My first book, Pharmaceutical Reason: Knowledge and Value in Global Psychiatry (Cambridge University Press, 2006), is an ethnographic and historical study of debates in psychiatry over the sources of mental suffering. Based on research conducted in Argentina and France, the book analyzes the contested global extension of novel biomedical techniques for understanding and intervening in mental illness. My approach to this field is inspired by the historical epistemology of the life sciences, which asks about the conditions of possibility for making novel truth claims about living beings. I address this question to the arena of contemporary psychiatry, in which clinical practice, the pharmaceutical industry, and patient activism interact in complex and often fraught ways.
The book begins by following an attempt by a French biotechnology company to find genetic loci linked to bipolar disorder using blood samples gathered from patients in a Buenos Aires public hospital. When the company faces unexpected difficulty finding enough bipolar patients for its study, the book turns to an investigation of the politics of medical classification in a distinctive epistemic milieu. In Argentina, the predominant form of mental health expertise—psychoanalysis—does not recognize the legitimacy of “bipolar disorder” as a diagnostic entity. This problem points to a broader set of ethical, political and epistemological debates in the psy-sciences. Building on work on standardization and classification in science and technology studies, the book argues that psychiatric classification—in particular, DSM—works as a “diagnostic infrastructure” that underpins the global expansion of biomedical psychiatry. In sites where this infrastructure is not already in place or encounters resistance, the underlying biomedical conceptions of the human that it presupposes do not take hold—even while psychopharmaceuticals may be highly prescribed. Thus, bipolar disorder and other novel psychiatric classifications do not “exist” as universally valid entities until constituted through highly fraught diagnostic tools and expert practices. Pharmaceutical Reason was translated into French as La Raison Pharmaceutique: Un défi pour la psychanalyse (Le Seuil, 2008), and was presented at Sciences Po in Paris. It was enthusiastically reviewed in leading journals in sociology, anthropology and the history of science, including the American Journal of Sociology, Contemporary Sociology, American Ethnologist, Anthropological Quarterly, and Isis. My encounters with pharmaceutical marketing practices during my time in Argentina inspired a broader research agenda examining the relation of the pharmaceutical industry to biomedical knowledge and practice in a global context. As an NIMH Postdoctoral Fellow in the Department of Social Medicine at Harvard Medical School, I collaborated with medical anthropologists Arthur Kleinman and Adriana Petryna to study the impact of the pharmaceutical industry on medical practice in multiple geographic settings, with the support of the Michael Crighton Fund. The project involved an international workshop of historians and anthropologists working on this theme, and culminated with the publication of a volume of essays co-edited by Petryna, Kleinman, and myself, entitled Global Pharmaceuticals: Ethics, Markets, Practices (Duke University Press, 2006). This collection has helped to spark a wave of interest in the social studies of pharmaceuticals among medical anthropologists and historians of medicine. In my own research in this area, I have continued to pursue the question of how experts in human behavior and thought constitute their objects of knowledge and intervention. This research has resulted in the publication of a number of articles and book chapters on topics such as the role of pharmaceutical marketing tactics in reshaping clinicians’ prescription practices, the techniques used by antidepressant researchers to minimize the placebo response in clinical trials in order to generate statistically significant evidence of efficacy, and the history of cognitive tests used to define phenotypic end-points in clinical studies of anti-psychotic medication.
