«Kent Academic Repository – Addiction in public health and criminal justice system governance: neuroscience, enhancement and ...»
This presents many possible future scenarios. Two extremes will be sketched out here.
Should notions of addiction be extended to cover prohibitions on specific psychoactive substances according to their potential for harm, an expansion of both criminal justice system and public health governance might be anticipated. An increasing number of us would be designated as suffering from conditions requiring treatment. Pharmaceuticals providing alternative means of experiencing pleasure, or of blocking the pleasure-inducing effects of prohibited psychoactive substances, would be characterised as medication. Avenues for enhancement and claims of cognitive liberty would not be favoured. Alternatively, should the latter prove successful, pharmaceuticals enabling us to experience a range of pleasures or abilities, ideally with potentially harmful side effects being blocked, would be made available in pure, regulated form. Any psychoactive substances posing irrevocable harm to others, like arsenic, would continue to be subjected to safeguards in keeping with the criminal justice system’s protective functions.
The disruption of the present systemic inconsistencies of the classification of psychoactive substances as lawful or unlawful which I have argued is catalysed by post-genomic genetics, neuroscience, happiness research, salutogenesis, and the discourses of pleasure, enhancement and cognitive liberty is inevitable under either scenario sketched out above, as well as in a range of others. Which will prove the more likely would appear to hinge upon the future relationship between ideas of freedom, medicalisation, pleasure and prohibition on the basis of harm. A crucial factor in determining which possible scenario will come into being will be the commodification of health. Part of the governance of freedom in neo-liberal society is the investment of commercial third parties, often in public/private partnerships, in the Published version available in ‘Genomics, Society and Policy, 2 (1) pp 92 – 109’
- 12 Kent Academic Repository – http://kar.kent.ac.uk ‘shaping of the intimate’, the construction of disease entities and a commodification of the means by which these might be treated.70 Risk societies and the health practices of individuals managing their risky selves have given rise to opportunities wherein biovalue might be generated. Such commercial ventures offer biological citizens a plethora of consumer choice in the form of genetic tests, pharmacogenetically tailored pharmaceuticals and neurochemical means by which we might enhance our mood control.71 Nor are the law abiding self-reflexive citizen consumers the only market for the products of biovalue. Pharmaceutical companies’ interests in providing medication on a large scale at a time when many patents for major drugs are running out have influenced how drugs are marketed, as well as the creation of novel disease entities such as female desire dysfunction disorder.72 Thus the size of the criminal justice system as a potential market for drugs which target neurochemistry associated with addiction is a substantial incentive to produce valuable additions to the arsenal of governance in the form of magic bullets like ritalin, which attract blanket prescription for behaviour which may be regarded as socially unwise. Under the first scenario, then, the likelihood of inappropriate medication of vulnerable offenders within the criminal justice system, and the ‘prophylactic’ treatment of those who are viewed as at risk of addiction, seems high. In that version of neo-liberal consumer society, a restricted range of pleasures, those which are lawful and do not make us fat, unhealthy or unhealthily unhappy, or in which we do not indulge to excess, would be made available to us within the commercial sector. Medications or medical treatments which restored those of us who slipped on primrose paths to return to the straight and narrow would be made available through the public health or the criminal justice system. Here the confluence of public health’s disease model of addiction, public health powers of compulsion, the criminal justice system’s orientation towards reintegration and retribution and simplistic applications of genetic and neurochemical knowledge, taken together, would constitute an impetus towards coercive treatment of so-called addicts and potential addicts which would threaten to overcome civil liberties protections.
Yet the catalysts explored above suggest that if our behaviour in relation to psychoactive substances is examined in the light of happiness research and neuroscience, most of us find ourselves happy enough without excessive striving in a companionable sort of fashion, and prefer to make up our own minds about which pleasures we choose. Hence arguments based upon enhancement and cognitive liberty discourse are likely to prove appealing to many. Insofaras we may purchase access to pleasure as a method of achieving health, we are fulfilling our dual responsibilities as consumer and healthy citizen. When we pay for a year’s gym membership in order to maintain cardio-vascular fitness, the self-interrogation practice we engage in before doing so exemplifies this duality. We might weigh up the merits of gym membership against liposuction in terms of cost and health benefits before choosing the former.
Many of us have no doubt traversed these decisions and transactions, particularly in the New Year. But most of us fall by the wayside. Almost all gym memberships lapse after the first three weeks. In similar fashion, the vast majority of us who embark upon diets of one sort or another abandon them and become fatter, despite a billion dollar industry selling us diets and fitness, in tangent with millions of pounds spent on public health exhortations to amend our ways. Does this mean we must be fixed with the cyclic identity of addicts in order to excuse our lack of will power, as Reith
contends? Or might happiness research, taken together with aspirations to enhancement and cognitive liberty provide an alternative way forward?
Happiness research can be read as encouraging communitarian as opposed to consumerist ideals. The ability to locate pleasure outside judicious rational consumption is applauded by Lord Layard. In his view, ‘[o]ne central fallacy is to think that our lives should be organised for the benefit of ourselves as consumers. We are both consumers and producers and it makes no sense to produce a wonderful material lifestyle, even wonderful health services for the population, if we as workers and producers are becoming more miserable’.73 Characterising addiction to alcohol (and, by extension, other addictions) as a ‘very meaningful indicator of unhappiness’74, he asserts that neurochemical and social science demonstrate that selfadvancement as a primary aim leads to anxiety, and that happiness is to be found through assisting others as well as oneself. Hence the task of policy makers is accepting that all humans are of equal moral worth and working to maximise human happiness via distributive justice. From this perspective, the cycle of addiction, medicalisation and governance constrained choice described by Reith would become disrupted as we found happiness in terms of both pleasure and eudaimonic meaning through altruism, affiliation and limiting consumption. A view of one another as possessing equal moral worth also supports claims that we should be free to choose means by which to enhance our lives as an exercise of cognitive liberty. In this scenario, then, the biotechnological industry would be free to develop products which produced pleasure or enhanced capacities within regulatory safeguards without the need to promote these as medications for constructed diseases. Nations would prosper from revenue accrued from taxing such products as well as from savings in the criminal justice system budget. We as citizens could engage in rational evaluation, choice and experience of pleasure to achieve eudaimonic meaning in our lives.
I have argued that neuroscience, happiness research, salutogenetic public health policies and the commercial potential of biovalue have contributed towards a situation where an explicit focus upon health as both commodity and means of governance entails public health policies which promote self-reflexive practices involving the measured manipulation of mood as not only permissible but obligatory. The strategic use of notions of addiction, risk and drug abuse have been used to anchor an elision of pleasure from past discursive strategies which have sought to promote the virtues of self-restraint essential for prudential self management, as neo-liberal governance frames resistance to these as weakness or crime. Reading health as both a commodity and a means of governance in neo-liberal consumer society means that treatment succeeds when we return to practices involving consumer choice.
The relationship between pleasure and health is problematic for both public health and criminal justice policies as they seek to delineate boundaries of permissibility surrounding psychoactive substances which promote pleasure. When pleasure is framed as both salutogenic and pathogenic, as where, say, orgasms provide endorphins which enhance our immune systems but sugar promotes diabetes, the need to regulate the self-reflexive consumption of pleasure becomes acute. Information supplied for this purpose creates a rational interrogation of pleasures and their effects which, when applied to criminal justice system prohibitions on the use of Published version available in ‘Genomics, Society and Policy, 2 (1) pp 92 – 109’
- 14 Kent Academic Repository – http://kar.kent.ac.uk psychoactive substances, reveals systemic inconsistencies. This encourages the framing of the consumption of psychoactive substances as more appropriately falling within the public health rather than criminal justice sphere of influence. Besides this, it adds force to the movement to decriminalise at least some prohibited psychoactive substances, and suggests that pharmaceuticals created in order to enhance our capacities or improve our moods to render us better than well might now be categorisable as virtuous salutogenic medications rather than vice-ridden designer drugs. Pharmaceutical manufacturers anxious to exploit biovalue fully, as patent protections run out, are likely to press for supportive reclassification here.
Thus the fragile accord between public health and criminal justice system policies becomes disrupted, whereupon the potential for re-evaluation of a range of pleasures, and the creation of new means to achieve them, is a plausible outcome. Rationales located in Layard’s rereading of utilitarianism, together with claims of cognitive liberty and the movement towards enhancement hold promise here. Perhaps, then, our notion of health, happiness, pleasure and criminal justice may become fleshed out to incorporate the complexities and ambivalences of our lived worlds.
Acknowledgements The author would like to thank the anonymous reviewers of Genomics, Society and Policy for their extremely helpful comments. All shortcomings are naturally her own.
1 G. Reith. Consumption and its Discontents: Addiction, Identity and the Problems of Freedom. British Journal of Sociology 2004; 55: 283-300.
2 R. Layard. 2005. Happiness: Lessons from a New Science. London, Penguin.
3 C. Waldby. Stem Cells, Tissue Cultures and the Production of Biovalue. Health 2002; 6: 305-323.
4 Foresight Brain, Science, Addiction and Drugs Project http://www.foresight.gov.uk ; A. Chatterjee.
Cosmetic Neurology: the Controversy Over Enhancing Movement, Mentation and Mood. Neurology 2004; 63: 968-974.
6 Layard, op. cit. note 2.
8 S. Lyubomirsky et al. The Benefits of Frequent Positive Affect: Does Happiness Lead to Success?
Psychological Bulletin (2005); 131: 803-855.
9 R. Ryan and E. Deci. Of Happiness and Human Potentials: a Review of research on Hedonic and Eudaimonic Well-Being. Annual Review of Psychology 2001; 52: 141-166.
10 M. Easton. The Survival of the Happiest. New Statesman 24 April 2006 http://www.newstatesman.com/200604240016 11 A. Stutzer and B. Frey. (2006) What Happiness Research Can Tell Us About Self-Control Problems and Utility Misprediction. Zurich, Institute for Empirical Research in Economics.
12 F. Elliott and S. Goodchild. Prozac Nation. Independent on Sunday, 15 April 2006: 1-4.
13 R. Layard. (2003) Lionel Robbins Memorial Lectures 2002/3. London, London School of Economics http://www.vwl.uni-mannheim.de/stahl/tobi/happy.pdf at 13; N. Pearce. In Conversation with Professor Richard (Lord) Layard. Public Policy Research 2005; 12: 188-95 at 190; Layard, op. cit.
note 2 at 205-21.
14 R. MacCoun and P. Reuter. 2001. Drug War Heresies: Learning from Other Vices, Times, and Places.
Cambridge, Cambridge University Press, J. Inciadi. 1999. The Drug Legalization Debate.. New York, Sage. M. Grosman et al. Illegal Drug Use and Policy. Health Affairs 2002 ; 21 : 134-145.
15 Jenkins, P. (1999) Synthetic Panics: Symbolic Politics of Designer Drugs. New York, New York University Press.
16 See April 2006 special issue of PLOS Medicine at http://medicine.plosjournals.org/perlserv/ ?request=index-html&issn=1549-1676 Published version available in ‘Genomics, Society and Policy, 2 (1) pp 92 – 109’
- 15 Kent Academic Repository – http://kar.kent.ac.uk 17 G. Annas et al. Protecting the Endangered Human: Towards an International Treaty Prohibiting Cloning and Inheritable Alternations. American Journal of Law & Medicine 2002; 28: 151-173, F.
Fukuyama. 2002. Our Posthuman Future: Consequences of the Biotechnological Revolution. London, Profile, L. Kass. 2002. Life, Liberty and the Defence of Dignity San Francisco, Encounter, P. Lauritzen.
Stem Cells, Biotechnology, and Human Rights: Implications for a Posthuman Future’ Hastings Center Report 2005; 35;: 25.-34, President’s Council on Bioethics. 2003. Beyond Therapy: Biotechnology and the Pursuit of Happiness Washington, PCB.
18 A. Caplan and C. Elliott. Is It Ethical to Use Enhancement Technologies to Make Us Better Than Well? 2004; 1: http://medicine.plosjournals.org/perlserv?request=get-document&doi=10.1371/ journal.pmed.0010052, M. Smith. Saving Humanity: Counter-Arguing Posthuman Enhancement Journal of Evolution and Technology 2005; 14: http://jetpress.org/volume14/smith.html.