What Do Drugs Do to You?

Every day, millions of people actively modify their minds by ingesting chemicals to alleviate symptoms, find respite from pain, open opportunities for mental exploration, and escape from—or into—altered states. From medication to recreational and spiritual substances, drugs are the most widely available formal and informal implements we have for modifying our minds.

Consider the harsh reality of a shot of tequila, the softening effect of a pot brownie, and the jolt from a midday espresso. College students and cross-country truck drivers pop uppers, and millions take painkillers to dull their chronic pain. There are antidepressants to counter the sense of meaninglessness and benzodiazepines for the endless anxieties of modernity. Drugs function below talk therapy as an implementation of neuroscientific research.

Source: Rami Gabriel, used with permission

The main targets of drug use are mood, malady, and personality. With limited resources of time, support networks, money, and patience, the sense of control over the mind offered by imbibing drugs is regarded by some as more efficient than therapy. When drugs work, they tend to work well and can aid individuals through their suffering; there are many such cases. There is plenty of evidence that there are molecular foundations for psychiatric illness.

Unfortunately, pharmaceuticals don’t always work. They may also bring along a raft of side effects, and sometimes drug use can torpedo the healing process or enable abuse.

Nevertheless, from loneliness to boredom, and from anxiety to depression, drugs can be used to counter everyday suffering. The way individual users understand their drug use in the context of their "abnormality" is part of an inchoate, often illogical, “neurobiological imaginary” that is replacing previously dominant psychodynamic language. Through biologizing their suffering in the biomedical health landscape, terms such as "chemically imbalanced" have become part of the way individuals find meaning in their illness. In this post, I explore how drug use relates to the sense of control.

A critical ethical issue at the core of drug use, whether it is medicinal, recreational, or legal, is agency. In the biomedical model of the mind, there are mechanistic accounts for how and why they come to act as they do. Whereas in the clinical model of the mind, psychiatry is part of the social process of self-making and the interpretation of symptoms is woven into the prognosis.

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. How we depict the mind impacts how we enact that vision.

Agency, or the sense of control, is a moral concept, whereas the 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.

My focus is on how the notion of agency, or control, shifts when we think of ourselves as biological machines that can be modified through drug use. This approach 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 miraculous salvation beyond the limits of our conscious abilities to create change in our mental lives. Drugs then become the technology by which we ensure adherence to social norms of behavior and achievement. 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.

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 an organ of meaning-making? In the biomedical model, meaning is beside the point.

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Yet discourse and agency clearly matter for an individual’s sense of herself as a moral actor in the world. The ability to reflect on one’s thoughts and behaviors is part of what we take the human experience to entail. Being able to talk and think about one’s thoughts, sometimes called reflexivity, may be a necessary condition for self-knowledge.

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. Empirical psychology co-exists with popular uses of psychology partly because the truths we believe in need to be meaningful to us. Despite the aspirations of the biomedical model, expressive individualism, ethical humanism, and discourses of subjectivity employed in practical uses of psychology, like drug use, play a more fundamental role in questions of meaning and ethics.

The recent popularization of entheogens like psilocybin, MDMA, and ketamine for therapeutic purposes affirms that experience and reflexivity may indeed be crucial for coping with the great ethical problems of the human condition because the sense of agency remains the basis of the exploration of personhood. Meaning is tied into how we discursively and experientially navigate our individuality in a world marked by affective signals. Our memories, our internalization of cultural symbols, and our process of self-making determine the values that give meaning to our lives. This distinction helps explain the tension between the popular and empirical uses of psychology and suggests that drugs can give us more control over our minds when they enable the ability to reflect on the mind.