Drugs and Agency

The ethical quandary at the core of how we represent the mind in practical uses of psychology is the technology of agency. The biomedical and psychodynamic (i.e., discursive) approaches are “two different ways to identify, understand, and respond to mental anguish.”[i] In the latter, there are mechanistic accounts for how and why they come to act as they do. In the former, psychiatry is part of the social process of self-making and the interpretation of symptoms is woven into the prognosis.[ii] Practitioners of either ilk enact different treatments: psychodynamic therapy consists of teaching patients to listen and look in different ways, whereas biomedical intervention is primarily concerned with assessing the proper diagnosis on the way to determining the appropriate psychopharmaceutical regiment.[iii] There is mimesis between how we depict the mind and how we enact that vision.[iv]
[iii] Luhrmann, 2000: 22.
My focus in this post about A Suspicious Science: The Uses of Psychology is the epistemological shift implied in a biomedical model. A positivist-pragmatic approach to the mind implies that drugs are reliable chemical levers between mental states. In this way, as technologies that manipulate the mind, drugs are tools. They seem to offer a theodicy of grace beyond the limits of our conscious abilities to create change in our mental lives.[v] Drugs then become the technology by which we ensure adherence to social norms of behavior and achievement, as in the widespread use of caffeine towards motivating efficiency and productivity during the work day. This implies a modicum of control or agency achieved by the conscious, careful user and her doctors, but it is not entirely clear whether the user is augmenting or occluding her agency in employing drugs as a tool to alter the mind.
[ii] Luhrmann, 2000.
[v] Davis, J. E. (2020). Chemically imbalanced: Everyday suffering, medication, and our quest for self-mastery. Chicago, IL: University of Chicago press. See conclusion.
The recent popularization of entheogens like psilocybin, MDMA, and ketamine for therapeutic purposes affirms that discursive experience may indeed be crucial for coping with the great ethical problems of the human condition because reflexive dimensions of experience like the sense of agency remain the basis of the discursive exploration of personhood. Meaning is tied in to how we discursively and experientially navigate our individuality in a world marked by affective signals like salience. Our memories, our internalization of cultural symbols, and our process of self-making within a set of local knowledge practices determine the values that give meaning to our lives. This distinction helps explain the tension between the uses of popular and empirical uses of psychology in our epistemic niche.

A biomedical approach is important, useful, and effective, but with human beings, it is not the whole story. The whole story is a mosaic of explanatory methods applied to a jungle of factors, perspectives, and contexts.[viii] Discursive uses of psychology, including the sense of immanence derived through entheogens and other psychoactive drugs promote engagement with this meaningful material. The empirical uses of psychology co-exist with the popular uses of psychology partly because the truths we believe in need to be meaningful to us. Despite the aspirations of positivist-pragmatist biomedical uses of psychology, expressive individualism, ethical humanism and discourses of subjectivity employed in practical uses of psychology, like drug use, play a more fundamental role for questions of meaning and ethics.
[i] Luhrmann, T. M. (2000). Of two minds: The growing disorder in American psychiatry. New York: Alfred A. Knopf. p. 7.
[vi] John Stuart Mill considered psychology to be a moral science that tells us why but also delivers the pleasure of explanation. Foucault, M. (1961/2006). Madness and Civilization. New York, NY: Vintage Books.
[vii] Suzanne and Aimé Césaire argued that humanism was in fact simply an abstract bourgeois apologetics during the colonial age of slavery and industrial production, and that what we need to actively fight for is a new situated, postcolonial humanism. Césaire, A. (1959). L’homme de culture et ses responsabilités. Présence Africaine, (24/25), nouvelle série, 116-122. Retrieved June 3, 2021, from http://www.jstor.org/stable/24349005. On a reconstituted nonracist humanism, see Wynter, S. (1984). The Ceremony Must be Found: After Humanism. boundary 2, Vol. 12, No. 3, On Humanism and the University I: The Discourse of Humanism (Spring – Autumn, 1984), pp. 19-70.
See Auerbach, E. (1957) Mimesis: The Representation of Reality in Western Literature. Garden City, N.Y.: Doubleday.
Agency is a moral concept, whereas mechanical description, while being practical and functional, does not itself amount to an ethical position. What is really at stake in the way we conceive of drug use is how it portrays individuals as moral actors and how these commitments are built out into our social institutions.[vi]
[iv] My use of the term mimesis refers to how our modes of depicting the mind in practical uses of psychology are themselves implicit representations of the mind. The classic discussion of mimesis is about how style, analogy, rhetoric, and other linguistic tools are used to represent reality.
[viii] Craver, C. (2007). Explaining the Brain: Mechanisms and the Mosaic Unity of Neuroscience. New York: Clarendon Press of Oxford University.
The language, or code, of neurotransmitters is mechanical and deterministic, whereas the language of pleasure, trauma or neurosis is humanistic and historical. Is the mind a mechanism to be modified by chemicals or is it, as the discursive use of psychology employed in therapeutic enterprises would have it, an organ of meaning-making? The positivist-pragmatist use of psychology exemplified by empirical psychology and psychopharmacology tends to neglect agency and discursive practices. In the biomedical model, meaning is beside the point. Yet, discourse and agency clearly matter for an individual’s sense of herself as a moral actor in the world. Reflexivity is part of what we take the human experience to entail; discourse is thus a condition for self-knowledge. The discursive uses of psychology are a continuation of humanism, but how must humanism be transformed in the light of our understanding of our nature as biological beings?[vii] The field of Neuropsychoanalysis, exemplified in the work of Mark Solms, attempts to answer this question by updating Freudian theory in light of contemporary neuroscience.