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The Cult of Pharmacology: How America Became the World's Most Trouble Drug Culture
by Richard DeGrandpre
Duke University Press 
Reviewed by Lux, 10/27/2008

Here is a historical question that should interest many Erowid readers – how did America’s relationship with psychoactive substances become so troubled? In The Cult of Pharmacology Richard DeGrandpre argues that dominant voices in US culture and science distort our understanding of psychoactive substances through a form of essentialism he calls “pharmacologicalism”, in which drug effects are explained entirely by the physical and chemical properties of the drugs themselves. A pharmacologicalist disregards contextual factors, such as the classic psychedelic parameters of set and setting.

Such misinterpretation gives rise to a “cult of pharmacology”, a culture which views psychoactive substances as possessing within themselves a quasi-occult capacity to influence the body and mind. The cult of pharmacology assumes that the “pharmacological potentialities contained within the drug’s chemical structure determine drug outcomes in the body, the brain, and behavior.” [pg. 27] Factors such as individual experiences and beliefs, context, developmental history, cultural factors, and circumstances of substance use are systematically disregarded by the cult.

One is reminded of the scene in Molière’s Le Malade Imaginaire in which several doctors debate how opium induces sleep. One doctor helpfully explains: “By virtue of its dormitive faculty.” All joking aside, this vacuous style of explanation is common in our journals and enshrined by our laws and institutions. Consider the discourse surrounding the nebulous concept of “addiction”. Opiates are widely viewed as nefarious compounds that possess within themselves an addictive faculty, if you will, such that those who take them are possessed by an uncontrollable urge to take them again. Such a person does not choose freely but has a disease, by virtue of which they lose their agency. In this model, the opiate becomes the agent, and the person is just along for the ride. But reality is much more complex, and such ideas do not withstand scrutiny.

US culture tends to value institutionally-sanctioned drug medicines as angels and to disparage illicit drugs as devils. This simplistic moralizing is intertwined with pharmacologicalism, which “dictates that the moral status of a drug exists as a purely scientific question that can be documented and classified once and for all, not as a societal one that must be considered and reconsidered across time and place.” [27] On the side of the angels we have antidepressant SSRIs (Prozac, Zoloft, etc.), which are marketed as correcting the basic biological causes of depression. Their effectiveness at treating depression is viewed as a result of their pharmacological actions. In other words, it’s the chemistry, stupid.

Only, it’s not. There is an incredible amount of conflicting evidence regarding the efficacy of SSRIs in treating depression, and the link between serotonin and mood is itself not well-established. DeGrandpre argues that SSRIs are our latest answer in the long search for mood-altering drugs that can take the edge off of a dull, domestic life. This search previously turned up opiate-based patent medicines, barbiturates, meprobamate (Miltown), and benzodiazepines (e.g. Valium). These substances were all greeted as angels, consumed in vast quantities for years, and then disparaged as devils as their ill effects gradually became apparent – especially the recurring hobgoblin of dependence.

This book is essential reading for gaining perspective on some of the deepest questions about psychoactive substance use in our times. Through the lens of his thesis, DeGrandpre analyzes the curious case of methylphenidate (Ritalin) and considers its striking similarities to cocaine. He asks, quite reasonably, how can one set of pharmacological effects be simultaneously regarded as angelic and diabolical? He provocatively questions the universally-accepted status of nicotine as the primary addictive power in cigarette smoking. He provides a compelling challenge to the concept of the central role of the mesolimbic dopamine system as a universal reinforcement mechanism.

With the idea of the “placebo text”, DeGrandpre offers a useful term for thinking about some of the contextual factors that influence drug experiences. The placebo text refers to the beliefs and expectations that one brings into any psychoactive experience, which can radically shape how the effects are interpreted and valued. Would opium be experienced as bliss-inducing by someone who didn’t know what they were taking? Do longtime cocaine users really like the cocaine effects, or do they like the ritualized process of snorting the powder itself? Could nicotine addiction be reinforced by exaggerated and widespread stories of the addictive powers of cigarettes? DeGrandpre offers counter-intuitive answers to all these questions.

Of course, the devil is in the details, and DeGrandpre has details to spare – sometimes to a fault. This book reads at times like an exhaustive compendium of research challenging the assumptions of pharmacologicalism, and DeGrandpre occasionally loses the forest for the trees.

One striking example of this problem is the chapter on tobacco. It begins as an engrossing history of the FDA’s dramatic turn against big tobacco companies in the United States in the early 1990s. DeGrandpre paints the FDA’s struggle to assert regulatory control over tobacco with the skill of a mystery novelist … until, somewhere in the middle of the story, he turns to an analysis of the addictive properties of nicotine. DeGrandpre developes the FDA history for 18 pages before dropping it, having made no mention of the tale’s dramatic end in the controversial Supreme Court decision, FDA v. Brown & Williamson.

There are a great many studies described in this book. All of them are fascinating, but it became laborious to keep track of the details – particularly because most of the studies have the same punch line: context matters. Once that is persuasively established by the middle of the book, the rest became more details, and it began to feel repetitive. By the end of the book, the thesis has lost its organizational force, and as a reader I felt strained.

Another limitation of this book is its one-sidedness. DeGrandpre gave us a term for discourse that disregards contextual factors, pharmacologicalism. Let us also have a term for discourse that disregards chemical and pharmacological factors – I propose anthropologicalism. Is DeGrandpre an anthropologicalist? That is, does he take his case too far, and argue past the point of reason that history and belief determine drug effects?

It seems to me that DeGrandpre may be an anthropologicalist insofar as he does a poor job of playing devil’s advocate. He has little to say about the mountain of scientific evidence gathered in recent decades that provides a powerful account of drug effects in pharmacological terms.

Who, then, belongs to the “cult of pharmacology”? Judging by the targets of this book, many of them seem to work in policy, in government, in law enforcement, and in medicine. They may exploit simplistic models that reinforce the institutional basis for their accumulations of money and power. While scientists are not immune, many pharmacologists are sensitive to the kinds of objections the book raises.

The idea that reductive essentialism is a destructive distortion is not new, and the concept of pharmacologicalism resembles several ideas in philosophy, such as the Marxist concept of reification. DeGrandpre makes a novel and productive move in bringing this critique to bear on our culture’s troubled relationship to psychoactive substances. He persuasively establishes that pharmacologicalism is a real problem, and does an admirable job of bringing nuance and complexity to this vitally important area of public debate. I strongly recommend this book for anyone who wishes to think about the history of psychoactive substances with complexity and nuance, and especially for anyone who is interested in drug policy.

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