depression performativity and the conflicted body auto-ethnography of self-medication

Original Article

Depression, performativity and theconflicted body: An auto-ethnographyof self-medication

Elena TrivelliGoldsmiths University, Media and Communications, New Cross, London, SE14 6NW, UK.

Abstract In this article, I discuss intimate practices of self-medication in relation topolitical preoccupations with the ethics of the pharmaceutical economy, and discursiveconstructions of illness. Partly self-ethnographic, the article draws from my personalexperience of clinical depression, and the discomforts in thinking of myself as a‘depressed’ subject who consumes medications. Intervening in debates on new materi-alism and affect studies, I offer an account of dynamics where the material and the dis-cursive, the human and the non-human, the personal and the political converge. I suggestthat the experience and performative effects of self-medication lie not only in the activa-tion of chemical compounds, but in the conscious bodily animation of cognitive andaffective relations with medications. In this analysis, I employ creative forms of writing, tofind a language of distress that blurs the boundary between the material and the discursive.Subjectivity (2014) 7, 151–170. doi:10.1057/sub.2014.4

Keywords: depression; self-medication; performativity; material/discursive

Of Drawers and Discourses

At the back of my top dresser drawer is a black calfskin wallet witha plaid interior, its fine stitching torn where the leather itself startedto tear. Finally too worn to be used, the wallet holds something moreimportant, my last tab of Ludiomil.

(Wight, 2007, p. 93)

In the top right drawer of my desk, I keep a plastic envelope with notes andpapers that contribute to this article, which I have accumulated for years.

Every now and then, new ideas and phrases come to the fore, filling pagesand pages of small portable notebooks in coffee shops, underground trains

© 2014 Macmillan Publishers Ltd. 1755-6341 Subjectivity Vol. 7, 2, 151–170www.palgrave-journals.com/sub/

http://dx.doi.org/10.1057/sub.2014.4

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or theatre halls. And then they get sucked into the plastic envelope. I always findan excuse to confine these small pages inside my top drawer.In the bottom right drawer of my desk, I keep stacks of antidepressants that

I have accumulated for years. Expiry dates are as important as the disparate rangeof dosage levels and trade names displayed on the boxes.These colourful objects haunt me like the white papers in the plastic envelope.

While I strive to finally pull the latter out and engage with them, I fight to leavethe former locked up in the drawer.But my drawers periodically make their call.Prone to depression, but critical of its clinical definition, and painfully aware of

various debates on its social and discursive construction, I sometimes find it hardto get out of bed, cook, wash, stop crying and drinking, think that I will ever wantto wake up again.Quite simply, my notes and paper fragments have stayed in the drawer for so

long, because I usually find it more manageable to think of depression as a socialconstruct, an ache that does not really belong to this body, a cultural label,a disembodied clinical entity. I tell myself, I know too much of the ‘behind thescenes’ to say ‘I have depression’. I warmly nestle in thinking that my distress isa discursive and social construct, and try to ignore my aching body.Losing oneself in analysing discourses and the ‘behind the scenes’ can help to

soothe the ache.I have been my own cynical critic for years now.But even when immersed in abstraction, the body makes its call. The body

aches, in and beyond any discourse on ‘depression’.My desk constitutes my research space, a safe place for my right hand to think

and write of labels, constructions and ‘pharmaceutical imaginaries’ (see Jenkins,2011a). But this space is also the territory where booze and books, apathy andanalysis, clenching nails and social theory, ‘self-help’ and ‘hopelessness’, pillsand bibliographies, spectacularly meet, and show that ‘there is more to biologythan biology’ (Moerman, 2002, p. 84).

Writing from and of Depression

When one digs out the caca of existence and of language, the poem mustsmell bad.

(Artaud in Sontag, 1976, p. 449)

I here employ my own experience of depression and self-medicating practices, todiscuss forms of meaning making where experience and discourses, sensing andthinking, constructions, collapses, and relapses, simultaneously converge and clash.I explore this confluence as a contribution to theorising subjectivity, making

a move towards potential ways ‘to “think” the body as discursive, material and

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embodied without reinstating the notion that the discursive and material are twoseparate, pre-existing entities that somehow “interact”’ (Blackman, 2007, p. 1).The discursive and the material here constitute a form of performativeco-enaction between a ‘pharmaceutical self’ and a ‘pharmaceutical imaginary’,or the subjective experience of self-medication and the transformations ofa ‘pharmaceutical body’, in relation to wider political perspectives on drugsconsumption (Jenkins, 2011a).If depression might occasionally make one’s private indecencies and frustra-

tions leak into the public sphere, writing from this leakage also blurs theboundary between the private and the public (Diedrich, 2007; Mol, 2008). I thusjoin a number of scholars who employ their own experiences of mental distress,in order to offer alternative accounts of intimate anguish vis-à-vis the socialsphere (Orr, 2006; Martin, 2007; Cvetkovich, 2012).This task – writing from and of a place where language and critical thinking

often fail – requires modes of writing that at times challenge traditional forms ofanalytical essaying, disclosing ‘the places where feeling and lived experiencecollide with academic training and critique’ (Cvetkovich, 2012, p. 80). Inengendering a language of distress, I combine a variety of literary sources andI juxtapose different language registers. In experimenting with writing as a formof doing, in performing writing, and in writing performatively (Pollock, 1998),I hope to generate an account ‘not only about the body but also through thebody’ (Diedrich, 2007, p. 115, my emphasis).In the first part of this article, I describe five ‘security blankets’ that frame

political and economic preoccupations on medication consumption – whichI employ as discursive defence mechanisms in my attempts to avoid being‘a depressed patient’.I then delve into the dialogue between the effects of depressive symptoms and

these defence mechanisms, which lead to the periodical choice of self-medication –

whereby ‘security blankets’move from a discursive realm to the tissues of my body.I explore this move by analysing the properties and agency of medications,

with reference to scholarly work on ‘new materialism’ and affect studies, fram-ing these properties as performative forms of co-enaction and co-constitutionbetween medications, bodily functions and critical thinking.

Security Blanket Number One: Medicalisation

The concept of ‘medicalisation’ emerged in the 1970s in the work of Ivan Illich,who defined it as the ‘expansion of what in medicine is deemed relevant to thegood practice of life’ (Illich, 2002 [1975], p. 59), and it refers to a context inwhich ‘a medical frame or definition has been applied to understand or manage aproblem’ (Conrad, 1992, p. 211).

Depression, performativity and the conflicted body

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Similarly, medical diagnosis of mental illness represents the shift from ‘mad-ness’ to ‘disease’ – the rationalisation of the irrational (Foucault, 2009 [1961]) –and, ‘for the medical industry, diagnosis is the foundation of business and atthe same time the first link in the value chain’ (Blech, 2006, p. 34). Withina biochemical model, ‘mental illness’ constitutes a disease that can be chemicallyaddressed by the ‘hope technology’ of the science of psychiatry (Franklin, 1998,p. 203).Biologist and journalist Jörg Blech (2006) explains that there are several media

strategies which collaborate in reinventing common conditions as ‘diseases’:normal life processes, personal and social problems are sold as medical problems,risks are sold as diseases, rare symptoms are sold as rampant epidemics, andslight symptoms are sold as harbingers of grave disorders.The hand writes: You are not really sick.

Security Blanket Number Two: Big Pharma

Since the 1950s, psychiatric practice has relied on drug therapy in the treatmentof depression. The consumption of antidepressants escalated in the late 1980s,when medications advertising increased, depression became more and moreunderstood in biological terms (Hewitt et al, 2000), and chemical curesprogressively replaced talking therapy, especially in women’s treatments of thecondition (Metzl, 2003).The optimisation of capital production within ‘Big Pharma’ (Law, 2006)

requires that a growing number of social and environmental problems beperceived as individual problems (see Fisher, 2009), and that an increasingnumber of actions, behaviours and emotional states become medicalised, therebyrequiring pharmaceutical remedies (Breggin, 1993 [1991]; Healy, 2004).As the World Health Organisation reports, ‘neuropsychiatric conditions are

the most important causes of disability, accounting for around one third of YLD[Years Lived with Disability] among adults aged 15 years and over’ (WorldHealth Organisation, 2008). Depression is the leading cause of disability for bothmen and women, but ‘the burden of depression is 50 per cent higher for femalesthan males’ (World Health Organisation, 2008). Depression is estimated to affectaround 350 million people (World Health Organisation, 2012), and by the year2020, it is projected to be the second cause of disability worldwide (World HealthOrganisation, 2008).There has been a considerable increase in the prescription of antidepressants.

In Britain, these prescriptions reached 31 million in 2006, and antidepres-sants are currently being taken by over two million Britons (McRae, 2008).In terms of world trade, the pharmaceutical industry comes second only tothe international arms trade (Kutchins and Kirk, 1999 [1997], p. xi),1 and the

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increasing ‘pharmaceuticalisation’ of suffering represents a powerful financialsource in the ‘antidepressant era’ (Healy, 1997).The hand writes: You are only playing your part in the capitalist machine.

Security Blanket Number Three: The Media

The definition of ‘health’ is so controversial that human experience can barely beframed as fully disease-free. Indeed, many advertising strategies rely on ‘disease’as a fluid concept, redefining it according to market needs. The manipulationof health education and information plays a part in this process, shaping theperception of one’s own body, happiness and well being (Blech, 2006). Assurgeon Imre Loeffler ironically puts it, ‘the World Health Organization’s famousdefinition of health as “complete physical, psychological and social wellbeing” isachieved only at the point of simultaneous orgasm, leaving most of us unhappy’(quoted in Smith, 2002, p. 884).Although an advert might seem to promote a specific medical product, it might

in fact ‘advertise’ the very disease the product is meant to cure, since it isfundamental to create the demand for a drug, for it to be successful. In otherwords, if for every ill there is a pill, ‘more and more often for every new pill, thereis a new disease as well’ (Blech, 2006, p. 3).With the increasing media representation of depression as a clinical condition

(Fee, 2000), the demand for medical care and medication consumption are on therise. It is in this sense that ‘drug manufacturers both appeal to common valuesand create them’ (Reynolds Whyte et al, 2002, p. 133, emphasis in the original).The American direct-to-consumer advertising industry is a renowned example inthis respect, where drug publicity fills the gaps between TV programmes, pagesof daily papers and weekly magazines, and posters on buses and trains (Horwitzand Wakefield, 2007).The hand writes: Your ache is a marketing construct.

Security Blanket Number Four: Neoliberalism and Self-Care

Medicine presents itself as a service that is available to the subject. If themediatised utopic images of health and happiness create a set of fears, needs anddesires, these are understood as personal deficiencies. The extensive campaign on‘quality of life’ invites the subject to pursue a state ‘beyond health’. It producesthe ‘ideal of a flawless human being’ which prompts ‘healthy people [to] swallowlife-enhancing medication in an attempt to be better than well’, promoting analmost obsessive cult of ‘healthism’, and the consumption of life-style drugs andsemi-medical products for experiences such as ageing, baldness or pregnancy



(Blech, 2006, p. 5). A short cruise into any pharmacy in the United Kingdommight contribute to turning everyday life experiences into medical(isable/ised)distress. The vitamins aisle, the ‘help your digestion aisle’, the ‘improve youreyesight’ aisle, the ‘brighten your skin’ aisle, the ‘maximise your focus’ aisle, the‘increase your energy’ aisle, the ‘regulate your period’ aisle. Among the aisles, theliminal space between ‘health’, ‘wellbeing’ and ‘life-enhancing technologies’becomes slippery. Pills popping, beauty boosting, sadness soothing: I lose trackof the difference.I should take my antidepressants to correct my depression. I should buy

into the commodification of health, disease and cure, where ‘health can bepurchased in the form of medicines’ (Reynolds Whyte et al, 2002, p. 16),transforming it into a good that can be bought. I should become an activelydisciplined, self-caring subject, developing the private and intimate ‘technol-ogies of (my) self’ that are needed to monitor subjects for social control(Luther et al, 1988).These ‘technologies of the self’ are part of what Michel Foucault, in his preface

to Gilles Deleuze and Félix Guattari’s Anti-Oedipus, defines as ‘the fascism in usall, in our heads and in our everyday behaviour, the fascism that causes us to lovepower, to desire the very thing that dominates and exploits us’ (2007 [1972], p. xiv).The hand writes: It’s not you. Society is sick.

Security Blanket Number Five: ‘It’s OK’

Anti-stigma information campaigns organised by charities such as MIND orRethink have relied on the statistic that one in four people will develop a mentalhealth problem, in the course of his or her life. This statistic, coupled with theawareness that women have a higher prevalence of anxiety and depressivedisorders than men (Metzl, 2011) should perhaps reassure me about the‘normality’ of my condition, or the ‘common cold of mental illness’. The celebrityconfession culture, in addition, contributes to staging a public scene in which‘depression today is everywhere’ (Leader, 2009 [2008], p. 11).2

It is an organic condition, possibly visible through brain scanning, calculableand quantifiable through chemical imbalances, and explainable through a geneticmodel (Carter, 2004 [1998]; Rose, 2004; Rose, 2007).However, I write on my papers, telling myself that ‘I have a biochemical

imbalance’ is an ideological statement grounded in the pharmaceutical industry,a default neoliberal rephrasing of ‘existential instability’ (Jenkins, 2011b, p. 35).With the ‘explanatory regime’ offered by the organic and biomedical model,

‘many pathologies of the active, responsible, choosing self have come to be seen asdepression’ (Rose, 2004, p. 107, my emphasis). Within this framework, individualbehaviour is decontextualised from social circumstances, and responsibility is

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transferred onto the ‘illness’. When ‘illness’ takes over as the explanation of one’sbehaviour, unconscious processes, life circumstances and decision-making facultiesturn into neurons, synapses or failed electric impulses. In this paradigm,one does not act. Illness does. I am not responsible for any occasional angeroutbursts, excessive drinking, cutting, burning. The illness is (see Sternberg, 2010).The political consequences of these ‘explanatory regimes’ have an even wider

social significance, for ‘normalising’ a condition such as depression implies that‘depression’ is socially acceptable, something that exists ‘in nature’, for which thesocial system can take no responsibility. Unemployment, social isolation, poorfamilial relations, physical or psychological abuse, poverty or the disinterestof the welfare state become ‘triggers’, rather than ‘causes’.While ‘mental illness affects us all’, it ‘strikes 1 in 4’ (Oneinfour, 2014,

my emphasis).Having been ‘struck’, my social responsibility would be to accept my condition

as an illness that is biologically rooted (see Dumit, 2003, 2005), and thenchemically address it.The hand writes: Resist your own fascist, don’t be a disciplined dupe.

Of Shreds, Shovels and Shame

I have resigned myself to death this yearSome will call this self-indulgence(they are lucky not to know its truth)Some will know the simple fact of painThis is becoming my normality.

(Kane, 2001, p. 208)

Sometimes, security blankets get torn and shredded by the aching body. Evenwhen I try to think of the ache in terms of ‘existential instability’, ‘socialconstructs’ or as a political response to social injustice (Cvetkovich, 2012),‘saying that capitalism […] is the problem does not help me to get up in themorning’ (Cvetkovich, 2012, p. 15).A now familiar bodily despair lurks behind my critical, cynical understanding

of depression, buried under sheets of scholarly papers and newspaper articles.Eppur si muove, ‘probably localised in the skin, but feeling like the radicalremoval of a limb and offering the mind nothing but tenuous, woolly pictures ofdistant limbs out of place. A sort of inner breakdown of the entire nervoussystem’ (Artaud, 1999 [1964], p. 55).Blankly staring at my books, my papers, my PC screen, I must ask myself ‘what

is going on when you can’t write?’ (Cvetkovich, 2012, p. 19).When an ‘inner breakdown of the entire nervous system’ can only be located

‘probabilistically’, the pain is unplaceable and, yet, everywhere. It becomes



utterly consuming, and fearfully unutterable, and as I let its groans resonatearound the room, I look for comfort among my small chemical objects. I retreatfrom the terrain of my critical thinking, suspend my knowledge of ‘behind thescenes’ constructions, statistics and sales. Something, somewhere, everywhere,aches. And all my sound critical thinking does not feel soothing enough, this time.While I am skilled at digging deeper, from the bottom of a pit, at some point theshovel stops. The bottom of the pit speaks: enough, already.A new resilience materialises between the drawers, with a different texture

from my papery safety blankets, more colourful, and with the unfortunate tasteof surrender. From the damp bottom of the pit, to the wooden surface of my desk,a mixture of a harsh ‘pull yourself together, idiot’ and a tender ‘take care ofyourself, my dear’ becomes a new incoherent, inconsistent and uncomfortableagent of endurance.I quickly swallow my pills, hoping that my cynical-critical self won’t notice.I ceremoniously turn into the epitomic subject of advanced liberalism, the

disciplined and caring entrepreneur of my own self.I shamefully feel my self-governance working its way down to my stomach

where, perhaps, it will meet with ‘the fascist in all of us’.I disturbingly picture them having a celebratory toast.And if I had to push the blankets on the side, to ‘take care of myself’, it is at

the very moment of care that the blankets – discourses around medicalisation,capitalisation of care, the media, neoliberalism – are summoned on my desk, andfind a life from the papers to my stomach. My blankets and my pills swim together.Integrated, intertwined, indivisible, they find a new voice in initial side effects –

tremors, thirst and increased tiredness – and progressive improvements in mymoods.During the intimate displacement of critical thinking, the shameful collapse of

the coherence between the personal and the political, as I consume my colourfulaids throughout the months, I produce myself as ‘the subject’ that haunts mysecurity blankets. A ‘consumer of antidepressants’, ‘one in four’, a ‘depressedwoman’ begins her performance, as an ensemble of capsules and gastric juices,hydrogen, nitrogen and pepsinogen, a new node in the value chain, a new vehiclefor the circulation of power, who will soon wink knowingly from my books,my papers, my PC screen.

Pill-Power

Where do I start? Where do I stop?How do I start?(As I mean to go on)How do I stop?How do I stop?How do I stop?

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How do I stop?How do I stop?How do I stop?How do I stop?How do I stop?[…]Every act is a symbolThe weight of which crushes me.

(Kane, 2001, p. 226)

A move of the hand, a twist of the wrist, the tin foil clicks and breaks. A cold,quick, reassuring noise. No matter how habitual, taking these pills is not merelya skeletal or muscular movement. This simple ritual of drawer opening, foilclicking, resilient and resigned swallowing, makes a little colourful object slidedown into my stomach, ready to swim, melt, affect me, change me. Make me.The physiological consequences of this ritual include both the effects of the

drugs on the body, and the operations of the body on the drugs, appropriating,absorbing and converting these impersonal molecules into my own metab-olites. There is here a reciprocity, a form of ‘co-enaction, co-constitution andco-evolution’ (Blackman and Hardbord, 2010, p. 306), that challenges concep-tual and physical boundaries of human and non-human. These relations blura neat distinction between body and compound, and as the body develops liminalstates of becoming-with the drugs, a ‘co-affective or hybrid relation of humanand non-human technology’ (Michael and Rosengarten, 2012, p. 6) calls intoquestion the status of medicines as inanimate ‘objects’ (Mol, 2008), throughforms of ‘prosthetically empowered embodiment’ (Braidotti 2010, p. 203).Scholarly work conducted under the rubrics of ‘neomaterialism’ (Braidotti,

2010), ‘vital materialism’ (Bennett, 2010, 2001) and ‘alternative ontologies’(Coole and Frost, 2010) attempts to frame ‘materiality [as] always somethingmore than “mere” matter: an excess, force, vitality, relationality, or differencethat renders matter active, self creative, productive, unpredictable’ (Coole andFrost, 2010, p. 9). Accordingly, objects are attributed a force, a ‘thing-power’(Bennett, 2010, 2001), where ‘qualities can belong to objects themselves ratherthan to our consciousness of them’ and they ‘are not inert targets for our thoughtsto animate’ (Thrift, 2010, p. 292).My pills, indeed, have plenty of qualities.They have aesthetic qualities. Half yellow and half green, or all green, or all

white; long capsules or round tablets; rough, smooth, or shiny surfaces. My pillsare a feast of diversity.They have chemical properties, from discomforting side effects to their

potential to uncover one’s ‘real self’ (Kramer, 1994 [1993]), and to impact onone’s self-esteem (Hewitt et al, 2000). Far from being ‘inert’, even as they rest intheir boxes, they are little capsules of potentialities.



Pill-Words

Words failed me […]. And I just don’t give a damn whether my sentencessound like French or Papuan.

(Artaud, 1999 [1964], p. 19)

Medicines are little objects. They are easy to carry, easy to take, easy to hide, easyto lose. Medicines are powerful. They live their lives between plastic and tin foil.They wait in small boxes until they are exchanged for symbolic pieces of paper.I walk them home. A bag of hope under my arm, and exhausted bags under myeyes. They enter my home – after all, I invited them in, these pills, that know howto speak to my despair (Orr, 2006, p. 9). In fact, there are various forms ofemotional bonds between the individual and the drug, even before theirconsumption (Leader, 2009 [2008], p. 1).These bonds are informed by cultural practices that frame the pills’ prosthetic

potentials as colourful metonymies of the doctor’s sober, immaculate, turmoil-free white coat (Reynolds Whyte et al, 2002, p. 123), and as myriads of minuscule‘hope technologies’ that embody science’s cleanliness and expertise, to whichI sometimes delegate the duty to ‘sort my mess out’.Within the cultural context in which they are distributed and consumed,

medicines might contribute to reassurance about the potential curability of one’scondition, turning distress into something which can be scientifically named,diagnosed and legitimised. Part of their performative power, in fact, lies infacilitating the communication of the non-communicable by turning distress into‘illness’, thereby making it ‘accessible for communication and therapeutic action’(Reynolds Whyte et al, 2002, p. 45; Van der Geest et al, 1996).From the bottom of the pit, from the damp room of depression, words often

fail, discourses collapse, PC screens turn blank, desks crack. When securityblankets don’t prove to be pain-proof, critical language, scholarly papers,thoughts on discursive constructions are abdicated and translated through theaching body as tamed forms of ‘whatever’. When, ‘all writing’ does feel like‘pigshit’, and the literary scene where ‘words have only one meaning’ and‘emotions are classifiable’ does feel like ‘a pigpen’ (Artaud, 1999 [1964], p. 75),one might resort to colourful chemical compounds, to find ‘words to say howwords fail’ (Leader, 2009 [2008], p. 191; see also Scarry, 1985).However, if these pills know how to speak to my despair (Orr, 2006, p. 9),

their way of speaking of my despair is not always soothing or reassuring.Years ago, after my first ‘major depressive episode’, I was given my

first prescription of fluoxetine hydrochloride. ‘I’m going to take antidepre-ssants for a while’, I said to a close friend. ‘I don’t think you’re depressed’, hereplied.The equation between taking antidepressant and being depressed – a form of

‘I take, therefore I am’ – which has haunted me ever since, sneaks beneath

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blankets, scholarly work and colourful tablets. In this context, ‘being clinicallydepressed’ and ‘taking medications’ are in a relationship of mutual constitution(see Butler, 1999), where self-medication enters a social and political discourse(Austin, 1962; Parker and Kosofsky Sedgwick, 1995), ‘produc[ing] the effectsthat it names’ (Butler, 1993, p. 2).

An ‘Art of Consumption’

Increasingly, pain-killing turns people into unfeeling spectators of their owndecaying selves.

(Illich, 2002 [1975], p. 154)

Elaborating on clinical research and practices of self-medication in the develop-ment of new medical compounds, Melinda Cooper (2012) suggests that theeconomic value of these compounds is co-created by clinicians, pharmaceuticalcompanies and user-patients. She particularly refers to a gradual move fromtraditional trials to forms of ‘user-generated innovation’ that employ socialnetworking models of data sharing.3 Although randomised controlled trials workby testing a hypothesis, forms of ‘user-generated innovation’ reconfigure the‘experimental’ element in the development of compounds, by potentially generat-ing unexpected outcomes (Cooper, 2012). As Cooper suggests, this context of‘distributed experiment’ implies ‘the recognition that a chemical compound hasno inherent therapeutic valence’ but produces a series of effects that will be thenframed as either beneficial or adverse (2012, p. 34). In this sense, whilemedications have the power to produce somatic, cognitive and emotionalchanges, ‘biochemistry itself produces effects that are contingent upon the art ofconsumption’ (Cooper, 2012, p. 34).I here employ Cooper’s ‘art of consumption’ (2012, p. 34) to indicate not only

the production and circulation of value in instances of ‘distributed experiment’,but also in intimate choices and practices of self-medication, to suggest that ‘thebodily effects of a drug lie in the soft science of consumption, not the hard scienceof biochemistry’ (2012, p. 34). The effects produced in ‘the art of consumption’are indeed intertwined with the subjectivity of the self-producing ‘patient’ and herrelationships with mass-produced capsules of potentialities.In fact, periodical waves of hope projected onto these capsules can push or

drag a body to the doctor. These intimate bonds are then enacted through thebodily performances of buying, carrying, foil clicking and swallowing, as ‘forces’that can ‘drive us towards movement’ (Seigworth and Gregg, 2010, p. 1). Theseforces of ‘in-between-ness’ (Seigworth and Gregg, 2010, p. 1, emphasis in theoriginal) are central to much work conducted within the ‘affective turn’ inthe social sciences and humanities (Clough and Halley, 2007), where the ‘body’



is approached not as a contained ‘thing’, but better defined by its capacity toaffect and be affected (Seigworth and Gregg, 2010; Blackman 2012).

Baring Life

Are we not baffled by this scandal, this wonder, this zoē, that is to say, by anidea of life that exuberantly exceeds bios and supremely ignores logos? Arewe not in awe of this piece of flesh called our “body”, of this aching meatcalled our “self” expressing the abject and simultaneously divine potency oflife?

(Braidotti, 2010, p. 208)

Although there is no single, unitary ‘theory of affect’, as Melissa Gregg andGregory Seigworth point out, there are many ‘swerves and knottings’ (2010,p. 5). A major line of argument has engaged with affect in organic and biologicalterms, as ‘free’ (Kosofsky Sedgwick, 2003) and ‘autonomous’ (Massumi, 2002);a bodily phenomenon ‘found in those intensities that pass from body to body’(Seigworth and Gregg, 2010, p. 1). Within an anti-intentionalist tradition, affectsare framed as pre-cognitive, pre-subjective and pre-verbal (Leys, 2011) ‘visceralforces beneath, alongside, or generally other than conscious knowing’ (Seigworthand Gregg, 2010, p. 1, emphasis in the original).This implies that what does not belong to conscious knowledge belongs to the

realm of the purely physical – hard wired in the brain, ‘plain’ bodily sensations or‘inbuilt behavioural-physiological responses’ (Leys, 2011, p. 438), whereinstances of ‘bare life’ are made intelligible, for example in the ‘half second delay’‘between action and consciousness’ (Thrift, 2004, p. 148). According to NigelThrift, this pre-conscious ‘period of bodily anticipation’ between 0.8 and 1.5 s(2004, p. 151) is the space-time of an ‘insidious body politics’ (2004, p. 148)where institutions exercise ‘projects of domination’ (2004, p. 146).4 In thisaccount, in a very material sense, ‘power works “autonomically”, bypassingreason and criticality and seizing the body at the level of neural circuits [and] thenervous system’ (Blackman, 2012, p. xi).‘[B]are life laid bare and anatomized’ (Thrift, 2008, p. 73). A bare body ‘caught

outside the utterable’, a ‘simple living body’ (Thrift, 2004, p. 148) that aches.Non-reflective, uncontaminated, ‘simple living’ ache.The ‘divine potency’ of the body that I tried to ignore, here it is.At times unwashed, coughing in her own vomit.Stoned, high, desperate, angry, bleeding, overweight, anorexic.Here it is, between the paper and the pill, the pen and the Prozac, between

excesses.Here it is, cursing over her own agency, failing to make the personal and the

political cohere, and painfully conscious of her failure.

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Conscious Mystification. Or, Wishing to be a Piece of Meat

For where I am there is no more thinking.(Artaud, 1999 [1964], p. 20)

The theory on my desk warns me, ‘exploitation must not be seen as such. It mustbe seen as benevolence. […] The colonists not only mystify the natives […], theyhave to mystify themselves’ (Laing, 1990 [1967], p. 49).The aching body at times indeed needs to be mystified, in an act of self-

medicalisation, subjectification, self-monitoring, and total abandonment. Yet,there is agency, even in abandonment. My security blankets and critical under-standings of discursive productions of ‘depression’ as an object of knowledge arenot completely adumbrated by the unutterable, shattering ache. This place, where‘there is no more thinking’, is the place where statistics, cynicism and discursivedefence mechanisms are consciously and willingly pushed to the side but,crucially, do not disappear.As I am suggesting, to put the medicines’ properties to work, to make their

aesthetic, chemical, cultural, political, financial molecules into a proper com-pound, cognitive processes of meaning making are fundamental (See Broom, 2007).The ‘piece of flesh’ that stops the shovel, or the ‘aching meat’ that groans and

calls for chemical help (Braidotti, 2010, p. 208) is not a purely corporealindecency, even when it is reduced to ‘the caca of existence’ (Artaud in Sontag,1976, p. 449).At its worst, paralysed on the bed or crouched up on the floor, the depressed

body is physically haunted by the discourses that circulate on its depression, inthe shape of market sales knowledge, or the renowned vicious circle of ‘feelingbad about feeling bad’. Caught in these circles, the depressed subject at timesmight deeply wish to only be a piece of ‘aching meat’, inhabiting a ‘non-reflectivebodily space before thought’ (Papoulias and Callard, 2010, p. 34), where ‘illness’is responsible, and only neurons are accountable. No explanations needed, noapologies for any erratic behaviour, no guilt feelings. If only it was ‘just my body’.In other words, ‘what appears to be an “obvious” biological matter is richly

freighted with meaning, history, tradition, [and it] requires consciousness to doits thing’ (Moerman, 2002, p. 84). The way the substance ‘does its thing’ worksby cognitive-affective, chemical, culturally contextual, and socially sharedproperties, and the ‘meaning response’ that is generated in self-medicatingpractices (Moerman, 2002) might be deeply dependent on thoughts around ‘thebehind the scenes’.In still other words, how hypocritical of me, to read about market constructs,

while the protagonists of these stories are feasting through my veins.Critically evaluating the choice and consequences of self-medication, and

bitterly monitoring how effectively my sadness fades, are foundations uponwhich discursive security blankets find a biopsychosocial existence in andthrough the medicated body.



As the materiality of pills, the debates that surround them, and the tissues of mybody blur their boundaries, ‘medication intake’ is also a form of ‘discourses intake’,whereby substances ‘do their thing’ by infusing bloodstream with chemicalaggregates, and by making my inside a hospitable home for social constructs.

From the Desk to the Screen, and All the Way Back

Do you take this woman, to be your true and wedded wife; and do yousolemnly promise before God and these witnesses to love, cherish, honourand protect her; to forsake all others for her sake; to cleave unto her, andher only, until death shall part you?I do.Do you ever feel guilty, worthless, or helpless?I do.Do you feel depressed and unhappy?I do.

Understanding the more or less habitual practice of taking antidepressants asa performative act suggests that this action expands its meaning beyond thecontext in which it is carried out, ‘accumulate[ing] the force of authority throughthe repetition or citation of a prior and authoritative set of practices’ (Butler,1995, p. 205).Performing the role of a sick woman within the integrated systems of drug

industry, psychiatry and the social field (Orr, 2006) has effects on my body andon the cultural and economic meaning of medicines. These effects re-assemble, asI sit at my desk, blurring the boundary between the private and the public, thepersonal and the political, generating an embittered – if pharmaceuticallyeffective – ‘meaning response’ (Moerman, 2002).The self-medicated body becomes a vessel of cultural and economic value, the

trained and disciplined ‘depressed subject’ of the countless statistics I pile up on mydesk, the resonance chamber of dialogues between defence mechanisms and ‘magicchemical bullets’. But the ‘magic’ of these bullets rests not solely in their chemicalcomposition. Their existence as agents and quasi-subjects is not only a question ofextra-discursive, but also of intra-discursive matter (Glynos, 2012, p. 173).My desk sees a subject on the mend, only at risk of a minor increase in self-

depreciation, triggered by the interaction between chemical turmoil and theore-tical cynicism. The piles of paper see a strange form of user-generated druginnovation, part of ‘distributed networks of self-experimental labour’ (Cooper,2012, p. 22). Actively partaking in what Jackie Orr defines as forms of ‘psycho-power’, I make my distressed body speak, accessing a manageable languagethrough ‘hope technologies’ that shape ‘the cultural production of perceptionitself’ (2006, p. 11).

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The ache never escapes its prickly blankets, it never lies outside the integratedsystems of power, for ‘even when the panicked [or depressed] body is your own,the experience of such a dis-ease never falls entirely outside the histories ofpower’s play’ and power’s production of depression as an object of knowledge(Orr, 2006, p. 11). Rather, when cure tastes like intoxication, ‘power’ findsa shelter in the stomach, a life in the bloodstream, and its perfusion into thetissues is both one of chemicals and discursive defence mechanisms.The practice of self-medication can be seen as ‘an active, interpretive process of

culturally informed self-communication’ and ‘a reflexive process of self-definitionand identity construction’ (Fee, 2000, p. 75). The dialogues among bodily states,critical thoughts, drawers, pills and papers fabricate ‘arts of being ill or doingillness’ (Diedrich, 2007, p. 25, emphasis in the original) that are structured bycontradictions of ‘informed choice’, co-constituted and co-enacted through thebodily infusion of discourses.

(Re)Capitulating and Discontinuing

I have here offered an account of some dynamics in which the material andthe discursive, the human and the non-human, the personal and the politicalconverge and clash in the consumption of medications. I have staged the self-medicating subject as ‘discursive, material and embodied’ (Blackman, 2007, p. 1),enacting a contradiction between scholarly appraisals of discursive constructionsof depression that are financial, sociological and political, and the choice ofpurchasing and consuming antidepressants. The performative potential of self-medication lies not only in the activation of chemical compounds, but in thebodily animation and the embodiment of this contradiction, embittering pro-cesses of ‘healing’.Depression comes in waves. Shamefully, I sometimes resort to my chemical

technologies of micro power and, as they softly rest in my body, know that ourromance will return to me as data on my PC screen.After years of waves, I am still convinced that depression is neither ‘out there’,

ready to ‘strike’, nor ‘in here’, lurking through my genes. If despair is assembled ata psychosocial level, ‘clinical depression’ is enacted and animated, nurtured andcursed, through the act of self-medication. I have staged this enaction as oneorchestrated by a subject who consciously decides to suspend her knowledge ofthe political implications of her choices, thus intervening in the debates around thesupposed anti-intentionalism of affective forces and practices.No matter how out of control or paralysed, this is neither a matter of ‘the

simple living body’ (Thrift, 2004, p. 148), nor of the ‘incursions being made bybusiness into bare life’ (Thrift, 2004, p. 153). Troublingly, these incursions aremy own.



It takes more than half a second to suspend critical thinking and attend toan ache that is socially and privately unwelcome, as well as deeply politicallyunsettling. It takes days to open a drawer, and months to close it. Every morning,it takes years of data gathering, notes assembling, reminiscing, cursing andclenching to swallow these ‘magic bullets’.At the ‘porous boundary between meaning and matter’ (Glynos, 2012, p. 173),

as the liminal spaces between the ‘in here’ and the ‘out there’ circulate inbloodstreams, statistics and social settings, I am compelled to ask, were we evertruly separate?

Acknowledgement

I would like to thank the anonymous reviewers of Subjectivity for their commentson the earlier drafts of this article.

About the Author

Elena Trivelli has recently received her PhD in Media and Communications fromGoldsmiths University. Her doctoral research examined the history of alternativepsychiatric movements in Italy and the work of Franco Basaglia, with particularreference to community and trauma, affective remembering practices, and formsof distributed unconscious. Her current work in the medical humanities concernsdiscussions around the somatic realm in cultural studies in relation to neuro-scientific research, and the implications both for scholarly work and health-careservices. Her academic background is in Performance Studies.

Notes

1 By ‘the pharmaceutical industry’ I refer to medication sales, direct-to-consumer advertising,money paid to psychiatrists, sponsorships and the financial support of patient advocacy groups andeducational organisations (Whitaker, 2010).

2 In the past five years, an increasing number of celebrities, such as Angelina Jolie, Woody Allen,Hugh Laurie and Stephen Fry, have publicly revealed that they have suffered from mental healthproblems.

3 Cooper traces patients’ voluntary participation in the development of new drugs in 1980s AIDSactivism, when activist-patients demanded a right to experimental and potentially high-risk drugs. Inrecent years, pharmaceutical companies have incorporated patients into the research process as a formof ‘innovation in practice’ (Cooper 2012, p. 26, emphasis in the original), where ‘user-generatedinnovation’ is a model of value production that employs networking sites based on the unpaidcontribution of users, such as PatientsLikeMe. Within a shift from test to ‘distributed experiment’,Cooper suggests that such forms of potential innovation are expressions of embodied labour that alsoarise through ‘ingestion and metabolic self-transformation’ (2012, p. 22).

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4 Thrift’s discussion is based upon Benjamin Libet’s experiment in the 1980s, where subjects were askedto carry out a simple physical movement and report the instant when they decided to perform it.Monitoring their brain activity with EEG electrodes, Libet concluded that an action is set in motionbefore the subject consciously decides to perform it, and the time that elapses between volition andaction ranges between 0.8 and 1.5 s (see Thrift, 2004). Thrift focuses on this ‘half second delay’ as a re-evaluation of the preconscious, or an instance of ‘bare life’ upon which, for example, commercialstrategies are engineered, such as the use of smells and sounds in retail settings ‘so as to produceimpulse purchases’ (2004, p. 158).

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