Chemically Imbalanced Everyday Suffering, Medication, and

Our Troubled Quest for Self Mastery

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Chemically Imbalanced
Everyday Suffering, Medication, and
Our Troubled Quest for Self-Mastery

J O S E P H E . D AV I S

The University of Chicago Press

Chicago and London
The University of Chicago Press, Chicago 60637
The University of Chicago Press, Ltd., London
© 2020 by The University of Chicago
All rights reserved. No part of this book may be used or reproduced in any
manner whatsoever without written permission, except in the case of brief
quotations in critical articles and reviews. For more information, contact the
University of Chicago Press, 1427 E. 60th St., Chicago, IL 60637.
Published 2020
Printed in the United States of America

29 28 27 26 25 24 23 22 21 20 1 2 3 4 5

ISBN-13: 978-0-226-68654-7 (cloth)

ISBN-13: 978-0-226-68668-4 (paper)
ISBN-13: 978-0-226-68671-4 (e-book)
DOI: https://doi.org/10.7208/chicago/9780226686714.001.0001

Library of Congress Cataloging-in-Publication Data

Names: Davis, Joseph E., author.

Title: Chemically imbalanced: everyday suffering, medication,
and our troubled quest for self-mastery / Joseph E. Davis.
Description: Chicago : University of Chicago Press, 2020. | Includes
bibliographical references and index.
Identifiers: LCCN 2019025708 | ISBN 9780226686547 (cloth) |
ISBN 9780226686684 (paperback) | ISBN 9780226686714 (ebook)
Subjects: LCSH: Affective disorders—Treatment. | Neurobehavioral
disorders—Treatment. | Neurobiology.
Classification: LCC RC537 .D35 2020 | DDC 616.85/27—dc23
LC record available at https://lccn.loc.gov/2019025708

This paper meets the requirements of ANSI/NISO Z39.48-1992

(Permanence of Paper).
For Monica
We must rid ourselves of the delusion that it is the major events which have the
most decisive influences on us. We are much more deeply and continuously in-
fluenced by the tiny catastrophes that make up daily life.

Siegfried Kracauer, The Mass Ornament

It is not to the different that one should look for understanding our differentness,
but to the ordinary.

Erving Goffman, Stigma

 CONTENTS

Preface / xi

INTRODUCTION /1

ONE / The Neurobiological Imaginary / 18

T WO / The Biologization of Everyday Suffering / 42

THREE / Appropriating Disorder / 70

FOUR / Resisting Differentness / 97

FIVE / Seeking Viable Selfhood / 123

SIX / After Psychology / 150

CONCLUSION / A Crisis of the Spirit / 176

Acknowledgments / 187
Appendix / 189
Notes / 193
Bibliography / 221
Index / 237
 P R E FAC E

We have all heard the story. The brain is the last scientific frontier and the
unraveling of its mysteries is playing an increasingly central role in how we
understand the world and ourselves. Breathless reports in the popular press
and in the best-selling writing of scientists inform us that we are in the
midst of a revolution, entering a new and enlightened era in which many
of our most persistent human problems will be conquered. Biological ex-
planations of mental life are sweeping away long-standing philosophical
problems—mind-body and nature-nurture—and the vexing enigmas of
human subjectivity and consciousness. Significant advances in genetics,
biochemistry, and neuroscience are yielding breakthroughs in the under-
standing of neural mechanisms and the physiology of human thought,
emotion, and behavior. Psychiatry, breaking free of its psychological past,
is becoming “clinical neuroscience” and will soon transform the way it
treats mental disorders. The days of the old “folk psychology” and such
long outdated notions as the soul are finally coming to an end.
That is the story, and judging from the book sales figures, positive media
coverage, and other evidence over the past several decades, neurobiological
accounts of mind, self, and behavior have been eagerly embraced by the
general public. Why? The enthusiastic reception, it seems safe to say, is not
in response to the discrediting of the old philosophies, or the appearance
of new treatments, or the scientific discovery of new phenomena. Though
there are countless new insights, the reality is far more pedestrian than the
hype. There is little settled knowledge of disorders or treatments or the re-
lationship of mind to body. In fact, many of the claims about the relation
of mind and mental states to brain are not really scientific at all and can-
not themselves be tested in any empirical way. They rest not so much on a
theory as on changed assumptions about human being. While the promise
 xii / Preface

of neuroscience responds to a widespread yearning for concreteness and a

promise of unambiguous solutions to intractable problems, the explana-
tory force of its insights and their actual productivity is not nearly enough
to explain the public appeal.
Something else, something in our common culture, is afoot. This book
is a field report on how ordinary people dealing with painful everyday
struggles with loss and failure and limitation engage with the new and
psychologically depthless talk of neurobiology. These encounters, in turn,
serve as a kind of stethoscope on our underlying condition, on a change in
the way that we imagine ourselves and how to get on in our world.
 INTRODUCTION

Like many of her college peers, Kristin, twenty-one, had experimented with
Adderall. Her first encounter with the preferred medication for treating at-
tention deficit/hyperactivity disorder (ADHD) came at a party, where she
met a student who was “just, like, crazy,” animated and making people
laugh. Not long into their conversation, he told Kristin that he was taking
Adderall. Getting started on it had been easy, he explained, because his
mother liked “pathologizing everything” and had sent him to a psychiatrist
to get an evaluation for his trouble focusing in high school. After a brief
session—“like two minutes,” the young man said—the psychiatrist wrote a
prescription. Impressed by his story, Kristin left the conversation thinking
they both had the same sort of thing. She wanted to try the drug.1
She didn’t have to wait. A friend at the party gave her a pill, and soon
she was feeling so good that she worried she might be experiencing an “ar-
tificial high.” She quickly got over her reservations, however, and, supplied
by friends, she began taking the medication on a regular basis. She grew
convinced that the drug could improve her social life and her ability to “get
things done.”
Kristin believed she needed help on both fronts. From a relatively af-
fluent home, she had done very well in high school and then matriculated
at a selective college known for its academic rigor. She anticipated chal-
lenging classes and hoped for a vibrant social life. But after two years, she
was disappointed and frustrated. The other students were just like Kristin
herself—“kind of shy, artistic, very smart, but [they had] a hard time inter-
acting.” She found them unhappy, and the social environment stifling. She
frequently felt sad and decided to transfer to a college with more of a party-
school reputation.
Kristin’s transition to the new environment was rocky: Once classes
 2 / Introduction

began, her expectations of an active social life quickly gave way to a per-
vasive sense of inadequacy. She was constantly angry with herself and, per-
haps even worse, afraid to take the initiative to meet new people. Not long
into the new semester, she decided to seek help.
At the student health center, she met with a counselor and found the
experience encouraging and helpful. It “was like going to confession,” she
said, “only more confessional.” She let the secrets she had been keeping in-
side “just spill out” and felt relief in doing so. But after three sessions, she
had had enough. Though still “afraid of things inside,” she saw no reason
to go back. She thought the counseling would be too much of a “hassle”
and unlikely to achieve anything “very lofty.”
Kristin wanted something else. She thought that many of the problems
in her social life reflected a larger issue of “focusing.” Her parents had often
told her that she needed more discipline. She had assumed they were right,
not because her grades were poor or she had trouble completing specific
tasks but because she believed she wasn’t living up to her full potential.
She had allowed herself to dabble instead of attempting to concentrate on
one particular thing. “I want to do everything in the world and hear every-
thing and do—like, just be a star,” she said, even while ruefully acknowl-
edging that she wasn’t particularly interested in her studies or involved in
many extracurricular activities. Then came her exhilarating experience with
the fellow at the party and trying Adderall.
Kristin went to the college learning center to pursue an ADHD diagno-
sis, but the specialist suggested that she read some books on effective learn-
ing strategies. Undeterred, she decided to seek the help of a psychiatrist in
private practice. What she encountered could not have been more differ-
ent from her sessions with the counselor at student health. The counselor
wanted to know what was going on with her life. Instead of “talking it out,”
the psychiatrist, by contrast, wanted to catalog her symptoms and did not
ask about her “personal perspective on them” or how she “might focus on
addressing them.” The psychiatrist’s goal was a diagnosis, and according to
Kristin, she told her that she “had some of the symptoms, not all of them,
of ADHD, and that a stimulant might help.” Then she wrote Kristin a pre-
scription. The session took about an hour and a half.
Kristin embraces the diagnosis, though on her own terms. ADHD is clas-
sified as a mental disorder in the Diagnostic and Statistical Manual of Mental
Disorders (DSM), the American Psychiatric Association’s resource book for
psychiatric diagnoses. But Kristin doesn’t see it that way and even contrasts
her definition with that of professionals. For her, conditions like ADHD
can be interpreted in different ways, and this very flexibility is part of what
 Introduction / 3

makes the diagnosis fit. In her creative activities, she sees distractibility as
conducive to innovation, while a debility in other areas requiring sustained
concentration on one thing. Having benefits as well as drawbacks makes it
different from a mental disorder. With schizophrenia, she says, “your brain
just takes over and you can’t get over it.”
Though Kristin does not see her ADHD as a mental disorder, she does
believe it is caused in significant part by a genetic aberration. The psychia-
trist did not offer this explanation, but she has talked with friends and read
about ADHD. She cites the experience of family members as contributing
to this view. Her grandmother and both of her siblings, she notes, have a
hard time focusing on things, especially her older sister, who urged her
to seek a prescription and who now believes she too has ADHD. She also
finds some confirmation of the biological interpretation in the fact that the
drug seems to facilitate her classwork.
For Kristin, her ADHD diagnosis helps fill the explanatory gap be-
tween her self-understanding and her circumstances. It confirms that her
struggles are both real and legitimate: “actual problems” that arise from
external causes, in her biology. These problems are things that you can ad-
dress. They are unlike “abstract moral failings,” Kristin’s term for speaking
about fixed dispositions in the self or personality, about something you
are, such as a “bad person.” But with the neurobiological account, she can
stop blaming herself for “being lazy” or a “poor listener.” No such moral
or mental framework is relevant.
While Kristin credits the stimulant with some positive results, it has not
made the difference she hoped it would. “I guess I used to go through a
day,” she says, “and imagine that I had only worked 50 percent as hard as I
could have and that one of these days, I was going to do 100 percent and I
was just going to be, it was just going to be great.” On the medication, she
does push herself somewhat harder, and she finds that the drug makes her
feel smarter and more interested in her class work. But there has been no
dramatic improvement, and she also finds it hard to relax when taking it.
Sometimes she feels that the medication improves her social interactions,
making her both more interesting and more interested in those around
her. But at other times she worries that, socially, she is “just kind of a pain.”
The drug is helpful, yes, she concludes, but “not like a wonder drug.”

Stories like Kristin’s are not unusual.2 They are only too common. Tens of
millions of people, dealing with everyday struggles, have been diagnosed
with a mental disorder and are being treated with a psychotropic medi-