Abstract
Early to mid-twentieth century studies on the neurophysiology of the role of conditioned cues in relapse, conducted at the Addiction Research Center in Lexington, Kentucky, were the historical antecedents to today's neuroimaging studies. Attempts in the 1940s to see ‘what's going on in the brains of these addicts’ were formative for the field, as was foundational work done in the 1940s and 1950s by Abraham Wikler on conditioned cues, the role of what he called the ‘limbic system’ in relapse, and possible uses of narcotic antagonists to prevent relapse by extinguishing cues. This article sketches the historical context in order to situate continuities between historical antecedents and a current ethnographic case study focused on current neuroimaging studies of the role of ‘craving’ – and neural processes that precede conscious ‘craving’ and occur ‘outside awareness’ – in relapse conducted by Anna Rose Childress at the Treatment Research Center in Philadelphia, Pennsylvania. The article showcases the incommensurability between claims that ‘addiction’ is a matter of individual choice, and claims that it is a neurochemical disorder disruptive of volition. Neuroscientists offer scientific vocabulary and imagery that both shape and respond to the social experience of addiction. The conclusion considers the value of moving toward a critical neuroscience more cognizant of the social worlds in which ‘addiction’ occurs, not in the restricted sense of ‘social factors’ but through awareness of the social–situational contexts and relationships within which ‘addictions’ are experienced and studied.
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Notes
‘[A]n entirely different tradition of research … has sought to identify the neural substrates of reward and reinforcement or incentive [commonly called “reward”] which has only marginally implicated the amygdala, or indeed, other limbic structures’ (Everitt and Robbins, 1992, p. 402). Studies on electrical stimulation of the brain reward system supersede an ‘older behavioristic notion of the goal as a reinforcer that cements or consolidates connections made between stimulus and response’ (p. 402). Everitt and Robbins, who publish both within the addiction research community and within the broader neuroscience community, argue ‘the’ amygdala cannot be viewed as a unitary structure because it is ‘neurochemically heterogeneous’ and urge others to acknowledge this complexity and ‘address it psychopharmacologically’ (p. 422). Speaking of ‘the amygdala’ as if it is a unified structural entity – for the sake of linguistic convenience and cultural competence – gestures toward the kind of closure, stability and unity necessary to make scientific claims stick.
For a useful attempt to offer methodologies by which to analyze how neuroscience influences society by situating neuroscience as itself a cultural activity and heightening the reflexivity of both practitioners and critics; see Choudhury et al (2009).
As a historian who has studied changing definitions of ‘addiction’, the material and social conditions within which research and redefinition occurred, and the succession of knowledge paradigms, ‘thought styles’, and forms of expertise considered authoritative to define it and make definitive knowledge claims, I believe it would be a mistake to take current debates as settled. For neuroscientists’ accounts differ (cf. Koob and Le Moal, 2006, pp. 18–19).
Karin Knorr Cetina's book, Epistemic Cultures: How the Sciences Make Knowledge concerns scientists as ‘epistemic subjects’ who are central to the varying social arrangements that sustain high-energy physics experiments by contrast to those that organize molecular biology laboratories (2001, pp. 223–224). Empirically based science studies looks closely at scientific practice to remedy ‘our present lack of understanding of the contemporary machineries of knowing, of their depth, and particularly of their diversity’ (2001, p. 2). That need to know more about the depth and diversity of sciences extends to the historical past.
At least ‘social factors’ appear; however, they appear as thin demographics based on an ahistorical version of ‘the social’ like that adopted in the ‘social neuroscience’ movement. My thanks to an anonymous reviewer who pointed me to the Wikipedia entry at www.en.wikipedia.org/wiki/Social_neuroscience: ‘Social neuroscience investigates the biological mechanisms that underlie social processes and behavior, … and applies concepts and methods of biology … to inform and refine theories of social behavior … [I]t uses social and behavioral constructs and data to inform and refine theories of neural organization and function’. By contrast ‘critical neuroscience’ urges a ‘reflexive turn’ towards the critical examination of ‘scientific practices and institutions, as well as the wider social contexts within which they work. The aim of this reflexivity is to reveal the contingent foundations of particular disciplinary perspectives, tacit presuppositions, and also their entanglement with the social dynamics operative in capitalist societies at large. This idea of critique relevant to Critical Neuroscience concerns ways to institute self-critical practices, which aim to achieve reflective awareness of the standpoint-specific biases and constraints that enter into the production, interpretive framing and subsequent application of neuroscientific knowledge’ (Choudhury et al, 2009, p. 66). The latter idea is much closer to what I envision happening within the field of addiction research – a field in which neuroscientists are already intensely aware of their ‘contingent foundations’, and worry that further aspersions – such as casting ‘addicts’ as having ‘brain dysfunction’ or ‘brain damage’ will work against their goal to destigmatize treatment and make it more effective.
For a fulsome application of the terms ‘molar’ and ‘molecular’ (Rose, 2003), see Keane and Hamill's (2010) contribution to this volume. While I demonstrate the need to see the process Rose points to within a longer time perspective, it is indisputable that therapeutic optimism in neurobiochemical models arises from the shift from the ‘molar’ to the ‘molecular’. Keane and Hamill astutely argues that adoption of neuroscientific models does not displace the moral weight and cultural freight of the concept of addiction. The emphasis on brain changes and persistent alteration central to the ‘neurobiochemicalization’ of addiction naturalizes difference in ways that reinforce the ‘othering’ of persons living with addictions.
Disunity is an acknowledged part of science explored in science studies, of which ‘laboratory studies’ are one part (Gilbert and Mulkay, 1984; Latour and Woolgar, 1986; Galison and Stump, 1996; Gieryn 1999; Cetina, 2001).
Ideological codes can be thought of along the lines of ‘buzzwords’ that intensify the effect of realism. Such codes are a key attribute of government documents and scientific texts, or the forms of ‘official discourse’ that Smith calls governing or ‘ruling relations’ (Smith, 1999, note 10, p. 84). Pointing to the intensified need for extra-local texts to coordinate multiple ‘locals’ due to the increased organizational complexity of advanced liberal societies, Smith emphasizes that ideological codes enable a ‘standardization of the local’ that stabilizes epistemic cultures that are otherwise ‘geographically and temporally dispersed and institutionally various’ (Smith, 1999, p. 158).
Keller (1992) describes sociotechnical borrowings between physics and molecular biology similar to how substance abuse research has incorporated neuroscience and genetics: ‘I want to argue that physics and physicists provided a resource of far greater import for the success of molecular biology than any particular skills; namely, they provided social authority. That authority was, of course, acquired in the first place through the formidable displays of technological and instrumental power issuing from physics itself, but this initially technical authority soon became available for deployment far beyond the domain of their technical triumphs; it became, in short, an authority that could be called upon for the essentially social process of reframing the character and goals of biological science. This borrowing proceeded in a variety of ways – first, through the borrowing of an agenda that was seen as looking like the agenda of physics; second, by borrowing the language and attitude of physicists; and finally, by borrowing the very names of physicists’ (p. 98).
This quotation and the next are from the Porter Bill (Public Law 70-672), signed on 19 January 1920.
I thank my co-authors on The Narcotic Farm: The Rise and Fall of America's First Prison for Drug Addicts (Campbell et al, 2008), JP Olsen and Luke Walden, who found this letter in the course of archival research for their film, ‘The Narcotic Farm’, on the US Public Health Service hospital in Lexington, Kentucky. The letter is housed at the National Archives in College Park, Maryland.
Clifton K. Himmelsbach, founding director of the laboratory at Lexington, was an experienced clinical researcher by the mid-1930s. He noted that the research team knew that Andrews’ observation ‘must have significance’, but ‘found the nut much too tough for us to crack’ (Martin and Isbell, 1978, p. 22).
While at the ARC, Wikler et al (1952) disproved clinical claims concerning the effectiveness of frontal lobotomy for treating narcotic addicts (Campbell 2007, pp. 124–126). Later at the University of Kentucky, Wikler et al (1972) published a study showing that rats whose limbic systems had lesions were compared to those who were intact performed so similarly in a ‘relapse test’ that ‘removal of limbic system structures would offer no relief from the ever-present problem of relapse in those who have been previously dependent on opiates’.
For an attempt to restore Wikler to his place in the history of neuroscience, see Timothy R. McIntire, ‘A Retrospective Survey of the Career of Abraham Wikler: Implications for the Understanding and Treatment of Drug Addiction in America Today’ (Boston University School of Medicine, 2008). My thanks to Conan Kornetsky for suggesting this source.
Shortly after leaving Lexington, Jerome H. Jaffe wrote a chapter on Drug Addiction and Drug Abuse for the third edition of Goodman and Gilman's classic textbook, The Pharmacological Basis of Therapeutics (1965). He used the term ‘chronic, relapsing disease’ (1965, p. 285), but noted in a 2007 interview with the author, that he did not say ‘this is a permanent relapsing brain disease. I said that basically the loss of flexibility with respect to a drug exists on a continuum. At one extreme, you have addiction, you have a compulsive drug-using disorder which begins to resemble a chronic relapsing disorder. There are milder forms that aren’t chronic. People recover. … . I just know too many people in complete recovery for me to view them as having a permanent brain disease … . There are lots and lots of complexities here that I think are glossed over and minimized when you say it's a brain disease. I think it's wrong to label every case of drug disorder as a chronic relapsing disorder. It doesn’t characterize everybody. … To me, the idea that addiction is a chronic, relapsing brain disorder is both counter-intuitive and counter to all observations’.
Even this new optics was rooted in the history of the ARC. William R. Martin hypothesized the existence of multiple opiate receptors, and accurately predicted their position in the brain before the simultaneous visualization of opiate receptors in the 1970s.
My use of the term ‘discourse’ is based on decades of analysis in the field of STS, which studies how scientists use figurative constructs, metaphor and metonymy not to question reality or reduce all science to ‘mere discourse’, but to show how discourse is a form of social action and science is a kind of culture. The basic insights are that language is a medium of social construction through which the construction of social reality and self-positioning take place and that discourse is a form of cultural and political work. Discourse analysis is a conceptual methodology by which to determine what cultural work is accomplished by which spoken, written or visual texts. Discourse is seen as historically and culturally specific even – or perhaps especially – when it purports to be ‘universal’, ‘objective’ or ‘neutral’, as scientific discourse almost always does.
See the fMRI study reported in Childress et al (2008). Childress et al (1999) reported on a PET study of ‘limbic activation’ in response to lengthy videos containing cocaine-related cues.
Author's interview with Charles P. O’Brien, College on Problems of Drug Dependence, Orlando, Florida, 2004 and Philadelphia, Pennsylvania, 2007.
Childress appeared in the 1997 Bill Moyers special, ‘Close to Home: The Hijacked Brain’ and the Home Box Office special, ‘Addiction’, which aired in March 2007 just a month before her appearances on ‘Good Morning, America’ and ‘The Oprah Winfrey Show’.
All quotes from Childress are from the interviews that I conducted with her in April 2007.
For a popular account of pressures entailed in the language of ‘coping’; see Moyers and Ketchum (2006), who considers disease as a life sentence: ‘What was this thing called addiction? A disease, they said, of body, mind and spirit, a progressive, chronic, inevitably fatal disease. What did those terms mean, what were these impenetrable concepts that fell so easily from the lips of the all-wise and all-knowing counselors?’ (p. 177).
Childress et al (2008) cite Freud's Interpretation of Dreams (1913; translated by A.A. Brill; New York: MacMillan). Freud believed there was a chemical basis for psychosexual behavior, positing that endogenous ‘toxins’ freed individuals from the ‘compulsion of logic’ and made them enter ‘suggestible’ states over which the pleasure principle no longer presided (Campbell, 2007, p. 21). States of ‘repetition compulsion’ appeared like ‘possession by some ‘daemonic’ power’ (Freud, 1961, pp. 26–30). In Three Essays on the Theory of Sexuality (1975), Freud sketched clinical similarity between neurotic disorders and the ‘phenomena of intoxication and abstinence that arise from the habitual use of toxic, pleasure-producing substances’ (1975, p. 82).
Volkow's remarks were made at the 35th anniversary celebration sponsored by Friends of NIDA and Robert DuPont's Institute for Behavior and Health on 21 May 2008.
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Campbell, N. Toward a critical neuroscience of ‘addiction’. BioSocieties 5, 89–104 (2010). https://doi.org/10.1057/biosoc.2009.2
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DOI: https://doi.org/10.1057/biosoc.2009.2