People believe in visions now more than ever. All that has changed is the content of those visions. So argues sociology professor Joseph Davis in his interesting new book, Chemically Imbalanced: Everyday Suffering, Medication, and Our Troubled Quest for Self-Mastery. That unhappy people today find relief through psychoactive medication is only part of the story, he explains. The much bigger part is the belief system by which they justify doing so.
The process begins, he argues, with the creation of the “neurobiological imaginary.” Patients imagine their bad feelings from a neurobiological, or medical, perspective, and take psychoactive drugs to feel better, believing their troubles to originate in their brains. Standing alter ego to the medical perspective is the psychological perspective, which offers talk therapy as a solution. Although opposed to the medical perspective, the psychological perspective completes the modern therapeutic design.
The division between the medical and the psychological is analogous to the division between the two political parties, or the old Cold War division between the free world and the socialist camp: Together, the medical and psychological perspectives create a whole that stands for modern mental health therapy. Although the two perspectives may disagree over how to manage everyday suffering, they conveniently divide up the treatment world in such a way as to provide for all contingencies. Even a rebel can barely imagine going outside the medical or psychological systems to seek treatment, for no alternative seems possible. No gray areas on the margins exist to muddy the therapeutic waters. Within the treatment world, a strong demarcation line between the medical and the psychological focuses everyone’s attention; competition between the two distracts people from thinking there can be any other way. Patients then choose either one modality or the other.
As more evidence of unity, the medical and the psychological camps recognize each other’s language, anchored somewhere in science, which allows their thinking to be influenced by one another in systematic ways. The two camps use many of the same words and phrases to manage everyday suffering, Davis observes, and they often draw from the same primary texts, including the Diagnostic and Statistical Manual of Mental Disorders (especially the DSM-III). Beneath the obvious differences lies convergence.
After explaining how the modern therapeutic system evolved, with the 19th century era of primitive biological psychiatry giving way to the early 20th century era of psychology, followed by a new era of biological psychiatry, including psychoactive drugs, the book arrives at a thoughtful chapter on just this subject of language. Not only does the “neurobiological imaginary” come with a particular vocabulary—for example, the words “self-esteem” and “depression”—but, more important, Davis explains, that vocabulary has entered into the everyday vernacular. Average people speak the same scientific-sounding language as health care professionals do when trying to grasp why they suffer. Davis interprets this event through the lens of social science, and says the public has arrived at what he calls an “impression point.” Yet another way to put it might be that ideology is at work here. An ideology is a belief system held by large by numbers of people, one that contains within it an element of hope and aspiration. Certain code words and phrases grow attached to the ideology, becoming a kind of linguistic shorthand, and adherents mouth them reflexively to convey their beliefs. When the patients interviewed by Davis speak these code words over and over again to explain how and why they suffer, and what their psychological goals are, one smells ideology at work.
Various forces combined to make this “impression point” possible. Davis, for example, rightly points to the drug companies’ direct-to-consumer advertising that began in the 1990s as an important contributing factor. Still, this does not explain why Valium, one of the earliest psychoactive drugs, achieved best-selling status in the 1970s, before the era of direct-to-consumer advertising. Perhaps best to say that multiple forces helped to usher in the age of the “neurobiological imaginary,” and have been at work for some time. Average people wanted the quickest, surest, and cleanest route to relief from their everyday suffering; doctors wanted to please their patients; drug companies wanted to sell their products; and our cultural predisposition toward science, including reverence for all things science, encouraged the various parties involved to stretch the truth about the link between brain matter and everyday unhappiness, and to encourage people to believe in it. All of us participated in a binding contract that perpetuated the ideology of the “neurobiological imaginary,” as each party got something out of it. No single party is to blame.
A particularly interesting question is how neuroscience offered up the necessary scientific rationale in all this. Although not discussed in the book, it may be the case that science itself became ideology, by encouraging a faulty reductive sequence of events that gave the air of science, but which were not science.
First, science mistakenly converted a dynamic process into a static phenomenon. Everyday unhappiness became a single phenomenon known as “unhappiness”—something that can be abstracted from the dynamically interactive system in which it appears, to be studied in isolation. Thus, instead of saying a person reveals unhappy thoughts and behavior, science called the person “unhappy.” The error was carried a step further when it included in the “unhappy” identity all kinds of variations, such as people who fly into a rage for no good reason, or people who withdraw from socializing. A multitude of behaviors were assumed to be manifestations of a unitary underlying property of the individuals, which allowed these behaviors to be explained through a single biological mechanism.
Once widely different types of behavior were isolated from the social context and agglomerated into the “unhappiness” identity, science as ideology then made it possible for unhappiness to be quantified and given a numerical value. How unhappy is a person? Very unhappy? A little unhappy? Unhappiness started to take on a degree of shading.
Once science quantified unhappiness, its prejudice in favor of statistical normality then took over. It assumed a bell-shaped curve for these numbers on the assumption that an entire population can be distributed along a single dimension. In this way a statistical manipulation was confused with a behavioral phenomenon, which itself was confused with a complex human behavioral experience.
Having quantified “unhappiness” and transformed it from a behavioral experience into an individual property called “unhappiness,” science then took one more step and ripped that property away from the individual altogether. It turned “unhappiness” into a part of the individual, meaning the individual’s brain or DNA. This is the biological connection that the ideology of the “neurobiological imaginary” was looking for. The syllogism enabled those who believe in the “neurobiological imaginary” to speak of “the unhappy brain” or “unhappiness in the genes,” which validated the medical solution to everyday suffering, as there is no reason to talk through a problem if it’s biological.
One senses ideology at work again in the last (and I think most thoughtful) chapters in the book, where Davis tries to make sense of the biological determinism suggested by the “neurobiological imaginary”—that is, the notion that we have little control over our emotional lives, since brain matter drives everything—and an opposing view among patients that self-mastery is, indeed, achievable. Many of the patients Davis interviewed thought they were very much in control of their lives. They dreamt of what they might accomplish emotionally. Davis shrewdly picks up on the contradiction, and notes that the reductionism in play here is not that of biology but “of the human person.” What he seems to mean by this is that the “neurobiological imaginary,” void of choice and free will, suddenly gives way among patients to an imagined liberal, autonomous, and self-mastered self.
We have come full circle, from the latest discoveries in science to one more variation on an age-old ideology that stokes human vanity, that encourages people to believe they have a higher self, a better self, a truer self, a more perfect self, a self that is unalloyed with the bad feelings that keep people down. Such ideologies date back to antiquity—for example, the philosophy of Manicheism was one of the first systems to preach the notion of a “higher self.” People want to imagine themselves operating on the highest plain of existence, lofty and majestic, complete and unassailable. Any belief system that allows them to do so will always find some followers.
It is the kind of belief system that arises when we put questions in unanswerable form: “Where and in what way can I achieve perfect happiness? Where can laws be found that will assure my peace and happiness?” No one can reply to people who state their problems in this way, at least not honestly. One can delude people into thinking they truly have a perfect self hidden somewhere inside them, or a perfect happiness within their grasp—this is what ideologies do—but wiser counsel advises them to frame their questions differently. They should be asking: “What sort of happiness can I achieve, given my fears and regrets that are a permanent part of me? Where can I find other people with weaknesses like my own, but who, thanks to our good intentions, we can find shelter together and keep company.” Such questions recognize the truth about humanity, that there is no permanent equilibrium in human affairs. One can attain a balance point for a time, but inevitably outside influences, the decay of our bodies, or our own passions destroy it, and one must climb the mountain again in the same manner.
This vacillation is happiness, or the best we can achieve. One can analyze its separate components and find small struggles, innumerable tiny conflicts, and, yes, bits of everyday suffering, and insist this cannot be happiness. But one would be wrong. Such happiness is no different from a great love, which people often equate with happiness, for great love can also be broken down into separate components, if one insists on doing so, and find bits of everyday suffering among them. Does not even the most ardent love also come with occasional pangs of jealousy, or moments of worry? And yet, great love is still thought to be happiness.
In any event, we have sort of two ideologies working together in sync today: one of the “neurobiological imaginary,” to justify taking drugs for everyday unhappiness, and to keep people from feeling badly for doing so; the other of the imagined higher self, which lets people feel proud in another way. What Davis has helped to expose is the contradiction in all this, the juxtaposition of the biological with the purely psychological. Tocqueville may have put the situation best when, over a century ago, he criticized scientists who went on stage to preach their doctrine of pure materialism, not unlike the way some scientists today preach the link between brain matter and mood. He observed they were as proud as gods, while declaring that man was less than a beast. Davis may have caught the same peculiar, yet, oh so human, tension within the “neurobiological imaginary.”