Sociological Reflections on the Neurosciences: Volume 13
Table of contents(20 chapters)
Advances in Medical Sociology
Advances in Medical Sociology
List of Contributors
Introduction: Neuroscience, Identity and Society
It should, we hope, by now be clear that neuroscience not simply warrants but perhaps demands attention from sociologists. However, to-date, debate around the ‘new brain sciences’ has been limited within sociology; it has mostly been ethicists who have opened up discussions on the normative and epistemological issues neuroscience raises. Of course, this is not to say that sociologists and other social scientists have been blind to the developments in the brain sciences; a variety of significant and nuanced analyses have begun to be advanced. There can be no doubt that a rich vein of creative and insightful scholarship in what might be called the social studies of the neurosciences is already in existence, and will surely widen. Yet, we can also see that much work remains to be done. It is our intention that this book will play an important role in the elaboration of scholarship in the field. To this end, we have sought and included a range of perspectives from (medical) sociologists and anthropologists, which vividly illustrate the varied social life of the neurosciences, and brightly illuminates the diverse conceptualisations, approaches and standpoints available to sociological analysts.
This chapter interrogates notions of the child and her brain as configured in the laboratory of pediatric neuroscientists, and by parents (overwhelmingly: mothers) of children classified for special education services on the basis of their varied learning capacities and incapacities. Data are drawn from my current New York-based study in a laboratory conducting fMRI research on resting-state differences amongst controls and children variously diagnosed with attention deficit hyper-activity disorder (ADHD), learning disabilities, autism and Tourette syndrome. Parents of children with those same diagnoses struggle with the strengths as well as the school-based weaknesses of their children, and in interviews they picture their children's brains quite differently than do the scientists. Young adult activists who grew up with the diagnoses of ADHD and learning disabilities appropriate lab-based descriptions of neurological difference to their own purposes, claiming a positive identity for themselves. At stake in the space between these diverse perspectives on childhood difference is the future of human developmental variability as it comes under biomedical research and regulation.
The ways in which the brain, as mapped by bioscience, has become popularly understood as the locus and determinant of the self is a topic of increasing importance within medical sociology. Nikolas Rose has influentially chronicled the emergence of a “neurochemical self,” determined by brain chemistry and thus fluid, malleable, and open to improvement via increasingly fine-tuned psychopharmacology. This chapter argues for the contemporaneous emergence of a neurostructural self, intrinsic to the growing neurodiversity movement. Drawing on trends in contemporary neuroscience and biological psychiatry, this model of “brainhood” conceptualizes the brain-as-self as a material system: governed by physical laws, and thus both morally innocent and robustly predictable. Rather than being infinitely open to intervention and optimization, however, the neurostructural self is imagined as fixed and immutable, resistant to the medical intervention and presumption of infinite flexibility inherent within neurochemical selfhood. This chapter draws on a two-year ethnographic study of autism spectrum disorders in North America, investigating the ways in which circulating discourses about medicine, culture, and identity are shaping the emergence, development and use of autism spectrum diagnoses in contexts of daily practice. In this chapter, I explore why individuals with the autism spectrum disorder known as Asperger's syndrome are particularly effective examplars, consumers, and producers of this neurostructural selfhood.
As the neurosciences endeavor to explain increasingly complex aspects of human biology and behavior, domains of human life that can only be assessed in social interaction become ever more important, if formally unacknowledged, dimensions of scientific research. Drawing on semi-structured interviews with 14 researchers who study epilepsy genetics, this chapter examines how neuroscientists encounter ‘the social.’ We find that at the beginning of their careers, researchers are intrigued by epilepsy as a disease of the brain and a means of exploring “the last frontier in medicine.” However, as they begin their investigations, the importance of building social relationships, gleaning the subtleties of seizure experience available only in patient narratives, and engaging with families in the field quickly emerge as important parts of epilepsy genetics research. Some researchers hope for and work toward a day when new techniques or models will allow them to forgo the time consuming, painstaking, and often invisible work of gathering detailed histories, combing through patient narratives, and traveling to field sites to meet with families. However, these accounts make clear that, at the current moment, much of “the molecular work” of epilepsy genetics research is built upon social interactions, relationships, and experiences.
This chapter presents a sociological analysis of the work involved in producing neuroimaging scans used in clinical practice. Drawing on fieldwork in magnetic resonance imaging (MRI) units in hospitals and free-standing imaging centers; in-depth interviews with technologists, radiologists, and neurologists; and reviews of relevant medical literatures, this analysis demonstrates how assembly line techniques structure neuroimaging work. Neuroimages (after being ordered by the referring clinician) are created in an image production line where scans of brains, breasts, livers, and other body parts are all produced: although some facilities may focus on one area of the body, most create an array of scans. Following MRI scans as they are produced demonstrates how medical work emphasizes repetition, specialization, and efficiency – key features of mass production. On the medical assembly line, the organization of work aims to transform patients into objects – ones that multiply as scans are created and circulated. Neurologists, radiologists, and technologists are positioned as skilled workers who manage the flow of bodies and the production of knowledge with the aim of producing health or, at the very least, knowledge of illness. Patients are also actors who actively impact the imaging production process. Previous scholarship has shown that diagnostic work involves a distributed form of expertise; one that involves patients, other medical professionals, machines, and neurologists. This chapter demonstrates that the deployment and synchronization of this expertise is a form of labor, involving distinct professions, professional hierarchies, and reimbursement systems. Working conditions are central to the production of MRI scans as knowledge and contribute to the social shaping of neuroimaging techniques.
This chapter presents findings of ethnographic work in a neuro-oncology clinic in Israel. It is claimed that patients, close-ones and physicians engage in creating metaphorical visions of the brain and brain tumours that reaffirm Cartesian dualism. The ‘brain talk’ involved visible and spatial terms and results in a particular kind of objectification of the organ of the self. The overbearing presence of visual media (i.e., magnetic resonance imaging, computed tomography, angiographic studies) further gave rise to particular forms of interactions with patients and physicians where the ‘imageable’ (i.e., the image on the screen) became the ‘imaginable’ (i.e., the metaphor). The images mostly referred to a domain of mundane objects: a meatball in a dish of spaghetti, a topping of olives over a pizza, the surface of the moon, a stone, an egg, an animal, a dark cloud. Furthermore, conversations with family members showed that formal facts and informed compassion were substituted by concrete representations. For them, and especially for the patient, these representations redefined an ungraspable situation, where a tumour – an object – can so easily affect the organ of their subjectivity, into something comprehensible through the materialistic, often mechanistic actions of most mundane objects. This, however, also created alienated objects within the boundaries of their own embodied selves. Patients, on the one hand, did not reject their own sense of ‘own-ness’, of having a lifeworld (lebenswelt) as subjective agents, but on the other, did talk about their own interiors as being an ‘other’: an object visible, observable and imaginable from a third-person standpoint – a standpoint drawing its authority from biomedical epistemology and practice.
Depressive disorder has been defined by increasingly specific neurophysiological mechanisms and features during the past two decades. At the same time, depression has grown into an epidemic proportion and become a major public health problem. Consequently, the scope of depressive experience and conduct has also widened and the meaning of depression has multiplied and become equivocal. This chapter analyses how this tension is handled in current Western mental health care. The focus of the study is the role of neuroscientific views in mental health reasoning and practice. The empirical case is the mental health discussion in Finland from the late 1980s to the present day. The analysis of the historical change in understandings of depression in Finnish psychiatry and mental health care provides a view of the relevance of neuroscientific models in defining depressive illness and outlining diagnostic and treatment practices. Moreover, the analysis brings forth the relationship of neuroscientific concepts to other ways of defining depression – epidemiology, diagnostic classification, psychodynamic and other psychological theories – within clinical reasoning. A conclusion to be drawn from the analysis of the Finnish case is that neurobiological concepts of depression have only limited influence on the ways in which the disorder is conceived within the practical context of mental health care. It seems that the idea of depression as a multi-factorial disorder remains a good enough conceptual framework for clinical practice. Even the influence of neurosciences on treatment is still somewhat marginal. Within current practices of depression management, it is not the brain that is treated but risks, symptoms, and persons.
Neuroscientific technologies have begun to change the ways in which we understand, respond to, and treat drug addiction. According to addiction researchers, neuroscience marks a new era because of its potential to locate the causes of addiction within the brain and to treat addiction through altering neurochemistry. However, little is known about how addiction neuroscience and new neurochemical treatments shape individuals' experience of addiction and constitute new arrangements of knowledge and power that shape subjectivity and governance. This chapter addresses these domains by drawing on an analysis of scientific literature about addiction neuroscience and qualitative interviews with people being treated for addiction with buprenorphine, a pharmaceutical treatment for opioid dependence. The chapter charts four major themes in the addiction neuroscience literature (pleasure and the limbic system, rationality and the role of the prefrontal cortex, theories of plasticity, and the role of volition) and explores how each of these is incorporated, adapted, or rejected by individuals being treated for addiction with a pharmaceutical. This analysis demonstrates how neuroscientific ideas are mediated by the lived experiences of those being treated under a neuroscientific model. It also suggests that while neuroscientific interventions, like pharmaceuticals, shape the experience of those being treated for addiction, so too do many other forces, including social circumstances, moral frameworks, the drive for autonomy, and the quest to be “normal.”
There is significant research describing how the development of neuroscience has affected the definition and treatment of neurological and psychiatric disorders, as well as brought about changes in research and care practices. Little is still known, however, about the ways in which these changes come about and on how they affect individuals’ – in particular, patients’ – experiences. In this chapter, I describe the changes imposed by neuroscientific practices not only on patients’ experience of their neurological or psychiatric disorder, but also on how they define themselves. In so doing, I draw on ethnographic research conducted among a neuroscientific team of a French hospital which has coordinated a research trial for the application of an experimental neurosurgical treatment – deep brain stimulation (DBS) – to patients suffering from obsessive compulsive disorder who are resistant to conventional treatments. This technology has been used since 1986 for treating various neurological and psychiatric disorders. My objective is to describe how the models of pathology conveyed by DBS and the experiences of patients suffering from a neurological or psychiatric disorder interact to constitute a form of personhood. I argue that, in certain situations, some of the patients attribute more significance to cerebrally orientated – or naturalistic – explanatory models and give a new value to their subjective experience: they ‘cerebralize’ and find inside the brain and its (dys)functions – or through an intervention on it – the source or the solution of a plurality of personal situations.
This chapter takes the ‘wakefulness promoting’ drug modafinil as an exemplarity case in the sociology of pharmaceutical enhancement. The chapter draws on empirical data collected through 25 interviews with prospective users of modafinil, focusing on two of the ways in which prospective users of modafinil imagined how the drug might be used in their specific social domains: the use of modafinil as a safety tool in the workplace and its use as a study aid by university students. The data presented in this chapter suggests that although a therapy-enhancement dichotomy is a useful heuristic; it could also be limiting to uphold as it may direct attention away from other ways in which uses for new technologies can be positioned, negotiated, realised and resisted by (potential) users in the context of their daily lives.
This chapter takes a critical look at the sociological notion of ‘medicalisation’ in relation to recent trends and developments in neuroscience, neurotechnology and society, taking memory, medicine and the brain as our prime focus and the disease category of mild cognitive impairment (MCI) as our empirical case study. Five relational nexuses in particular are identified as relevant to these developments and debates, namely the bio-psych nexus, the pharma-psych nexus, the selves-subjectivity nexus, the wellness-enhancement nexus, and the neuroculture-neurofuture nexus. We show that developments in memory medicine and the shifting boundaries of cognitive health, as embodied and expressed in the case of MCI, shed further valuable light on these issues and the interconnectivity of these relational nexuses. As an emergent disease and susceptibility category, MCI illuminates not only the fuzzy boundaries between normal and abnormal cognitive functioning, but also the working of neuroscientific, neurocultural and pharmacological interests, which, in this case, are already claiming MCI as the next locus of enhancing the mind and optimising aging. Thinking both within and beyond medicalisation challenges us to find new ways to critically understand the ideas about life and health as they travel, translate or migrate from (neuro)scientific and clinical spheres to cultural life and patient experience.
A neuroscientific turn has been diagnosed in several disciplines, but sociology has not yet undertaken this turn. While other social science disciplines are engaging in a lively discussion with the ‘new brain sciences’ and have established extensive collaboration, exchange between neuroscience and sociology is almost absent. Besides a general scepticism towards “reductionist” explanations, this is largely due to sociology focusing on its traditional role as observer and critic of current developments in science. In this chapter, I argue that this ‘sociology of neuroscience’ approach should be complemented by an increased attention to actual neuroscientific findings with respect to key theoretical concepts in sociology and social theory more generally. I discuss how contemporary neuroscience research can assist in sharpening and empirically refining our understanding of a number of micro-sociological concepts that often elude investigation with more traditional social science methods. I highlight the possible benefits and pitfalls of such endeavours by discussing the ‘neurosociology’ paradigm and sketch alternative ways of mutual engagement with the new brain sciences.
Recent years have seen an explosion in research by scholars from the social sciences and humanities who apply neuroscience to research in their home disciplines. One way these ‘neuroscholars’ have engaged in conversations with neuroscience is by incorporating books of popular neuroscience into their work. This chapter explores some of the textual changes that result from the translation of neuroscience to popular neuroscience, and through rhetorical analysis, examines how popular neuroscience is used to support claims in emerging disciplines like neuroeconomics, neuroliterary criticism, neurolaw, and neuroeducation. An examination of scholarship from several disciplines – including sociology – reveals that popular neuroscience is often marshaled not as a translation or accommodation of science, but as science itself via two primary rhetorical strategies we have termed ‘fact finding’ and ‘theory building.’
Neuroscience, with its promise to peer into the brain and explain the sources of human behavior and human consciousness, has captured the scientific, clinical, and public imaginations. Among those in the thrall of neuroscience are a group of ethicists who are carving out a new subspecialty within the field of bioethics: neuroethics. Neuroethics has taken as its task the policing of neuroscience. By virtue of its very existence, neuroethics presents a threat to its parent field bioethics. In its struggle to maintain authority as the guardian of neuroscience, neuroethics must respond to criticisms from bioethicists who see no need for the subspecialty. We describe the social history of neuroethics and use that history to consider several issues of concern to social scientists, including the social contexts that generate ethical questions and shape the way those questions are framed and answered; strategies used by neuroethicists to secure a place in an occupational structure that includes life scientists and other ethics experts; and the impact of the field of neuroethics on both the work of neuroscience and public perceptions of the value and danger of the science of the brain.
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