulated in terms of its opposite’.66 How does this fit in with pleasure? O’Malley and Valverde associate the elision of pleasure in liberal discourses of addiction with its subsumption within forms of rational and responsible enjoyment.67 Agreeing with Fox that pleasure is read as risk in public health today, they characterise criminal justice policies embodied in the harm minimisation movement as based upon a rational choice actor performing the felicity calculus in order to avoid harms rather than to experience pleasures.68 Hence, any right to pleasure within a consumer society is in tension with, but subservient to, the prudential duty to eschew risk. As they conclude, ‘Liberal government has thus accumulated a battery of pleasure-denying characterisations, each with its own discursive
effectiveness, each linked with an appropriate set of governing techniques. Beastliness requires and justifies force and compulsions;
compulsive behaviours trigger and validate therapeutics; free choice consumers require and are provided with information and skilling.
Thus does liberalism arm itself with a multiplicity of responses, becoming potentially ever more flexible and adaptable in its capacity to govern without pleasure’.69 My suggestion in this paper is that neo-liberal governance today has moved on from this position. In my view, it now draws upon healthcare’s focus upon salutogenesis, post-genomic genetics and neuroscience to colonise pleasure as a means to ensure that rational consumers aspire both to maintain neurochemical mood control and to apply the aesthetic of moderation to the consumption of lawful psychoactive substances in ways which will maximise health. From this perspective, liberalism as portrayed by Reith, O’Malley and Valverde governs not without but through both freedom and pleasure. Addiction accepted as a chronic relapsing disease provides a rationale for a cyclic progression of citizens from the rigours of rational consumption to the shriven status of the sick, before their return from excess to self-reflexivity. Yet while the evidence from post-genomic genetics and neuroscience provides some support for the extension of notions of addiction to ordinary activities like shopping and sex, it also undermines the designation of specific psychoactive substances as lawful or unlawful on the basis of harm read as addiction. If almost everything we imbibe or do has addictive potential, the grounds upon which some things might be prohibited become problematic unless reasons other than addiction are proffered and proven.