Drugs & Media: New Perspectives on Communication, Consumption, and Consciousness 9781628927887, 9781441119889, 9781441134929

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Prologue

Defining our Terms Similar patterns of interaction and effect can occur with the use of certain drugs and media. And yet, when considering the complexities entailed in the roles played by these communication technologies in and for the human sensorium1 we’ll discover that linear, one-way causal stories, or any clear-cut sequences of cause and effect for that matter, simply do not apply.2 So it is worthwhile to begin by discussing some conventional definitions, as well as a few perennial concerns, surrounding drugs and media today. Two reputable online dictionaries provide the following details: Drug (via Wikipedia). Not surprisingly, perhaps, coffee is the first example of a drug illustrated there. It is described as “the most widely used psychotropic substance in the world.” Again, not much of a surprise for many readers, but how do we define drugs in our culture? A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function. There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage. In pharmacology, a drug is “a chemical substance used in the treatment, cure, prevention, or diagnosis of disease or used to otherwise enhance physical or mental well-being.” Drugs may be prescribed for a limited duration, or on a regular basis for chronic disorders. Recreational drugs are chemical substances that affect the central nervous system, such as opioids or hallucinogens. They may be used for perceived beneficial effects on perception, consciousness, personality, and behavior. Some drugs can cause addiction and habituation.

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viii Prologue Drugs are usually distinguished from endogenous biochemicals by being introduced from outside the organism. For example, insulin is a hormone that is synthesized in the body; it is called a hormone when it is synthesized by the pancreas inside the body, but if it is introduced into the body from outside, it is called a drug. Many natural substances such as beers, wines, and some mushrooms, blur the line between food and recreational drugs, as when ingested they affect the functioning of both mind and body.

While not a problem per se, the potential for a great deal of deliberation concerning what constitutes a drug is evident in these sentences. Deliberation, confusion and contradictions are endemic to defining as an enterprise, and with drugs in particular this seems to be the case now, more than ever. For example, think about what is implied by “normal” in the first entry, or notice the curious thing about insulin in the next-to-last, and the confusion between food and drugs following that. To get a better handle on some of this confusion we can extend our etymological inquiry into the realms of medicine and biology, as we find many interesting connections between drugs, medicine, media and culture there. Medicine (at Dictionary.com) is defined, variously, as: Any substance or substances used in treating disease or illness; medicament; remedy. The art or science of restoring or preserving health or due physical condition, as by means of drugs, surgical operations or appliances, or manipulations: often divided into medicine proper, surgery, and obstetrics. The art or science of treating disease with drugs or curative substances, as distinguished from surgery and obstetrics. The medical profession. Any object or practice regarded as having magical powers (among North American Indians).

And more or less what one might expect here too – though the American Indian spin is certainly intriguing. Elsewhere in this entry we get some detail on medicine both as a thing and a process. We also find that the intention behind medicine is generally a good intention: its origins pointing to medico (Latin), itself adapted from medeor (I heal, cure), in turn borrowed from the Greek verb μέδομαι (or medome; take care of, think, execute with great art). We find, in other words, a consistent notion of somehow providing remedy. Indeed, the history of medicine has deep and earnest roots in a bona fide quest for remedies – the easing of pain and suffering, the finding of cures, the amelioration of disease, the Hippocratic Oath, etc. There is another side to medicine, however, that is at once less salient and more ubiquitous in the way it is experienced.

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Nostrum Remedium (via Wikipedia’s Wiktionary): Latin for “our remedy” or “local remedy,” or, more colloquially perhaps, “quack medicine.”

Nostrum remedium refers to a plethora of folk medicines or popular cures that were typically untested and not ordinarily used by medical specialists of the day. It is interesting to note that while the Latin derivation is now quite obscure, “local remedies” enjoyed a vibrant commerce throughout the 18th, 19th centuries and into the 20th century in the United States at least. Nostra remedia seem to have been “local” in two senses of the term: (1) geographic locale, and (2) more or less immediate in terms of their palliative effects being, presumably, experienced quickly. But at least where a substance is concerned, such “drugs” were often considered to be of questionable effectiveness. In the United States such “patent” medicines included things like Moxie, Coca Cola, 7UP, Luden’s cough drops, Angostura bitters, Dr. Kilmer’s swamp root, and Doans Pills. These popular palliatives were considered to be of dubious effect by medical professionals – at least as far as the claims made by their purveyors were concerned. Now, as several contributors to this volume make clear, what binds these more dubious drugs to drugs that are generally considered to be sound in terms of function and effect is the way in which the side-effects become, in many ways, the real effects to be considered. We need only turn on the TV to see how some of the latest blockbuster drugs are being advertised along with a dizzying list of side-effects. Audiences are warned about heart palpitations, blurred vision, shortness of breath and even suicidal thoughts that have been attributed to some anti-depressants. Dry mouth, dizziness and drowsiness are often mentioned as common side-effects associated with many antihistamines. We’re reminded of stomach pains that might accompany a standard dosage of aspirin, and warned not to mix aspirin and ibuprofen, as the cumulative effect of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) can irritate the gastrointestinal tract. Or pay close attention to the next impotence or anti-depression drug commercial that comes on the radio or television. The lists of effects and side-effects make up the lions share of the audio track. Robert Whitaker (2010) painstakingly tracks an associated phenomenon as it has occurred over the last half of the 20th century in the United States. The biggest side-effect that occurs in the consumption of many popular drugs still on the market today is the placebo effect: a still quite mysterious psycho-somatic effect that can, in many cases, produce a legitimate and much desired remedy for the condition in question. This fact suggests it is the systemic relation we must look at – the ongoing interactions between organism and environment (drug/ chemical/medium) that matters.3 We’ll revisit questions of effect, side-effect and

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x Prologue placebo effect shortly, but before we go any further, it is important to draw out the connection between drugs and media promised a few pages ago. Consider some standard definitions of medium circulating today. Medium (via Dictionary.com). Here with medium, and in the next set of entries for culture, some brief characterizations are interjected after each sub-entry. An intervening substance through which something else is transmitted or carried on. This is a fairly conventional definition from one of the most popular online dictionaries, yet seems naīve in its suggestion that the medium plays a purely mechanistic and neutral role. An agency by which something is accomplished, conveyed, or transferred. Still a “neutral transmission” bias evident here, but we see the glimmerings of the active nature of the thing. This might even be an appropriate sub-entry for “drug.” A surrounding environment in which something functions and thrives. And now we begin to see a more organic, systemic, and indeed biological way of thinking about media. It should remind us (as Neil Postman reminded me), of a high-school biology classroom – full of Bunsen burners and strewn with saltstained Petri dishes, beakers and fleakers and such. It is typical to find something very close to these three entries for medium in just about any dictionary or encyclopedia (online or off). Clearly, like drug, there is some squirreliness surrounding this idea as well. Inspired by James Carey’s Communication as Culture (1989), I started urging my students to compare entries for medium and culture in their favorite dictionary. The word culture (from the Latin cultura, stemming from colere, meaning “to cultivate”) is a term that has various meanings. For example, in 1952, Alfred Kroeber and Clyde Kluckhohn compiled a list of 164 definitions of “culture” in Culture: A Critical Review of Concepts and Definitions. However, the word “culture” is most commonly used in three basic senses: Culture (from Wikipedia): Excellence of taste in the fine arts and humanities, also known as high culture. The integrated pattern of human behavior that includes thought, speech, action, and artifacts, and depends upon the human capacity for learning and transmitting knowledge to succeeding generations. The set of shared attitudes, values, goals, and practices that characterizes an institution, organization or group.

We can probably dispense with the first sense, as it betrays an outmoded, classbased interpretation of culture that does not correspond to the experience of

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most people these days (“cultured” or otherwise). And so, while keeping certain features distinct, media ecologists do recognize a special affinity between media and cultures – most notably, the awareness that both engender integrated patterns of behavior, thought, speech, action and artifacts. From this perspective media are cultures and cultures are media. It is not a stretch at all to understand why, since, from a biological outlook (the conceptual grounding of media ecology), whatever surrounds us or contains us will necessarily play a role in our development. In offering a bit more detail on the process of development that any culture (as medium) represents, I particularly like these two entries for culture (as a verb): to grow (microorganisms, tissues, etc.) in or on a controlled or defined medium. to introduce (living material) into a culture medium.

And if we want to get really “biological” about it, we might consider the following clause found via Wikipedia under Growth Medium/Culture Medium: “Viruses are obligate intracellular parasites that require a growth medium or culture medium containing living cells to propagate.” This clause is particularly thought-provoking because it suggests not only parasitism, but also symbiotic relation between organisms and media/cultures. In fact, it prompts us to flip the figure/ground relation between medium/culture (i.e. ecology or environment) and organism, whereby one organism becomes the medium or environment for another (for an insightful analysis of these possibilities in the realm of media studies see Logan, 2008).

The Effects and Side-Effects of New Media (as Nostra Remedia) On a bad day I might be willing to argue that e-portfolios and other course management applications are becoming the new patent medicines or nostra remedia intended, presumably, to ameliorate problems and pathologies deeply embedded in our educational systems, or at least assuage some of the latest worries regarding them. I sometimes wonder if there is an “e-portfolio placebo effect.” What are the intended effects, and the side-effects, of these new initiatives? On the one hand we have hopes that these technologies will enhance the teaching and learning experience and produce more well-rounded students who have more focus, more drive, and a better sense of their trajectory through school and life. On the other hand, new emphases on public legibility, “deliverables,” outcomes assessments, and a continued shift toward visual representation seem to be in the offing too. For this reason, I want the reader to consider the term culture as

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xii Prologue well, for there is a real sense in which our communication media have always functioned very much like cultures. If the jury is still out regarding e-portfolios, there is a potential connection between nostra remedia and some other communication technologies we are hearing about and/or using today. There seems to be a well-worn pattern here in fact. Without suggesting they were or are ineffective, we could consider the way books were impressed upon children a couple of hundred years after Gutenberg’s invention, and in the process spurred a new kind of identity – the pupil – and very specific kind of educational theory and practice. History is replete with instances of new media quickly disseminating into cultures without much testing or apparent concern about the potential effects and side-effects beyond some narrowly defined end or purpose determined by others, and often elsewhere. This was certainly the case with television at the midpoint of the 20th century in the United States, and it is apparently becoming the case with virtual books like those made available via the iPod, Kindle and Nook at the start of the 21st. In the pages that follow, contributors make the case that, like our media, many of our drugs also function as constitutive environments for the people who use them. But they also point to the way in which our media and our drugs often function as environments for those who don’t use them, and even some who have quite possibly never even heard of them. Let’s consider a first example in this regard. Along with the innovation and diffusion of many drugs and media, we find that a significant but often overlooked side-effect of any drug or medium has always been a new awareness, acceptance, even belief in the appropriateness or inherent good in certain kinds of behavior, or ways of being. In Listening to Prozac (1993) Dr. Peter Kramer points to the application and rapid diffusion of anti-depressant drugs in the United States in the late 1980s, and a new premium on extroversion that emerged along with them. This could be contrasted with the premium placed on introversion in previous eras. McLuhan (1964, 1969), and Eisenstein (1979), suggest some of that cultural valuation was a consequence of print technology and books. In addition to the consumption of particular content (the direct and intentional effect of the book some might say) there was also a new value placed on quiet stoicism, and a kind of virtual solitude expected, even promoted, in school children.4 Along with a new tendency towards linear, sequential patterns of thought, the ability to compare, contrast, dissect, and abstract knowledge is touted as one of the “side-effects” of the book as a communication technology. And of course non-readers were not exempt from other consequences of literacy (Goody and Watt, 1963), including a growing expectation or awareness concerning the cumulative and categorical nature of “real” or “legitimate”, knowledge. Over time, with the emergence of visual media forms like television, drugs like Prozac, and

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now social media taking hold, these same habits and attitudes are again being obsolesced, progressively devalued and even, for some, pathologized in our culture today. The same can be said of the devaluation of sadness (Horwitz and Wakefield, 2007).5 These are just some of the potential ways non-users of both media and drugs are also affected by them.

Media-as-Addiction and Media-as-Disease Modern history is replete with claims that media use can become addictive or akin to a disease. Literal readings of these notions go back at least as far as the early 17th century, when concern over such things as the apparently anti-social tendencies of “habitual” readers worried parents, teachers and priests. The addiction and disease worries then turned into tropes and metaphors in the mid-20th century – consider the thread running from MacCoby (1951) to Winn (1977) to Rushkoff (1995) to Brodie (2009) in this regard. Consider, as well, terminology that has become part of common parlance over the last fifty years: we can “inoculate against” undesirable information, we “spread the news,” and “plug in,” we “get online,” and endure all kinds of “media exposure” as “users” and, interestingly enough these days, “going viral” is something many folks aspire to. The disease models of addiction subscribe to a causal story that sounds similar to one popular account of mental illness today, and all three seem to follow a methodological reduction to the level of synapse. Some of the fiercest advocates of the “disease” and “illness” models point to problems even further down, into the genome. Where talk of addiction is concerned, if there is some mention of the role of environment in the etiological account, choice or intention typically have little or nothing to do with it, and the “outside world” is generally treated as a peripheral concern. Likewise, it is not at all uncommon today, especially where mental illness is concerned, for a practitioner gathering details surrounding a “mood-swing problem” to quickly suspect a neurological dysfunction or chemical imbalance in the brain, and report that they have a good handle on the problem.

Media and Drugs as Mind Tools It would seem that the most accepted way of talking about “addiction-like” media use in the psychological literature is described instead as a kind of impulse control disorder (Beard and Wolf, 2001; Retrevo, 2010). One problem with this formulation ignores the very intimate relationships we tend to enjoy with our tools (chemical, physical, conceptual, etc.). Like a baseball bat or a bicycle, and like many drugs too, so many of these things seem to function as intimate parts

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xiv Prologue of us – they become, in a very real sense, seamless mind tools.6 They not only allow us to do things we couldn’t do before; they also change the way we think about ourselves and the world around us. They sometimes deaden, but can also enliven our senses, our mental capacities and physical abilities, and often start to feel like crucial parts of what define and drive us. Mind tools of various sorts have probably always been functional components of who and what we are. The difficulty in understanding these tools is that so many become largely transparent to consciousness. It’s hard to see them precisely because we tend to see through them. The suggestion here is that our efforts to understand drug and media use though “addiction” or “disease” or “illness,” or even “lack-of-impulse-control” lenses will probably never be particularly useful efforts. Such approaches are based on a fundamental misunderstanding about human being that assumes certain things that are not so, including Descarte’s mind-body split and the monistic identity thesis in psychology, which accepts, among other things, that a one-to-one correspondence exists between neurochemical events and observable behaviors. It seems more likely that our media and drug use are ongoing processes involving organism-environment systems engaged in the consumption, metabolizing and processing of matter, energy, and symbolic content. But since humans seem unique insofar as we can be self-reflexive system-builders and adept abstract symbol users, things tend to get complicated, and fast. Having detailed some of the critical terms employed throughout (and considered some of the critical approach entailed in) this book, let’s turn next to some of the theory ultimately informing many of the essays contained here.

The Noosphere (and Nootropics) It may be, with some of the latest drugs being synthesized and in the cutting-edge environments now being deployed and populated online, that we are coming close to some next phase in human evolution hinted at by Alvin Toffler, Nicholas Negroponte, Bill Gates, Sergey Brin and Larry Page, and other techno-futurists. On the other hand, we could be participating in something Vladimir Vernadsky and Teilhard de Chardin might have dubbed a kind of “noospheric degeneration.” Verdansky and de Chardin generally agreed that the noosphere or “sphere of human thought” is the third in a natural succession of phases of development of increased complexity on Earth (after the geosphere and the biosphere).7 If the three spheres are as intimately related as recent arguments in ecology and mounting empirical work in the environmental and biological sciences suggest, then many individual-level media habits and pathologies are already manifesting or will eventually manifest as forms of noospheric, biospheric, and eventually geospheric degeneration as well.8

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Extending Vernadsky’s concept, de Chardin (1955) employed the term noosphere to describe the “collective consciousness” of human beings that comes about through the interaction of human minds. “The noosphere has grown in step with the organization of the human mass in relation to itself as it populates the earth. As mankind organizes itself in more complex social networks, the higher the noosphere will grow in awareness (ibid).” The way de Chardin describes the noosphere suggests that it might be analogous to an ethereal communication system much like the Internet. The parallels are sometimes uncanny and, indeed, this is one reason why de Chardin has been dubbed the “patron saint” of the Internet. But while the terms are often conflated, de Chardin’s noosphere is not synonymous with Toffler’s infosphere. Toffler’s term seems to correspond much more closely with what we know today as the Internet (we should note that terms like technosphere (Prophet, 1995), and semiosphere (Hoffmeyer, 1998), put additional strain on efforts to make sense out of these concepts). With an intimate and inexorable (if often invisible) relation between the three spheres in mind, and considering ongoing environmental degradation, as well as social, organizational and economic upheavals – and all of their reverberations in politics, business, education, news and entertainment – there are a few other questions at stake: Are digital environments beginning to feed off of our natural environment? Is our digital infrastructure proving itself parasitic upon our physical infrastructure? Such possibilities would certainly rail against the popular understanding. Nonetheless, from love letters, liner notes, term papers, credit reports, tax documents and medical records, to classrooms, bank lobbies and office buildings, the environments we inhabit seem to be moving rapidly from atoms to electrons. Can we find the right kinds of balance between the two? And would more balance ease additional degeneration occurring along the threesphered continuum ? It was Dr. Corneliu Giurgea who actually coined the term nootropics in 1964, the same year McLuhan’s Understanding Media was published. Giurgea described various kinds of “cognitive enhancers” or “smart drugs,” including mood stabilizers, and memory and mood enhancers. Nootropics alter the availability and interplay of chemicals in the brain. They affect memory, planning, concentration, and may reduce obsessive, impulsive and compulsive behaviors. Many are stimulants, and can be naturally-occurring organic substances or chemical compounds synthesized in a lab. The “theory” behind nootropics in fact far pre-dates the term, however. For example, a number of artifacts and practices, dubbed “mind changers” by 18th-century Iroquois, were introduced by English, French, and Dutch settlers. These included alcohol, the Bible, playing cards, and the violin, and they were thought to have wrought pernicious sorts of havoc on all indigenous peoples.9

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xvi Prologue The theory behind nootropics has some interesting parallels to a strand of thought in the philosophy of mind and cognitive science. If still considered a peripheral movement in these disciplines, the theoretical foundation for the “extended mind” hypothesis extends at least as far back as Plato with his discussion of the psychodynamic effects of writing in The Phaedrus. Today, the empirical evidence continues to mount regarding McLuhan’s notion of media functioning as extensions or prostheses of humans, and the way communication media in particular function as an integral part of the human cognitive apparatus.

Extended Minds in the World Some of the best arguments for this theory and outlook come from a relatively recent movement in the cognitive sciences and the philosophy of mind known variously as “existential cognition” (McClamrock, 1995); “embodied cognition” (Clark, 1997); “embodied mind” (Varela, Thompson and Rosch, 1992; Lakoff and Johnson, 1999); “enactive cognition” and “extended cognition” (Clark and Chalmers 1998; Clark 2003, 2005), and more recently “distributed cognition” (Lindblom and Ziemke, 2008). In defending these general perspectives, Chemero and Silberstein (2006) offer three basic claims. The first is that “mind exists in the entire body, and not just in the central nervous system. The second claim is that certain environmental or social background conditions are necessary for certain cognitive functions. And the third claim holds that brain-body-world are dynamically coupled and thus mental states and cognitive functions might be viewed as extending spatiotemporally beyond the skin of the organism” (p. 1).10 J. J. Gibson (1979) suggests that “[t]he words ‘animal’ and ‘environment’ make an inseparable pair. Each term implies the other. No animal could exist without an environment surrounding it. Equally, though not so obvious, an environment implies an animal (or at least an organism) to be surrounded” (p. 8). The extended mind camp and Gibson’s work all support McLuhan’s core thesis regarding communication media as prostheses or extensions of the humans who use them. The meta-mental loop and surrogate situation, both implied in the passage below, and described via philosopher Andy Clark later in this volume, lends both conceptual and empirical support to McLuhan’s characterization of communication media as physical and cognitive extensions: [W]e actively create restricted artificial environments that allow us to deploy basic perception-action-reason routines in the absence of their proper objects. Examples include the use of real-world models, diagrams and other concrete external symbols to support dense looping interactions with a variety of stable external structures that stand in for the absent states of affairs. Language itself, I shall finally

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suggest, is the most potent and fundamental form of such surrogacy. Words are both cheap stand-ins for gross behavioral outcomes, and the concrete objects that structure new spaces for basic forms of learning and reason (Clark, 2005).

Simulations and Sedatives Jean Baudrillard (1995) controversially declared that the Gulf War never happened. Of course, the ground skirmish did take place. I know well several people who were there and can attest to the mayhem. But that’s not really what Baudrillard was getting at. He was commenting on the powerful ability our modern, imagebased news media have to snip, skew, blend and blur the reporting of events so as to often render them quite unrecognizable from the actual events that occurred at some particular place and time. The “take-away” from Baudrillard’s analysis for me was: how do media hallucinations compare to stress-related, fatigue-driven, or chemically-induced hallucinations? I started coming up with some pithy expressions to help me talk about Baudrillard and better broach these questions with my students. To get them thinking in more productive ways about the technologyas-environment idea (and even the drug-as-environment idea), I suggested they consider the way crystal meth might affect how a person perceives the world around them, and how, say, liquid crystal-D might do so as well (the latter is how I referred to an LCD computer screen during one seminar). From nitrogen narcosis, a condition caused by prolonged immersion in deep water followed by surfacing too rapidly, to McLuhan’s narcissus narcosis, prompted by excessive immersion in particular medium without much “surfacing” at all, I wanted my students to start to consider how different media might be considered a pathology or a palliative, a cause or cure for them and for the wider cultural systems they inhabit. That’s what this book is all about. Along with our drugs, what do our media do to, for, in, and with us?

Notes 1

2

Walter Ong’s (1982) term for what equates nicely to the total human “sensory apparatus” (Gibson, 1979), or the “brain-body,” or “mind-body,” in an increasing number of new treatments of mind, cognition and consciousness to be discussed in this volume. Along the way we build a critique of what has come to be called the “disease model of addiction,” as this approach to thinking about anything that potentially functions as a communication medium tends to take our collective eye off the ball with respect to the nature of the relationships human beings sustain with media. However, this book is not about addiction, nor does it

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xviii Prologue offer specific remedies for anyone who might think they are addicted to drugs or media (or both for that matter). But one thing that should become clear by the end of the book is that there are no one-to-one correspondences between particular drugs, or media, and their often similar effects. By the same token, there are no unequivocal “cures.” Instead, we’ll discover similar patterns of interaction and effect that can occur with the use of certain drugs and media. 3 We know this is the case because biological organisms tend to have different reactions to different drugs in different contexts (i.e. the same metabolism can have different reactions to the same drug in different contexts, or the same reactions to different drugs in the same context – or any permutation of organism, reaction, drug, and context for that matter). 4 While different forms of meditation served this function in the Far East for millennia, books were the first medium to promote the idea of “being all alone, together” in the West. 5 In a similar vein, consider Viagra and the new hypersexualized man (one who can now live up to his procreative, prurient, or merely playful aspirations to a much greater extent) with his virtual-libido just a pill away, this new kind of homoerectus seems quite roguish in comparison to the more settled, stable image of the man involved in a relationship and who feels at home in the dyad. As I argue in my chapter devoted to an analysis of erectile dysfunction (ED) drugs, it is not yet clear what, exactly, is being fixed and what is being damaged – treated or troubled – by the use of these drugs in our culture today. By the same token, online dating services like match.com and eharmony.com promise to help single people find compatible mates otherwise obscured in an anonymous sea of potential others. Of course, these tools can be used by those seeking to deceive in various ways as well, but what seems most troubling for many people who do their best to employ such systems and services toward honorable ends is the attendant awareness of an always-on, always-available pool of potentials standing by (not to mention the regular, automated email notices from such services announcing new “matches” and checking in to see if everything is going well). It is quite likely that this contributes to a kind of culture-wide attention deficit disorder (ADD) regarding what it means to be in a serious relationship in the digital age. 6 Take the Pavlovian-like response so many people exhibit these days as their email chimes, tweets, or text message alerts make their media appliance blink, beep or vibrate. Almost like breathing, it can indeed feel quite autonomic. But whether autonomic or maybe just automatic, these kinds of interactions blend into actions. They become habitual and even develop into a sort of natural instinct. (Cf. McLuhan’s notion of our becoming servomechanisms of our tools). 7 While certainly comprised of all three, the human being seems to stand at the nexus of the three spheres. We are all (as currently instantiated) the “inbetween” of the geosphere and noosphere. As a biological manifestation,

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the human animal functions as medium for all three spheres. Or as Teilhard de Chardin puts it somewhat more eloquently: “[w]e are not human beings having a spiritual experience. We are spiritual beings having a human experience” (The Phenomenon of Man, 1955). De Chardin believed (or felt compelled to write and speak as though he believed) that the noosphere would eventually evolve into a final, ultimate manifestation which he dubbed the Omega Point. Upon closer inspection this has a lot of similarities to Hegel’s synthesis or Nietsche’s Übermench, as all three have been interpreted as implying notions of a divine entity or supreme being. 8 Through the last third of the 20th century, media researcher George Gerbner (and legions of practitioners utilizing his “cultivation” approach to media studies) exhaustively documented the adverse perceptual side-effects associated with exposure to disproportionate amounts of violence, as well as skewed presentations of class, gender and ethnicity on television. Other research conducted throughout the final quarter of the 20th century has sought to measure causal connections between media use and varieties of ADD, ADHD and PTSD among other modern ills. A missing component to these investigations is a closer look at the socio-psychological, spiritual, and ultimately physical and ecological causes and/or wider significances of various forms of attention disorder, media sickness, time sickness, sensory deprivation, sensory overload and the like. 9 The violin itself came to symbolize the decadence and superfluous nature of European society. Thought to deprive the Indian of his ancient rhythms, the instrument emphasized the flighty melodies and contrived world of the White man (MacDougall, 2009). There have been updates to this outlook regarding new media. “Not unlike drugs or alcohol,” observed Marie Winn (1977), “the television experience allows the participant to blot out the real world and enter into a pleasurable and passive mental state. The worries and anxieties of reality are as effectively deferred by becoming absorbed in a television program as by going on a ‘trip’ induced by drugs or alcohol” (p. 23). According to Terrence McKenna, in Food of the Gods (1992), television should be explicitly compared to a powerful hallucinogen, and may even function as a kind of electronic heroin. “Television is by nature the dominator drug par excellence. Control of content, uniformity of content, repeatability of content make it inevitably a tool of coercion, brainwashing, and manipulation. Television induces a trance state in the viewer that is the necessary precondition for brainwashing. As with all other drugs and technologies, television’s basic character cannot be changed; television is no more reformable than is the technology that produces automatic assault rifles” (p. 218). Hyperbole aside, there might be some things worth looking into here. 10 Cf. Lindblom and Ziemke (2008) “[T]he distributed cognition approach expands the unit of analysis and focuses on ‘real-time’ interactions between

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xx Prologue the various interactants and their environment, instead of focusing on mental structures in individual minds. This means, contrary to viewing cognition as mainly internal processes, social interactions are considered to be directly observable cognitive events. With this crucial change in perspective, much of cognition previously hidden ‘inside’ the skull has now become apparent. This means, information is neither pre-given nor hidden internally, but can emerge in the interaction and be manifested in visible embodied actions” (p. 4).

References Baudrillard, Jean (1995). The Gulf War Did Not Take Place. Bloomington: Indiana University Press. Beard, Keith and Eve M. Wolf (2001). “Modification in the Proposed Diagnostic Criteria for Internet Addiction.” CyberPsychology & Behavior 4(3): 377–83. Brodie, Richard (2009). Virus of the Mind: The New Science of the Meme. Carlsbad, CA: Hay House. Carey, J. (1989). Communication as Culture. London: Routledge. de Chardin, Teilhard, P. (1955). The Phenomenon of Man. New York: Harper & Row. Chemero, T. and M. Silberstein (2006). “Defending Extended Cognition.” Paper available online at: http://philsci-archive.pitt.edu Clark, Andy (1997). Being There: Putting Brain, Body, and World Back Together Again. Cambridge: MIT Press. Clark, Andy (2003). Natural Born Cyborgs. Oxford: Oxford University Press. Clark, Andy (2005). “Beyond the Flesh: Some Lessons from a Mole Cricket.” Artificial Life 11(1-2): 233–44. http://www.philosophy.ed.ac.uk/people/clark/ pubs/burrowspaper.pdf Clark, Andy and David Chalmers (1998). “The Extended Mind.” Analysis 58: 10–23. Eisenstein, E. (1979). The Printing Press as an Agent of Change: Communications and Cultural Transformations in Early-modern Europe. New York: Cambridge University Press. Gibson, J. (1979). The Ecological Approach to Visual Perception. Boston: Houghton Mifflin. Goody, Jack and Ian Watt (1963). “The Consequences of Literacy.” Comparative Studies in Society and History 5(3): 304–345. Hoffmeyer, J. (1998). “The Unfolding Semiosphere.” In Gertrudis Van de Vijver, Stanley Salthe and Manuela Delpos (eds), Evolutionary Systems: Biological and Epistemological Perspectives on Selection and Self-Organization. Dordrecht: Kluwer. Horwitz, A. and J. Wakefield (2007). The Loss of Sadness: How Psychiatry

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Transformed Normal Sorrow into Depressive Disorder. Oxford: Oxford University Press. Kramer, Peter D. (1993). Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self. New York: Viking Press. Kroeber, Alfred and Clyde Kluckhohn (1952). Culture: A Critical Review of Concepts and Definitions. Cambridge: Cambridge University Press. Lakoff, George and Mark Johnson (1999). Philosophy in the Flesh: The Embodied Mind and its Challenge to Western Thought. New York: Basic Books. Lindblom, J. and Tom Ziemke (2008). “Interacting Socially through Embodied Action.” In F. Morganti, A. Carassa and G. Riva (eds), Enacting Intersubjectivity: A Cognitive and Social Perspective on the Study of Interactions, pp. 49–63. Amsterdam: IOS Press. Logan, R. (2008). The Extended Mind: The Emergence of Language, the Human Mind and Culture. Toronto: University of Toronto Press. MacCoby, E. (1951). “Television: Its Impact on School Children.” Public Opinion Quarterly 15: 421–44. MacDougall, R. (2009). Cultural Technics: Making Meaning at the Interfaces of Oral and Electronic Culture. Saarbrücken: VDM Verlag. McClamrock, R. (1995). Computational Minds in the World. Chicago: Chicago University Press. McKenna, T. (1992). Food of the Gods. New York: Bantam Books. McLuhan, M. (1964). Understanding Media: The Extensions of Man. New York: McGraw Hill. McLuhan, M. (1969). “The Playboy Interview: Marshall McLuhan.” In Eric McLuhan and Frank Zingrone (eds), Essential McLuhan. Toronto: Anansi, 1995. Ong, Walter J. (1982). Orality and Literacy: The Technologizing of the Word. London: Routledge. Prophet, Jane (1995). “TechnoSphere: A Case Study in Networked Collaboration.” Presented at the 5th National Photography Conference: “Agents of Change: The Photographers’ Guide to the Future,” September 22-24. Retrevo (2010). “Is Social Media a New Addiction?” Retrevo Studies. http://www.retrevo.com/content/blog/2010/03/social-media-new-addiction%3F Rushkoff, Douglas (1995). Media Virus: Hidden Agendas in Popular Culture. New York: Ballantine Books. Varela, F., E. Thompson and E. Rosch (1992). The Embodied Mind: Cognitive Science and Human Experience. Cambridge, MA: MIT Press. Whitaker, Robert (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York: Random House. Winn, M. (1977). The Plug in Drug. New York: Penguin.

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Introduction

We know Major Tom’s a junkie

– D. Bowie

This book was inspired by an interest in articulating some of the sensible but subtle connections between drugs and media with respect to the way both function as environments for the individuals who use them. With an ear to the past and an eye on the future, contributors engage in historical research, textual criticism and semiotic analysis, phenomenological inquiry, informed speculations and philosophical reflections. In the tradition of Marshall McLuhan, most of the essays are explorations, investigations, provocations and probes. They venture into what remains, in many respects, uncharted territory: the systemic roles played by many popular drugs and media in our culture today from an ecological perspective. Early tracings of the project can be found in a series of informal conversations with colleagues online and in person concerning some obvious similarities between the way drugs and media are talked about in the office and on the street.1 For example, a student of mine opined in his media journal a few years back: “I got my iPod, and I got my drugs.” He was referring to Ritalin at the time, though a number of chemical compounds could just as easily be appended to the iPod in that statement. This prompted me to begin thinking about how I might more systematically assess what was going on there. That journal entry, and other statements like it I’d noticed in a few other student writings, conjured scenes from Ken Russell’s 1980 film Altered States. After all, two central players in the film were not even people. The first was a powerful chemical concoction made from plant matter indigenous to Mexico, and the second was a large stainless-steel sensorydeprivation tank that would hopefully heighten and focus any effects associated with the drug. The lead human character, an errant psychology professor played by William Hurt, repeatedly “inhabited” both technologies. Later, as he becomes less of a novice with the ancient tribal mixture, he is able to turn the trick with the drug alone. But I won’t spoil the plot any further for the uninitiated. 1

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As more of my students and so many other people in our culture today make their way through the day popping pills and plugging into machines of various kinds, I figured I had a pretty good handle on what it might mean to “inhabit” one’s iPod or other portable music device. After all, like millions of others, I’ve also logged thousands of hours walking, running, riding, sliding and driving through the world with a personal soundtrack. Early on it was a first-generation Sony Walkman. These days it’s a small MP3 player or mobile phone that carries my music. So I can describe those experiences well enough (and they certainly have felt drug-induced at times). Pulling me down, lifting me up, I’d either find myself intentionally programming desired emotional states into my music compilations, or being led by a selection of music that was not my own. But does it really make sense to talk about “inhabiting” a drug? Like Thomas Nagel’s question What is it Like to Be a Bat? (1974), can we ask in any systematic way what it’s like to be a person who maintains a regular dosage of Ritalin or Adderall if we have never been that kind of being? Like many people I know, I get pretty distracted and fidgety at times, and happen to satisfy most of the criteria for ADHD listed in the latest edition of the American Psychiatric Association’s Diagnostic Statistical Manual. I have no personal experience with those particular drugs though. Was I missing out on something else altogether? By the same token, what is it like to climb into the world – that particular way of seeing and being – enabled by a powerful perception-altering drug like Prozac or Abilify, or take a daily estrogen or testosterone dose, or a vasodilator like Viagra? For these as well I had no reference, at least no direct experience. However, I might have an idea of what these drugs do to me from the “outside” so to speak. As some of the contributors to this book suggest, after all, there are a host of social-psychological, cultural, and other systemic effects associated with drugs of this sort. That is to say, we might consider the various ways drugs, and media, affect the folks who don’t use them as well. For sure, even if I don’t use some of these drugs and media myself, I have to admit that my world is in some measure colored, constituted, and defined by multi-media and multiple drugs. Before (and after) any content they carry, the “logics” embedded in these tools impact the way we eat, sleep, socialize, think, and learn. Their presence is everywhere, spinning out far beyond the particular persons and places within which they are used. The argument embedded in this collection of essays is that media and drugs both function as experiential and perceptual environments or ecologies for the people who use them – as well as those who do not. Neil Postman gives us a sense of what it means to live in media, to inhabit spaces, places and systems as environments: The word ecology implies the study of environments: their structure, content, and impact on people. An environment is, after all, a complex message system which imposes on human beings certain ways of thinking, feeling, and behaving.

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It structures what we can see and say and, therefore, do. It assigns roles to us and insists on our playing them (sometimes, as in the case of a courtroom, or classroom, or business office, the specifications are quite explicit and formal). In the case of media environments (e.g., books, radio, film, television, etc.), the specifications are more often implicit and informal, half concealed by our assumption that what we are dealing with is not an environment but merely a machine” (Postman, 1970: 3).

Most people don’t spend much time thinking about how technologies of various kinds might alter the way they see, say, and do things. And this makes perfect sense given the way many different kinds of technology have become so finely integrated into daily life. Indeed, wondering what it might mean to inhabit an automobile or a GPS system, or radio or television, or a laptop computer connected to the Internet (and on to Facebook or YouTube or Twitter) is sort of like wondering what it means to breathe, or sleep, or eat these days. It just doesn’t come naturally to wonder in this way. And so we can push Postman’s observation a bit further to consider the way people “inhabit” drugs – and several contributors to this volume do just that. They describe the way pharmaceuticals, including some mind-altering (psychotropic, or nootropic) substances, also function as constitutive environments for the people who use them (and again, even those who don’t).2 Like Postman’s media, and beyond ways of seeing, saying, and doing, a host of sexual dysfunction, attention deficit, anti-depressant and anti-anxiety drugs also seem to alter our individual and collective ways of thinking and feeling. About half of this book contains analyses concerning how such drugs function as perceptual technologies or mind tools that intervene at various points along what is perhaps best described as a brain-body-world system. The remainder consider the way communication media function in this capacity, including television, radio, print media, the iPod, mobile phones, GPS systems, and even prescription drug vending machines.

Media Ecology In general, media ecologists study the systemic or environmental effects associated with communication technologies of various sorts. While perhaps not all selfdescribed media ecologists, all of the contributors to this volume were interested in shedding new light on some of the ways people “inhabit” drugs and media. Inspired by a systems view or ecological outlook, this book contributes to a critique and movement away from the reductive analyses and methodologies that still characterize much of contemporary research in the social and behavioral sciences. As such, it incorporates threads of the phenomenological movement in the philosophy of mind, and is part of a larger and much more mature movement in the physical sciences (biology, chemistry, physics) “away from the rigidly compartmentalized,

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uncoordinated specialization in scientific inquiry which characterized the Newtonian world, and a movement toward increasing integration of both the physical and the social sciences” (Nystrom, 1973: 6). It is part of a growing, if still dispersed, effort to answer an early call sent out to communication researchers and other social scientists by Christine Nystrom to help those interested in such issues develop “a coherent framework in which to organize their subject matter [and] their questions” (ibid.). Nystrom was calling for movement toward a research paradigm for the “preparadigmatic science” and the “emerging metadiscipline” known as Media Ecology. Media Ecology, and a systems perspective, constitutes part of this methodological turn. But again, it is not one entirely unknown or even new to those paying attention to developments in one small corner of the communication discipline. Lance Strate, in this volume, suggests what an ecological approach to communication studies might entail: [A]n ecological approach, as I understand it, requires us to attend to connections, interaction, structure, and relationships, as the focal point of any study. While this suggests a need to deal with great complexity in examining networks of variables, it is also possible to zero in on one particular connection or relationship, approaching the elements as a dialectic, for example as Claude Lévi-Strauss (1969) does in his discussion of the mediation of binary oppositions. In regard to the latter, we might consider a variety of pairs, such as nature and culture, biology and technology, body and mind, space and time, the word and the image, the acoustic and the visual, and the interior and the exterior. The dialectic between the inner and the outer, then, is fundamental, and as such it holds a subtle but vital place for us. (p. xx)

The Nature and Function of Systems (the Science behind Media Ecology) In the preceding passage Strate tips his hat to systems theory, a well-developed interdisciplinary approach to scientific analysis that seeks to understand the properties of systems and structures as wholes. Formally articulated in the 1940s by Ludwig Von Bertalanffy and others, the systems approach is inspired by thinking and research in the philosophy of science, biology, physics, and engineering.3 Von Bertalanffy was reacting against the reductionism of his day, and attempting to revive the unity of science. He emphasized that any legitimate system is an open system by virtue of its relationship to the surrounding environment, and can acquire qualitatively new properties through a phenomenon called emergence.4 While media are not drugs according to any currently accepted definition, and while the initial stimuli each present are often distinct, the lower-level neurophysical processes and higher-level behavioral outcomes of the use of some drugs and certain media can be very similar. Consider, for example, the way alcohol,

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fatigue, a real or virtual roller-coaster ride, or an inner-ear infection can produce very similar brain-body states (i.e. the same symptoms or manifest outcomes, like nausea, dizziness, trouble ambulating, etc.). These are examples of equifinality. Like these different etiological tracings, certain drugs and media also direct and color perceptions, and alter the phenomenological experience of the individuals who use them in similar ways. What’s more, they can exert these similar effects both at the higher level of outward appearance, behavior, and social interaction, and at the microscopic level of cell and synapse. Unintended consequences and side-effects are often the emergent, higher-level properties of various kinds of systems, including physical, biological, chemical, and technological systems. It should be a banal truism at this point to say that the suburbs or smog are by-product or side-effects intimately bound up with the invention, mass production, and diffusion of the internal-combustion-powered automobile. And even the casual observer will recognize how digital communication media alter the pace and scale of information flows in a way that has practical consequences at home, at work, in business, and leisure. These are the quantitative changes that are simple enough to detect. But these quantitative changes often also prompt systemic changes that include qualitative effects of the sort that are not always so easily seen or felt. We hear a lot about the effects and side-effects of various drugs on the market these days. Indeed, where pharmaceuticals are involved, the unique metabolisms of different drug users will often result in any number of unintended side-effects. Most tend to be unwanted and harmful in some way, but there are also side-effects that are not only desired, but actually become the main or desired effect that combats some other problem – either real or perceived.5 Or, as Robert Whitaker suggests in Anatomy of an Epidemic (2009), follow-up and replication studies performed to check corporate-sponsored drug research sometimes reveals that the biggest side-effect of many popular psychiatric medications is the placebo effect. There are also, in addition to all of this, powerful effects of drugs that occur, not initially at the level of synapse, but rather within and thoughout a society and wider culture. These are the more widespread systemic effects that the idea of a drug can exert. Robert Romanyshyn’s Technology as Symptom and Dream (1989) is instructive in this regard. Romanyshyn points to the way doctors and certainly patients themselves can become passive variables in the larger context of the pharmaceutical establishment: “[e]ven physicians, formerly a culture’s very symbol of power, are powerless as they increasingly become mere conduits between their patients and the major drug manufacturers. Patients, in turn, are more and more merely passive objects on whom cures are wrought and to whom things are done” (p. 21). This passage, written more than twenty years ago, speaks even better today to the way drug and media users become passive conduits through which things get done for, in and to them. Patients take on the role of carrier or vehicle for the drug

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(both as chemical compound and powerful economic and ideological device) that often insinuates itself deep into the culture and begins to constitute part of a tenacious sociotechnical system (see Latour, Mauguin and Teil, 1992). Romanyshyn is certainly on to something here, and we should extend his analysis into the realm of communication technology. To be sure, the same can be said of most media we encounter on a day-to-day basis. It was McLuhan who observed early on that we become the content of the media we employ: the telephone, email, eBay, Google, Facebook, in almost every case, the sender is sent – and often processed, poked, prodded, persuaded and bought and sold along the way.

The Tetrads (or Laws of Media) In an effort to facilitate a “systems view” throughout this book, I urged each author to draw up a tetrad for one of the drugs or media or concepts they were writing about in their respective chapters. The tetrad (McLuhan and McLuhan, 1988) is, above all else, a heuristic device and interpretive framework. It is emblematic of a systems view because it offers a kind of “4D” perspective on any human technology. The tetrad helps us see the relationships between figure and ground, signal and noise, past, present and future, and graphically represents the interrelation of various intentional and unintentional effects, side-effects, and direct and indirect effects that might be less obvious but still associated with any technology in question. As participants in the modern information society we are enmeshed in a swirl of emergent phenomena and non-linear relations where cause and effect remains, but only to be perturbed by plurality, clouded in equifinality, and aggravated in multiply-realizable features and forms. With some adjustments, McLuhan’s “tetrads” (McLuhan and McLuhan, 1988) or laws of media can help us at least get an initial handle on some of this. When constructed with careful attention to the subtleties involved, the tetrad reveals some of the social-psychological, cognitive and communicative roles a technology plays – and plays out – in a culture.6 The tetrad can be used to illustrate the four laws (or law-like effects) of any medium or technology. According to the tetrad, all media: ENHANCE (extend or intensify) something; REVERSE (or transcend themselves), by “flipping into” something new; RETRIEVE (or bring something back from the past); and OBSOLESCE (make some things outmoded). But the generic tetrads McLuhan (1977) originally postulated were only a kind of “first-pass,” global analysis of the effects of a given technology. This is still largely the case in McLuhan and McLuhan’s Laws of Media (1988), where almost the entire second half of the 250-page book is devoted to “tetradic analyses” of everything from alcohol,

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high-rise buildings, the refrigerator, and sewer pipe, to the cliché, the brothel, the computer, Newton’s first laws of motion, and tactile space. However, toward the end of the book there is a small section devoted to “alternate versions,” and “chains and clusters” of tetrads for several technologies, including the airplane, the credit card, wine, romanticism, symbolist poetry, visual space, the feminist, and rhetoric. It is in these sections that the real potential of the tetrad is hinted at. The essential point is that all technologies always have multiple and sometimes even canceling effects across different arenas, time spaces, and levels of human action and experience. The tetrad fills in the story of any technological artifact. It also helps us tease out any number of complementarities that tend to get ignored or obscured when thinking about technologies in general. Some of these complementarities might include:

Whole Part Concrete Abstract Simultaneous Sequential Subjective Objective Implosive Explosive Being Becoming At-hand At-a-distance Percept Concept Personal Social Decentralism Centralism Unity Plurality Ground Figure

When any given device or system comes to market, what we typically see and hear about first in the advertising and promotional campaign is the myriad enhancements it will provide. We also typically learn of the impending obsolescence of several current or previous technologies or practices in the face of the new. We might even hear about how this new-fangled thing brings something valuable back from the past. This nostalgic/recycling function may be superficial or significant, but some harkening back to what has come before is common – if only to render an aesthetic/emotional appeal. However, we rarely hear anything about what new sorts of problems arise with the implementation of the innovation. This is the reversal quadrant: what sorts of proclivities or embedded logics of action are bound up in the idea or thing, or what might happen if we become too reliant upon it, or if it gets over-used or abused.7

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Plan of the Book In the prologue, I define, unpack, compare, and sometimes refine a number of key terms and phrases that have been alluded to, appropriated, and often abused over time in both the professional and popular spheres. These include drug, medicine, medium, and culture, among others. Following this refining, or redefining, I interrogate several additional terms and concepts that help frame the discussion of drugs and media in the chapters that follow. Most notably, these include: mediaas-disease, media-as-drug, the noosphere, and the notion of a mind tool. In Part 1: Consciousness Technologies: The Environmental Properties of Drugs and Media, the roles played by drugs and media as constitutive perceptual environments are investigated from several angles. Lance Strate begins with “Drugs: The Intensions of Humanity,” and suggests how drugs are technologies defined by their ability to effect change within an organism. As technologies, drugs also fit into McLuhan’s (1964) concept of communication media, specifically as augmentations or extensions of the body’s metabolism. However Strate also suggests that, as metabolic extensions, drugs are peculiar sorts of media in that their most immediate effects are directed back upon the individual rather than out into the environment like other types of technology. Drawing on Alfred Korzybski’s distinction between extensional and intensional orientations, drugs can therefore be seen as applying the extensional to the intensional. This inversion, in effect, turns the individual inside out, transforming the inner being into its own environment, and thereby challenging traditional notions of the self and individual. The use of drugs to influence perception, thought, and consciousness can be seen as extensions of the individual’s intensionality. In the end, according to Strate, it is a dialectic and tensegrity between our extensions and intensions that is needed for human survival and evolution. In “Drugs as Environments: Being Inside What is Inside Us,” Corey Anton submits that drug users find themselves within the senses of space and time furnished by the particular drugs they ingest. But so, too, do non-users within a particular culture increasingly face a world shaped and organized by the various drugs in dominance. Like Strate, Anton suggests that drugs are environmental in their own right because they operate as a mode of mediation, a kind of “chemical third” dynamically interposed within self as well as between self and world. He begins by reviewing some of the obstacles to understanding the mediating role that drug use plays in culture and life and then provides a basic orientation to chemical mediation more generally. Marshall McLuhan’s well-known and controversial distinction between “hot” and “cool” media is drawn upon to suggest a parallel distinction and relationship between what Anton calls “loose” and “tight” drugs. Along the way Anton outlines and illustrates the historical progression from

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predominantly loose drugs to today’s world of tight pharmaceuticals, showing how the transition from loose drugs to tight drugs fundamentally depends upon the rise and persistence of various forms of hot media.  In “Perceptual Amplifiers and Inhibitors: Some Parallels between Modern Media and Drug Use,” I take the popular media-as-drug trope to task and describe several functional similarities between some popular media and drugs used today by drawing on relevant work in the philosophy of mind, neurology, psychology, and media ecology. A new picture of human cognition is emerging that recognizes a very intimate relationship between brain, body, and world that requires us to attend more closely to the role these “perceptual technologies” or “mind tools” play in our lives on a day-to-day, minute-by-minute even second to second basis. By altering slightly the wording in the following clause that was part of a recent “call to action” in cognitive science and the philosophy of mind, I fashion a similar call for those working in the fields of communication, pharmocology, and psychology, “[w]hether or not [the drug as medium, medium as drug idea] is true (either metaphysically or methodologically), or [just] a useful operating assumption, is an open empirical question and must be settled as such. The history of science tells us this is the only safe way to progress lest our theories become self-sealing” (Chemero and Silberstein, 2006). Part 2: Relationship and Identity Transformation: The Environmental Effects of Drugs and Media begins with Valerie V. Peterson’s “Sex-Drug Technologies: A Media Ecological Approach to Birth Control and ED Drugs.” Peterson offers an insightful analysis of the phenomenological, social, and cultural effects of several popular drugs that are now central components in our thinking about ourselves as sexual beings. Peterson argues that chemical media used for sexual and reproductive control deserve consideration as significant communication media in and of themselves with profound personal and cultural implications. She suggests that hormonal forms of birth control such as the birth control pill, shot, implant, and patch, and erectile dysfunction (ED) drugs such as Cialis, Levitra and Viagra significantly alter perceptions of space and time, personal capacities, and other understandings and conceptions of self and world. She stresses the point that this is true not only for people who use these drugs, but also anyone who lives in a culture where substantial numbers of other people use them. Elaborating on that point, Peterson explores the notion of human vulnerability, media as environments, “drugs as media,” the space/time effects of sex-related drugs, and implications of sex-drug mediation for human relations and human possibility. In “ED Drugs and the Re-making of the Real Man” I offer something of a top-down, corporate view in portions of the analysis that nicely complements Peterson’s more “bottom-up” phenomenological approach to thinking about sex drug use in the United States today. I argue that the popularity of impotence or erectile dysfunction drugs and the powerful imagery of their promotional

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campaigns are significant contributors to the social reconstruction of men’s sexuality, and popular understandings of the aging male heterosexual in particular. This is noteworthy since here we have a demographic that has, historically, been relatively resistant to the whims of the psycho-medico establishment. Given men’s physiological makeup, the emerging social expectations of male sexuality may be wholly unrealistic, with its matter-over-mind rhetoric. Examining the language and imagery of several ED drug campaigns, and considering some popular therapeutic discourse on the topic, I speculate on some of the new expectations facing men that have been generated by the sexual pharmacology industry. Finally, I suggest how these new expectations liberate and constrain men in various ways, solidify a male ethos that focuses almost exclusively on the physical component, and recast what it means for a man, as a sexual being, to grow older in our society today. Where I end describing the discursive power embedded in these new chemical icons, Brett Robinson closes this section of the book by turning the conversation to another potent sign of the times. In “Recreational Dubs: Constituting Apple’s iPod Cult,” Robinson offers a novel take on the ubiquitous iPod digital music player. He suggests that the device functions primarily to maintain “technological tribes” in contemporary culture. Drawing an analogy between the iPod and the role of sacred objects and substances in both ancient and extant tribal cultures, Robinson goes beyond the notion that the Apple brand inspires an unusually devoted following often likened to a cult in the popular press. There is, in fact, much more to be said about the iPod phenomenon. Beyond descriptions of the tightly-knit communities that have organized themselves around the iPod and other popular Apple products and services, he looks at the device as a totemic object in technological society that inspires devotion based on its ability to alter perception and, ironically, provide escape from the banality of our modern, over-mediated culture. Part 3: Selling Drugs, Pushing Media: Advertising, Consumption, Diagnostics and Dissemination begins with Jonah Bossewitch’s “Pediatric Bipolar and the Media of Madness.” Bossewitch explores the various connections between interactive media landscapes inhabited by youth, the behavioral expectations imposed on them in schools, and the role of psychoactive drugs in mediating this tension. He points to an explosive rise in the controversial diagnosis of pediatric bipolar and the prescription of anti-psychotics to children, and wonders if American children really have grown more irritable and defiant, or whether adult perceptions of their behavior have somehow changed. Beyond this, he asks how we might effectively study and explain these dramatic transformations in perception, judgment, and behavior. Finally, Bossewitch proposes a hypothesis that offers one compelling explanation for these developments and lays out a research program to continue investigation of this most pressing issue in our culture.

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Cristina Hanganu-Bresch, in “Treat her with Prozac: Four Decades of Directto-Physician Antidepressant Advertising,” undertakes a comparative cross-cultural and diachronic analysis of four direct-to-physician antidepressant ad campaigns for two very successful antidepressants in two countries – the US and the UK. She looks at Amitriptyline (Elavil in the US, Tryptizol in the UK, promoted 1960–1980) and the newer Prozac (promoted 1988–2001). As putative vehicles for improved health, these drugs prompted debate on what constitutes illness and health, and, ultimately, being human. Hanganu-Bresch paints a rich picture of how drugs are mediated to the physicians who prescribe them. She notes that while most drug advertisements seem to seriously struggle in bridging the gap between humanist and capitalist ideals, psychotropic ads in particular have to resort to a variety of stylistic strategies (in terms of composition, symbols, and metaphors) to translate an occult chemical into mental health, human values and, ultimately, profit. Bringing us fully into the 21st century with a cutting-edge socio-technical analysis, in “The Extended Pharmacist: Entering the Era of Remote Drug Dispensation and Pharmaceutical Counseling,” Phil Rose and Ainsley Moore explore the emerging field of telepharmacy (the use of telecommunications for the provision of pharmacy services at a distance). The authors look closely at a Canadian invention called MedCentre, an automated drug-dispensing machine. The most distinguishing feature of the technology may be its synchronous audio-visual link with a remote pharmacist. The authors describe the various components of this technology and the particular manifestations its inventors most actively promote, including interplay between systems of e-prescribing, electronic patient health data, and sophisticated quality control. Rose and Moore then investigate the various possible services and disservices that the technology might be expected eventually to perform when implemented, along with its possible broader cultural ramifications for patients, pharmacists, and physicians. In “Media Peddlers, Pushers, and Pharmacists: Toward a Producer-Intention Model of the Media,” Brecken Chinn Swartz notes that consumption metaphors abound in the highly competitive world of the “daily feed.” Responding to the perceived needs of our modern society, she details some of the ways journalists and other media producers strive to suit our “tastes” to get us to “consume” their messages. They often “spice up” otherwise “bland” reporting, or make efforts to add more “meat” or more “juicy tidbits” to a story. Conceptualizing the media as delivering “food for thought” that may profoundly affect individual and collective consciousness, Chinn Swartz suggests scholars can benefit from hermeneutic tools that allow us to look more carefully into the intentions of those who produce, package, and market the foods and messages we consume. Grounded

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in depth interviews with international broadcasters from different cultures, she recommends a new conceptual vocabulary to assist aspiring and professional media producers to more reflexively consider their roles in shaping the “daily media diet.” Part 4: Psychopharmacological Approaches to Understanding Communication Technology begins with Ronan Hallowell’s “Media Ecological Psychopharmacosophy: An Ecology of Mind for Today,” where he argues that drugs are chemical communication media. Hallowell suggests that a media ecological approach to understanding the relationship and interaction between chemical media, more traditional media, and some new forms of communication media can be useful for designing media ecologies that help, rather than hinder, the positive possibilities of human evolution. As humanity enters a new epoch in the Earth’s history (Hallowell employs the term “Anthropocene”) human societies will be forced to deal with the environmental and social crises of our times. Since communication is integral to human consciousness and the doing of culture, and since both are enacted through chemical media (i.e. biochemistry), media ecology (or the study of the complex interactions among various forms of media) can serve a unique role in designing human cultures that contribute to a viable, sustainable future. Hallowell reviews some history regarding the evolution of human consciousness, and the role that chemical and communication media have played in that evolution. He then describes a mainstream scientific investigation that centers upon the Amazonian psychoactive tea ayahuasca as a chemical media research tool to spur innovation in scholarship on global change solutions. Closing the final section of the book with an essay entitled “Psychoactive Media,” John P. Skinnon, a practicing PharmD with personal interest in the philosophy of mind and epistemology, evaluates some of the observed similarities between the use of psychotropic drugs and certain communication media (including the psychoactive nature of television). He begins with a review of the basic brain anatomy involved and unpacks the biochemistry underlying several major neurotransmitter systems (including serotonin and dopamine). Skinnon suggests that these endogenous neurotransmitters, and some of their structural and/or functional analogs found outside the body, can and often do trigger fairly particular states of mind – some very similar to those prompted by television viewing, still the most pervasive form of media consumption in the United States. Finally, Skinnon points to several different modes of cultural conditioning implied by these various “drug/media,” including definitions of normalcy and pathology, and suggests that they have the capacity to change what we might think of as “human nature.” I then follow up with two somewhat unorthodox “closing” chapters. While I thread some of the insights made throughout the preceding essays and sections

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to suggest several recurrent themes worthy of our sustained attention, I do not engage in the more conventional editorial function. That is to say, I don’t undertake a recapitulation and analysis of explicit topics and issues addressed within and between the various chapters. I purposely leave most of that threading work to the reader and suggest, as well, that in ferreting out the many different connections and associations no doubt possible, they inspect and compare the tetrads drawn up by each of the authors regarding their respective technology. In Part 5 “The Road Ahead”, in the chapter “Environmental Engineering for Ecological Balance” and in the Epilogue, I opt, instead, to pay homage to Marshall McLuhan and his fecund penchant for the mosaic and the linguistic probe. In an effort to move forward by looking not through the rearview mirror but rather the front windscreen, I gather together some of the latest arguments, insights and developments at the leading edge of science in the hope of prompting new ruminations, and new research, regarding the personal, socio-cultural, even biospheric and evolutionary roles played by media and drugs today.

Notes 1

Peter Kramer writes about a patient named “Sam” in the preface to his 1993 book Listening to Prozac. Sam described himself as “less driven” after the drug took hold. As Kramer puts it, the medication “redefined what was essential and what was contingent about his own personality – and the drug agreed with his wife when she was being critical” as well. Sam “allowed Prozac not only to cure the episodes of depression but also tell him how he was constituted. I might have been struck by this response to Prozac had I not observed a parallel tendency in myself. Though I had never taken psychotherapeutic medication, I too seemed to be under its influence” (Kramer, 1993, xi). Similar to the way Dr. Kramer describes the effect of Prozac on his own thoughts and perceptions, I was seeing what appeared to be the focusing effect of Ritalin and Adderall in my classrooms and feeling their tug elsewhere. Again, even though I don’t use those drugs myself, my day-today existence includes interactions with a large number who do. What I’ve noticed about many of my students taking such medications is that they seem to think about themselves – as individuals and as thinkers and learners too – very differently than some of my other students who report that they are not using these drugs (though they don’t always appear so different to me since they also, often, seem unfocused and elsewhere, and can be easily distracted by just about any new stimulus that presents itself). And while I don’t use my portable music device all that much anymore, I have a sense of how that technology alters the world I inhabit – even when I am not using it. I know, for instance, what it’s like to be among hundreds of people plugged into their

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sound machines and transfixed on their mobile phone screens. I have felt the effects of sonic and screen-based solipsism around campus and about town. 2 Indeed, Viagra, Zoloft, Ritalin, and even birth control pills don’t simply prompt erections, mitigate depression, focus and calm over-active minds, and prevent conception. They are potent perceptual/experiential technologies as well. Beyond the metaphor and the meme, they are media in and of themselves that enhance and/or inhibit physical, social and symbolic experience – our individual and collective ways of seeing and being in the world. 3 More recently, systems theory has been applied to sociology, political science, economics, and communication, and is closely associated with cybernetics: “the study of communication and control processes in biological, mechanical, and electronic systems, especially the comparison of these processes in biological and artificial systems” (American Heritage Dictionary, 2009). This, in turn, implies emergence and holism. The essence of both emergence and holism is stated in the expression: the whole is more than the sum of its parts. An emergent property is any organized pattern or property that is not the property of any single entity at a lower level of organization, nor can it be easily predicted or deduced from behavior in any lower-level processes or entities, but nonetheless appears to be caused or prompted by those lower-level processes or entities. Put another way, holism necessitates emergent properties that are irreducible, and tends to defy simple one-to-one mappings between causes and effects. 4 A termite “cathedral,” the shape and behavior of a flock of birds, or the formation of snowflakes falling through the air have all been invoked as examples of emergence. Wetness – or liquidity – is an emergent property that arises from the combination of hydrogen and oxygen (both gases at the same temperature and pressure). The inter-linked structure of the World Wide Web is another oft-cited example of emergence. Consciousness, and indeed life itself, are widely considered to be emergent phenomena. While easily abused as a concept, and certainly still understudied in the sciences today, the idea of emergence has prompted a wider, more whole view of the world around us, and a more integrated and relational understanding of what might at first blush appear to be isolated phenomena. For example, rather than reducing an entity (e.g. the human body or a computer) to their constituent parts or elements (e.g. organs and cells or transistors and microchips and their various properties), systems theory builds on its recognition of emergence and holism as conditions of nature. Holism suggests that the relations between parts are always, by virtue of the specifics of these relations, connected and organized into larger, functional wholes. It is the general outlook of systems theory that the particular patterns of organization between lower-level elements is what determines a system’s “logic” and function. This encapsulates the associated doctrine

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of multiple-realizability: that the structure and function of the whole are not necessarily determined by the material, substance, or “makeup” of those distinct lower-level elements or parts. Examples are ubiquitous, and in a later chapter I’ll offer several instances of multiple-realizability where different constituent/lower-level features combine to instantiate higherlevel properties that have the same or similar function, including an iris, a watch, and a bomb. Depending on the scope of the analysis, constituent features might include phonemes, words, particles, chemical compounds, cells, transistors, people, political parties, economic systems, entire nations, or the planet itself. The question of function, and the concepts of holism and multiple-realizability are necessary to a system-theoretic or “ecological view.” Bertalanffy originally used the terms equifinality and multifinality to describe the makeup and function of systems, and we can use these terms to better understand our relationships to both media and drugs. Equifinality refers to situations where different initial conditions lead to the same or functionally-similar end effect, whereas multifinality describes situations or processes in which similar initial conditions lead to different ends or effects. 5 Lance Strate (in this volume), cites Scott Eastham in his book Biotech Time-Bomb (2003) who suggests that the side-effects of any drug might be considered its real effects – or, in any case, the effects that matter most when we assume a field or systems view. Where drugs are concerned, this really is the difference between limiting the unit of analysis to the patient, as opposed to looking more holistically at the wider society within which the patient dwells. 6 But there is certainly some tweaking still to be done: “Perhaps the overambitiously phrased and deterministic laws of media can contribute to the creation of distinctions between different kinds of effects; if so, it can be worthwhile to try them out. So far in the public debate on the Internet, contributors tend to argue, simplistically, either that the Internet and related technologies are necessary conditions for true democracy or that they entail the end of democracy; that they obliterate hierarchies or strengthen them; and that they either homogenize or heterogenize people – render them more similar or more different. All points of view may be true, but they apply to different social fields, and at the end of the day, they are wrongly phrased. McLuhan’s model can be a starting-point (although it needs supplementing) for a more accurate reflection on these issues” (Eriksen, 1996). Unfortunately, it’s been fifteen years since Erikson offered these suggestions and the public conversation around technology nonetheless still retains that either-or feel. For the most part, after sending off a sort of “tetrad cheat sheet” to a couple of folks who requested one, I left each author to their own devices in constructing their tetrads. 7 Despite the word “law” that often accompanies the tetrad title in print and online, it is not a rigid discriminator. The construction of a tetrad is

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an interpretive enterprise, and in this book the tetrads drawn up by each contributor are intended to merely provide a starting point, a collection of suggestions or provocations for the reader to consider. Some tetrads will appear quite dense – others will seem stark by contrast. The reader might only find one or two, perhaps three items in each quadrant to be compelling at first glance. Others may feel compelled to fill out a quadrant (or two) in a certain tetrad with more detail. Tetrads are always subject to erasure, editing, and augmentation. Taken together, however, the tetrads that appear at the end of each chapter provide a good way to think about – to compare and contrast – what’s being discussed in other chapters in parallel fashion.

References American Heritage Dictionary (2009). http://www.thefreedictionary.com Chemero, T. and M. Silberstein (2006). “Defending Extended Cognition.” PhilSci Archive. http://philsci-archive.pitt.edu/archive/00003204/ Eriksen, Thomas H. (1996). The Internet, the “Laws of Media” and Identity Politics. http://folk.uio.no/geirthe/Tetrads.html Kramer, Peter D. (1993). Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self. New York: Viking Press. Latour, B., P. Mauguin and G. Teil (1992). “A Note on Socio-technical Graphs.” Social Studies of Science 22: 33–58, 91–94. McLuhan, M. (1964). Understanding Media: The Extensions of Man. New York: McGraw Hill. McLuhan, Marshall (1977). “Laws of Media.” English Journal 67(8): 92–94. McLuhan, Marshall and Eric McLuhan (1988). Laws of Media: The New Science. Toronto, Ontario: University of Toronto Press. Nagel, Thomas (1974). “What is it Like to Be a Bat?” The Philosophical Review LXXXIII, 4 (October): 435–50. Nystrom, Christine (1973). “Towards a Science of Media Ecology: The Formulation of Integrated Conceptual Paradigms for the Study of Human Communication Systems.” Doctoral dissertation, New York University. Postman, Neil (1970). “The Reformed English Curriculum.” In A. C. Eurich (ed.), High School 1980: The Shape of the Future in American Secondary Education, pp. 160–68. New York: Pitman. Romanyshyn, Robert (1989). Technology as Symptom and Dream. New York: Routledge. Whitaker, Robert (2009). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York: Random House.

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Chapter One

Drugs: The Intensions of Humanity Lance Strate

“In 13.9 Seconds A Drum Majorette Can Twirl A Baton 25 Times. . . But In Only TWO SECONDS Bayer Aspirin Is Ready to Go To Work!” – Advertisement for Bayer Aspirin appearing in McLuhan’s The Mechanical Bride (1951)

Having first encountered Marshall McLuhan’s Understanding Media (1964) as a student during the seventies, two questions inevitably were raised. The first question was based on the fact that McLuhan used the term medium to encompass all forms of human technologies and techniques, inventions and innovations, including clothing, and housing, bicycles and motorcars, clocks and automation, weapons and even games: Given such a very broad definition, along with McLuhan’s special emphasis on the relation of media to sense perception, it seemed only natural to ask whether drugs are media too, or more precisely, whether drugs could be categorized as media based on McLuhan’s perspective. The second question owed much to McLuhan’s unique writing style, inspired as it was from the poetic, stream-of-consciousness fiction of James Joyce: Given McLuhan’s often opaque, discontinuous, and aphoristic prose, it seemed only natural to ask if McLuhan himself was on drugs. McLuhan was an icon of the sixties, after all, a time when electric and psychedelic were used almost interchangeably, and Timothy Leary credited McLuhan with providing him with the slogan, tune in, turn on, drop out. But there is no evidence of McLuhan engaging in any experimentation of the sort that Leary was famous for, McLuhan was quite conservative as a matter 19

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of fact, although it is clear that he was wired differently than the typical individual; in his own estimation, he was a right-hemisphere person, whereas individuals in western, literate cultures tend to rely on their left hemispheres (but see also the discussion of McLuhan’s neurological abnormalities in the recent biographical pastiche authored by Douglas Coupland, 2010). I should note that the phrase on drugs, even when employed humorously, has a relatively negative connotation, as it suggests a disconnection from reality. Similarly, there are negative meanings attached to the idiom of doing drugs, and often to that of taking drugs, whether the implication is that the individual is hooked, or temporarily under the influence. By the same token, while the phrase altered states may have the ring of clinical neutrality, the term high is rarely a neutral one, although it can be coded both positively and negatively, the latter especially when posed as the interrogative, are you high? While sometimes carrying a note of disapproval, references to drug use can also come across as relatively value free, but this is not the case when we refer to drug users or simply users, both of which convey a suggestion of drug abuse. Interestingly, individuals operating computers, playing videogames, and working with other forms of digital media also tend to be referred to as users, reinforcing the McLuhan-Leary connection (Leary himself becoming an advocate of virtual reality during the nineties). In contrast, the term drugged connotes coercion and victimization, someone forced or tricked into ingesting drugs and unwillingly subjected to their effects, e.g., impaired judgment, lowered inhibitions, unconsciousness; drugged out, on the other hand, retains the sense of voluntary dysfunctional behavior. Underlying this vocabulary is the fact that we sometimes use the word drugs in a very general (you might say generic) sense, to refer to any substance that has the ability to alter the biological functioning of an organism in some way when it is absorbed, but we also use the term in a more specific sense to refer to the kinds of drugs that are designated as illicit, either by virtue of having been outlawed altogether, or by being used in an unlawful manner. And while we still may go to the drug store to fill our prescriptions or purchase over-the counter drugs, the industry that produces licit drugs prefers to call their products pharmaceuticals, and they are otherwise referred to as medications, both of which provide the aegis of a professional aura. And yet, it is certainly well known that any distinctions that might be made concerning pharmaceuticals, medications, and drugs (e.g., the distinction between the licit and the illicit) are purely symbolic divisions, social constructions, and legal fictions (albeit fictions with very real consequences). Even the distinction between drugs and food is a fuzzy one. Is alcohol, which is served in restaurants and sold in supermarkets in some instances (e.g., in New York State), a food or a drug? Is sugar a drug, when refined into a purely chemical state, given that it does seem to be habit-forming if not addictive, and that its

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ingestion has some physiological and psychological effects? Is it any wonder then that both food and drugs are subject to common oversight in the United States on the part of the Food and Drug Administration? It is certainly clear that governmental and professional authority and legitimacy in regard to drugs has been significantly diminished over the past half century, which may be attributed to several factors. For one, there was the coalescence of a drug culture (or rather, multiple drug cultures) as part of the counterculture movement of the sixties and seventies. The experimentation with both licit and illicit drugs provided first-hand evidence for some, and word-of-mouth testimonials for others, of the potentially positive experience of recreational drug use, and this stood in hard contrast to false claims and propaganda tactics that had been used in the war on drugs (a phrase coined by Richard Nixon in 1971) through much of the 20th century. Counterculture suspicion of government and corporations dovetailed with the conspiracy theories and paranoia of the far right in regard to rumors that the medical establishment and pharmaceutical industry have been withholding cures to diseases because they would reduce profit margins. As American society became increasingly more risk-aversive during this period (Perkinson, 1996), the thought that potential cures might be withheld pending clinical trials, or because evidence of their efficacy was in dispute, became difficult to accept for many citizens. For example, during the seventies in the United States, a great controversy surrounded Laetrile, a drug some claimed to be able to cure cancer, despite evidence to the contrary, not to mention harmful side-effects, and advocates argued that cancer patients ought to have the option to use the drug (especially given that some had been obtaining it illegally from sources outside of the U.S.). Also associated with the counterculture, and its attendant New Age spirituality, came an increasing interest in alternative medicine and homeopathic remedies, with the understanding that many modern drugs are derived from traditional folk remedies, and with the implication that there are bodies of knowledge that fall outside of the expertise of physicians. And even those individuals who accepted the preeminence of scientific medicine started to question the need for doctors to prescribe medication when it was patently obvious to them that what they needed was an antibiotic, pain reliever, or allergy medication. The loss of authority of medical professionals no doubt was reinforced by ways in which medical insurance altered the practice of medicine, in some instances reducing doctors to salaried employees of Health Maintenance Organizations, in others dictating which drugs could be prescribed, or covered, including requirements for generic substitutions. All of these factors have contributed to changing attitudes towards drugs, and the legal and professional attempts to control them, but most important of all is the transition to an electronic culture that occurred in the mid-20th

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century, as discussed by McLuhan (1964). Electronic media have undermined the institutions of typographic culture, in part by disseminating information faster and more widely than was previously possible, in part by making information increasingly more accessible through a bypassing of the requirements for literacy and schooling (Meyrowitz, 1985). This served to undermine what Innis (1951) referred to as monopolies of knowledge, eroding barriers to professional expertise. From Dr. Kildare to WebMD, the electronic media environment has given the general public access to information that once was restricted to medical professionals and legal authorities, and thereby undermined their role as arbiter of which drugs can be used, by whom, and under what circumstances. Indeed, the postliterate culture associated with television and computer technology is related to the erosion of the authority of the prescribed prescription, of the medical establishment as an elite institution. It should come as no surprise, then, that in the era of the Internet we have come to refer to recreational drug use and also alcohol abuse as self-medication.

Substances and Technologies We can therefore understand that the term drugs refers to a category that is relatively abstract and ambiguous, with fuzzy boundaries that can be somewhat arbitrary, determined by social conventions, and subject to change over time. At the same time, it ought to be clear that the term stands for something more than a legal fiction or cultural construct, that there is a real referent here. Drugs refer to something substantial; indeed, the very word substance is sometimes used as a synonym for a drug, along with such phrases as controlled substances, addictive substances, and substance abuse. As substances, drugs are placed within the scientific realm of chemistry, but they are chemical substances that are defined by the nature of their effects on organisms. It follows then that drugs are neither purely chemical nor biological, but rather are situated along the interface between the two, defined by the effects of the chemical upon the biological. A substance that has no effect when absorbed by an organism would not be categorized as a drug; it might be categorized as food if it held any nutritional value or otherwise contributed to the look or taste of other foodstuffs, and it could be used a placebo, a pseudodrug, and perhaps be linked to a placebo effect. Typically, drugs are defined by their intended effects, which is why the undesirable consequences of using a drug are referred to by the euphemism of side-effects. However much we might wish to downplay the costs in favor of the benefits, drugs are unavoidably characterized by a surplus of effects, functional and dysfunctional. Insofar as they are advertised to be fast, safe, and effective, the typical mantra of the pharmaceutical industry, it is clear that drugs are evaluated according to the supreme technological criterion of

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efficiency (Ellul, 1964). In sum, drugs are technologies, defined by their ability to effect change in an organism, valued for their effectiveness, and therefore in many ways paradigm examples of the phenomenon of technology. McLuhan as much as acknowledges this in his first book, The Mechanical Bride: Folklore of Industrial Man (1951), in his analysis of an ad for Bayer aspirin. As part of his larger argument that advertisements and other popular arts in the United States during the mid-20th century reflected the mechanical-industrial nature of American society, he noted the close relationship between the claims made for Bayer’s fast relief of pain and the authoritarian nature of mechanization. It is regrettable, if not puzzling, that McLuhan never followed up on this initial probe, by including drugs as one of his many case studies in Understanding Media, for example; but of course drugs favor efficiency and function over form, and McLuhan was interested in both form and formal causality (as made clear in Media and Formal Cause, 2011). Extrapolating from McLuhan’s early analysis, and incorporating Ellul’s critique of la technique as a general phenomenon, we can see in the pill the technological promise of the quick fix, the easy cure, the product that can solve all of our problems. Indeed, the technological imperative dovetails nicely with the culture of consumerism, at least in the promotion of over-thecounter remedies. This can be seen in alcohol advertising as well, for example in commercials that show beer to be a means of enhancing social and romantic interactions (Postman et al., 1987; Strate, 1992, 2000). Postman acknowledged the metaphoric significance of drugs as technology in an essay entitled, “The Educationist as Painkiller” in his collection, Conscientious Objections (1988), and included a broader discussion of medical technologies in Technopoly (1992), based in part on Ivan Illich’s own critique of the medical profession in his book, Medical Nemesis (1975). Scott Eastham also engages in severe criticism of our blind faith in technology, with particular emphasis on genetic engineering, in Biotech Time-Bomb (2003), where he expands on the concept of side-effects associated with medication, in arguing that, in regard to all types of technology, the side-effects are in fact the real effects, and often enough of greater significance than the intended effects. We can certainly see manifestations of la technique and technopoly in the 1950s fantasies of magic pills that would take the place of schooling and allow us to learn a language or a subject overnight, in the role of the birth control pill in sparking the sexual revolution of the sixties, in the many types of diet pills that have fed our cult of thinness, in the popular notion of smart drugs associated with the youth culture of the nineties (Rushkoff, 1994), in the rise of a Prozac nation (Wurtzel, 1995) relying on medication to treat depression, in the scandalous use of steroids to enhance athletic performance, in the rise of Ritalin and related drugs prescribed (and quite possibly over-prescribed) to treat Attention Deficit

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Disorder and Attention Deficit Hyperactivity Disorder (and sometimes used by students lacking such diagnoses to improve academic performance), in the rise of Viagra and similar drugs prescribed or purchased illicitly for male sexual performance, and in the proliferation of advertisements, including frequent television commercials promoting every manner of pharmaceutical imaginable. It is in these and other phenomena, and particularly in the shift in the medical practice of psychiatry from Freudian psychotherapy to the use of medication to correct neurochemical imbalances, that we find not only the triumph of the technological imperative, but its deepest challenge to the human person, in its reduction of will and reason to a series of chemical reactions (a point I will return to later in this essay). It is not my intent to dwell on this question, and I will simply note in passing that such reductionist views are at the very least debatable; systems theory makes clear that the whole is greater than the sum of its parts, and there is a quantum leap that occurs as we move from the chemical base to the biological, and another quantum jump to go from the biological to the psychological (and from there, we might imagine, to the spiritual). At this point, I wish simply to note that in Understanding Media, McLuhan’s (1964) concept of medium is interchangeable with that of technology (see also Strate, 2006, 2008; Strate and Wachtel, 2005), and since it is eminently clear that drugs are a type of technology, we can also recognize them as a form of media. Having now answered the first question that I posed at the beginning of this essay, I will turn to a consideration of drugs as media.

Media and Extensions McLuhan (1964) famously referred to media as extensions of man, understanding technology as an extension of the human body and its capabilities; he attributed this idea to Edward T. Hall (1959), although he likely first encountered it from C. K. Ogden and I. A. Richards (1923), if not Ralph Waldo Emerson (1883). And it all seems quite clear when we consider tools, such as the hammer as an extension of the fist, the screwdriver as an extension of the fingernail, and the knife as an extension of the teeth. Along the same lines, clothing is extension of the skin, as are buildings; shoes are extensions of the feet, while the wheel is an extension of the motion of the feet when we are running. Fire is an extension of the body’s metabolism, and containers are extensions of many aspects of the body, the cupped hands, the mouth, the stomach, intestines, and bladder, and as Lewis Mumford (1967) noted, the female breasts and uterus. Eyeglasses, binoculars, telescopes and microscopes all are extensions of the eye, as are photography and the moving image, and writing and printing according to McLuhan; along the

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same lines, hearing aids, public address systems, sound recording technologies, and radio are extensions of the ear. Electric circuitry and electronic communications systems are extensions of the central nervous system, and the computer is an extension of the brain. All of this is familiar territory, of course, and all of it begins with the human body (McLuhan did not categorize the body itself as a medium, although it seems perfectly consistent with his approach to do so), which exists within an environment. The body is extended outward into the environment in some way by the addition of a medium or technology. As a medium, the extension goes between the body and the environment, and in that way shielding the body from the environment, and becoming the body’s new environment. Cut off from the environment, the body is numbed by its extension, which acts like a prosthetic device. Put another way, the body and its environment are in a dialogue or dialectical relationship to one another, and our technological extensions mediate between the two polar oppositions. In entering into this relationship, the body and the environment do not remain unchanged by the interaction. The technology acts upon the environment, altering the environment. And, aside from the fact that the altered environment will in turn alter the body, the technology itself also feeds back into the body, and has an effect upon the body. As McLuhan’s colleague John Culkin (1967) put it, “we shape our tools, and thereafter they shape us” (p. 52). The fundamental dichotomy at work here is between the interior and the exterior, the inner being of the organism and the outer world of the environment. From a systems perspective, there is the fundamental difference between the system itself, which is composed of interdependent parts that are situated within the system, and the environment, which is situated outside of the system. The system differentiates itself from its environment by maintaining a boundary between itself and the outside world. The relationship between interiors and exteriors is therefore of particular interest when we take a systems view or ecological approach. More generally, an ecological approach, as I understand it, requires us to attend to connections, interaction, structure, and relationships, as the focal point of any study. While this suggests a need to deal with great complexity in examining networks of variables, it is also possible to zero in on one particular connection or relationship, approaching the elements as a dialectic, for example as Claude Lévi-Strauss (1969) does in his discussion of the mediation of binary oppositions. In regard to the latter, we might consider a variety of pairs, such as nature and culture, biology and technology, body and mind, space and time, the word and the image, the acoustic and the visual, and the interior and the exterior. The dialectic between the inner and the outer, then, is fundamental, and as such it holds a subtle but vital place for us. As extensions of the body and mind, our media and technologies are exteriorizations of the interior of our physical and psychical being. Perhaps the primary

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example of this is language, which takes its primary physical form as speech, in essence being an exhalation. In McLuhan’s understanding, all media, and that includes all technologies, are viewed as languages, each with its own grammar and vocabulary, and its own equivalent to phonemes or signifiers. Moreover, extending the Sapir-Whorf hypothesis, as Edmund Carpenter (1960) does, each medium or technology is associated with its own particular way of viewing the world, whether it is a photograph, or an automobile, or a tool (so, for example, we have Mark Twain’s observation that when you have a hammer in your hand, everything around you looks like a nail). Spoken language, then, is the archetype of media and technology, rather than, say, tools or fire or pottery or cave painting. And as McLuhan noted, speech, as an utterance, is an outerance. Coming from within, speech is an outward projection; you might say a cri de coeur. This begins in infancy as we move from crying to producing the complex vocalizations known as baby talk, even before the sounds we produce have any symbolic meaning attached to them. These externalizations not only affect the outer environment, say by summoning a significant other to our side, but also feed back into ourselves as we hear ourselves (this perhaps relates to Pavlov’s view that a symbol is a signal of a signal). Our outerings also lead to feedback from others, providing positive and negative reinforcement, or alternately may be ignored, potentially leading to extinction of the specific behavior. But more than an external process of stimulusresponse, our linguistic and symbolic behavior can become internalized as silent thought, as scholars such as Lev Vygotsky (1986) and George Herbert Mead (1934) have explained. Along the same lines, our media and technological extensions may also be internalized, for example, when we write or read in our heads, or visualize a person’s face in photographic pose, typically a close-up, or visualize our experiences as a movie.

Extensions and Intensions McLuhan’s (1964) emphasis on media as extensions matches his own methodology, which he characterized as a probing of the environment. Thus, an extension is a probe used to test and gather information about some aspect of the outer world. And like McLuhan, Alfred Korzybski (1993) was also concerned with extensions of the human person, albeit not so much with the distinctions between different types of extensions, or media, but rather with the process by which we may extend ourselves into our environment (see also Strate, 2011). We extend ourselves into the environment figuratively by way of our senses, which provides us with information about the outside world, and literally through the instruments we use to extend our senses. In this way, we can accumulate knowledge about the world, evaluate that knowledge by engaging in reality-testing, and use

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that knowledge to act upon the world, functioning in a manner akin to scientists and engineers. In Korzybski’s general semantics, this extensional orientation is recommended as a means of maintaining individual sanity, and achieving collective progress. And the extensional orientation is contrasted with the intensional orientation that people commonly employ. Intensionality (spelled with an “s” and not to be confused with intentionality spelled with a “t” and referring to purpose) is a term that indicates the inner world of assumptions and presumptions, of concepts and precepts, the realm of deductive logic as opposed to inductive reasoning. McLuhan was known to identify his method as involving percepts rather than concepts, that is, perception rather than (pre)conception, withholding judgment in favor of describing things as they appear, and in this McLuhan was advocating for an extensional rather than intensional orientation. Indeed, from McLuhan’s perspective, an extensional orientation is our only hope for coping with the intensional effects of technological innovation, that is, their effects upon the human psyche. It is important to note that this is not a naïve view about the objective nature of reality. Korzybski (1993) was quite clear in explaining that perception itself is a form of abstracting, at a lower level than symbolization, but nevertheless cut from the same cloth. Perception is what occurs when stimuli coming from the environment are registered along the organism-as-a-system’s boundary, be it a membrane or organs of sense perception, and that irritation results in an internal response, as when nerve cells fire, transmitting electrochemical signals from the retina to the brain; as a result of this internal processing, the mind constructs an internal map of the external reality. The map is not the territory, Korzybski insisted, but it can correspond in some way to the territory; it can be structurally similar to the territory, and therefore have pragmatic, predictive value. Of course, insofar as a map need not bear any relationship to the territory it purports to represent, different maps may differ significantly in their accuracy or functionality. Our extensions, then, including our sense perception as well as our technologies, provided us with an indirect, abstracted, mediated understanding of our environment, imperfect but superior to any understanding we could obtain solely by internal reasoning, logic, or imagination. In linguistic and semiological terms, extensions put us in touch with the referent in its relation to the sign, while intensions direct us to the inner world of meanings and thoughts, concepts and ideas, the portion of the sign that is known as the signified as it relates to the signifier. Again, the referent can only be an experience, not the event itself; only a percept rather than an actual “thing.” In this binary opposition we can see exactly where scholars following the continental tradition of semiology that informs cultural studies, poststructuralism and postmodernism went off the rails, so to speak, as they essentially abandoned consideration of the referent

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and only concerned themselves with the relationship between signifier and signified, thereby losing themselves in an intensional orientation; in contrast, the North American intellectual tradition, including C. S. Peirce’s (1991) semiotics, Korzybski’s (1993) general semantics, and Susanne Langer’s (1957) philosophy of symbolic form, retained the all-important interest in the relationship between sign and referent, and therefore held on to an extensional orientation.

Drugs as Media Given McLuhan’s emphasis on the extensions of the organism, it is understandable how drugs would tend to be overlooked in discussions of media and technology. Whereas a medium is directed towards something other than the self, some aspect of the self ’s environment, drugs are directed back at the self. Technology typically is an outering of the inner being that feeds back into the self as it alters the environment, but that feedback is a secondary, indirect effect, whereas in the case of drugs it is the primary effect; typically, we employ media without any awareness of the effects that they have on ourselves, whereas drugs are used with the conscious purpose of effecting a change on body, and maybe mind, and it is only the side-effects that are unintended. As media, drugs are extensions of the body, and specifically extend the body’s own inner chemistry, our metabolic processes (in this, drugs are akin to fire, and perhaps it follows that experimentation with drugs is tantamount to playing with fire). As media, drugs are a means by which we extend ourselves into ourselves; they are extensions of the system that become intrusions back into the system. This is not so much a case of standing McLuhan on his head as it is turning him inside out (and not to prove him wrong, I hasten to add, but rather to extend his arguments into new terrain). As exteriorizations of interior processes that are directed back into the inner being, drugs transform the interior into a new form of exterior. Put another way, drugs turn our inner subjectivity into an outer objectivity. Indeed, all medical technology has functioned in such a way as to objectify the body, to treat it as external, outside of the system rather than inside of it, open for inspection, available to scientific and technical intervention. This objectification of the organism, of the self, is ultimately dehumanizing, and it is for this reason that holistic medicine seeks to provide an alternative to medical science, one that treats the whole person, taking into account psychological, social, and cultural factors. Such ecological approaches, including those that incorporate alternative medicine, homeopathic medicine, folkloric remedies, etc., may provide useful supplements to scientific diagnosis and technical treatment, and may offer at least a feeling of hope when medical methods fail, but have difficulty competing with the effectiveness and efficiency associated with the objectification of the body.

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In turning ourselves inside out, in extending the self back into itself, and treating the interior as an exterior, we become our own environment. It is of course relatively easy to treat other persons as external and environmental, and subject them to a process of objectification. It is a little more difficult, but far from impossible, to objectify one’s own body, especially when experiencing illness, injury, or aging. Cartesian dualism of body and mind, or the more traditional dichotomy between body and soul, comes quite naturally to us. But in understanding drugs as media, an alternative dialectic presents itself, not the dialectic between polar oppositions (body vs. mind/soul), but the relationship between environment and system, container and contained, medium and content. The body is typically viewed as existing within an environment; if drugs act upon the body itself as an environment, the question presents itself, what is the system that resides within the body-as-environment? Korzybski (1993) pointed to the nervous system as isolated from the rest of the body (and note McLuhan’s, 1964, own emphasis on electronic media as extensions of the nervous system), and it is true that the nervous system, or even more specifically the brain, creates its own map of the body as environment. The phantom pain felt by the amputee would be a case of the map of the body not corresponding to the actual territory. In fact, the inner, bodily senses referred to as vestibular, proprioceptive, and the kinetic need to be activated before the outer senses of sight, hearing, smell, taste, and touch can be fully operational. So far, we are on fairly safe ground in considering the body as the environment for the nervous system, but if drugs also act upon the nervous system and the brain, and they quite often do, that would render those organs environmental as well. What then is the system that exists within the environment of the brain? Is it that vague concept that we call the mind, or consciousness, perhaps as a system made up of interdependent parts we call thoughts? Is it a non-material information system, a pattern or network of relations that might be transferred from one medium to another, say by downloading the contents of the nervous system into a computer? Might it be something else entirely, something along the lines of what has been referred to as the spirit, or the soul? Or have we externalized the inner being out of existence? Have we become entirely environmental, pure medium, ground without a figure, map without a territory, surfaces lacking any depth, hyperreal simulations of the human person? The reduction of human consciousness to neurological activity, and neurological activity to chemical reactions that can be controlled through technological means, threatens to eliminate the possibility of the spirit or soul, and more importantly the possibility of the psyche as a conscious agent capable of taking personal responsibility for one’s actions. This poses an unprecedented ethical dilemma that we will continue to grapple with into the foreseeable future. And as drugs are extensions of metabolic functioning, they bring with them a desacralization and

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demystification of life itself, and an increasing mastery over life that takes us back to its very origins. Ultimately, we arrive at the fuzzy boundary between chemistry and biology, for example, between pharmaceuticals and gene therapy.

My Extensions, Are They Not My Intensions? And yet, as much as we can seem to be closing in on an anti-solipsistic moment, the eradication of the interior self as it is made environmental, we must ultimately acknowledge that all of our understanding of the environment, including the selfas-environment, is based on our inner maps, and not direct knowledge of the outer territory. Korzybski (1993) grappled with the paradox that the empiricism that he subscribed to ultimately leads to the deadend of Plato’s cave, that science cannot entirely validate sense perception, that what we know about the world amounts to shadows and reflections, abstractions of reality, the tingling of nerve endings resolved into a chorus of thought processes. We can never entirely escape the spectre of solipsism, the question of maya, the suspicion of social construction, the presence of our own intensionality. Despite the best efforts of science and technology, there is an aspect of the human organism that resists externalization; there is something about thought and mind and consciousness that resists objectification. Like Medusa’s face, we may find ourselves frozen to stone, or at least subject to the vertigo associated with being stoned, when forced to confront such phenomena, and can only safely encounter them indirectly, in mirror image through the outering process of speech, writing, artistic expression, and other forms of media. It is here that we may sense the presence of a system that is truly the self, a system that we have no way of stepping outside of. It is a system that can be influenced by external factors, including drugs, but that cannot be turned inside out. And it is in this regard that drugs as media pose an interesting challenge for us, that is, in particular those drugs that are psychoactive or mind-altering, that are said to expand and thereby extend the mind, and in doing so alter our intensionality. In this sense, drugs are not only extensions of the human body, but also intensions of humanity, and intensions for humanity, if they truly function as enhancements of consciousness, intensions of humanity. Drugs are certainly not the only means by which minds can be altered, consciousness expanded or raised, the doors of perception opened, etc. (nor are they necessarily the best means for obtaining those ends). It is not unusual to compare drug-induced states with those obtained naturally via techniques such as prayer, mystical contemplation and meditation, spiritual exercises (such as those prescribed by Ignatius of Loyola), and other forms of mental training and discipline. In a sense, all of education, which has its counterpart in the form of smart drugs, might be understood as an attempt to act upon human intensionality, and that includes Korzybski’s general semantics and McLuhan’s media ecology.

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As we act upon our intensionality through the use of drugs or by other means, we may alter our extensionality, that is, our view of the world. Kenneth Burke (1969) notes that alcohol is in effect a scene, one of the elements of his dramatistic pentad consisting of act, agent, scene, agency, and purpose, because drinking changes our perceptions of and feelings about our environment, which in effect changes the environment itself. This is reflected in some of the language about drugs that we use, for example in the phrase on drugs, which suggests that they are the ground that we climb up on, thereby getting high (perhaps leading to a fall in which case we are said to be under the influence, at least until we come down). We generally understand such altered states to be a distortion of our extensionality, although in some instances claims are made that the use of certain drugs enhance sense perception, and thereby extend it, perhaps by altering sense ratios, inducing synaesthesia, or simply by quieting the inner monologue and thereby eliminating linguistic interference and allowing the individual to return to a prelinguistic state, a function also attributed to meditation. Here too, Korzybski’s general semantics and McLuhan’s notions of training the senses through arts education are attempts to change intensionalities in order to encourage the maintenance of an extensional orientation. And it is important to note that this is more than simply altering the map of an unchanging territory, as we may act upon our environment in different ways as our perceptions and worldview changes, and in this way modify our environment accordingly. Even more challenging, however, is the attempt to explore one’s own intensionality in and of itself, that is, the exploration of consciousness from within. This is where the drug-oriented speculations of Timothy Leary and others come into play. They represent a strategy of taking an intensional orientation to its extreme in order for it to flip into its reverse, and arrive at a new kind of extensionality. The problem, again, is that it is essentially impossible to adopt an extensional orientation directed towards our own intensionality. We cannot step outside of the system of our own consciousness and study it objectively. The alternative is to create, in effect, what McLuhan (1964) called an anti-environment. Technologies for altering consciousness, whether by pharmaceuticals and other natural substances, or by techniques such as meditation, create an anti-environment not in space but in time, a period of altered consciousness that can serve as a point of comparison for understanding everyday consciousness (at least, in theory). I would suggest, however, that our best methods for the exploration and understanding of consciousness remain the process of communication, the outering of our inner world. Speech is the basis of the talking cure, of psychotherapy, the means by which we explore our own thought-world, and Carl Rogers (1951) has demonstrated the simple utility of reflective listening in helping us to know our own minds. And the medium of

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writing, the single more important invention in human history, had the effect of separating the knower from the known, as Eric Havelock (1963) put it, opening up space for us to view and review, reflect upon, criticize, and evaluate our own intensionality. Indeed all forms of communication and expression, all arts and media, serve this function in one way or another. We go outside of ourselves in order to explore our inner landscape. Apart from the problem of understanding consciousness, the tension between the extensional and the intensional is a dialectic that goes to the essence of what it means to be human. In this respect, Buckminster Fuller’s concept of tensegrity (Fuller and Applewhite, 1975) fits nicely, for what we seek is a balance between tension and integrity, between push and pull, between the exterior and the interior, between the environment and the self, between the medium and the message. Life and consciousness alike depend upon processes by which we extend the system out into its environment and abstract the environment into the system, externalize the internal and internalize the external, and alter the world to suit ourselves, and alter ourselves to adapt to our world. This is the eco-logic that represents the key to human survival, and evolution.

References Burke, K. (1969). A Grammar of Motives. Berkeley, CA: University of California Press. Carpenter, E. (1960). “The New Languages.” In E. Carpenter and M. McLuhan (eds), Explorations in Communication, pp. 162–79. Boston, MA: Beacon Press. Coupland, D. (2010). Marshall McLuhan: You Know Nothing of My Work! New York: Atlas.

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Culkin, J. (1967). “Each Culture Develops its Own Sense Ratio to Meet the Demands of its Environment.” In G. Stearn (ed.), McLuhan: Hot and Cool, pp. 49–57. New York: New American Library. Eastham, S. (2003). Biotech Time-Bomb: How Genetic Engineering could Irreversibly Change the World. Ponsonby, New Zealand: RSVP. Ellul, J. (1964). The Technological Society (J. Wilkinson, trans.). New York: Knopf. Emerson, R. W. (1883). The Conduct of Life and Society and Solitude. London: Macmillan. Fuller, R. B. and E. J. Applewhite (1975). Synergetics: e\Explorations in the Geometry of Thinking. New York: Macmillan. Hall, E. T. (1959). The Silent Language. Garden City, NY: Doubleday. Havelock, E. A. (1963). Preface to Plato. Cambridge, MA: The Belknap Press of Harvard University Press. Illich, I. (1975). Medical Nemesis: The Expropriation of Health. London: Calder & Boyars. Innis, H. A. (1951). The Bias of Communication. Toronto: University of Toronto Press. Korzybski, A. (1993). Science and Sanity: An Introduction to Non-Aristotelian Systems and General Semantics (5th ed.). Englewood, NJ: International Non-Aristotelian Library/Institute of General Semantics. Langer, S. K. K. (1957). Philosophy in a New Key: A Study in the Symbolism of Reason, Rite and Art (3rd ed.). Cambridge, MA: Harvard University Press. Lévi-Strauss, C. (1969). The Raw and the Cooked (J. Weightman and D. Weightman, trans.). New York: Harper & Row. McLuhan, M. (1951). The Mechanical Bride: Folklore of Industrial Man. New York: Vanguard. McLuhan, M. (1964). Understanding Media: The Extensions of Man. New York: McGraw-Hill. McLuhan, M. and E. McLuhan (2011). Media and Formal Cause. Houston: NeoPoiesis Press. Mead, G. H. (1934). Mind, Self and Society from the Standpoint of a Social Behaviorist (C. W. Morris, ed.). Chicago: University of Chicago Press. Meyrowitz, J. (1985). No Sense of Place: The Impact of Electronic Media on Social Behavior. New York: Oxford University Press. Mumford, L. (1967). The Myth of the Machine: I. Technics and Human Development. New York: Harcourt, Brace. Ogden, C. K. and I. A. Richards (1923). The Meaning of Meaning: A Study of the Influence of Language upon Thought and of the Science of Symbolism. New York: Harcourt, Brace. Peirce, C. S. (1991). Peirce on Signs: Writing on Semiotic. Chapel Hill, NC: University of North Carolina Press. Perkinson, H. (1996). No Safety in Numbers: How the Computer Quantified Everything and Made People Risk-aversive. Cresskill, NJ: Hampton Press.

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Postman, N. (1988). Conscientious Objections: Stirring up Trouble about Language, Technology, and Education. New York: Alfred A. Knopf. Postman, N. (1992). Technopoly: The Surrender of Culture to Technology. New York: Alfred A. Knopf. Postman, N., C. Nystrom, L. Strate and C. Weingartner (1987). Myths, Men, and Beer: An Analysis of Beer Commercials on Broadcast Television, 1987. Falls Church, VA: American Automobile Association Foundation for Traffic Safety. Rogers, C. R. (1951). Client-centered Therapy: Its Current Practice, Implications, and Theory. Boston, MA: Houghton Mifflin. Rushkoff, D. (1994). Cyberia: Life in the Trenches of Hyperspace. New York: HarperCollins. Strate, L. (1992). “Beer Commercials: A Manual on Masculinity.” In S. Craig (ed.), Men, Masculinity, and the Media, pp. 78–92. Newbury Park, CA: Sage. Strate, L. (2000). “Intoxicating Consumptions: Beer Commercials and the Problem of Public Health and Safety.” In R. Andersen and L. Strate (eds), Critical Studies in Media Commercialism, pp. 145–57. London: Oxford University Press. Strate, L. (2006). Echoes and Reflections: On Media Ecology as a Field of Study. Cresskill, NJ: Hampton Press. Strate, L. (2008). “Studying Media as Media: McLuhan and the Media Ecology Approach.” Media Tropes 1(1): 127–42. Strate, L. (2011). On the Binding Biases of Time and Other Essays on General Semantics and Media Ecology. Fort Worth, TX: Institute of General Semantics. Strate, L. and E. A. Wachtel (2005). The Legacy of McLuhan. Cresskill, NJ: Hampton Press. Vygotsky, L. S. (1986). Thought and Language (revised ed., A. Kozulin, trans. and ed.). Cambridge, MA: MIT Press. Wurtzel, E. (1995). Prozac Nation: Young and Depressed in America. New York: Riverhead Books.

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Chapter Two

Drugs as Environments: Being Inside What is Inside Us* Corey Anton

Introduction If you don’t think drugs have done good things for us, then take all of your records, tapes and CDs and burn them.

– Bill Hicks

Drugs are environments, and not only do drug users find themselves within the senses of space and time furnished by particular drugs ingested, but even non-users within a particular culture increasingly face a world partly shaped and organized by various drugs in dominance. Drugs serve as forms of chemical mediation, and, as such, they are not simply objects and/or things within an already given space and time, as if they were merely co-present and extensive with bodies and other material objects. Environmental in their own right, drugs basically operate as a mode of mediation, a kind of chemical third dynamically interposed within self as well as between self and world. Before advancing any further, I need to underscore that the words “drug” and “chemical” are very abstract terms; they are high-level abstractions that gloss over countless differences between and within members of each category. As rough groupings for sets of substances that differ in scope, range, and application, these terms nebulously refer to particular material means people have for mediating their relationship to the larger world, to others, and/or to themselves. The word 35

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“drugs” makes indiscriminant reference to a wide range of substances, and any coherent picture of drug use in general must therefore account for a range of dense particulars and attend to different kinds of drugs and different kinds of uses within different kinds of settings. Across the lot, though, we also need to see the larger patterns that can be identified when we stop, step back, and globally consider the nature and historical development of various kinds of chemical mediation. Accordingly, my specific goals within the chapter are, first, to review some of the obstacles to understanding the mediating role that drug use plays in culture and life, and second, to provide a basic orientation to chemical mediation more generally. Third, I draw upon Marshall McLuhan’s well-known and controversial distinction between “hot” and “cool” media to suggest a parallel distinction and relationship between what I will be calling “loose” and “tight” drugs. I further outline and illustrate the historical progression from earlier times of predominantly loose drugs to today’s hotbed of tight pharmaceuticals, maintaining that this transition from loose drugs to tight drugs fundamentally depends upon the rise and persistence of various forms of hot media. In particular, tight chemical mediation heavily relies upon numbers, clocks, calendars, schedules, and various forms of statistical literacy – including batteries of psychological inventories – used for increased technological control and more exacting definitions of “health,” “wellness,” and “normalcy.”

Two Basic Obstacles A basic obstacle to understanding the dynamic role that chemicals play in mediating human interaction is the sheer controversy that routinely surrounds public talk about “drugs” and “drug use.” Many people in popular culture, despite the wide variety of chemicals available and the great diversity of settings in which they are used, talk about “drugs” and “drug use” with a knee-jerk twitchiness. They seem to presume that “drug talk” is either pro or con, and they therefore suspect that any nuanced consideration of the issues is ipso facto some kind of advocacy for drug use. Fear, habit, ignorance, various kinds of ideology and/or a stake in the status quo, all of these exert pressures against open and honest dialogue about drugs, drug use, and drug-related issues, especially if the dialogue helps to demonstrate further complexity or ambiguity. Consider just one example: Andrew Weil, who at the time was Director of Harvard Medical Center, was interviewed on CSPAN about “the drug problem in America.” He stressed that one of the main problems in the US is many people’s unwillingness to honestly engage in thoughtful discussion about drugs and drug use, and he noted as an example that in that year, many

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millions of dollars were spent on various forms of drug treatment programs, drug rehabilitation programs, increased law enforcement, increased prison capacities, educational “Just Say No” programs, etc. He then asked, “Do you know how much was spent that same year studying people who regularly use drugs but who seem not negatively affected by them?” He quickly answered himself with, “Zero…We seem not interested in that question.” To which he immediately added, “Again, don’t misunderstand me; I’m not ‘advocating drugs.’ I’m trying to illustrate the difficulty of open talk about the issues.” The challenge of this first obstacle is that those very people who often call for a “Just Say No” orientation to drugs seem unwilling to either recognize or admit the contradictions posed by the alcohol, tobacco, and pharmaceutical lobbies who continuously tell people about their right to and interests in saying “Yes.” And, what is worse, the line that separates legal from illegal drugs is not always drawn with common sense or clear reasoning. Alcohol, for example, is an exceptionally dangerous drug, especially depending upon the proof. In high concentrations it is a poison, an antiseptic, a sterilizer, something that kills virtually everything it touches. Physically addictive, damaging to vital bodily organs, alcohol is related to countless life-debilitating diseases. In comparison, cannabis or marijuana is non-toxic, not physically addictive and may even have some medicinal value. Why, then, is alcohol legal and cannabis illegal? Well, for starters, it is partly because prohibition failed! But rather than fall here into a partisan debate, it might be best to simply admit that a major obstacle is that many people still seem to believe that there could be something like a chemical-free environment, or that people could live without any drugs whatsoever. The simplest way to summarize this first obstacle is to suggest that people need to think about chemical mediation openly, broadly, without too narrow a focus upon any particular drug, and they need to consider the degree to which various forms of chemical mediation are inescapable, not only for individual users of those chemicals but for the cultural members in whose culture certain drugs come to dominance. This is, obviously, a serious obstacle and challenge. A related but more meta-level challenge comes, at least in Western culture, from a rigid adherence to something like an inner “soul” or “mind stuff,” something isolated, pure, independent, and untarnished by any commerce with the material world. Starting with an overdrawn separation between themselves and the larger physical world, many people have forgotten that bodies are composed of matter that is incomprehensibly older than those bodies and that all persons have become who they are by ingesting that which was previously not them.2 The basic problem here is not just under-recognition of the degree to which our bodies are composed of worldly matter. It is a failure to accept the possibility that the evolution of human consciousness may be inseparable from

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the long and digressive ancient history of varied kinds of drug use. The expression “you are what you eat” is no mere metaphor. When expanded to include all that organisms ingest, it nicely hints at the fuzzy boundaries throughout the growth and development of bodily existence including its most subtle and intangible dimensions: consciousness itself. In his speculative but intriguing and provocative works, Terrence McKenna argues that the radical transformation in consciousness running concurrent with the advent of human language was, in fact, partly the outcome of changes in dietary practices, including a significant increase and steady intake of psilocybin. Over a developmental period spanning up to as long as a million years, argues McKenna, the ingesting of various species of psychedelic mushrooms was part of the evolution of human consciousness. There is, admittedly, contemporary neuro-physiological research supporting the claim that psilocybin affects areas of the brain that deal with both language and “religion” or spirituality but McKenna’s account remains somewhat speculative. On the other hand, it does seem, at the least, to move in the right direction by combating the notion of a consciousness that could be itself without taking in what it is not. More open acceptance of the idea that we are literally of the planet not merely on it can be found in the writings of Carlos Castenada (1976). His discussion of the nature of plant consciousness suggests that our bodies and even our minds are a temporary synthesis of various worldly materials. Castenada, somewhat metaphorically, suggests that each plant has its own manner of consciousness, and when any plant is ritually harvested and consumed, the plant consciousness is momentarily released into the person consuming it. As a consequence, the person experiences the presence of an other consciousness, and he or she may even learn how to engage in a dialogue with that organic consciousness or find a way to make use of the otherness that it provides. In the same way that dreams can comparatively help people gain a sense of the nature of reality, plant consciousness can help people learn, understand, and say more about the world by giving consciousness an extension to and from itself. It is interesting how, in many ways, we come to see ourselves anew as we have new others look upon us; others are the distance by which we take a new perspective upon ourselves. Consciousness, too, is much like a ray of light that illuminates what it is not but in that regard remains unable to apprehend itself. Only by refraction, only in a different shade of light, can consciousness come to appropriate varying parts of itself. And so, by taking what is outside their bodies and putting it inside them and thereby extending them, people gain various kinds of distance to encounter both the world and themselves anew. By taking what is outside themselves and putting it inside, people have a way to extend themselves; they create a means of interposition. It is as if the mediation allows an intervening,

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a distancing: sometimes the mediation makes the world more transparent, other times it makes the world more explicit. Sometimes it makes the self more recessed, sometimes more pronounced. At the very least, it is perhaps safe to say that the full history of human consciousness includes a long and rather convoluted history of many different kinds of changes of consciousness, and that humans have extended themselves in many different kinds of ways, including by putting parts of the world inside themselves.

Understanding Chemical Mediation Throughout his much-celebrated book Understanding Media, Marshall McLuhan illustrates how humans have extended themselves through various communication media and how such technological extensions serve as metabolic membranes that not only extend the senses and alter the body’s sensory balance but also amplify the range and scope of human involvements and concerns. As McLuhan (1964) further suggests, media begin as anti-environmental controls but then soon enough become environmental in their own right. Neil Postman also creatively depicts how media can be understood as environmental where he comparatively reflects upon a Petri dish from high school biology class. The Petri dish holds an aqueous solution, which is also known as a “medium,” and this medium, given the proper conditions and stimulus, will grow various kinds of cultures. Kenneth Burke (1966) addresses this theme of technological mediation where he suggests that humans “have been separated from their natural conditions by instruments of their own making.” To say that media are environmental is to point out how the history of humanity is the history of organisms who have come to dwell within the space and time of their extensions; our sense of where and when we are – and even who we are – all of these are some function of the ways our bodies are mediated. The broad sketch outlined here stresses that media are not best understood as mere objects that people create and employ within an already existing environment. On the contrary, they are the environments in which we do what we do and through which we become who we have taken ourselves to be. But even here, these ideas need to be safeguarded against overly anthropomorphic or egocentric interpretations. In fact, as the media ecological tradition often draws heavily upon thinkers who appreciated organicism, naturalism, holism, and systems theory, a more apt summation of the general principle of mediation is humans are “an extension of nature that re-makes the nature that makes” the humans (McLuhan and Nevitt, 1972: 66). Here we find a rendering more akin to the philosophical positions of “transactionalism” as outlined by thinkers such as John Dewey and Arthur Bentley (1949) as well as Adelbert Ames Jr. (see Cantril 1960), where mediation is understood as dynamic and is not imagined to operate

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between two items that would maintain self-same integrity before, during, and after the interaction. Instead, elements brought together into a whole through the mediation (whether it be chemical, tactile, olfactory, oral, visual, mechanical, or electrical) are thereby released into new forms of space and time, new possibilities of being-in-the-world. By allowing a “third” to slide between, people gain various kinds of distance from themselves, from others, and/or from the world; they gain some kind of relief from their normal or routine (or at least prior) interaction with themselves, others, or world. Chemical mediation functions at both the individual (i.e. psychological) level and the collective (i.e. sociological) level, and each level needs careful attention. First, we must attend to the ways that any particular drug serves as a mediating factor for an individual and to that extent serves as an environment for the individual, with its own sense of space and time, its own where and when of concern. This also means that the effects of drugs are not, as it were, literally within the chemicals per se; they emerge only upon various kinds of transactions with the body and the physical setting.3 We commonly speak of people being on drugs, meaning that the drug’s effects are not merely within the drug itself nor are the drug’s effects wholly contained within the person’s body. On the contrary, the user is held or suspended by the effects, carried along by them, on them, as if the effects flowed through the person to the environment and facilitated – enabled and constrained – certain kinds of interaction. McLuhan, for that matter, might as well have been talking about drugs in particular when he suggested that, “The user is the content.” Second, the effects of any dominant drug (drugs such as alcohol, caffeine, refined sugar, the birth-control pill, fertility drugs, anti-anxiety drugs, mooddrugs, and various kinds of performance-enhancing chemicals) reach well beyond those experienced by the individuals who use the drugs and even beyond the experiences of the user’s close relations. Each drug becomes part of the general environment in which people find themselves. Any dominant chemical medium within a culture or subculture becomes a source of passive constraint, one that enables and shapes codes of normalcy for that collective. Moreover, just as any dominant media becomes a kind of economic staple similar to corn or oil – and so “the medium is the message” in the simple sense that one comes to live in a society whose various forms of livelihood rely upon that medium – so too various drugs quickly become staples which economies rely upon and which shape various patterns of association.4 Fruitful comparison can be made to Ivan Illich’s (1991) notion of “lay literacy” which highlights how many of literacy’s dominant effects come by way of the social organization and structure that orchestrates people’s lives – an organization and structure so pervasive that we don’t think of it as literacy per se, perhaps

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largely because no pen and paper are involved. Consider, for example, the long straight highway, or the arrangements of products in stores and supermarkets, or the squared-off street corner with its street signs intersecting at right angles, or the basic strategy of alphabetic means of organization within folders, file cabinets, and other information retrieval systems: all of these are the effects, the environment, of the alphabet. And so too are product expiration dates, standardized parts for a given make of automobile, sized clothing available off the rack, and employment and restaurant practices that require standardization, uniformity, and seriality (cf. McLuhan, 1964). All of these are environmental side-effects of the alphabet and printing press; they are part of contemporary experience within modern Western cultures regardless of any particular individual’s ability to read. This same point could be made if we comparatively consider what might be termed, “lay drug use.” By the notion of “lay drug use” I refer to all of the ways that chemicals, more than simply impacting the specific individuals who use them, come to shape and structure the larger environment in which individuals interact. Consider, as one example, how morphine, isolated from opium in 1806, related to ending public torture. Dennis Gabor, in his The Mature Society, graphically conveys this point As long as the pain was unavoidable, the common people delighted not only in public tooth-pulling by the barber at the fairs, but also in public executions. Not many people nowadays could stand the sight of the tumbril moving slowly through the streets of a town, with the delinquent tied to a stake, and the executioner with the brazier next to him digging the red-hot poker into the screaming wretch… Remember also that Cruelty is conspicuously missing from the Seven Deadly Sins. If now we abhor it even more than the others, this is, I believe, due in part to the fact that physical pain is no longer an unavoidable component of life. (Gabor 1972: 55)

Once pain could be removed completely from human experience, it now seemed overly cruel to participate in public torture; partly because of morphine, the larger culture radically changed, increasingly took spectacles of cruelty as intolerable and/or unacceptable, as it no longer understood physical suffering as inevitable. As another set of examples, think for just a moment how the birth-control pill has ushered in many different kinds of social changes in both private and public spheres (Peterson, 2010). The effects here range far and wide including: changing gender roles, a more competitive workplace for both men and women, a narrowing disparity between wages that undermines the male-breadwinner/ female-homemaker model of the family, smaller families, larger age gaps between the generations, the emergence of latch-key kids, and a growing population of

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leisured DINKs (dual income, no kids). And all of these environmental effects play out regardless of whether any particular individual takes the birth-control pill or not. As a final example on this second level of analysis, I recall comedian Bill Hicks who once suggested that if you were to completely remove all drug use from human history, you would also have to remove some of the world’s greatest music, art, and literature. It is funny to think about, and to ask honestly about the extent to which that might be partly true. Seriously, is that merely a comedian offering exaggeration (something comic because it is obviously not true), or is this something that seems funny to many people because they recognize an untold or an under-recognized truth about drug use and artistic expression? At the least, we can acknowledge that we live in an environment heavily influenced by many different kinds of drugs, whether we have taken any ourselves or not. On a daily basis, even if only indirectly and bit by bit, we routinely consume materials that were created or inspired under the influence of some kinds of chemicals: we watch some television or read a poem, or listen to a song, or study a work of philosophy or literature, or look at a beautiful painting. What seems most needed is an ability to talk about this fact, to address what it means, without giving the impression of “advocating drugs.”

The Historical Tightening of Loose Drugs One can foresee that the fight against drugs will be a never ending struggle. We shall be able to call ourselves lucky if the civilization of the future can co-exist with the new, chemically produced drugs, as our Western civilization has in the past co-existed with alcohol. The probable alternatives are either a new, harmless drug like Aldous Huxley’s ‘Soma,’ or else a society closely supervised by the police. (Gabor, 1972: 13–14)

Much of McLuhan’s Understanding Media documents how, after thousands of years of “heat up,” Western culture now is in the process of cooling down. But, perhaps obviously, he did not have chemical mediation in mind. In fact, whereas McLuhan suggests that we are witnessing a “reversal of the overheated medium,” one might well argue that drugs are hotter than ever and that this “hot bed” of contemporary pharmaceuticals relies not only upon number, literacy, clocks, and calendars, but implies a growing trend toward a more rigidified and tightly

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standardized sense of the “normal.” The electric age admittedly may have ushered in dance crazes such as “the twist” and invited hairdos to grow more sculptural, but in other areas of lives, specifically inward and intimate areas, more and more people have sought an increasingly homogenous notion of the normal, one that rivals the uniformity of any cornflake or Cadillac coming down an industrial conveyer belt (cf. Anton 2011). Modern pharmacology, as the dominant form of contemporary chemical mediation, epitomizes new horizons of heating up and has offered new kinds of “homogenized Dagwoods,” even if such normalcy has become less publically visible amidst showy rebellions against conformity and uniformity. Following McLuhan’s well-known distinction between “cool” media and “hot” media, we accordingly can distinguish, in a comparative rather than an absolute sense, between “loose” drugs and “tight” drugs.5 “Loose drugs” refer to those forms of chemical mediation that explicitly alter consciousness and experience by loosening individuals from the grip of “normal” experience and daily, weekly, monthly or even annual routine; loose drugs open and extend the scope and range of what is considered “normal” conscious experience. Loose drugs suggest images of recreational uses, maybe even of illegal substances, where users attempt to get “loosened up,” “tipsy,” “jacked up,” “high,” “mellowed out” or, perhaps, “a glimpse of cosmic consciousness.” Loose drugs span the entire range of pharmacological terminology and include but are not limited to: stimulants, depressants, and psychedelics. One way to frame this is to suggest that effects of drugs are sometimes the figure and sometimes the ground. When a drug’s effects are felt as figure rather than habituated ground, we could call the drug in question a “loose drug.” Generally speaking, what was traditionally or popularly meant by the expression “street drugs” is likely something akin to “loose drugs” whereas the expression “tight drugs” are more synonymous with contemporary notions of “medical grade pharmaceuticals.” “Tight drugs,” one might say, are designed to be transparent in their operations.6 They attempt to mediate without being experienced per se, or, if they are to be felt at all, their effects are experienced as an increased attunement or alignment to a more clearly defined and circumscribed notion of “normalcy.” Tight drugs normalize and “make right,” bring about a desired state of affairs, in a background and would-be seamless way. One way to help to contextualize the broad, sweeping, and pervasive transition from loose to tight drugs is to recall that germ theory is not even 200 years old, the birth-control pill just celebrated its fiftyyear anniversary, and the modern sciences of microbiology and pharmacology are still in their infancy. The general implication is that more and more people are using drugs even though they are not directly feeling the chemicals; or, perhaps, the drug’s effects

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pass increasingly below awareness or at least they seem less and less encumbering. Moreover, a proliferation of tight drugs coupled with increased use of hot media have resulted in people imagining that they can target and spot-fix specific areas of their bodily, conscious, or psychic lives and bring themselves into tighter alignment with a more nuanced and refined notion of normalcy, preferably without any side-effects. This is so much the case that modern drugs, especially cutting-edge “tight” pharmaceuticals, can be expected to be transparent – imagined to be operative without notice – to the point that some people, when they hear of various possible undesirable side-effects, actually seem surprised at such residual looseness. It is as if they imagine drugs could bring about a desired remediation without any effects other than the desired ones. In fact, when people are surprised and dismayed by the long list of side-effects that can be heard at the end of the latest new drug ad, this surprise is partly the outcome of the rise of and generalized orientation to tight drugs. Loose drugs, on the other hand, seem never to have carried along such expectations of functional transparency. One factor to consider when differentiating between loose and tight drugs is the time-lapse for the onset of user effects. Generally speaking, tight drugs take longer to take effect (sometimes dosage levels may take a day or two to become stable) and their effects are meant to function rather than to be noticed, meaning also that they are subject to greater timing and dietary regularity demands. Loose drugs, on the contrary, generally set in more quickly and have greater unpredictability regarding their potency and duration of effect. As a general guideline, then, if the strength or dosage of a drug is unclear and its effects are near instantaneous, it is a loose one. Not that all loose drugs have a quick set in, but a quick set in is a likely sign of a loose drug. Many tight drugs, on the contrary, are regulated to be “time-released” or are managed in dosage to an exacting degree. Whereas unintentional overdose is easiest with drugs of unknown and varying potency and for which the body develops a quick tolerance, the more that dosage can be known and regulated with precision, the more that that drug can be used in tight ways.7 Alcohol is an interesting drug to examine in this context. Found throughout the world, dating back to 5000 to 2000 b.c.e. for many regions, alcohol has been produced through the fermenting of wheat, grain, fruit, and barley. In the ancient world, alcohol was used for both mundane and religious or ceremonial purposes. For many Europeans during the early modern period as well as in colonial America, alcohol consumption was a regular part of daily life. Until the temperance movement in the 1800s, men and women consumed a couple of pints of porter or mead throughout the day, often because these were safer to drink than water or other potables. By today’s standards of normalcy, life prior to the 1800s was looser, as it likely included a little bit of alcohol for breakfast.8

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But what needs to be underscored once more are the ways that modern “hot” technologies of number and literacy as well as the kinds of laws that they have made possible have allowed for exact specification of “proof,” a term not used until the late 18th century. Proof, an exact measure of the percentage of alcohol by volume, has turned even alcoholic beverages into a tighter drug, at least in contemporary US culture. No longer a jug of “hooch,” “moonshine,” or other “fire water” of unspecified potency, modern liquor laws demand that today’s liquor has some indication of proof printed on the bottle. Modern US culture also has developed portable digital breathalyzers, which can detect with relative accuracy the amount of alcohol currently within a person’s system. Such different kinds of precise measurement, taken together, have allowed the loosening effects of alcohol to be regulated and tightened to a much greater degree than was possible prior to the dominance of hot technologies.9 Central to McLuhan’s thinking was the reversal implied in the move from the mechanical age to the electric age.10 But what McLuhan seems to have under-anticipated were the kinds of continuity that were developing between the mechanical principles of the printed age and the newly emerging tight forms of chemical mediation.11 It would seem that tight drugs were hardly possible, or scarcely available, or at the least simply not prevalent, until Western culture had been significantly heated by alphabetic, print-based and mechanical technologies. Formulaic drugs, patented with proprietary rights, represent the mechanical principle of uniformity in fullest attenuation. Recall that McLuhan differentiates between hot and cool media in various ways, but stresses most generally that hot media are low in participation and are roughly of the standard, uniform, repeatable type (1964).12 Without the ability to measure fine dosages accurately, almost all drugs are fairly loose, and, hence, literacy, calendars, weights and measures, exact specification of dosage are all essential for enabling “tight” drugs, but this does not mean that all drugs whose dosage can be accurately measured are therefore tight. LSD-25 (Lysergic acid diethylamide), a drug with doses measured in micrograms, offers a useful illustration of this claim as well as a good entrance into the rough and comparative nature of the terms “loose” and “tight.” McLuhan identified LSD, along with the 60’s counter-culture movement, as related to the “cool down” happening within the culture (cf. McLuhan and Fiore, 1968: 73–85).13 Although LSD is an obvious case of a strong psychedelic and therefore can be considered to be a loose drug, it is by historical and cultural standards a fairly refined, controlled, and predicable psychedelic, at least compared to some other psychedelics. When contrasted to licking poisonous frogs, eating various kinds and/or sizes of mushrooms, peyote, or other psychedelic substances found throughout nature, some of which can including vomiting, out-of-body experiences, and “trips” that vary greatly in length and intensity, LSD

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appears relatively measured, predictable, and clinically safe. In some ways, LSD is a microcosm of the drift from loose to tight drugs, one that represents how hotter and hotter cultures have made even something as loosening as a strong psychedelic experience measurable and tightened to the degree of relatively safe experimentation. Hence, the fact that the 1960s witnessed increased “drug use” then, was not simply part of the cool down that was occurring by way of televisual extensions.14 We can openly grant this but still maintain that such “radicalism” was just as much a symptom of the ever-tightening forms of chemical mediation that ran concurrent with growing hot technologies (calendars, scales, tables, charts, and other measuring instruments which use standardized uniform units). Considered from the perspective of a media ecological big history, loose drugs began as anti-environmental controls that, given habit and regular use, became environmental in their own right. In fact, the early history of drug use is largely the use of loose drugs for religious or ceremonial purposes. Even today, the word “drug” aligns with recreational uses that put people at variance with normal routine mundane functioning. The effect of such drugs has been to widen the range of human experience and to open the parameters of acceptable engagement and interaction. Despite this widening of the ranges of possible human experience over the past several millennia, the last couple of centuries have been characterized by tightening codes of normalization (Foucault, 1993).15 This means that although the latitude of acceptable experiences has widened when examined from a large scale, there has been of late a kind of narrowing by focusing on certain kinds of variation and then rigidifying adherence to these particular variations. But, perhaps obviously, the drift from loose to tight does not simply occur on large cultural and social levels. It also happens on the individual level. Individuals who have become addicted to a drug, or to various drugs, can be tightly attuned to their drugs, tethered, as it were, to them, needing them for their sense of normalcy. Consider the kinds of everyday “up” and “down” drugs that people regularly use: caffeine, refined sugar, and alcohol. In their initial uses for users, these drugs may have been experienced as a “loosen up” and were used mainly for gaining kinds of distance from normal routine functioning. But, eventually, as such drugs become regular parts of dietary intake, the users come to take the effects as a normal part of their day and may even increasingly schedule their lives around habituated times of use. Day and time of use is a major component of the tight use of drugs. For example, getting up and having coffee for breakfast may come to feel normal and transparent, as may a glass of wine after work. Examples of this sort well illustrate how drugs, as forms of chemical mediation, begin as anti-environmental controls and then, soon enough, become environmental in their own right.

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Concluding Observations It is not uncommon for people on these trips, especially with new chemical drugs, as opposed to organic ones, to develop the illusion that they are themselves computers.

(McLuhan and Fiore, 1968: 73)

This brief and mostly heuristic paper explored chemical mediation and the role that drugs play in both removing people from routine and normal functioning as well as helping them align with more precision to a desired sense of “normalcy,” both personally and socially. I have tried to contribute to the ongoing discussion about chemical mediation, about different kinds of drugs, about the range of effects both direct and indirect, both personal and social. Drugs, I have tried to show, can be understood as environments on two different levels. First, we can find individuals under the influence of drugs but we also can recognize the larger cultural impact that sheer usage of various drugs have. One can live in an alcohol-dominated culture and deal with the environmental effects regardless of whether or not one consumes any alcohol oneself. A painfully simple example is someone wholly sober who is killed or maimed by a drunk driver. More subtle and difficult to grasp examples include: how one’s private alcohol consumption relates to shared insurance costs, how morphine makes plastic surgery seem more desirable, how LSD use relates to vegetarianism, or how diabetes medicines impact the economy, or how erectile dysfunction drugs have changed the size of families and altered the organization of family patterns. A general trend noted was that the kinds of drugs traditionally used for loosening come less from nature and more from the lab. For explicitly altering consciousness, many young people now have access to highly potent and dangerous drugs such as MDMA, PCP, methamphetamine, or heroin, as well as an increasing array of pharmaceuticals that can be used recreationally for their side-effects (e.g. Ritalin, Valium or Prozac). But the tidal wave of drugs flooding the contemporary world are not, it must be underscored, actually designed for “getting off ” or for recreational purposes at all. On the contrary, we find instead tons and tons of bodily medicines for heart, nervous system, kidneys, lungs, and a growing number of medicines for depression, anxiety, insomnia, and countless other undesired bodily conditions.16 Moreover, as US culture becomes a more geriatric society and as medical advances continue to raise expectations regarding heath and “normal” functioning, we will continue to see more and more people who are “on drugs,” basically addicted to those drugs, even though they are not

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getting high on them. And the youngsters of this culture, even those who hardly know about drugs, will unwittingly orient a good deal of their sense of physical and psychic normalcy, of basic health, and even of life-expectancy, according to the increasing numbers of people who have been mediating themselves and their world through tight pharmaceuticals.

Notes I wish to express thanks to Robert McDougall for inviting me to write this chapter and to Valerie V. Peterson for much early discussion and assistance, and to Barry D. Liss for help in the final stages. 2 Much of this obstacle comes from various semantics haggles over all that is ingestible. For example, ever wonder about the difference between a herb and a spice? (i.e. a leaf or flower rather than a root or nut). How about a fruit and a vegetable? Salts are not drugs but sugars are, and yet there are many health problems and largely negative social consequences that come from too large a salt intake. We need to think about chemical mediation in terms of vitamins and minerals and overall dietary practices as environments, not just “drugs.” 3 A fairly classic distinction to be made when talking about how different drugs affect different individuals differently is the tri-part division of “drug,” “set,” and “setting.” This distinction, originated by Timothy Leary, suggests that we should not look for the effects of drugs in a drug itself, as if the effects of the drugs were somehow contained within them. The point is well taken and suggests attention be paid to the interactions between drugs and the settings in which people find themselves as well as factors such as history of use, current mind set, expectations, etc. 4 See McLuhan (1964) for discussions on how media, as commodities or staples, become environmental. Sufficient attention needs to be paid to the social and political forces that drugs as staples provide. The Boston Tea Party is one classic case to consider, where the social interruption and economic damage, and political statement are amply evident, and the contemporary concern and arguments over medical marijuana provide an excellent case and point. 5 See Goffman’s (1963) discussion of “Tightness and Looseness.” 6 Obviously medical drugs rather than recreational drugs are ancient, but ancient medical drugs were often anything but transparent. Almost always relying upon homeopathic magic of similarity or contagion, such obtrusive treatments were largely figure even though they were meant to cure or normalize. By the standards of today’s orientations, pre-microbiology medicine was anything but tight and/or transparent. 7 I have written elsewhere about the difficulties of satiation and insatiability,

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problems of ever-wavering tolerance, and how they related to non-linear systems, including drugs and media (Anton, 2007). Future study ought to consider how developments in cooling systems in the 19th century were pivotal to enabling sanitary storage of potables and how these factors played a heavy role in enabling the temperance movement. We should applaud such tightening for good reason, as alcohol and motor vehicles do not mix. There is much to be said of how the electric and digital revolutions have made possible kinds of asynchronicity, increased capacities for people to interact without the tight confines of schedules and synchronized movements or spaces. But this is not at all the case with many modern pharmaceuticals. Such drugs often demand a tight attunement to clock and calendrical time. Admittedly, McLuhan has much to say about the ways that drugs and media interact. He writes, “Wines have a hard going in a literary society because their first appeals are sensory and direct. This appeal is hard to spell out, but becomes a challenge to the literary. So the idea of wines, their social aura is rarified and intellectualized. Wines then become something to talk about but not to drink” (McLuhan, 1967, #18). Worthwhile consideration could be given to the extent that loose drugs commonly offer ritualizations and user participations that approximate a kind of art form, whether rolling one’s own cigarettes, sipping wine, making green tea, brewing yerba maté or vaporizing sensually appreciated cannabis, whereas tight drugs, what basically amounts to acts of pill swallowing, have little to no ritualization (other than regularity) and are generally not open to sensory dimensions and artful participations. Much could be said about wine as a loose drug, but as one illustration see McLuhan’s “How about Wine” section from his Verbi-Voco-Visual Explorations where he writes, A wine dinner is a social situation where people are gradually exhilarated, their tongues LOOSENED, their response to others quickened, and their exchanges flow easily… With wines, the pleasure is in the drinking, in the total experience…Almost all wine writing that is not descriptive of the country or the people is bad…you can only describe wine well when you are talking to someone, face to face, who is also drinking the wine. (McLuhan, 1967, #18) McLuhan nicely trades upon metaphors of media as drugs or as forms of chemical mediation. He suggests, for example, that America and England “had their shots to help immunize them from the tribalizing effects of radio,” and it is worth noting that McLuhan, when publically interviewed and asked if he had ever taken LSD, replied that he did not but that he’d read Finnegans Wake aloud and he further suggested that LSD may just be the lazy man’s form of Finnegans Wake. A point for further reflection by media ecologists is that today’s media are indeed drugs, and they may be drugs

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most suited for the lazy. That is, if LSD is the lazy man’s Finnegans Wake, what, exactly, does that make YouTube or Facebook? 14 The interweaving of chemical and electric mediation are interestingly expressed by McLuhan and Fiore where they write: “As a sort of capsule observation, it could be said that the computer is the LSD of the business world, transforming its outlook and objectives” (1968: 83). 15 Beyond the scope the present paper, future scholars ought to explore the work of Michel Foucault, especially his writings on codes of normalization and on the many regimentations of the body, which also could be well supplemented by historical investigations into modern policing of many foods out of the diet by the sheer creation of supermarkets and processed distinctions between “food” and “non-food.” 16 Far beyond the scope of this chapter, future research should explore the environmental impact and effects of the growing sea of drug trash. It would seem that larger and larger amounts of old and expired pharmaceuticals indirectly make their way into the water supply and/or food chain.

References Anton, C. (2007). “On the Nonlinearity of Human Communication: Insatiability, Context, Form.” Atlantic Journal of Communication 15(2): 79–102. Anton, C. (2011). “Clocks, Synchronization, and the Fate of Leisure: A brief media ecological history of digital technologies,” Communication Uncovered: General Semantics and Media Ecology. Fort Worth, TX: Institute of General Semantics. Burke, K. (1966). Language as Symbolic Action. Berkeley, CA: University of California Press. Cantril, H., ed. (1960). The Morning Notes of Adelbert Ames, Jr. Including a Correspondence with John Dewey. New Jersey: Rutgers University Press. Castenada, C. (1976). Teachings of Don Juan: A Yaqui Way of Knowledge; Separate Reality; Journey to Ixtlan; Tales of Power; 4 Vol. Box Set. New York: Pocket Books.

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Dewey, J. and A. F. Bentley (1949). Knowing and the Known. Boston, MA: Beacon Hill. Foucault, M. (1993). “About the Beginning of the Hermeneutics of the Self.” Political Theory 2: 198–227. Gabor, D. (1972). The Mature Society. New York: Praeger. Goffman, E. (1963). “Tightness and Looseness.” In Behavior in Public Places: Notes on the Social Organization of Gatherings. New York: Free Press. Illich, I. (1991). “A Plea for Research on Lay Literacy.” In D. Olson and N. Torrance (eds), Literacy and Orality. Cambridge, MA: Cambridge University Press. McLuhan, M. (1964). Understanding Media: Extensions of Man. Cambridge, MA: MIT Press. McLuhan, M. (1967). Verbi-Voco-Visual Explorations. New York: Something Else Press. McLuhan, M. and Q. Fiore (1968). War and Peace in the Global Village. New York: Bantam Books. McLuhan, M. and B. Nevitt (1972). Take Today: The Executive as Dropout. New York: Harcourt Brace Jovanovich. Peterson, Valerie, V. (2010). “Birth Control: An Extension of ‘Man.’” Explorations in Media Ecology 9(1): 1–20.

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Chapter Three

Perceptual Amplifiers and Inhibitors: Some Parallels between Modern Media and Drug Use Robert C. MacDougall

Take a pitcher full of water and set it down in the water – now it has water inside and water outside. We musn’t give it a name, lest silly people start talking again about the body and the soul. – Kabir

Introduction In this chapter I review and integrate some related work in cognitive science, the philosophy of mind, neurology, and media ecology. Such an integration suggests that communication media, broadly construed as “perception technologies” or “mind tools,” actively intervene at various points along a brain-body-world continuum. As the several contributors to this collection make clear, media and drugs can often play analogous roles to impinge on the nexus of that continuum – what Walter Ong described as the sensorium, his holistic term for the total human sensory apparatus, and a concept that has obvious parallels to J. J. Gibson’s (1979) sensory apparatus. We find that many media, like many drugs, actively engage the 52

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sensorium to sometimes enhance and sometimes inhibit the efficiency of various perceptual and thought processes. Borrowing another term from perceptual psychologist J. J. Gibson, we’ll see how these “mind tools” function as affordances that can reveal different sorts of thought and action possibilities to their users and, in so doing, enhance and extend our capabilities in some powerful and productive ways. Of course, like any tool, mind tools can also be mis-used or over-used. In these cases they can degrade, impede or inhibit our physical, social, and symbolic capabilities as well – how we think, feel, perceive, and act in the world. Some valuable insights can be gleaned from social, psychological, and phenomenological analyses of media use in this regard (McLuhan, 1964; Gumpert and Cathcart, 1985; Meyrowitz, 1985; Abram, 1996; Strate, 2006), but only a handful of investigators have seriously considered the detrimental and/or palliative effects of communication technologies from a pharmacological, neurological, or ultimately biological perspective. As with drugs, are we “prescribed” (and/or do we selfprescribe) particular media in our efforts to stem a variety of dis-ease, to borrow McLuhan’s spin on the term? Or, as with some drugs, how might certain media promote dis-ease or otherwise become hazardous to individuals and/or groups who use them? Philosopher David Abram suggests in his 1996 book The Spell of the Sensuous that the dis-ease McLuhan described is a by-product or side-effect of the prevailing modern “relation between human community and the natural world” (p. 21). With a continued trend toward multi-mediation in so many facets of daily life, Abram’s insights, like McLuhan’s, seem more relevant today than ever. As with the popular layering of drugs (the notorious “drug salad” or drug mix), it is commonplace today for many of us to find ourselves layered in media, enmeshed, embedded, and constituted by a complicated media mix. But of what sort and proportion? While the focus in this chapter is on the role of media, I’ll suggest drugs also increasingly impinge upon that relation between human community and the natural world Abram points to.

On the Nature of Systems Mutliple-realizability is a term I employ throughout this chapter that is analogous to Bertalanffy’s equifinality, described, along with systems theory, in the introduction to this volume. The doctrine of multiple-realizability suggests that single mental kinds (properties, belief states, events, etc.) are realized in many distinct physical kinds. For example, the same functional memory can be instantiated in any number of things or processes: hearing a catchy phrase or a familiar sounding voice, seeing a pile of rocks, a certain alpine vista, notches on a stick, scribblings on a tattered ATM receipt, the writing in a published book or a computer file, etc.

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Consider these additional examples of multiple-realizability: an iris (in a human eye composed of protein chains, or in the “eye” of an SLR camera composed of metal or plastic); a watch (analog vs digital); a bomb (black powder, C4, a jet airliner full of fuel, fissile material, etc.). Examples are ubiquitous. Indeed, this is how our world is composed. And at the human level, just as there are a plurality of causes underlying the same subjective experience (consider anxiety, dizziness, or sluggishness) it is also the multifinality of drug and media effects that further stymies our efforts to understand modern drug- and media-enabled experience. Multifinality is the term Bertalanffy used to describe how the same causes can lead to different effects. Or, the way the same lower-level configurations can manifest in different higherlevel organizations, symptoms, and behavioral outcomes. In the philosophy of mind a close analog to multifinality is context-dependence. Indeed, the world is a complex and messy place. Along with ferreting out different causes manifesting in very similar effects and outcomes, we have to contend with the other side of the systemic equation. The definition and function of some thing is a consequence of causal constraints built into the organization of surrounding contexts or environments. At the biological level we might consider the way identical stem cells can grow into different tissues depending upon a particular chemical milieu. Or consider the way context or environment determines the “essence” of an inanimate object. For example, due to its particular position in even a relatively simple assemblage like a Briggs & Stratton lawn mower engine, a butterfly valve constitutes a carburetor when it is positioned after the fuel jets, whereas the identical valve functions as a choke when positioned before the fuel jets. Whether they have heard of the terms or not, mechanical engineers take multiple-realizability and context dependence as truisms. They are intrinsic to design and function in the “natural” and “human-made” worlds. At the social-psychological level the same concepts apply. In these cases, however, the causal and definitional stories can become incredibly complex. Consider the legal status of corporations as persons, or how, in some families, the way a cat, dog or parakeet can play the functionally equivalent role of a “person” (or perhaps even a “child” in the lives of a childless or elderly couple). By the same token, it is not at all uncommon these days to find a teenager with a biological brother, a step-sister, a neighbor two doors down, an individual known only through Facebook, a favorite movie star, and even a cartoon character all performing as friends in his life. We come to discover, in other words, that the meaning of something or someone has a lot to do with the position, or the way it or they fit into a particular system. The difference between a hormone and a neurotransmitter is also often simply a matter of context-dependence, or where the action occurs (see John Skinnon’s discussion of that distinction in this

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volume). Meaning or identity, in short, are both heavily dependent upon the context-specific role something or someone plays – it’s about how things and people function within larger systems. Of course, the idea that drugs and media might play similar roles in and for the human sensorium is a well-worn trope. From concerns in the 1950s and 60s that young radio listeners were being brainwashed, drugged, or poisoned by artists and disk jockeys alike, to widespread assertions spanning the next two decades that television was akin to heroin, there is a colorful history here.

A Brief History of Tele-visual Effects: (the Emergence of the Medium-as-Drug Metaphor) In 1951 Eleanor MacCoby conducted one of the first formal studies of television’s effects on the developing personality and social interaction patterns of children. By way of in-depth interviews with the parents of more than six-hundred two to eighteen year olds in the Boston area, MacCoby concluded that television contributes to: “interference with the practice of real-life skills,” “vicarious habit formation,” “addiction to excitement,” “frustration tolerance,” and “substitute satisfaction.” Today, with more than sixty years of television viewing behind us, and with the average number of sets in the American household ranging between four and seven (depending on which survey one subscribes to), MacCoby’s study might seem a bit naïve to many readers. Indeed it’s difficult to conceive of such a pernicious device lurking in our midst.1 However, small pockets of philosophical speculation and even some empirical work in the 1950s offer a tentative backing to MacCoby’s argument. Just four years after her Harvard study, Marshall McLuhan, in the Mechanical Bride (1951), pondered the mind-altering effects of advertising through a host of new media. A year after that we find a compelling argument further bolstering MacCoby’s account. Horton and Wohl (1956) pointed to television as the progenitor of something they called “intimacy at a distance” and the attendant “parasocial relationship” that often results.2 This was perhaps one manifestation of what MacCoby initially described as a new kind of interference to the “natural” development of social skills, the source of unprecedented personal and interpersonal frustrations, and social anxieties.3 Horton and Wohl pointed to the mediated relationship many viewers cultivated with their favorite television personas as one side-effect of the demand put on them to adapt to and assimilate these new interactional contexts. They described a kind of alternate reality featuring one-way modes of intimacy that sound very much like MacCoby’s “substitute satisfactions,” essentially surrogate experiences, stand-ins and ready-made, if rough, analogues to face-to-face interaction

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(MacCoby’s baseline for what she termed “real-life”). There is also a similarity here to something Dr. Peter Kramer (1993) called “cosmetic psychoparmacology,” a term he coined to describe the social-psychological effects of the anti-depressant Prozac. A lot of over-worked metaphors have been deployed in the last fifty years to describe our relationship with media. But it may be high time to start taking some of these concerns more seriously. In doing so, however, we’ll need to redirect the analysis away from ostensive behaviors and other external indicators of obsession, addiction and abuse. Considering a spectrum of effects spanning the neurological to sociological levels, it can be fruitful to look at modern media use as a kind of drug use, and vice versa. Before we consider some of this new research, however, a much earlier speculation should be reassessed.

Dispelling Descartes’ Ghost Much in the way symbolic interactionists have argued convincingly that we require language to also know thyself, it is plausible that certain internal (neural) structures and certain external structures (both physical and symbolic) constitute crucial parts of the sensory apparatus that allows human beings to know and empathize with others. Regarding just this, McLuhan went so far as to suggest that television, and other emerging electronic media forms, may prompt a return to something resembling the total sensory involvement of the tribal milieu.4 And yet there may be a problem with the outcomes given new work on embodiment in the neuro and cognitive sciences. The concern is that without the full sensory immersion afforded by our “original condition” of physically embodied face-toface interaction, the experience of empathy may be more difficult to achieve due to a lack of legitimate (possibly even necessary) redundancies across sensory modalities, including vision, hearing, touch, smell, interoception, etc. Science, in short, is finally showing us how and why Descartes’ original mind-body problem is no longer a problem. McLuhan was pointing in the direction of a brain-body all along, and the general argument put forward by Andy Clark and other theoristresearchers in the “extended mind” camp for natural brain-body-world linkages extends McLuhan’s original argument. To understand the new brain-body/brain-body-world concept, consider the way creatures like us naturally perceive by seeking correspondence between the senses. To this point, J. J. Gibson (1966) urged us to consider how we actually experience fire: we see a visual flame, feel the heat, often smell a tell-tale odor, and may even hear subtle “crackling” sounds, etc. Problems experiencing virtual fire notwithstanding, the experience of empathy via electronic media may already be proving itself difficult to achieve in our new environments characterized by

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disembodiment and decontextualization.5 And this may be due to the way multimedia use formally demands a kind of sensory multitasking even before a specific task has been chosen or assigned. Our difficulties with task management, and even apparent problems in achieving empathy, stem from the likelihood that perception (our multilayered sense-experience of the external world) is intimately connected to the incessant interoceptive and proprioceptive functions of our bodies. As Abram (1996) puts it, “[m]y senses connect up with each other in the things I perceive” (p. 62). Here Abram describes a sort of incessant perceptual feedback loop going out into and through the world, and, in effect, brings the world back in to us. Abram continues: “each perceived thing gathers my senses together into a coherent way – enabling me to experience the thing itself as a center of forces, as another nexus or experience, as an other” (ibid.). In a series of beautifully written passages Abram points to perception as the process of always, in effect, bringing in the other as another.6 Gesturing toward the notion that we are, and have always been, “extended” beings, Abram describes the body as an “open circuit that completes itself only in things, in others, in the encompassing earth” (ibid.). The significance this notion holds for our understanding of modern drug and media use cannot be underestimated. Antonio Damasio, a well-know practitioner in the neurosciences, describes interoception as our interior sense made possible through the brain’s monitoring of the body’s internal milieu7 and via dispositional representations and somatic markers in the brain. While there is not enough space to unpack all three of these here, it is safe to say that Damasio’s constructs presuppose a multi-way feedback loop system that flattens the hierarchy and interweaves the relations between brain and body, and body and world. Despite all of the empirical work that is revealing these intimate connections, a nagging presupposition remains in the popular mind. It also still lingers with many specialists regarding the nature of mind, perception, and even freedom-of-will. It is the tenacious belief that homo sapiens, the thinking ape (and, in particular the thinking human brain), is the sole arbiter of thought, intention and informed action. In an early effort to dispel something he called the “single agent theory” as a way of referring to the discrete/autonomous mind misapprehension, Marvin Minsky, in “Why People Think Computers Can’t,” observed: It isn’t hard to see why every culture gets attached to this idea. No matter how ridiculous it may seem, scientifically it underlies all principles of law, work, and morality. Without it, all our canons of responsibility would fail, of blame and virtue, right and wrong. What use would solving problems be, without that myth; how could we have societies at all? The trouble is, we cannot build good theories of mind that way…[w]e’ll have to understand that Self, itself, is not a single thing. (1982: 6)

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Minsky’s call to clarity of course asks for no mean feat. It violates our intuition to think in this way about the mind. It would be akin, perhaps, to asking a pre-Copernican European to subscribe to the notion of a spherical Earth that spins at the periphery of the galaxy. But without the knowledge and tools we now have at our disposal, the suggestion that the world is anything but flat, and sits at the center of the sky, would be met with both distaste and disdain. Besides any dogma one might have believed, this is what our senses (primarily vision) would immediately suggest. Of course these misapprehensions as well took some time to shed. In that article written for a popular audience Minsky goes on to suggest that while our brain is certainly a necessary and central component to thinking, it is not sufficient or, perhaps tantamount to having a mind or for the doing of cognition. Others, including Clark (2003), Chemero and Silberstein (2006) have significantly honed this same idea. Whether based on carbon, silicon, or something else, recent work in the neuro and brain sciences suggest that if we are to understand cognition, we’ll need to understand its multiply-realizable and context-dependent nature, studying it as it occurs: embodied and embedded in particular contexts and dynamically coupled within and between bodies, and through language and a host of worldly artifacts. Put another way, our brains are always, already both physically and informationally coupled to the world. This perspective has been a long time coming, yet it is also right in line with Gregory Bateson’s general definition of mind. A mind, for Bateson, could be anything with the capacity for homeostatic feedback. In the foreword to Steps to an Ecology of Mind (2000: x–xi), Bateson’s daughter Mary Catherine encapsulates her father’s theory of mind nicely: [A] mental system was for Gregory one with a capacity to process and respond to information in self-corrective ways, a characteristic of living systems from cells to forests to civilizations. Now he expanded that characterization into a list of defining criteria for mind. It becomes clear that a mind is composed of multiple material parts, the arrangements of which allow for process and pattern. Mind is thus not separable from its material base, and traditional dualisms separating mind from body or mind from matter are erroneous. A mind can include nonliving elements as well as multiple organisms, may function for brief as well as expanded periods, is not necessarily defined by a boundary such as an envelope of skin, and consciousness, if present at all, is always only partial. This emphasis on mental systems as including more than single organisms leads Gregory to the insistence that the unit of survival is always organism and environment (Bateson, 2000: foreword; emphasis in original).

Bateson did not seem to allow for the possibility that components of mind might also be embedded in non-material artifacts like language. However he was, like

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Minksy, an early adopter of what is now called the extended mind or extended cognition thesis.8 As we consider the close relationship between media and drugs in the communication process, the reader is urged to temporarily suspend all residual chauvinisms they might have regarding any special status for brains (and human brains in particular) when it comes to questions of mind. Like the medieval world view, this is by no means an easy task – given how the misapprehension is a direct consequence of the way we experience the world. But the discrete, encapsulated mind or “single agent” theory remains compelling because of its apparent correspondence with our everyday experience and intuitions. Indeed, our subjective vantage points betray us here once again. It intuitively just feels right to think that my brain-qua-mind is the seat of my actions. I certainly have the ongoing impression that I am the master of my own thoughts. Surely, my brain is where my mind resides. Again, this just seems to be the case. It must be so. How could it be otherwise? Along with Bateson and Minsky, and with the help of cognitive philosopher Andy Clark and others in the extended mind camp, we can conceive of an almost infinite number of “surrogate situations,” “metamental loops,” and additional “dynamic couplings” that have played easily-missed roles in human intelligence and cognition ever since the first vaguely human form picked up a stick to extend her arm and grab some previously just-out-of-reach object or morsel of food. A stick is not merely a stick. It is a physical tool. But it is also a mind tool.9 Sticks, stones, media of all kinds, ideas and concepts, and certainly many drugs too can function as mind tools. But these tools don’t merely allow us to do things we couldn’t do before; they also change the way we think about ourselves and the world around us. We know that they sometimes deaden, but can also enliven our senses, our mental capacities and physical abilities, and are crucial parts of what constitutes and drives us. Mind tools, in other words, have always been components of who and what we are. The difficulty in understanding the nature of our relationships with these tools is really the key difficulty in understanding the human condition. From bicycles, baseball bats and boxing gloves, to cars, cell phones and computers, they all eventually become transparent to consciousness. It’s hard to see them precisely because we tend to see through them. Language is the quintessential medium and mind tool (or drug, depending on whom you ask). Like any media ecologist worth his salt, Clark points to language as one of the original mind tools, the preeminent “complementary external artifact” that not only helps us relay ideas, but is also a “computation-transforming instrument, a tool which allows biological cognition to confront and solve an expanded class of problems and thus actually expands the realm of the thinkable” (Clark, 1996a: 3–4). I’ll treat the drug question briefly in a short while, and elsewhere in this volume other contributors illustrate how certain drugs function as

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complementary external artifacts as well; they’re just the sort that become internalized through their actual consumption or absorption through our mouths, nose, skin and viscera. While kernels of the idea go at least as far back as Aristotle, it was the French philosopher Henri Bergson who pointed out about one hundred years ago that language, despite all of its powerful advantages, was also one of the first numbing agents. Bergson argued that language is always reductive in its effect on the human sensorium: “we instinctively tend to solidify our impressions [sensed experience] in order to express them through language. Hence we confuse the feeling itself, which is in a perpetual state of becoming, with its permanent external object, and especially with the word which expresses this object” (Bergson, 1910: 130, in Rubidge, 2003). Bergson could have just as easily been describing McLuhan’s concept/percept distinction in “warning that the reductive tendencies of reflective consciousness, which relies on symbolic references to the world, could lead to the diminution of the importance of the sense of the world, and obscure the importance of the corporal in understanding the environments, physical, social and cultural, that we inhabit” (Bergson, 1910: 5, in Rubidge, 2003). In a similar way, Abram (1996) admits to wondering if his culture’s lack of awareness of other animals and in the land is responsible for our inability to see and to perceive these myriad others: “a real inability to clearly see, or focus upon, anything outside the realm of human technology, or to hear as meaningful anything other than human speech” (p. 27). What’s more, regarding the numbing, anesthetizing qualities of language, Abram asserts that “the phonetic alphabet in particular enabled the abstraction of previously ephemeral qualities like ‘goodness’ and ‘justice’ from their inherence in situations – to a new realm independent of the flux of ordinary experience” (p. 111).10 Language certainly affords us many wonderful enhancements, but we should remain cognizant that the tools we employ, including language, also significantly abstract, numb, reduce, or narrow our perceptions in significant ways. “Fundamentalist readings” (of, say, religious or political material) are not really the exceptions to the rule. We tend to take written language especially seriously. Indeed, most media users tend to take their media seriously. That is to say, they see them as neutral conduits, and interpret their content as being generally accurate or representational of things out there in the world. And yet we know that seeing a “war” on TV, or seeing a city from a bus or car window, or getting much of our daily intake of information through texting or email or Facebook also offer quite partial views of what exist. Or to borrow a useful spin from Alfred Korzybski, the founder of general semantics, the intensional orientation to the world that is enabled by language tends to reify highly abstract definitions and descriptions, without reference to lower-order verbal and non-verbal experiences. This is but one facet of the

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Sapir-Whorf hypothesis given currency through Whorf ’s inquiries into the nature of Hopi linguistic structure, with its own verb bias. Later, Ong (1982, 1991) described the abstracting and concretizing effects of specific languages and mapped out the psychodynamics of spoken language more generally. Indeed, all tools give and take, but so much of the numbing, enabling, dulling, and sharpening associated with our tool use occurs below the level of conscious awareness. It is especially challenging to check the deleterious effects of a technology like language for this reason. As McLuhan suggests, it is notoriously difficult to understand media precisely because we are immersed in them. We live in them as we live in language. We are like Kabir’s pitcher (see beginning of this essay) – both filled and surrounded – and so constituted by these things. Our mind tools have been working us over for a very long time – certainly long before computers and other electronic media forms were invented. Philosopher Andy Clark offers fresh insight into how our mind tools might work with two important concepts: the metamental loop and the surrogate situation.

Metamental Loops and Surrogate Situations The metamental loop (Clark, 1996b) and surrogate situation (Clark, 2005) describe dynamic cognitive and physical processes, objects and ideas through which an organism incorporates information embedded as organized matter and energy in the surrounding environment. A surrogate situation might include observer-relevant physical and symbolic structures (and other nexuses of meaning potential) that exist in the world. The metamental loop is triggered by what amounts to natural or intuitive affinities and relations between self and world embedded in a wide variety of these situations. They might emerge out of the environment (both physical and symbolic) as perceived action potentials or “affordances,” according to Gibson (1979). Clark borrows liberally from Gibson’s affordance theory and describes a collection of intentional objects11 that can be naturally-occurring patterns and configurations, or human-made artifacts and features in the environment. Language, of course, is one symbolic variety, but there are other mind tools – from memorable terrestrial vistas to special celestial configurations, to rocks, bones and sticks, notebooks, maps and media and drugs of all sorts – to name just a few of these common components of surrogate situations we have at our disposal that allow meta-mental looping to occur. Since the dawn of human time our ancestors were sharpening an awareness of the meanings physical and then symbolic structures have in relation to them. The first ancient ponderings of what was “going on” in the mind of a neighbor hefting a massive carcass would be one example of a metamental loop, with that other mind (or, brain/body)

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playing a host or surrogate role for the onlooker. Clark’s metamental loop has an affinity with Mead’s (1934) “minding” and Cooley’s (1902) “looking-glass self,” two concepts that describe ways of taking-the-role-of-the-other, and provides a foundation for a theory of other minds. A relatively new area of neuroanatomy considers the putative existence of mirror neurons. These structures may help us understand why even the solitary and apparently “simple” act of watching another engage in some action is, an inherently social undertaking (even when seen from a physical distance, or from afar through remote mediation).12 So we begin to see how communication that takes place via a wide variety of media, along with the information, data, and memory storage capacities made possible by them, offer a collection of surrogate situations deployed and inhabited by human cognizers.13 The meaning and action potentials embedded in artifacts of all kinds have the potential to alter the causal structure of the world. And this structure will be very different for a truly naked ape – as opposed to one “well equipped.”14 For what is special about human brains, and what best explains the distinctive features of human intelligence, is precisely their ability to enter into deep and complex relationships with non-biological constructs, props, and aids. This ability, however, does not depend on physical wire-and-implant mergers, so much as on our openness to information-processing mergers. Such mergers may be consummated without the intrusion of silicon and wire into flesh and blood, as anyone who has felt himself thinking via the act of writing knows. (Clark, 2003: 5)

For example, at the moment he drew it, DaVinci’s Vitruvian Man (circa 1487) was already a gross misrepresentation – an underestimation in fact – of the human being and of human being. His own habit of putting stylus to paper itself betrays the myth of the naked ape, and was certainly part of what made DaVinci’s mind such a powerful, distributed engine of reason and association. While not taking anything away from the innate talents with which he may have been endowed, the master was also who he was because of a powerful collection of cognitive tools and extensions he regularly employed, and the myriad surrogate situations he inhabited that were constituted by them.15 Consider language, writing, mathematics, geometry, chemistry, materials science, early theories of aerodynamics, physics, not to mention, some fairly sophisticated forms of hands-on tinkering. Of course, humans were dabbling in various kinds of symbiotic relation with artifacts and machines of all kinds well before DaVinci’s time. As already stated, spoken language has been blending, bending, and extending us for tens of thousands of years (Clark, 2003; Logan, 2008), and today we are cyborgs “not in the merely superficial sense of combining flesh and wires but in the more profound sense of being human-technology symbionts: thinking and

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reasoning systems whose minds and selves are spread across biological brain and non-biological circuitry” (Clark, 2003: 3).

A Natural Condition Clark aligns himself closely with other advocates of the extended mind hypothesis in thinking that humans are the most skilled artisans and users of artificial and virtual environments, but he also points out that tool-making and tool-use are skills achieved by some of the most “lowly” creatures on the planet. He spends a journal article describing the way a tiny cricket fashions an earthen cavern that enables it to become the most boastful bug on the planet.16 In similar vein, Richard Dawkins (1982) describes the beaver dam as a natural extension of the beaver. Dawkins also assumes a broad, functional perspective given the way he considers the impact of the organism on the surrounding environment and wider ecology, including other beavers and other species. He refers to the dam as part of the “extended phenotype” of the beaver. Burrows and nests of various kinds are examples of extended phenotypes that Dawkins and others have pointed to across the natural world. When it comes to the human lifeworld, we can point to everything from a shack to a skyscraper, a wooden sled to a space shuttle, a slide rule to a super computer, a cell phone to a powerful psychotropic substance as components of the extended human phenotype. And here, especially, we begin to see how builders and users are not the only entities impacted by the construction of such things. We see, as well, how the line begins to blur between notions of what counts as natural (more ascribed) and cultural (more achieved) attributes of organisms. Indeed, McLuhan’s extensions, Gibson’s affordances, Clark’s meta-mental loops and surrogate situations, and even Dawkins’ extended phenotype all suggest that Google is becoming as much a part of “human nature” as language – the incorporation or assimilation is just happening a lot faster. The binary view (the natural/cultural or nature/nurture view that tends to set nature and technology in opposition) becomes an outmoded and undue separation.17 Bergson, McLuhan, Ong, Clark, all suggest there is a kind of natural affinity, even a biological relationship, that we enjoy with our tools and artifacts. As the 18th-century Scottish philosopher David Hume pointed out, however, an is does not always imply an ought. It is an open question, in other words, whether or not many of our quite natural couplings, loopings, and extensions out into the world (and from the world back into us) are creating the kinds of beings we want or should aspire to be. While it might seem obvious to Google’s Bryn and Page, Microsoft’s Gates or Apple’s Jobs that the latest digital appendages will increase or enhance the human condition, it is not at all obvious that this is the case.

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New work in psychology, the philosophy of mind, and the neurosciences supports the notion that many biological organisms develop intimate and integrative relationships, whereby they recognize and relate accordingly, to objects and concepts in their environments whether it benefits them or not (cf. McLuhan, 1964; Gibson, 1979; Clark, 2003). We know, for instance, that many relatively abstract models of the world (an almost infinite collection of signaling systems and surrogate symbol and memory devices like the ubiquitous shopping list, an Alzheimer patient’s notebook, or some bit of electronic text, twitter or prattle) can be effective aids for the organism/s involved. Text messaging, for example, is increasingly being used to accomplish many communicative tasks. Whether this means quickly, efficiently, effectively and with control, or functional in some other way, we do seem to be getting things done with various tools that can also be considered “installed thought processes,” as efficiency guru David Allen describes his Getting Things Done (GTD) program. But we’re also seeing why the task-orientation and means-to-end ethos emerging along with many of these tools (both our drugs and our more conventional media) should be cause for concern. Allen advocates for more complexity in our tools. He points out that “the workings of an automatic transmission are more complicated than a manual transmission… To simplify a complex event, you need a complex system” (quoted in G. Wolf, 2007). However, complex systems, models and representations might not always be the best prescription. Contrary to Allen’s complexity thesis, Clark gestures in the direction of a rule of parsimony operating in nature. But whether tools be simple or complex, McLuhan seems to have been most on the mark in suggesting that a kind of perceptual numbing accompanies the use of any tool that ostensibly affords new efficiencies. Unfortunately, the inefficiencies, ineffectiveness and numbing that come with some of our tools tend to be glossed over by Clark and many of his associates in the extended mind camp.

Human as Bottleneck: Multitasking, Decontexting, and Disembodiment Both Clark and Allen say a great deal about the superior cognitive abilities many of our tools afford, though Clark also admits that such “upgrades” are almost always mixed blessings: “Every new capacity brings new limits and new demands” (2003: 10). Indeed, the general implication that newer = better is suspect, as a fuller sweep of emerging multitasking research reveals some counter-intuitive findings, including alarming trends in sub-par information handling capabilities by humans employing a host of electronic and digital devices.18 But this situation is novel only with respect to the kinds of tools we now use. Humans have long been involved in tight reciprocal relationships with tools of various kinds. However, our

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new digital devices and systems possess a wholly different nature than their older mechanical cousins. One striking difference is the manner in which these tools tend to warp perceptions of both space and time.19 The logic of automation puts us in direct instrumental relation to our machines. And ever since automation began, perhaps with Gutenberg’s movable-type press, humans have increasingly played the role of “biological bottleneck.” Electronic and digital tools only up the ante, putting more stresses on the human component of these larger systems. For instance, tools like Google create a situation where, to consider the question of quantity alone, the sheer speed and scale of data flows are no longer intended for human parsing at all. The theory behind multitasking is that we can get more done in the same amount of time if we distribute the processing, or computational work across a field of “modules.” But the emerging facts suggest otherwise. Humans, by and large, tend to be pretty bad multitaskers, and those who tend to think they are particularly good at it often end up performing in sub-par fashion relative to the multitasking set. An associated effect of multi-tasking is “decontexting” – the yanking of a cognizer from one environment (temporal, physical, symbolic) into another.20 Along with answering a personal call at a business meeting or texting to a third party while engaged in a face-to-face conversation, this can be a subtle thing too. For example, I find that in the final stages of editing a manuscript that a hard copy constrains my thought process in some productive ways. It forces a linear progression on the editing task which ends up being more efficient than a computer editing session (which has the tendency to become much more recursive to the point of sometimes inducing a kind of vertigo). Many of my colleagues agree (though some don’t) and for students having trouble with writing I have recommended this strategy to help them clarify their ideas. Here again we see mixed perceptions and mixed results. Some come back and say it did the trick while others consider it an exercise in futility. The point is that “old” (these days called “slow”) media still offer some benefits that get buried in the flux of the new. Just as automatic transmissions and anti-lock braking mechanisms simplify the process of driving from the vantage point of the human user, these advances also quite literally numb us to feeling of the road in large measure due to the absence of certain potentially valuable forms of feedback from the surface over which we are travelling. Similarly, with all of their convenience, it is easy to see how a phone call, email, IM or text message may sometimes numb us to our interactions with others (both those on the other end of the exchange and those in our physical presence). Like enhanced cruise control or an automatic braking system, these new tools can also sometimes result in misperceptions, misjudgments and misinterpretations.21

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The sometimes Functional Equivalence of Drugs and Media in and for the Human Mind-Body The descriptions some of my research participants offer regarding their use of an iPod to attenuate or trigger various mood and emotional states resemble some of the personal accounts provided by others who are, or have been, prescribed Abilify, Adderall, Celexa, Eskalith, Ritalin, Paxil, Prozac, Wellbutrin, or Zoloft to mitigate the debilitating effects of attention problems, mood swings, depression and anxiety. So, in addition to any number of potential chemical imbalances inferred by physicians, we might again consider multitasking, perhaps one of the most over-hyped and misunderstood practices today, as one probable source of our troubles here. Analogous to the way an overburdened PC will sometimes freeze, the kind of multitasking that typically goes along with and makes way for our new media tools may often cause our brains and bodies to, in a sense, freeze up trying to reframe and recontext. This is due in part to the fact that our brains are never “in a vat” as the “Cartesians Split” allows. To the contrary, brains have always been embedded in heads (usually equipped with ears and eyes) that tilt and turn, gimbal-like, atop articulated bodies moving through space and over time in complex environments. How, then, do the built-in sensory redundancies of the body deal with our new (surrogate) situations?22 Percepts sometimes literally move us in ways concepts like spoken and written words, or other linguistic stand-ins, can’t (consider a low-flying bird, or a startling noise). Reading, however, is a great tool for higher concept construction (cf. Clark, 2003; Greenfield, 2009; Wolf, 2007) and this is why our increasingly image-based situations and environments should be complemented by other, older media forms. This could be the one prescription McLuhan did offer us. Echoing Aristotle’s notion of the golden mean, he called for sensory balance in our employment of communication technology. This all suggests that some of our newer surrogate situations, like the “full immersion” VR systems now being tested (or what any cutting-edge gaming system or even Second Life is approaching), cannot support the rich sensory life we require as fully feeling, thinking, human beings. Alexithymia is an emotional processing disorder that often manifests as a difficulty in providing verbal descriptions of emotional states. Are alexithymic symptoms isolated to those with a genetic predisposition? Is it one outcome of alcohol abuse? These are open questions too, but it may be one of many emerging conditions we’ll also have to contend with in our new media environments where bodily-written emotional content seems largely exempt. On the far end, psychotocism, or the total inability to empathize with others, might be another.

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Chunking and bracketing percepts in the way so many modern media do puts us increasingly out-of-synch with the way we evolved: intimately and automatically mediated by our bodies. So many are living in the digital in-between of suspended time and space that has certain functional similarities to the experience of occupying a sensory deprivation chamber (or perhaps being subject to an “epidural” performed at the T1 vertebrae for the more fully immersed). The big difference is that we are also often awash in a sea of stimuli. If Descartes was finally going out of fashion at the tail-end of the 20th century, some of our modern media habits as well as some interpretations of the outputs offered by our new diagnostic mechanisms like fMRI are bringing back, and in the process reifying, his description of the human animal as a being rigidly separated along a mind-body cleavage. In other words, while there is no shortage of stimuli in our mediated experiences today, there may be surprisingly little information about us coming at us through our Blackberries, Droids and iPhones. This may be problematic for the simple fact that stimulation does not equal information as J. J. Gibson (1966) warned.23 Damasio and Damasio (2006), for instance, are confident in saying that we feel emotions in the flesh.24 If the Damasios have it right, subtle changes in body state trigger the appropriate somatic markers which then prompt checks of correspondence with dispositional representations at the neurological level (synaptic relations between neurons) regarding specific states of the body. This maps out what Antonio Damasio originally referred to as the “brain-body loop.” The dispositional representations encoded among and between neurons distributed in the brain can refer to both real or “as if ” states of the body (Damasio, 1994, 1999; Damasio and Damasio, 2006). Clark’s assertion that “we actively create restricted artificial environments that allow us to deploy basic perception-action-reason routines in the absence of their proper objects” gets at this same idea (2005: 233). The multiply-realizable nature of these “intentional objects” (cf. Gibson’s “affordances”) suggests why surrogate situations (in the realm of the written word, including anything from a two-word text message to a two-page hand-written letter) can be so compelling. Again and in line with the media ecological outlook, language was the first surrogate situation allowing human beings to breach the barriers of skin and skull, and model their worlds in more abstract, but also powerful ways. However, if the realities our new languages allow comprise an infinite number of scenarios and situations, these needn’t be limited to spaces outside of the brain-body complex. At this point, however, we can stretch Clark’s original usage of “surrogate situation” to consider the functional similarity between drugs and media.

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Some Functional Parallels between Drugs and Media Most drugs – organic and synthesized – intervene and interpose at strategic points in the internal milieu (in the viscera) and at the neurological level of dispositional representations in the brain, where they function to variously amplify, suppress, or altogether inhibit the transmission of chemical and electrical signals occurring there. Acknowledging that the brain is a necessary though not sufficient part of what constitutes a mind, we move into a position to take seriously the idea that drugs and media can and often do play interchangeable roles in the human sensorium. Powerful psychotropic drugs like MDMA and LSD can afford the user with an experiential “all-at-onceness” (simultaneity) and “all-at-oneness” (singularity), to borrow McLuhan’s phrasings. He suggested that the new designer drugs of his time could even make people feel as though they function, in a sense, like computers (McLuhan and Fiore, 1968). Participation in a well-oiled basketball, baseball or hockey squad often manifests a similar feeling of being but one node in a broader intention/action loop, but this is an experience that can now be had “individually” with electronic media of various sorts. As UCLA’s Patricia Greenfield has pointed out, in “using more visual media, students will process information better … however, most visual media are real-time media that do not allow time for reflection, analysis or imagination – those do not get developed by real-time media such as television or video games” (quoted in Wolpert, 2009). Greenfield suggests that new digital technologies are not the easy solution to our latest worries in education, since there are always other skills being supplanted, ignored, or obsolesced in the course of innovation. In other words, the latest might not always be the greatest. And yet it comes as a revelation to many especially where these mind tools are concerned, that newer does not always unequivocally mean better. Many new media users likely mistaken high band-width (i.e. data throughput or processing capacity) for rich meaning or high information content. Along with the “Cartesian split,” we would benefit from this particular delusion of modernity as well. With these “high-bandwidth” visual media we tend to get a near-constant cascade of stimuli impinging on our senses. Some drugs (LSD, MDMA, heroin) seem to function as “real-time” mind tools in a similar way. Greenfield cautions against the over-use of many electronic and media forms and even seems comfortable asserting that reading not only develops vocabulary, but also imagination, reflection inductive reasoning and critical thinking too. In terms of drugs that might mimic some of these “slower” media, the stimulants Ritalin and Adderall seem more like print – a “hotter” medium or highly focused (or

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focusing) perceptual/cognitive device. We might also liken the use of a GPS receiver to Ritalin or Adderall in this way. Functionally, a GPS device can often enhance the efficiency of the traveler. But in practice it does so with a trade-off: by narrowing the individual’s sensory experience – often bracketing the visual field and effectively focusing attention on the route ahead, second only to the GPS screen itself. Watch a GPS-enabled driver the next time you find yourself along for a ride in a vehicle so equipped. Sideways glances become relatively rare. By the same token, observe closely a kid (or adult) who is taking a standard dosage of Adderall. There seems to be growing support for that one prescription of sensory balance McLuhan offered. “No one medium is good for everything,” asserts UCLA’s Greenfield. “If we want to develop a variety of skills, we need a balanced media diet. Each medium has costs and benefits in terms of what skills each develops” (in Wolpert, 2009). Greenfield even states that “[w]iring classrooms for Internet access does not enhance learning” (ibid.), a bold claim for sure in this technophilic climate. But clearly, many folks do not do a particularly good job striking such a balance these days. What’s more, as suggested throughout this chapter, our lopsided, sensory-biased media and drug practices can diminish the benefits gained from the natural redundancies afforded by the parallel perceptual circuits of the body.

Conclusion: Building the Perfect Beast Greenfield maintains a much more holistic view than most mainstream media researchers today. She cites a number of interrelated factors, suggesting that many of the changes we are seeing are “related to our increased use of technology, as well as other factors, including increased levels of formal education, improved nutrition, smaller families and increased societal complexity” (in Wolpert, 2009). She contends that our new learning environments and all of the surrogate situations they represent “are producing learners with a new profile of cognitive skills (including sophisticated iconic representation and spatial visualization skills). Formal education must adapt to these changes, taking advantage of new strengths in visual-spatial intelligence and compensating for new weaknesses in higherorder cognitive processes: abstract vocabulary, mindfulness, reflection, inductive problem solving, critical thinking, and imagination” (in Wolpert, 2009). Greenfield’s prescription echoes that implied by Maryanne Wolf (2007). Wolf is even more specific in her prescription, however, arguing that a much older technology and practice is crucial in enabling such skills to gain a solid cognitive hold. Wolf champions long-form reading (and two hours at a stretch). Like bona-fide systems thinkers, both Wolf and Greenfield talk about cognitive tools with particular tasks in mind, and this may be the best route to cultivating

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the kind of brain-bodies that will allow us to create and sustain a world worth inhabiting. And so I think again about my students and their extensions. These younger people report sometimes feeling out-of-control as they quite naturally become the de facto center of their worlds; 24/7 communicative nexuses connected to everything, but less in touch with the immediate sphere around them. Clearly, all of this context-switching is taking its toll as the definitions of various social spaces continue to blur and obsolesce in the face of out-of-place and out-of-time communication practices. When Meyrowitz (1985) commented on the loss of information specialness, he was writing on the cusp of the Internet age. If he was not being prescriptive at the time, we may now have to be. New rules are being put into place “top-down” in an effort to cope with the media frenzy. Explicit, paternalistic-sounding directives are showing up on placards in banks, hospitals, and other places of business, and/or repeated over loudspeakers on buses, trains and planes asking us to curtail or cease and desist our technology use in such contexts for various reasons. Of course, such edicts are most often designed to enhance the organizational efficiency of the environments themselves. But there is, as yet, little guidance with respect to how we might use our tools on a personal basis. In a special supplement provided by one of New England’s premier health insurance organizations entitled “The Mental Toll of Multitasking and Modern Gadgets,” the same is implied, but only a superficial discussion is offered to help individuals deal with the tumult. Our “internal” environments are left to contend with what may often be a debilitating cacophony of stimuli. And so, given that humans are turning out to be notoriously bad multitaskers, must we simply deal with the dis-ease? Then again, before the average media user will take any of this seriously they’ll need to first dispel Descartes’ ghost and then shed what Minsky (1982) called the “single agent theory,” the notion that what goes into thinking is all in the head. As I’ve tried to demonstrate in this chapter, such a view is turning out to be a woefully inadequate account of human perception, cognition, and consciousness.

Notes 1 With a puritanical bent to some of the language, and a clear separation drawn between fantasy and real-life in full force, MacCoby sounds like so many doomsayers of the time predicting an end of family life, education, and civil society. More than two decades later, Jerry Mander’s Four Arguments for the Elimination of Television (1978), and Mary Winn’s The Plug-In Drug (1977), picked up the mantle. Then came Neil Postman’s Amusing Ourselves to Death (1985), offering a somewhat more subtle argument. Postman

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focused his analysis less on the content of television, and described instead the way the “grammar” of TV structures the content issuing from the tube as well as the public discourse that follows. 2 Yet this was certainly not the first manifestation of a kind of virtual reality or surrogate situation afforded early media users. Books and radio accomplished some of this as well. And our distant ancestors were surely able to get out of their immediate social contexts with the first daydreams, private ponderings, and fatigue- and chemical-induced “trips” after working hard to establish a safe perimeter in some primordial field or forest. No doubt, as our ancestors learned to tighten the controls on their physical space, the attendant temporal space subsequently freed up became the first environment allowing minds to wander. 3 We might also consider the millions of video-game-playing adolescents and adults dubbed “addicts” and “junkies” since the 80s who will admit to obsessively playing these games. And now we find ourselves in the midst of frenetic Blackberry (or “crackberry”) and iPhone users, certainly among the most obsessive in the PDA/smartphone set. 4 McLuhan (1969) was asked in an interview why drug use seemed so natural for young people at the time. He responded: “They’re a natural means of smoothing cultural transitions, and also a short cut into the electric vortex. The upsurge in drug taking is intimately related to the impact of the electric media. Look at the metaphor for getting high: turning on. One turns on his consciousness through drugs just as he opens up all his senses to a total depth involvement by turning on the TV dial. Drug taking is stimulated by today’s pervasive environment of instant information, with its feedback mechanism of the inner trip. The inner trip is not the sole prerogative of the LSD traveler; it’s the universal experience of TV watchers. LSD is a way of miming the invisible electronic world; it releases a person from acquired verbal and visual habits and reactions, and gives the potential of instant and total involvement, both all-at-onceness and all-at-oneness, which are the basic needs of people translated by electric extensions of their central nervous systems out of the old rational, sequential value system. The attraction to hallucinogenic drugs is a means of achieving empathy with our penetrating electric environment, an environment that in itself is a drugless inner trip” (pp. 19–20). 5 Parsing out the senses is a very artificial/human thing that has come along quite late in our collective evolution. In actuality, they blend together to form a seamless impression. As David Abram suggests, “[t]he intertwining of sensory modalities seems unusual to us only to the extent that we have become estranged from our direct experience” (Abram, 1996: 60). 6 Abram’s thinking is heavily inspired by Maurice Merleau-Ponty, and one can’t help but be reminded here of the latter’s description of touching a table and feeling it touching him back (cf. Merleau-Ponty, 1968, on self-other identity, and the “reversibility thesis”).

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“The chemical bath in which all body cells live and of which the blood is an expression – the internal milieu – also ends up sending signals to the brain, not via nerves, but via chemical molecules, which impinge directly on certain parts of the brain designed to receive their messages” (Damasio and Damasio, 2006: 17). 8 For an up-to-date account of the general extended cognition thesis see Chemero and Silberstein (2006). 9 Mind tools can get pretty complex. Consider the following tools as forms of dynamic coupling: two approaches to the establishment of a local “boundary” for an only-child (a three-year-old boy who is beginning to wonder, and, in the process, wander). One is physical, the other more symbolic or purely informational. The first is in the form of a wooden fence enclosing the property, with two latching gates not manipulable by the boy. Now, a functionally similar boundary system might take the form of a series of demonstrations (“walk throughs”), followed by periodic gestural and verbal reminders such that the child does not stray past the equivalent delineations of the physical enclosure. Of course, depending on the temperaments of parent/s and child, the “respectability” of other kids and people in the neighborhood, and a host of other contextual details and contingencies, one system may over time prove more effective than the other in keeping the child in. But we could say, for a certain time span at least, that the two systems (the physical and the symbolic) were functionally equivalent. What’s more, we’ll likely discover that a number of additional functions emerge out of the physical fence in particular (we might call them “side-effects,” like an explicit barrier to passers-by, a visual obstacle to and from the street, the need to operate the gate for some visitors, etc.). These examples illustrate how physical and informational forms of dynamic coupling represent different approaches to rearranging the causal structure of the world. They also illustrate the necessity of a systemic/holistic outlook in coming to understand the relative success, failure and wider meanings associated with two different boundary systems. 10 As Abram points out, with language we lost a valuable concreteness to thought, but a cognitive explosion occurred in human potential thanks to the causal potency embedded in the new “situations” language allowed. A quantum leap occurred when we climbed in to language. When our forebears developed linguistic conventions to refer to things across space and over time this also helped direct actions and colored the human condition. This is the shift noted by Korzybski from the extensional orientation to the intensional orientation enabled by language. Spoken language, and then the alphabet, in turn spawned the written letter that enabled even more connections to distant others (in space and time). Writing is another example of a surrogate situation we often inhabit – with its alternative, asynchronous, one-way interactional context. Then there are the telephone

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and the television, each enabling its own kind of connections and loopings to and from distant others in what is perceived as “real-time,” and each constituting two more experientially unique situations that can also create an abstracted, ambiguous “sense of place” for the participants involved (Meyrowitz, 1985). 11 An intentional object might be the biological, on-board, or “natural” memory of an address, the same address recorded on a mobile device, or even scribbled on a well-worn matchbook. 12 Jaron Lanier, who popularized the term virtual reality, has recently taken up a critical stance regarding our new virtual experiences. In his new book You are Not a Gadget: A Manifesto (2010), Lanier observes: “The slightest change in something as seemingly trivial as the ease of use of a button can sometimes completely alter behavior patterns. For instance, Stanford University researcher Jeremy Bailenson has demonstrated that changing the height of one’s avatar in immersive virtual reality transforms self-esteem and social self-perception. Technologies are extensions of ourselves, and, like avatars in Jeremy’s lab, our identities can be shifted by the quirks of gadgets. It is impossible to work with information technology without also engaging in social engineering” (p. 4). Lanier’s insight and Bailenson’s work both extend the extended mind thesis and nicely illustrate McLuhan’s early take on the phenomenological effects of communication media as extensions, prostheses, or tools. Whether we are talking about a cell phone subscription or a Celexa prescription, similar capacities and effects may emerge out of their use, including the attenuation of feelings of anxiety or depression, or any number of new ways of seeing. 13 What might not be so obvious, however, is the degree to which these tools (objects, devices, and ideas) have causal efficacy, or consequences specific to their unique design. Because of their particular organization, our tools can alter the course of lives by variously enhancing or limiting the actions of those who are pushed to adopt, or who choose to think and work with such tools. They are part of what constitutes our “minds in the world” (McClamrock, 1995), components of a distributed/extended cognitive apparatus that both physically and informationally couples us to the surrounding environment. 14 Our new tools and the environments they represent hold both positive and negative potential and are surely consequential to human cognition, communication and action. Most of this has yet to be systematically addressed in the research, but recent experiments (see, for example, Umiltà et al., 2008) demonstrate how the primate brain can actually create new neuronal connections that explicitly map (i.e. incorporate) external artifacts into the body schema. Several recent studies report how laboratory-raised, non-human primates exposed to tool use can exhibit intelligent behaviors,

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such as imitation and reference vocal control, that are never seen in their wild counterparts. Tool-use training appears to forge a novel corticocortical connection that underlies this boost in capacity, which normally exists only as latent potential in lower primates. Although tool-use training is patently non-naturalistic, its marked effects on brain organization and behavior could shed light on the evolution of higher intelligence in humans (Iriki, 2006). It’s likely that the kind of disembodiment or re-embodiments now made possible through electronic media tend to reconfigure the way the brainbody “talks” to itself, and to the world. In other words, if mirror neurons play a role in Damasio’s postulated “as-if body loop,” and this allows for the possibility of some relatively “accurate” (mediated) simulations of the experiences of the embodied, in-context organism, there may be some hazards built into our new contexts – and especially when the cognizer is physically outside of them. Concerning different linguistic forms, it has also been observed (cf. Damasio and Damasio, 2006) that simply reading about another person doing or feeling something can also trigger activity in the mirror neuron system. The question is, to what extent, and to what effect? Does reading mitigate emotional responses by biasing activity in the left hemisphere and other rational centers of the brain as classic media theory suggests? The jury is still out, and investigators will need to look much further into these questions. In “Beyond the Flesh: Some Lessons from a Mole Cricket” (2005) Clark details the process whereby a small arthropod instinctually constructs a subterranean cavern that happens to function nicely as a super-efficient sound amplifier. When finished with the project, and positioned properly at the narrow end of the expansion chamber (both apparently and functionally it is a modified double exponential horn, or megaphone, or klipsch horn), the tiny mole cricket makes one of the loudest sounds produced by any animal alive today. This carefully-built burrow effectively enhances the little bug’s social skills – making it something of a loud-mouthed extrovert. We might say that the burrow does for the mole cricket what Prozac has been shown to do for many people who use it. According to Peter Kramer (1993), the drug makes extroverts the preferred social type. What’s more, the drug, like the burrow, impacts not only the “user,” but also all others occupying the same cultural niche in some fashion. These binaries might aptly describe different levels of explanation, but they are not discrete ontological levels. They do not exist in the world – either in us or in the environments we inhabit. See Ophir, Nass and Wagner (2009) for a good example of recent empirical tests concerning multitasking. For example, researchers at the universities at Glasgow and Paisley in Scotland collected data which suggests that as much as “one third of workers in Britain are experiencing stress as a result of emailing. Feelings of

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frustration, fatigue and general unhappiness at their work rate are apparent as many workers struggle to respond to the sheer level of emails that are being received and the perceived pressure to respond within a certain time” (MSO.net, 2007). It is interesting that this online news article points to the quantity of content as the smoking gun. Little is said of the nature of the content, the media form that carries it, or the kind of context switches often involved. What seems likely is that the effects of disembodiment (disembedding the communicator perceptually from the contexts of interaction) may be more causal here. 20 Decontexting sounds a lot like “context switching,” a term first coined by computer scientists back in the 1960s to describe discrete task processing. In a digital computational device these changes in situation or context go largely unnoticed by human users. However, in humans, such movement tends to disrupt the occurrence of flow (Csikszentmihalyi, 1990), which is often distinguished into “internal” (interoception: both cognitive and emotional) and “external” (physical) components. Internal flow describes the internal or subjective or phenomenological aspects of feeling in-tune and in-synch during a particular task. But as Damasio (1999), and Damasio and Damasio (2006) suggest, these two kinds of flow are probably much more intimately related than typically perceived. 21 McLuhan captures this general idea with his thoughts on the protective “amputation” or numbing of the senses that accompanies so much of our modern media use. “[A]ll media, from the phonetic alphabet to the computer, are extensions of man that cause deep and lasting changes in him and transform his environment. Such an extension is an intensification, an amplification of an organ, sense or function, and whenever it takes place, the central nervous system appears to institute a self-protective numbing of the affected area, insulating and anesthetizing it from conscious awareness of what’s happening to it” (1969: 5). 22 Putative structures in our brains currently dubbed mirror neurons may play a role here. Studies concerning the function of these structures in the prefrontal cortex of many animal brains, including humans, suggest that the successful use of tools requires the incorporation of objects into the body schema. That is to say, everything from a bone shard or pointed stick, to a shovel, axe, hand gun or cell phone, can function as “natural” or de facto extensions of the organism wielding the tool. The question is: can these neural structures still do their jobs effectively by way of substantially leaner or more abstract representations as in the case of an emailed or tweeted description of an emotional state? Indeed, the full (bodily) response is not present in such instances. It is unclear then, as yet, just how mirror neurons encode information. For instance, do they work like “digital” on-off switches, or can they trigger something more akin to a gestalt impression? Whatever the case, it seems worthwhile noting that we rarely see a person

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reacting to a spoken or written description of, say, someone biting into a lemon in the often very physical way seers of a lemon-biter do via TV or film or even snapshot. Communication researches should also note that Mead’s (1934) notion of the social self capable of “taking the role of the other” is significantly bolstered by the mirror neuron hypothesis, with the likelihood that we do so automatically under normal conditions. Along with McLuhan, Mead seemed to be requiring some yet-to-be-discovered somatic mechanism like the mirror neuron system well before the science pointed in that direction. McNeill (1992) suggests that “the crucial shift in the function of mirror neurons occurred when they began to respond to significances other than the actions themselves,” (p. 40) and refers explicitly to Mead who argued that “[g]estures become significant symbols when they implicitly arouse in an individual making them the same response which they explicitly arouse in other individuals” (p. 250). Hence, meaningfulness emerges from the ability to activate a social reaction of another in yourself, a way of reacting in your own actions similarly to the actions of others, which McNeill denotes Mead’s loop (in Lindblom and Ziemke 2008: 9). The new science of mirror neurons is also discussed briefly in the final chapter of this book. 23 There is a similar confusion between information and knowledge today. In the introduction to this volume I described the origin of the term noosphere which was, for Teilhard de Chardin (1955), akin to the “collective consciousness” of human beings that comes about through the interaction of human minds. While the concept has been hastily associated with the Internet recently, upon closer reading, it is Toffler’s use of the term “infosphere” that seems more in line with the current instantiation of the Internet. Indeed, stimulation is not necessarily information, information does not always mean knowledge, and Teilhard’s noosphere is not synonymous with Toffler’s infosphere. 24 Whether we directly experience, watch, read about, or merely think of something or someone, we can get similar activity in the somatosensory regions of the brain (in the prefrontal cortex and, specifically, the anterior intraparietal sulcus). It would seem that, as a central processor, the brain is easily duped by functionally similar stimuli and the chemical equivalencies they trigger. This duping – and doping – occurs in tandem with subtle changes in the internal milieu and is attended by a whole cascade of neuro-physiological events. Working beneath all of this is what Damasio calls the “body loop” and “as-if body loop” systems. Despite the faithfulness of the latter, with its “somatic markers,” and the distributed “dispositional representations” they encode in the brain, we may not receive the same clear signals afforded us in these “as-if,” “extended,” “surrogate,” or virtual communicative/perceptual situations (i.e. those created in applications like email, Facebook, or even Second Life).

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References Abram, David (1996). The Spell of the Sensuous. New York: Vintage Books. Bateson, G. (2000). Steps to an Ecology of Mind. Chicago. University of Chicago Press. Bergson, H. (1910). Time and Free Will (F. L. Pogson, trans.). London: Allen and Unwin. Chardin, Teilhard, P. (1955). The Phenomenon of Man. New York: Harper Perennial. Chemero, T. and M. Silberstein (2006). “Defending Extended Cognition.” http:// philsci-archive.pitt.edu/archive/00003204/ Clark, A. (1996a). Putting Brain, Body, and World Back Together Again. Cambridge: MIT Press. Clark, A. (1996b). “Linguistic Anchors in the Sea of Thought.” Pragmatics and Cognition 4(1): 93–103. Clark, A. (2003). Natural Born Cyborgs. Oxford: Oxford University Press. Clark, A. (2005). “Beyond the Flesh: Some Lessons from a Mole Cricket.” Artificial Life 11(1-2): 233–44. http://www.philosophy.ed.ac.uk/people/clark/ pubs/burrowspaper.pdf Cooley, C. H. (1902). Human Nature and Social Order. New York: Scribner’s. Csikszentmihalyi, Mihaly (1990). Flow: The Psychology of Optimal Experience. New York: Harper Perennial. Damasio, A. (1994). Descartes’ Error: Emotion, Reason and the Human Brain. New York: Putnam Books.

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Damasio, A. (1999). The Feeling of What Happens: Body and Emotion in the Making of Consciousness. New York: Harcourt Brace. Damasio, A. and H. Damasio (2006). “Minding the Body.” Daedalus 135(3): 15–22. Dawkins, R. (1982). The Extended Phenotype: The Gene as the Unit of Selection. Oxford: W. H. Freeman and Company. Gibson, J. (1966). The Senses Considered as Perceptual Systems. Boston: Houghton Mifflin. Gibson, J. (1979). The Ecological Approach to Visual Perception. Boston: Houghton Mifflin. Greenfield, P. (2009). “Technology and Informal Education: What is Taught, What is Learned.” Science 323, no. 5910: 69–71. Gumpert, G. and R. Cathcart (1985). “Media Grammars, Generations, and Media Gaps.” Critical Studies in Mass Communication 2: 23–35. Horton, D. and R. Wohl (1956). “Mass Communication and Para-social Interaction: Observations on Intimacy at a Distance.” Psychiatry 19: 215–29. Iriki, A. (2006). “The Neural Origins and Implications of Imitation, Mirror Neurons and Tool Use.” Current Opinion in Neurobiology 16(6): 660–67. Kramer, Peter D. (1993). Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self. New York: Viking Press. Lanier, Jaron (2010). You are Not a Gadget: A Manifesto. New York: Knopf. Lindblom, J. and Tom Ziemke (2008). “Interacting Socially through Embodied Action.” In F. Morganti, A. Carassa and G. Riva (eds), Enacting Intersubjectivity: A Cognitive and Social Perspective on the Study of Interactions, pp. 49–63. Amsterdam: IOS Press. Logan, R. (2008). The Extended Mind: The Emergence of Language, the Human Mind and Culture. Toronto: University of Toronto Press. MacCoby, E. (1951). “Television: Its Impact on School Children.” Public Opinion Quarterly 15: 421–44. Mander, J. (1978). Four Arguments for the Elimination of Television. New York: Harper Collins. McClamrock, R. (1995). Computational Minds in the World. Chicago: Chicago University Press. McLuhan, M. (1951). The Mechanical Bride: Folklore of Industrial Man. New York: Vanguard. McLuhan, M. (1964). Understanding Media: The Extensions of Man. New York: McGraw Hill. McLuhan, M. (1969). “The Playboy Interview: Marshall McLuhan.” In Eric McLuhan and Frank Zingrone (eds), Essential McLuhan. Toronto: Anansi, 1995. McLuhan, M. and Q. Fiore, with J. Agel (1968). War and Peace in the Global Village. New York: McGraw-Hill.

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McNeill, D. (1992). Hand and Mind. Chicago: Chicago: Chicago University Press. Mead, G. H. (1934). Mind, Self and Society. Chicago: Chicago University Press. Merleau-Ponty, Maurice (1968). The Visible and the Invisible. Chicago, IL: Northwestern University Press. Meyrowitz, J. (1985). No Sense of Place: The Impact of Electronic Media on Social Behavior. New York: Oxford University Press. Minsky, M (1982). “Why People Think Computers Can’t.” AI Magazine 3(4), Fall. MSO.net (2007). “Email Anxiety for Employees.” http://www.mso.net/ EMail-anxiety-for-employees Ong, W. J. (1982). Orality and Literacy: The Technologizing of the Word. London: Routledge. Ong, W. J. (1991). “The Shifting Sensorium.” In David Howes (ed.), The Varieties of Sensory Experience. Toronto: University of Toronto Press. Ophir, E., C. Nass and E. Wagner (2009). “Cognitive Control in Media Multitaskers.” Proceedings of the National Academy of Sciences 106(37): 15583–15587. Postman, N. (1985). Amusing Ourselves to Death: Public Discourse in the Age of Show Business. New York: Penguin. Rubidge, S. (2003). “Spaces of Sensation: The Immersive Installation and Corporal Literacy.” Paper given at the 2003 International AILA Conference on Literacy, University of Ghent. http://www.sensedigital.co.uk/writing/ CorpLitGhent.pdf Strate, Lance (2006). Echoes and Reflections: On Media Ecology as a Field of Study. Cresskill, NJ: Hampton Press. Umiltà, M., L. Escola, I. Intskirveli, F. Grammont, M. Rochat, F. Caruana, A. Jezzini, V. Gallese and G. Rizzolatti (2008). “When Pliers become Fingers in the Monkey Motor System.” Proceedings of the National Academy of Sciences of the United States of America 12; 105(6): 2209–2213. Winn, M. (1977). The Plug-In Drug. New York: Penguin. Wolf, G. (2007). “Getting Things Done: Guru David Allen and his Cult of Hyperefficiency.” Wired 15(10). http://www.wired.com/techbiz/people/ magazine/15-10/ff_allen?currentPage=all Wolf, Maryanne (2007). Proust and the Squid: The Story and Science of the Reading Brain. New York: Harper Perennial. Wolpert, S. (2009). “Is Technology Producing a Decline in Critical Thinking and Analysis? Studies Shed Light on Multi-tasking, Video Games and Learning.” http://newsroom.ucla.edu/portal/ucla/is-technology-producing-adecline-79127.aspx

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Chapter Four

Sex-Drug Technologies: A Media Ecological Approach to Birth Control and ED Drugs Valerie V. Peterson*

“Technology proposes itself as the architect of our intimacies”

– Sherry Turkle (2011)

Humans have used drugs for thousands of years. Drugs have been featured prominently in religious and social rituals, they have been taken for sport, and they have been used to achieve a variety of consciousness states. The effects of these chemical media have intensified over time, as innovation, research, and development have brought forth powerful new drugs that can treat illness, cure disease, ease pain, affect consciousness in new and different ways, and induce new and ostensibly better states of awareness. In this sense, drugs “extend” humans, but this extension is one that permeates bodies from within, altering those who take them “from the inside.” At the same time, drugs extend the world. This is because human bodies are part of the world – and because humans beings are the kind of beings that tend to name, understand, and constitute the world as their world in particular. In other words, by means of what they do “in” us humans, drugs change the nature of that which we experience and think we know about “outside” of us. Drugs used for sexual and reproductive control significantly challenge boundaries of “inside” and “outside.” These drugs include erectile dysfunction (ED) drugs such as 83

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Cialis, Levitra and Viagra and hormonal forms of birth control like the birth-control pill, shot, implant, and patch. Defined as treatments, medicines, or drugs, sex- and reproduction-related drugs are not typically thought of as communication media. But this classification/characterization is not as far-fetched as it may initially seem. Most obviously, sex- and reproduction-related drugs affect human communication because sex is itself a communicative process. Like dancing, gender performance, and other arts of performance and gesture, movement can be meaningful and even “readable,” depending upon the context. In such arts, drugs are often used to control, shape, alter, and enhance communicative behavior. Beyond these more obvious effects, however, sex- and reproduction-related drugs significantly alter perceptions of space and time, individual capacities, understandings/conceptions of self, and understandings of the world. This is true not only in those who use the drugs, but in those who live in cultures where substantial numbers of other people use them. In other words, the widespread use of sexand reproduction-related drugs alters not only small-scale social relations but also large-scale social relations, and social reality itself. Along with clothing, money, clocks, housing, personal computers, satellites, cell phones, email, and a host of other technologies, hormonal means of contraception and ED drugs deserve consideration as significant media with profound implications for the modern and postmodern era. To this end, this paper explores human vulnerability, media as environments, “drugs as media,” the space/time effects of sex-related drugs, and implications of sex-drug mediation for human relations and human possibility.

Humans and Vulnerability We are all vulnerable as corporeal, biological, mortal beings, and most people find at least some of their own vulnerabilities hard to accept. Certain facts, however, are unavoidable: we have bodies that need food and air and shelter from the elements. We can be harmed physically, by other people or by animals or by forces of nature, as well as by allergies or microbes or viruses. These and other dangers confirm to us that we are not always the “masters of our own house.” But it is remarkably easy to forget about these vulnerabilities when we feel safe and are not in pain and have enough food and drink and sleep. We also forget about vulnerabilities when we exhibit talent and prowess. In these moments, we experience bodily transparency – a state in which our bodies recede from our conscious awareness (Leder, 1990). When our desires are thwarted, however, or when disability, pain, hunger, exhaustion, weakness, or fear take hold of us and remind us of our limitations, the body can come forcefully into view, demanding our attention and making us deal with it as an object. Human vulnerability is also symbolic. Unlike other animals, whose artifacts have a direct physical use in the promotion of vital ends such as nutrition,

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reproduction, and hibernation, humans are “symbolical beings,” capable of creating cultural practices and technologies that help ensure our basic survival and needs. Humans also regularly traffic in the “biologically useless” realms of image and eidos (ideas and ideals and appearances), and we regularly concern ourselves with matters beyond simple physiological subsistence of organism and species (Jonas, 1979). Through symbol-making and symbol-using, humans create both shared and individualized realities and, as a consequence, respond to and can be vulnerable to more than just the immediate physical world. Our use of time tenses and our understanding of “deep time” are part of this equation. So, too, are the imagination, and forethought that the understanding of deep time makes possible (Shlain, 2003). These capacities open up whole new worlds of possibility, with whole new ways that we might find ourselves vulnerable. The common playground phrase “sticks and stones may break my bones, but words will never hurt me!” points to just these facts: Even as the speaker of the mantra denies the power of symbolic action, he or she acknowledges it, both by bothering to address the speech of others, and by addressing the speech of others with more speech. In human experience, there is no such “thing” as a simple or discrete “thing.” Objects and people are made sense of within complex social contexts and relations that are colored by what people “know” and what they believe (Berger, 1972). Out of this mix, and aided by a perspectivalism that is informed by scientific and technological developments, “individuals” have emerged, with histories, hopes, ideas, and interpretations (Royce, 1967). These individuals, driven by questions such as, “Am I normal?” “How can I be whole?” “What makes me different?” “How do I look to others?” “What does this [event, action, statement] mean?” and “What does ‘all this’ mean?” both assess the past, and potentially shape the future. Not all humans are equally vulnerable, nor are they vulnerable at the same times or in the same ways. Bodies of young people and old people, male and female bodies, and healthy and disabled bodies differ. Another way to put it is to say that we have created categories like male, female, disabled, young, and old for good reasons, despite the fact that human bodies are more similar than they are different, and despite the fact that it is best to consider humans, first and foremost, as humans. Problems often arise when differences between bodies are thought of as “differences from” a politically or culturally dominant type, or a type posited as the “ideal” or “normal” case (Reeder, 1996). Problems also arise when the vulnerabilities of dominant groups receive more attention than those with less public sway.2 An interesting case is when media are intentionally or unintentionally used to help alleviate vulnerability in one group or “type” of body so that those bodies are more like the other “types” or the dominant “type.” These mediations are

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interesting not only because they can shift the balance of power in interpersonal relations, but because their impact can manifest itself in significant and surprising new ways in broader social hierarchies, communities, and cultures. People do not typically like being vulnerable. But vulnerability in and of itself is not simply good or bad. Do we want to be vulnerable to physical or emotional suffering or disease or pain? The easy answer is “No.” But intimacy requires an “opening up” of the self to others – and the courage to deal with the consequences. When we let new people into our lives, be they children or lovers or friends, we open ourselves up to potential sufferings and diseases and pains. Avoiding these hardships would require living completely inviolate lives – lives closed off to intimate encounters with others. Such lives may appear outwardly successful, but they seldom build character and are often emotionally shallow. Such people aren’t particularly fun to be around, and tend toward bland, negative, and even hazardous social relations. Vulnerability, on the other hand, can afford us a means by which to grow in our humanity and humility, and to appreciate and practice virtues like compassion and gentleness (Nussbaum, 1986). Vulnerability, in short, is what makes us human. A few readers might object here, arguing that, soon, the acceptance of vulnerability will no longer be necessary. Transhumanists, in particular, seek to liberate the human race from its biological constraints. More specifically, transhumanists advocate the funding of research in medicine and technology that would radically undermine vulnerability by extending life span, improving memory, and enhancing other bodily capacities. They see advances in these areas as a great humanitarian opportunity to genuinely improve the human condition (Bostrom, 2005). However, without sufficient compassion or ethics to accompany such advances, inequities in financial resources, disparate access to health care, and human preferences and biases would only extend the distance between the “haves” and “have nots” in terms of both sociopolitical power and life itself. What the transhumanists fail to recognize is that the compassion and ethical sensibilities necessary to steer the responsible application of medical and technological advances are intimately tied up with vulnerabilities of the body, and that eliminating these vulnerabilities would substantially disable the very means by which “humans” make “humane” decisions.

Media as Extensions and Environments Vulnerability is intimately related to media ecology because media are, among other things, extensions of the human body. One of the ways media extend the human is by reducing human vulnerabilities in different ways. In Understanding Media: The Extensions of Man, Marshall McLuhan discusses how media extend

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human senses, human capacity, and the broader human landscape. Elaborating on what he means when he says the “medium is the message,” McLuhan writes, “the personal and social consequences of any medium – that is, of any extension of ourselves – result from the new scale that is introduced into our affairs by each extension of ourselves, or by any new technology” (1964: 23). This means a medium’s “effect” is not simply the messages it conveys (in the way a telegraph line conveys a series of signals), but the way it shapes, and through continued use, re-shapes or augments human existence (e.g., in the way the telegraph standardized time zones, spawned futures trading, and coordinated high-speed travel). Media extend the human by affecting the senses. As McLuhan and Fiore write, “by altering the environment, [media] evoke in us unique ratios of sense perceptions. The extension of any one sense alters the way we think and act – the way we perceive the world” (1967: 41). McLuhan also pointed out that “the medium is the message.” One implication of this statement is that newly developed media mirror earlier media (use conventions from older media), partly so that users might benefit from some form of continuity across change. “The ‘content’ of any medium,” writes McLuhan, “is always another medium” (p. 23). McLuhan explains how users of media are not simply using “tools” to their own ends, but are themselves “used” by media, when media become environments – even when individual persons may choose not to use a medium. “Technologies,” McLuhan writes, “begin as anti-environments, as controls, and then become environmental (1969a: 30–31). While media may start as tools, they do not stay that way. Eventually, they become environments that we may take for granted or forget about, and that, among other things, carry forward previous technologies. Or, as McLuhan puts it in Take Today: The Executive as Dropout, “Man is an extension of nature that remakes the nature that makes the man” (McLuhan and Nevitt 1972: 66). In these and other commentaries, McLuhan not only explains what media are and how humans relate to them, he illustrates how specific technological advances in history qualify and have “played out” as “extensions of man.”

Media Ecology and Drugs A number of scholars have explored the effects of drugs or medicines (e.g., Alpert and Dass, 1971; Leary and Potter, 2001; McKenna, 1992; and Weil, 1973), but few present their observations explicitly in media ecological terms. McLuhan refers to drugs and alcohol in his writings, but often briefly, in the context of a probe, interview, or tetrad.3 In Laws of Media, McLuhan and McLuhan do write one sentence specifically about the pill: “‘The Pill’ tends to banish insecurity and uncertainty, while enhancing the ‘programmable machine’ approach to the body and numbing the user to its more human (fallible) dimensions, thus providing an

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amoral base for promiscuity” (1988: 99). This is a rich sentence, indeed; however, it is both the beginning and the end of the discussion. In Marshall McLuhan’s other writings, and in other media ecological scholarship, communication media as traditionally understood (printing press, telegraph, books, computers, etc.), receive the most comment, probably because these media convey spoken speech or written words (their content is a familiar prior medium or media). Other media studied are highly visible and primarily mechanical (e.g., clocks, automobiles and highways, etc.) and may have been used as exemplars because they are easy to see, or easier to think of as “public” technologies, or perhaps because drugs were simply not as pervasive or normalized as they are today.4 With the growth of the pharmaceutical industry and the proliferation of drug use in the U.S., it is worth addressing drugs as the technologically and socially significant media that they are. My specific concern is with drug technologies related to the control of sex and reproduction. While a broader treatment of relevant sex technologies would also focus on sexual apparatuses (physical sexual aids and sex toys), or barrier methods of contraception (IUD, diaphragm, condom, vasectomy, female sterilization methods, etc.), the focus here is on pharmaceuticals and their unique qualities. Erectile dysfunction (ED) drugs (e.g., Viagra, Levitra, Cialis), and hormonal forms of birth control such as the patch, pill, implant, or shot (e.g., Ortho Tri-Cyclen, Seasonale, Depo-Provera) are both highly effective, easily concealed, non-mechanical, and fully reversible means of altering sexual situations. Unique space and time alterations brought about by these technologies significantly affect both what people imagine as possible for themselves, and what they imagine is possible for others.

Sex, Space, Time, and Vulnerability While men and women are vulnerable in many similar ways, they differ in average body size, hormones (and their consequences, including aggression, lactation, and menstruation), and the sensitivity of their sex organs to physical injury. Areas of vulnerability more closely related to the sex act and procreation include fertility and the design and behavior of sex organs. Fertility is a kind of power, especially when a baby is wanted. In some cultures, having a baby (or babies) is the first step toward a secure old age. In others, having a baby is a status symbol, or a rite of passage into adulthood and the practices of family. Numerous stories, myths, and legends have valorized maternity and motherhood, and the importance of mothers in the lives of their children. When mothers and mothering are supported both materially and socially, and when mothering is combined with adequate social status, motherhood can be

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a significant and influential social role, not only for the children of particular women, but in and for the broader community. But in capitalist cultures, being able to have a baby (and having babies) is not always an advantage, and it is clearly a disadvantage when the demands of/desires for pregnancy and childrearing interfere with demands of/desires for achievement in education and/or gainful employment. Poor social support for childrearing, expectations of mobility in the work population, and lack of dependable health care do not improve the situation. Under these circumstances, and if there is low social status, few resources, little social support for mothering, and/or little or no desire to conceive a child, fertile women may be at both personal and social risk when they engage in sexual intercourse. Some people have addressed these circumstances with strict religious doctrine, which includes abstaining from sex before marriage. We know however, that what is espoused in theory is very often not carried out in practice. Others regard contraception as an ethical necessity in any situation where sexual relations might lead to an unwanted pregnancy (Borowitz, 1969). Not surprisingly, women interested in their own personal and social well-being who do not have or use birth control are more likely to take a defensive stance when it comes to sexual intimacies, and women (and some men) who are sexually active and do not want children, or who are not in a situation conducive to child-bearing and childrearing, are more likely to make use of contraceptives (Matteson, 1995). Hormonal contraceptives, used correctly, make unintended pregnancy much less likely. They extend the “logic” of the condom – a logic which says “no” to pregnancy – but unlike condoms and other barrier, mechanical, or surgical methods of birth control, hormonal contraceptives (drugs) require paying close attention to the clock and calendar. Having a shot or hormonal implant means making and keeping appointments for shots or procedures at regular intervals. Using a contraceptive patch means remembering to refill prescriptions and replace patches. Using the pill means remembering to take a pill once a day, every day, at the same time. And all methods require engagement with the medical and pharmaceutical industries, extending the reach of corporations and institutions into the private lives of those who use them. These practices also extend the effects of the modern clock by shifting a woman’s attention from the cyclical time of her menstrual cycle (and the moon) to clock time and the weekly and monthly calendar (Shlain, 2003). The shift from cyclical to clock time is good for capitalism and employers because it creates more predictable female wage-workers, and thus more workers overall, but it also adds new pressures and expectations on women workers to regularly power through the physical and physiological challenges of menstruation, to be child-free, and/or to time pregnancies effectively and wisely (D’Emilio and Freedman, 1988).

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This same logic also explains the huge upsurge in C-section deliveries in the U.S. over the last several decades. While not directly related to hormonal contraceptives, the shift from cyclical to clock time afforded by hormonal contraceptives makes it easier for doctors and insurance companies to press for more predictability – and revenue – in the birthing ward. Mothers also may want to know exactly when the baby will arrive so they can attend to other things in their lives. The use of hormonal contraceptives means not only that women are more able to see themselves as taking other than a defensive stance toward sex, but also that women and men may be more able to practically and philosophically separate sex from procreation (Russell, 1970). Under these circumstances, meanings and practices of sex proliferate: from sex as pleasurable physiological activity, baby making, and survival of the species; to sex as sport, or performance, or fetish, or social ritual, or interpersonal communication. As meanings of sex proliferate, the significance of paternity, female chastity, marriage, and the patriarchal nuclear family are undermined.5 A side-effect of hormonal contraceptives, however, is an increased susceptibility to sexually transmitted diseases. This is because when women are using hormonal contraceptives, they (and their sexual partner/s) may and often do opt for having sex without barrier methods of protection (specifically condoms). If these women are not monogamous (and some are not), and/or if their partner/s are not monogamous and fail to use condoms, then both the women and their partner/s increase their risk of getting an STD. Thus, what started as a reduction in vulnerability to pregnancy, results in an increased vulnerability to diseases, some of which are more harmful to women than to men (e.g., HPV).6 A different but in some ways related matter of sex and sexuality is the use of erectile dysfunction (ED) drugs to stimulate/create erection. Unlike women’s arousal, which may be more easily hidden or faked, men’s sexual arousal, when translated into an erection, is more obvious (it is a “space” or “spatial” issue). There is also the somewhat related matter of sexual performance, which may include erection, relative size (or “fit”), fitness, talent, style, and other elements. When problems of fit arise, men are often blamed (they are the ones accused of being “too small” or “too large”) even though there is also reason to blame women for this aspect of interaction, since women’s bodies also vary in terms of space (ability to accommodate). In general, it is easier to blame what is more easily seen. In its crudest form, intercourse requires readiness of the male sex organ more so than it requires the readiness of female sex parts. This is because a woman may take part in intercourse regardless of the readiness of her parts, and, hence, her

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parts are not as often accused of “failure.”7 Intercourse may also require that a man know his body well enough that he may, to some degree, control his private parts, especially if he is interested in having intercourse contribute to his partner’s sexual pleasure. But private parts are not always so obedient. Time and timing are part of the matter. A person may desire sex and feel as though it’s a good time for sex, but their partner may not be interested, or some other element of the context may not be right. Or sex may be desired but bodies or body parts may not be ready or willing. During sex, time and timing can also relate to the pacing of arousal and satisfaction (aesthetics of form), and may be further complicated by age, mental state, the effects of alcohol/drugs/medications, sexual experience, level of intimacy, and other factors. The vulnerability associated with erections is suggested in many ways across cultures, from boasts and overcompensations to all kinds of personal and social ridicule. Concerns about size, control, sexual performance, and timing can be seen in dirty jokes, gossip, home remedies, and comedy routines. Men’s contribution to female sexual pleasure has received comment from authors of sacred texts, sex manuals, and self-help books, as well as by matchmakers, sex/marriage therapists, and TV talk show hosts. Not surprisingly, interest in pharmaceutical treatments for erectile dysfunction has been high, and man/ men are using them. ED drugs such as Viagra, Levitra, and Cialis are now used not only by patients with significant symptoms and legitimate need, but also by more “average” consumers who use the drugs for consistency’s sake, as a crutch, or just for sport. In all these cases, ED drugs control time by making time and timing less of an issue. They help make every moment a potentially sexual moment, a moment that can be chosen regardless of other situational factors. ED drugs also help keep sexual focus on the penis and (re)assert its importance to women’s sexual pleasure. The dependability ED drugs afford ensures that at least the erection part of a man’s sexual performance is no longer a worry or a concern. With such drugs, male body parts are made more obedient, and an age-old form of male vulnerability is undermined/alleviated.7

Conclusion There are two significant consequences of sex drugs such as hormonal forms of birth control and ED drugs. First, sex-related drugs narrow the gap between men’s and women’s sexual vulnerabilities (and, thereby, between men and women) by extending women’s control over their own reproductive functions and giving men more sexual reliability. The logic of the condom, “No procreation with you” is also the “message” of hormonal contraceptives, but hormonal contraceptives’

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increased effectiveness and less mechanical requirements extend and add nuance to this message. With hormonal forms of contraception, pregnancies and families are more easily planned, work and family can be more easily reconciled, and the meanings of sex proliferate. At the same time, ED drugs make the male sex organ less fickle and more reliable. It is worth noting that ED drugs may have the added effect of bolstering male dominance and heteronormativity, by once again putting the penis front and center in sexual practice – this time through its pleasure-bringing function. At the same time, the gender similarity won by hormonal forms of birth control comes at a cost of increased STDs, one which plays out as a “disease dissimilarity” that burdens women more heavily than men. Second, sex-related drugs increase men’s and women’s sense of self-control and self-cause. In the same way that antidepressants give people with mental illness ways to control and mediate their moods, and insulin gives people with diabetes a way to control and mediate their sugar levels, sex-related drugs allow men and women to take control of their bodies and make changes to their bodies that they see as advantageous. The effect of this separation of “self ” from “body” (of mediating – of putting something “in-between”) is both empowering, and debilitating. It is empowering because an autonomous self is born out of the experience, one who can craft a life more to his or her own liking. It is debilitating because the separation of “the self ” from “the body” is an artificial (analytic) distinction that will ultimately be revealed as a ruse when a serious loss of control (e.g., severe accident, illness, death) is unavoidable. The proper reaction to these consequences is not to try to recapture a “better time” of sexual vulnerability – one before birth-control and ED drugs when sex relations and gender roles were clear and unproblematic. History tells us that no such “better time” ever existed. Instead, I have argued that sex-related drugs, as perceptual and experiential mediators of time and space, afford men and women new ways of existing in the world (sexually and otherwise), alter the sexual equation between men and women, translate old ideologies into new social and cultural contexts, and extend human experience and human relations. Shared and special vulnerabilities are the basis of humanity and of humanism – they help us recognize our indebtedness to each other, and our mutual interdependence. By eliminating vulnerabilities from our bodies, our lives, and our relationships, we may deceive ourselves regarding how much power and control we have over ourselves, and may undermine our ability to come close to and really know and love other people. Of course, there are benefits to reducing vulnerabilities, especially vulnerabilities like debilitating pain and extreme suffering.

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Hormonal methods of birth-control and ED drugs offer disadvantages and advantages to those who live in their environments. The inflated self-cause, heteronormativity, and dangers of disease they introduce are balanced by the new intimacies and social relations that their mediation and partial restructuring of the sex/gender “playing field” make possible. Both are “messages” of these media. Women and men are vulnerable in many of the same ways, because women and men are both human. The more sex-related drugs undermine differences between women and men, the more our vulnerabilities coincide. This need not be a bad thing. We need to think carefully about vulnerability, our own vulnerability, others’ vulnerabilities, and the social effects of technologies that influence human vulnerability in general. Instead of trying to recover earlier pre-technological vulnerabilities, or exploit existing vulnerabilities, or create new vulnerabilities in perpetual power plays, we might, instead, spend our energies trying to ensure that the way we negotiate, alter, and mediate our vulnerabilities leads us toward rather than away from healthy intimacies and a deeper humanity. TETRAD: Hormonal Birth-control Drugs Enhances Reverses Non-procreative sex for women Wage worker sex roles Sexual activity Desire for parenting Orgasms Retrieves Obsolesces Androgyny of youth condoms/diaphragms STDs “the withdrawal method” prostitution

Notes *

Author’s Note: Some ideas in this chapter are drawn from an essay published in Explorations in Media Ecology 9.1 (2010), and also from a short chapter on vulnerability in Sex, Ethics, and Communication (Cognella Academic Press, 2011). 1 Compare, for example, the amount of money in the U.S. spent on finding a cure for male-pattern baldness to money spent on heart disease prevention in women. 2 See the Playboy interview (1969b) and also the tetrad “Drugs: e.g., tranquilizers” in Laws of Media (McLuhan and McLuhan, 1988: 141). 3 Though birth control affects all “mankind,” it is more closely associated with women in the popular mind (even with regard to condom use and

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vasectomy). Women more often weigh the virtues of various contraceptive methods, speak of them during physical examinations, buy them, and ensure their use. The lack of scholarly attention given to birth control, then, may be a consequence of associating “mankind” with men (Moulton, 1977), and birth control with women. Two exceptions to this are Bertrand Russell’s Marriage and Morals (1970), which discusses sex and population control in relation to family and the state (that is, ecologically) and Lewis Mumford’s discussion of population control and rubber in Technics and Civilization (1934). Had hormonal methods of contraception been developed and widely used in Mumford’s day, it is likely he would have recognized and commented upon their significance. 4 For more on this, see Peterson (2010). 5 Sexual failure in women is usually called “frigidity,” and has to do with arousal and orgasm, but while a woman’s arousal and orgasm are desirable sexual responses, the lack of these responses does not interfere with the mere accomplishment of the act of intercourse. 6 It is also worth noting that because of the design of their sex organs, women are more susceptible to infection from STDs than are men. Preferring pharmaceutical methods of contraception to barrier methods (which lessen physical contact and the transmission of disease) can exacerbate this vulnerability. 7 See MacDougall (2006).

prostitution

References Alpert, R. and R. Dass (1971). Remember: Be Here Now. San Cristobal, New Mexico: Lama Foundation. Berger, J. (1972). Ways of Seeing. London: British Broadcasting Company and Penguin Books.

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Borowitz, E. B. (1969). Choosing a Sex Ethic: A Jewish Inquiry. New York: Schocken Books. Bostrom, N. (2005). “In Defense of Posthuman Dignity.” Bioethics 19(3): 202–214. D’Emilio, J. and E. B. Freedman (1988). Intimate Matters: A History of Sexuality in America. New York: Harper & Row. Jonas, H. (1979). The Phenomenon of Life: Toward a Philosophical Biology. Chicago: University of Chicago Press. Leary, T. and B. Potter (2001). The Politics of Psychopharmacology. Berkeley, CA: Ronin Publishing. Leder, D. (1990). The Absent Body. Chicago: University of Chicago Press. MacDougall, R. (2006). “Remaking the Real Man: Erectile Dysfunction Palliatives and the Social Re-construction of the Male Heterosexual Life Cycle.” Sexuality & Culture 10(3): 59–90. McKenna, Terence (1992). The Archaic Revival: Speculations on Psychedelic Mushrooms, the Amazon, Virtual Reality, UFOs, Evolution, Shamanism, the Rebirth of the Goddess and the End of History. San Francisco: Harper and Row. McLuhan, M. (1964). Understanding Media: The Extensions of Man. Cambridge, MA: MIT Press. McLuhan, M. (1969a). Counterblast. New York: Harcourt, Brace & World. McLuhan, M. (1969b). Playboy interview: Playboy Magazine (March): 26–27, 45, 55–56, 61, 63. McLuhan, M. and Q. Fiore (1967). The Medium is the Massage: An Inventory of Effects. Corte Madera, CA: Ginko Press. McLuhan, M. and E. McLuhan (1988). Laws of Media: The New Science. Toronto: University of Toronto Press. McLuhan, M. and B. Nevitt (1972). Take Today: The Executive as Dropout. New York: Harcourt, Brace, Jovanovich. Matteson, P. (1995). Advocating for Self: Women’s Decisions concerning Contraception. New York: Harrington Park Press. Moulton, J. (1977). “The Myth of the Neutral ‘Man’.” In M. Vetterling-Braggin, F. Elliston and J. English (eds), Feminism and Philosophy, pp. 124–37. New York: Littlefield, Adams and Co. Nussbaum, M. (1986). The Fragility of Goodness: Luck and Ethics in Greek Tragedy and Philosophy. New York: Cambridge University Press. Peterson, V. (2010). “Birth Control: An Extension of ‘Man’.” Explorations in Media Ecology 9(1): 1–20. Reeder, H. (1996). “A Critical Look at Gender Difference in Communication Research.” Communication Studies 47(4): 318–30. Royce, J. (1967). “Perception, Conception, and Interpretation.” In The Problem of Christianity, pp. 109–163. New York: Archon Books. Russell, B. (1970). Marriage and Morals. New York: Liveright Publishing Corporation.

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Shlain, L. (2003). Sex, Time and Power: How Women’s Sexuality Shaped Human Evolution. New York: Viking Press. Turkle, S. (2011). Alone Together: Why We Expect More from Technology and Less from Each Other. New York: Basic Books. Weil, A. (1973). The Natural Mind: A New Way of Looking at Drugs and the Higher Consciousness. New York: Houghton Mifflin Harcourt.

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Chapter Five

ED Drugs and the Re-making of the Real Man* Robert C. MacDougall

Introduction “Man is an extension of nature that remakes the nature that makes the man” – McLuhan and Nevitt (1972)

The commercial explosion of sexual enhancement drugs over the past fifteen years has contributed to a discursive reformation of male sexuality that is showing no signs of slowing.1 This chapter focuses on the case of men’s aging sexuality since that has been the steady subject of so many large-scale advertising campaigns of late in the United States and abroad. The aim of this analysis is two-fold. First, I provide a critique of marketing trends set in motion by the pharmaceutical industry and suggest how the popularity of Viagra, Levitra, Cialis and other male sexual enhancement drugs may be contributing to a troubling development spanning what I call elsewhere in this volume the “psycho-cultural” continuum. These include a popular move toward a matter-over-mind outlook regarding general health issues, and an emerging, if still largely understudied, phenomenon: the reconstruction of aging as a treatable medical problem. Second, I point to a continued drift toward social individuation in the United States wherein people are progressively being urged to isolate themselves (physically, psychologically, and emotionally) from each other, and from the wider collective. Both of these trends reify a kind of Cartesian 97

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mind-body dualism that further decouples an already alienated male psyche from the idea of romantic love, and removes him from the context of intimate relationships. While there is a corner of popular opinion that casts erectile dysfunction (ED) as a primarily psychological problem, difficulties with achieving erections are real and find root in the natural aging process. There is, indeed, a natural physical aging process that impacts a predictable array of bodily functions. However, this fact has been marshaled in a disproportionate and unprecedented way by the medical and pharmaceutical establishments. For the latter, one of the things this ensures is the maintenance and even expansion of a patient base that generates tens of billions of dollars annually in the United States alone.

Business as Usual Pharmaceutical giants like Pfizer continue to champion their drugs. In this case Viagra, the “Pfizer Riser,” is their answer to ED released in 1998. Much like its competitors, the drug more or less guarantees erections for between $10 and $20 a dose. However, the commodification of sex and sexuality is hardly a new business. Similar claims, and similar bargains, have probably been around for thousands of years. But aphrodisiacs, potency supplements, and sexual elixirs of ancient lore – from hot peppers and goat genitals to rhino horns and shark fins – have given way to a new and very powerful mix of chemical engineering, medical diagnostics, and sophisticated integrated marketing techniques enabled by our modern media ecology. The discussion that follows concerns the way natural physical processes are being systematically problematized today through the manipulation, dissemination, and recycling of verbal and non-verbal symbols.2 On this view, Viagra, Cialis, and other ED drugs are being sold as antidotes to combat the process of aging as much as solve any specific type of medical problem. Sex and ideas about sexuality form a discursive field within which the manipulation of symbols takes place, and it is within this new information environment that virtually every man will suffer from this new problem of aging. Current thoughts on the matter from industry and medical experts, as well as semiotic, content, and rhetorical analyses of several Viagra advertisements illustrate the connection between ED drugs and aging. A discussion of some of the social and philosophical ramifications of this trend in the medical and pharmacological marketing industries, as well as suggestions for future research, conclude the chapter. Some excellent work that began the millennium remains pertinent. Researchers examined intersections between medicine, aging, and sexuality, including Fishman (2001), Fishman and Mamo (2001), Loe (2001), and Marshall (2002).

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Fishman and Mamo (2001) analyze national marketing content and provide a social critique of recent sexual disorder products and suggest a reiteration of the dominant narratives of masculinity and femininity. However, several important questions associated with the ED phenomenon seem to remain unresolved in the literature. For instance, if it is a truism that we are medicalizing phenomena that are a part of nature (or, specifically, a part of the natural aging process), are the medical establishment and advertising industries complicit in creating individual, relational and systemic social pathologies stemming from concerns about sexual dysfunction where such far-ranging pathologies never really used to exist? Note how such a question, however compound, does not cast doubt on the existence or seriousness of the problems themselves. No one who is an astute observer really wonders whether sexual dysfunctions in general and ED in particular are real phenomena. Whatever their physical, social, or psychological etiology, sexual dysfunctions are increasingly recognized by sufferers to be a major quality-of-life problem. These problems are, no doubt, real. But have they always been so psychically and relationally debilitating? Beyond all of this, do such questions reiterate an unabashed brand of Cartesian dualism in the medical and promotional discourse surrounding these drugs? And if so, what are the wider cultural ramifications of this discursive move? Finally, moving beyond the conventional stereotypes, are men’s sexual responses in reality so much less complicated than women’s? The upshot today seems to be that, for many afflicted, if there is a drug that can help, then not much else matters. Where one’s sexual health is concerned this perception seems to be at its strongest. As modern medicine, sanitation technologies and diet have extended life, most people also feel a powerful need to add to the quality of that longer life. Viagra and all of its cousins certainly seem like a great idea. In August of 2003 the FDA approved Bayer AG and GlaxoSmithKline’s Levitra for prescription use in the United States. A third option, the faster-acting and longer-lasting Cialis, hit the market several months later. What has been dubbed Le Weekend in France and The Weekender in Australia has become the same in the USA. Some close reading of ED drug marketing content and an analysis of the media employed to disseminate these messages suggest a reformatting of the masculine persona is well underway. It is arguable that while the heterosexual man is still being portrayed as a rugged individualist, that hyper-masculine persona is being destabilized as a subject position in recent “lifestyle drug” media campaigns targeting men across the lifespan. A full-page, full-color Viagra advertisement found in Men’s Health features a forty-something African American man who commands the viewer’s attention. Pfizer’s little blue rhomboid pill is highlighted in the top right-hand corner of the ad frame. The primary text above the gentleman’s head reads: One awkward

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moment with my doctor ended two awkward years with my wife. The text detailing his narrative continues at chest level: With VIAGRA she and I have a lot of catching up to do. The man is alone. He wears a leather aviator’s jacket and khakis and appears to be in his garage. He exudes an Indiana Jones style and manner. His left leg is supported by a tool box perhaps, or a small stool. He smiles fiendishly at the camera. Well, he should be smiling. For one, there’s a little red sports car in the background. It is a vintage roadster. If the make and model are not obvious, the car screams of self-indulgence. Extending this idea, we suspect our hero will get another kind of action tonight. But have he and his wife not been getting along until recently? Have they been apart, literally? It is as if he has returned from a long trip in his car. While he mentions his wife, and while he wears a wedding band in the appropriate place, he is the only person in view. But what of the latent levels of the ad? What else is being implied here? The subtext of the advertisement fills in another part of the larger narrative. With VIAGRA she and I have a lot of catching up to do. Here Viagra (you know, like Niagara) functions as an interposed third in this relationship. It is indeed a ménage à trois with Viagra playing host. Like many drugs, ED drugs are, as Corey Anton asserts in this volume, “environmental in their own right, [they] basically operate as a mode of mediation, a kind of chemical third dynamically interposed within self as well as between self and world.” There is a very real sense in which these new drugs are mediating millions of relationships of various kinds around the world. There is also something about the power of science/medicine being alluded to in this advertisement. Indeed, subjecting oneself to science – while apparently painful – has served this man well. His “one awkward moment with the doctor,” with his doctor becoming a kind of savior or confessor, has allowed him to experience newfound salvation. That awkward moment seems analogous to the Catholic confessional, as science itself becomes one more religion. Michel Foucault’s genealogy of sexuality in modern society documents the close histories of the church, medical establishment, and the pathologization of the sexual body that has ensued. It would be hard to top John Desmond’s clear and succinct framing of Foucault’s history: [T]he Bourgeoisie became preoccupied with insuring and increasing the normality, health and longevity of their stock. The creation of a ‘healthy’ sexuality involved the identification and rooting out of all that was ‘unhealthy’ in the social body of the bourgeois class. This involved the construction of a ‘body’ of knowledge by medics and other experts (who were themselves of course bourgeois). The mechanism for revealing this knowledge was borrowed from the Church in the form of a confessional. People confessed their diverse problems to the medics and the medics in turn came up with a range of perversions and other unnatural sexual identities.

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Sexuality thus came to be seen as an object of medical attention, via the understanding of the etiology (cause) of ‘nervous disorders’, and of psychiatric attention, etc. (Desmond, 2002: 122)

In this ad it is the religion of the self being sold. Notions of marriage and stable relationship are more than just alluded to in this advertisement, but they are secondary – even afterthoughts. In its totality, the ad points to sex as the primary tie that binds, with Viagra (via your doctor) allowing one to get it.

Speed, Ease and a Mind-Body Problem The idea that sex – especially good sex – is an issue of mind over matter (or brain over body) has been part of popular culture for quite some time. However, before the steady approval of Viagra around the world in the late 1990s, men with erectile problems seeking to have better sex had to endure a variety of invasive procedures that were often painful and unpredictable in their results. For instance, inflatable shunts have been around for at least 50 years. Self-administered drugs that are injected directly into the penis are a bit more recent. Many observers agree that it was the injection of a chemical compound that began the shift in public attention from the therapeutic community’s psychological perspective of sexual arousal and sexual problems to the medical community’s more concrete physical approach. The watershed moment occurred at a urology conference in Las Vegas in 1983 when a scientist who’d injected a drug [probably papaverine or phentolamine] into the base of his penis before speaking, dropped his pants at the podium, walked through the aisles and allowed fellow urologists to marvel at his breakthrough. As a demonstration of matter over mind it was potent. (Verghese, 2003b: 1)

It was, in a sense, a parlor trick. However, the demonstration prompted a new way of thinking about the libido, as well as the entire phenomenology of sex. With a single shot an erection could be achieved without arousal – and, without question. If ED sufferers and continued dysfunction research suggest that there still needs to be some mental stimulation involved, the primacy of the material (read chemical) causes of impotency had, presumably, been established. Viagra takes effect in 30 to 60 minutes. A host of drug companies are working on reducing that time. The makers of Levitra and Cialis respectively claim that their pills can make an erection occur in 20 minutes and keep the “window of opportunity” open for up to four times as long as the “Pfizer Riser” (Berger, 1998). Small tablets in clinical trials across Europe can be absorbed directly into the blood

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stream under the tongue, circumventing the entire digestive circuit (which adds to the onset time, and subtracts potency from the drug’s effectiveness). “These drugs are everywhere and are bound to become ever more deeply embedded in sexuality and the culture that surrounds it” (Verghese, 2003a). Designer drugs intended to improve sexual functioning should prompt us to rethink our very basic understandings and expectations of some of the most intimate moments a human being can experience. Here again, however, the precedents run deep into our collective pasts. Chemical enhancements ranging from things as mundane as aspirin and caffeine, to modern depression and anxiety palliatives like paroxetine (Paxil) and sertraline (Zoloft) have steadily raised our expectations of human performance in terms of physical energy, alertness, mood, mental clarity, and a host of other reported benefits. One outcome of all of this is that our relationship to our bodies has undergone a significant change in the last 50 to 100 years. If mass-mediated advertising offers us a window onto the conversation a culture is having with itself, then the popular ad content we are seeing today may be reifying a potentially corrosive mind-body dualism where the individual begins to think of themselves through the lens of a machine metaphor, with chemical interventions akin to the fuel additives designed to enhance motor vehicle performance. Peter Kramer’s Listening to Prozac (1993), and Elizabeth Wurtzel’s Prozac Nation (1995) raised some serious questions around the role Prozac and other selective serotonin reuptake inhibitors (SSRIs) play as mediators of interpersonal relationships, as well as a catalyst for personal transformation. There is no question, Prozac “did more than just perk people up, it seems to have fundamentally changed many personalities, [and allowed many people to achieve] a better self than their original self ” (Kramer, 1993: 6). Earnest testimonials to that effect still abound on prozac.com; stories about finally finding “my true self ” and “the real me.” Prozac was touted early on as the magic bullet for depression and debilitating anxiety disorders; the pill for brains in need of fixing. Some equally intriguing philosophical questions are emerging around new sexual enhancement drugs. Now we enter an era when the magic bullet for sexual energy, confidence, youthfulness, and masculinity comes in the form of a pill. “In the Viagra Era large numbers of heterosexual men join the ranks of those with bodies deemed in need of fixing” (Loe, 2001). The simple mechanical fix has become the predominant metaphor in most advertisements for Viagra and its cousins. For instance, a sports/mechanical metaphor informs readers of a Levitra ad online that, with Levitra, they can “Stay in the Game,” and “When you’re in the zone it’s all good.” Being in the zone – like a quarterback nailing every pass, or a motor revving in the peak torque range of the power band – ensures top performance. Of course, as Loe (2001) points out, “consumers collaborate with medical

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professionals and pharmaceutical companies in an attempt to understand and fix ‘broken’ bodies” (p.120). Viagra, Levitra and Cialis have been a blessing for so many simply due to the fact that these drugs open up treatment options for men who until recently had little choice but to self-inject, endure quasi-medieval implant procedures, or undertake time-consuming and costly psycho-therapy programs. The first two are now becoming much less common due to the prevalence and ease of obtaining ED drug prescriptions. Regarding the third, Dr. Peter Kramer points out that during consultation sessions with their patients it “was not uncommon to hear any mid-20th century therapist suggest that your penis is smarter than you are… meaning that maybe there is something you should explore about the nature of the relationship – to find where your ambivalence lies” (Kramer, 2003). But if critics today lament the popular move toward the “pharmaceutical fix,” as driven by impatient, wishful, and overly-simplistic thinking, there was something potentially disingenuous about the “Freudian fix” as well. Do drugs like Viagra really uncouple users from their psyches? Do they make it unnecessary to come to grips with our selves? Like questions asked during the Prozac explosion almost two decades ago, these are some of the critical concerns surrounding pharmaceutical treatments of sexual dysfunction today. Such concerns become much more pressing when we consider the profound effect these new drug practices might have on the human life cycle itself. Sex until death do us part? A welcome relief, or something else altogether? The idea is generally considered a very welcome thing in the United States and Europe because our perceptions of aging have been changing in step with the progressive lengthening of the lifespan. “We’re seeing wonderful healthy examples of aging and aging sexuality and this will clearly be an asset, but I think that what has also happened is that sex has become the single most important feature of a relationship. At least this is the impression one gets when you watch television and leaf through magazines” (Verghese, 2003b). Dr. Verghese’s caveat should be noted, but the tougher cynic might wonder if this is anything new. Sex as the most important feature of a relationship? Let us evaluate for a moment what we know and feel, against what we see and hear. As one leaves adolescence behind, the importance of sexual intercourse loses some of its stature. This is not because the act itself necessarily loses any of its sensory effects, although that is sometimes the case. Rather, other features of the relationship enhance the evolving bond between persons such that sex becomes just one of many reasons why we are with a particular person. Two things are assumed in the previous evaluation. The first is that ED medication is used within the context of a relational dyad. Second, drug therapy is initiated in an effort to enhance a relationship in trouble due to, presumably, a

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flagging sex life. This is not always the case however. It is well-known that Viagra is not just being used exclusively by men with ED or even men in relationships per se. Many younger men with intact erectile mechanisms are taking the drug recreationally along with cocaine, MDMA, or amphetamines. Many gay men are using Viagra recreationally as well. In such instances these drugs are not being used to treat disease or for relational repair. In these cases ED drug use is more about enhancement, simulation, and a kind of virtual sexual reality. These trends suggest a reconstruction of sexuality in the thirties, the twenties, and even as early as the teen years is underway – a reconstruction that appears to be related to the ED drug frenzy.3 But we’ll look further into the nature of ED drug use in the context of established relationships with people beyond the age of forty since those are still the people we find most in the extant advertising material, and indeed, comprises the largest population of ED drug users. In these cases, says Bets Davis (until 2004, co-founder of the Women’s Sexual Health Foundation based in Boston) “[s]ex as the most important part of a relationship is more a media-driven myth than something based in reality … most of our clients don’t hold to this.” Nonetheless, the subtle narrative in the first Viagra advertisement featuring the forty-something African-American man (as well as the several to be discussed shortly) point to sex as the primary element securing the relational bond. All of this is occurring as we are now seeing some very energetic, healthy examples of older age and aging sexuality.4 Given some of the biological realities that may set limits on male physiology, however, the push for erections that never let you down may still be too much to ask (at the physiological and psychological levels of analysis). Considering the physiological component, the Baltimore Longitudinal Study of Aging documents in a recent issue of the International Journal of Impotency Research, how 55 percent of men aged 75 years, and 75 percent of men 80 years old, reported no erections at all (O’Leary, 2003: 190). Why, then, is there a consistent 50 percent drop-out rate with Viagra users with only some of the complaints citing unacceptable side-effects like nausea, back pain, blurred vision, etc? ED patients must not be renewing their prescriptions for other reasons as well. Pfizer admits that their drug alone does not cause an erection. It is not, after all, like the infamous “magic shot” used at that fateful urology conference in Las Vegas. This fact suggests something other than physical sexual stimulation is still required to achieve the desired results. And yet, advertisements like one paid for by the Boston Medical Group forms part of an emerging “conventional” discourse on the issue. The centered, two-inch-high all-capital, and bolded lettering reads: Sex for Life. The secondary text just beneath: Erection Problems? Premature Ejaculation? And at the third level: Immediate Results! (only one consultation usually required).

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Sex for Life? Considering adequate treatment of the psychological and emotional components, one problem that often arises is that the results various men themselves reap from Viagra (and similar drugs) differ so widely that such guarantees cannot really be made. In fact, there is no way to insure that a man in a close relationship who feels, or is led to believe, that he is not performing up to par sexually, will be able to restore the explicitly sexual component (now potentially damaged) in what might otherwise be a very meaningful and rewarding relationship. If the preceding is a reasonable enough scenario, then Viagra and other similar products that make up the larger pharmaceutical marketing edifice may actually function to increase the number of sexual dysfunction cases in the United States and abroad. This is one fairly insidious, if often invisible, effect of a focused symbol system that has insinuated itself into the wider information ecology. Another full-page advertisement for Viagra found in a recent issue of US News and World Report is again split horizontally, with a vivid image filling the top half of the page, and the detailed textual narrative and consumer information below. The little blue rhomboid is featured this time in the center-left portion of the page, between text and image. Up top we see an early-middle-aged man. That is to say, he has the square jaw, physique, blinding white teeth and subtle skin tone of a handsome thirty-something, yet his salt-and-pepperish hair betrays his being closer to an early fifty-something. He is George Clooney-esque. He wears a thickcollared knit sweater and while his torso and lower extremities are out of view, he appears to be stretched horizontally, lounging on what may be a porch sofa or hammock. His hands are above his chest, fingers interlocked. The primary text superimposed across his chest and lower shoulder reads: VIAGRA. It works for older guys. Younger guys. Even Skeptical guys. The lower half of the ad frames the secondary text, which contains a detailed, highlighted informal narrative like so: Think you’re too young for VIAGRA? Do you figure “it only happens once in a while, so I’ll just live with it”? Then nothing’s going to change, especially your sex life. See, erectile difficulties, such as erectile dysfunction (ED), are a health condition. ED can be caused by many common factors, including smoking, stress, and high blood pressure. In fact, 1 out of 3 men of all ages have ED to some degree. Fortunately, VIAGRA can help men both get and keep an erection. Which is why more than 9 million men have turned to VIAGRA to treat their ED. For more information, call 1-888-4VIAGRA or visit www.viagra.com. VIAGRA has already helped many love lives. How can it help yours?

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The emphases (bold, all-caps) are faithful to the original ad copy. Below the wording is the Viagra logo, and the compound spelled out in parentheses: “(sildenafil nitrate),” which sits above the small print detailing the common side-effects and precautions. A double-meaning associated with the idea of skepticism is discernible in the ad. In an effort to capture the attention and hopeful allegiance of all men, the young and the old are first hailed directly. The suggestion is that while the original widespread understanding of ED was as an affliction of the old, clearly younger men have been shown to suffer the symptoms as well. It is the more recent social awareness and apparent acceptance of erectile problems in the young that the ad is attempting to remind us of and bolster – that Viagra can work for you no matter your age. The other sort of skepticism being conjured in the ad is that of personal denial: Who me? What problem? I don’t have a problem! The ad anticipates this kind of resistance, and so the subject’s demeanor is defiant, his smile almost self-righteously indignant. But the ad copy hails him again, and seems to challenge him directly: So, you don’t think you have a problem eh? It is also notable that this man is alone. While he appears by himself in the image, once again (as in the first ad discussed), a ring is just visible on the third finger of the left hand. This is easily overlooked, but despite the barely visible ring, the question remains concerning precisely who it is this man might be with, or whether he is in fact presently with anyone at all. Along with the skepticism-asself-denial embedded in the text, the story being told by the imagery is ultimately more about individual satisfaction and gratification and less about any kind of gratification gleaned from a relationship. It is not about intimacy, but rather, personal satisfaction. This may be why, until very recently, men have been featured, with these kinds of one-on-one dialogues between the subject and the friendly Viagra narrator offering frank advice like a trusted buddy. Finally, then, the ad also achieves the following: it prompts this older man to suddenly see himself as not-so-old, since this is a dysfunction that obviously afflicts younger men, too. In other words, this attempt to inflate him is part of the appeal – part of how he is hoodwinked into thinking and feeling positively about the company and its product. Dr. Jennifer Berman, a urologist specializing in female sexual dysfunction at UCLA Medical Center, argues that “[h]istorically men have used sex to control, victimize and subdue women. This has leveled some in recent years but this pill and others now allow men to continue participating in this kind of subjugation into older age” (Berman, 2003). Even as the gap between men and women in the professional world continues to close in terms of rank and salary, and the number of women obtaining college and graduate degrees are at an all-time high, Dr. Berman is not the first to cry foul.

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Sex for the Self’s (and Sex’s) Sake: Remaking the Later Years Along with the individualistic, even narcissistic, trend apparent in recent commercial and non-commercial media regarding sexuality today, we may be witnessing another slowly emerging social fact. An idea embedded in these popular advertising campaigns is that so much of the intimate romantic experience many people seem to long for depends on sexuality – or, more specifically, the act of sex alone. This may be particularly damaging to persons in their middleage and beyond who, due to marked extensions in life expectancy, make up an increasingly large proportion of our population. “The potential lack of investment in other kinds of intimacy, and in developing something to celebrate in old age besides consummating the relationship will affect us for generations to come” (Verghese, 2003b). This idea is reiterated by Bets Davis. “The second half of our lives is such that it encourages an inward examination of one’s life and the core beliefs about oneself and one’s relationships to others” (Davis, 2003). Indeed, what is absent in so many of these advertisements are the relational and social aspects of sexuality and intimacy that are not about intercourse. In “At Any Age,” an article written several years ago for the special sex issue of Albany New York’s Metroland, an urban paper not unlike Boston’s Phoenix or NYC’s Village Voice, several middle- to older-aged interviewees describe their relationships. A sixty-three-year-old women opines: “[y]ou can’t think of your former body, the way you looked. That patronizing idea of beauty, youth, and what is sexy. Sexy is what you project. If he likes you and admires you, that’s it – you’re sexy” (in Price, 2003: 11–12). The author of the piece, herself beyond middle age, notes that “most anything can be a turn-on at 20, but at 70, after years of sexual experience, sexual expressions are more refined. Sex can be an artist’s masterwork after years of study” (ibid.). The same sixty-something interviewee admits: “I’ve slowed down. I’ve done it a million times. More concentration is where it’s at. When my mind wanders it’s no good – I may as well be somewhere else. All of sex is mindset. Dirty thoughts, clean thinking – it’s all in your head” (ibid.). From this we would deduce that sexuality in later years appears to be more subtle and nuanced than sex at twenty-three, or thirty. This all, in turn, requires a close, realworld examination of what good lovemaking is made of. As we age, lovemaking may become a more holistic set of intimate experiences, with deeper forms of connection and a new emphasis on other forms of communication, physicality and affection. Dr. Berman is sure sexual function is individually defined. “It depends on what the individual and the couple wants. This generation of boomers coming into menopause are very different than their mothers. They’re not taking no for

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an answer. They’re not accepting that this is what happens to you when you get old” (Berman, 2003). Our aging population seems to be what is governing this heightened awareness of sex in older people, and in part explains the pharmaceutical industry’s rush to create drugs that enhance sexual vitality. In other words, they do so because there is an apparent demand for it. Yet, it is possible that some people are unsure about what it is they are asking for. Berman admits a legitimate need for drugs like Viagra in many cases, but like Price’s older respondents, she wants to be sure that we do not reduce human sexuality to only the purely physical manifestations. The trend in pharmaceutical sexual dysfunction treatments taken with the staggering statistics regarding SSRI and other depression and anxiety prescriptions in the United States suggests that we have almost entirely dismissed the notion of mind-over-matter as a way of thinking about ourselves. This is occurring as so many of us know (at both rational and intuitive levels) that the basis of depression or anxiety, or frigidity or impotency, is often in the mind, so to speak. In these cases we often come to admit that there is something wrong with the way we are thinking about our selves, our jobs, our relationship with a significant other, or our sex lives. The emerging standard drug treatment is rapidly becoming an issue of matter over mind. As to whether this will be a positive move remains an open question, but it is important that a clear distinction is made between the medical community’s growing knowledge on the issue of ED and the developing public impression through paid advertising and word of mouth. The current and stable opinion in the field of urology is still that “erectile dysfunction is a neurovascular phenomenon that requires intact psychological, neural, and vascular components” (Nehral, 2002). While accurate assessments of neurological and vascular components are relatively straightforward, what is meant by an “intact psychological component” is much less clear. What does it mean to think and feel okay about sex with another person? Is the act of sexual intercourse first and foremost a physical, psychological, emotional or spiritual act? Is it a relational act above all else? Answers to these questions might vary as widely as the relational dyads themselves. The general solution now being proffered, however, is decidedly one-sided despite the general admission in the medical community that “it is notoriously difficult to make a diagnosis of true erectile dysfunction” (Berger, 1998: 765). The problem is that such opinions get muddled in the wake of statements disseminated by the drug makers themselves. In direct opposition to the scientific opinion regarding diagnosis, Pfizer’s chairman and managing director protested to the London Times that “the diagnosis is straightforward … and best carried out by General Practitioners” (ibid.). A similar perspective informs readers and viewers of an

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advertising campaign that exceeded 100 million dollars before a rival even came on the scene. In 2003, virtually all Viagra advertisements proclaimed Viagra’s excellent safety profile, prompting prospective ED patients to “speak with their doctors…and ask for a free sample.” Indeed, it all appears quite simple and straightforward. Today, so-called lifestyle drugs of all types (such as Viagra) are available to anyone with access to the Internet and a credit card. At the beginning of a new sexual millennium, “functioning normally” (or for some, hyper-potency) is still the goal for both the medical establishment and the public, and a new “widespread dysfunctionality” is the hurdle. But for whom? American medical, technological, and pharmaceutical industries currently appear concerned about primarily one segment of the population: those with money and penises. (Loe, 2001: 103)

The profit motive may be outstripping the dictates of the Hippocratic Oath. Consider the logic underlying the diagnosis of any number of variants of sexual dysfunction today: essentially, if the desire is there, and the mechanics stymie satisfaction of the desire, there is a problem. The following is a synopsis of a conversation between Dr. Rosemary Basson, a leading sexual dysfunction specialist from Vancouver, BC and Brian Deer, an investigative reporter. Mr. Deer was trying to pin Dr. Basson down on how a “sexual problem” is identified: At present, the [American] psychiatric association has an essential requirement to diagnose a disorder: “marked distress or interpersonal difficulty.” And the [World Health Organization] includes a crucial prerequisite that for a person to have a problem they must be “unable to participate in a sexual relationship as he or she would wish”. But these criteria will be dumped if the plans unveiled [at the Paris conference] gain a foothold in official classifications. In place of the requirement that a patient must complain of a problem, Basson wants to substitute “descriptors”, including a “scale of distress” which, according to her committee, includes “none”. “You are saying that women can have this sexual interest disorder even if they don’t feel they have a problem themselves?” “Yes,” she says. “It’s a bit like saying a man can’t ejaculate. Now, he’s not trying to be a father. He doesn’t care. He enjoys everything he does – the arousal and intercourse – if he wants to. He just doesn’t ejaculate, and he doesn’t mind. Does he have a disorder or not?” Ouch. “I’d say he probably did.” “Why?” she hits back. “If it doesn’t bother him?” “For the same reason you could have a broken leg and not be concerned,” I joke. “I agree with you on both of them,” she says. “You’ve still got a disorder. I think the man’s got a disorder. And it’s reasonable to say the woman’s got a disorder, even

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though it doesn’t bug her. Because it’s a kind of assumption that most women have an interest in sex.” Hey presto, the numbers with a disorder hit the ceiling like a guy with no problem at all. Although research published in June from the world-famous Kinsey Institute in Indiana suggests that only 7.2% of women complain of this problem, according to a stream of papers recently pumped into the medical literature, the number of women who say they “lack interest in sex” is between one third and 40%. Here’s a vision of a market to restore vigorous appetite to the most dysfunctional pharmaceutical boss. (Deer, 2003: 5).

Excluding the established medical reasons (diabetes, prostate disease, neural damage or decay, vascular problems, etc.), we are applying a chemical/physical solution to something that is not always clearly a physical problem. Instead, it is a more holistic psycho-emotional-physiological problem, and/or it is never even viewed by the persons involved as a problem at all. Mr. Deer’s interview with Dr. Basson, like the language in many ED drug advertising campaigns, demonstrate how the intrinsic, subjective, or phenomenological experience of people – and the mind-over-matter outlook on life that often engenders – which has, hitherto, been a reliable baseline test for general life satisfaction, is being supplanted by a much more extrinsic and remote diagnostic that is based almost exclusively upon physiological parameters (such as stiffness and duration of erection). Like male sexual dysfunction diagnosis, female sexual dysfunctions are notoriously difficult to pin down, yet new products are vying for federal approval that, again, reduce the issue to little more than the chemical/physiological level. Dr. Leonore Tiefer suggested in a statement made to an FDA advisory committee hearing on December 2, 2004 that Intrinsa (a testosterone patch for women) trivializes women’s sexual experience. Dr. Tiefer argued that assessing sexual experience in general is subtle and complex and yet often done arbitrarily by medical professionals. She warned federal advisors at the time that “the new diagnosis of Female Sexual Dysfunction is a rush to medicalize women’s sexual problems, to exaggerate the physical component and minimize the non-physical component” (Batchelor, 2003). The prevailing opinion regarding female sexual dysfunction still seems to align with this statement made almost ten years ago, which suggests that the psychological and physical factors are equally split: “Female sexual, response is – surprise – a highly complex affair, affected in equal measures by factors physiological and psychological. Problems could have vascular, hormonal or neurological causes, or they could be symptomatic of a bad relationship, a house full of demanding kids, or a voice in a women’s head that say’s good girls don’t care about orgasms” (Rosner, 2001).

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But are men really so different, or do they just have physical problems when erections become difficult to achieve? While I could locate some early speculations regarding a kind of “male menopause” (Featherstone and Hepworth, 1985) more recent research has found no biological equivalent to this phenomenon in men. Regardless, are men’s sexual responses in reality so much less complicated than women’s? Even moving beyond the typical stereotypes, when the whole issue for men is reduced to a simple mechanical question – a kind of “plumbing problem” – an essentialist fallacy looms. We may be forgetting something important by attending only to the symptoms themselves. And this should be no real surprise, as a reductive outlook is part and parcel to the western, allopathic medical philosophy itself. As detailed elsewhere in this volume, reductionism is a common conceptual by-product of the scientific method itself, with the habit of isolating variables and a dogged interest in assigning linear and neat and clean causal connections. Indeed, a collection of clear causal stories are alive and well in the ED movement. Analogies to the way drugs like Viagra and Cialis are being employed can be found in the thirty-year trend away from traditional analytic therapy, and toward drug therapy for so many kinds of depression and anxiety disorders. We seem unable to stabilize between the two poles: the psychological and the physical. Consider the teenager suffering from severe depression. The scenario is unfortunately ubiquitous. His doctor wants to prescribe three or four powerful psychotropic medications, citing a neurochemical imbalance. The chemical imbalance likely exists, but that may not be the most important question simply because it may not be the original problem. Without conjuring any debate-killing nature/nurture dichotomies, the question surrounding such diagnoses – which are extraordinarily common today due to growing public impatience for fast cures and bewildering physician patient loads – is that they often ignore the attendant fact that the young man in question was raised in a very disapproving, self-negating social environment. They ignore, in other words, the reality of equifinality5: the notion that a particular end state is attainable through any number of different means. Perhaps he was regularly referred to as a “worthless piece of garbage” by an abusive step-father, or hailed a “loser” by mean-spirited school mates. As opposed to the way a bright sunny day, or an unexpected smile from across a crowded room might prevent the reuptake of serotonin, prolonged grey skies and drizzle, or repeated negative statements, can trigger chemical cascades that do their work to empty synapses of the famous mood enhancer. The chances are that troubling home and school experiences are significant elements that have contributed to the young man’s now very disproportionate brain chemistry. With prescription in hand, and his synaptic vesicles now teeming with paroxetine and other serotonin

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reuptake inhibitors, the young man will undoubtedly feel better, but that feeling of contentment will, in a very real sense, be simulated. It will not spring from the manifold experiences of his daily life, not grounded in the phenomenal lifeworld. Whatever positive phenomenological experience he now has is probably based on a much more narrowed frame of analysis. Countless ED scenarios may be more like this than many realize, or even want to believe. This focus on symptoms at the expense of what are often more ecological origins for experience negates some important facts about our natures as human beings. At one level we are of course embodied, physical animals. And resisting, still, any sort of essentialist doctrine, we are also social animals. If “social media” are no doubt altering the meaning of sociality in some counter-intuitive ways, social activity has been one of our most defining characteristics as a species for a very long time. As our progenitors moved away from highly competitive hunter-gatherer contexts, through the agrarian phase, and into industrial and modern times, the need to be social very likely evolved in step with the symbolic and physical environments we built around us. Persistent and cumulative, non-arbitrary signaling systems (language) provided the symbols, and shelters and barricades of various sorts, followed often by hamlets, villages, towns and cities, provided the physical spaces and places that prompted further language use. It may be that with these increasingly common attempts to treat depression, or anxiety, or ED only at the physical level, we decontextualize each other as the socially embedded beings that we still are – at least for the time being. Perhaps, with all our new drugs and media, we have finally found what we have been looking for – a way to be all alone, together, at last. Along with several other contributors to this volume, in fact, I’ll argue that this is consistent with the direction we have been headed as a society for some time now. From personal water craft and personal pan pizzas, to personal digital assistants, personal computers, and personal web pages and profiles, being isolated (and maybe indexed and easily identifiable?) emerges as a new ideal – a kind of 21st century virtue. Interestingly enough, at least upon initial inspection, the advertisement described next appears to counter this trend. This Viagra ad (found in Newsweek) with the standard split-frame layout depicts this time a thirty-something-looking couple. They are African-American. They frolic on a clean white duvet atop a large bed. They are in the midst of a lively play-wrestling bout it seems, dressed in tee shirts and khakis, no socks. Both wear plainly visible wedding bands. They are ecstatic. The primary text reads: VIAGRA. Because relationships should be built on trust. The secondary language in the right-hand column assures readers: You can trust the experience of VIAGRA. However, the irony barely gets below the surface here. Without even straining the

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interpretation, we are prompted to believe that trust includes, first and foremost perhaps, the reliable expectation of a ready and firm erection.

A World Made, not Found In the same way teenagers, young adults, and more recently adolescents are being prompted to look, live and love like mythic twenty-something sexual dynamos – so “older adults,” and middle- and older-aged folks are being coaxed to rethink their positions along the life span as far as sex is concerned. No doubt, advertising, “Hollywood,” the music industry, and all of the pop cultural messages still in circulation since the first MTV broadcast in 1980 have functioned together to rewrite this new story of youth.6 If one is heartened to learn that legitimate sexual problems in women are being discussed now with more equal voice to men’s in both the medical and psychotherapeutic camps, and that women’s sexual problems seem to have balanced rooting in both the psychological and physical, the increased trend to look at men’s sexual problems as primarily physical-based is disconcerting. It is troubling because a discursive shift toward either end of that dichotomy can send deleterious reverberations through the collective psyche of a culture. To look at men through the physical or the psychological lens solely is to invite dangerous distortions of who and what men are – as well as what they can possibly become. An emphasis on the physical over-simplifies what it means to be a man, whereas undue focus on the psychological component probably creates unnecessary confusion. Nonetheless, this either/or dichotomy continues to be sustained even in the academic debate surrounding the cultural significance of male sexual dysfunction drugs. What we need is more of a both/and perspective or we will continue to look for our lost keys in that dark alley beneath the only working street lamp – call it The light of Viagra (powered by Pfizer).

Conclusion: A Culture of Simulation? While efforts on the part of the female to attract a mate for protection, procreation and the provision of food likely predate the emergence of a self-aware consciousness, many modern human women have been tucking their tummies, enlarging and perking up their breasts, and whitening their teeth for several decades now with the help (not to mention the direct prompting) of the medical establishment. Some commentators suggest that we have only ever had “the surface” to consider (cf. Sartre, Baudrillard, Plant). Now men have joined the ranks of those seeking sanctioned medical treatments for reasons other than curing disease. This is what makes the present moment in history so unique. A

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phenomenon driven by science, commerce, self-interest, and pride seems to be fundamentally changing the nature of human intimacy such that we are getting to the point when it will be difficult to say what is real-qua-natural and what is not.7 Sadie Plant, author of Writing on Drugs (1999), suggests how drugs like Ecstacy steal identity from its users. “Even the uses of legal drugs have increased in modern society. We can just about kill any ‘pain’ we might have, via the use of synthetically created pills. Bad sex life? –Try Viagra! Depressed? – Try Prozac! Anything else, Sir?” (Plant, in Gjerde 2000). What is it, then, that we are trying so hard to escape, and disguise from ourselves? Why is it that we have this urge to soothe and comfort ourselves so much, to escape via alcohol or drugs, to artificial paradises? [It] could be that everything around us has become more and more detached and impersonal. The sheer speed of change in society at large, which we now have to keep pace with, makes everything seem more fluid and ‘ungraspable’. This, in itself, is a stress factor that makes us want to escape from the problems of everyday life, using whatever ‘device’ that may take us there (ibid.).

Plant’s use of the term “device” is appropriate, as a wide array of chemical, mechanical, and electronic technologies are being employed by humans today to alter the “fitness” their organism in environments physical, social and symbolic. While it may be tough to argue with people in relationships who are struggling with ED that these drugs are anything but an unmitigated godsend, many relational partners are often left wondering – is it me or is it the pill? Indeed, it is not merely the identity of the person using the drug that is in flux. This analysis suggests that the progressive embracing of a matter-over-mind framework by the pharmaceutical and medical establishments may, counterintuitively perhaps, sometimes function to undermine an intimate relationship. The discourse that constitutes sexual dysfunction advertisements will not, in and of itself, issue in a new way of thinking about sex, sexuality and aging, as there are always alternative decodings of mediated messages circulating in any culture. That is to say, Viagra and other ED drug campaigns simultaneously undergo a significant degree of parody and derision in addition to the lock-step allegiance they enjoy. However, the imagery and language which paints science at the beck and call of the autonomous individual is bound to have an effect on the way a society thinks about itself. A destabilization of what it even means to relate to another person seems to be in the offing as well. This is a significant and pressing concern, and other researchers and practitioners need to consider methods that might help attenuate relational instability and mitigate the frequency of relational dissolution in the

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face of a growing assemblage of new products that intervene in the relational process. With both “medically legitimate” and recreational uses of Viagra and its ilk, a general matter-over-mind framework is put in place. The reconstruction of the male psyche – of what it means to be a man – entailed by these drugs and the ideological reverberations sent throughout the culture even seems to suggest that a society-wide “porn-industry outlook” on sex and relationships is in the offing. The fact that ED drugs were quickly incorporated into the porn world should come as a surprise to no one, and the wider phenomenon also contributes to the commodification of everyday experience. Unfortunately, this framing also sets the stage for a new framework in which all is matter, there is no mind, and the concept of relationship becomes something akin to an afterthought. Ultimately, technology, even medical technology, is not value-neutral even though we tend to see it that way. But the technology here is outwardly so simple, so marvelous, that it is tough to imagine shortcomings: swallow a little pill, rise to the occasion, attain tantric nirvana and descend to baseline. But what is the baseline and has it been altered? The widespread use of drugs like Viagra will change relationships, and will alter the nature of growing old. We hope it will be for the better though we cannot assume that… I feel the urge to take a walk, to look around, to savor this moment. We may one day marvel at the poignancy and purity of intimacy – before the hype of these pills made it into a jingle (Verghese, 2003b).

In this chapter I’ve suggested that products like Viagra, Levitra, and Cialis are not simply being promoted as medications to solve medical problems. Above and beyond these local effects, ED drugs also offer themselves as antidotes that slow down the process of aging itself through a recasting of what it means to be a sexual being. On this view, ED drugs underlie a (sometimes) subtle rewriting of the significance we append to thoughts about sex and sexuality wherein aging becomes the pressing problem – not sexual problems per se. And we can be sure that all will be urged to suffer from this new problem of aging, since what may seem perfectly fine from within will be painted as problematic from the outside. If not a new role for them, mass-mediated texts are now taking on a more central role as relational intermediary, such that the would-be ED sufferer begins to hear their doctor, or an actor, or even their spouse saying: “even though you think you feel good (about yourself, your relationship, and your penis), I can assure you that you really don’t. There is something seriously wrong here.” Perhaps we should be concerned when our private, inner sense is increasingly colonized, and regularly de-legitimized, in these ways. Having considered some of the promotional and therapeutic discourse surrounding sexual dysfunction that is circulating through our culture today,

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there are several obvious limitations to the current analysis. One shortcoming is the convenience sampling method employed, which culled data from a broad mix of sources across a ten-year time span. A more systematic approach to data collection that focuses on particular sources and more narrow and updated time frames and audiences might help locate specific trends in the way different cohorts of men are cast within relational contexts in the ED material. It is likely, for instance, that the promotional and therapeutic material regarding ED in certain vehicles – like the very popular magazines Muscle and Stuff – may disproportionately cast young to middle-aged men as testosterone-saturated lone agents seeking their next release since that is often precisely the persona these publications are capitalizing upon. Beyond this, an ethnographic investigation into the subjective readings (by ED sufferers and non-ED sufferers alike) of these advertisements and promotional materials, and of the regular talk embedded in everyday life, might illuminate some of the ways people differentially incorporate these narratives into their self-concepts and spin them out into their particular world views. If, as I have argued, the reification of a kind of Cartesian mind-body dualism is in the offing here, things could get considerably worse before they get better. A further decoupling of an already outlandish male psyche from the idea of romantic love, and distancing the man even further from the context of intimate relationships seems, to me in any case, a pernicious sort of proposal. Indeed, if the male of the species has always been somewhat prone to proud delusions of various kinds, there may be something going on with ED drugs that prompts men to believe that they can look and act like Jabba the Hut just as long as they can come up with a hard penis at the right moment. These drugs might also have the effect of convincing some women that this, indeed, is what makes for a real man. Others, of course (both men and women), are likely to discard such ways of thinking about the self and others as problematic. For all of these potentialities, and more, future work needs to explore the relational and social implications of an emerging “matter over mind” framework now embedding itself in the conceptual ecology, paying particular attention to some of the psychic and relational pitfalls that likely attend to this general outlook on life.

Notes Author’s Note: An earlier version of this analysis was published in Sexuality and Culture 10(3) (2006). 1 If a number of new chemical palliatives for “female sexual dysfunction” remain in queue for FDA approval, most of these drugs are intended to help post-menopausal women (while readily available in the UK, the

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controversial testosterone patch has met substantial government resistance in the U.S.). In the interim, it has been discovered that along with behavioral treatments such as individual and couples’ therapy, switching from one antidepressant medication to another can “solve” what have been termed “frigidity and arousal” problems in women. There is an opportunity here as well to investigate the procedural logics underlying differential recommendations made to men and women regarding drug and talk therapy. 2 The commercial material used for analysis includes Viagra, Levitra and Cialis advertisements found in print and Internet sources. The Internet content was gleaned from fixed layouts in the side margins, as well as part of the cycle of pop-up advertisements on several mainstream Internet news sites, including USA Today.com, MSNBC.com, and CNN.com. A sampling of print media oriented toward young and middle-aged men was culled from the magazine sections at two large, regional supermarkets, one national drug store chain, the periodical collection at a small urban liberal arts college, and the offerings in waiting rooms of two physician’s offices in the City of Boston. The titles from that sampling include: People, USA Today, Newsweek, Time, Men’s Health, US News and World Report, and Muscle. Finally, six web sites related to men’s health, including two clinical/therapeutic sources for addressing sexual issues in aging adults were sampled including: Clinical Perspectives on Elderly Sexuality and the self-diagnostic section of seniorindian.com: “Sexuality and Aging,” among others. The “non-commercial” content considered in this study include six web sites, three newspaper stories, and five magazine articles. These were content analyzed in an effort to locate persistent connections between conceptions of sex and conceptions of relationship or love, as well as sex and problem or dysfunction. Derivations of love, relationship, couple, problem, issue and concern were also counted, among others. To give a representative view onto the linguistic patterns discovered, some details from an article entitled “Sex and the Elderly,” by Debora Demeter found on the The Human Sexuality Web (www.umkc.edu/ sites/hsw/age) are as follows: Derivations of the word sex (sexual, sexuality, sexually) appear 64 times in the 2133 word article. Love appears once. The words relationship and couple appear 8 and 9 times respectively. The words men, males, him, and his appear 41 times, with women, females, her, and hers showing up 23 times in the article. An academic paper entitled “Sexual Issues for Aging Adults,” written in 2000 by Charette Dersch, Steven M. Harris, et al. from Texas Technological University reveals a similar patterning. In that 2,919 word paper, derivations of the male descriptor appear 22 times, compared to 8 for the female. Derivations of the word sex appear 164 times. Love appears once. Relationship appears 9 times. Couple appears twice. These findings are notable because sexuality is effectively being decoupled from the concepts of relationship, intimacy and love in so much of the media content now available – commercial, informational,

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even academic. By contrast, and perhaps somewhat counter-intuitively, it is revealing to learn that the phrase “survival of the fittest” shows up just 3 times in Darwin’s Origin of Species. The word “love,” on the other hand, appears 97 times. This is not entirely new. Throughout the 1950s in the United States with such role models as James Dean, Marlon Brando and Elvis Presley leading the way, we find a very tenable argument for the social construction of the teenager. After 1960, the term “teenager” even begins to take on its own meaning with those years delimiting a new and distinct phase of the lifespan (with all of the requisite rituals and experiences that entails). There have been a spate of new ads recently (mostly for Cialis), featuring what appear to be fifty- and sixty-something couples who usually end up in separate deep-well bathtubs in the last scene of a 30-second spot. The narrative here is a curious one. Why two tubs? Was the pill a dud? This concept is discussed in detail in my other chapter in this volume concerning some of the functional equivalencies of drugs and media. But even as an observer who generally subscribes to the social constructionist thesis, I nonetheless remain ambivalent about the cultural meaning of all of this. I hold no stock in an essentialist notion of “human nature,” so I do not worry about anything we have irrevocably lost. Indeed, our natures seem to continually change through time to fit the social and physical conditions we have created for ourselves – conditions which have, in turn, done their work to recreate us. And yet, with all of this remaking of the “real man” that has been going on recently, it is very easy (and certainly tempting) to point fingers at the medical establishment and/or pharmaceutical industry. Of course, in the final analysis we have all, together, made this current state of affairs. We did not find it in Nature. If we want to understand what makes the man we have only to attend to the films we watch, the material we read, the people we associate with, the jokes we tell, the things we take seriously, and those we dismiss – they all work together to construct and maintain the ideas we believe in and the worlds we inhabit. The culture of simulation continues to crystallize all around us as a host of other drugs and surgical enhancement options become commonplace. Civic life too is becoming populated by Baudrillard’s simulacra. Regarding the latter, we have witnessed the near total dissolution of any pretense that politics can (and perhaps should be) something you play at.

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References Batchelor, Suzanne (2003). “Female Sexual Dysfunction Diagnosis Questioned.” http://www.womensenews.org/article.cfm/dyn/aid/1262 Berger, Abi (1998). “The Rise and Fall of Viagra.” British Medical Journal 317(7161): 824. Berman, Jennifer (2003). Special guest. “Viagra Nation.” On Point with Tom Ashbrook (call-in radio magazine). WBUR/Boston NPR affiliate. Aired October 17, 2003. http://www.onpointradio.org/shows/2003/09/20030917_b_main.asp Davis, Bets (2003). Co-Founder of The Women’s Sexual Health Foundation. Interviewed at Emerson College, November 3. Deer, Brian (2003). “Love Sickness: Sexual Interest Disorder.” The Sunday Times Magazine (London). September 28. Desmond, John (2002). Consuming Behaviour. London: Palgrave. Featherstone, M. and M. Hepworth (1985). “The Male Menopause: Lifestyles and Sexuality.” Maturitas (MWN), 7(3): 235–46. Fishman, J. (2001). “Manufacturing Desire: The Commodification of Female Sexual Desire.” Social Studies of Science 34(2): 187–218. Fishman, J. and L. Mamo (2001). “What’s in a Disorder: A Cultural Analysis of Medical and Pharmaceutical Constructions of Male and Female Sexual Dysfunction.” In E. Kaschak and Leonore Tiefer (eds), A New View of Women’s Sexual Problems, 179–93. Binghamton, NY: Haworth Press. Gjerde, Geir (2000). “Deconstructing the Concept of Reality.” http://kunst.no/ geir2000/ TEXTS/simulation/simulation.html (accessed March 1, 2005). Kramer, Peter (1993). Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self. New York: Penguin. Kramer, Peter (2003). Special guest. “Viagra Nation.” On Point with Tom Ashbrook (call-in radio magazine). WBUR/Boston NPR affiliate. Aired October 17, 2003. http://www.onpoint radio.org/shows/2003/09/20030917_b_main.asp

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Loe, Meika (2001). “Fixing Broken Masculinity: Viagra as a Technology for the Production of Gender and Sexuality.” Sexuality & Culture 5(3): 97–125. MacDougall, R. (2006). “Remaking the Real Man: Erectile Dysfunction Palliatives and the Social Re-Construction of the Male HeteroSexual Life Cycle.” Sexuality and Culture 10(3): 59–90. Marshall, B. (2002). “‘Hard Science’: Gendered Constructions of Sexual Dysfunction in the ‘Viagra Age’.” Sexualities 5(2): 131–58. Nehral, Ajay (2002). “Global Perspectives and Controversies in the Epidemiology of Male Erectile Dysfunction.” Current Opinion in Urology 12(6): 493–97. O’Leary, M. P., et al. (2003). “Distribution of a Brief Sexual Inventory in Community Men.” International Journal of Impotence Research 15(3): 185–91. Price, Barbara (2003). “At Any Age.” Metroland: The Sex Issue, February 13: 11–12. Rosner, Hillary (2001). “The Science of O.” New York Magazine, April 30. Verghese, Abraham (2003a). Special guest. “Viagra Nation.” On Point with Tom Ashbrook (call-in radio magazine). WBUR/Boston NPR affiliate. Aired October 17, 2003. http://www.onpointradio.org/shows/2003/09/20030917_b_ main.asp Verghese, Abraham (2003b). “The Way We Love Now.” Wall Street Journal. September 7. Wurtzel, Elizabeth (1995). Prozac Nation. New York: Riverhead Books

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Chapter Six

Recreational Dubs: Constituting Apple’s iPod Cult Brett Robinson

Introduction “There are quiet places also in the mind, . . . [b]ut we build bandstands and factories on them. Deliberately-to put a stop to the quietness. We don’t like the quietness.” – Aldous Huxley (1954)

Apple’s introduction of the iPod in October 2001 was not typical for the highprofile technology company. Lacking the hype and spectacle of other Apple product launches, the iPod event took place in a modest auditorium in front of a select group of journalists and investors. The public mood was somber after terrorist attacks in New York and Washington the previous month. Apple CEO Steve Jobs paced the small stage in his signature black mock turtleneck and jeans with no belt. He made the case that the new device was faster and had more storage capacity and longer battery life than the other portable music players on the market. The iPod could hold an entire music library, and fit in your pocket. As with most Apple products, the technical story of the iPod pales in comparison to the cultural significance of the device. In July 2004, Newsweek christened millions of iPod users “iPod Nation,” announcing that the music player had gone from “gizmo” to “life-changing cultural icon.” Apple is nearing a quarter of a billion iPods produced; nearly 21 million were sold in the first quarter of 2010 121

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alone.1 iTunes, the iPod’s companion music download software, recently surpassed 10 billion downloaded songs.2 iPod accessories include armbands, speakers, clock radios, cases and plug-ins that track exercise output and biorhythms. The market for add-ons is a $1 billion business and growing. iPods are workout companions, fashion accessories, portable DJs and tokens of membership in the Apple technology cult. By some accounts it would seem that Apple products are endowed with a share of the divine. The iPod has been called an “object of devotion” that has inspired a “cult of iPod.”3 iPod owners comment on the device’s ability to make them feel “cosmically connected” to their music (Bull, 2008: 151) and to make their surroundings seem more “spiritual and sacred” (p. 46). The ritualistic use of certain drugs, particularly hallucinogenic ones, also carries this spiritual association. Timothy Leary’s experimental use of the hallucinogenic drug LSD in the 1960s and his founding of a church of LSD is one way in which altered perception and the sacred have been linked. The veneration of drugs like peyote among Native Americans, particularly among the Huichol tribe of central Mexico, is another example of equating altered consciousness with a spiritual consciousness.4 In the case of the iPod, part of its appeal and popularity may be related to this relationship between altered perception and spiritual awareness. Academic treatments of Apple have identified the brand’s user community as one that contains the essential features of a religious community. According to Belk and Tumbat (2005), the Apple brand community is sustained by a series of popular myths and technological rituals that give shape to a consumer religion of revering products that have the ability to alter perception. Markus Giesler uses the term “technotranscendence”5 to describe consumers who use the iPod to “transcend the here and now” by being physically present but mentally elsewhere, somewhere in the music (Kahney, 2005). Leander Kahney’s book The Cult of iPod describes the author’s experience using the iPod while working out: “High as a kite off the exercise, the music transports me to nirvana. Sometimes, when the right tune pops up, I’m truly in heaven” (p. 3). The mystical, drug-like qualities of the listening experience are most evident in the current practice of “i-dosing.” “i-dosers” consume audio tracks that are marketed as “digital drugs.” These tracks use a binaural or two-toned technology to “alter brain waves and mental state producing a state of ecstasy for the user.”6 “i-dosers” use headphones to listen to these atonal sounds while remaining motionless. A Wired.com report provides the following information on “i-dosing”: Those who want to get addicted to the “drugs” can purchase tracks that will purportedly bring about the same effects of marijuana, cocaine, opium and peyote.

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While street drugs rarely come with instruction manuals, potential digital drug users are advised to buy a 40-page guide so that they learn how to properly get high on MP3s.7

The i-doser.com website markets audio files for computers, iPhone and iPods. The site also contains links to “legal” herbal drugs that promise similar narcotic effects. The iPod’s association with drugs and transcendence is part of a broader therapeutic discourse that exists in postmodern secular culture. The proliferation of pharmacological solutions for disorders like erectile dysfunction is indicative of the way in which many drugs are being used to reinvigorate the pleasure centers of the body in order to sustain a certain feeling or quality of life. This applies equally to mental disorders like depression where prescriptions for Prozac and Celexa seem to outweigh diet and exercise efforts to rebalance brain chemistry. As an electronic tool for altering perception, the iPod is part of this therapeutic culture where electrical and chemical forms of mediation work on the electrochemical processes in the brain. The iPod floods the sensorium with “prescribed” music and is often coupled with activities like exercise where endorphin and serotonin production naturally occurs. In this way, the iPod acts as a digital appendage that provides mood enhancement. The device becomes a symbolic/electronic form of the ingested drugs that serve the same general purpose. The historical roots of the iPod’s development illustrate an even deeper set of connections between the popular device and the drug discourse. Apple founder Steve Jobs describes his first experience on LSD in a wheat field: “All of a sudden the wheat field was playing Bach. It was the most wonderful experience of my life up to that point. I felt like the conductor of this symphony with Bach coming through the wheat field” (Niermann and Sack, 2008: 57). A historical view of the iPod reveals a narrative about the LSD counterculture that spawned the personal computer revolution and ultimately paved the way for the early versions of media hard drives like the iPod. Jobs spent his formative years in dalliances with LSD and Zen Buddhism. The intersection of the chemical and the spiritual informs Jobs’ grandiose visions for the computer and seems to represent the manifestation of Aldous Huxley’s prophetic pronouncement in the Herald Examiner: All existing drugs are treacherous and harmful. The heaven into which they usher their victims soon turns into a hell of sickness and moral degradation. They kill, first the soul, then, in a few years, the body. What is the remedy? ‘Prohibition,’ answer all contemporary governments in chorus. But the results of prohibition are not encouraging. Men and women feel such an urgent need to take occasional holidays from reality, that they will do almost anything to procure the means of escape. The way to prevent people from drinking too much alcohol, or becoming

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addicts to morphine and cocaine, is to give them an efficient but wholesome substitute for these delicious and (in the present imperfect world) necessary poisons. The man who invents such a substance will be counted among the greatest benefactors of suffering humanity. (Stevens, 1987: 10)

LSD would become such a substance for many seeking the “means of escape.” However, the prohibition of LSD in Schedule I of the U.S. Controlled Substances Act of 1970 put an end to widespread use of the drug. The link between psychedelics and the personal computers that would follow in the decades of the 70s and 80s was captured best by countercultural high priest Timothy Leary who saw the psychedelic movement of the 1960s and the computer movement of the 1980s as reflections of each other (Hamit, 1993). Leary saw mind-altering substances as a mode of grasping what was going on with the human mind when other spiritual and scientific metaphors fell short. By understanding computers and their ability to mimic the cognitive functions of the human mind like memory, information processing and so on, one could more fully understand psychedelic drugs and their effects. The small, colorful iPod has become something of a glass and aluminum version of the LSD tab designed to alter consciousness and provide a highly personalized means of perceptual escape. The iPod is only one form of electronic mediation among many that bring about a psychological and emotional response from users. In this chapter, I do not intend to make any scientific link between iPod use and drug use. Instead, I am interested in the ways in which the phenomenology and representation of iPod listening recalls the therapeutic and drug discourse of altered states. I consider representations of the iPod through a textual analysis of Apple’s advertising for the popular music player. I will argue that technology does not speak for itself; it is spoken through social practices and the various ways that it is represented. As the preceding examples illustrate, the discourse of academics, journalists and cultural figures contributes to the way the technological object is imagined and used. In order to set the stage for such a reading, I intend to provide two contextual narratives that will inform the meaning-making process of the iPod advertisements. First, I will discuss the close relationship between mediation and consciousness that takes into account the various ways that technological objects bear a cultural resemblance to psychoactive drugs. Using the Huichol tribe and peyote veneration as an example, we see a tendency to sacralize objects that alter or “elevate” consciousness. For the Huichol tribe of central Mexico, the peyote plant is sacred and evokes great reverence by those who participate in the hallucinogenic rituals. In much the same way, the iPod is symbolic of a desire to escape the here and now by entering a self-imposed soundscape. This form of escape

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might be seen as a more sedate consumer version of the LSD or peyote experience but the resulting affection for the instrument of mediation is pervasive. The designers of Apple products have an eye (and ear) for the capacity of media devices to deliver aesthetic pleasure, but we must take another step to get from the aesthetic experience to the religious or spiritual devotion exhibited by LSD devotees and the Huichol. Indeed, the emotional high derived from music delivered on an elegantly designed iPod is not enough to make one “religious” in the anthropological sense. It is the restructuring of one’s life based on such an experience that constitutes a religious experience (Otto and Harvey, 1923). This is the essence of the iPod movement – a move away from conventional forms of social behavior, particularly in urban environments, toward a more private and mediated encounter with the outside world. The following section considers this interwoven history of drug use and media technologies as the contextual field within which the iPod is imagined and represented in its promotional texts. The advertising text does not exist in a vacuum so I will begin by situating the ads in a historical context that considers the iPod as a cultural artifact that shares a formal affinity with other forms of acoustic immersion. I will first consider the story of the invention of the Audiac as an analogical way of understanding the ways in which iPod “becomes intelligible as it is aligned with a past moment with which it has a secret affinity” (Peters, 1999: 2). The following narrative reveals a family resemblance that may be temporally remote but formally aligned with the iPod phenomenon. The devices that Apple develops represent re-imaginations of cultural debris. The iPhone is the cell phone reimagined. The iPad is the previously failed tablet computer reimagined. One could argue that the iPod is the Sony Walkman reimagined. The Walkman does provide some interesting parallels, but I will take a longer view in an attempt to capture some of the broader social and material conditions that led to the development of the iPod. A 1960 story in Popular Science (Maisel, 1960) profiled a Massachusetts dentist who developed an “audioanalgesic” for use during painful dental procedures. The idea behind the device was to create an acoustic overload that would drown out the sound of the 100dB pneumatic dental drill and reduce the associated pain.8 The device was called the Audiac and was conceived by psychologist and acoustic engineer Dr. J. C. R. Licklider after a routine visit to Dr. Wallace Gardner’s office where the two men had a discussion about objectionable sounds in the dental office and how they might be masked. Licklider took the idea to a team of acoustical engineers at his research lab in Cambridge, and the resulting technology was an electronic noise generator that used high-intensity musical sound to mask the sound of the 100 dB drill. The results were quite positive. By the end of the first year, 63 percent of patients reported completely effective suppression of pain. For another 25

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percent, the noise-music combination so reduced the perception of pain that they refused anesthetics for later dental sessions. One patient even agreed to have a molar extracted without conventional anesthetic. “As the forceps gripped his molar, the patient turned the noise volume all the way up and closed his eyes. When he opened them again, he couldn’t believe the tooth was already out” (Maisel, 1960: 62). Licklider concluded that the Audiac worked largely because it blocked action upon the nerves that transmit sensations of pain. The controlled sound simply swamped the pain “message” to the brain. What is interesting about the Audiac is that it emerged in a cultural moment that also witnessed the beginnings of the personal computer. The Audiac’s inventor, Dr. Licklider, was a founding member of the ARPAnet project that led to the modern Internet. J. C. R. Licklider went on to mentor Robert Taylor, founder of the Xerox PARC’s Computer Science Laboratory (CSL). The two men co-authored the seminal article, “The Computer as a Communication Device” that opens with the line, “In a few years, men will be able to communicate more effectively through a machine than face to face.”9 The work of Licklider and Taylor on human/computer interaction would eventually come to the attention of Apple founder Steve Jobs (Markoff, 2005). During a visit to CSL in 1979, Steve Jobs met with Xerox PARC researchers to discuss graphical user interface (GUI) and later cited the experience as an inspiration for conceiving the Apple Macintosh (Dodgson, 2000). In addition to crossing paths with the PARC researchers, Jobs had some other experiences in the 1970s that may have planted the seeds for the iPod. Jobs fit into a class of counterculturalists known as “wireheads” who were obsessed with expanding human consciousness, both technologically and pharmacologically. Various members of the ARPAnet project and the CSL experimented with LSD, including Douglas Engelbart who would invent the computer mouse. In 1979, the same year that Jobs visited the CSL and received his inspiration for the Macintosh, the Sony Walkman was released. In an interview with Time magazine in 1981, a New York TV producer declared, “There are buses, airplanes, sirens… You have to replace them with something louder, by force-feeding your own sounds into your ears.”10 The Walkman would become the Audiac of urban life in the 1980s. Twenty years later, just weeks after the terrorist attacks of September 11, 2001, Steve Jobs would unleash the iPod in a historical moment that witnessed a horrific assault on urban life as jet airplanes smashed into skyscrapers and leveled a section of lower Manhattan. The era of televisual terrorism universalized the destruction of that day, and the psychic damage was as profound in San Francisco as it was in New York. Society needed a mediated antidote. An analogical connection can be made here that illustrates the impeccable timing of the iPod launch after such a tragedy. Following the shock, there was

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something needed to fill the void and address the psychological damage that had been done. In a country already gobbling up anti-depressants at astounding rates, the remedy had to be something more personal and even more numbing. In 1900, Georg Simmel describes urban culture in a way that presages the utility of the iPod: The jostling crowdedness and the motley disorder of metropolitan communication…would…be unbearable without…psychological distance. Since contemporary urban culture…forces us to be physically close to an enormous number of people,…people would sink completely into despair if the objectification of social relationships did not bring with it an inner boundary and reserve. The pecuniary character of relationships, either openly or concealed in a thousand forms, places [a]…functional distance between people that is an inner protection… against the overcrowded proximity. (Benjamin and Tiedemann, 1999: 448)

Simmel’s critique, re-articulated through Walter Benjamin, references the impersonal character of relationships in the modern city. On a normal day the job defines us and our social function and also serves as a psychological barrier between thousands of anonymous individuals. In the jarring moment of apocalyptic destruction that was 9/11 the formal boundaries are dissolved and the social distance is temporarily eviscerated. The collective becomes communal and functional distinctions are momentarily forgotten as everyone becomes subject to the catastrophic spectacle. An ad hoc religion emerges in which everyone prays for deliverance from the unbearable circumstances. But the moment is fleeting and something else is ultimately needed to numb the pain. Those who embrace urban life are accustomed to surprise and instability – it is part of what makes city living so stimulating. However, after 9/11 and the incessant replay of the event, the impulse was to change the channel. With the iPod, urban dwellers found a way to move through the tumult of the decapitated city by self-medicating with music. The Audiac story and the post-9/11 mentality reveal an important feature of iPod culture: the narcotizing effect of audio immersion. Scuba divers are susceptible to a condition known as nitrogen narcosis. In this state, caused by a decrease in atmospheric pressure, divers who rise too quickly cause the nitrogen to boil out of the blood, inducing euphoric effects, relief of anxiety, feelings of tranquility and mastery of the environment. To use a slightly different but related aquatic analogy, marine biologists have found that shrimp exposed to fluxotine, the active substance in the anti-depressant Prozac, that has been flushed from the human water supply, exhibit reckless behaviors like swimming toward lighted areas where they become easy prey. These altered states result from a change in the surrounding atmosphere or environment that has direct physiological effects.

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The media ecology argument contends that media technologies are capable of producing similar cultural results. The political movements of the 1960s were largely fueled by drug experiences and experimentation providing another example of the environmental effects of drug use and the development of particular ideologies. Timothy Leary championed the use of LSD as a way to expand human consciousness and drop out of the “tribal game” (Leary, 1968: 141). Leary’s social movement utilized and embraced all manner of religious metaphor to further the cause. In 1966, Leary founded the League for Spiritual Discovery, a religion declaring LSD as its holy sacrament. Thirty years later, Leary called the computer the “LSD of the 1990s” (Misztal, 2000: 177). Steve Jobs’ LSD experience in the wheat field reinforces the idea that drugs and computers have a history of being imagined as gateways to enhanced consciousness. What began in the dental chair as a way to numb the pain has become a societal coping mechanism. Like the Audiac, the iPod finds itself in a historical context in which the absence or removal of pain has become the drug du jour. The pop psychology of daytime talk shows peddled by celebrities like Dr. Phil and Oprah reflects the ways in which Americans imagine personal and emotional struggle as problems to be solved, be it by gurus, celebrities or psychotherapists. The material dimension of this therapeutic culture includes all of the pharmaceutical and technological mediations that are deployed to eviscerate the pain inherent in the human condition. The rise of therapeutic culture and the decline of traditional religion has been well-documented (Miller, 2004). The therapeutic discourse is constituted by medical practice, popular culture, religious rhetoric and advertising itself. Unlike most ads or products that wistfully promise intense experiences or emotional escape, the iPod actually delivers such experiences through the ritual and universal form of music (Bull, 2008). The iPod works as a sacramental relic in the digital culture. If it does not channel the supernatural, it does channel the desired enhancements, distractions and diversions that have become the sacraments of therapeutic culture for, “the lack of something definite at the center of the soul impels us to search for momentary satisfaction in ever-new stimulations, sensations and external activities” (Levine, 2006: 28). iPods restructure the sensorium by placing a heavy emphasis on the auditory sense in situations that should demand full sensory engagement. The simple act of crossing a city street is made perilous when plugged into an iPod. A 38-year-old man jogging on a South Carolina beach was killed in 2009 by a single-engine plane trying to make an emergency landing on the beach. The man did not hear the plane approaching because he was wearing an iPod. The character of accidents that result from distraction, be it chemical or digital, suggests a number of similarities that are often less than desirable. The

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phrase “iPod oblivion” has become common among legislators in urban areas who are attempting to curb accidents caused by iPod listeners who step into moving traffic when crossing the street. Psychologists call this trance-like state “divided attention” or “inattentional blindness.”11 iPods alter our perception of and engagement with the surrounding environment. Everyday social situations are transformed by the tiny device. The simple act of saying hello has been impacted by the presence of a device that seems to signal, “I am not interested…leave me alone.” The iPod is part of an ecosystem of mobile devices that restructure our engagement with the social world. In the case of personal technology the physical dimension of mediated experience has a lot to do with our emotional attachment to these devices. In a Time magazine article introducing the Apple iPad (the most recent manifestation from Apple that borrows features from the iPod), author Stephen Fry writes, What [Apple lead designer] Ive and his team understand is that if you have an object in your pocket or hand for hours every day, then your relationship with it is profound, human and emotional. Apple’s success has been founded on consumer products that address this side of us.12

“This side of us” includes the aesthetic and sensory experiences that accompany our frequent, increasingly seamless, intimate engagements with personal technology. The emotional dimension of the device relationship is tied to the brain’s neurochemical processes and reactions that sensory experience elicits. The brain chemical dopamine is a neurotransmitter that modulates feelings and its production can be tied to both drug consumption and media consumption.13 Researchers have found that digital stimuli, from music to incoming email messages, give users a “dopamine squirt.”14 The iPod penetrates the human body and pours its contents into the ears. Walter Ong noted the way in which the “interiorizing forces of the oral world relates in a special way to the sacral, to the ultimate concerns of existence” (Ong, 1982: 74). The iPod can be carried everywhere, manipulated with the fingertips and revered for its delivery of aural pleasure. The iPod speaks to a romantic sensibility that celebrates the heightening of aesthetic experience and reiterates the aphorism penned by Walter Pater, “All art constantly aspires towards the condition of music” (Durant, 1984: 8). This deep sensory engagement generates a powerful affective bond between user and device. In a market saturated with chemical and herbal mood mediators, the iPod represents an electronic alternative for creating legal doses of neurochemical pleasure. In the Greek Narcissus myth, the young man is captivated by his reflection in a pool of water. Marshall McLuhan reminds us that Narcissus was not admiring himself but mistook the reflection in the water for another person. The point

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of the myth for McLuhan is that fact that “men at once become fascinated by an extension of themselves in any material other than themselves” (1994: 41). Drugs are like this in their ability to enter the body and impinge upon complex biological and neurological systems. They become extensions of our own biological processes. The iPod is also a good example of this. At the most basic level, the iPod extends and amplifies our sense of hearing. The consequence of this amplification in McLuhan’s theory is the self-amputation of the sense of hearing. We develop a narcosis when we put on the iPod; physiological numbing results from the tuning out of our immediate physical environment and the tuning in to an imaginary aural space. If we understand drug use as a form of mediation then it is conceivable that certain forms of mediation can have drug-like effects. The aural immersion provided by the iPod transforms the sensory and social environment by reshaping the user’s sensory field. The ear buds dampen ambient sound and provide a manufactured field of sound where the ratio of aural stimulation as compared to the other senses is significantly altered. This practice represents an autoamputation of sorts where the sound normally received by the ear from the surrounding environment is avoided in favor of an electronically programmed soundtrack. Many users describe the resulting experience as being cinematic, one where the “real” world plays out in front of the iPod listener who is tuned to a personalized soundtrack (Bull, 2008). A reasonable parallel can be drawn between the iPod and LSD or peyote where the sensorium is rearranged to create an altered state. Whereas LSD and peyote tend to create visual hallucinogenic experiences they can also create synaesthetic effects in which one can smell colors or feel sounds. The parallels with the drug culture do not stop with the senses; they also apply to the distinct ideologies that tend to accompany drug use. For example, the recreational drug ecstasy is an integral part of the rave dance culture. It is used to reduce inhibitions and promote freer forms of sexuality. The drug culture thus breeds a particular worldview that is rooted in the experience and practices of those who use the drug.

Textual Analysis Now that we have established a phenomenological link between the practices of aural immersion and drug-induced states, I will provide a reading of two iconic Apple advertisements as a way to discuss the ways in which the technological and the pharmacological exhibit analogical characteristics. The ads fall into two distinct visual paradigms, the silhouette and the city. The most prominent visual paradigm initiated by the Apple iPod advertising campaign is the “silhouette.”

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The iPod “silhouette” advertising campaign has been called a “masterpiece” by ad industry pundits (Garfield 2010: 1) and a “towering achievement in art direction” (Garfield 2004a: 33). In the campaign, silhouetted figures perform against bright backgrounds filled with neon color. The silhouettes carry white iPods, identifiable by the signature white wires that extend from the small pocket device to the performer’s ears. A musical soundtrack animates the performers and celebrates the iPod’s primary benefit, aural pleasure. The campaign is enchanting and has achieved a coveted status in American advertising; it is iconic. Advertising Age praised the iPod silhouette campaign for its art direction and the fact that the “imagery is uniquely synonymous with the product itself ” (Garfield 2004b: 57). In industry parlance, this is a desirable trait because sophisticated campaigns work to represent the “unique selling proposition” or “USP” in its purest form. The USP is that one special idea that advertisers want consumers to remember about the product, so it is the most important strategic statement informing the design and delivery of the advertisement. In the case of the iPod ads, allowing for expressive individuality within a cool and creative collective of fellow iPod owners is the perfect pitch for the target audience of young, hip music lovers who believe their music can be an intense statement of individuality, but also a totem that guarantees membership in a special group. From a messaging standpoint, Apple has been enormously successful in this regard. However, a case can be made for the imagery of the advertising being synonymous with more than just the product itself. The imagery also works as the iconography of the brand cult, providing devotional images that are shrines to the narcotizing power of mediation. Apple’s advertising campaign for the iPod pivots around the figure of the silhouette, a form of drawing and cut-out that was used to capture the profiles of aristocrats prior to photography but was also accessible to bourgeois families that wanted to commemorate children and relatives. The silhouette as art form predates the photograph. The art form now known as silhouette or cut-out used to be called shade or shadowgraph. Etienne de Silhouette, a French finance minister in the 18th century known for his penurious economic policies, posthumously had his name appropriated for the inexpensive silhouette art form. This included the popular art of shade portraits that were cutting into the business of professional painters and portrait artists. Silhouettes predated photography and so it was a democratized technology, allowing upper- and lower-class citizens to participate in the art form that was seen as both simple and refined. Portraits of working-class citizens proliferated alongside portraits of the aristocracy. A 1922 edition of Printer’s Ink refers to the growing interest in silhouettes for advertising as a “new cult in illustration.” The form is part of a cult of remembrance. Advertisers adopted the silhouette technique noting the “great novelty

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and advertising power” of “grafting new ideas on the old form.” The adoption of the silhouette in advertising signaled an ironic move away from its roots as a very personal art form to one that represented a figurative state of anonymity – an “any-body” that had the capacity to appeal to a wider audience. The dancing silhouette in the iPod ad is an old form brought to life by music. At the level of product benefits, the idea of immense storage capacity and elegant interface are grafted on to the old forms of mobile private listening. Additionally, silhouettes are considered collectors’ items, another message that the iPod campaign hopes to convey by offering multiple models and colors for consumption; not to mention the advertiser’s hope that users collect “thousands of songs” by downloading them from Apple’s iTunes store. The silhouette thus provides an expressive metaphor for capturing product benefits and religious resonance by granting new life to an old form. The “Hey Mama” ad was part of a trio of 2003 iPod television ads that featured dancing silhouettes on bright-colored backgrounds. The ads are striking in their simplicity. Their minimalism is consistent with the aesthetic of Apple machines, lacking ornamentation and stripped down to essential forms. In the ads, black cut-outs of human figures dance energetically while connected to white iPods via the signature white wires and ear buds. The background of the scene is a rotating series of neon colors. Apple execs hesitated when TBWA/Chiat-Day agency creatives suggested the neon set because it was not consistent with Apple’s signature white background for advertising. The creatives eventually got their way and the colorful array of ads became part of the campaign’s iconic appeal. In the spots, individual dancers are featured in rapid succession, creating a kaleidoscopic effect of kinetic energy and color. The ghostly figures move to the beat of music in an ebullient display of expressive moves, flipping, falling, and jumping around the colored space. They are “no-bodies” who float freely in a space seemingly devoid of physical restraint. The kinetic and colorful experience represents a consumerized “trip” where the stimuli is legal and safely modulated by remote control. The opening sequence of the “Hey Mama” ad features a close-up of a human profile mouthing the opening line of the song, “La, la, la, la, la.” The blackness of the face obscures the detail of facial features. We see only the profile outline of the nose and mouth. The face is accented by a white line that runs into the ear. The background of the scene is a neon pink color. The visual design of the ad is a study in negative space. In photography, negative space is the area that surrounds the subject of the photograph. The non-descript background gives visual priority to the foreground subject. In the case of the silhouettes, the colored background provides visual contrast, giving shape to the dancers. However, the dancers seem cut out of the background rather than projecting their own dimensionality. The color and fluidity of the advertisements bear a striking resemblance to actual

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descriptions of LSD trips, this one from a patient’s notes during an experiment administered in a Pennsylvania hospital in 1967, “…a phosphorescent blue glow settles. It’s gorgeous. I blink and it turns pink, then back to blue. I’m floating, undulating. [The doctor’s] features refuse to stay regular; they wobble fluidly” (Gannon, 1967). The description of the change in colors mimics the cuts in the commercial where the background changes from one neon color to another. The fluidity of the doctor’s features also recalls the flowing motion of the silhouettes that occupy the neon space of the iPod ads. The silhouettes invite the viewer to ponder the identity of the ecstatic figures and perhaps insert one’s self into the black cut-outs. This aesthetic quality serves an important rhetorical function in the way in which the ads and the product are imagined. In one way, the lack of dimensionality in the silhouette ads resists a “deeper” read. Two-dimensional figures dancing on horizonless backgrounds appear to be no more than animated shadows just enjoying the music. However, in their apparent emptiness, the signifiers act as deep reservoirs of a dense narrative about our relationship with music and technology. The challenge of interpreting such a cultural artifact then is an abundance of meaning rather than a lack. One way in which the black silhouette can be read is as a loss of ego. Steve Jobs’ Buddhist worldview is consistent with this idea that human enlightenment is predicated on losing the ego – perhaps the iPod is an electronic means of reaching such a state? A description of an LSD trip by chemist Albert Hoffman reinforces this language, “My ‘ego’ was suspended somewhere in space… I observed and registered clearly that my ‘alter ego’ was moving around the room” (Coleman, 2001: 66). If we read “lack of dimension” as a signifier, we may consider the steamrolling of identity brought on by the advent of screen-based technology. Life online is characterized by two-dimensional representations of the self. Avatars, emoticons, text, and photographs serve as signifiers of personality and emotion in the absence of body language, inflection and physical presence. This symptom of life in digital culture is rendered metaphorically by the silhouette campaign. As such, the iPod and the experience of aural immersion and dance serve as a mode of resistance to such conceptions of identity. Dance is an expression of the entire body. It is kinetic and physical, both qualities that run counter to the sedentary posture attributed to computer use. The paradox of the Apple ideology and iconography is its ability to identify social tensions brought on by greater technology use while also offering redemption from such pessimistic circumstances. The shadow dancers also connote a binary of presence and absence. This reflects the social trend common among iPod users who make themselves physically present but are mentally elsewhere as they listen to music. Again, we can draw a parallel with the drug user who desires to remain partially connected

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to his/her physical environment while simultaneously enjoying an altered state of consciousness. The shadow signifies this trace of physical presence that is also free from the exigencies of dimensionality and embodiment. In a parody of contemporary image advertising where models are chosen for their symbolic appearance, the model/actor is rendered black, opaque, and virtually featureless. The silhouette hinges not on resemblance, but semblance: “at its etymological origins [semblance refers to] a phantasm, in other words, a specter. Conjured and then concretized, the practice of the silhouette, like that of black magic, is indeed…a black art” (Saltzman, 2006: 57). The dancing specters work as signifiers that grant a metaphysical character to the ads. The iPod Nano 2G commercial is visually darker than some of the other silhouette ads. The background is dark and the dancers are not lit. The only light in the scene comes from the device itself. The iPods in each scene are held in the hand rather than attached to the body and they glow with vibrant greens, pinks and blues. The music is more sedate and the refrain “Listen, listen to the music” is repeated over and over at what sounds like a slower playback speed. The musical artist, Cut Chemist, creates music that falls within the genre of acid house music, a repetitive beat with spoken word refrains that are crafted to induce trance. The hip-hop convention of record scratching punctuates the slow, sweeping movements of the dancers who use the glowing iPods to paint the darkened air with neon light. A trail follows each of their movements in an apparent homage to the LSD effect of seeing trails behind moving objects. One is reminded of the use of glow sticks at rave events. In Graham St. John’s Rave Culture and Religion (2004: 158) a 21-year-old female describes the sensory experience of a rave this way: “Sometimes when I walk into a rave and smell the familiar scent of incense, the sight of glow sticks, and the overpowering beat of trance, I get this lightheaded sensation and sense of weightlessness in my body that reminds me of the first experience I had on E. It’s awesome.” “E” refers to the drug ecstasy, a common fixture at rave events that promotes feelings of euphoria and sexual arousal. The connotation of the rave signified by the aesthetic of the Cut Chemist iPod ad is indicative of the way in which the iPod is being imagined in the ads as a portable rave or dance hall where drug use is fairly common. The visual and musical details of the ad suggest a musical and technological immersion that evokes the sensations associated with mind-altering drugs. In this way, the iPod is again portrayed as a narcotic that has domesticated and legalized the drug trip. In an example of life imitating art, a phenomenon known as the silent rave has developed around the iPod’s popularity. A silent rave is an event where participants gather in a predetermined location to listen to the same iPod playlist. The use of headphones precludes outside observers from hearing what the group is listening to, but the ravers remain in sync musically through their iPods. In April

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2010, Harvard students collaborated with the American Repertory Theater to host a “Silent LED Rave.”15 The event was dubbed an “art and social experiment” that was designed to “visualize music.” Students downloaded a playlist beforehand that also contained a special LED color that would light up the device screen when the music was played. The concept for the event recalls the Cut Chemist ad in which iPod users paint the dark with their glowing devices. The notion that one can visualize music seems to be at the heart of the iPod campaign. The visual challenge for the advertiser is to convey aural experience through a visual medium. The second motif in the iPod campaign is the iPod in the city. The “Ride” ad opens in a narrow hallway. Sunlight floods in from a doorway at the end of the hallway. The scene denotes an urban building that opens onto a city street. We can hear the rumble of traffic and sirens in the street. A human figure moves, in silhouette, toward the open door at the end of the hallway. The figure moving toward the door is blackened by the light pouring in from the end of the hallway. This lighting technique that places the actor in silhouette is a subtle nod to the rest of the iPod campaign featuring silhouettes as dancers. Unlike the silhouette ads that are set in an abstract neon space, “Ride” is set in the physicality of an urban environment. The ad does not open with a musical soundtrack; instead we hear the soundtrack of the city street, car engines and police sirens. The “hallway” scene only lasts a few seconds but it provides some evocative connotations. The literal meaning of the hallway denotes an urban structure, perhaps an apartment building. The male figure walks out of the hallway into the light. Here again we notice the reliance of Apple representation on the dualism of black and white, dark and light. According to Lessl (1993) the use of this type of irreducible metaphor that references the metaphysical is indicative of religious communication. To read the dark/light metaphor in metaphysical terms recalls Plato’s allegory of the cave. In Plato’s allegory, Socrates teaches that sensory perception of the world provides only a reflection of reality. He uses the image of prisoners in a cave to suggest that what we perceive in this world are shadows of ideal forms, and that the real is only accessible in the sunlit space outside the cave where objects come into full view. The prisoners cannot fathom this because their senses have become so accustomed to the shadows that even the light source in the cave would pain their eyes to view. “And suppose once more, that he is reluctantly dragged up a steep and rugged ascent, and held fast until he’s forced into the presence of the sun itself, is he not likely to be pained and irritated? When he approaches the light his eyes will be dazzled, and he will not be able to see anything at all of what are now called realities” (Plato, 1942: 143). This philosophical position represents Plato’s metaphysics, wherein spiritual and material knowledge are divided. In the allegory of iPod, the literal representation of the darkened hallway opening onto the light of the city street provides a metaphor for understanding

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one of the primary benefits of iPod, the silencing of echoes. “And suppose further that the prison had an echo which came from the other side, would they not be sure to fancy when one of the passers-by spoke that the voice which they heard came from the passing shadow?” (Cottingham, 1996: 68). The echoes that haunt the prisoners of Plato’s cave are muted by the manufactured sound of the iPod device. The desire to connect dispersed voices and noises to a source is diminished as the interior soundtrack takes over. The metaphysical implication is that the sensory apparatus is short-circuited and the listener is liberated by pre-selected sounds that stir the emotions and lift the spirit. The iPod ad speaks to the death of the flaneur who once soaked in all the sensory stimulation of the city. Now, the traveler is removed, detached, engaged with a species of “angelism” where discarnate music and voices flood the ear, blocking the embodied sounds of the city that once enchanted the urban drifter. The next few cuts are fairly quick, less than a second, and provide more images from the man’s perspective; passing people on a crosswalk, walking by a passing car and walking past a man carrying a small child on his shoulders. The man with the child on his shoulders is a visual analogy for the way in which the iPod experience is akin to having a portable companion. Both associations are rejections of the idea that city life is characterized by anonymous isolation. Instead, the presence of a companion, be it canine, child or personal stereo, reveals the relatively minute but powerful intimacies of city life. The customary sounds of the city street: horns honking, loud voices, automobile engines, are muffled and transformed by the soundtrack. Indeed, the iPod makes everything for the listener. The world becomes scenery for the personal soundtrack. Much like Steve Jobs’ LSD experience in the wheat field, the city can be brought to new life by Mahler, Radiohead or Jay-Z. The dramatic turn in the ad occurs at the 13-second mark when the iPod man passes a row of handbills that cover the wall next to the sidewalk. The posters happen to be comprised of 26 iPod silhouette ads. At this point, we are presented with a visual proposition where the most recognizable signifier of the iPod campaign, the dancing silhouette, becomes part of the background in this iPod ad. We are suddenly watching ads within an ad. This level of self-awareness is uncommon for Apple during this period as the company tends to privilege more imaginary spaces that lend themselves to aesthetic minimalism. The mosaic of posters seems to provide the only color in the frame. It becomes clear that the buildings, wall and even a leafless tree that stand in front of the wall are rendered lifeless next to the kinetic and colorful posters. In this way, the posters are not perceived as clutter or visual noise, but provide an energy that enlivens the city street. The shot composition in Figure 1 features the tree in the foreground striking a dramatic pose that seems to mimic the dancers, its arms pushing outward and reaching for the transcendent high that the music delivers.

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Figure 1: iPod in the city (Image: TBWA/Chiat-Day)

It is the advertisements that provide the vitality in this particular urban scene. Without the neon colors and the kinetic energy of the dancing shadows, the scene would look almost post-apocalyptic, the light from the overexposed sky highlighting the dullest features of the buildings and the dead tree. In a subtle symbolic reversal, it is the ads that are imbued with an animistic spirit while the tree remains lifeless. “Mother tree” of Germanic pagan lore looks rather stodgy standing in front of her animated children, her branches outstretched in an attempt to mimic the contorted bliss of ecstatic dance. The ads are the most visually arresting element in the scene and also the most enchanted. The two-dimensional figures dance to the music of the actor’s iPod as he walks by, pausing only when he pauses the song on his iPod to take in this strange occurrence. It is this encounter with the animated spirits of the iPod images that ultimately stops the actor in his tracks. The experience is reminiscent of an LSD trip where the drug shakes one’s faith in reality (Coleman, 2001). Neither the marvels of modern architecture that surround him nor the multitude of other real human beings that cross his path seem worthy of a second glance. The actor traverses the city wrapped in a sonorous envelope, glibly acknowledging the other human beings as passing shadows on his aurally-induced pleasure cruise. It is only when he is confronted with the dancing shadows of the ads come-to-life that he is jolted from his oblivious state. He must stop the music to confirm that he indeed has the power to animate these paper hallucinations.

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When the music stops they stop dancing. When the music resumes, they begin dancing again. The elements of his environment are merely prop and puppet on a stage. The ready response of the animated ads is an extension of what the iPod listener experiences with this particular form of “mobile privatization,” that his or her ideal environment is heavily mediated and therefore entirely programmable.

Conclusion This chapter considers the Apple iPod and its official representations as cultural artifacts that celebrate the narcotizing power of modern technology. This power is linked to a cultural discourse that remains fascinated by mediated experiences that allow for the manipulation of perception. The altered states of perception brought about by drugs like LSD and peyote are domesticated and made suitable for popular consumption by the Apple iPod. The history of the device demonstrates the way in which the computer culture and drug culture became intermingled at a very early stage. Formative LSD experiences and Zen Buddhism are also seen as contributing to the sensibility adopted by Steve Jobs in which tools of mediation are seen as gateways to higher consciousness. The chemical substances of the 1960s and tribal cultures are rearticulated in electronic form in the guise of the iPod. This connection between mediation and altered perception can be read through the phenomenology of private iPod listening and the promotional texts produced by the Apple computer company. By imagining the iPod device as a gateway to perceptual realms once reserved for drugs like LSD and ecstasy, Apple offers the tech-obsessed public a domesticated medium for achieving altered states of consciousness. These altered states are by no means as jarring or disorienting as typical drug “trips” but their appeal is functionally similar. They invite the user to step out of the banal circumstances of everyday life and enter an aural realm that renders the world more cinematic. The listener’s lifeworld is transformed by injecting a soundtrack that re-enchants the world with aesthetic beauty and pathos. The consumer promotion of this type of experience is one that works reflexively with the drug culture from which it came as the German ad in Figure 2 demonstrates. The ad copy reads “not all drugs are as harmless as music.” If, as Pater suggests, “all art aspires to the condition of music” then such a parody is not necessarily a product of the iPod’s iconicity; rather, it is that the experience of music remains at the apex of aesthetic pleasure. It is no coincidence that LSD was closely associated with the songs and artists of the 1960s that sought to recreate their experiences in musical form. The rock band, The Doors, famously borrowed their name from

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Figure 2: “Not all drugs are as harmless as music” (Image: Berliner Suchthilfe)

Aldous Huxley’s book about his LSD experiences, The Doors of Perception. The practice of “i-dosing” described earlier in this chapter may be indicative of the direction in which we are headed. The neo-Gnostic sensibilities of technological culture, in which the physical world has taken a backseat to the virtual, are leading us down a path where recreational modes of altering perception include both the chemical and the electronic.

Notes 1

http://www.apple.com/pr/library/2010/01/25results.html (accessed July 31, 2011). 2 Ibid. 3 http://news.bbc.co.uk/2/hi/business/4170591.stm (accessed July 31, 2011). 4 http://csp.org/communities/docs/fikes-nac_history.html (accessed July 31, 2011) 5 Kahney attributes the term to Markus Giesler, marketing professor at York University in Toronto. 6 http://w w w.huffingtonpost.com/2010/07/15/digital-drugs-getteens-h_n_647397.html (accessed July 31, 2011). 7 http://www.wired.com/threatlevel/2010/07/digital-drugs/ (accessed July 31, 2011).

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8

The first iPod (the iPod Classic) has a 78-page manual that instructs the user on how to use the screen menus, how to access media, and how to troubleshoot and clean the device. Near the end of the manual is a section on safety where the manufacturer warns users about the potential for hearing loss. The danger of hearing loss associated with the iPod has been taken seriously by members of the medical community. Audiologists found that the risk of permanent hearing loss increases with just five minutes of daily exposure to portable music at full volume. The link between portable music players and hearing loss prompted the French government to cap volume levels for portable music players at 100 dB, the same decibel level as a pneumatic dental drill. 9 http://en.wikipedia.org/wiki/Robert_Taylor_(computer_scientist) (accessed July 31, 2011). 10 http://www.time.com/time/magazine/article/0,9171,951690,00.html (accessed July 31, 2011). 11 http://www.bbc.co.uk/news/10463227 (accessed July 31, 2011). 12 http://www.time.com/time/magazine/article/0,9171,1977113-3,00.html (accessed August 8, 2011). 13 http://www.npr.org/templates/story/story.php?storyId=101334645 (accessed July 31, 2011). 14 http://www.nytimes.com/2010/06/07/technology/07brain.html (accessed July 31, 2011). 15 http://www.thecrimson.com/article/2010/4/29/dance-art-music-show/ (accessed July 31, 2011).

References Belk, R. and G. Tumbat (2005). “The Cult of Macintosh.” Consumption, Markets and Culture 8(3): 205–217. Benjamin, W. and R. Tiedemann (1999). The Arcades Project. Cambridge, MA: Belknap Press.

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Bull, M. (2008). Sound Moves: iPod Culture and Urban Experience. New York: Routledge. Coleman, J. W. (2001). The New Buddhism: The Western Transformation of an Ancient Tradition. Oxford and New York: Oxford University Press. Cottingham, J. (1996). Western Philosophy: An Anthology. Oxford/Cambridge, MA: Blackwell. Dodgson, M. (2000). The Management of Technological Innovation: An International and Strategic Approach. Oxford and New York: Oxford University Press. Durant, A. (1984). Conditions of Music. Albany: State University of New York Press. Gannon, R. (1967). “My LSD Trip.” Popular Science, December: 62. Garfield, B. (2004a). “Garfield’s AdReview.” Advertising Age, June 21: 33. Garfield, B. (2004b). “Garfield’s AdReview.” Advertising Age, June 28: 57. Garfield, B. (2010). “Garfield Says Adieu, Adreview.” Advertising Age, April 5: 1. Hamit, F. (1993). Virtual Reality and the Exploration of Cyberspace. Carmel, IN: Sams Pub. Kahney, L. (2005). The Cult of iPod. San Francisco: No Starch Press. Leary, T. (1968). The Politics of Ecstasy. New York: Putnam. Lessl, T. M. (1993). “Toward a Definition of Religious Communication: Scientific and Religious Uses of Evolution.” Journal of Communication and Religion 16: 127–38. Levine, D. N. (2006). Powers of the Mind: The Reinvention of Liberal Learning in America. Chicago: University of Chicago Press. Maisel, A. Q. (1960). “Who’s Afraid of the Dentist.” Popular Science, August: 59–62. Markoff, J. (2005). What the Dormouse Said: How the Sixties Counterculture Shaped the Personal Computer Industry. New York: Viking. McLuhan, M. (1994). Understanding Media: The Extensions of Man. Cambridge, MA: MIT Press. Miller, V. J. (2004). Consuming Religion: Christian Faith and Practice in a Consumer Culture. New York: Continuum. Misztal, B. A. (2000). Informality: Social Theory and Contemporary Practice. London and New York: Routledge. Niermann, I. and A. Sack (2008). The Curious World of Drugs and their Friends: A Very Trippy Miscellany. New York: Penguin Group. Ong, W. J. (1982). Orality and Literacy: The Technologizing of the Word. London/ New York: Methuen. Otto, R. and J. W. Harvey (1923). The Idea of the Holy: An Inquiry into the Non-rational Factor in the Idea of the Divine and its Relation to the Rational. London and New York: H. Milford, Oxford University Press. Peters, J. D. (1999). Speaking into the Air: A History of the Idea of Communication. Chicago: University of Chicago Press.

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Plato, and F. M. Cornfor (1942). The Republic of Plato. Oxford: Clarendon Press. Saltzman, L. (2006). Making Memory Matter: Strategies of Remembrance in Contemporary Art. Chicago: University of Chicago Press. St. John, G. (2004). Rave Culture and Religion. London and New York: Routledge. Stevens, J. (1987). Storming Heaven: LSD and the American Dream. New York: Atlantic Monthly Press.

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Chapter Seven

Pediatric Bipolar and the Media of Madness Jonah Bossewitch

The notion of “fact,” let us recall, had the disadvantage of not taking into account the enormous work of shaping, formatting, ordering, and deducing, needed to give the data a meaning they never have on their own. – (Latour, 2004: 117)

Atypical Childhoods This past decade has witnessed a profound shift in our judgment of behavior in children in the U.S., as childhood itself is increasingly pathologized. The explosive rise in the controversial diagnosis of pediatric bipolar has received sparse coverage in the mainstream media, despite the scandalous activities that psychiatrists and pharmaceutical company executives have perpetrated to promote the existence and treatment of this condition (Carey, 2007; Wallace-Well, 2009). We have moved beyond the era of prescribing kids Ritalin because they can’t stop fidgeting. With the profusion of bipolar diagnoses in children and its common treatment with powerful and dangerous atypical anti-psychotic medication, significant numbers of adolescents and teens are being chemically swaddled and sedated. Parents are under increasing pressure from teachers and other parents to “correct” their children’s behavior with potent mind- and mood-altering drugs, often with devastating side-effects (Yan, 2008). Has the behavior of American youth grown more irritable and defiant, or has the adult judgment of their behavior changed? How can we explain the variations in diagnoses around the globe? Why are similar childhood and adolescent 145

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behaviors diagnosed in some settings and not in others? If there is a dramatic shift in youth behavior, what factors and dynamics might be precipitating these changes? How can we effectively study and explain these dramatic transformations in judgment and behavior? This chapter offers one explanation for these developments and lays out a research program for a continuing investigation of these urgent questions. First, I highlight the controversy around the diagnosis of pediatric bipolar and the emerging relations between the media of surveillance and structures of social control which constitute a distinct media ecology. This ecology is articulated through the interactive media landscapes inhabited by youth, the behavioral expectations imposed on them in schools, and the role of psychoactive drugs in mediating this tension. Finally, I catalog the intersections between media, communications, and madness studies and propose a research agenda for studying this controversy using approaches drawn from a multidisciplinary perspective. The media and communicative environments that we inhabit shape our experiences, perspectives, and behaviors (McLuhan, 1964; Ong, 1982). These environments are undergoing revolutionary changes, and correspondingly, so is identity formation and social interaction (Castells, 1996). James Carey writes that “communication is a symbolic process whereby reality is produced, maintained, repaired, and transformed” (Carey, 1992: 23). Both McLuhan’s and Carey’s interdisciplinary approaches for studying media and communications as culture suggest a powerful stance for interrogating the representations of pharmaceuticals and mental illness in advertising, popular culture, and the press. McLuhan believed that “ideally, advertising aims at the goal of a programmed harmony among all human impulses and aspirations and endeavors,” a claim that applies to psychiatry as easily as advertising (1964: 227). As more authoritative judgments are made through the interpretation of records gathered through institutional surveillance, diagnostic constructs and practices are subtly changing in response to this new form of scrutiny. Psychoactive drugs distort, deflect, and otherwise alter phenomenological experiences in ways that can be productively analyzed as a form of mediation. Just as traditional media mediate communications between senders and receivers, psychoactive drugs modulate cognitive and perceptual apparatuses, and effectively mediate experiences of reality. Like traditional media, these drugs shape our experiences, perspectives, and behaviors – our ways of seeing and being in the world.

Evidence-based Child Abuse Before analyzing statistics and trends, a few powerful anecdotes will vividly illustrate the contours and extent of this growing controversy.

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Consider the case of Rebecca Reily, a four-year-old girl in Boston who died on December 2006 after an overdose of the anti-psychotic Seroquel, administered by her parents (Creamer and Mishra, 2007; Couric, 2007). Her parents are currently facing first-degree murder charges, but they claim to have been following doctor’s orders. Rebecca’s psychiatrist, Dr. Kayoko Kifuji, diagnosed her with attention deficit and hyperactivity disorder and bipolar disorder when she was just two and a half years old, and prescribed a powerful cocktail of psychotropic medications. Dr. Kifuji’s license was not suspended, although she voluntarily suspended her practice pending the resolution of the outstanding civil and criminal charges (Wen, 2009). Her hospital has issued the statement: “The care we provided was appropriate and within responsible professional standards” (Creamer and Mishra, 2007). Sadly, this case is not an isolated occurrence. Reports recently surfaced about another three-year-old girl, Destiny Hager, who died in April 2006 of complications resulting from known side-effects of the antipsychotics Seroquel and Godeon (Carpenter, 2009). An autopsy of the 38-lb girl revealed “antipsychotic drugs present in concentrations considered therapeutic in adults” (Carpenter, 2009). Her psychiatrist, Vernon Kliewer, who had been practicing children’s psychiatry for over fifty years, was investigated by the Kansas Board of healing arts for his treatment of Destiny and five other children aged two to five years old. Kliewer negotiated a settlement that didn’t require him to admit any wrongdoing, and he has voluntarily stopped treating patients under age six (Carpenter, 2009). In January 2008, PBS Frontline aired an hour-long documentary called The Medicated Child, profiling the lives of three children diagnosed between four to six years old with bipolar disorder (Garviria, 2008). The children and their families were all struggling with devastating side-effects and complications, such as involuntary tics and spasms (tardive dyskinesia) and extreme weight gain, resulting from their treatment. The documentary argued that a massive public health experiment is currently being conducted on the nation’s youth, without anyone’s informed consent (Garviria, 2008). In one segment a mother was feeding her son corndogs, Gatorade, Goldfish crackers, and cookies, while she complained on-camera about his erratic hyperactive behavior. In another, a young girl was goaded by her psychiatrist into sharing her violent fantasies, though the doctor fails to explore the connections to her father’s trauma as an Iraqi war veteran. In yet another, a mother makes an appointment to reduce her son’s medications but is told by their psychiatrist that drugs are the only therapeutic option. She leaves the office with an additional prescription for Xanax to relieve her son’s first-dayof-school anxiety. In November 2008 the Wall Street Journal’s health blog reported on a class action lawsuit brought against Jansen (owned by Johnson & Johnson) for the

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side-effects of their antipsychotic Risperdal causing gynecomcastia, or male breast growth, in ten young boys (Mundy, 2008; Couric, 2009). Boys ranging from four to fourteen years old have been prescribed Risperdal for ADHD and bipolar disorder, and have developed female breasts that can only be treated with mastectomies. These stories are horrifying, but they are not exceptions. In 2007 in Florida 23 infants under 1 years old were prescribed antipsychotics, prompting a perfunctory review process for all Medicaid prescriptions of antipsychotics to children under six (Hundley, 2009). Between 1994–2003 the diagnosis of bipolar in American children and adolescents has jumped 4000 percent (Carey, 2007). This rise is an indicator of the systematic marketing and lobbying campaigns to expand the diagnostic criteria, and to brand children with a new disease. We will discuss later the expanding role of advertising and marketing in the growth of diagnoses and treatments, but these campaigns are multi-pronged – direct to psychiatrists, general practitioners, legislators, and the public. During this period of rampant increase in the treatment of pediatric bipolar, it should be noted that the diagnosis does not even exist in the current version of the Diagnostic Statistical Manual, DSM-IV-TR, the official guide to mental disorders published by the American Psychiatric Association. The antipsychotics administered to these children have been prescribed “off-label” (Shekelle et al., 2007). Doctors are permitted by law to prescribe any medication they judge helpful, but the FDA must approve a drug for a particular treatment before the pharmaceutical companies are allowed to market that drug for that usage. Numerous scandals, such as the Eli Lilly’s Vivi Zyprexa campaign, have involved drug companies specifically marketing drugs for off-label uses (Dawdy, 2007). A recent study found that between August 2006 and July 2007, 37 percent of prescriptions for antipsychotic drugs were written by family doctors – general practitioners, not psychiatric specialists (Morgan, 2009). In summer 2008 the FDA legislated pediatric bipolar into existence, so that clinical trials could proceed prior to the publication of the DSM-V in 2013 (Dawdy, 2008). The FDA evaded inquiries demanding a definition of the disorder, and finally supplied very thin evidence for its existence (Dawdy, 2008). In 2007 the FDA approved Johnson & Johnson’s Risperdal for use in children as young as ten, and the approval for Bristol-Myers Squibb’s Abilify followed in 2008 (Office of the Commissioner, 2007). In 2009 an FDA advisory panel backed the expanded use of three commonly prescribed antipsychotic drugs for children – Lilly’s Zyprexa, AstraZeneca’s Seroquel and Pfizer’s Geodon (Dawdy, 2009). Side-effects including massive weight gain, metabolic disorders, tardive dyskinesia, and diabetes are common amongst this class of drugs (Ücok and Gaebel, 2008). The long-term effects on developing children are still unknown (Heavy, 2009).

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Even within the psychiatric community, there is little consensus about pediatric bipolar diagnoses and treatments. All the way back in 2000, psychiatrist Dr. Lawrence Diller wrote the following in a story published by Salon.com. The situation has continued to worsen dramatically since then. Diagnosing bipolar disorder in children as young as 3 has become the latest rage. It justifies using a host of medications to treat very difficult-to-manage, unhappy children. The old-line drug, lithium, has been replaced by newer, untested (in children) mood stabilizers like Neurontin or Depakote as a first-choice intervention for pediatric “manic depression.” Finally, a new class of anti-psychotic medications – the most popular these days is Risperdal – is heralded as the ultimately effective treatment for a number of diagnoses whose common features are not hallucinations or psychosis, but severe acting-out behaviors. More than 200,000 children receive anti-psychotic medications, mostly to control unruly behavior rather than to treat hallucinations or other symptoms of schizophrenia. No other society prescribes psychoactive medications to children the way we do. We use 80 percent of the world’s stimulants such as Ritalin. Only Canada comes close to our rates, using half, per capita, the amounts we do. Europe and industrialized Asia use one-10th of what we do. Psychiatrists in those countries are perplexed and worried about trends in America. The use of psychoactive drugs other than Ritalin for preteen children is virtually unheard of outside this country (Diller, 2000).

A handful of academic researchers (Crystal et al., 2009), independent journalists such as Philip Dawdy of FuriousSeasons.com (Dawdy, 2007) and bloggers have been closely following these developments. They have tracked and documented the dramatic increases in childhood diagnoses and prescriptions, and raised concerns over the long-term safety of these drugs due to their serious side-effects and known developmental and metabolic issues. They have pointed out the discrepancies between American and international diagnoses (Lane, 2009), as well as the more aggressive prescription patterns for children covered by Medicaid versus those covered by private insurance (Martin et al., 2002). But the surge in diagnoses and prescriptions continues to grow (Wilson, 2009).

Pathological Soothsayers and Permanent Records If these trends are not sufficiently jarring, the future is even more disconcerting. Psychiatry continues to innovate, and is poised to push beyond pathologizing formerly normal behaviors by pathologizing risk with the growing rise of

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prodromal diagnoses, also known as Psychotic Risk Syndrome. A prodrome is a symptom or group of symptoms that appears shortly before an acute attack of illness. The etymology of this word traces back to a Greek term meaning “running before” or precursor (Prodromal, n.d.). An emerging trend in clinical psychiatry is the appropriation of this concept under the paradigm of “early intervention in psychosis” for “at-risk” patients. Psychiatrists are preventively diagnosing mental illness and treating people prior to them exhibiting any behavioral symptoms. Children and adolescents are especially vulnerable to prodromal diagnoses, and much of the research and marketing is directed at preventing children from developing mental illnesses. The Editor in Chief of the peer-reviewed journal Current Psychiatry identifies early diagnosis and intervention as one of the top six trends affecting psychiatric practice: Earlier diagnosis and early intervention The past decade has witnessed a surge of progress in identifying individuals at high risk for psychosis or mood disorders. The “prodrome” has become a fertile area of research, with a focus on early “treatment” even before the clinical syndrome of schizophrenia or mania appears. The goal is to try to delay, modify, or ameliorate incipient serious mental illness by using both pharmacotherapy and psychotherapy. (Nasrallah, 2009)

Instinctively, preventative health care seems like a good thing. Western medicine is often criticized for primarily responding to acute crises, instead of proactively promoting health and well-being. However, the reductionist flattening of minds into brains leads to categorical errors which pervert the Hippocratic principle to “do no harm.” Applying the medical paradigm to the treatment of risks, instead of disorders, stretches the dangerously elastic diagnostic net beyond breaking point. Analogies between mental conditions and diseases of the body, such as diabetes, measles, or heart failure, are often the point of departure for proponents of prodromal treatment. However, these casual comparisons mask assumptions and disguise relevant disanalogies. The pathologization of diverse mental states remains controversial, unlike life-threatening viruses or organ failures. Furthermore, there is currently no casual theory explaining why some people’s psychological experiences degenerate into crisis. Arguably, there can never be such a theory until we make significant progress towards resolving the mind/ body problem, (a.k.a. the “hard problem” of consciousness). Without a causal theory explaining the transitions between mental states, all prodromal diagnoses of mental conditions are necessarily speculative correlations. The roots of prodromal diagnosis of mental conditions can be traced back to work on the prodromal identification of schizophrenia:

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What is needed is not the early diagnosis of schizophrenia, but the diagnosis of pre-psychotic schizophrenia. We must learn to recognize that state of mind which will develop into schizophrenia unless appropriate measures are taken to prevent deterioration (Meares, 1959: 55)

However, the identification of reliable predictors of schizophrenia has proven to be notoriously difficult and conceptually slippery: Identifying symptoms or signs that reliably predict onset would obviously aid attempts to prevent mental disorders. Such specific predictors do not currently exist. In fact, one could argue that if any such risk factors were identified they would be conceptualized as early phenomena of the disorder itself… The nonspecific nature of these common features is notable (Yung et al., 1996: 285).

The clinical gaze embodied in the pages of the DSM has always been rooted in behaviorism – the symptoms it defines are all observable behaviors. The trend towards prodromal mental diagnoses is flawed precisely because it cedes even more power to an already cold and inhumane apparatus, which fails to listen to the voices of the people it claims to treat (Whitaker, 2003). The risks of preemptive discipline and prescriptive moral judgment rhymes with eugenics, and are simply too great and damaging for this practice to continue (Foucault, 1988). Patients, especially children, are being indicted on the basis of hereditary factors, thought crimes, and innocuous deviant behavior. In a distinctly Orwellian twist, patients exhibiting symptoms are psychotic, while those that don’t exhibit symptoms (yet) are prodromal (Orwell, 1961). Furthermore, the psychopharmacological treatments prescribed for these prodromal diagnoses are physically dangerous and psychologically damaging. As already discussed, the atypical antipsychotics that are often prescribed in these circumstances have been linked to excessive weight gain, metabolic disorders, and diabetes (Yan, 2008). The stigma attached to these diagnoses is also emotionally threatening. Advertising campaigns such as the award-winning “Prescribe Early” poster, “which used a macabre abandoned wallet, teddy bear and keys on a barren street to reposition a drug that was being used too late to achieve its maximum benefits” (Rosenberg, 2009), have heightened the pressure to preventively prescribe dangerous medication, before it is too late. Children and teens often traverse defiant emotional terrain on their journey of self-discovery and becoming. Adult disapproval towards behaviors (smoking, drinking, inappropriateness, and irritability) and appearances (fashion, body piercing, hairstyle) has increasingly taken the form of chemical discipline, with psychiatry’s permission and blessing (White, Anjum and Schulz, 2006). Defiant

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teenagers are threatened with prodromal diagnoses based on their alternative fashion choices and misunderstood behavior. Smoking and substance abuse have already been associated with bipolar in teens, and are already being used as diagnostic criteria (Wilens et al., 2008). A recent article in the American Journal of Psychiatry introduces the following patient and explores if this teenage girl is prodromal for schizophrenia: A 13-year-old girl, currently in the eighth grade and with a history of attention deficit hyperactivity disorder, was brought by her mother to a university-affiliated outpatient psychiatric clinic after a gradual decline in her academic performance was noted… She had tasted alcohol in the past but denied current use. She had also used marijuana a half-dozen times … her parents claimed that she had been withdrawn and had appeared sad and that at times they needed to prompt her to take a shower. She had a maternal aunt with bipolar affective disorder and a great uncle who had been institutionalized for unknown reasons … she was dressed in Goth attire, including a black T-shirt with images of letters dripping blood; she had dyed black hair. Her affect was blunted but was slightly more animated when her parents left the room. She denied thoughts of suicide. She reported occasionally hearing whispering voices calling her name and saying that she is worthless. She also reported the belief that her friends did not like her as much as they had… (White et al., 2006: 376)

The trend towards prodromal diagnoses coincides with a parallel trend in society towards the auto-classification and prediction of citizen and consumer behavior (Andrejevic, 2007). Governments and corporations have a strong interest in predictive behavioral models of every person they monitor (Stanley and Steinhardt, 2003). These systems are currently making their way off the lab bench, and into production systems (Robert, 2005). Already, algorithms to automatically classify human behavior based only on video streams have been deployed in nursing homes, casinos, the Olympics, and urban environments (IBM Smart Surveillance Solution, n. d.; Informedia Digital Video Understanding, n. d.). As computers scientists and engineers contend with the challenge of automatically classifying the full range of human behaviors, the DSM’s ready-made ontology may prove too convenient to challenge. Just as code enacts law, diagnostic labels are on their way to being represented in software, where their embodiment will take on a life of its own. When that occurs we will have seen the successful establishment of a new epistemological environment; indeed, an intentional entity that opaquely collects, categorizes, interprets, and proffers definitions of illness similarly to the way Google defines news – that is to say, with what amounts to an arbitrary sort of logic and rigor.

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Such a future for psychiatry is quite disturbed. Prodromal treatment is the latest progression in an ever-constricting system of social control. Preventative psychiatric treatment hints at forms of control that resonate with fears of omniscient surveillance, and we can begin to glimpse how grotesque these practices might become in an era of pervasive surveillance and electronic medical records. Pathologizing the neurologically diverse is bad enough. Extending this attitude, and treatment, to those at risk of neurological diversity is ethically dubious and threatens our freedom as individuals, as families, as members of co-cultures, and beyond.

Means, Motives, and Opportunities The role of advertising and mass marketing in the creation of blockbuster diseases and drugs has been widely investigated and researched, but is still unappreciated. The pharmaceutical companies continue to innovate around peddling influence and persuasion with incredibly sophisticated and subtle marketing efforts. In his book Shyness: How Normal Behavior Became a Sickness Christopher Lane documents the explosive rise in disease and drug marketing, with many pharmaceutical marketing budgets dwarfing the marketing budgets of Hollywood blockbusters (Lane, 2008). When it comes to mental and lifestyle illnesses, cynics argue that the pharmaceutical companies are in the business of manufacturing illnesses for which they conveniently also sell the cure. The 2007 documentary Does Your Soul Have a Cold? documents the aggressive, wholesale export of American definitions of depression to Japan, a culture with alternative interpretations and understandings of social norms (Mills, 2007). These direct-to-consumer and direct-to-doctor advertising and marketing campaigns continue because they are unregulated, and they work. The rampant marketing of these treatments directly to the public is a relatively recent phenomenon, and it is notable that direct-to-consumer drug advertising is illegal in many countries outside of the U.S. There is a desperate need for more research around the persuasive tactics employed in the marketing of blockbuster drugs worldwide. Beyond the advertising dynamics, to fully appreciate the financial motives behind the expansion into these new markets it is essential to understand the role of intellectual property law in this political economy and burgeoning information ecology. Pharmaceutical companies are granted patents on their discoveries, guaranteeing them a monopoly that is supposed to incentivize innovation. Putting aside the ethics of controlling potentially life-saving drugs, all of these patents eventually expire, leaving drug companies with a gaping shortfall in profits to fill (Hari, 2009). Expanding diagnostic criteria for treatment extends the patent clock, and gives drug companies more time to reap bumper profits from their drugs.

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It is notable that the rise in pediatric bipolar, and its standard treatment with atypical anti-psychotics, coincided with many of the drugs used to treat hyperactivity coming off patent. Eli Lilly’s own internal memos, revealed upon discovery in a class action suit against Zyprexa, clearly indicate that Lilly had initiated internal marketing campaigns to promote the prescription of Zyprexa (a powerful and dangerous anti-psychotic) for seniors with dementia, and children with behavioral disorders (Dawdy, 2007). At the time of these internal campaigns, Zyprexa was not approved for either of these populations or indications (Dawdy, 2009). The memos are explicit about wanting their sales representatives to target general medical practitioners, not just psychiatrists (Dawdy, 2007). Were there simply not enough schizophrenics to satisfy the insatiable financial ambitions of the company, such that they needed to expand their diagnostic net to include more potential customers? In the wake of a series of scandals involving prominent academic psychiatrists’ conflicts of interest, kickbacks, and fraud, Senator Charles Grassley has begun investigating the influence of drug companies on the practice of medicine (Kweskin, 2010). One of the most egregious perpetrators is Harvard University psychiatrist, Joseph Beiderman, a leading champion of pediatric bipolar diagnosis. Beiderman failed to disclose to his employer over $1.6 million in consulting fees from drugmakers earned between 2000 and 2007 (Harris and Carey, 2008). He has also been accused of submitting ghostwritten papers for publication in scientific journals, and for accepting payments to participate in Johnson & Johnson’s Center for Education in the Study of Pediatric Bipolar (Harris, 2008). At one point, Biederman assured Johnson & Johnson that planned studies “will support the safety and effectiveness of risperidone in this age group,” effectively guaranteeing the outcome of the study before it was even conducted (Harris, 2009). A campaign trumpeting the “extreme shortage of child psychiatrists” is currently running across the Internet, specifically targeting medical students (Kaplan Medical, n.d.). An anticipated shortage of child psychiatrists is based on the Surgeon General Report’s claim that “about 20 percent of children are estimated to have mental disorders with at least mild functional impairment” (U.S. Surgeon General, 1999). Legislation is currently winding its way through Congress which will forgive student loans for doctors who enter child psychiatry (Child Health Care Crisis Relief Act, 2009).

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Towards a Hypothesis of Behavioral Revolutions: Spirited Students and Explosive Communications The available evidence that children’s behavior is dramatically different than prior generations is inconclusive. It is entirely plausible that our adult standards and judgments have changed, not their behavior. However, if we really are witnessing a rise in childhood irritability and behavioral issues in the classroom, there are several very important research questions we need to be asking. We are in the midst of a monumental revolution in communications and media, and the forces we are unleashing have barely begun to be cataloged and appreciated (Benkler, 2006; Carey 1992; Castells, 1996; Peters, 2001). We need to study the interplay between the media environments we are immersed in, and our day-to-day experience of the world – the tensions between these worlds, and our strategies for mediating these tensions. Consider the impact of boredom and stress on the K-12 demographic. Outside of school, many of our children are immersed in hyper-stimulating, interactive, participatory play. In The Shallows, Nicholas Carr ascribes increasing distractability in adults to prolonged immersions in these sorts of media ecologies (Carr, 2010). Today’s youth are playing incredibly sophisticated video games, consuming complex media, and participating in ever-accelerating communication explosion (Johnson, 2005). Meanwhile, in most classrooms they are being lectured at by teachers performing an 18th-century, colonial, “banking model” of education (Freire, 2000). Generally speaking, many of these students are bored out of their wits. What impact is the media and communications revolution having on the experiences and behaviors of childhood, and how does education need to adapt to this context? While I am not advocating that all instruction should become entertainment, it is crucial to recognize that many of today’s students are unprepared to concentrate or focus for sustained periods of time. The capacity to concentrate and study cannot be presumed as a baseline skill, if it ever was before. No student has ever given 100 percent to their teacher, but if the hyperkinetic child is a natural byproduct of our hyperkinetic media ecologies, we need to introduce curricula that teaches a greater balance in our symbolic and epistemological forms. Teaching students how to focus, concentrate, and study needs to be on the syllabus alongside reading, writing, and arithmetic. Students are also under an inordinate amount of stress. The No Child Left Behind Act (2001) has homogenized curriculum across the country and mandated an endless flow of standardized tests. Surveillance is on the rise, and many public schools are now outfitted with security guards and metal detectors. Preliminary research has demonstrated that these factors actually lead to increased stress and

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anxiety, instead of providing safe and secure environments as they are intended (Weiss, 2006). The emotional climate at these schools is deteriorating rapidly, but without the proper instruments to assess these factors, it is quite difficult to address them (Center for Social and Emotional Education, n.d.). Compound these factors with the elimination of art, music, recess, and even physical education in many public school systems (Center for Social and Emotional Education, n.d.) and the conditions for restless agitation are in place. If we factor in poor nutrition and sleep deprivation the arrows of causation become even stronger. Pilot studies have shown that improved nutrition can reduce violence and behavioral unrest in prisons and schools (Laurance, 2008). There has also recently been research demonstrating that sleep deprivation leads to hyperactivity and irritability, not the other way around, as was long believed (Brody, 2007). Finally, teachers are no longer formally responsible for teaching children how to recognize and manage their own emotions. These reflective skills are simply not part of the curriculum, and as friction and tension emerge in more systematic ways every day, the issues are dealt with primarily as disciplinary or psychiatric matters, not emotional or social side-effects of a collection of symbolic, nutritional and metabolic imbalances In response to these profound failures in the educational system a frightening pattern has emerged. These problems are currently being mediated through very powerful psychiatric medications, which slow down children by dulling their minds and sedating their bodies. Some of the most independent, creative, and sensitive students are being selected for their deviance, and drugged until they conform to an authoritative standard. Parents are under intense pressure from schools and other parents to “correct” their children’s behavior. These children’s behaviors and experiences are being molded and shaped by the psychotropic drugs they are forced to consume. Children who are diagnosed with attention deficit hyperactivity disorder, conduct disorder, oppositional defiance disorder, depression, bipolar disorder, anxiety disorder, shyness disorder, and autism, are being prescribed anti-psychotics at alarming rates. It is unclear what the ethical response to disruptive behavior in the classroom ought to be. Few of us want to live in a world twenty years from now run by people raised on potent psychiatric medications. According to Lloyd deMause, a prominent psychoanalyst and historian of childhood, child abuse extends deeply and broadly throughout human histories and cultures, and is far more widespread than most of us are prepared to admit (Demause, 1982). The notion that parents and teachers are receiving a blessing from medical authorities to “shut their kids up” is an important backdrop against which to consider these practices.

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We need to aggressively explore educational models that support and embrace diverse learning styles. As Clayton Christensen argues in Disrupting Class, we need to begin to embrace student-centric learning models in response to the individual needs of each student (Christensen, Johnson and Horn, 2008). Instead, we seem to have chosen a homogenizing strategy, and are forcing all students to conform to a monolithic learning style and uniform standards of assessment, even if it requires powerful drugs to modify their personalities and dispositions.

Labels, Facts, and Values The proponents of pediatric bipolar often rely on rhetorical sleights of hand to bolster their case by strategically framing the terms of the debate. They conflate facts with value judgments, and wield these facts in an attempt to short-circuit and shut down all debate. They cite neurotransmitter activity, brain imaging, genetic markers, and heredity as proof that patients are “sick” when, at best, this evidence signifies difference and diversity. This diagnostic strategy is decidedly one-sided, and this anthology advocates a more holistic approach toward understanding these phenomena that extends from synapses to social systems. Even if biochemistry, neurology, and genetics can be convincingly correlated with diverse mental states, the judgment of these states as ill or diseased involves an additional unacknowledged leap of faith. Spokespeople for the prevailing medical model claim an objective view from nowhere, but their vantage point is loaded with subjective value judgments. Many are so thoroughly immersed in the disease paradigm that they don’t even recognize the implicit subjectivity in these pronouncements. These flagrant distortions are most visible at the diagnostic boundaries, such as when moody toddlers and defiant adolescents are diagnosed as diseased. All too often, purportedly neutral facts are loaded with value judgments, but presented as incontrovertible on the basis of their “facthood.” This perspective does not deny the possibility of varying degrees of confidence in different assertions, but we must demand recognition of the inevitable entanglement of subjectivity in our descriptions of a complex and contingent world (Alcoff, 1991). The real-world implications of the misuse of language and rhetoric are serious and potent (Davis, 1997). As Mary Kurchinka explains in her bestselling book, Raising your Spirited Child, language and labels are extremely powerful (Kurcinka, 1998). We always have a choice to describe identical behaviors with words that carry different connotations. Are children acting: explosive/spirited, demanding/high standards, unpredictable/flexible, loud/enthusiastic, argumentative/opinionated, stubborn/ assertive, nosy/curious, wild/energetic, manipulative/charismatic, impatient/

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compelling, anxious/cautious, explosive/dramatic, picky/selective, distractible/ perceptive (Kurcinka, 1998)? These simple descriptive choices construct and perpetuate vastly different worlds. They communicate expectations as well as reinforce condemnation or support. To avoid the deadlock of epistemological paralysis we must listen closely to language and voices of the people we are trying to help. Genuine respect for people’s agency requires that we take their stories and experiences seriously. These multiplicities of personal narratives demand reconceptualizations of mental health that defy the psychiatry’s mainstream messaging (Lewis, 2011; Whitaker, 2010). As the mantra of the disability rights movement powerfully insists: “Nothing about us without us.”

Mad Controversies and Diagnostic Media What are some of the strategies, methods, and approaches we can marshal to study these complex phenomena? The controversies around pediatric bipolar are tangled and emotionally charged. The traditional human, social, and life sciences can and should bring the full force of their disciplines to bear on these questions. Additionally, media and communications studies are positioned to offer unique and valuable perspectives on these issues (Peters, 2009). Building on work in Science and Technology Studies and Bruno Latour’s interpretation of Actor-Network-Theory (Latour, 2005), scholars have begun to pioneer techniques for mapping and visualizing contemporary public controversies (Venturini, 2010). At their core, these techniques involve “just” observing and describing, but as Tommaso Venturini elaborates in his description of these methods, “just” is a deceptively simple word. He claims that “the three commandments of sociological observation according to the cartography of controversies [are]: 1. you shall not restrain your observation to any single theory or methodology; 2. you shall observe from as many viewpoints as possible; 3. you shall listen to actors’ voices more than to your own presumptions” (p. 5). A comprehensive cartography of the controversies around pediatric bipolar is beyond the scope of this essay, but we can actively imagine a future project which fills in the cartographic detail of the territory we have surveyed. The controversies surrounding pediatric bipolar are fertile sites for studying the dynamics of public controversies since critics have engaged the issues on multiple conceptual fronts using a variety of tools and media. Like many controversies involving public health and psychiatry’s clinical gaze, the issues surrounding pediatric bipolar provoke debates about the integrity of rhetoric, science, and politics. As Bradley Lewis rigorously demonstrates in Moving beyond Prozac (2006), the discourses participating in this controversy encompass multiple

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perspectives which span these dimensions. The rhetorical critiques are theoryladen challenges to the ideological frames which are constructed and mobilized to describe the issues. The scientific critiques accept (or bracket) the dominant research paradigms and concentrate on questioning the validity of the research claims, on their own terms. Finally, the political critiques accept the narrow focus of the research, and instead question processes such as the construction of the research agenda, the voices involved in formulating policy recommendations, and the conflicts of interest and aggressive marketing practices that influence behavior and perception. These dimensions often overlap, and are difficult to disentangle completely in debate or analysis. However, it is important to clarify our assumptions when studying this controversy. The controversies surrounding pediatric bipolar suffer from a lack of clarity regarding the essence(s) of the debate. Many of the arguments against the diagnosis of children and adolescents with bipolar disorder apply with equal force to adult psychiatric diagnoses. Activists have struggled for decades (Coleman, 2008), if not centuries (Whitaker, 2003), to resist the plodding advance of psychiatric biopower. Challenging psychiatric methods and paradigms, questioning the validity of pharmaceutical research, and protesting the political processes of mental health policy, are nothing new. This research agenda should be designed to answer the following questions: What is the special significance of children at the center of this particular controversy? What are the underlying economic and psycho-social forces motivating the steady expansion of diagnostic criterion and driving us to pathologize the full range of human experience? What is the relationship between contemporary media and madness? Why has this controversy provoked such a passionate outcry from psychiatrists, activists, and independent journalists, but received scant attention from the mainstream media or the Federal government? Are alternative explanations for purported shifts in the behavior of children and adolescents being adequately explored? Whose voices and perspectives should be taken into account in deciding these questions? Much like familiar elements of our mainstream media ecology such as advertising and the press, psychiatric diagnoses and psychotropic drugs directly mediate and shape our experience of reality. They also, literally, mediate our behaviors, perceptions, desires, and expectations. An entire generation is growing up inhabiting a perpetually drugged-out existence, as their constitutive environment is regulated by drugs that sedate bodies and turn minds sluggish. Our youth’s ways of seeing and being in the world is being actively shaped by diagnostic labels and mind-numbing drugs. Scholars, journalists, educators, and activists must work together to marshal all the methods at their disposal to comprehend and quarantine this epidemic of injustice.

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Latour, B. (2004). Politics of Nature: How to Bring the Sciences into Democracy. Cambridge, MA: Harvard University Press. Latour, B. (2005). Reassembling the Social. Oxford: Oxford University Press. Laurance, J. (2008). “Prison Study to Investigate Link between Junk Food and Violence.” The Independent, January 29. http://www.independent.co.uk/ life-style/health-and-families/health-news/prison-study-to-investigate-linkbetween-junk-food-and-violence-775176.html (accessed July 31, 2011). Lewis, B. E. (2006). Moving beyond Prozac, DSM, and the New Psychiatry: The Birth of Postpsychiatry (annotated edition). Michigan: University of Michigan Press. Lewis, B. E. (2011). Narrative Psychiatry: How Stories Can Shape Clinical Practice. Baltimore: Johns Hopkins University Press. Martin, A., T. Sherwin, D. Stubbe, T. Van Hoof, L. Scahill and D. Leslie (2002). “Datapoints: Use of Multiple Psychotropic Drugs by Medicaid-insured and Privately Insured Children.” Psychiatric Services 53(12): 1508. doi:10.1176/ appi.ps.53.12.1508 McLuhan, M. (1964). Understanding Media: The Extensions of Man. New York: McGraw Hill. Meares, A. (1959). “The Diagnosis of Prepsychotic Schizophrenia.” Lancet I: 55–58. Mills, Mike (Director). (2007). Does Your Soul Have a Cold? [Motion picture]. Rainbow Media: IFC TV. Morgan, D. (2009). “U.S. Family Doctors Prescribe Most Mental Health Drugs.” Reuters, September 30. http://www.reuters.com/article/healthNews/ idUSTRE58T0NE20090930 (accessed July 31, 2011). Mundy, A. (2008). “Risperdal Can Have Troubling Side Effects in Boys.” Wall Street Journal, November 25. http://blogs.wsj.com/ health/2008/11/25/risperdal-can-have-troubling-side-effects-in-boys (accessed July 31, 2011). Nasrallah, H. (2009). “Psychiatry’s Future is Here. Here are 6 Trends that Will Affect Your Practice.” Current Psychiatry 8(2), February. http://www.currentpsychiatry. com/article_pages.asp?AID=7301&UID= (accessed April 19, 2010). No Child Left Behind Act of 2001, Pub.L. 107-110, 115 Stat. 1425. (2002, January 8). Office of the Commissioner. (2007). “FDA Approves Risperdal for Two Psychiatric Conditions in Children and Adolescents.” August 22. http://www. fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108969.htm (accessed July 31, 2011). Ong, W. (1982). Orality and Literacy: The Technologizing of the Word. New Accents Series. London and New York: Methuen. Orwell, G. (1961). 1984. New York: New American Library. Peters, J. D. (2001). Speaking into the Air: A History of the Idea of Communication. Chicago: University of Chicago Press.

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Peters, J. D. (2009). “Broadcasting and Schizophrenia.” Media, Culture & Society 32(1): 1–18. doi:10.1177/0163443709350101 Prodromal (n.d.). In Oxford English Dictionary. http://www.oed.com Robert, O. (2005). No Place to Hide: Behind the Scenes of our Emerging Surveillance Society. New York: Free Press. Rosenberg, M. (2009). “Big Pharma Gone Wild.” Pharma Times Magazine, February 3. AlterNet. http://onlinejournal.com/artman/publish/article_4258. shtml. (accessed April 19, 2010). Shekelle, P., M. Maglione, S. Bagley, M. Suttorp, W. A. Mojica, J. Carter, C. Rolon, L. Hilton, A. Zhou, S. Chen, and P. Glassman (2007). “Comparative Effectiveness of Off-label Use of Atypical Antipsychotics.” Comparative Effectiveness Review 6, January. (Prepared by the Southern California/RAND Evidence-based Practice Center under Contract No. 290-02-0003.) Rockville, MD: Agency for Healthcare Research and Quality. www.effectivehealthcare. ahrq.gov/reports/final.cfm. (accessed April 19, 2010). Stanley, J. and B. Steinhardt (2003). “Bigger Monster, Weaker Chains: The Growth of an American Surveillance Society.” ACLU, January 15. http://www. aclu.org/privacy/gen/15162pub20030115.html (accessed July 31, 2011). Ücok, A., and W. Gaebel (2008). “Side Effects of Atypical Antipsychotics: A Brief Overview.” World Psychiatry 7(1): 58–62. U.S. Surgeon General (1999). “US Surgeon General: Mental Health: A Report of the Surgeon General.” Washington, DC: U.S. Government Printing Office. http://mentalhealth.samhsa.gov/features/SurgeonGeneralReport/chapter2/ sec2_1.asp (accessed April 19, 2010). Venturini, T. (2010). “Diving in Magma: How to Explore Controversies with Actor-Network Theory.” Public Understanding of Science 19(3): 258–73. doi:10.1177/0963662509102694 Wallace-Well, B. (2009). “Bitter Pill.” Rolling Stone, January 28. http://www. rollingstone.com/politics/story/25569107/bitter_pill (accessed April 19, 2010). Weiss, J. (2006). “Urban Teens Write and Perform Resistance to School Surveillance.” Threat-n-Youth: Cultural Studies Responds to Violence and Education, March 31–April 1. Teachers College, Columbia University. Wen, P. (2009). “Psychiatrist will Not be Prosecuted in Girl’s Death.” The Boston Globe, July 2. http://www.boston.com/news/local/massachusetts/ articles/2009/07/02/psychiatrist_will_not_be_prosecuted_in_girl8217s_ death/ (accessed July 31, 2011). Whitaker, R. (2003). Mad in America. Cambridge, MA: Da Capo Press. Whitaker, R. (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York: Random House Digital, Inc. White, T., A. Anjum and S. C. Schulz (2006). “The Schizophrenia Prodrome.” American Journal of Psychiatry 163(3): 376–80. doi:10.1176/appi.ajp.163.3.376

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Wilens, T. E., J. Biederman, J. J. Adamson, A. Henin, S. Sgambati, M. Gignac, et al. (2008). “Further Evidence of an Association between Adolescent Bipolar Disorder with Smoking and Substance Use Disorders: A Controlled Study.” Drug and Alcohol Dependence 95(3): 188–98. doi:10.1016/j. drugalcdep.2007.12.016 Wilson, D. (2009). “Poor Children Likelier to get Antipsychotics.” The New York Times, December 12. http://www.nytimes.com/2009/12/12/ health/12medicaid.html (accessed July 31, 2011). Yan, J. (2008). “FDA Extends Black-Box Warning to All Antipsychotics.” Psychiatric News 43(14): 1–27. http://pn.psychiatryonline.org/cgi/content/ full/43/14/1 (accessed July 31, 2011). Yung, A. R., P. D. McGorry, C. A. McFarlane, H. J. Jackson, G. C. Patton and A. Rakkar (1996). “Monitoring and Care of Young People at Incipient Risk of Psychosis.” Schizophrenic Bulletin 22(2): 283–303. http:// schizophreniabulletin.oxfordjournals.org/cgi/ pmidlookup?view=long &pmid=8782287 (accessed April 19, 2010).

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Chapter Eight

Treat her with Prozac: Four Decades of Direct-to-Physician Antidepressant Advertising Cristina Hanganu-Bresch

Introduction “Society, which defines itself as sane, must be able to localize and confine the mad, if only visually, in order to create a separation between the sane and the insane.” – Sander Gilman (1988)

The soaring popularity of antidepressants by the 1990s came after decades of lockstep efforts by manufacturers, marketers, and clinicians to present a pharmaceutical solution to the problem of depression, which skirted the margins of both philosophy and medicine and often defied psychoanalytical treatment. Discovered almost by accident in the late 1940s (imipramine, the “gold standard” for antidepressants, was initially used as a treatment for tuberculosis), antidepressants were relatively ignored for a while as psychopharmaceutical researchers pursued drugs perceived to be both more effective and in greater demand, such as antipsychotics (Healy, 1999). After their early dissemination in the 1950s, antidepressants grew in popularity due to a conflation of factors such as the explosive growth of the pharmaceutical industry (partly prompted by research advances spurred by World War II), the decline of the 166

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Freudian psychiatric model, and a formidable marketing machinery. Callahan and Berrios (2005), writing about the history of the treatment of depression in primary care in England and the United States, noted that the popularity of psychopharmaceuticals was indeed due to three factors: safety, efficacy, and marketing (p. 109). Pharmaceutical companies spent enormous amounts of money on marketing in the 1970s and 1980s, primarily for advertising and direct mailing to physicians. Studies show that “there was one pharmaceutical sales representative for every 8 physicians in the United States and for every 18 physicians in the United Kingdom” (Prather, quoted in Callahan and Berrios, 2005: 110); these numbers are directly reflected in the number of prescriptions written for these drugs. Coincidentally, the number of depression diagnoses surged during this period, from less than one hundred cases of depression per million in the early 1950s to one in ten, or more than one hundred thousand per million in 2000 (Callahan and Berrios 2005: 2). Cultural critics as well as the scientific community have taken a serious interest in the phenomenon of widespread marketing of minor tranquilizers, especially given the fact that these drugs are mostly the product of for-profit pharmaceutical companies, rather than academic research. In fact, historian of psychiatry Edward Shorter claimed that “one could call psychopharmacology the creation of the drug industry, rather than of the academy or clinicians” (1997: 265). Concerns with the “overmedicated” state of modern society as well as with the “Machiavellian” marketing techniques of Big Pharma date back at least to the early 1970s, and they are well publicized on both sides of the Atlantic. For example, writing for Science in 1970, Lennard et al. voiced an early expression of such fears: “Changing the human condition is a monumental undertaking. While seeking to change cognitive shapes through chemical means is more convenient and economical, the drug solution has already become another technological Trojan horse.” Today, these issues remain as relevant as ever. Societal anxiety surrounding psychopharmaceuticals is at least partly due to our current perception of drugs as sites of cultural tension. As chemical “crutches,” drugs prompt debate on what constitutes illness and health, and, ultimately, our humanity; as consumer products, they are economic units enmeshed in capitalist ideology. Thus, the function of antidepressant advertisements is to bridge a gulf, however precarious, between values found on opposite ends of the axiological spectrum: personal fulfillment or individual happiness, and industrial capitalism or economic success. To explore this chasm, this chapter focuses on four antidepressant ad campaigns that illustrate how depression has been marketed to physicians over a period of time during which societal response to psychotropic medication changed and the principles of psychiatric practice evolved. This analysis is both diachronic (spanning four decades of antidepressant advertising, from the 1960s to 2001) and cross-cultural, since psychopharmaceuticals found a particularly responsive market in both the US and Great Britain. The journals

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selected for this sample, the American Journal of Psychiatry (AJP) and the British Journal of Psychiatry (BJP), are first-tier publications in the field, distributed to all members of the American Psychiatric Association, and the Royal College of Psychiatrists. Two representative antidepressant drugs were selected: amitriptyline, marketed as Elavil in the US and Tryptizol in the UK throughout the 60s and 70s; and fluoxetine, marketed as Prozac in both the US and the UK between 1987 and 2001. Ads will be described in terms of content (topic, participants, scientific illustrations) as well as semiotic structure. To avoid the labyrinthine trappings of a catchall semiotic vocabulary, Kress and van Leeuwen’s “visual grammar” categories (2001) are used here since they constitute one of the most coherent visual semiotic taxonomies to date. Such descriptors will reveal how psychiatrists were prompted to re-frame mood disorders such as depression in reducible, positivistic terms, and persuaded, eventually, to give up a mindset of “talk therapy” in favor of solely drug therapy. The following sections will examine, chronologically, these four ad campaigns (Elavil in AJP, Tryptizol in BJP, Prozac in AJP and Prozac in BJP).

Elavil, American Journal of Psychiatry, 1961–1979 Elavil’s marketing campaign in the American Journal of Psychiatry (AJP) can roughly be divided into three distinct periods. The first, 1961 to 1964, employs mainly a combination of logos and ethos-based appeals (to science and to the authority of important psychiatrists, respectively). The second period, roughly 1964 to 1972, is characterized by pathos and focused on the personal and social aspects of depression. Finally, the third period, up to 1979, is focused on the idea of treatment and professional ethos. The ads in the first period are structured primarily around major figures in the history of psychiatry (such as Pinel, Kraeplin, Bleuler, Meyer, Jung, and Freud) and their writings on depression, with the counterbalance of chemotherapy (drug) as the proposed modern treatment; they also employ scientific illustrations – specifically tables and line and bar charts that compare Elavil’s efficacy to other similar drugs. The first step in the Elavil advertising campaign, therefore, is to market the drug as different: first as a modern answer to age-old psychiatric conundrums, and second as a marked improvement over available contemporary remedies. The composition of these ads is “polarized” according to Kress and van Leeuwen (2001), which means there is no central element. A drawing of a famous psychiatrist on the left is balanced with an informational page about Elavil on the right (Fig. 1). This conforms to Kress and van Leeuwen’s hypothesis of the placement of information in a Western-based coding system: the “old” or “given” is on the left, and the “new” is on the right. The “historical” reading from old to new is thus seamless and underlies the theme of continued psychiatric progress.

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Figure 1. Elavil, AJP 1963. “Bleuler…on depression”

The ads so far appear to have an “analytical temporal structure” (Kress and van Leeuwen 2001: following a relatively linear narrative), relying on ethos and the contrast between old and new psychiatry to lend credibility to the new drug. The salience of the portraits (revealed by their size and placement) turns these fathers of modern psychiatry into virtual endorsers of the drug. Thus, the early Elavil ads try to establish a tradition of psychiatric treatments at the same time that they announce a chemical breakthrough in the treatment of depression. In 1964, Elavil ads start employing pathos as their main rhetorical appeal. They still use spreads and multiple panels, and their semiotic make-up consists, by and large, of covert taxonomies; in classificational structures of this type, according to Kress and van Leeuwen, “a set of participants (‘subordinates’) is distributed symmetrically across the picture space, at equal distance from each other, equal in size, and orientated towards the vertical and horizontal axes in the same way” (p. 88). In the “social suicide” Elavil ad in Figure 2, the structure could be interpreted as a temporal process, but “taxonomy” is a better descriptor, given that there is no clear indicator of a timeline. Each of these four panels is a member of an

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Figure 2. Elavil, AJP 1964: “Depression may lead to social suicide”

overarching superordinating element, “social suicide”; all of them are hierarchically equal (same size and symmetric arrangement). A brief narrative of the toll of depression is provided in the first paragraph, below the image, offering the “clef ” for the images: it is the story of a depressed woman and her subsequent social “decline” captioned by the four panels (“marital discord,” “occupational problems,” “social estrangement,” “pathologic tension outlets”). The woman who is the common denominator in all images is never once shown in a position of what Kress and van Leeuwen call “demand” (i.e., looking at the viewer). Her tentative body posture, photographed at an oblique angle, the fact that she never faces the camera, and the impersonality of the long shot allow the audience (i.e., psychiatrists) to distance themselves from the subject of the dramatic tableaux. The staged quality of the pictures, each structured around a narrative semiotic kernel (transactional actions in the first two panels, and reactions for the last two) invites the psychiatrist to position himself as an omniscient spectator who can grasp many instances of this woman’s life at once and aptly diagnose her. By and large, the pictures are decontextualized – only the bare minimum of background is provided, further contributing to the stagey feel of the ad and to

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the artificial “timeless” quality of the picture (“this is social suicide”). The lack of a “real” background also gives a strange diorama quality to the pictures; thus, the psychiatrist is ultimately presented with an educational laboratory display, rather than with an emotive story. The anachronistic chauvinist slant of the pictures plays second fiddle to the code that allows us to interpret these images as manifestations of depression. The forty-plus years that separate modern audiences from this ad render the ad’s sexism woefully apparent. It is hard to read the threatening postures of the men in the first two pictures as signs of her illness: they seem to be the active initiators of an unpleasant argument by leaning forward towards the woman and directing their hands (or fists) at her, while she stands or sits in a submissive, almost cowering, position. The two women shunning her appear to be gossiping, and the alcoholism angle in the last panel has moralistic undertones, as it plays on the stereotype of the outcast woman in need of rescue. If depression is a social anomaly, the “norm” represented by the players in the protagonist’s life seems depressingly undesirable. Like many women depicted in antidepressant ads, the “social suicide” victim in the Elavil ad is married, typecast in a lower hierarchical position in the workplace and in a precarious or endangered social or family role, and in need of rescue (a portrait that confirms Metzl’s 2003 discussion of the Freudian undertones of women in psychotropic drug ads). To restore her mental health is to mend the social fabric. The ad does not hint at an etiology of depression, but focuses on consequences; is not concerned with the person as much as it is with commenting amply on her failure to fulfill her social obligations. Medication is thus a tool for restoring the status quo. Furthermore, in this ad, she is portrayed as the goal (in Kress and van Leeuwen parlance) of somebody else’s action or reaction; by contrast, her gaze is “object-less,” directed downwards or mid-distance; she is objectified, both for the other participants in the pictures, and for the viewer (i.e., psychiatrist) himself. The sequence of pictures implies that the woman’s depression is the reason for marital strain, work-related problems, and social isolation. Whereas the ad does not make the visual argument that it is all a matter of chemistry, the counterposition with the promise-laden copy and the simplified table that accompanies all early Elavil ads allows the audience to draw the inference. There is nothing wrong with the social status quo, except for her; and the magic pill promises to correct that imbalance. During this stage of the marketing campaign, patients are, as a rule of thumb, shown as part of a covert taxonomy (they are instantiations of the concept “depression”). In a 1969 ad (see Figure 3), a woman is shown in the typical posture of the melancholic (head bent, hand supporting head, visible frown on her face) leaning on a window frame. The second page shows an identical window, but with

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the blinds drawn. The caption implies that there is a patient behind the blinds that is completely “shut down” from the outside world; the woman in the first frame doesn’t fare much better, as she has to “face each day with dread.”

Figure 3. Elavil, AJP 1969. “Whatever the degree of depression”

Windows are consistently found in drug ads as places that mediate the passage between two worlds – in this case, between an inner world of depression and an outer world of normality. In this ad, the window also acts as a framing device, effectively symbolizing the patient’s utter isolation and inability to communicate with the outside world. The use of the window (and door) in antidepressant ad imagery leads to a cascade of inferences about depression as that which separates the inner from the outer, the personal from the social, the domestic from the public, the static from the dynamic, the darkness from the light. As in the “social suicide” ad in Figure 2, the psychiatrist is invited to recognize symptoms and degrees of depression, and file them under “Elavil,” as the drug holds the key to this opening toward the world. The third period of Elavil ads brings in the doctor even closer. The patient may be present, but she or he is undergoing “productive” psychotherapy, for which the drug is a mere facilitator. The mastery of the doctor, trained to recognize symptoms, is what ensures success, and the drug paves the way for it; a different

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kind of pathos infuses these ads, this time directed at the target audience’s ego. Women are again stereotypically typecast as depressed, helpless, and in symbolically lower positions than men. The woman undergoing therapy in the 1977 ad (second panel) is featured on the left of the image, looking up at a doctor casually sitting on a table and looking down at her (Fig. 4). By contrast, in the 1978 ad, the man talks to the doctor as his equal, and in a second shot, where they are shown walking together toward the door (where the door carries the same underlying symbolism as mentioned above), we notice that the patient in fact is taller than the doctor, and also placed in a “new” position (Fig. 5). This kind of superior-inferior placement and relative infantilization of women relative to men confirms Erving Goffmann’s groundbreaking study of gender bias in advertising (1979). Goffmann commented extensively on the “ritualization of subordination” emerging from consumer ads: classic rituals such as lowering oneself physically in some form are deployed in ads universally.

Figure 4. Elavil, AJP 1977. “…penetrating the symptom barrier to productive psychotherapy”

The 1978 ad further reaches out to its intended audience by placing the doctor with the back to the viewer, having approximately the same vantage point as the viewer of the ad observing the patient who “is getting better”; it is as if the shot was taken behind the viewer’s shoulder. This conversational posture of the doctor

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Figure 5. Elavil, AJP 1978. “He’s getting better…and Elavil is helping”

is a frequent topos in the American psychotropic ads of this period. The room is full of accoutrements and furnishings typically associated with male sensibility (leather chairs, dark-wood shelves filled to the brim with books, a globe, a ship painting, and a Persian rug). All of these higher-end furnishings are also marks of the prosperity of the doctor. The not-so-subtle inference is that his success is owed in fact to Elavil. Still, the long shadow of Freud reaches out to the viewer from this picture. Depression is presented in these ads in purely psychotherapeutic terms, as something that the patient must work through together with his psychoanalyst in order to get better. The discrete image of the drug (colorful pills against a green background) visually distills and punctuates the ad, looking subordinate to “talk therapy.” Towards the end of the 70s, Elavil’s patent on amitriptyline expired and the drug started to be produced under different name brands. The last ads in Elavil’s campaign, run in 1979, address that competition by claiming that “there is no substitute for experience – yours…or ours” (see Figure 6). The appeal is again to the psychiatrist’s authority, but that authority is now equaled by the drug’s prestige as well. The two panels are also part of a covert taxonomy: they both stand for the same thing, “experience.” The two protagonists (experienced psychiatrist on the

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Figure 6. Elavil, AJP 1979. “There is no substitute for experience”

left, tried and true bottle of the proven drug on the right) share the same hierarchical placement, except the drug is in the “new” position, concluding the visual argument. Although they are visually equal, the drug has, in fact, the last symbolic “word” in this statement through the meaning of composition. The appeal of the ad has shifted from the previous arguments from authority or pathos to a bold assertion of the drug’s own ethos. Fictional endorsers or patients eliciting recognition and sympathy are no longer necessary. The ad enrolls its audience as its ultimate endorser through the narrativized subjective perspective (Kress and van Leeuwen, 2001): only the psychiatrist’s hands are visible – male, mature, white, inviting the viewer to identify with the prescription writer and with the attributes touted for Elavil. The doctor’s replacement with a bottle of pills in the second frame, however, unwittingly speaks volumes about the direction psychiatry is headed.

Tryptizol, British Journal of Psychiatry, 1960–1979 Like their American counterparts, the Tryptizol ads published in the British Journal of Psychiatry can also be divided into three “ad periods,” although the results of this division are rather different. The first period (1960–1964) is characterized by

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the abstract and symbolic suggestive representations; according to Kress and van Leeuwen, “[s]uggestive processes represent meaning and identity as coming from within, as deriving from qualities of the Carrier themselves, whereas Symbolic Attributive processes represent meaning and identity as being conferred to the Carrier” (2001: 112). The first Tryptizol ads lack patients as “Carriers”; instead, they suggest the theme of depression through moods and symbolic objects. From 1965 to approximately 1971, Tryptizol ads consistently depict human subjects – patients – in their ads. Finally, the last eight years of Tryptizol ads employ, as a rule, symbolic semiotic structures, and make a more sustained appeal to ethos by contrasting new and old psychiatry. As was the case with Elavil, the first period of Tryptizol’s campaign is marked by attempts to emphasize the “uniqueness” of the drug, specifically its dual action as tranquilizer and antidepressant – an angle which, as in the Elavil ad campaign, is dropped later on. Ads feature low modality suggestive drawings, employing visual metaphors to suggest the comorbidity of anxiety and depression.

Figure 7. Tryptizol, BJP 1962. “Often two sides of the same coin”

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The bottom half of one of the first Tryptizol ads (see Figure 7) is occupied by text, whereas the top half is reserved to a symbolic suggestive illustration – rather generic and timeless, that is, not anchored in an individual reality. In symbolic suggestive structures, according to Kress and van Leeuwen, there is only a carrier, and emphasis is on mood/atmosphere. Depression as the main topic in these first ads is illustrated by a timeless, symbolic, generic image. Symptoms are described as matter of fact (“sleep disturbance,” “depressed mood” etc.), completely disembodied from a carrier. The drug treats symptoms, but not patients; in that sense, it also is a generic entity. The drug is presented as a fortunate solution to a medical puzzle (the comorbidity of anxiety and depression). By contrast, the Tryptizol ads of the second phase show a realistic-looking potential patient whose symptoms are ripe for chemical manipulation (see Figure 8). When patients are shown, they are overwhelmingly female; the major difference from the Elavil campaign resides in the preference for the medium and close shot, betraying a smaller social distance from the depressed patient than in the American ads (which favored the more “impersonal” long shots).

Figure 8. Tryptizol, BJP 1965. “Waiting for the dawn”

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The woman lying in bed is a topos of antidepressant ads, used in both American and British psychiatric journals quite frequently. Whether she is “depressed” (hence, lying awake, wishing for sleep) or “happy” because the drug is working (hence, sleeping peacefully and unaware of the viewer’s gaze), she is, still, usually married – wedding ring is carefully displayed whenever possible, or sometimes there is a hint of a partner, sound asleep on the other side of the bed. By placing a woman in certain semiotically relevant positions (bent, looking to the left, often decontextualized, and in an intimate or medium shot), the ad allows the psychiatrist to use the patriarchal cultural baggage described by Goffmann (1979) to work in his favor. Decontextualization works to render the portrait “timeless” while hinting at the loneliness and isolation engendered by depression. The last period of the Tryptizol ads is markedly symbolic and more abstract than before. The marketing angle emphasizes the improvements in the patient’s sleep patterns. When patients are present, they are, this time, shown in long shots and utterly generic poses.

Figure 9. Tryptizol, BJP 1975. “1875–1975”

The “1875–1975” Tryptizol ad (Fig. 9) is a fascinating contrast between “old” and “new” psychiatry which pits a psychiatric diorama against a close-up of a

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Tryptizol capsule. The “1875” picture shows three psychiatrists surrounding a seated old man posed in a typical “depressed” posture (hanging head, downward glance, idle hands, black clothes). The caption is an excerpt from a resolution adopted by the Royal College of Physicians of London in 1875, describing the educational equivalency between instruction in “a lunatic asylum” and in “a general hospital.” The meaning of the picture and its caption comes in full play when contrasted with the 1975 one, showing a close-up of a Tryptizol capsule, held between a thumb and index finger. “Tryptizol 75 once-a-day dosage for many depressed patients,” the caption tells us, “means more convenient and easily remembered treatment for patients – more certainty of patient compliance for physicians.” The pictures are identical in size, but not in perspective: the tips of the fingers holding a pill in “1975” fill the same space as the four participants in “1875.” The protagonists of the historical tableau are shown in “offer” (passive) stances, which reinforce their helplessness. The angle of the shot is oblique – facing the corner, as opposed to the frontal shot of the pill-holding hand. Both the angle of the shot and the size of the shot (the long shot is “impersonal” according to Kress and van Leeuwen) suggest detachment from psychiatry’s antiquated methods, by contrast with the sense of immediacy and here-ness of the frontal angle and the close up for the pill. The audience is constructed as a detached observer of the first tableau, and as an engaged viewer – or perhaps consumer – in the second. The play of perspective emphasizes the pill’s “magic” and is reminiscent of the ads for domestic technologies, whose overarching trope is also the “before/after” structure. The new psychiatric technology eliminates the doctor; it eliminates even the patient. The narrative told by the two panels is one of optimism in science’s progress, a positivist faith that technology can provide the solution to society’s medical and spiritual ailments. The first picture illustrates an exercise in futility; the second – a paragon of efficiency. The implication is not that we need to effect social change to create a better world, but rather that we need to create better drugs so we can be better adjusted to the world we are born into. Maladjustment is really an internal function and rests with the individual; any social implications of depression simply do not enter the equation. The brain, however, enters into that malleable meaning of “setting” as something that can be adjusted, tweaked, mended, so it performs its given social function – enabling the person to operate according to its set predisposition – mother, housewife, or middle management clerk (on an aside: the jobs of these people are almost always “ordinary,” involving little or no leadership or high achievement positions). This intimation of the “magical” change of one’s outlook to effectively facilitate integration is fairly obvious in one of the last ads run for Tryptizol (see Figure 10).

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Figure 10. Tryptizol, BJP 1979. “Tryptizol helps make living worthwhile”

While there is no indication about the quality of life that is made “worthwhile” through the pill, removal from society seems to be the major pernicious effect of depression. The “life” he is cut from is all but synonymous with “culture and society,” whereas solitude and nature come across as markers of depression. In this ad, a slouched silhouette is headed off into a gold-sepia sunset in the middle of a field taken over by weeds. The barren, uncivilized nature is a symbol for social isolation; it’s also contrasted with the promise of the drug (presented as a schematic drawing in the upper right corner – the “ideal” position according to Kress and van Leeuwen). The figure of the depressed man as a traveler is also a topos in British advertising, though much less so in the American ads. This may be because the British ads pick up, in general, on more past cultural references than their American counterparts; in particular, the figure of the “mad traveler” is persistently employed both as an echo of early representations of “madness” and as an allusion to the shortly lived 19th-century psychiatric diagnosis of “fugue” (cf. Gilman, 1982; Hacking, 1998). The “mad” (or melancholic) traveler is always caught in between two destinations/two worlds, always in transit, but never finding peace because “he” is essentially homeless, quite literally “out” of his mind. The freedom of movement is illusory, as the wandering is aimless.

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Prozac, American Journal of Psychiatry, 1987–2001 The first Prozac ad was published in 1987, 26 years after the first Elavil ad. By then, psychiatry had changed considerably. It is the year of the publication of the DSM-IIIR, and the golden age of selective serotonin uptake inhibitors (SSRIs) is poised to begin. The most powerful explanatory hypothesis available regarding the mechanism of depression is neurotransmitter-centered, and Prozac’s amazing clinical success and consequent popularity only confirms that hypothesis. Prozac, the most famous brand in psychopharmacology, soon became a phenomenon and the new gold standard for antidepressants. The Prozac campaign in the American Journal of Psychiatry can be divided into three fairly distinct periods: the first (1987–1990) is focused on scientific imagery and text (based on logos); the second (1991–1998) focuses on patients and appeals primarily to pathos; and the third, 1999–2001 (when Prozac’s patent expires) is focused more on the drug itself and its status, appealing mainly to ethos. This division seems to follow pretty closely the one for Elavil, suggesting that perhaps there is a pattern in the way antidepressants are marketed in the U.S.: making bold scientific claims in the beginning, powerful emotional appeals in the middleperiod, and tapering off into “prestige” and brand-driven appeals as they approach the expiration date of their patent.

Figure 11: Prozac, AJP 1990. “Unique…Specific”

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The first period is particularly fascinating in the Prozac ads because of the efforts made to explain the antidepressant chemical mechanism. One of the early Prozac ads from the 1990s (see Fig. 11) employs a computer-generated 3D grid to depict a “battle” engaging receptors, neurotransmitters, and Prozac. The image is reminiscent of a videogame still frame; the grid is the brain (and, by extension, the battlefield), the synaptic cleft is the localized battle, the Prozac “molecules” are foot soldiers, and so on. No labels are needed to identify the agents in this confrontation – the preliminary work had been done by other antidepressant ads. What the composition may lack in scientific accuracy, it more than makes up for in dramatic effect. An orange glow permeates the underside of the axon, where little red molecules of serotonin seem to escape towards another neuronal connection. Here’s where the picture abandons the pretense of “scientific” illustration and introduces, in a mixed-code, comic-book manner, the real “heroes” of the story: two Prozac logos (gold-orange spheres with undulating striations underneath that “calm down” or “straighten up” toward the top). The other important thing that happens in this visual is the placement of this epic depression “battle” somewhere “outside” the human being affected. While this is a commonplace of medical imagery in the Western world, mental illness had, so far, been less amenable to such objectification. The age-old duality mind-body, so enduring in our culture, is now stretched to its ultimate conclusion – the “person” is separate both from the mind (loosely construed as located in the brain) and the body. Brain cells are “floating” in a vast, generic, three-dimensional grid; the Prozac logo-soldiers are deployed to fix a “chemical” process that simulates a serotonin spill which needs to be contained; the “battlefield” looks like a space-age simulation. None of the players seems to be either the patient or the doctor. A disembodied part of the brain is defended by a chemical shield (the heroic Prozac pill) against another part of the brain. It is not clear how this benefits the human being presumably in possession of said axon; in fact there is no “whole person” to speak of here. Depression is depersonalized; the psychiatrist becomes a spectator; and the drug is medicine in action – a shiny chemical gadget that the clinician can deploy into the virtual-reality grid of the patient’s brain. The ad captures in a nutshell Prozac’s phenomenal medical and cultural success as the “real” protagonist in our generic battle against mental illness. Such representations, which start back in the 1980s, turn depression from a human experience with identifiable causes, socially alienating consequences, and treatments that often involve human relationships (with doctors, among others), into a transparent chemical and biological mechanism underpinned by the “serotonin uptake” theory. The ads for the new brand of antidepressants objectify the patient, flatten the multidimensional aspects of depression into a chemical cartoon, and eliminate the doctor. The disembodied brain and the drug are the

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only ones actually entering a relationship. This is also an effective way to restore ethos to the field of psychiatry, which is transitioning from a Freudian model into a biological model. Representing mental illness as a molecular process and the drug as acting at molecular level is, in effect, a transubstantiation: if happiness is caused by chemistry and the drug can influence that chemistry, the discourse surrounding mental illness is flattened, simplified, and tamed. For a biological psychiatrist that may still face credibility issues from other branches of medicine, this is a very seductive argument. Once the status and mechanism of the drug are established, the second phase in the Prozac marketing campaign moves to show a pronounced preference toward human representations. The logos-oriented, scientific illustration era (laden as it is with charged assumptions about the nature of mental illness) is replaced by a sweeping appeal to pathos: the audience is invited to respond emotionally to the ad. Unsurprisingly, the overwhelming majority of the subjects

Figure 12. Prozac, AJP 1997. “PROZAC for both restful nights and productive days”

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are white females, generally decontextualized, shown usually in close or medium shots; toward the end of the 90s, the ads feature more occurrences of couples and family life (Fig. 12). The young couple in the 1997 ad are painting their house and stopping for a moment to “pose” for the camera. They are both wearing jeans, clean clothes, and display shining smiles. She leans on her husband and tilts her head a little. This is just one of several instances of painting as a metonymy for happiness, a topos frequently employed across antidepressant ads in the 1990s and early 2000s (Hanganu-Bresch, 2008). Painting is an ocularcentric occupation, and painting is symbolic of illusion, façade, surface, appearances, as well as of covering, mending, and mirroring. The couple is positioned on the right, in the “goal” position (Kress and van Leeuwen, 2001), above the “Prozac” logo (again, in the lower right corner), as if they are supported by it. The requisite “reclining woman” juxtaposed with “woman working” is used again in another 1997 ad (Fig. 13).

Figure 13. Prozac, AJP 1997

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This ad uses the diagonal “dynamic strip” effect – in fact, very similar to a paintbrush whose “color” is ‘Prozac’ – and the various “normality” representations it engenders (rest/work). The doctor is now, in fact, the painter recreating reality with a Prozac brush. Starting with 1999, Prozac ads assume a cartoonish quality. They rely mostly on decontextualized objects set against a bright, cartoonish orange background. The human face all but disappears, and is replaced by metonymic allusions, such as in the 1999 ads depicted in Figure 14.

Figure 14. Prozac, AJP 1999. “Just like normal”

In this series of late Prozac ads, women are invoked as having regained their sense of normalcy (“Sue’s playing with her kids again…just like normal,” “Barb’s golfing again…just like normal”). The human representations are replaced with metonymical hints of “normal” activities which have three things in common: they are performed by women, they are middle- or upper-middle-class leisure activities involving the outdoors, and they are acceptable “failures” (the basketball shot catches “nothing but the rim,” the golfing ends up “in a slice,” the kite is stuck in a tree). This ethos seems in contrast with the accusatory tone of the 1964 Elavil ad (where the hapless protagonist was a social failure) – but at a closer look, it is apparent that these minor failures are really disguised markers of success (golfing is, after all, perceived as an upper-crust sport). The “just like normal” slogan “anchors” (Barthes, 2002[1960]) the image as representative of normality. The bright orange background and the cartoon quality of the drawings are symbolic indicators of the simplicity of the course of treatment for depression; at a meta-level, they signify the cartoonish quality of life on Prozac. The drug here is an enhancer of a simple, angst-free middle-class life, allowing people to enjoy quotidian leisure activities (the copy elaborates: “Depression can keep your patients from enjoying the simple pleasures of life…etc.”); or, perhaps more

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accurately, a leveler, the dial the psychiatrist adjusts to achieve acceptable levels of social conformity. The parallels with Huxley’s feel-good soma in Brave New World are hard to ignore; the ads are reminiscent of “the warm, the richly coloured, the infinitely friendly world of soma-holiday. How kind, how good-looking, how delightfully amusing every one was!” Prozac ads in 2000 and 2001 ads simply show the pill (a device rarely used in the antidepressant ads) as the main persuasive technique (see Fig. 15).

Figure 15. Prozac, AJP 2000. “There’s only One”

The Prozac capsule is central to this ad, which focuses on the convenience and on the Number One status of the drug. The diagonal formed by the pillbox moves upward to the right, a compositionally “optimistic” message, especially as the “vector” (Kress and van Leeuwen, 2001) originates in the pill. Human presence or hint thereof is dispensed with. The appeal of the ad is purely ethos-driven, just as in the last Elavil ads.

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Prozac, British Journal of Psychiatry, 1990–2000 Prozac ads in the British journal fall in two categories: early 90s before-after structures, and late-90s ethos-based structures. Unlike their American counterparts, no actual face of depression or happiness is fully featured in the first period (1990–1995); human presence is connoted through synecdoche – parts for the whole (e.g., feet or eyes for the person) – or metonymy (e.g., kitchen for the place where the person lives). The second phase of Prozac advertising in BJP, starting about 1995, focuses solely on Prozac’s domination of the antidepressant market, choosing visual metaphors signifying “leadership.” The human presence in such ads is merely symbolical.

Figure 16. Prozac, BJP 1990

The first ads for Prozac in BJP date back to 1989 and show the legs and feet of a group of people, playing on a visual pun (“Isn’t it time to look at depression from a different point of view?”). The second ad in the series provides narrative coherence to the first ad, by providing the “after” shot. Depression’s absolute opposite here is “out and about” – which makes immobility/passivity its chief characteristic. Both women and men’s legs and feet are shown, though the women are central to the first ad (connoting depression), and the men are foregrounded in the second ad (as “out and about”). The woman in the fancy red shoes in the second ad carries a shopping bag (shopping is an occupation that women, unlike men, are often shown as doing in antidepressant ads), while the men are shod in work boots, and are poised for manual labor. The images are symbolic-attributive processes; they work by invoking general notions of “active” vs. “passive” and

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implying that getting out of depression is a simple matter turning from a state of rest to one of motion. The agency, however, does not belong to the patients, or even to the doctor; Prozac has the power to set things in motion. The depression/ happiness pair are cast as bodily functions – as literally, what one can do with one’s body – or in one’s environment (as the dirty/clean kitchen metaphor suggests in a 1990 ad; Fig. 17, first panel).

Figure 17. Two ads for Prozac in BJP, 1990

The binary opposites that play into the depression/happiness duality are mobile/immobile, dirty and disorganized/clean and organized, and sedated/ alert. They are all represented through symbolic attributive structures woven into temporal, before-after processes. No doctor and, significantly, no patients are present, except metonymically. The latter category of British Prozac ads is focused on the status of the drug itself, much like the ethos-centered American Prozac ads after 2000; the British ads, however, turn to visual metaphors of leadership to connote Prozac’s leading status (see Fig. 18). These three ads (from 1995, 1997, and 1998, respectively) turn to sports imagery as an obvious metaphoric reservoir for competitive “leadership.” Under variations of the slogan “True leadership has to be earned,” images of a victorious climber on top of a cliff, a running race with a leader breaking away from

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Figure 18. Prozac, BJP 1995, 1997, 1998. “True leadership has to be earned”

the pack, and a driver in a formula-one race car are used to signify Prozac’s “World’s No. 1 prescribed antidepressant” status. There are no claims made about depression (at least through images), about happiness, about patients, or even about doctors. However, the leadership images from highly competitive sports dominated by men are meant to connect with an audience assumed to be dominated by male psychiatrists (the phallic connotations of the rock climbing ad, and to a certain extent of the running race one, can hardly be missed). Fight and competition metaphors underscore the ads’ message. Although outwardly focused on branding, the ads are about putting the psychiatrist in command. The perspectives used denote omniscience – the viewer is so positioned to instantly and comfortably grab the bigger picture, view the whole race dynamics from above, and even be positioned in the driver’s seat in the last ad, in leading position. “World’s No. 1” status transfers, metonymically, onto the symbolic status of the Prozac-prescribing psychiatrist as “No. 1.”

Discussion This analysis, however cursory, suggests that antidepressant ad campaigns are organized in cycles that conform to the relative success and prestige of the drug; these cycles are respectively logos, pathos, and ethos-oriented (i.e., invoking scientific authority, appealing to emotions, or relying on the authority of the brand). These cycles were more obvious in the American than in the British ads; still, in all four ad campaigns described, the pathos and the ethos phases are always present, and always in that order. In the pathos phase, the marketing for the old antidepressant (Elavil/Tryptizol) relies, generally, on representations of depression; by contrast, the marketing for the newer antidepressant employs more direct representations of “happiness” or “normality.” The earlier ads (1960s and 1970s) need

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to sell the pill to a practice community still dominated by the Freudian paradigm, to which the idea of mood engineering via prescription drugs is relatively new, as is the ubiquity of the diagnosis of depression; by contrast, newer drug campaigns, from 1980 on, work with a “primed” audience who is abandoning the psychodynamic paradigm in favor of the biological one. It thus appears that the greater the need for persuasion (as in the earlier ads), the greater the emphasis on realistic detail and on the visual representations of depression symptoms; the lesser the need for persuasion (as in the later ads), the higher the incidence of symbolic structures and the greater the emphasis on images of happiness and success. In very broad lines, it can be said that the early antidepressant ads sell depression; the later ones sell happiness. Images of doctors are a rare, but consistent, presence in the early American Elavil ads; however, they are missing altogether in all British ads as well as in American Prozac ads. Also, causation (a Freudian category that was most important in both diagnosis and treatment) is, in general, absent. Depression is represented as a decontextualized disease, with no cause other than, perhaps, rogue synapses, requiring, by and large, no therapeutic process. The ads reduce depression to symptoms; and this reduction makes the drug a very attractive option. Representations of patienthood are heavily biased in terms of class, race, and gender. Typically, all patients are white and overwhelmingly middle-class as shown by dress or occupation, fitting (anachronistically) the category of the “worried well” patient described by Peter Kramer (1993), the psychiatrist who discovered that Prozac made his patients “better than well.” Mini-narratives of these patients are often used to provide the psychiatrist recognizable scripts for their practice. Such narratives act as case-study kernels for the doctor, providing cognitive models that would facilitate a diagnostic in “real life” (as in the case of the “social suicide” Elavil ad, for example). All ads tend to cast more females than males in “depressed” roles; furthermore, women-as-patients are typically cast in a “lower” position or lesser and/or stereotyped social role. Women are also often decontextualized, disembodied, or placed in domestic settings (kitchen, bed, bedroom). These gendered representations perpetuate a public image of depression as a women’s affliction, and discourage recognition of the disease in men by reinforcing a series of stereotypical inferences that equate the feminine with weakness, inferiority, and depression. In terms of cross-cultural differences, American ads seem to prefer more visual taxonomies as a way of structuring their imagistic evidence, employ more doctor references and more scientific illustrations, and are generally visually organized to be “interpreted” left-to-right. The British ads tend, in exchange, to be much more symbolic, to employ no scientific illustrations, and are usually organized top-bottom; they also never mention psychotherapy. American ads also seem to provide more “framing narratives” (e.g. scenarios) for depression than the British ones. There are

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also subtle preferences in the symbolic imagery between the two journals; while some depression/happiness metaphors transcend culture (e.g., the window), others some seem to be more culture-specific (e.g., the traveler in the British ads). The British ads, being generally much more connotative than denotative, tend to use a broader palette of metaphors to convey their message. By contrast, the American ads tend to be slightly more “concrete” and rely on some sort of scientific visuals to back up their claims. Also, overt representations of “happiness” and couples are avoided in the British journal. An antagonistic model of depression (as something that has to be “fought” or “defeated”) is promoted in both journals, although it is more evident in the American journal, especially in the “scientific” illustrations. Depression is gradually reduced to a mechanism; treatment – to a matter of brand loyalty. Eventually, the patient disappears completely from the later ads, and is replaced by pure branding. In their imagery, the antidepressant ads have rendered doctor, treatment, and patient entirely invisible, and replaced the mental care process with one pill, “the only one.” The ads undoubtedly reflect (perhaps even helped effect) the same symbolic transformation in the contemporary mentality of health-care providers and recipients alike; this is true especially since the advent of direct-to-consumer psychotropic drug advertising in the 1990s (which picks up on most of the same devices discussed here for the directto-physician ads). Calls to reform the psychopharmacologic treatment model are already in place (see Healy, 2004; Callahan and Berrios, 2005; Shorter, 2008); however, it remains to be seen whether, how, and when we can move beyond the chemical paradigm of happiness. One step towards that vision should be the acknowledgment that the Prozac-filtered life is a constraining and impoverished version of reality, something that the history of antidepressant advertising abundantly demonstrates.

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References American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders (revised 3rd ed.). Washington, DC. Barthes, R. (2002). “Rhetoric of the Image.” In J. Evans and S. Hall (eds), Visual Culture: The Reader, pp. 33–40. London, Thousand Oaks, New Delhi: Sage Publications. Callahan, C. and G. Berrios (2005). Reinventing Depression: A History of the Treatment of Depression in Primary Care, 1940–2004. Oxford: Oxford University Press. Gilman, S. (1982). Seeing the Insane. London and Lincoln: University of Nebraska Press. Gilman, S. (1988). Disease and Representation: Images of Illness from Madness to AIDS. Ithaca: Cornell University Press. Goffmann, E. (1979). Gender Advertisements. New York: Harper. Hacking, I. (1998). Mad Travelers: Reflections on the Reality of Transient Mental Illnesses. Charlottesville: University of Virginia Press. Hanganu-Bresch, C. (2008). Faces of Depression: A Study of Antidepressant Advertisements in the American and British Journals of Psychiatry, 1960–2004. Dissertation Abstract International, 69/05. (UMN No. AAT 3313444). Retrieved May 2008, from Dissertations and Theses database. Available at http://search.proquest.com/docview/304523129?accountid=29001 Healy, D. (1999). “The Origins of Antidepressants.” In H. Freeman (ed.), A Century of Psychiatry, pp. 169–72. Barcelona: Harcourt. Healy, D. (2004). Let Them Eat Prozac. New York: New York University Press. Kramer, P. (1993). Listening to Prozac. New York: Viking. Kress, G. and T. van Leeuwen (2001). Reading Images: The Grammar of Visual Design. London and New York: Routledge. Lennard, Henry L., Epstein, L.J., Ransom, D. C., Bernstein, A. (1970). Hazards Implicit in Prescribing Psychoactive Drugs. Science (31): 438-441. Metzl, J. (2003). Prozac on the Couch. Durham, NC: Duke University Press. Shorter, E. (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: John Wiley & Sons. Shorter, E. (2008). Before Prozac: The Troubled History of Mood Disorders in Psychiatry. Oxford: Oxford University Press.

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Chapter Nine

The Extended Pharmacist: Entering the Era of Remote Drug Dispensation and Pharmaceutical Counseling Phil Rose and Ainsley Moore

“The reason doctors prescribe so much medicine, Mr. Mawmsey, is because it’s the only way they can make their money. If they could charge for their consultation then they wouldn’t have to overdose the King’s legion. And that’s the worst kind of treason, eh?” – Dr. Tertius Lydgate, in George Elliot’s Middlemarch (1874)

In his seminal book Understanding Media: The Extensions of Man (1964), Marshall McLuhan popularized the notion that all of our technologies function as extensions of some physical or psychic human faculty, or, in some cases, some combination thereof. And he suggested that, with electricity, human beings had extended and externalized their central nervous systems. McLuhan and other students of media in his wake have provided significant accounts of the massive cultural changes that have accompanied this profound evolutionary development. But they have less commonly turned their attention toward such patterns of change as they occur within the practice of medicine. In this regard, telemedicine 193

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is one of the key defining features of an emerging field devoted to the study and clinical application of remote medical practice. Telepharmacy, similarly, uses telecommunications in the provision of pharmacy services from a distance. And sure to become an increasingly popular tool in the arsenal of the telepharmacist is the remotely supervised, automated drugdispensing machine. Automated dispensing was originally introduced in the 1960s, but here we investigate perhaps the most contemporary manifestation of this cultural form, specifically, the new MedCentre kiosk, a technology developed – partly with a $1.5 million grant from the Canadian government – by the Ontario-based Canadian company PharmaTrust (also known as PCA Services Inc.). As some suggest, the MedCentre promises to be to pharmacy what the automated teller machine has become to banks. A number of different variations of the technology exist, but the version that PharmaTrust most actively promotes enables patients to get prescriptions approved and dispensed from a machine, under the supervision of an off-site pharmacist synchronously connected to the patient through an audio-visual link. A number of trials of the technology have been taking place in the province of Ontario since 2007, and these expanded to the United Kingdom in the summer of 2010, while its introduction to a handful of American states is imminent. Not that the U.S. is a stranger to telepharmacy technologies, given it was in that country during the 1990s that they were first pioneered by AutoMed’s Telepharmacy Solutions. The principle of caveat emptor has long been a feature of our laws of commercial transaction, so it is well recognized that we are always prudent to weigh vendor claims for their technologies very carefully, particularly given the propensity for what has been aptly identified as “vendor utopianism.” But this is especially true, also, since the inventors of technologies are not always the most reliable judges of their progeny’s broader cultural effects. Neil Postman, appropriately, offers three useful questions to be considered in relation to any technological development: 1 What is the problem to which this technology is a solution? 2 Whose problem is it actually? 3 If there is a legitimate problem here to be solved, what other problems will be created by my using this technology? We intend to apply these heuristic questions to the MedCentre, identifying and evaluating potential costs and benefits, as well as accounting for and briefly describing effects of the unit’s possible technical attributes in different settings in which they will most likely be found in the near future. Following this, in reference to McLuhan’s laws of media, we will consider the technology’s possible broader cultural ramifications for the practice of pharmacy and medicine.

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MedCentre as Medium Postman (1985) clarifies that a technology is to a medium as the brain is to the mind. While the first is a physical apparatus, the latter is the uses to which that apparatus is put. As we have noted, in this regard, the MedCentre has a number of different technical manifestations, and this fact will inherently affect how it can be variously used, as well as the different types of environments in which it may find those uses. Here we are going to consider the holistic variation of the machine, which PharmaTrust appears most actively to be promoting, and whose scope of networked interaction includes the following: • a central server linked to physician computers and health record databases • a drug distribution server application that ensures quality control and facilitates home delivery service • a third-party payment transaction server • a possible fourth-party server for adjudicating insurance claims • a remote audio-visual link between pharmacists and patients. According to the company’s American patent application, the machine is designed preferably to operate within the setting of a physician’s clinical operation. And though it can be made to work with handwritten prescriptions, it is intended for use within a system that generates a human and a machine-readable script (possibly bar code), which patients can then present at a kiosk or any traditional outlet, as per their choosing. Although a recent Canadian Medical Association Journal (Woodward 2009) article reports that only 12 percent of American doctors’ offices presently use paperless prescriptions, the Obama administration has mandated that Medicare payments will be cut to doctors who have not made the shift from paper by 2012. This, of course, represents an effort to move physicians in the direction of complete “e-prescribing,” where, after a doctor fills out a prescription authorization on a computer, it is digitally sent directly to a pharmacy, or, alternatively, to a “pharmacy in a box,” but minus any type of computer printout. Alternatively, in other jurisdictions, the prescription information could be loaded on to a smart card, or saved to a Radio Frequency Identification (RFID) tag. Where policies, privacy laws, regulatory requirements, and other factors permit, the MedCentre is also meant to be connected to a database capable of storing, compiling and retrieving relevant patient information, such as name and address, diagnostic history, and drug history (medications, known drug allergies, and contraindications). Both the doctor and the dispensary can access the clinic’s management system or patient database either via the server, or by way of secure network connection. On the physician’s end, user authentication is required

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through a user name and password, biometric capabilities, smart card, or any other appropriate means, and patient user identity can be similarly authenticated. Alternatively, the machine can prompt patients for a personal identification number, or associate certain questions to answers that they provide through the machine’s graphic interface. The version of the invention that the company typically most advances includes an audio-visual consultation with a remote call-centre pharmacist – from PharmaTrust or some other service provider – transmitted over a private virtual network, or secured Internet connection. A degree of user privacy is created through the use of a standard telephone handset connected to the kiosk dispensary, in tandem with the audio-visual platform of Skype. These electronic extensions of pharmacist and patient represent, perhaps, the focal components of the coming service environment for prescription drug dispensation and pharmacist-patient interactions. *** To reconsider Postman’s aforementioned questions it would appear that the most pressing problem to which this technology appears to be a solution is for those who have limited access to prescription medications and pharmaceutical services. But which people? Or, as per Postman’s second question, whose problem is this actually? The fact is that many people in various countries still live in remote areas. And as Nissen and Tett (2003) recount in Australia, “mortality and morbidity increase as one travels away from metropolitan centres to more rural and remote locations” (p. 39). Such patterns are common in other countries, too, since these communities generally have less access to health services. Lim et al. (2009) refer to the global health workforce shortage as a crisis expected to worsen, but recruiting and retaining rural and remote hospital pharmacists is especially difficult. Poulson et al. (2010) record the situation in Queensland, where, between the years 2000 and 2005, the number of pharmacists fell from 80 to 73 per 100,000; and only 42 of its 116 public hospitals were employing qualified pharmacists. In Canada, virtual pharmacists have provided long-distance care since 2003, and this technique some suggest may provide a potential solution to the nation-wide shortage of 2000 pharmacists (Peartree Solutions Inc., 2001). Pharmacy technicians at remote sites in Kootenay Regional Hospital in the province of British Columbia began communicating via videoconferencing to a central pharmacist when a nearby town hospital could not recruit its own. Telepharmacists in Ontario, meanwhile, began providing remote services to hospitals in Moose Factory and Timmins in 2004 (CADTH, 2006), and remote dispensing has now also been introduced in Australia, Singapore, and Malaysia (Davies, 2010).

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Many communities are simply not able to support pharmacies, and in places like south-central Alaska, the rural Anchorage Service Unit spans approximately 107,413 square miles – an enormous area where transportation occurs by snowmobiles, ferries, and airplanes. Other American states, such as Arizona, Idaho, Oregon, Utah, Virginia, and Washington, experience distance-related barriers to access as well, sometimes for specific groups, such as the rural elderly in west Texas. This, of course, is also in the context of the long-time American pharmacist shortage, a situation expected only to continue to worsen. But as Judy Rose (2007) attests, “safe and effective medication use is enhanced by the inclusion of a pharmacist in the patient’s medical management team” (p. 18). So it would seem, then, if telepharmacy – practiced along the lines of the MedCentre – could fill some of these gaps, this would represent significant progress in healthcare for under-served groups. Before we address any new issues that such use of the MedCentre might create, we should identify further problems to which this technology would appear to proffer solutions. In this relation, whether for depression, high cholesterol, high blood pressure or diabetes, a patient’s drug program requires his or her compliance and adherence to prescribed drugs, in order for the individual to maintain good health. According to PharmaTrust company spokesperson Christina Bisanz (in Lynas, 2009), nevertheless, 25 percent of patient prescriptions are never actually filled. “If we can provide some accessibility and convenience for the patient, to have them fill that prescription at point of care,” she suggests, intimating that the technology should not be reserved only for remote jurisdictions, “then we also think we have an opportunity to improve compliance” (p. 13).1 The PharmaTrust MedCentre is presented as the remedy for another set of issues in its role as a node in a closed loop e-prescription and electronic medication administration system. Some frequently unsafe features of the traditional prescribing procedure involve medication errors resulting from a number of elements: these include the notoriously messy handwriting of physicians, pharmacist transcription errors, inaccurate dosages or incorrect drugs, overlooked adverse drug interactions, and dispensing mistakes. “Over 50% of medication errors,” according to Keeys et al. (2002), “are due to prescribing errors, followed by administration errors, transcription errors, and dispensing errors” (p. 717). Even the latter are significant, however, as Anacleto et al. (2005) report: Factors associated with dispensing errors may be communication failures, problems related to package labels, work overload, the physical structure of the working environment, distraction and interruption, the use of incorrect and outdated information sources and the lack of patient knowledge and education about the drugs they use. So-called banal dispensing errors reach significant epidemiological levels (p. 325).

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Among the people for whom this situation is a problem are the 1.5 million Americans who are harmed by medication mistakes every year, including the estimated 7,000 annual fatalities (Oren et al., 2003), a figure which, in the Canadian context, alarmingly, is reported to translate into 12,000 a year, or just over 30 per day (Picard, 2010). But e-prescribing and automated dispensing systems are reported to increase accuracy, while advocates of electronic medication administration point to the ability of such systems to create medication alerts as an additional layer of protection in the prescription procedure. The MedCentre’s inventors also point to the machine’s ability to cross-reference the machine-readable description of a prescription with patient information, in order to validate dispensing the order to users. They highlight other functional aspects of the invention, moreover, including its quality control and monitoring, inventory and distribution management, and audit functionality. As their U.S. patent application outlines: Before the item is released to the patient, it undergoes a final set of validation checks to protect patient safety and ensure that the correct item is being dispensed. In one implementation of the invention all pedigree data associated with the item (during the process of preparing the item for use in a dispensary) is compared with the attributes of the item in the patient bay. An RFID scan is performed to ensure that the item is the item scanned earlier in the process. The item pedigree attributes are analyzed to ensure that the drug is safe to dispense. For example, the expiry date has not passed, there has been nor [sic] recall on the item’s bin or lot by the manufacturer, etc. The item’s environmental variable history is processed to ensure that it has been subjected to no unacceptable excursions in temperature or humidity. This is supported by the fact that temperature and humidity are continually monitored and logged in the warehouse as well as the dispensary. By examining the environmental variable log for the times in which a given item resided in the warehouse or a particular dispensary, temperature and humidity history can be determined for the item and compared with the acceptable ranges as set by the pharmaceutical manufacturer. The package history of the item is also drawn from the event log of the system, and validated for acceptability. This history is comprised of each movement-based event to which the item has been subjected. For example, the history could log the date and time of shipment from the manufacturer, receipt in the warehouse, repackaging and serialization (i.e. application of the item’s RFID tag and entry of its pedigree attribute in the inventory management system), placement in dispensary and dispensing to the patient (the current date and time). The presence of all of these events in the item’s history provides a strong indication that the appropriate processes were followed, and delivers further evidence in support of the safety of the drug for dispensing to the patient. A weigh scale is also present in or near the patient bay, and the item

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weight is compared to the weight in its associated pedigree data set to make sure that it is within an expected tolerance based on the addition of the label, etc (p. 9).

Aside from functioning as a further mechanism for the achievement of drug safety, this type of quality and inventory control is said to result in significant cost savings, in part by diverting patient flow away from emergency-room use and hospitalization. But this is also a result of avoiding wastage due to expired medications and overstock, problems that tend to belong to hospital wards, remote medical clinics, and insurers. Ultimately, of course, it is also a problem for consumers and taxpayers – that is, patients. The inconvenience and inefficiency of traditional prescribing and dispensing processes is yet another problem to which proponents claim the MedCentre is a solution. In this regard, doctors have reported that electronic prescribing and medication administration systems (an ensemble of technologies with which the MedCentre is intended to achieve synergy) have increased their office productivity and convenience. We have already mentioned how most prescriptions are presently chirographic and paper-based, and this, according to the MedCentre’s patent application, results in pharmacies currently having to call physicians in order to clarify up to 10 percent of their prescriptions as a result of illegibility. The MedCentre promises to be quick, efficient, and convenient for patients too, who can save an extra trip should they achieve point-of-care pharmaceutical services following their appointment at the doctor’s clinic, something they’ll especially appreciate if they happen to be feeling very ill. Even in the apparently unlikely instance when the drug is not available in the machine, immediate home delivery can be arranged, while prescriptions could also be conveniently and automatically refilled when necessary, and delivered directly to people’s homes. MedCentre’s inventors propose also, finally, that their invention will create a stronger link between the work of physicians and pharmacists, because the latter will be better positioned to help monitor and manage chronic conditions, especially because automated drug dispensing technology will shift pharmacist work activities away from dispensing, and toward more patient counseling. In the studies that have appeared regarding satisfaction with telemedical encounters, most patients, overall, are satisfied with these services, though some have their misgivings. As one study reports regarding remote dermatology in the United Kingdom: Eighty-five per cent of telemedicine patients (n = 66) agreed that they would be happy to use this system again. However, 38% (n = 30) agreed with the statement that they would prefer to discuss their skin problem with the dermatologist in person. In addition, 40% (n = 31) said they would feel that something important

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was missing if they did not see the dermatologist in person. Nonetheless, 76% (n = 60) agreed that they would rather have their skin problem managed via telemedicine than have to wait a few weeks to see the dermatologist in person, which suggests that waiting time is an important factor in determining patients’ satisfaction (Collins et al., 2004: 31).

Studies related to telepharmacy counseling, specifically, have produced similar findings. Despite patient satisfaction being slightly greater with counseling received in person than that received via two-way video conferencing in Spokane, Washington, responses in both instances were generally positive, while patients at remote sites indicated that they did not have any preference between traditional and face-to-face counseling (Clifton et al., 2003). Another study concerning counseling for meter-dose inhaler technique given to remote adolescent asthma patients in rural Arkansas demonstrated that for this particular community, comprised largely of African-American youth, pharmacist-provided education via interactive compressed video was superior to instruction provided in the form of written instructions on an inhaler package insert (Bynum et al., 2001).

MedCentre Unbound Some of the claims being made on behalf of these aforementioned new electronic systems are being challenged as unfounded. In relation to the drug allergy and interaction alerts generated by e-prescribing systems, for instance, physicians are apparently encountering the problems of chronic information overload. Weingart et al. (2009) report that up to 37 percent of such alerts were inappropriate or irrelevant because trivial, or generated by interactions with out-of-date medications. Consequently, surveys of physicians in Britain, America, and Australia report that they habitually ignore them. Without intending to detract from the ways in which such systems might be useful – helping clinicians, for example, who are not familiar with a particular patient or drug, or, in some cases, educating them about potential interactions – Weingart et al. conclude that it is necessary for firms that maintain drug alert databases “to develop alerts that help, rather than hinder, good clinical practice both by paring down low-yield alerts to combat ‘alert fatigue’ and by enhancing features of alerts that support clinical decision making” (p. 577). Proposed cost savings and claims of greater efficiency made on behalf of the MedCentre include reduced drug and personnel expenditures. Nevertheless, as Balka et al. (2007) confirm, few studies provide primary evidence for such outcomes, and as R. W. Tallon (1996) warns, nor had clinical investigators

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successfully demonstrated substantial savings by the mid-1990s.2 With regard to the claim that automation will shift pharmacist work activities away from dispensing and toward more counseling of patients, Humphries et al. (2008) conclude that an automatic dispensing system by itself “does not appear to shift pharmacist work activities from dispensing to patient counseling or to increase job satisfaction” (p. 774). Findings regarding the prevention of medication errors by systems of electronic prescribing and dispensing are also mixed. Oren and colleagues (2003), for example, cite one study of computer physician order entry that found a decrease in rates of serious medication errors and potential adverse drug events (errors that resulted in no injury by chance). “Furthermore,” as they write, “these reductions were observed across all levels of severity for nonintercepted serious medication errors. Specifically, dosage errors decreased by 23% and errors associated with known allergies fell 56%” (p. 1448). Weingart et al. (2009) also note how e-prescribing, with decision support among adult inpatients, has been shown to reduce serious medication errors by as much as 55 percent. Although most in a survey of 29 e-prescribing systems were either not able to measure direct improvements in patient outcomes or simply did not, 66 percent were found to improve practitioner performance. And although only 10 studies (1 outpatient, 9 inpatient) attempted to detect such differences, the researchers found that computerized order entry with decision support reduced adverse drug events in half of those investigations reviewed. On the other hand, Susan Paparella (2006) notes how – as recorded by the Patient Safety Reporting System in Pennsylvania (the only state that requires the reporting of near misses as well as serious adverse events) – up to 15 percent of reported errors cite these machines as the source of the drug involved in the error. Paparella suggests that such events might be avoided with systems that use bar-coding technology for stocking, retrieval, and drug administration processes, while Gaunt et al. (2007) recommend both the desirability of automated vending units that support patient medication profiles, and of ensuring a pharmacist reviews the drug, dosage, frequency, and route of administration for all new medication orders before prescriptions are administered. They counsel, also, that pharmacists screen for allergies, laboratory values, and interactions with foods or other medication, and all of these the MedCentre proposes to do. As Oren et al. (2003) conclude, controlled and generalizable research is lacking with regard to critical evaluations of the impact on medication errors and other adverse outcomes of these new technologies (among which they include computerized physician order entry, automated dispensing, computerized medication administration records, and bar coding). Thus, studies confirming their benefits are few, as are those providing evidence for their appropriate use, observations

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supported a few years later by Balka et al. (2007), who studied the implementation of an automated drug dispensing system (ADS) within a large Canadian tertiary care facility. As the researchers report with regard to that particular setting: The failure to situate the ADS technology within its social context (in which nurses lack time, pharmacy was not adequately staffed during the transition to the ADS, and new monitoring procedures were introduced that added demands to both nursing and pharmacy roles) resulted in a situation where the potential of the ADS was, at best, only partially realized. According to Barker, unless properly applied the ADS will not reduce errors. Results from research about the impact of ADS have been mixed—some studies show a reduction in medication errors, while other studies have drawn attention to mechanical and human problems in their use (Balka et al., 2007: S54).

Balka et al. direct our attention to the importance of the social and clinical milieus in which such technologies are to be implemented – the primary constituent involved when distinguishing a technology from its operation as a medium. To summarize the evidence, the Canadian Agency for Drugs and Technologies in Health (CADTH) conducted a systematic review3 of automated medication dispensing technology in 2009 (updated in 2010), looking at outcomes of medication error rates. A not-for-profit, independent organization funded by federal, provincial and territorial governments in Canada, CADTH is tasked with providing impartial advice and evidence-based information to Canadian healthcare decision makers about the effectiveness of technologies. The agency provides an important source of summary information on telehealth, telepharmacy, and automated dispensing technology. It prioritized the importance of understanding the latter, based on a survey reporting that, although a majority of Canadian hospitals (56 percent) used a form of automated dispensing, and another 33 percent indicated an intention to invest in the technology, there was a lack of evidence supporting its benefits. The systematic review was based on clinical studies that met some minimum criteria of study design, which could include randomized controlled trials, controlled clinical trials, observational studies (cohort and case control), before and after, or time series studies. Methodological standards for studies to be considered in the review required a comparator group, either to another technology or to usual care (i.e. standard practice). The agency concluded that, based on studies of low internal validity (which provided the only data available), automated medication dispensing systems, bar coding for medication administration, and the simultaneous use of the technologies reduced the risk of dispensing or medication errors in hospitals. Studies reported a range of reduced dispensing errors, medication errors, and adverse medication events

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from 30–40 percent overall among hospital ward dispensing systems. Bar-code medication dispensing devices, meanwhile, were associated with a 15–96 percent decrease in dispensing and filling errors. They further report that the magnitude of the benefit cannot reliably be estimated, as studies were conducted using equipment that is no longer available for purchase, or not available in Canada. Additionally, they caution that the impact of automation on the more important outcomes of death, injury, or harm cannot be estimated, because these outcomes were not measured. CADTH identified important methodological limitations for most of these studies; none for instance were conducted in a Canadian setting, nor were any of them randomized controlled studies.4 We should note that the agency also cites research identifying how errors sometimes increase with the use of automatic dispensing cabinets. One such study conducted in a cardiac intensive care unit, for example, reported a 70 percent increase in medication error rates, and this should remind us again of the importance of understanding the intended clinical context of any technology.

Implementing the MedCentre At this point we can begin to address Postman’s third question, namely, “If there is a legitimate problem here to be solved, what other problems will be created by my using this technology?” Preventing good intentions from leading to bad outcomes ultimately requires us to consider the various contexts within which the MedCentre might be implemented. In this regard, Balka and her colleagues elucidate how new technologies engender new procedures, and, thus, new patterns of workflow. These researchers also draw our attention to the necessity for technical design to be completed in technology use, especially given that designers – let alone managers – tend to lack awareness of some of the invisible work carried out in many clinical spaces. To ensure their success and to help avoid socio-technical conflicts, technology implementations must be conducted at a system-wide level, particularly since they frequently cross over jurisdictional boundaries. Multi-jurisdictional problems, the researchers observe, need to be solved at organizational rather than departmental levels, and must be undertaken in a way that clearly delineates accountabilities for implementing agreed-upon changes. As this volume clearly attests, McLuhan’s laws of media represent another useful heuristic tool for ascertaining the potential dynamics of a new technology in either micro or macro settings. To reiterate, there are four laws, and these are expressed in the form of questions: 1 What does the medium extend, enhance, or intensify? 2 What does the medium displace or make obsolete?

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3 What does the medium retrieve that had been obsolesced earlier? 4 What does the medium flip into, produce, or become when pushed to extremes? These questions we will address in a general way, with brief consideration given to various possible contexts in which the MedCentre might be found, but, again, we will emphasize considerations regarding its recommended implementation in physicians’ practices. 1. What does the medium extend, enhance, or intensify? We have, of course, already detailed a number of such potential characteristics. To recapitulate, however, the MedCentre promises to enhance pharmaceutical services in remote or otherwise underserviced areas, thereby intensifying the satisfaction of patients in such places as well. In this regard, the primary goal is to promote equitable access to health services that would otherwise be unavailable, thereby eliminating distance barriers. Real-time telehealth has been practiced globally for fifty years, and Canadian provincial and federal agencies have regarded it as a significant component in serving the needs of geographically isolated communities. The amount of available research continues to grow, and an increasing number of systematic reviews have addressed various aspects of telehealth. CADTH conducted a meta-analysis of such reviews, in order to assess health outcomes and access to health care in relation to telemedicine applications. Such high-quality systematic reviews, we should note, indicate support for improved health outcomes. The MedCentre promises to intensify people’s satisfaction in other localities as well by augmenting the choice of venues where patients can have prescriptions filled, and by increasing the general convenience of access – not simply in spatial, but in temporal terms, given that PharmaTrust intends to offer its services 24/7. In this way, hospital emergency departments have creatively dealt with the challenges of medication dispensing after hours through their adoption of outpatient automated dispensing systems. Staff in both a rural and an urban emergency department in Minnesota enthusiastically received such point-of-care systems, and identified an improvement in care and convenience for both staff and patients. Nurses, thus, were no longer responsible for labeling and dispensing the starter packs of medications that patients would use in the interim until pharmacies opened (Gordon et al., 2005). In some situations, pharmacists are extending themselves electronically from home, experiencing a new flexibility in their working day or conducting “on-call” services, but in a greater number of locations than previously. The company promises to amplify patient satisfaction even further by offering multi-lingual service provision, including sign language. As noted, the MedCentre could also

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potentially enhance medication compliance, not simply for the greater convenience of access it can offer, but also because it is intended to facilitate seamless integration in drug treatments. The requirement of going to the pharmacy to refill prescriptions, purportedly, is notorious for creating treatment gaps, but PharmaTrust’s system proposes to deliver repeat prescriptions automatically to the doors of patients, a few days prior to the end of their previous ones. Safety, too, may prove to be enhanced through reductions in inaccurate dosages, incorrect drugs, and other dispensing errors, and – where the invention is linked with e-prescribing systems – through the reduction of errors due to poor physician handwriting, pharmacist transcription errors, or overlooked adverse drug interactions (once IT companies have managed to improve drug alert systems). The MedCentre’s quality control and monitoring systems are expected also to increase safety, as is its inventory and distribution management, its audit functionality, its cross-referencing of the machine-readable prescription with patient information, and its remote pharmacist’s verification of patient information and of the order the machine is dispensing (this by way of six live cameras inside the machine with which the extended pharmacist will monitor dispensing). The automated nature of this procedure, according to PharmaTrust, should enlarge the counseling role of pharmacists, in addition to enhancing their interprofessional relationship with physicians – at least insofar as the system is expected to reduce the amount of time required for pharmacies having to call physicians’ offices to confirm prescriptions, provide them access to the patient’s medical and drug record, and to the extent that doctors will be informed that their patients’ prescriptions have been filled. Of course, if patient compliance is increased, this will facilitate the broad dispersal of drugs and increase demand for production, enhancing sales and the profits of PharmaTrust, which, naturally, claims that its intervention will make drugs cheaper. 2. What does the medium displace or make obsolete? The primary reason for the visual representation of the laws in tetrad form is to emphasize the simultaneity of the processes involved in the environmental influences that technologies exert in any given socio-cultural setting. So, at the same time that e-prescribing enhances the safety of drug use, it does so through the obsolescence of illegible, handwritten prescriptions. Extended in conjunction with the MedCentre into remote areas, these work together to displace the population’s former situation involving little or no service. Additionally, the combination may displace older techniques in the activities of long-established telepharmacy systems, such as the Australian Flying Doctor Service’s medical chest program, established in 1942, a small number of years after the organization first began its telehealth consultations in 1929 using Morse code and the Traegel Pedal wireless

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(see Margolis and Ypinazar, 2008). Depending on the contexts in which they may eventually be found – and it is likely they could be found in all types of commercial and non-commercial venues – MedCentre also promises to push aside the activity of late-night running around trying to find an open pharmacy. This it will do much in the way that instant teller machines obsolesced the need to get money out of the bank prior to noon on Saturdays, in the event one might need cash for the remainder of a weekend. Among other things that the MedCentre promises to displace are on-site pharmacies in those clinics that presently have them, as well as the presently embodied clinical pharmacists of interprofessional health teams. This, of course, is not to mention pharmacy technicians.5 Postman successfully captures the dynamic of obsolescence in his suggestion that it is necessary to attend not just to what technologies do, but also to what they undo. In this way, as the audio-visual link in telepharmacy extends the disembodied simulacra of pharmacists and patients across space, it is worth recalling the sentiment that one quarter of British subjects expressed in the aforementioned telemedicine study: that something important would be missing if they did not see the dermatologist in person. In part, what this would be, from a clinical point of view, is loss of the immediacy of the embodied face-to-face relation. Both for patients and pharmacists, the nuances of nonverbal communication, social and cultural cues, or signs of cognitive impairment are inevitably more difficult to discern through the decontexualizing transmission channel of Skype, the platform that PharmaTrust intends to utilize for its audio-visual transmission. Should pharmacists begin working from home, this may also serve to obsolesce their former professional deportment, since the very nature of people’s relationship to their medications may be altered or degraded through deformalizing the process of procurement from a professional in a white coat, positioned behind a counter in a quasi-clinical environment. Laxity of this relationship is an important consideration, given the potential for great harm or loss of benefit associated with a too easygoing approach to pharmacotherapy. From the patient’s perspective, another important thing that most likely would be missing is a continuous relationship with a community pharmacist, given that one can easily predict the eventuality of patients being counseled by a different offshore pharmacist each time they stood in front of such vending machines. Should this occur it would decimate the patient-practitioner relationship – a pillar of patient-centered care associated with one-third greater compliance with medications (Kerse et al., 2004).6 Those involved in the industry of telepharmacy generally know the importance of this aspect of their activity, and, therefore, stress the necessity for their field to develop ongoing partnerships with patients by “personalizing” relationships, based on individual data, needs, and preferences. “Building a relationship and empowering patients to be partners in their care are the most crucial ingredients of a

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successful telepharmacy program,” according to the report of a focus group for the American Society of Health-System Pharmacists (ASHP 2001). Telepharmacists, the report says, require “special training to communicate with patient populations that have different levels of health care access, interest, and knowledge,” pointing out also that such training is quite distinct from that required for solving problems related to medication. This training, they note, includes sensitivity to understanding what it is like to have particular chronic conditions, and also includes learning to communicate effectively via televisual electronic link, especially in order to assess patients’ levels of motivation and comprehension in the absence of face-to-face contact. One’s ability to comprehend the indications, side-effects, and risks of taking a medication is germane to the ethical principle of autonomy, a fundamental tenet of informed consent. Ensuring informed consent through the mediating effects of televisual communication presents new challenges to this vital aspect of ethical medication management. This whole existential shift is more likely to trouble the elderly than the young, not simply for reasons of cultural alienation, but because – despite comprising only 13 percent of the population – senior citizens represent one-third of all Canadian prescription drug use, and are the demographic most likely to be faced with the problem of co-morbidities. Averaging 9–13 prescriptions every year, and, with the augmented life expectancy of an aging population, the careful management of polypharmacy for seniors will become increasingly crucial. As Liaw and Peterson (2009) elucidate within the Australian context, around a third of elderly patients have two or more doctors prescribing them drugs, creating a fragmentation that can encourage communication breakdown, and increased risk of adverse drug reactions for seniors. And they point out that it is little surprise that communication failures between health-care professionals and patients are the principal cause of preventable hospital admissions that are drug-related. In this regard, a foundational element in the drug regime of the elderly that the MedCentre may obsolesce is the dosette, the apparatus that pharmacists fill weekly or bi-weekly in order to keep patient regimens straight. Unless the company is intending to serve up to one third of its potential clientele solely by its home delivery option (which it may), PharmaTrust will have to work out how the machine can eventually fill and dispense dosettes. 3. What does the medium retrieve that had been obsolesced earlier? At the same time that the MedCentre will be enhancing and displacing people and things in a variety of ways, it is retrieving others that formerly had been obsolesced. With its sending automatic reminders to patients to refill their prescriptions, it is tempting to say that the MedCentre retrieves, if not the medicine man, the patient’s mother – or, in some scenarios, perhaps, a nurse.

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More importantly PharmaTrust deliberately intends to help retrieve the previous tradition of physicians both prescribing and dispensing medications, a distinction that in the West first separated the work of physicians and pharmacists in 1231 with the Edict of Palermo, forbidding physicians from forming business relationships. Such was common practice in continental Europe by the 18th century. Notwithstanding the June 1632 regulation that forbade apothecaries in the UK from selling or prescribing poisonous substances or drugs, “save on the written prescription of a physician or upon a note in writing from the purchaser” (Penn 1979: 298), it was not until the National Insurance Bill in 1911 and the consolidation of universal medicine with the achievement of the welfare state that the nation firmly established the separation of prescribing and dispensing. Similarly, according to Deborah Anne Savage (1994), the majority of U.S. doctors’ offices included facilities for preparing drugs as late as the 1940s. It was only in modern times, as Penn recounts, that the idea of a prescription-only drug really came into being, and that physicians became so divorced from the actual preparation of their medicines. Frequently with herbs they gathered themselves, it was once common for physicians to formulate their own products, alongside those they were likely to get from another apothecary known to them, nonetheless quite possibly still according to their own special direction. Only in the 19th century – with the rise of the pharmaceutical industry and the rapidly increasing numbers of potent drugs – did emphases on universally applicable standards become raised. Knowing that the average doctor writes approximately 10,000 prescriptions a year, PharmaTrust writes in its U.S. patent application: This corresponds to enormous revenue generated for pharmacies. The present invention is designed to dispense medicine inside physician clinics or directly to patients’ homes, delivering a more convenient service to patients while capturing a portion of the revenue stream that would otherwise go to pharmacies… [T]he dispensing of drugs by doctors enables redirecting of certain revenue to doctors which in turns [sic] relieves pressure on the health care system and enables doctors to take the time required to cover drug related issues such as interactions more exhaustively and using better tools than what is currently possible under the existing system. The doctor is the entry point for patients to a drug therapy regime… (p. 13).

The reason for instituting this separation between prescribing and dispensing in the first place was to address the conflict of interest that exists when financial incentives encourage hospitals, physicians, or pharmacists not to act in the best interest of patients. Dispensing can quickly become more profitable than providing consultation and other services, and thereby promote the misuse,

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overuse, and inappropriate use of drugs. Separation of these practices functions as a mechanism of check and balance that reduces the propensity toward this type of incentive structure, and enhances the quality of prescription drug consumption in general. 4. What does the medium flip into, produce, or become when pushed to extremes? If PharmaTrust were to allow the dosette to become obsolesced, without any type of remediation, it would soon become a polypharmacy nightmare that the MedCentre system would rapidly need to address. And were the company to follow through on its suggested arrangement to facilitate physicians’ profiting from the prescription of drugs, we could fully expect that, when pushed to such an extreme, its invention would flip into a significant mass conflict of interest. In oriental medicine – as practiced in places like China, Hong Kong, Thailand, and Japan – the roles of physicians for the most part still have yet to be differentiated, and this has long allowed them to continue both prescribing and dispensing medications, a reality that has likely contributed to the situation that Chou and colleagues (2003: 316) describe, in reference to a report by the Organization for Economic Cooperation and Development (OECD): For example, drug expenditure as a share of total health expenditure is approximately 30% for Japan, South Korea and Taiwan, and as high as 52% for China (National Health Economic Institute 2000), compared with an average of 10–14% among OECD countries where, in most cases, prescribing and dispensing are separate activities (OECD 1999, cited in Chou et al. 2003: 316).

As a result of consuming considerably more drugs than people of other developed nations, South Koreans, in an attempt to counteract the situation, finally introduced measures in 2000 in order to separate prescribing and dispensing (Kwon 2003). This was soon followed by Taiwan, where unofficial estimates had surmised that half of drug fees represented profit, and that companies frequently bestowed upon physicians a type of “kickback” for dispensing particular drugs (Chou et al., 2003). In response to the serious shortage of health-care professionals, many policymakers in Western countries have sought to complement strategies for attracting more people into these professions by simply expanding their roles. In this regard, a trend exists for allowing pharmacist involvement in supplementary prescribing, as in England by 2003 (followed in 2005 by an extension of this role to podiatrists, physiotherapists, optometrists and radiographers), which was subsequently followed in 2006 by a further enlargement of the pharmacist’s role to include

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independent prescribing. It is likewise now legal in Canada and the U.S. for pharmacists to prescribe a range of medicines. It is worth reiterating, however, that the same conflict of interest exists for the prescribing pharmacist as for the dispensing doctor. There has been similar movement in the direction of reinstating the connection of physicians to dispensing. The Office of the Inspector General of the U.S. released a report in 1989 titled Physician Drug Dispensing: An Overview of State Regulation (Kusserow, 1989), wherein it cited the recent greater involvement of the Federal Government with this issue. While the Federal Trade Commission (FTC) had been discouraging states from unreasonably restricting or prohibiting physician dispensing of prescription drugs (suggesting that this could enhance competition in the prescription drug market and, thus, lead to better services and lower prices), the U.S. Congress had just considered legislation prohibiting practitioners from for-profit drug dispensing, excepting in special situations. Unsurprisingly, this move attracted widespread attention from various groups. The Inspector General also cited how six states reportedly imposed no regulations on physician dispensing at that time, while the remaining states exerted only minimal restrictions on the practice, limiting these for the most part to mere procedural requirements. Notwithstanding, the report suggested that although low, with three quarters of regulatory officials estimating that 5 percent or less of physicians in their states were dispensing for profit, the incidence of physician dispensing seemed to be growing across the country, according to the opinions of approximately half of the officials. More recently, Nystrom and Clark (2006) point out that most states still allow this practice, but doctors, in addition to following storage and other procedural guidelines, can only prescribe to their own patients, and must allow them the possibility of filling prescriptions elsewhere. The Code of Ethics of the American Medical Association stipulates that physicians are permitted to dispense medications within their office practices if no patient exploitation occurs. Accordingly, Nystrom and Clark note that dispensing can net American physicians an extra $70,000–$100,000 in annual income. From interviews with pharmacy customers in the Philippines, James and colleagues (2009) determined that patients using pharmacies owned by publicsector physicians were 5.4 times likely to have prescriptions from such physicians, and were persuaded by these physicians to use their pharmacies. Additionally, they spent 49.3 percent more than customers using non-physician-owned pharmacies. They have, likewise, found that dispensing doctors in Zimbabwe and the UK prescribed more medicines than their non-dispensing counterparts. Moreover, the researchers noted studies in Taiwan that analyzed outpatient clinics. Among visits to clinics that lacked “on-site” pharmacists (pharmacists hired by physicians to dispense their prescription drugs), they found the probability of receiving a prescription and drug spending during visits to be, respectively, 17–34 percent

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and 12–36 percent less. They also cite research concluding that pharmacies with physician links were filling a significant and increasing proportion of all Taiwanese prescriptions. As Lee and colleagues (2007) record in this regard, because the Taiwan Medical Association pressured its Department of Health to allow physicians to employ on-site pharmacists to dispense drugs at their clinics, the separation prohibiting profiteering has not been properly achieved, and so the conflict of interest remains irresolute. Lim et al. (2009) conducted the first systematic review in this area, and found international evidence indicating that dispensing doctors prescribed a greater number of pharmaceutical items compared to non-dispensing doctors, and less frequently prescribed cheaper generic drug formulations. They found limited evidence also that these professionals had associations with poor dispensing standards, and prescribed antibiotics less judiciously, notwithstanding the different national health systems in which they practiced. Given the ease with which excessive antibiotic therapy flips into non-resistant bacterial strains, the World Health Organization (WHO), as Chou and company (2003) note, recommends a ceiling of 23 percent of a nation’s population to be receiving antibiotic treatment at any time. While the prevalence of antibiotic treatment among South Koreans was 59 percent prior to imposed separation of prescribing and dispensing activities, prescriptions for antibiotics declined, as James et al. (2009) report, following the segregation of drug dispensing and prescribing in 2000. Kim and Ruger (2008) elucidate how this transformation, nevertheless, has come at great cost to South Korean society, distorting the supply of medical services as physicians have made up for lost income through increased provision of uninsured services, and through the creation of transportation difficulties and time costs for patients. This is not to mention, as Lee and colleagues (2007) point out, how physicians’ fees increased as much as 44 percent, and how further costs accrued with their starting to prescribe more expensive brand-name drugs – likely the result of representatives of pharmaceutical companies providing them with free drug samples for the infamous “drug cupboard.” Always biased towards new, patent-bearing drugs, conflicts of interest are so great with such medication sample handouts (which tend to represent over half of the promotion costs of drug companies) that many medical practitioners advocate discontinuing the longstanding practice of accepting them, in order to prevent such activity, too, from influencing the prescribing habits of physicians. Others, on a number of grounds, even eschew the habit of holding court with drug-company representatives at all (see Brody 2005). There is insufficient space here to investigate what the MedCentre might potentially produce should the security of the contents of the machine be compromised, or its associated systems lose patient history data; imperil patient personal

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information through possible breaches of network security; compromise patient safety through external manipulation of its RFID tags; or become an extra source of revenue for doctors as a means of advertising. These, however, are all issues that deserve significant consideration in evaluating the advantages and disadvantages of such innovations.

Conclusion According to the province of Ontario’s Medicine Act, 1991 (O. Reg 114/94 as amended O. Reg 122/03), a physician may only dispense, sell, or compound a drug where the services of a pharmacist are not reasonably readily available. “The introduction of kiosks into the Ontario health-care system,” as the College of Physicians and Surgeons of Ontario (2010) recently observed, however, “has the potential of involving many more physicians in dispensing activities” (p. 26). The College observes that, under the current scenario that the MedCentre presents, pharmacists and not physicians are accountable for dispensing. But it recognizes that this situation is likely to change, and so, in collaboration with the Ontario College of Pharmacists, it recently developed a policy statement on dispensing that outlines its expectations for drug-dispensing physicians. Among these are that physicians need to be aware that it is a conflict of interest for them to profit on the sale of a drug to a patient, except in very limited circumstances. This position seems one that will stymie the aspirations of PharmaTrust’s preferred business model, as will current regulations in the U.S. state of Wyoming, where telepharmacies can only be located in medical clinics or community health centers that are a minimum of 25 miles from an existing pharmacy (Davies, 2010). We can fully expect, however, that such issues will continue to be contested in the years to come. In the decade since surgeons in New York removed the gall bladder of a 68-year-old woman located more than 3,500 miles away in Strasbourg, France, the roles of remote clinicians have been increasing. Deshpande et al. (2008), on behalf of CADTH, cite one high-quality review, which concludes that telemedicine could improve access to care, especially for rare diseases, and that it may reduce strain on the limited number of specialists in various areas. Applications in psychiatry, meanwhile, recommend that videoconferencing is useful in specialties involving verbal communication and relationship building. The researchers find also that remote monitoring reduces hospital admissions and death for patients with congestive heart failure, and that home-based telemedicine improves monitoring of chronic conditions, while enhancing quality of life for the elderly. The report’s authors conclude optimistically that with advancing technology and decreasing costs, telehealth may become a mainstream method of health-care delivery. And

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they further recommend support for high-quality telehealth initiatives, which may decrease disparity in areas of limited health-care resources, and could contribute to realizing the principles of the Canada Health Act. With regard to telepharmacy services, however, an evidence gap remains, given that reviews of such services are not yet available. Nonetheless, Perras et al. (2009), in another study for CADTH, have found that – in hospital care units (excepting the intensive care unit, where large capital expenditures are invested on a small number of patients) – automated drug dispensing machines prove to be less costly than manual systems. But error rates they have found were used as surrogate measures of impact on health, such as harm, illness, or death, which were not directly assessed. Most importantly, however, the agency concludes that, based on the quality of data, automated dispensing devices do not necessarily ensure better patient outcomes or greater efficiency, and these may vary with different health-care settings. In sum, then, there is no direct evidence that the MedCentre will reduce medication errors, improve adherence to medications, or improve health outcomes. Indirect evidence, derived from hospital settings linking automated dispensing technology to reduction in medication errors, is limited by the lack of high-quality studies, while the impact of automation on important health outcomes like injury and death remains unstudied. The greatest possibilities for the cultivation of beneficial service environments for the MedCentre would appear to lie in the provision of geographically remote or under-served populations. For the moment, combining automated dispensing and telepharmacy is uncharted territory; and we require further research to investigate patient-focused services, and to appraise more fully the clinical, economic, and humanistic outcomes of these telepharmacy services.

Notes 1

2 3

This, of course, assumes that point-of-care convenience improves compliance, something that to date has not been established. Bisanz, moreover, tells us nothing about the kind of individuals that make up this one-quarter of patients, which leaves us with insufficient information for answering Postman’s second question – that is, whose problem is this exactly? Depending on the clinical context and professional group, others indicate measurable increases in nurse productivity, which were then counterbalanced by reduced pharmacy productivity and enlarged medication costs. The systematic review in medical literature is a detailed structural analysis of previously conducted research, which provides a means to condense data, assess quality of data, and summarize evidence.

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4 Well-designed randomized controlled trials are considered to yield the highest level of quantitative medical evidence. 5 The Ontario government introduced legislation in December 2010 under The Pharmacy Act that recognizes pharmacy technicians as a new class of registrants with the Ontario College of Pharmacists. Preparations for these changes began in 1998, and they enable pharmacy technicians to take responsibility for certain dispensing activities within the pharmacy. It is ironic, therefore, that just as the accountabilities, rights, responsibilities, accredited education programs, and licensing examinations for this profession are coming into existence, the role itself may soon be obsolesced. 6 The aforementioned legislation to regulate pharmacy technicians in Ontario is also intended to allow pharmacists to expand their services and scope of practice, in order to develop long-term relationships with patients in the clinical context.

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Balka, E., N. Kahnamoui and K. Nutland (2007). “Who is in Charge of Patient Safety? Work Practice, Work Processes and Utopian Views of Automatic Drug Dispensing Systems.” International Journal of Medical Informatics 76: S48–57. Brody, H. (2005). “The Company We Keep: Why Physicians Should Refuse to See Pharmaceutical Representatives.” Annals of Family Medicine 3(1): 82–85. Bynum, A., D. Hopkins, A. Thomas, N. Copeland and C. Irwin (2001). “The Effect of Telepharmacy Counseling on Metered-dose Inhaler Technique among Adolescents with Asthma in Rural Arkansas.” Telemedicine Journal and e-Health 7(3): 207–218. CADTH (Canadian Agency for Drugs and Technologies in Health) (2006). “Virtual Pharmacists Provide Long Distance Care.” Health Technology Update. http://www.cadth.ca/index.php/en/hta/reports-publications/healthtechnology-update/issue2/telepharmacy (accessed December 6, 2010). CADTH (Canadian Agency for Drugs and Technologies in Health) (2010). “Automated Medication Dispensing Systems: A Review of the Clinical Benefits, Harms, and Cost-Effectiveness.” Health Technology Assessment. http://www.cadth.ca/media/pdf/l0220_automated_dispensers_htis-2.pdf (accessed December 6, 2010). Chou, Y., W. C. Yip, C.-H. Lee, N. Huang, Y.-P. Sun and H.-J. Chang (2003). “Impact of Separating Drug Prescribing and Dispensing on Provider Behaviour: Taiwan’s Experience.” Health Policy and Planning 18(3): 316–29. Clifton, G. D., H. Byer, K. Heaton, D. J. Haberman and H. Gill (2003). “Provision of Pharmacy Services to Underserved Populations via Remote Dispensing and Two-way Videoconferencing.” American Journal of Health-System Pharmacy 60: 2577–2582. College of Physicians and Surgeons of Ontario (2010). “Dispensing Drugs.” Dialogue 2. http://www.cpso.on.ca/uploadedFiles/policies/policies/ policyitems/dispensing_drugs.pdf (accessed December 6, 2010). Collins, B., T. F. Borders, K. Tebrink and K. T. Xu (2007). “Utilization of Prescription Medications and Ancillary Pharmacy Services among Rural Elders in West Texas: Distance Barriers and Implications for Telepharmacy.” Journal of Health and Human Services Administration 30(1): 75–79. Collins, K., S. Walters and I. Bowns (2004). “Patient Satisfaction with Teledermatology: Quantitative and Qualitative Results from a Randomized Controlled Trial.” Journal of Telemedicine and Telecare 10: 29–33. Crowe, B. and P. MacIssac (2006). “The Application of Qualitative Approaches to the Evaluation of Telehealth Systems in Australia.” Journal of Telemedicine and Telecare 12: 33–35. Dansky, K. H., D. Thompson and T. Sanner (2006). “A Framework for Evaluating eHealth Research.” Evaluation and Program Planning 29: 397–404. Davies, J. (2010). “Telepharmacy – Opportunity or Threat?” British Journal of Clinical Pharmacy 2: 211–12.

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Deshpande, A., S. Khoja, A. McKibbon, A. R. Jadad (2008). Real-Time (Synchronous) Telehealth in Primary Care: Systematic Review of Systematic Reviews [Technology report no 100]. Ottawa: Canadian Agency for Drugs and Technologies in Health. Doughty, K., P. King and G. Williams (1997). “An Automated Drug Dose Calculation and Delivery System Based on Telemedicine.” Journal of Telemedicine and Telecare 3: 92–93. Franklin, B. D., K. O’Grady and P. Donyai (2007). “The Impact of a Closed-Loop Electronic Prescribing and Administration System on Prescribing Errors, Administration Errors and Staff Time: A Before-and-After Study.” Quality and Safety in Health Care 16: 279–84. Gaunt, M. J., J. Johnston and M. M. Davis (2007). “automated Dispensing Cabinets. Don’t Assume they’re Safe; Correct Design and Use are Crucial.” American Journal of Nursing 107(8): 27–28. Gordon, J., R. Hadsall and J. Schommer (2005). “Automated MedicationDispensing System in Two Hospital Emergency Departments.” American Journal of Health-System Pharmacy 62: 1917–23. Hall, K. B., S. E. Tett and L. M. Nissen (2006). “Perceptions of the Influence of Prescription Medicine Samples on Prescribing by Family Physicians.” Medical Care 44(4): 383–87. Humphries, T. L., T. Delate, D. K. Helling and B. Richardson (2008). “Impact of an Automated Dispensing System in Outpatient Pharmacies.” Journal of the American Pharmacy Association 48(6): 774–79. James, C. D., J. Peabody, O. Solon, S. Quimbo and K. Hanson (2009). “An Unhealthy Public-Private Tension: Pharmacy Ownership, Prescribing, and Spending in the Philippines.” Health Affairs 28(4): 1022–33. Keeys, C. A., K. Dandurand, J. Harris, L. Gbadamosi, J. Vincent, B. Jackson-Tyger and J. King (2002). “Providing Nighttime Pharmaceutical Services through Telepharmacy.” American Journal of Health-System Pharmacy 59: 716–21. Kerse, N., S. Beutow, A. G. Mainous, G. Young, G. Coster and B. Arroll (2004). “Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation.” Annals of Family Medicine 5: 455–61. Kim, H. J. and J. P. Ruger (2008). “Pharmaceutical Reform in South Korea and the Lessons it Provides.” Health Affairs 27(4): 260–69. Kusserow, R. (1989). Physician Drug Dispensing: An Overview of State Regulation. Office of U.S. Inspector General: Office of Analysis and Inspections. Kwon, S. (2003). “Pharmaceutical Reform and Physician Strikes in Korea: Separation of Drug Prescribing and Dispensing.” Social Science and Medicine 57: 529–38. Lee, Y.-C., K.-H. Huang, and Y.-T. Huang (2007). “Adverse Pharmaceutical Payment Incentives and Providers’ Behaviour: The Emergence of GP-Owned Gateway Pharmacies in Taiwan.” Health Policy and Planning 22(6): 427–35. Liaw, S.-T. and G. Peterson (2009). “Doctor and Pharmacist – Back to the Apothecary!” Australian Health Review 33(2): 268–78.

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Lim, D., J. Emery, J. Lewis, and B. Sunderland (2009). “A Systematic Review of the Literature Comparing the Practices of Dispensing and Non-Dispensing Doctors.” Health Policy 92: 1–9. Lynas, K. (2009). “Automated Medication Dispensary with Remote Pharmacy Counseling Moves into the Marketplace.” Canadian Pharmacists Journal 142(1): 13. Margolis, S. A. and V. A. Ypinazar (2008). “Tele-pharmacy in Remote Medical Practice: The Royal Flying Doctor Service Medical Chest Program.” Rural and Remote Health 8(937). http://www.rrh.org.au (accessed December 6, 2010). McLuhan, M. (1994[1964]). Understanding Media: The Extensions of Man. Cambridge: MIT Press. Nissen, L. and S. Tett (2003). “Can Telepharmacy Provide Pharmacy Services in the Bush?” Journal of Telemedicine and Telecare 9 (Suppl. 2): S2: 39-41. Nystrom, J. S. and R. L. Clark (2006). “Physician Dispensing: An Old Idea is New Again.” MGMA Connexion 6(7): 36–41. Oren, E., E. R. Shaffer and B. J. Gugliemo (2003). “Impact of Emerging Technologies on Medication Errors and Adverse Drug Events.” American Journal of Health-System Pharmacy 60: 1447–58. Paparella, S. (2006). “Automated Medication Dispensing Systems: Not Error free.” Journal of Emergency Nursing 32: 71–74. Peartree Solutions Inc. (2001). A Situational Analysis of Human Resource Issues in the Pharmacy Profession in Canada. Ottawa (ON), Human Resources Development Canada. http://www.pharmacyhr.ca/Articles/Eng/68.pdf (accessed December 6, 2010). Penn, R. (1979). “The State Control of Medicines: The First 3000 Years.” British Journal of Clinical Pharmacology 8: 293–305. Perras, C., P. Jacobs, M. Boucher, G. Murphy, J. Hope, P. Lefebvre, S. McGill and A. Morrison (2009). Technologies to Reduce Errors in Dispensing and Administration of Medication in Hospitals: Clinical and Economic Analyses [Technology report number 121]. Ottawa: Canadian Agency for Drugs and Technologies in Health. Picard, A. (2010). “Why Does Drug Testing Stop Once it’s on the Market?” The Globe and Mail, November 17. http://www.theglobeandmail.com/life/ health/andre-picard/why-do-the-tests-stop-once-a-drug-is-on-the-market/ article1803105/ (accessed December 6, 2010). Postman, N. (1985). Amusing Ourselves to Death: Public Discourse in the Age of Show Business. New York: Penguin Group. Poulson, L. K., L. Nissen and I. Coombes (2010). “Pharmaceutical Review using Telemedicine – a Before and After Feasibility Study.” Journal of Telemedicine and Telecare 16: 95–99. Rose, J. L. (2007). “Improved and Expanded Pharmacy Care in Rural Alaska through Telepharmacy and Alternative Methods Demonstration Project.” International Journal of Circumpolar Health 66: 14–22.

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Savage, D. A. (1994). “The Professions in Theory and History: The Case of Pharmacy.” Business and Economic History 23(2): 130–60. Sketris, I., S. E. Tett and K. E. M. Groves (2003). “Prescription Drug Samples – Does this Marketing Strategy Counteract Policies for Quality Use of Medicines?” Journal of Clinical Pharmacy and Therapeutics 28: 259–71. Tallon, R. W. (1996). “Automated Medication Dispensing Systems.” Nursing Management 27(8): 45. Temple, J. and B. Ludwig (2010). “Implementation and Evaluation of Carousel Technology in an University Medical Center Pharmacy.” American Journal of Health-System Pharmacy 67(10): 821–29. Weingart, S. N., M. Massagli, A. Cyrulik, T. Isaac, L. Morway, D. Z. Sands and J. S. Weissman (2009). “Assessing the Value of Electronic Prescribing in Ambulatory Care: A Focus Group Study.” International Journal of Medical Informatics 78: 571–78. Woehlck, H. J., A. M. McQueen and L. A. Connolly (2007). “Off-hours Unavailability of Drugs During Emergency Situations with Automated Drug Dispensing Machines.” Canadian Journal of Anaesthesia 54(5): 403–404. Wong, B. J., M. D. Rancourt and S. T. Clark (1999). “Choosing an Automated Dispensing Machine.” American Journal of Health-System Pharmacy 56(14): 1398–99. Woodward, C. (2009). “Digital Rx: Obama Pushing for Paperless Prescriptions.” Canadian Medical Association Journal 180(8): 806.

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Chapter Ten

Media Peddlers, Pushers, and Pharmacists: Toward a Producer-Intention Model of the Media Brecken Chinn Swartz

Filling our Bellies “Dis-moi ce que tu manges, je te dirai ce que tu es.” [Tell me what you eat and I will tell you what you are]. – Anthelme Brillat-Savarin, in Physiologie du Gout, ou Meditations de Gastronomie Transcendante (1826)

Traveling in southwestern China along the Chinese border with Burma, some fellow backpackers and I stopped in a small roadside restaurant for lunch. Exulting over the tastiness of the stir-fried vegetables, a fellow traveler noted that the dish was likely full of MSG (monosodium glutamate), a flavor-enhancing food additive called weijin by the Chinese and used as freely and liberally as salt. We asked the proprietor, who went to the back of the shop and brought out his little weijin container to show us, filled with pretty white crystals and a small spoon. The proprietor commented that the business down the street, though, had some even better stuff that they threw into dishes by the handful, and that the clientele really liked it. He named the key additive in Chinese, but not being overly familiar with 219

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Chinese cooking, I had to look it up. Thumbing through my tattered dictionary, I found the word: cocaine. “I bet they’ve got a line out the door,” my friend quipped. It’s a conundrum we all face – the tricky balancing act between pleasure and enjoyment on one end, and habituation and addiction on the other. Why is adding MSG to a dish worse than adding copious amounts of salt, when both have been found to have negative impacts on the body, particularly in large quantities? Should the government set limits on the amount of sugar or caffeine we (or at least children) can ingest? Where should the line be drawn between “legal” and “illegal” drugs? Should it be based on the neural pathways stimulated? On the risk for addiction and overdose? On the risk of “harm”? What is “harm,” anyway, and whose job is it to prevent it?

Filling our Minds Whether we like it or not, the majority of people on our planet are tuned into communication media of some sort – radio, television, the Internet. And just as we humans receive our physical nourishment from the foods we eat, our minds are fed and developed by the messages and media we consume – our “food for thought.” Commercial and government-owned or subsidized media systems continue the relentless push toward rapid globalization as we make our way into the 21st century, a dramatic development in our world’s history that will undoubtedly carry untold implications for all the residents of this planet we live on. As strategic “battles for the hearts and minds” rage, both publicly and privately, it is time to seriously consider the ways we feed each other, and what this will mean for the ways we live together, both now and in the future. To do this, instead of simply studying messages and systems and structures and functions, it may be helpful to boil things down to where they begin – with us, with people. If we can understand better what we truly hope to do, perhaps we can figure out better ways to accomplish it. Even beyond the content of messages we send, today the most powerful story of the stimulating and potentially addictive power of the media comes through the way we consume messages throughout the day – hi-def screens, hi-def audio, and most vexingly of all, the maddeningly convenient hand-held devices we find almost always within arm’s reach. As “technology addiction” becomes a growing concern, clinical support groups are forming and municipalities are passing anti-texting and hands-free laws to keep us from compulsively reaching for our devices, even when doing so (for instance, when driving) puts us at grave risk of terrible harm. Although it is clear that powerful phones and other hand-held devices are with us to stay, helping us stay connected with loved ones, news, and entertainment

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throughout the day, it is time to ask important questions of ourselves, and of those whose work forms both the structure and content of the sticky webs of media that flood our minds each day. If “we are what we eat” (or see, or think about), how is the minute-by-minute “message fix” we crave affecting our internal/mental diet? If our “food for thought,” our nourishment for consciousness, comes nearly perpetually, minute by minute, day by day, at what point do we become mentally “fat” to the point of dysfunction? And are we solely to blame? If there’s “cocaine” in our food, so to speak, are we at primary fault if we find it exceedingly difficult not to eat? Is there any point at which media producers share some responsibility for the effects their work creates? Is the consumer that spends money for a device or a message and thus fuels the industry that spawns it also in some way a “producer”? How do we study our way into the cycle of production and consumption to be able to better understand and perhaps even shift our choices that we find to be harmful? Psychopharmacological studies involving mice and rats suggest that the operant effects of direct reliance on pleasure-inducing behaviors, e.g., lever presses that administer food or even morphine to the brain, can be ameliorated by contextual factors such as novelty of rewards or an enriched environment (Nakazato, 2005; Xu et al., 2007). Along those lines, this work suggests that rather than seeking for the enactment of extrinsic measures to “control” the pleasure content in media, an impossible task anyway under our commercial media paradigm, educators of all kinds need to take seriously the charge to enrich educational environments in ways that support value-oriented discussions about the potential benefits and risks of media consumption. Classes in particular which train and empower students in producing media of their own (from speechmaking to advertising) must deliberately raise questions about who benefits from “packaging pleasure” into media products in ways that impact consumer agency. Conversations must be ongoing on both supply side and demand side to undergird conscious choices about production and consumption of mediated content.

Back to the Beginning It is telling that the field of media studies was born under the toxic conditions of wartime, fueled by fear of what media do “to us” rather than what we do with them. It was during the height of the global suspicion of World War II and the onset of the Cold War that the systematic study of mediated communication entered modern life, carrying with it an imperative of the greatest magnitude. International political stakes were high, lives were being lost, and the consequences of psychological warfare were very real. Hitler was one of the earliest

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to use media for political “propaganda” purposes, and certainly with great effect (Hitler, 1943; Qualter, 1962). One by one, nations of the Allied, Axis, and Communist blocs scrambled to assemble international broadcasting mechanisms so as not to be left without a voice on the world stage (Jackall, 1995; Jowett and O’Donnell, 1999). Mass communication was a relatively new phenomenon, and people in power wanted to know as soon as possible what potential effects media would have on their world and on their ability to exert their will. In 1948, early media scholar Harold Lasswell put forward his simple media equation: Who – Says what – To whom – In which channel – With what effect? (Lasswell, 1948). For scholars working in the immediate post-WWII years and at the outset of the Cold War, it was imperative to begin media study right at the end of the equation, with effects research. How do media affect our attitudes and behavior? What powers and limitations do they hold? Can media make us believe or do just about anything? Unfortunately, the lab-based fruits of this early program of research were less than conclusive, giving mixed results and raising more questions than answers (Rogers, 1994; Hiebert and Gibbons, 2000; Perry, 2002). In the late 1950s and 1960s, media theorists became fascinated with computers and their potential, shifting their focus in Lasswell’s media equation back a notch to “In which channel,” or medium analysis, following the thought process of McLuhan’s (1964) axiom, “the medium is the message.” In the 1970s and 1980s, the “me generation” blossomed, and media scholars took yet one more step back in the media equation, focusing on Lasswell’s “To whom.” Audience analysis and other consumer-centered approaches to studying media became popular, and “uses and gratifications” became the media buzz words (Katz, Gurevitch and Haas, 1973; Katz, Blumler and Gurevitch, 1974). By the 1990s, emphasis had again shifted a step further back in the media equation to Lasswell’s “Says what,” or message/content analysis, which underpins the framing and rhetorical approaches that have accompanied us into the modern era of communication research (Hiebert and Gibbons, 2000; Rachlin, 1988). Today more than ever, channel analysis remains central to our understanding of the media “equation.” Communicators, both professional and amateur, have a wider host of options than ever before to communicate, in ways both big and small, throughout society. A handheld device can be with us just about anywhere – in the classroom, in line at the store, in the bathroom stall – and increasingly market pressures to make messages not only “sticky” but virtually omnipresent is coming into full capacity to reach into our most tender moments. The second our brain hits a lull, we reach for the stimulation we crave, consuming whatever words, pictures, and ideas can be most conveniently and compelling delivered in the moment.

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And why should we hold back? The communicator wishes to communicate, and we crave to consume – a match made in heaven. Yet, as the pace and pitch and power of the potpourri of messages become ever more encompassing, questions of balance, sustainability, and simple restraint come to the fore – not only for consumers, but for the producers and purveyors as well. If we lace our “food for thought” with ingredients that make them irresistible, or even addictive, what have we done to ourselves and our society? Who gets to decide how “much” is too much? How often are student producers faced with these types of ethical questions before being subjected to market pressures that may impact their choices? Educators and activists need better tools and metaphors to frame discussions on moral reasoning that can promote ethics and mindfulness in those cultivating skills to make media messages compelling and even irresistible for those who consume them.

Ingredients in the Daily Feed Human beings are consumers; we spend significant amounts of time, resources, and energy each day to acquire both physical food as well as mental “food for thought.” Those who feed us tend to respond to our complex tastes by supplying what we want, when and where we want it, as evidenced by the tremendous proliferation of tasty convenience foods available just about anywhere in the developed (and now the developing) world. We are caught up at every moment in contexts and life spaces that cause us to wish to relieve stress through consumption – with choices about food for our bodies and media for our minds being the most intimate choices of all, as we select what we “become,” both physically and mentally. As the old adage goes, “We are what we eat (and think, and consume).” In the highly competitive world of the “daily feed,” culinary metaphors already abound. Responding to the perceived needs of our modern society, journalists and other media producers strive to suit our “tastes” to get us to “consume” their messages. They often “spice up” otherwise “bland” stories, or make efforts to add more “meat” or more “juicy tidbits” to a piece. “Sweet” stories are nice, as long as they do not become “syrupy” or “saccharine.” Of course, “stale” news must be avoided, as well as topics that might cause “indigestion” for the audience. Some reporters clearly act as “short-order cooks,” simply assembling details from prescribed sets of story elements, whereas other journalists style themselves more as professional “chefs,” striving for the complexity and creativity that will suit the “taste” of a more elite market. Judging by our discourse, food metaphors seem to apply readily to the process by which we produce and consume media products.

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Thus, as we seek to understand the dynamics of the “daily feed,” we must look carefully into the intentions of those who produce and market the foods and messages we consume. Certainly there are those media outlets that deliberately produce mental “junk food” simply because it sells, whereas others consciously try to serve up a nourishing balance of information to promote both individual and societal health and well-being. Although the thought of having some worldwide regulatory body overseeing the “health content” of the messages we consume is rather terrifying, if media producers were individually and collectively to view themselves as feeding their audience instead of just entertaining them – merely gaining attention for the purpose of selling it to advertisers – subtle shifts might occur in our media that could lead to significant benefits over time. Commensurate with market pressures that reward any mediated content that can rack up high numbers of “hits” or “views,” educators and industry leaders need to utilize skillful means to recognize and reward content for its merit in other terms as well. Like food labels that educate consumers on their nutritional value of the food they are eating, there needs to be a more widely-available conceptual vocabulary available to both producers and consumers to help us make informed choices about the media we absorb, not only the content but also the media channels themselves, in which are held the power to deliver content with such compelling convenience and immediacy.

Beyond Gatekeeping The father of gatekeeping theory, Kurt Lewin, died before his unfinished manuscript was published in 1947, pairing the terms gatekeeping and communication for the first time (Lewin, 1947; Shoemaker, 1991). As a part of his larger work in field theory defining individual life spaces as causally connected to human social action (Hample, 1997), Lewin’s “theory of channels and gatekeepers,” as it came to be called, was developed as a means of understanding social changes in a community through the metaphor of food choices. Lewin pointed out that food reaches a family’s table through “channels,” such as the garden, the grocery store, and the refrigerator. At each stage of the production process, decisions are made about harvesting, storage, preparation, etc., and at any juncture an individual item may be accepted or rejected and never make it to the dinner table. The key to Lewin’s analysis was the examination of forces acting upon the selection decisions made by the gatekeepers along the way, which Lewin felt could be measured and modeled psychologically in the same way that models of physical forces were used in physics. Although a physicist by training, Lewin (1951) made the connection of this application of field theory to communication when he wrote in another posthumously published manuscript that the gatekeeping process “holds not

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only for food channels but also for the traveling of a news item through certain communication channels in a group, for movement of goods, and the social locomotion of individuals in organizations” (p. 187). Although Lewin’s work focused on simple “foods” such as tomatoes traveling through the system, from garden to table, today larger questions are raised by advancements in preservatives, additives, packaging, refrigeration, and mass distribution systems that make it not only possible but amazingly convenient to deliver foods far from their place of origin. By the time a gram of sugar has been taken from the field through production into a vacuum-packed cupcake in a vending machine, so many hands have been involved that questions of acceptability and sustainability are no longer just one person’s choice to make. Mass distribution systems and convenience foods have come to play such a powerful role in our modern economy that, today, organic foods and farmers’ markets are, in most contexts, a luxury of the wealthy. The commercial pressure for convenience, both in the foods we eat and the messages we consume, has driven our society so far from naturally-occurring local interactions that humans are bloated with packaged stimulation for body and mind, yet starving for a simple face-toface conversation or a natural peach. Why would one choose peach-flavored candy over the naturally-occurring flavor in its original fruit form? Even though refined sugar is known to have significantly more negative effects on blood sugar, overall health, and even cognition than natural fruit (Mitka, 2009), the fact is that the average consumer spends far more on fruit flavored candies, sodas, and other processed products than the flavors in their natural, organic form. Why? Clearly convenience is a crucial driver of today’s modern food market, since refined products can be stored, distributed, and consumed conveniently without refrigeration or spoiling. Consumers have come to expect instant gratification to the degree that we consistently sacrifice nutritional value for the sake of having what we want, when we want it. And producers are all too happy to meet that demand. Yet what of the impact on individuals’ health, not to mention our planetary economy, when the bulk of our diet is refined, processed, filled with additives and preservatives? Students need to explore the possibilities inherent in the various trajectories of the choices they make that impact the consciousness of others. Lewin discussed dynamic “life spaces” that humans create and inhabit, and today it is clear that our possibilities for these life spaces are increasingly defined by what is in our pockets – from the mobile devices we carry to the spare change we plunk into the nearest vending machine. McLuhan’s (1964) invitation to look more deeply into not only the content we imbibe, but the medium through which we receive it, invites us to examine our modes of message-delivery and consumption with an eye that is at once analytical and defocalized. Our theoretical landscape

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as researchers must be to “see the forest” in examining the aggregated unseen patterns that shape our behavior, yet also comprehend the very real “uses and gratifications” of the individual consumer. Under our capitalist economic system, the utilitarian realities of supply and demand are accepted and even celebrated as bringing us exactly what we pay for. So what happens when what we want and pay for brings us clear and certain harm? This is a juncture at which understanding motivations and holding ourselves accountable at every point in the process, at the points of production and distribution, as well as at the point of consumption, offers us a more comprehensive model from which to make informed choices. Educators must take increasing responsibility to ensure that students have facility with conceptual vocabulary to frame and analyze their choices in terms of not only content, but also packaging and modes of delivery. Courses ranging from Communication to Business to the Arts must give students chances to reflect.

From Gatekeeping to Recipe-Building One difficulty with Lewin’s gatekeeping paradigm is that it can become cumbersome when applied to complex, multi-layered tasks. In its simplest form, Lewin describes the process by which each individual item of food makes it to a family’s table. “Do I keep this item or throw it away? Do I keep that item or throw it away?” However, anyone who has ever prepared a meal knows that cooking is much more artful and complex than that – we are not robots that operate digitally via “yes” or “no.” Thus, it is necessary to develop a fuller vocabulary to describe the multi-faceted strategic decisions we make in not only selecting, but also in preparing a message for the consumption of others. Lewin’s gatekeeping theory was first notably applied in 1950 by David Manning White, who spent time with a small-city newspaper editor whom he dubbed “Mr. Gates.” White examined the editor’s rationale behind the decisions he made about individual news items, 90 percent of which were not used by the newspaper. Later gatekeeping studies, such as those by Gieber (1956), McNelly (1959), Snider (1967), Bass (1969), and McQuail and Windahl (1981), kept with White’s tradition of examining the news item selection process, focusing on the simple “yes” or “no” of whether an item was accepted for publication or not and why. Although Chibnall’s (1977) work did make the important theoretical leap of conceiving of news personnel as “creators” rather than mere “gatherers” of the news, gatekeeping theory still has not lived up to its potential of helping us understand the complexities of communicators’ dynamic “life spaces,” as proposed by Lewin. Previous studies delineating strategies or factors that influence media decisionmaking, consistent with White’s (1950) early Mr. Gates news study, have focused mainly on newsworthiness, the basic “yes/no” of story selection. For instance, Allan (1999) gleaned a comprehensive list of 12 newsworthiness factors cited throughout

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media literature: conflict, relevance, timeliness, simplification, personalization, unexpectedness, continuity, composition, reference to elite nations, reference to elite persons, cultural specificity, and negativity. However, in order to more fully address the entire repertoire of taste that media producers may draw from to make their stories appealing to their audiences, it is necessary to expand this list to account not only for the mere yes/no of which stories will be included, but also to account for the strategic presentational style of stories as crafted by those who produce them. The above-listed newsworthiness factors fail to account for a reporter’s individual aesthetic sense, for instance, nor do they address a journalist’s desire for her work to positively impact the lives of her audience. In other words, newsworthiness factors lead us to believe that there is something inherent in the piece of news itself that makes it “worthy” of being broadcast. This conceptual framework suggests that little room remains for reflexive consideration of human judgment or values of the communicator. This project makes use of a newly-developed list of strategic communication factors that transcend basic newsworthiness and move us further into the multilayered decision-making process engaged in by media producers themselves. The ten categories include: aesthetics, breadth, convenience, depth, emotionality, freshness, germaneness, helpfulness, incisiveness, and justice. (These categories are described, in both journalistic and culinary terms, in Table 1.) Aesthetics refers simply to what looks or sounds good – how to create a “good narrative” through fitting together words, scenes, and sounds to make a coherent piece (i.e., packaging or presentation). Breadth means drawing on universal values or interests to try to attract the broadest audience possible (i.e., appealing to the masses). Convenience refers to how readily producers can gather necessary footage or sound, working within constraints such as time, staffing, or equipment (i.e., “fast food”). Depth is about making a piece thought-provoking or analytical, gaining in-depth or “expert” information, and avoiding sensationalism (i.e., something complex for the discriminating palate). Emotionality describes making a program exciting, moving, sexy, or fun – appealing to people’s feelings to attract attention or touch them in a certain way (i.e., “junk food” or “comfort food,” something yummy/tasty? but not necessarily healthy). Freshness is making a program unique or clever; innovating in such a way that material is new, different, and creative (i.e., something “straight out of the garden”). Germaneness has to do with making a program relevant to current circumstances, addressing what is going on at a given time (i.e., seasonal or holiday dishes). Helpfulness means striving to make a program educational or useful to viewers, provide a needed service, or change the world for the better (i.e., something nutritious). Incisiveness provides the ability to analyze a situation and add something that is needed, providing missing elements or serving a “watchdog” role (i.e., nutritional supplements). Justice describes making a program fair, balanced, accurate, objective, or impartial (i.e., balanced meal).

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Table 1: Description of communication value scheme Category Aesthetics

Breadth

Convenience

Depth

Emotion

Freshness

Germaneness

Helpfulness

Incisiveness

Justice

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Journalistic Description What looks or sounds good; what are the elements of a “good narrative”; how words, scenes, and sounds are organized to make a coherent package How to engage the broadest possible audience; appealing to universally shared values, tastes, or interests How easy it will be for the producers to gather necessary footage or sound; how to work within constraints such as time, staffing, or equipment How to make a program thoughtprovoking or analytical; gaining in-depth or “expert” information; avoiding sensationalism How to make a program personal, heartwarming, exciting, or fun; appealing to people’s feelings to attract attention or touch them in a certain way How to make a program unique or clever; innovating in such a way that material is new, different, and creative How to make a program relevant to current circumstances; addressing what is going on at a given time How to make a program educational or useful to viewers; providing a needed service; changing the world for the better How to analyze and add something needed; providing missing elements; serving a “watchdog” role How to make a program fair, balanced, or objective

Culinary Description Attractive, aesthetically pleasing

Something everyone likes

Ingredients on hand or readily available

“Haute cuisine”; something complex for the discriminating palate Tasty or evocative: spicy, sweet, salty, etc.

Fresh ingredients, something “right out of the garden”

Appropriate for the occasion, such as seasonal or holidayspecific food Healthy, organic food that promotes wellness for individuals and/or the planet Performing a vital function not otherwise provided, such as vitamin supplements Creating a well-balanced diet without undue emphasis on one particular food

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The ten categories used in this study were devised through pilot-testing among both American and Chinese international broadcasters at the BBC World Service in London, the Voice of America in Washington DC, and at a variety of international news outlets in Beijing. Participants were asked to freelist “words that would make them happy if they were used to describe their work,” and then further descriptors were sought through interviews and focus groups. Once a list of words was compiled, they were sorted and organized to fall into exhaustive general categories. Naturally, these ten categories have some degree of overlap, and it would be unusual for a journalist to be motivated by one sole category, to the exclusion of others. As we have noted, strategic decision-making in journalism is a multi-layered process in much the same way as cooking. If I am preparing a holiday dinner for my family, I will probably focus largely on “germane” elements that evoke the holiday spirit, seeking heartwarming ingredients and spices that are traditional and satisfying to my guests. Of course, I want also to serve a nutritious, fresh, and balanced meal, yet on a special holiday occasion, I might choose to splurge, erring on the side of more emotionally evocative recipes. However, if I am preparing a summer salad for a picnic, I may choose to focus most of my efforts on freshness in order to use some of the vegetables currently coming out of my garden. And to make the salad palatable to everyone at the picnic, I may seek breadth, choosing a fairly universally-accepted salad dressing. The point is that no one category is used exclusively by any media producer at any particular time – media production is a highly creative, multi-faceted process that adapts dynamically to meet evolving needs. Yet there are circumstantial and preferential patterns to be found between individuals, media organizations, and even national cultures. Just as culture shapes our diet, cultural influences may also impact our communicative choices in ways that we have yet to fully understand. Using a culinary metaphor takes a conversation about values into a shared universal space that transcends language, politics, economic systems, and a great deal of historical baggage. Talking about food offers a respect for “taste” and a focus on health versus enjoyment that shines a clear light on our daily choices. Everyone in the world eats. All media producers want their work to be “palatable” in some way to their audience. Thus, with the range of options provided by our ten-pronged category scheme, we may begin to work within a common conceptual vocabulary through which we can discuss and more clearly understand the choices we make, both as producers and consumers of mediated messages. After all, the creation and maintenance of “culture” is an iterative process, and at every moment we are situated in the highly contextual world of communicative decision-making. Developing and refining categories through which to discuss our choices can provide a number of new ingredients to our conceptual “cookbook.”

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Suiting ‘Taste’ in Media Production and Consumption If we conceive of media like food, we realize that the fare we produce does have profound effects on those who consume it. When we prepare food for another, we note how much salt or sugar or spice we add – the exigency of the context determines the levels of each we deem acceptable. We want others to enjoy our fare – we don’t want it to be proclaimed “too salty” or “too sweet” – yet clearly the levels we accept tend to increase in response to habituation over time. A childhood diet of sugar cereals and snacks leads us to learn the response of seeking food for comfort, stimulation, and acceptance. We become addicted to salt and sugar – the inexorable bag of chips or cookies becomes irresistible. Our compulsive choices spawn the convenience store industry. And then, like the proverbial frog in the boiling water, it is often too late before we realize the toll on our health. Our guilt and shame spawns the weight-loss industry. We are hooked in a cycle of need, gratification, mortification, and more consumption. Do those who gain financially from the process have any responsibility to bear? John Culkin quipped, “We don’t know who discovered water, but we’re certain it wasn’t a fish” (Carpenter, 1970). The most powerful reality of an “ecology” is that its constituent parts are invisible unless explicitly revealed. As we consume at our respective tier of the food chain, the ingredients that made up our food remain outside of our awareness – the cake we put in our mouth consists of eggs, of milk, of sugar… Does it matter if the ingredients themselves are organic, fair trade, compassionately obtained? We crave the icing and eat the cake, yet our purchase decision supports myriad supply chains that we may or may not care to see. As our cultural “tastes” aggregate, we create the economic and social conditions of our society. Those of us in the economy responsible for the education, training, hiring, firing, and promotion of those who generate media should take pains to foster serious conversations on the interaction of demand, supply, and societal conditions. Living in China, I often heard people say that American treats and desserts were “too sweet” for the general taste. Yet salt and spice levels in food were copious. In the U.S., I see people avoid Chinese food because of the high levels of additives such as MSG, yet other stimulants and preservatives abound. Clearly, how we conceive of health and balance is impacted significantly by cultural norms and expectations. Given the opportunity to reflect on their media work in culinary terms, journalists were quick to discover interesting insights around their own tastes, values, and ethics – an exercise that media producers, both student and professional, should have on a regular basis. Here are a few examples of what Chinese and Western reporters told me they strive for in their work:

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• Perhaps a stir-fried vegetable dish, because I like things clear and concise, not sloppy. No need to say something useless. I prefer things which are plain, that is to say, you could find facts, truthful stories inside. I don’t like greasy things, like stories with lots of adjectives and jargon. (Voice of America, Chinese Service) • I would say a peanut butter and wildflower honey sandwich on really good peasant bread. The peasant bread for substance and honesty. The peanut butter for the flavor and comfort, and ease to make. And the wildflower honey because it’s sweet in itself when it’s doing its own thing rather than, you know, being shaped or domesticated. All together, it has substance, comfort, flavor, and a bit of a wild streak. (Voice of America, English Feature Service) • I think it’s like a fish-flavored vegetable that grows in Sichuan and Yunnan Provinces. You may not like it in the beginning because of the fishy smell. But one day, you might suddenly find it so delicious. The more you eat, the more addicted you’ll become. (China Central Television) • Maybe something spicy and light. It’s not something completely risk-free, but interesting enough to attract attention, you know, a bit on the spicy side, so they get a lovely shock, but then hopefully it wouldn’t upset their stomach completely, you know. You can still think, “That’s interesting, I’d like to experiment a little bit more.” (BBC World Service, Chinese Branch) • It would have to be cultural fusion. That’s absolutely paramount. So it would have to be sort of Eurasian dish or, you know, Indochinese or something. It’s the global conversation, it’s the meeting of cultures. And it would have to be delicious. The dish probably hasn’t been invented yet. (BBC World Service, English Features) For both the professional and the novice communicator, describing the fare one strives to produce in culinary terms reveals quite a bit about both our internal moral landscape, and our perception of the external communication environment. How we reach out, how we engage, what we seek to provide – a “conversation,” a “lovely shock,” an “addiction” – what can we learn from what we want to give? Do we find that we strive to be a media pusher, peddler, or pharmacist? Do we view our work as helping society in some way, or is our ultimate goal to simply generate consumption or even addiction?

Conclusions Conceiving of communication as the “food for thought” we feed to those around us provides a poignant opportunity to reflect on our motivations. Particularly as we receive compensation and monetary transactions become involved around the

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messages we produce and send, we see that we fill not only a role in the social environment, but that we have become a brick in developing an economy. The stories we tell, the images we select, the patterns we reinforce – each choice creates the very fabric of our social reality. As consumers, we form an ecology. Likewise, as producers, particularly as message producers, we make complex multi-layered choices about stories to tell, images to select, postproduction to buff up our content’s appeal, and a medium through which to deliver our “product.” In the case of delivering food, we feed the very cells that create the organism that buys our product – an intimate process. And in the case of delivering media content, we feed the very mental processes that create the tastes, the norms, the values, and the conscious reality of our culture. Does it matter if the consciousness-creators view themselves as peddlers, pushers, or pharmacists? Nutritional wisdom teaches us that the healthiest approach to eating is a mindful, balanced diet. Few would argue that fostering physical, mental, and social health requires contributions from all sides – of course from consumers themselves, and from the business and government institutions that create the very frameworks through which messages flow. It is easy and convenient under arguments of “freedom of speech” or “free market economics” to place responsibility mainly at the feet of consumers for the demand which spawns supply. Yet when the initial supply is designed to be addictive, as in the case of a drug pusher who gives out free samples, does the society create mechanisms to stop, slow, or at least explicate the transaction at hand long enough to consider eventual outcomes? Media producers, purveyors, and magnates are also complicit and responsible. Budding professional communicators need meaningful opportunities to think reflexively about their role in society – whether they want to be short-order cooks, convenience store peddlers, street pushers, healers, teachers, or some other thing. Those employed in generating the “food for thought” that fuels our society need opportunities to consider the health benefits and risks of what they produce. Universities and training programs must take an active and developmental role in fostering a higher sense of consciousness and purpose in communication and media students to better understand their role within the global media ecology as they produce and peddle the “daily feed.”

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References Allan, S. (1999). News Culture. Buckingham, UK: Open University Press. Bass, A. Z. (1969). “Refining the ‘Gatekeeper’ Concept: A UN Radio Case Study.” Journalism Quarterly 46: 69–72. Carpenter, E. S. (1970). They Became What they Beheld. New York: Outerbridge & Dienstfrey. Chibnall, S. (1977). Law-and-Order News: An Analysis of Crime Reporting in the British Press. London: Tavistock. Gieber, W. (1956). “Across the Deck: A Study of 16 Telegraph Editors.” Journalism Quarterly 33: 423–32. Hample, D. (1997). “Framing Message Production Research with Field Theory.” In J. O. Greene (ed.), Message Production: Advances in Communication Theory, pp. 171–92. Mahwah, NJ: Lawrence Erlbaum Associates. Hiebert, R. E. and S. J. Gibbons (2000). Exploring Mass Media for a Changing World. Mahweh, NJ: Lawrence Erlbaum Associates. Hitler, A. (1943). Mein Kampf. (R. Mannheim, trans.). New York: Houghton Mifflin. Jackall, R. (ed.) (1995). Propaganda. New York: New York University Press. Jowett, G. S. and V. O’Donnell (1999). Propaganda and Persuasion (3rd ed.). Thousand Oaks, CA: Sage. Katz, E., J. G. Blumler and M. Gurevitch (1974). “Utilization of Mass Communication by the Individual.” In J. G. Blumler and E. Katz (eds), The Uses of Mass Communication: Current Perspectives on Gratifications Research, pp. 19–32. Beverly Hills, CA: Sage.

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Katz, E., M. Gurevitch and H. Haas (1973). “On the Use of Mass media for Important Things.” American Sociological Review 38: 164–81. Lasswell, H. D. (1948). “The Structure and Function of Communication in Society.” In L. Bryson (ed.), The Communication of Ideas, pp. 37–51. New York: Harper. Lewin, K. (1947). “Frontiers in Group Dynamics: II. Channels of Group Life; Social Planning and Action Research.” Human Relations 1: 5–40. Lewin, K. (1951). Field Theory in Social Science: Selected Theoretical Papers. New York: Harper. McLuhan, M. (1964). Understanding Media: The Extensions of Men. New York: McGraw-Hill. McNelly, J. T. (1959). “Intermediary Communicators in the International Flow of News.” Journalism Quarterly 36: 23–26. McQuail, D. and S. Windahl (1981). Communication Models for the Study of Mass Communications. New York: Longman. Mitka, M. (2009). “AHA: Added Sugar Not so Sweet.” Journal of the American Medical Association 302(16): 1741–1742. Nakazato, T. (2005). “Striatal Dopamine Release in the Rat During a Cued Lever-Press Task for Food Reward and the Development of Changes over Time Measured Using High-Speed Voltammetry.” Experimental Brain Research 166(1): 137–46. Perry, D. K. (2002). Theory and Research in Mass Communication: Contexts and Consequences (2nd ed.). Mahweh, NJ: Lawrence Erlbaum Associates. Qualter, T. (1962). Propaganda and Psychological Warfare. New York: Random House. Rachlin, A. (1988). News as Hegemonic Reality: American Political Culture and the Framing of News Accounts. New York: Praeger. Rogers, E. M. (1994). A History of Communication Study: A Biographical Approach. New York: Free Press. Shoemaker, P. J. (1991). Gatekeeping. Newbury Park, CA: Sage. Snider, P. B. (1967). “‘Mr. Gates’ Revisited: A 1966 Version of the 1949 Case Study.” Journalism Quarterly 44: 419–27. White, D. M. (1950). “The ‘Gate Keeper’: A Case Study in the Selection of News.” Journalism Quarterly 27: 383–90. Xu, Z., B. Hou, Y. Gao, F. He and Z. Zhang (2007). “Effects of Enriched Environment on Morphine-induced Reward in Mice.” Experimental Neurology 204(2): 714–19.

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Chapter Eleven

Media Ecological Psychopharmacosophy: An Ecology of Mind for Today Ronan Hallowell

Drugs, Media and Media Ecology I am completely convinced that there is a wealth of information built into us, with miles of intuitive knowledge tucked away in the genetic material of every one of our cells. Something akin to a library containing uncountable reference volumes, but without some means of access, there is no way to even begin to guess at the extent and quality of what is there. – Alexander Shulgin (1975)

What is the relationship between drugs and communication media? Are drugs media, and vice versa? Should drugs be considered chemical media? Drugs and media shape cognition, consciousness and the worlds we live in, but exactly how they do this remains quite opaque even to most specialists.1 Speaking, writing, printing and electronic media are four communication media that scholars recognize as having had revolutionary impact on the development of consciousness, society, knowledge discovery and culture (Ong, 1982; Abram, 1996; McLuhan, 1964). Chemical media and drugs should also be included in this natural history of human media. Media ecology serves as a useful interdisciplinary lens with which to examine drugs, media and consciousness because its historiographic perspective supplies 237

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a broad context for considering how chemical, communication and other media have driven the evolution of consciousness, cultures and civilizations. Neil Postman (1970) believed the central mandate of media ecology is to understand how configurations of communication media enhance or decrease the chances of human survival. In our time, anthropogenic factors are forcing immense and potentially cataclysmic changes in the biosphere that will have long-term effects. Since human consciousness is the primary causal factor of current Earth changes (Zalasiewicz et al., 2008), and since human consciousness is rooted in biochemistry, chemical media need to be considered in relationship to the media ecological imperative. As concerned citizens of Earth, we should steer our collective consciousness in directions that renew the great symphony of life and strive to manifest humanity’s greatest potential. A whole cadre of media theorists have demonstrated that different media have served as crucial shapers of consciousness in the cognitive history of humanity (Benjamin, 1968; Gibson, 1979). As McLuhan argued, the forms of media afford certain ratios between the senses and perceptions in human cognition through the stimulation of patterns of neural firing. Walter Ong, with his discussion of the human “sensorium,” said much the same. Different constellations of neurochemical, sensory, and perceptual ratios have played a critical role in the evolution of consciousness: from individual and social cognition, to the development of language, knowledge, societies, and cultures. Deeper understanding of how such constellations have shaped, and continue to shape, individual brains, and collective minds and cultures is critical if humanity is to take an active role in co-creating a viable future. Media ecology is well suited to study the complex interactions of chemical media, communication media and cultural artifacts. Media ecology…is concerned to understand how technologies and techniques of communication control the form, quantity, speed, distribution, and direction of information; and how, in turn, such information configurations or biases affect people’s perceptions, values, and attitudes. (Postman, 1979: 186)

Including chemical media in the study of media ecology will deepen the field itself, and offer unique insights into perils and prospects of various uses and configurations of drugs and media. This chapter examines how a media ecological approach to chemical media could be applied to research with the vision-inducing Amazonian tea ayahuasca.2 Skillful design and syntheses of chemical and communication media environments can foster the positive evolution of consciousness in ways that contribute to human survival and a renewed florescence of the biosphere itself. Ennobling visions created from these new (or sometimes very

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ancient) media ecologies might then inspire concerned scholars and citizens to co-create new, biophilic trajectories in the human adventure. New visions can provide the motivation and direction for creative social change. Moral exhortation seldom inspires action among those who are reluctant to change. Visions, on the other hand, present positive alternatives in an imaginative way. They summarize a set of values using concrete images rather than abstract principles. (Barbour, 1993: 266)

Chemical and communication media, when used with care and intention, can induce and communicate human visionary capacities. In ancient cultures, visionary experience was primarily internal. However, external factors such as rituals helped induce the visionary state, and in many cases the visions were meant to be shared with the community to map directions for the community to travel together. Grob et al. (1996) describe the visions induced by ayahuasca during traditional ceremonies as “syntonic visions.” Syntony, a term most often used in psychiatry, means “[being] responsive to and in harmony with [the] environment so that affect is appropriate to the given situation” (Oxford Dictionaries, 2011). Winkelman (1996) argues that substances like ayahuasca should be called “psychointegrator plants.” Their [psychointegrator plants’] importance lies in the activation of emotional and personal processes of the limbic system and paleomammalian brain which underlie personal identity, attachment and social bonding, emotional stability, convictions and beliefs, and their integration with neocortex processes. Psychointegrators stimulate the integration of behavioral protomentation and social-emotional dynamics with language based ratiomentation, egoic representations and personal identity. These biochemically based physiological effects may force: emotional reactions, awareness of repressed memories, integration of emotional and rational processes, and the resolution of conflicts through integration of different functional systems of the brain. (p. 2)

Psychointegration and syntony work together to help individuals tune their personal brain/mind systems and calibrate their consciousness with people and the environment around them. In tribal societies, including those in the Amazon, social cohesion was critical for survival. Ayahuasca’s ability to induce syntonic visions helped provide “revelation, blessing, healing, and ontological security” (Grob et al., 1996: 86). Syntonic visions may be one of the most important aspects of the ayahuasca experience. It could be argued that some pathological instantiations of the contemporary world crisis, pertaining to our relationship with the environment, are illustrative of a “syntony deficit disorder.”

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In today’s world, inner vision has been externalized through screen technology. Rather than lament this reality, our prodigious ability to perceptualize knowledge with digital media should draw from wisdom traditions, ethics and other ways of knowing to guide us in judicious use of the powers at our command. Communication technologies such as computer animation, music, dance, and mixed reality3 can show and tell new visions for building positive futures.

An Ecology of Mind for Today A perpetual bio-chemical flow facilitates our autopoiesis through autonomic and genetic processes and through the modulation of stimuli received through the body’s sense organs. A passing back and forth of information through chemical, molecular, and cellular interactions takes place within the body and between the body and its environment, including the social environment and communication media that so uniquely characterize human existence. Media, broadly considered, are channels and environments that chemical, linguistic, electronic, symbolic, and other information travel through, and which affect an individual’s consciousness through the modulation of chemical states in the brain. These channels are loops that shape organisms and their environments. Systems of media, in Gregory Bateson’s (1972) terminology, create “ecologies of mind.” These systems mold individuals’ cognition, co-determine social structures and shape the form and content of cultures. For the purposes of this chapter, I will focus on the ancient and continued use of hallucinogenic plants as chemical media in shamanic cultures, and in contemporary settings in South and North America and Europe. This inquiry necessarily excludes many other kinds of drugs and questions that they raise. Hallucinogens are important chemical media to consider because of the unique impact they have on brain chemistry and perception. This chapter does not argue that hallucinogens offer instant enlightenment, or that people should just ingest them willy-nilly. However, the experience of many shamanic cultures and recent research indicate that hallucinogens – under certain controlled circumstances – do have something useful to contribute to our understandings of the mind, brain, and consciousness (Griffiths, Richards, McCann & Jesse, 2006; Ruck, H. Smith, K. Smith & Walsh, 2005). Synesthetic, syntonic, and psychointegrative capacities of certain plant-based hallucinogens, such as the Amazonian tea ayahuasca, have deep heuristic potential for tapping reservoirs of knowledge and wisdom enfolded in the very cells and DNA of our own bodies.4 This chapter focuses on ayahuasca because its use has spread rapidly outside of the Amazon in the past twenty years. Also, the ethnopharmacology and indigenous shamanism associated with ayahuasca deserves deeper study. The renowned Harvard botany professor Richard Evans Schultes

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argued that Amazonian knowledge of psychoactive plants was the most developed in the world (Schultes and Hofmann, 1979). Ayahuasca use dates back hundreds, perhaps thousands of years, and the co-evolution of humans with the jungle tea is remarkable. Ayahuasca research has both scientific and social merit. Ayahuasca’s unique consciousness altering effects caused by dimethyltryptamime (DMT) can teach researchers more about the brain and mind. DMT occurs naturally in the brain and its molecular structure is very similar to serotonin. Ayahuasca could be used as a tool, by appropriately prepared researchers, to stimulate “lateral thinking” (de Bono, 1967) about the greatest problems humanity faces. “Lateral thinking refers to solving problems through an indirect and creative approach. Lateral thinking is about reasoning that is not immediately obvious and about ideas that may not be obtainable by using only traditional step-by-step logic” (http://en.wikipedia.org/wiki/Lateral_thinking). Suggesting that psychedelic drugs might yield real insight into the mind and generate new perspectives on many of the new and perennial problems of our times usually raises eyebrows. Nonetheless, great minds have attested to this possibility. For example, Richard Evans Schultes and Albert Hofmann (1979) have referred to hallucinogenic plants as “media for attaining ‘the mystic experience’” (p. 9). Philosopher William James, writing of his mind-altering experiences with nitrous oxide, said: One conclusion was forced upon my mind at that time, and my impression of its truth has ever since remained unshaken. It is that our normal waking consciousness, rational consciousness as we call it, is but one special type of consciousness, whilst all about it, parted from it by the flimsiest of screens, there lie potential forms of consciousness entirely different… No account of the universe in its totality can be final which leaves these other forms of consciousness quite disregarded. (James, 1961: 390–91, emphasis added)

Ancient shamanic traditions, including extant ayahuasca traditions in the Amazon, knew how to navigate these other worlds of consciousness for the benefit and survival of their tribe. Syntony inducing effects of ayahuasca helped individuals and tribes become more sensitive to the complex ecology of the Amazon. Despite the fact that many indigenous Amazonian cultures, and their knowledge bases, have been decimated, links to these ancient sources of wisdom remain. Synthesizing these ancient sources of wisdom, with new knowledge and insight generated through innovative use of communication media, offer the potential for creating an ecology of mind capable of realizing transformative evolutionary possibilities for people and the planet.

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Perceptions and World Views Our brains and bodies are awash in a chemical ocean. When a drug enters the bloodstream, it intervenes in the chemical make-up of an organism and becomes part of the medium in which biochemistry functions. A psychoactive drug affects the brain and consciousness through the alteration of perception. Effects can range from addictive pleasure seeking, mood regulation and cognitive enhancement, to a wide variety of non-ordinary states of consciousness. Communication media also alter and shape perception. These effects play a significant role in a person’s psychology and world view. How we perceive and view the world contributes to how we co-create the world we live in. Shifting perceptions and world views in syntony-enhancing ways can contribute to life-giving (vivogenic) and life-loving (biophilic) responses to our world’s myriad problems. Chemical and communication media can help both individuals and societies forge new ecologies of mind that aim toward a renewing human presence on the planet. The body mediates human consciousness, so to understand the effects of drugs and media we must consider how organic physical processes, communication media, culture, and the human mind interact to create our lived environments. The world that comes into being through the medium of our bodies is not a homogenous or solipsistic one; it is literally a concrescence of “others.” The existence of others, and the “worlds” that relations among others co-create, serve as a basis for human ethics, the consideration of human acts upon others. Media scholars Mitchell and Hansen (2010), based on their etymology of the term media, argue that media studies should focus on this fundamental relationality: As a term denoting the ‘pervading or enveloping substance’ in which human organisms live, medium designates a minimal relationality, a minimal openness to alterity, a minimal environmental coupling (in the terminology of contemporary ethological cognitive science), that appears somehow central to our understanding of ourselves as ‘essentially’ prosthetic beings. Following the morphing of medium into the collective singular media, this minimal relationality comes into focus for itself: thus media studies can and should designate the study of our fundamental relationality, of the irreducible role of mediation in the history of human being. (p. xii, emphasis in original)

Many of today’s human problems are rooted in conflicts with otherness. These conflicts are not only straining human societies, they are ruining the biosphere. New forms of relationality, both with the human and more-than-human worlds, require new ways to foster openness to alterity and transformative communication. Hallucinogenic plants are a unique medium for contacting alterity.

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Psychoactive drugs from plants have a long history in the evolution of humans (Ruck et al., 2005; Schultes and Hofmann, 1979; Grob, 1998) and deserve a central place in the study of chemical media and media ecology. Electronic communication media and digital technology, such as 3D animation, have recently enabled humans to create fantastic, psychedelic worlds with bits, pixels, sound waves, and beams of light (Cameron, 2009). This profound capacity to exteriorize the imagination can be used to share individuals’ syntonic visions occasioned by chemical media. Rather than merely entertaining and distracting ourselves with chemical and communication media, we should harness their potential to train the pilots and passengers of Spaceship Earth to navigate a flight path with vivogenic potential, rather than flying the Mother Ship into lifeless oblivion. Certain substances, such as ayahuasca, hold great potential as visionary mediums, as therapeutic agents, and as doorways to profound realms of consciousness heretofore mostly ignored or demonized in Western traditions. I propose the term psychopharmacosophy to describe the study of psychoactive drugs for the generation of knowledge and wisdom that seeks to contribute to a biophilic renaissance. Moreover, I argue that these different media, old and new, are not necessarily at odds or mutually exclusive. Designing integral media ecologies that can transcend, or mitigate, problematic aspects of a particular medium, while accentuating its vivogenic dimensions, will serve individual and collective desires for meaning-making and foster bio-restorative opportunities for individual and collective action. Paying attention to how media mold our relationality, while also envisioning the repair and renewal of our planet, increases the chances that we may leave a legacy of hope and possibility to future generations.

World in Crisis Human history has altered, and our current behavior continues to alter, the Earth in many profound ways that are unique in the evolution of the planet thus far. Never before has massive geological and environmental change been caused by human industrial activity and, as far as we know, such epochal change has not occurred over such a short period of time (Crutzen, 2002). This industrial activity, and the modes of human social and civilizational organization that accompany it, have dramatically disrupted geo-biological systems globally, and on a time scale that, up until our current situation, had previously taken place over the course of thousands, millions, or billions of years. In larger evolutionary perspective, this is not necessarily a crisis for the Earth itself, and some forms of life may very well survive the current mass extinction,5 even possibly humans. Nonetheless, for a vast range of life forms, including humans, mass

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extinction and a degraded biosphere present a grave existential crisis. Dennis J. McKenna (2005) summarizes the human roots of the world crisis in these terms: Humans are good at nothing if not hubris, arrogance, and self-delusion. We assume that we dominate nature; that we are somehow separate from, and superior to, nature, even as we set about busily undermining and wrecking the very homeostatic global mechanisms that have kept our earth stable and hospitable to life for the last four and a half billion years… For the first time in the history of our species, and indeed of our planet, we are forced to confront the possibility that thoughtless and unsustainable human activity may be posing a real threat to our species’ survival, and possibly the survival of all life on the planet. (p. 232)

Recognition of this immense influence of human activity upon planetary processes has led to the recent coining of the term Anthropocene epoch by Nobel Prizewinning atmospheric chemist Paul J. Crutzen (Crutzen and Stoermer, 2000) to indicate a new epoch in the Earth’s history. The term Anthropocene, proposed and increasingly employed to denote the current interval of anthropogenic global environmental change, may be discussed on stratigraphic grounds. A case can be made for its consideration as a formal epoch in that, since the start of the Industrial Revolution, Earth has endured changes sufficient to leave a global stratigraphic signature distinct from that of the Holocene or of previous Pleistocene interglacial phases, encompassing novel biotic, sedimentary, and geochemical change. (Zalasiewicz et al., 2008: 4)

Pondering a disruption of this magnitude can be overwhelming and lead to various strategies of avoidance, delusion, or despair. It is impossible to know, for certain, how one should comport oneself in light of such startling information. Unlike natural disasters, such as asteroid strikes or immense volcanic eruptions, the massive anthropogenic Earth changes that are now underway are the result of a human species possessed of self-reflexive consciousness, language, society, culture, and technology. The many impressive achievements of modern industrial civilization, with its concomitant advances in science and technology, are difficult to reconcile with the global sequelae these developments have introduced into the biosphere, and human history, culture, and civilization. Despite the cognitive dissonance engendered by a consideration of our “moment in history,” the gifts and burdens of human intelligence, compassion, creativity, and spirituality call out to human actors to confront these challenges and work toward potential solutions with creativity, fortitude, and aplomb. Some ancient ways may hold the

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key to a better future for humanity and the planet if their insights can somehow work synergistically with technological culture and the Technosphere itself. James G. Speth in The Bridge at the End of the World (2008) argues that, “today’s environmental reality is linked powerfully with other realities, including growing social inequality and neglect and the erosion of democratic governance and popular control… [A]s citizens we must now mobilize our spiritual and political resources for transformative change” (p. xi). Speth believes that, “we will never do the things that are needed unless we know the full extent of our predicament” (p. 234). The more we understand about the history, dynamics, and nature of our predicament, and the realities we inhabit, the better our chances of developing knowledge bases that can serve as ameliorative and biophilic attractors. Indeed, as geologian Thomas Berry has argued, we need to learn the story of the Earth and the Universe so we can come to a deeper awareness of the macrophase relationship between the Earth’s biosphere and humanity. Communication media are the conduits of story in our world. We must creatively engage media to create the new languages needed to communicate visions and stories that can build “the bridge at the end of the world” to a realm of hope and possibility rather than slough toward dystopic scenarios that are easily imagined. We need a shift from a human-centered language to an Earth-centered language… Among the greatest changes linguistically is the change from our present efforts at an exclusively univocal, literal, scientific, objective language to a multivalent language much richer in its symbolic and poetic qualities… A more symbolic language is needed to enter into the depths of things to understand both the qualitative differences and multivalent aspects of every reality. (Swimme and Berry, 1992: 16)

When employed with knowledge of ancient wisdom, creativity, care and a sense of responsibility, communication media such as mixed reality can create new synesthetic media languages that can help shed light on the “multivalent aspects of every reality” (ibid.). This integral synthesis can serve as a means to share visions, map possible ameliorative evolutionary directions, and design aspects of human culture to interact more intelligently with the biosphere that ultimately bears our existence, and upon which we depend for our very lives. This vast interdisciplinary project requires new modes of thought, creativity, technology, social organization and culture. Education is paramount for tackling what we face. As H. G. Wells said so well, “Human history becomes more and more a race between education and catastrophe.” Much of the damage being done to the planet (and ourselves) results from erroneous and anachronistic world views that lead to pathology. The genesis of these world views, systems

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of thought, ideologies, gestalts etc. need to be understood through accelerated learning grounded in our deepest human potential and evolutionary wisdom. Understanding the roots of today’s crises is necessary, but not sufficient, to manifest a world transformed. Appropriately prepared pioneers of consciousness and servants of a better future should employ multiple ways of knowing, including visionary states induced by psyschointegrator plants, to push the envelope of the known and create new worlds.

Roots of the World Crisis In some sense, life on Earth, and existence itself, are perpetually in a crisis between creation and destruction, life and death. Indeed, there is no constant quite like constant change. Whether it is the destruction of a supernova, a natural disaster, or predation among animals, being and non-being are held in dynamic tension. Taking a larger view of the paradoxical nature of creation and destruction can help assuage some anxiety that arises when one considers the profoundly destructive times we live in. To become too overwhelmed with the gravity of the world crisis is counterproductive; at the same time, to ignore the fact that anthropogenic factors are rupturing the life-support systems of the planet and fueling strife is to turn our backs on our endowment of intelligence, empathy, and creativity. Human existence has never been utopian. To cling to some set of idealized images of the past will not serve us well. Our ancestors’ struggles to survive being hunted by predators on the African savannahs; their migrations through cold, treacherous landscapes; and their subjection to the vagaries and vicissitudes of nature surely wrought intense and protracted misery at times. Yet, this is not the only story of our hunter-gatherer past. The emergence of self-reflexive consciousness and language, the discovery of fire, the making of tools, the caring cooperation among family and tribe, led to a period of human development, perhaps 50,000 years or more, where instances of religion, arts, and tribal cultures emerged and likely flourished. Geographer Jared Diamond (1987) has argued that our hunter-gatherer past was not just nasty, brutish and short, as Hobbes said, and as it has often been portrayed since. Citing a variety of archeological research and studies of recent hunter-gatherer Kalahari Bushmen and their farming neighbors, he notes that, on several measures, the Bushmen fared better than their neighbors. “It turns out these people have plenty of leisure time, sleep a good deal, and work less hard than their farming neighbors” (Diamond, 1987: 65). Bucking the commonly accepted narrative that farming was a vast improvement over hunting and gathering, Diamond postulates that the transition from the Paleolithic to the Neolithic Agricultural Revolution was, “the worst mistake in the history of the human race” (Diamond, 1987: 64).

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Diamond’s argument locates the roots of our current world crisis in this transition.6 Citing studies in paleopathology, Diamond provides evidence that, although populations grew larger in the Neolithic Age because of storehouses of food, health declined in many ways because of a shift from a varied diet, to a diet made up mostly of a few starchy crops. “[E]arly farmers gained cheap calories at the cost of poor nutrition… Farmers [also] ran the risk of starvation if one crop failed. Finally, the mere fact that agriculture encouraged people to clump together in crowded societies, many of which then carried on trade with other crowded societies, led to the spread of parasites and infectious diseases” (Diamond, 1987: 65). Storing of surplus food, in addition to increasing population, also supported the development of elites and fostered social inequality. This also may have been a crucial factor that increased inequality between the sexes. “Freed from the need to transport their babies during a nomadic existence, and under pressure to produce more hands to till the fields, farming women tended to have more frequent pregnancies than their hunter-gatherer counterparts – with consequent drains on their health” (Diamond, 1987: 66). These changes between the Paleolithic and Neolithic period varied according to geography and a multitude of other factors. Remnants of old social patterns may have continued for many generations, yet a major shift was underway. Feminist scholars such as Marija Gimbutas (2007) and Riane Eisler (1988) have described Neolithic and Bronze Age cultures in Southeastern Europe, Anatolia, and Minoan Crete that apparently retained many earlier Paleolithic egalitarian qualities. These cultures were eventually overwhelmed by successive waves of patriarchal warrior pastoralists from areas such as the Pontic Steppe (and in the case of Minoan Crete by the Dorians, a neighboring Greek patriarchal tribe).7 Though details about such pre-historic times remain speculative, it is reasonable to assert that the Agricultural Revolution played a pivotal role in the rise of patriarchal dominator civilizations in Eurasia. Modern Western civilization has its roots in this evolution. Another important step for Eurasian civilizations, after the development of agriculture, was the emergence of writing. Writing introduced important changes in cognition and social organization that had both positive and negative effects. Writing allowed for the encoding, preservation, and dissemination of knowledge in a durable and reproducible fashion. However, as philosopher David Abram (1996) argues, writing began to sever human language from the extrahuman world of nature that had previously served as the matrix of reference and had embedded human communication in dialogue with nature. The development of the Greek phonetic alphabetic, where “semantically meaningless letters are used to correspond with semantically meaningless sounds” (McLuhan, 1964: 86), sundered the “oral awareness of the invisible depths that enfold us” (Abram,

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1996: 250). A deep chasm between human thought and the more-than-human world emerged because the alphabet became so abstracted that its form no longer directly referred to the environment from whence it came. Abram traces the development of this phenomenon in the earlier Hebrew aleph-beth. With the advent of the [Hebrew] aleph-beth, a new distance opens between human culture and the rest of nature… [T]he written character no longer refers us to any sensible phenomenon out in the world, or even to the name of such a phenomenon…, but solely to a gesture to be made by the human mouth… A direct association is established between the pictorial sign and the vocal gesture, for the first time completely bypassing the thing pictured. The evocative phenomena – the entities imaged – are no longer a necessary part of the equation. Human utterances are now elicited, directly, by the human-made signs; the larger, more-than-human life-world is no longer a part of the semiotic… (Abram, 1996: 100–101, emphasis in original)

McLuhan also notes that the form of the phonetic alphabet affected a cognitive shift away from the immersive, auditory world of tribal life, to a visually biased and linear perspective. This shift facilitated, “The breaking up of every kind of experience into uniform units in order to produce faster action and change of form (applied knowledge)… [This] has been the secret of Western power over man and nature alike” (McLuhan, 1964: 88). The cognitive distancing of consciousness from nature, and the lineal breaking up of experience as the model of rationality, set in motion the subject/object dualism that has characterized Western thought. In addition to this cognitive distancing that promulgated anthropocentric and individualistic world views, the phonetic alphabet also buttressed military power. “The alphabet meant power and authority and control of military structures at a distance” (McLuhan, 1964: 85). Large-scale militarism has been a key factor in Western civilization and remains so today. In addition to facilitating control of military structures at a distance, alphabetic writing also facilitated the development of Western intellectual traditions (such as Greek philosophy and mathematics and Judeo-Christian religious traditions) that ultimately led to the Renaissance, the printing press, the Scientific Revolution, and the Enlightenment. Since the advent of writing, each important stage in the evolution of Western thought has been characterized by an increasingly sharp subject/object dualism. Modernity brought this dualism to an apotheosis with the mechanistic Newtonian-Cartesian cosmology and the industrial revolution (Tarnas, 1992). Though the epistemology of modern Western science has penetrated many of the mechanisms of the material world in a way not previously achieved by

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humans, various historical and cognitive circumstances have simultaneously led to a diminution of other ways of perceiving and knowing that serve important roles in healthy human adaptation. Western civilization, and the scientific revolution, at once expanded and constricted various aspects of human consciousness. The rigid attempt to completely separate objective and subjective knowledge has led to profound existential and ontological alienation. As Western thought divorced itself from a sensuous embeddedness in the natural world, a view of nature as an “other” to be controlled, over against nature as primordial matrix and interlocutor, became firmly ensconced. This view delegitimized, and often demonized, other ways of knowing rooted in indigenous and oral traditions. The burning alive of tens of thousands of women…as ‘witches’ during the sixteenth and seventeenth centuries may usefully be understood as the attempted, and nearly successful, extermination of the last orally preserved traditions of Europe – the last traditions rooted in the direct, participatory experience of plants, animals, and elements – in order to clear the way for the dominion of alphabetic reason over a natural world increasingly construed as a passive and mechanical set of objects. (Abram, 1996: 199)

Despite 20th-century scientific revolutions in cosmology and quantum physics that call into question Western subject/object dualism, a vestigial and pervasive mechanistic world view lives on – most notably in the workings of the world economic system. The immense wealth and power that ruling elites in the world economic system have achieved by exploiting the modern Western world view makes it difficult to effect change. In addition, hegemonic social systems largely work against new ideas that threaten the status quo. Nonetheless, change is inevitable and the current epochal disruption of the biosphere will force humans to eventually re-consider many of the assumptions we make about the nature of reality. Critically understanding the shortcomings of Western mechanistic thinking, and learning from the insights of other ways of knowing, can help people of goodwill contribute to an evolution of human consciousness that re-grounds itself in the web of life. To do this, we need to expand our perceptual registers to include the full range of human mind-brain-body potential. We must also seek to understand how our origins and destiny are rooted in the larger process of life on the planet. Biologist Edward O. Wilson eloquently calls for such inquiry when he says: [T]he green prehuman earth is…a guide to the birthplace of our spirit, but it is slipping away… Viewed from the perspective of evolutionary time, all other species are our distant kin because we share a remote ancestry… To disregard the

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diversity of life is to risk catapulting ourselves into an alien environment… We have little grasp of our true nature, of what it is to be human and therefore where our descendants might someday wish we had directed Spaceship Earth. Our troubles… arise from the fact that we do not know what we are and cannot agree on what we want to be. The primary cause of this intellectual failure is ignorance of our origins… Humanity is part of nature… The more closely we identify ourselves with the rest of life, the more quickly we will be able to discover the sources of human sensibility and acquire knowledge on which an enduring ethic, a sense of preferred direction, can be built. (Wilson, 1992: 344–48, emphasis added)

It is axiomatic in many human wisdom traditions to valorize origins as a foundation for cosmontological understanding and individual and social wellbeing (Eliade, 1959; Swimme and Berry, 1992). A look back to our origins is part of finding our way into the future. This look back should not be an atavistic regression, but rather a holotropic8 (Koestler, 1968; Wilber, 1996; Grof and Bennet, 1993) inclusion of the rich lessons of our evolutionary heritage for the purpose of enacting new forms of human civilization that overcome harmful aspects of the modern industrial world that suffer from destructive views driving many human societies since the agricultural revolution. Understanding our origins, on Earth and in the cosmos, is both a scientific and humanistic endeavor. Insights from science, religion, indigenous traditions etc. are needed “to discover the sources of human sensibility and acquire knowledge on which an enduring ethic, a sense of preferred direction, can be built” (Wilson, 1992: 348). Cosmology, biology, ecology, history, and indigenous ways of knowing are all needed to craft a story of humanity that can unite and compel. The incredible power of media and technology to spin engrossing narratives and create “imaginary” worlds should be used to tell this universe story. For peoples, generally, their story of the universe and the human role in the universe is their primary source of intelligibility and value. Only through this story of how the universe came to be in the beginning and how it came to be as it is does a person come to appreciate the meaning of life or to derive the psychic energy needed to deal effectively with those crisis moments that occur in the life of the individual and in the life of the society. (Berry, 1988: xi)

Contemporary scientific cosmology has discovered many amazing facts about the vast universe we live in. However, scientific cosmology has yet to offer a fully integrative story. Although pre-modern cosmologies did not have access to scientific domains of knowledge that could explain physical processes of outer space, as we do, many pre-modern and indigenous cultures had sophisticated cosmologies

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that tapped the outer reaches of inner space. Exploration of inner space, which has been lacking in modern Western civilization, was pursued through ritual, arts, myth, and practices that induced non-ordinary states of consciousness (e.g. fasting, yoga, dreams, meditation, and psychoactive plants). These methods of exploring cosmological, ontological, and metaphysical realities yielded insights that bestowed meaning on human life. If science could learn to tell the story of the universe in a compelling way that explains what we know, and what mysteries remain, scientific cosmology could provide a larger context for understanding the role of humans in both planetary and universal terms.

Remedies for a Wounded World Solutions to the world crisis will require people to tap all forms of intelligence available to humans. Unique approaches are needed to access the depths of human potential. Cutting-edge research will need to work with the cognitive biases of the dominant Western mind and seek ways to push beyond the limits of linear, mechanistic thinking. Fields of study such as chaos theory and general systems theory have begun work in this direction, but their insights are mostly limited to a small group of academics. Also, their methods of inquiry are still based predominantly in Western intellectual modes of thought. Western science cannot, and should not, be done away with; it is essential for survival. However, the Western mind needs to evolve in a way that leverages its gifts and recognizes its limitations while working with other ways of knowing that use different approaches for cultivating knowledge and wisdom. Indigenous knowledge of non-ordinary states of consciousness can help illumine blind spots in the thinking of modern man (Eliade, 1959). In many shamanic cultures, hallucinogenic plants have been used as a catalyst for entering non-ordinary states to learn, heal, and survive. Renewed academic research on hallucinogens in the United States and Europe, that started in the early 1990s, suggests that there is great potential for exploring the mind through thoughtful and controlled use of certain hallucinogenic compounds such as psilocybin and ayahuasca (Griffiths et al., 2006; Grob et al., 1996; Grob et al., 2010; Riba et al., 2001). Earlier research on hallucinogens had also shown promise (Harman, McKim, Mogar, Fadiman & Stolaroff, 1966), but its potential was overshadowed by the vicissitudes of the 1960s drug culture, and social backlash against it, that resulted in the outlawing of scientific research on hallucinogens. Though still marginalized, acknowledgement of the value of indigenous ways of knowing has increased since the 1960s. In recent times, many scientists have been tutored by jungle shamans and attest to their profound knowledge (Davis,

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1996; Plotkin, 1993). Kelly Morris, a senior editor at the prestigious British medical journal The Lancet, has written affirmatively about a group of scholars who acknowledge the deep wisdom held in the Amazon and its traditional inhabitants. Experts on the region, including Sir Ghillean Prance…and anthropologists Francoise Freedman and Luis Eduardo Luna, point to a view of the Amazon as a storehouse of knowledge with the inhabitants as caretakers… On many levels, then, we can learn much from these supposed ‘noble savages’: useful plant lore, eco-awareness, skills almost lost from western societies such as eidetic memory, and even perhaps the ability to use psychoactive substances to expand consciousness and gain knowledge, without that drug use becoming de-ritualized and abusive… Many westerners may find laughable the concept of accessing some greater knowledge through drug-induced visions. But decades of anthropological and ethnobotanical research has failed to explain some great mysteries of Amazonian wisdom… [F] urther scientific exploration of this repository for the good of humanity is surely reason alone for the protection of the Amazon region and its inhabitants. (Morris, 1999: 1914, emphasis added)

Syntony promoting psychointegrator plants, such as ayahuasca, that stimulate ancient mammalian brain circuitry, soften the strict subject/object dualisms of the Western mind. Stepping out of one’s habitual perceptions and thought patterns is important when searching for solutions to difficult problems. Ayahuasca is known for its complex alteration of perception, its awe-inspiring visions and its induction of rich cosmological ideation. “Ayahuasca has the special effect of enhancing people’s concerns with questions regarding the origin of the universe and the forces and laws that govern the natural world” (Shanon, 2003: 169). Psychedelics like ayahuasca can help open up a person’s innate capacity for imagination by stimulating a rich internal world of consciousness, latent in each of us, but which is usually hidden in our normal waking states. Thinkers from Einstein to the religious scholar Mircea Eliade have touted the importance of imagination and its ability to visualize whole systems. Eliade claimed that the sterilization of imagination is one of the core problems of the modern world and that its reawakening through an understanding of ancient ways of knowing, in service of new modes of thought, presents one of the best avenues of hope for humanity’s evolution. He says, To have imagination is to enjoy a richness of interior life, an uninterrupted flow of images… To have imagination is to be able to see the world in its totality, for the power and the mission of the Images is to show all that remains refractory to the concept. (Eliade, 1961: 20, emphasis in original)

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Ayahuasca can help stimulate the internal flow of images and evoke profound psychosomatic insights related to individual, group, and biotic consciousness. Ayahuasca holds a special place in the psychedelic pharmacopoeia due to its long history of use in the Amazon and its unique phytochemical profile. The Amazon is the most bio-diverse environment on the planet and ayahuasca shamanism’s history of symbiosis with the jungle has produced vast libraries of pharmacosophic insight. Psychoactive plants are not indicated for everyone, nor are they a panacea. Indeed, there is a wide range of substances, some with great potential and some best left alone. Clearly, wise discernment in these matters is paramount. However, unfounded fears and prejudices surrounding certain psychoactive substances should not impede critical research that has immense potential. A body of ethnobotanical, anthropological, and ecological knowledge developed by researchers such as Richard Evans Schultes, Marlene Dobkin de Rios, Charles Grob, Benny Shanon, Huston Smith, and others, indicates that indigenous pharmacognostic knowledge and remnants that have emerged in hybrid forms in South and North America, and also recently in Europe, offer profound insights regarding the nature of human consciousness and its relationship to the natural world. Deeper knowledge of these realms should be used to better understand the world crisis and to seek mitigation and adaptation strategies. Advances in communication media such as 3D modeling, computer graphics/animation, scientific visualization, digital music production, mixed reality, telepresence, and digital storytelling should be leveraged to communicate research on ayahuasca, psychopharmacosophy, and the world crisis.

Creativity and Challenge-Based Scholarship with Ayahuasca According to the editors of the journal Global Environmental Change, “We have entered an unprecedented era with regard to the impact of human actions on the Earth’s biophysical systems” (Kotchen and Young, 2007: 150). Despite the overwhelming scientific evidence that critical aspects of global change are anthropogenic, there is still a significant group who deny it. Yet another group are those who admit that global change is happening, but remain optimistic that humans will adapt, and that in some circumstances there will be likely benefits to global warming (most of these benefits will accrue to wealthy northerners; it is generally acknowledged that poor countries near the equator will probably not fare so well). One can downplay the severity or existence of the world crisis but, for people who cannot shelter themselves from massive environmental and social change with wealth and mobility, the ruptures of the postmodern world present real strife

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and suffering. Clinging to an overly alarmist perspective regarding the world crisis can be counterproductive; nonetheless a sense of urgency and hope is necessary to spur innovation. Climate change, environmental degradation, overpopulation, economic inequality, and social upheaval (i.e. global change) presents scientists, scholars, professionals, and world citizens with an array of problems of monumental complexity. Scientific, social, and moral questions converge in ways that our current U.S. society, and the broader world community, appear ill-equipped to address. Solutions to social, political, economic, and environmental problems must deal with the “coupling” of the human world and the biosphere. “[B]usiness as usual in scientific endeavors will not produce answers to the most urgent questions about coupled systems. In order to meet the challenges of the Anthropocene, we need to develop models and methods that are capable of illuminating the interactions between biophysical forces and anthropogenic drivers” (Kotchen and Young, 2007: 149). Immense creativity is needed in all domains of thought. Communication plays a central role in facilitating cultural change and the evolution of consciousness. New approaches to research, and new communication modalities and configurations – seemingly outside of what we can currently conceive – may hold important insights that will inspire individuals and societies to imagine and implement new possibilities. Modes of inquiry that catalyze creative, integral thought need to be nurtured. Challenge-based scholarship provides a framework for such inquiry and research. Based on the pedagogical theories of problem, inquiry and project-based learning (Johnson, Smith, Smythe & Varon, 2009), challenge-based learning (and scholarship) “is designed to equip a new generation of students [scholars] to solve real problems, develop 21st-century skills, and make a difference in their academic community and the world” (Apple, 2008: 7). Challenge-based scholarship provides a theoretical, practical, and experiential approach to tackling major problems. Within this context, psychedelics such as ayahuasca could be explored for their potential to spur lateral thinking, to catalyze creativity and access modes of consciousness that may give deeper insights into the nature of our problems and potential solutions. Effective communication that can evoke metanoia (a change of mind and heart) is fundamental for the invention and implementation of solutions to global change problems. Safe and innovative use of psychedelics could expand the range of communicative possibilities within individual minds, and between members of communities and cultures. Advanced communication media ecologies, such as a mixed-reality environment where researchers undertake psychedelic experiences, could enhance those experiences and also provide mediums for those insights to be captured, expressed, and shared. Scholars and other highly gifted adults are uniquely positioned to help solve global change

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problems, but even society’s most gifted need help imagining breakthroughs to extremely difficult problems. Metanoia requires looking at the world with new eyes and in a way that bridges rational and emotional intelligence. A syntonypromoting change of mind and heart requires the integration and rewiring of the three main layers of the brain: the brain stem and cerebellum (reptilian); the limbic system (emotional); and the cerebrum or cortex (higher functions, thought etc.). Altered states of consciousness play an important role in creating unique neural communication patterns that integrate the tripartite brain in ways not usually available in regular states of consciousness. Psychointegrator plants, such as ayahuasca, when used ritually and with proper preparation and precautions, can induce profound altered states of consciousness that shamans across cultures and the ages have accessed for the communal and evolutionary benefit of their tribes. Altered states of consciousness (ASCs) reflect fundamental principles of the human nervous system, involving natural reactions that induce the relaxation response and brain synchronization, as well as visionary experiences that reflect a presentational symbolic capacity. ASCs involve high-voltage, slow-frequency brain wave activity originating in the limbic system–brain stem connections that drive synchronizing patterns into the frontal cortex. This integrates activities of different levels of the brain with coherent brain wave impulses from lower brain structures through the frontal cortex, producing a synthesis of behavior, emotion, and thought. (Winkelman, 2002: 1879)

Cultures throughout history have used other techniques such as fasting, meditating, breathing, austerities etc. to evoke altered states of consciousness for healing, accelerated learning, and mental, emotional, and physical integration. These techniques are useful for some, but the potential of psychedelics should not be ignored, especially for individuals who respond well to the psychedelic experience. In shamanic cultures, the shaman was the primary person who explored altered states of consciousness. Shamans were the doctors, philosophers, cosmologists, and psychopharmacosophists of their cultures; they were the gifted, talented (and sometimes mad and marginal) members of their societies (Eliade, 1964). In our times, gifted and appropriately screened teams of scientists, scholars, philanthropists, social entrepreneurs, artists, medical professionals and others could explore the edges of human potential with ayahuasca and bring back their lessons learned for the purpose of advancing research projects that attempt to design and implement solutions to global change problems and endow the future with resources that could serve vivogenic evolutionary trajectories. In the late 1960s, shortly before hallucinogen research was halted, a group of San Francisco

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academics conducted a unique experiment with highly intelligent professionals to see if psychedelics could be used to spur creative problem solving (Harman et al., 1966). Based on the frequently reported similarities between creative and psychedelic (drug-induced, consciousness-expansion) experiences, a preliminary study was conducted to explore the effects of psychedelic agents…on creative problemsolving ability. Twenty-seven professionally employed males were given a single psychedelic experience in 1 of 7 small groups…following extensive selection… procedures. This drug-induced problem-solving session was carefully structured with particular focus on establishing Ss’ expectancies and a psychosocial milieu conducive to creative activity. Tentative findings based on tests of creativity, on subjective reports and self ratings, and on the utility of problem solutions suggested that, if given according to this carefully structured regimen, psychedelic agents seem to facilitate creative problem-solving, particularly in the ‘illumination phase’. (Harman et al., 1966: 212)

The researchers acknowledged that their findings were preliminary and the generalizability of the results was limited. They had hoped to continue this research with a larger sample size and more rigorous experimental design; however restrictions on hallucinogen research precluded that. Eleven core observations related to creative problem solving emerged from this research that indicated that the psychedelic agent helped induce: (1) Low inhibition; (2) Capacity to structure problems in a larger context; (3) High fluency and flexibility of ideation; (4) High capacity for visual imagery and fantasy; (5) High ability to concentrate; (6) High empathy with external processes and objects; (7) High empathy with people; (8) Accessibility of unconscious resources; (9) Ability to associate seemingly dissimilar elements in meaningful ways; (10) High motivation to obtain closure; an appetite for elegance; (11) Capacity to visualize the completed solution in its entirety. (Harman et al., 1966: 221–25).

Increasing these abilities through challenge-based scholarship with ayahuasca to address various global change problems could bear fruit. Harman and Fadiman’s (1970) vision for this kind of research aimed to, ultimately, help gifted people develop their creative problem solving abilities even further. A much more important application in the long run… is the use of the psychedelic agents as training facilitators to gradually upgrade the performance level of already effective personnel. This would require establishment of accepted training procedures and certification provisions for those qualified to use them…

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Among consequences of this line of exploration, the most significant of all, in our estimation, is the gaining of new knowledge of the mysterious higher processes of the human mind [and] the framing of new and more productive research questions. (Harman and Fadiman, 1970: 226)

Research, such as Harman and Fadiman describe above, might possibly be explored in the current cultural atmosphere if experiments were meticulously designed following best practices that have begun to be established by leaders in the field. Considering the current state of the world, I believe enough data exists to warrant the design of new experiments such as I am suggesting. Ayahuasca is a good candidate for use as a research psychedelic agent because it has already established itself around the world, it is linked with deep shamanic knowledge from the Amazon, its chemical make-up contains an endogenous brain metabolite (DMT) that is closely related in structure to serotonin, it is possible to safely produce (Riba et al., 2001; McIlhenny, Pipkin, Standish, Wechkin & Strassman, 2009) ethnographic and anecdotal data indicate that it is a powerful consciousness expanding substance (Shanon, 2003), and it has a low potential for abuse (Johnson, Richards and Griffiths, 2008). Building upon recent and respectable scientific research on hallucinogens (Grob et al., 2010, 1996; Griffiths et al,. 2006; McIlhenny et al., 2009; Riba et al., 2001) and research on the development of high performance teams (Senge et al., 2010), properly screened study volunteers would participate in safe ayahuasca ceremonies, led by a qualified ritual leader, with fellow researchers to discover if ayahuasca increases creative problem solving related to global change issues. The ceremonies would be preceded by substantial collaboration between participants (12–18 months) working on a particular problem, such as social impacts of climate change in three vulnerable world cities. A control group that does not take ayahuasca, but follows the same research program, would be included in the experiment design. A research psychiatrist would be recruited to serve as medical director. She would lead a team of mental health professionals who would be trained as session guides (and medics if necessary) and who would conduct pre-screening of potential candidates, and administer pre- and postsession assessment instruments specifically developed for this experiment, along with administering existing batteries relevant for the testing of the experiment’s hypothesis (Lopez, 2011). An independent evaluator would work with the research team to create mixed methods instruments for assessing the project’s procedures and outcomes. The pre-ceremony collaboration would include development of digital knowledge bases that would be used for visualization/perceptualization of working models that would help refine the framing of research questions leading up to the ceremony. Following the ayahuasca session, participants would collaborate for

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approximately one week in structured groups with scholarly media producers and Hollywood writers, directors, and digital artists using advanced media labs to rapidly perceptualize insights from participants’ experiences and relate them to their areas of research expertise and to the group research topic. Approximately 12–18 months of post-session work would allow researchers and media production teams to complete immersive mixed-reality narrative presentations of their research findings. During this time the principal investigator, and the core project team, would compile assessment data and publish findings from quantitative analysis of data as well as presenting qualitative narratives from project participants. By translating the inner visions of highly gifted researchers – who are focused on innovative solutions to global change problems – into the immersive languages of 21st-century media, some of the world’s brightest people can more clearly communicate perils and prospects for mitigating and adapting our human presence on the planet in ways that serve the greater good of humanity, and the life-systems of the planet.

Conclusion: Media Ecological Psychopharmacosphy and the Mechanisms of Syntony Thomas Berry said many times that he believed modern civilizations had become autistic in relationship to the natural systems of the Earth. “What we have gained by controlling the world as a collection of objects we have lost in our capacity for intimacy in the communion of subjects” (Swimme and Berry, 1992: 249). Autism is characterized by social and communicative impairments that prevent the autistic person from interpreting subtle non-verbal and verbal cues that take place in normal social interaction. These impairments can result in syntony deficits, learning difficulties, and problems relating to others. In Berry’s analogy, contemporary societies are not effectively interpreting the messages we are receiving from the larger Earth-system about the immense geo-biological changes unleashed by humans in the Anthropocene. Our inability to decode messages from the biosphere about the deleterious effects of human behavior on the biosphere itself prevents humanity from taking steps needed to revise our world views and behavior in ways that could serve both humanity and Earth evolution. Individually, and collectively, we need to restore and enhance our ability to syntonically communicate, understand, and learn in ways that are appropriate for our moment in history. A media ecological psychopharmacosophy can help shed light on the mechanisms of syntony and encourage experiments and pedagogies that can share syntonic visions through immersive 21st-century media. The research experiment I described in the previous section would be a first step in such a direction.

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Psychointegration and ritual are two mechanisms of syntony that play a fundamental role in the media ecological psychopharmacosphy I propose. Shamanic use of ayahuasca, under certain circumstances, can promote psychointegration both through the psychoactivity of the tea – which stimulates communication between the modular systems of the brain – and through ritual that promotes group bonding. [The brain’s] modular systems manage language, music, mimesis (imitation), animal species classification, self, inference of other’s mental states (mind reading), and tool use. Basic aspects of shamanism involve the use of these innate representational modules for understanding self, social others, and their mental capacities… Community ritual represents the importance of the role of symbolic processes and social others in synchronizing human psychobiological functions. (Winkelman, 2002: 1879)

This kind of ancient media ecology needs to be united with integral postmodern media ecologies that seek to help, not hinder, the survival of humans and the biosphere. Chemical and communication media are the cognitive environments we live within; from these complex interactions of mind and matter, we enact physical and psychic worlds. Greater understanding regarding how our consciousness co-creates the worlds we live in is critical if we are to successfully engage with the challenges of the Anthropocene. Under some circumstances, psychedelic drugs can provide profound insight into the deepest recesses of the mind and its relationship to all that is. Albert Hofmann, father of LSD, also believed that a major shift of world view is necessary to combat our modern malaise. He argued that certain psychoactive drugs, used in appropriate ways, could help shift a person’s world view by inducing a mystical experience that shows the radical interconnectedness of our individual consciousness with the greater web of life. The spiritual crisis pervading all spheres of Western industrial society can be remedied only by a change in our world view. We shall have to shift from the materialistic, dualistic belief that people and their environment are separate, toward a new consciousness of an all-encompassing reality which embraces the experiencing ego, a reality in which people feel their oneness with animate nature and all of creation. Everything that can contribute to such a fundamental alteration in our perception of reality must therefore command earnest attention. (Hofmann, 1980: xii)

As I mentioned earlier in the chapter, I do not believe that psychedelic drugs are a panacea and I am not advocating unsupervised or unsafe use outside of

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a research context. Nonetheless, innovative research with a substance such as ayahuasca could help us think “afresh about the relationship between people and their world” (Welcome to the Anthropocene, 2011: 11). Recent scientific research with psychedelics has taken great pains to design research protocols that are rigorous and emphasize safety. In 2006, a study titled, “Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance” (Griffiths et al.) appeared in the prestigious journal Psychopharmacology. The principal author, a mainstream and well-respected neuroscientist from Johns Hopkins University named Roland Griffiths, along with his co-authors, described in detail their government approved research with 36 healthy subjects. Unlike many previous research studies on hallucinogens that had examined the effects of hallucinogens on people with physical or mental illnesses (Grob, 2007; Grof, 2001), this study focused on healthy adults who had never had any previous experience with hallucinogens. A significant number of participants had deeply profound experiences of a mystical nature that many considered to be one of the most important experiences of their lives. Although this research is still considered controversial by some, the study and its follow up (Griffiths et al., 2008; Johnson et al., 2008) received many positive reviews both in scientific circles and in the popular media (csp.org/psilocybin/).9 The rigorous methodology of the study and the meticulous attention to detail in creating a safe set and setting for the research participants demonstrated that hallucinogen research can be conducted safely and that the results of the research are valuable to many academic disciplines. “When administered under supportive conditions, psilocybin occasioned experiences similar to spontaneously occurring mystical experiences” (Griffiths et al., 2006: 268). True mystical experiences that tap the wisdom of consciousness (in contrast to pathological psychosis) can be useful for developing the potential of individuals and society. The brief sketch of proposed research described in this chapter seeks to draw from exemplary studies like the one conducted by Griffiths and his colleagues. These powerful tools for inquiry exist, and we live in perilous times that call for out-of-the-box thinking. Scientific discovery is based on experimentation, pushing the boundaries of knowledge, ongoing revision of theories, and development of ever-more sophisticated ways to observe and understand natural phenomena. A media ecological psychopharmacosophy that bridges ways of knowing, and responsibly explores pharmacology and the mind, can help erect the scaffolding needed to build a viable future for our descendants; a future in which the highest potentials of human creativity, love, and intelligence may have a chance to mature and flourish.

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Notes 1 2

3

4 5

6

7

8

“We [still] do not know how the brain creates consciousness” (Searle, 2009: n.p.). Ayahuasca, a Quecha term that means “vine of the soul” or “vine of the dead,” is a psychoactive Amazonian plant decoction that has been used for ritual and healing by indigenous peoples of northwestern South America since antiquity. Mixed reality is a somewhat cumbersome term that emerged from research in virtual reality in the 1980s and 1990s. Around this time the term augmented reality was used to indicate working with “real” space, as well as “virtual” space. Mixed reality takes this a step further and posits varied interpositions and overlays of computer and screen realities on top of our quotidian material realities. Ramachandran (2007) believes that synesthesia can be an important component of very high-level creativity. Scientists such as Leakey and Lewin (1996) argue that the Earth is in the midst of a sixth mass extinction. He and Hubbell (2011) in a recent article in Nature argue that species extinction rates have been overestimated (possibly by as much as 160%). Nonetheless, He and Hubbell still believe that habitat loss and species extinction are significant ecological problems. Diamond’s thesis is debatable considering the nature of studying the pre-historic past. Nonetheless, the basics of his thesis are argued for by others such as Abram (1996). Anthropologist Walter L. Williams provides evidence for this thesis in his research (personal communication, October 12, 2010). See also Wells (2010). Though Gimbutas’ and Eisler’s interpretations of “Old Europe” are disputed by some scholars such as Renfrew (1987), readings of classicists such as Jaquetta Hawkes, Martin Nilsson, and Karl Kerényi give plausible evidence for more matricentric traditions that survived in Minoan Crete and played an important role in aspects of Mycenaean Crete with some remnants surviving into Classical Greece. Grof and Bennet (1993) use the term holotropic to mean “moving towards wholeness.” My use of the term also intends to include Koestler’s (1968) concept of the holon where something can be both a part and a whole and where parts and wholes have nested hierarchy relationships. Wilber (1996) expands on the idea of holons at length. In holonic evolution, systems and parts of systems evolve through a process of transcending and including that results in a new system that leads to further iterations of the evolutionary process.

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Senge, P., B. Smith, N. Kruschwitz, J. Laur and S. Schley (2010). The Necessary Revolution: Working Together to Create a Sustainable World. New York: Crown Business. Shanon, B. (2003). The Antipodes of the Mind: Charting the Phenomenology of the Ayahuasca Experience. New York: Oxford University Press. Speth, J. G. (2008). The Bridge at the End of the World: Capitalism, the Environment and the Crossing from Crisis to Sustainability. New Haven: Yale University Press. Swimme, B. and T. Berry (1992). The Universe Story. San Francisco: Harper San Francisco. Tarnas, R. (1992). The Passion of the Western Mind: Understanding the Ideas that have Shaped our World View. New York: Ballantine. Welcome to the Anthropocene (2011). The Economist, May 28: 11. Wells, S. (2010). Pandora’s Seed: The Unforeseen Lost of Civilization. New York: Random House. Wilber, K. (1996). A Brief History of Everything. Boston: Shambhala. Williams, W. L. (2010). Personal communication, October 12, 2010. Wilson, E. O. (1992). The Diversity of Life. Cambridge, MA: Belknap Press of Harvard University Press. Winkelman, M. (1996). “Psychointegrator Plants: Their Roles in Human Culture and Health.” In M. Winkelman and W. Andritzky (eds), Sacred Plants, Consciousness and Healing: Yearbook of Cross-cultural Medicine and Psychotherapy, pp. 9–53. Berlin: Verlag fur Wissenschaft und Bildung. Winkelman, M. (2002). “Shamanism as Neurotheology and Evolutionary Psychology.” American Behavioral Scientist 45: 1875–1887. DOI: 10.1177/0002764202045012010. Zalasiewicz, J., M. Williams, A. Smith, T. L. Barr, A. L. Coe, P. R. Bown, P. Brenchley, P. Cantrill, D. Gale, A. Gibbard, G. Philip, F. John, M. W. Hounslow, A. C. Kerr, P. Pearson, R. Knox, J. Powell, C. Waters, J. Marshall, M. Oates, P. Rawson and P. Stone (2008). “Are We Now Living in the Anthropocene?” Geological Society of America Today 18(2): 4–8.

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Chapter Twelve

Psychoactive Media John P. Skinnon

Introduction “Man has demonstrated that he is master of everything – except his own nature.” – Henry Miller (1945)

The definition of “drug” is vague. Whether defined legally, medically, or colloquially it is generally accepted that a drug is a substance that enters the body and alters metabolism in some way. Can a communication medium or technology be considered a drug? Media are not exogenous substances introduced into the organism, but some may facilitate functionally-equivalent effects to certain drugs. One example, which I will present later in this chapter, is the similarity between television and opiates, such as codeine, morphine, opium, and heroin. A major difference is that medicine, and the exact chemistry thereof, can be meticulously tailored and easily concentrated to achieve an endorphin rush not attainable by our endogenous physiology. However, beyond the super-concentration and fine-tuning attainable via medicinal chemistry, the effect of media and some medicines are similar and can produce similar effects on the mind-body system. This suggests that the visual and auditory stimulation delivered through a television or other form of media can interact with the human brain and mind-body system, prompting a cascade of neurotransmitters and hormones to be released, leading to a change in our neurophysiology, or an altered “state of mind.” Media can produce fairly rapid changes in physiology, which can be understood through chemical footprints, revealing clues to the activity taking place in and through what is arguably the most complicated structure we know of today – the human brain. 266

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In today’s industrialized society we use television, the Internet, and other media without much reflection or awareness that these technologies can actually change our physiology, alter brain chemistry, and hence impact perceptual states. We generally do not examine this potential of media. My personal experience discussing these ideas with other health field professionals has been met with a strange resistance. Surely, media and drugs cannot be placed in the same category. This seems to be the prevailing intuitive popular response. What’s more, it seems that many people are uncomfortable exploring the similarities between media and drugs, especially with respect to any potential effects on the human brain. I will explore this further because the empirical evidence rails against the prevailing intuition. It can be shown that media such as radio and television have parallels to certain drugs in terms of their neurophysiological effect. The harmful effects of psychotropic drugs have been hammered into the cultural consciousness without much consideration of possible benefits; and discussion of physically induced changes on the mind-body system, actualized by media consumption, is practically non-existent. I would speculate that common opinions held regarding the consumption of drugs and media are based mostly on propaganda and naïveté, without much thought or investigation of the facts. The point I want to make here is that drugs and media can be classified together, and we should take them for what they are: mind-body altering technologies. As humans we have an uncanny ability to turn almost anything into an “addiction.” Finding a balance can often be difficult. The addictive nature of television consumption, in particular, will be explored further in the chapter. Depression, malaise, or unenthused sensations can be altered or attenuated through media use, in much the same way many of us drink coffee and alcohol, take antidepressants, or use other drugs to change the mind-body state. The “quick fix” of some medications and certain types of media equate to similar strategies employed in efforts to mitigate a variety of deleterious, unwanted, or simply uncomfortable states of mind or ways of being. When speaking of drug addiction, there is often some confusion between mental addiction and physical dependence. Many drugs (especially illicit drugs) have the potential for both. There is, however, a major difference worth discussing here. Many drugs, mentally addictive or not, have the potential for the user to develop a physical dependence, mostly because of receptor down-regulation, which is discussed later in this chapter. Drugs such as heroin, alcohol, or nicotine cause the user to develop a physical dependence, and can cause great physical discomfort or even death when stopped suddenly, while other drugs simply cause a mental addiction. The addictive potential of media discussed in this book is referring to the mentally addictive component of addiction, and is not suggesting a physical dependence. I won’t go so far as to say that media cannot cause a physical dependence, but I haven’t found any data suggesting this. This

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necessitates that we look beyond the purely physical effects and manifestations of media use. It is difficult to gather empirical evidence that helps us understand the effects of television on neurochemistry. One reason is that there has been surprisingly little sustained and reliable empirical work that actually focuses on television as a media form. Most purported work of this sort that has been conducted over the past fifty years is concerned with different forms of content, like violence, comedy, pornography and the like (cf. Thayer, 1989; Pert, 1997). Second, the human brain is so complex and variable that it is difficult to measure and quantify media input or processing. The subject matter doesn’t lend itself to scientific testing like medicinal chemistry, i.e. one cannot quantify the results of 1500mg of television three times a day for six months. This hinders our normal approach for medical understanding of what is physically occurring in the brain. With theories of the mind and specialized spin-offs of brain science, including neurophysiology/ biochemistry, just now beginning to submit the groundwork for model building, at this time all we can expect is a partial understanding to guide our thoughts and research in the right direction. And yet, with powerful tools of analysis (both conceptual and technological), research in this particular area looks promising. Some commentators seem to believe that the problem has been solved, as Daniel Dennett seems to suggest in Consciousness Explained (1991). Others declare that it never will be, including David Chalmers in his recent book The Character of Consciousness (2010). The casual reader might get the sense that we are chasing our tails in an effort to build an understanding of how the brain works via cognitive science and the philosophy of mind. While an approach informed by pharmacology does not promise to solve all the hard questions, I think it can offer some grounded insights into the mind-body problem, the nature of consciousness, and other puzzles of the brain.

Neurotransmitters Neurons communicate using different chemical signals. These include the small neurotransmitters, peptides, cannabinoids, and even some poisonous gases such as nitric oxide (not to be confused with nitrous oxide or laughing gas) and carbon monoxide. Drugs almost always exert their effect by mimicking one of these chemical signals, or by inhibiting them. To oversimplify it a bit, a drug that mimics a natural or endogenous chemical signal is known as an “agonist,” and a drug that inhibits an endogenous chemical signal is called an “antagonist.” A simple example is morphine, which is an endorphin “agonist.” Narcon, or naloxone, given for opiate overdose, such as morphine, is an endorphin antagonist. Morphine works by “looking like” a natural endogenous endorphin, and the body treats it as one. Naloxone also works by chemically “looking like” endogenous endorphins, however,

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it will bind, and even kick out, morphine or other “agonists” (which means it has a higher affinity for the receptor than morphine), and however, naloxone will not turn on the receptor; it will bind to it and stop it from turning on, effectively blocking it. There are numerous ways to agonize, or antagonize, a receptor, but we needn’t understand exactly how this works to gain a basic understanding of the roles these chemicals and compounds play in human neurophysiology. As long as one understands that an agonist turns it on, and an antagonist turns it off, then we will be on our way toward understanding most of the medical terminology. Next, we have to learn the functions of the most abundant neurotransmitters, and what turning them “on” and “off ” does. For example, once you know that catecholamines (namely dopamine, norepinephrine, and epinephrine) are involved in precipitating fight or flight syndrome, and you know something is a catecholamine agonist, it is easy enough to then predict the effects in the brain and sometimes even the general behavioral outcomes in the organism. Cocaine or amphetamines such as speed are examples of catecholamine agonists. This can be simplified to mean it will mimic a fight or flight syndrome. One can predict the effects of these drugs if one understands the physiological effects of fight or flight syndrome. Increased heart rate, increased pupil size to see better, decreased digestion, increased panic or paranoia, and the list goes on. The body is amazingly predictable in this way. Most of what one intuitively thinks might help your organism survive while in flight or flight mode tends to happen. This is an easy example to consider. However, things do indeed get more complicated as one progresses further into the neurochemical puzzle that is the human brain. Most of the small neurotransmitters fall into two chemical groups, namely monoamines and amino acids; with some miscellaneous chemicals such as acetylcholine. There are many neurotransmitters not mentioned in this chapter, including melatonin and histamine, but, given space limitations, I will focus on the major, well-known neurotransmitter systems that are known to have a large impact on cognition. These neurotransmitters tend to have drug analogs or “look-a-likes” which agonize or antagonize them. Studying these drugs can help us understand some of the roles they and their neurotransmitter counterparts play in the brain. Monoamines (serotonin, dopamine, norepinephrine, epinephrine) Serotonin (5-HT)

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IUPAC (International Union of Pure and Applied Chemistry) name: 5-Hydroxytryptamine or 3-(2-aminoethyl)-1H-indol-5-ol Serotonin (abbreviated 5-HT {5-hydroxytryptamine}) was first isolated in 1948; it was named sero-tonin because it was found in the serum and the first physiological action it was known to produce was a vasoconstrictive effect (Rapport, Green and Page, 1948). Serotonin equates to “serum-tonicity” from its Latin prefix and Greek suffix; maybe the slight etymological disparity exists to point out that the “tonic” action is not an effect on the “serum,” the “tonic” action is on the “vasculature.” It could have been named Vasotonin. But alas, we are stuck with the most famous pop culture neurotransmitter starting with an “S” instead of a “V.” While the word serotonin is known by many, its vasoconstrictive effects are seldom discussed. What is common knowledge is that 5-HT is responsible for making you “happy,” as evidenced by the meteoric rise of Prozac use in our culture. We reduce the equation and suggest to ourselves that if you’re unhappy you don’t have enough serotonin. Indeed, this may be an oversimplification. However, let’s take a closer look. Here’s an operative excerpt from the American College of Neuropsychopharmacology website: The neurotransmitter serotonin (5-hydroxytryptamine, 5-HT) mediates a wide range of physiological functions by interacting with multiple receptors, and these receptors have been implicated as playing important roles in certain pathological and psychopathological conditions. In the past 16 years, seven distinct families of 5-HT receptors have been identified (5-HT1–5-HT7), and subpopulations have been described for several of these. At least 15 subpopulations now have been cloned. The profusion of 5-HT receptors should eventually allow a better understanding of the different and complex processes in which 5-HT is involved. (Glennon et al., 2000)

To further complicate things, 5-HT can be an excitatory or inhibitory neurotransmitter. And 5-HT can mediate the release of some of the other neurotransmitters, including common neurotransmitters such as: glutamate, GABA, dopamine, epinephrine and norepinephrine, and acetylcholine; as well as mediating the release of various hormones (Nichols and Nichols, 2008). Increasing available 5-HT can have different effects based on which receptors in the body they are binding to. As stated in the ACNP website quotation above, there are at least 15 receptor subtypes. Now, this is odd. There is only one kind of serotonin in your body, but there are at least 15 different types of receptors for it. As it turns out, each receptor

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has a different affinity for 5-HT, which may change under certain conditions. What’s more, serotonin receptors are spread throughout the body. They are found in the central nervous system, peripheral nervous system, GI tract (in fact, about 80 percent of serotonin is found in the gut), blood vessels, on smooth muscles, and even on platelets (Nichols and Nichols, 2008). Serotonin is a hormone as well. The difference between a hormone and a neurotransmitter is really a semantic one. It is heavily dependent upon context. That is to say, the name implies where the chemical action occurs. A hormone is a chemical messenger in the body, while the same chemical formulation is a neurotransmitter when it is packaged into vesicles in the synapses of the brain. With these chemicals present in many areas of the body, and spread throughout the brain (with at least 15 receptor subtypes), they can affect many changes in the internal milieu (including, sometimes, opposing reactions) based on location or on which receptor subtypes get “turned on” by the chemical. Pharmacologists have discovered that you can make a drug that targets certain receptor subtypes, which are usually localized to certain areas in the body. For instance a drug may have no affinity for receptor 5-HT3-7, a low affinity for 5-HT1A, and a strong affinity for 5-HT2A – 2C. With many combinations of selectively targeting different receptor subtypes, medicines can be used to target certain neurons, and create predictable effects. So, again, the point I’m making here is that it does become complicated. For example, a statement such as “drug A increases serotonin,” and “medium B increases serotonin,” and therefore “they are analogous” is an unjust over-simplification. Drugs defined as 5-HT agonists can be used for depression, anxiety, migraine and cluster headaches, gastrointestinal disorders, thermoregulation, weight loss, and psychedelic drug experiences. There’s even an experimental 5-HT agonist called AS-19 which can reduce amnesia caused by other medications. 5-HT ant-agonists are used for antiemesis, gastroprokinetics, antipsychotic effects, and Alzheimer’s disease. Some 5-HT agonists are also antagonists for different 5-HT receptor subtypes (Nichols and Nichols, 2008). To conclude this rather brief summary of serotonin, stating that a drug is a serotonin agonist does not specify any one physiological response in particular. The “triggers” and “effects” of drugs that impinge on brain chemistry and on the mind-body system are both multiply-realizable and context-dependent.1 Taking a serotonin agonist could mean that you took a drug which made your headache go away (Imitrex), or made you less depressed (Prozac), or manifested an experience in which you were communing with “jeweled self-dribbling basketballs,” as Terence McKenna was fond of saying while describing his personal experiences with DMT. All three of these drugs increase serotonin activity, and all induce quite different experiences.

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The story is basically the same with all neurotransmitters and hormones; there are many different effects from drugs targeting different receptor subtypes of the same neurotransmitter. But, again, why is there one kind of serotonin and 15 different receptor configurations? It may mean that there is something missing from the pharmacological puzzle, or it may be explained by the curious observation that the affinity with which neurotransmitters/hormones/drugs (aka ligands, from Latin liganus or ligare meaning “to bind” which is where ligament derives its meaning) bind to receptors is more directly controlled by receptors than the chemical itself. The receptors regulate themselves, and can become less sensitive to agonists if there is an over abundance of them, which is how drug dependence develops. This is something called the “Two State Receptor Theory” (Leff, 1995), and proposes that receptors will change their protein conformation, which will affect the affinity it has for the ligand. What’s more, receptors will change their conformation under different circumstances (Rang, 2006). Let’s run through an even more simplified look at some other major neurotransmitters. The next three neurotransmitters are catecholamines, named because they all contain a “catechol” chemical group, connected through an ethyl chain to an “amine” (an organic compound with a nitrogen atom). They are, namely, dopamine (DA), norepinephrine (NE), and epinephrine (EPI); the latter two also known as noradrenalin and adrenalin, respectively. They are all produced, along with cortisol, to raise blood glucose levels, during fight or flight syndrome or during times of stress. Many stimulant drugs, like cocaine and amphetamines, affect the catecholamine receptors in various proportions and complex ways, chemically inducing a type of “fight or flight” response (Purves et al., 2008). Catecholamine agonists and antagonists are also called cholinergics and anti-cholinergics, respectively. Catechol

Dopamine

Norepinephrine Epinephrine

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Notice the catechol group, connected to an amine (a nitrogen group). The similarity explains why some drugs which have affinity for dopamine commonly have affinity for norepinephrine as well, and vice versa. Dopamine IUPAC name: 4-(2-aminoethyl)benzene-1,2-diol Dopamine (DA) is a catecholamine. It gets metabolized into epinephrine and norepinephrine. It is a hormone and a neurotransmitter, meaning it acts in the body and the brain (Rang 2003). Diseases due to dopamine imbalance in the brain include Parkinson’s disease, in which there is not enough dopamine, and schizophrenia where there is too much dopamine (but only in certain areas of the brain, with some areas actually having too little). Norepinephrine IUPAC name: 4-[(1R)-2-amino-1-hydroxyethyl]benzene-1,2-diol Norepinephrine (NE) is one of the catecholamines released during stress or in “fight or flight syndrome.” The adrenal glands secrete norepinephrine and epinephrine, and their chemical structures are very similar. Norepinephrine, like epinephrine, functions as neurotransmitter and a hormone. It is involved with attention, alertness, arousal, and has influences on the reward system. Norepinephrine agonists are used for ADHD, depression, schizophrenia, and hypotension (Rang, 2003). Epinephrine IUPAC name: (R)-4-(1-hydroxy-2-(methylamino)ethyl)benzene-1,2-diol Epinephrine (EPI) is the last of our catecholamine neurotransmitters. As a medicine epinephrine is primarily used to treat anaphylactic shock, which is a body-wide allergic reaction, commonly treated with Epipens. It can also be used to treat cardiac arrest (Sicherer, 2006). It is the hormone/neurotransmitter responsible for the somatic effects of the fight or flight syndrome. Keeping this in mind, it is easy to guess what effects epinephrine has on the body: it increases heart rate, dilates pupils, dilates airway passages, and constricts blood vessels (Rang, 2003). Epinephrine is unique among other associated neurotransmitters in that it does not have many drug imitators. You would think there would be a host of drugs

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designed to mimic the adrenalin junkie effect endogenously produced in the body. Actually, adrenalin junkie is a bit of a misnomer; it would be more correct to call someone an endorphin junkie. Unlike dopamine and norepinephrine, epinephrine has effects primarily on the body and not in the brain (Rang, 2003). Because straight adrenalin (epinephrine) doesn’t produce the types of effects found to be most favorable to adrenalin junkies, there must be more going on with the adrenalin junkie effect, most likely due to release of endorphins and possibly the other catecholamines. Endorphins are endogenous opioid peptides (the word endorphin comes from endogenous morphine), and they are also released during fight or flight mode, along with the catecholamines (Boecker et al., 2008). Neuropeptides: endorphins, enkephalins, dynorphins, endomorphins, nociceptin and neurotensin Peptides are small proteins. Like all proteins they are made up of a chain of amino acids. There are presently about 100 known neuropeptides (http://www.neuropeptides.nl/). The only peptides I focus on here are the neuropeptides that bind to the opioid receptors. Neuropeptides can act as neurotransmitters themselves, or by modulating neurotransmitters. Most neurons function by releasing one of the small neurotransmitters, along with one or more neuropeptides. They act differently than the small neurotransmitters in a few ways; they tend to have prolonged effects, they are generally more potent than other neurotransmitters. They also tend to affect neuron populations (i.e. communication can occur between one population of neurons and another, as opposed to one neuron to another). The term endorphin refers to peptides that activate opioid receptors and is not a specific peptide, it is a peptide family. The same is true for enkephalins and dynorphins. The various families have different affinities for the different opioid receptor subtypes (Fine and Portenoy, 2004).2 Neurotensin is the only neuropeptide I will mention here that is not related to the opioid system. It interacts with the dopaminergic system. It has recently been shown to have effects similar to antipsychotic medications, and may be the endogenous antipsychotic that the antipsychotic medicines mimic (Kinkead et al., 2005).

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Amino acids: glutamic acid, GABA, aspartic acid, glycine GABA (gamma-Aminobutyric acid)

IUPAC name: 4-aminobutanoic acid GABA is the main inhibitory neurotransmitter in the brain, and is also responsible for muscle tone (Watanabe et al., 2002). There are many medicines that mimic GABA (GABA agonists or GABA-ergics); examples include alcohol, benzodiazepines, and barbiturates. GABA antagonists, such as Flumazenil, are only used for GABA agonist overdoses, including benzodiazepine overdoses (Valium, Xanax, Ativan, etc.), and it’s effective for overdoses for non-benzodiazepine class of benzodiazepine-like drugs such as Ambien and Sonata whose pharmacological actions are similar, but structurally distant (Walker, J. E. (1983). Glutamate, GABA, and CNS disease: A review.” Neurochemical Research Volume 8: Number 4, 521–550. DOI: 10.1007/BF00965107). GABA agonists generally relieve anxiety, produce sedation, and have anticonvulsant effects. Many also cause amnesia as a side- effect.

Glutamate IUPAC name: Glutamic acid Glutamate is the most abundant excitatory neurotransmitter in the nervous system. About 50 percent of the neurotransmitters in the brain produce glutamate, and 30–40 percent produce GABA (Walker, J. E. (1983). Glutamate, GABA, and CNS disease: A review.” Neurochemical Research Volume 8: Number 4, 521–550. DOI: 10.1007/BF00965107). They have opposing actions, glutamate is primarily excitatory, and GABA is primarily inhibitory. Glutamate is also a precursor to

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GABA, meaning glutamate gets metabolized into GABA, which works as a kind of self-regulatory mechanism because of their opposing excitatory-inhibitory actions. Glutamate is important for learning and memory, and is involved in synaptic plasticity (McEntee and Crook, 1993). Synaptic plasticity is the ability neurons have to change the strength of the connection in the synapse between two nerve cells. The Hebbian theory put forth by Donald Hebb in 1949 describes the mechanism for synaptic plasticity. A lot can be understood from Hebb’s now well-known catchphrase: “Cells that fire together, wire together.” This simplified catchphrase helps us understand how memories are formed, and may even help us understand our behavioral make-up. Memories, habits, “triggers” for emotional states are “wired together” with great strength, and because of that “hard-wiring” it can easily be set off. For example the neuronal network for the memory of your name has been fired together over and over and over in your life. It is now essentially unforgettable. Whereas the neuronal network you formed for other names, like those learned in some forgotten history textbook you once knew, are no longer recoverable. This gives some neurobiological support to what some people from all over the world have always known; everything, including emotions and personality traits, can be manipulated if you understand this principle. The Dali Lama spoke to Howard Cutler about this in his book The Art of Happiness (Cutler 1998). He said you can choose to be a happy person or an angry person. It is a simple rule, to train your mind. If you desire to make something hard-wired, one would simply try to use this wiring network in the brain as often as possible. And to try to get rid of something hard-wired one would try to pay attention and realize quickly when it is being triggered and decide to avoid this thought; as one might do to break a habit, or stop unwanted emotional states. Memory is thought to be formed by a complex network of neurons firing together, and enhancing synaptic plasticity is one of the main effects of glutamate. The dominant glutamate receptor targeted by medicines is the NMDA receptor. The only well-known drugs affecting glutamate receptors are NMDA receptor antagonists; examples of these are PCP (angel dust), ketamine, and dextromethorphine. All three of these drugs, at specific doses, are dissociative hallucinogens. Dissociative is not an adjective to describe the hallucinatory state; it is actually used to describe the physiological effect they have on the brain, which is to stop the brain from communicating functionally as a whole, and therefore “dissociate” some areas of the brain from being able to communicate with other areas (Tamminga et al., 1987). These drugs are also known for bizarre hallucinations, with strange dreamlike states and out-of-body type of experiences at doses where long-term memory formation is still functioning, and amnesia and anesthetic states are reached if the dose is pushed far enough.

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PCP was actually used as an anesthetic in the United States less than fifty years ago. Ketamine was developed by Park Davis in 1962 as a safer alternative to PCP as there were problems with toxicity using PCP as an anesthetic (Rudgley, 1998). Ketamine is still used in veterinary medicine but is not commonly used as an anesthetic for humans anymore, as some people report remembering dream-like states. It has recently been explored for antidepressant effects at very sub-anesthetic dosages (Zarate et al., 2006). Dextromethorphan (DXM) is the only NMDA receptor antagonist sold over the counter in the U.S. It is not over the counter for its NMDA receptor agonist activity, but because at a low dose it acts on the opioid receptors, like codeine, which makes it a substitute for opioids to suppress coughing. It was actually developed as a plan to find a substitute for codeine, without the addictive potential (Memorandum 1977). At 15–30 mg the opioid agonistic activity begins and DXM acts as a cough suppressant. At doses between 240–1500mg it becomes a dissociate hallucinogen (Shulgin, 1975). To clarify one point that is easily overlooked, NMDA receptors are actually glutamate receptors, but are one of three kinds of glutamate receptors that are stimulated by glutamate and NMDA. The fact that these compounds antagonize glutamate action explains why experiences induced by them cause amnesia.

Acetylcholine IUPAC name: 2-Acetoxy-N,N,N-trimethylethanaminium Acetylcholine (ACh) is a major neurotransmitter in both the central and peripheral nervous systems. It is involved with muscle activity, and in the brain it is involved with synaptic plasticity and hence memory and learning, possibly by enhancing NMDA receptor activity. ACh is also involved with sustaining attention (Himmelheber et al., 2000), and enhancing the sensory information when waking up (Jones, 2005). Like NMDA antagonists, ACh antagonists cause problems with learning and memory. There are two subcategories of acetylcholine receptors, nicotinic and muscarinic. Nicotinic ACh receptors are stimulated by nicotine and ACh. Muscarinic receptors are stimulated by muscarin and ACh. Muscarin is named after the first species it was isolated from, namely the famous red and white

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mushroom Amanita muscaria. Muscarin is not however responsible for the hallucinations described in folklore involving these mushrooms. The ingredients responsible for hallucinatory effects of these mushrooms are mainly from muscimol and also possibly from ibotenic acid (Bowden et al., 1965). Muscimol is a GABA agonist, and ibotenic acid is mainly an NMDA agonist, with some GABA agonist activity.3 The GABA agonist activity is completely different from that of psilocybin mushrooms (aka magic mushrooms). There are many medicines involved with ACh. Some notable ACh agonists are nicotine and drugs used to treat Alzheimer’s disease. A peer-reviewed study by van Duijn and Hofman states that nicotine might actually decrease your chance of getting Alzheimer’s disease (1991). If Alzheimer’s was the only disease of concern, then it may be advisable to smoke. However, we know that smoking causes a large number of other diseases. Perhaps nicotine could be used prophylactically as a pill or through various other delivery mechanisms that are relatively harmless. Nicotine has not been shown to cause any diseases on its own. Smoke, tar, and various carcinogens created by burning tobacco cause most problems associated with smoking (Benowitz, 1998). There are a large amount of medicines that antagonize acetylcholoine called anticholinergics. Some notable anticholinergics are atropine (found in belladonna, aka deadly nightshade), and neuromuscular blockers, such as those used for anesthesia or curare used by South American natives as a poison for arrow darts. Anticholinergics are used for respiratory disorders like asthma, gastrointestinal disorders like ulcerative colitis, Parkinson’s disease, genito-urinary disorders such as cystitis, and for insomnia.

Building an Understanding As expressed by several other contributors to this volume, I too see a need to get past a deeply rooted stigma in modern western cultures when it comes to even talking about drugs. Both popular and academic talk about drugs is often interpreted as a kind of perfunctory, even immoral activity, advocating the taking of illicit substances. Our current cultural ideology regarding drugs is based primarily on fear and ignorance. Instead of this we need an open dialogue to contemplate the contemporary relationship between drugs and our day-to-day lives – as well as a richer, more accurate historical perspective. The Chemical Muse (Hillman, 2008) and This is Your Country on Drugs (Grim, 2009) are two recent and well-thought-out books which argue that drugs, broadly construed as mind-body altering substances and artifacts, have been instrumental to the very maintenance of cultures and civilizations throughout history. History shows us that psychoactive medicines from ayahuasca to zacatechichi, or

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chocolate to heroin, can and have offered functional and quite legitimate states of consciousness for their human users. There has been a slow upward creep in the number of legitimate academic inquiries into drug uses and effects. One example is the use of psilocybin (the active ingredient in magic mushrooms) for terminally ill patients to help them cope with their terminal situation. There has also been a surge, the last couple of decades, in the study of media effects on the mind-body system. An example of this is a research project being conducted now at the University of California at San Diego (UCSD) involving the relationship between TV and cortisol levels. I believe we are in the midst of a paradigm shift in this regard, as biological approaches to understanding media use increase every year at national and international conferences in the fields of communication, neuroscience, and psychology. We can no longer ignore the way drugs and other communication media fundamentally alter the nature of human perception and experience. As Marshall McLuhan was fond of saying “We don’t know who discovered water, but we are pretty sure it wasn’t a fish.” A fish is of course unable to notice the water because it is enveloped by it. Water is a constitutive part of its being. Like the fish in water, we live in and are both carried and constituted by these environments created by language, culture, drugs, and media. And we tend to be largely unaware of that within which we dwell. We are living in environments, both material and virtual, that are taken as real and legitimate to consciousness experience. In other words, drugs and media of various kinds have been an integral and essential part of the environments and the “realities” we inhabit. Given this reality, it would be ill-advised at this crucial moment in human history to rule out any potentially effective methods and means that might help us better understand what is going on in our now “ordinary” states of mind. The pressing question is this: how might we understand the ordinary consciousness we swim in? The fish cannot “see” or study the water they swim in, except by some perturbation. Like the fish, one way to see what is going on here is to periodically perturb our realities chemically, physically, with certain media or technologies, or any other way that can lead to better ways of building an understanding of our being-in-the-world, to borrow one of Heidegger’s favorite hyphenates. Philosophers like Paul Feyerabend, Alfred North Whitehead, Henri Bergson, Johann Gottlieb Fichte, David Hume and long before them Heraclitus too. They all said much the same regarding the nature of reality. For all of these thinkers the world was conceived to be, in a word, messy. Biology has always been particularly messy in this way – multiply-realizable, non-linear, with emergent properties that are hard to grasp on the first pass. (MacDougall, personal correspondence)

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So what do we do about it; where do we go from here? The only thing we can do is to take everything for what it is. For what it’s worth. Not what it should be worth, or used to be worth, but to assess and make an informed decision regarding what value it has for us now. It’s a journey that brings us to new understandings of the relationships between the things we produce and use, and the kinds of beings we become in the process – a process of mutual production, and mutual becoming. Or, as John Culkin, a friend and colleague of McLuhan’s liked to say: “We shape our tools and thereafter they shape us” (in Stearn 1967: 60). Psychological, economic, and computational approaches to understanding media have had their turn. An artistic-philosophical-literary-socio-historical-quasi-biological approach like McLuhan’s should be given a whirl. Indeed, because some of these things I describe in this chapter are illicit, they are rarely introduced into the academic context as objects of formal study. For most researchers these avenues of study simply do not exist. Which is to say that a panoply of induced states of consciousness are off-limits in our efforts at building better models for understanding ourselves, our local environment, and our wider world. Researchers tend to police themselves with regard to subject matter in fear that it might be frowned upon professionally. It is quite probable that some systematic and institutionalized form of drug and mind-body research could actually help us build better models of mind; and of self and society if they were included in academic discussions of communication and consciousness without fear or confusion as to whether or not this is a legitimate study. It has been theorized by Terence McKenna and others that humans have always enjoyed an intimate relationship with psychoactive plants. As McKenna explains in Food of the Gods (1992), there may have been a symbiotic relationship between people and psychoactive plants which played a role in our enormous leap in brain size in a very short time (relative to other evolutionary changes), and the development of language. All evidence suggests that this is a legitimate field of study in its own right simply due to the fact that a large percentage of the population today uses some technique (chemical or media-based) as discussed in this collection of essays to alter their consciousness, their states of mind and body. Why still the taboo? A recurrent theme in recent books such as This is Your Country on Drugs (Grim, 2009) and The Chemical Muse (Hillman, 2008) is that people have always experimented with mind-altering drugs, or used some other mind-altering techniques. Whether or not the tendency is encoded into our DNA, it seems to be a reliable and quite predictable part of our “human nature.” There is a looming tautology in our culture’s thinking about illicit drugs: “they are bad because they are illegal.” But if balance is applied, as it was with success by many psychologists

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and psychiatrists with LSD and ecstasy before they were taken off the agenda for medical use (and any type of academic inquiry) as they were classified as Schedule-1 controlled substance, then the intelligent use of some of these substances can be beneficial, not just for individual psychology, but academic inquiry as well. Some of these drugs are known as “consciousness expanding”; whether or not that statement can be considered true (i.e. factual) is debatable, but they have been shown to increase creativity, and make you think differently, to say the least. However, I am willing to bet, in reading just this previous paragraph, that some readers will feel as though I am advocating illicit drug use in some nefarious way. As Andrew Weil and Winifred Rosen suggest in Chocolate to Morphine: Understanding Mind-Active Drugs (Weil and Rosen, 1983), there are no good or bad drugs, just smart and foolish relationships with them. When I first read this book I thought the whole argument seemed sketchy; there cannot be an intelligent way to use cocaine, for instance. But then Weil, a highly respected MD, went on to explain an intelligent way to use cocaine – not for its anesthetic properties, but to actually use it as a psychoactive substance. It is the way it was used for at least one thousand years by the natives of South America. Chewing coca leaves releases a sublingual dose of cocaine, giving the user an energy boost comparable to caffeine. But when chemistry is applied to isolate the active ingredient and use of the isolate as a psychoactive drug ensues, we may indeed find that there is no intelligent use for it at all. Perhaps this is a side-effect of modern chemistry, or mass production; perhaps there is some way of using the isolate intelligently; however, the risk for addiction far outweighs any potential value as a useful drug in my opinion. Anything has the potential to be used addictively, whether it’s a substance or a technology, or an activity. Then again, this urge to over-use may be an innate behavior, an inseparable part of being human. As suggested by Weil and Rosen (1983), the key to using anything in a non-addictive way is in finding a balance (e.g. drugs, media, compulsive work behaviors, etc.). If the intent is to relieve stress, or the like, then getting high might actually make sense. But the use of any media, drug, or other experience could be used with purpose, even if the plan is to simply have fun and relax. We need to become more intentional in our drug and media use, to think it through more thoroughly on all fronts. Perhaps the only way to achieve this is to decriminalize the activity. To be sure, it is easier for someone to discuss openly and deal with an addiction if societal condemnation is taken out of the mix. Stirring up feelings of guilt due to the general public opinion regarding drugs seems unjust and will make it extremely difficult for us to learn anything valuable about these substances. As Weil and Rosen (1983) point out, all modern historical civilizations have established a few drugs that are deemed “socially acceptable,” and the rest become

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stigmatized. It sometimes cycles, as demonstrated in the U.S. with alcohol. Alcohol use became socially less acceptable than heroin and cocaine from around 1870–1890. Then the climate changed as the public opinion shifted against heroin and cocaine and people turned back to alcohol as a socially acceptable recreational drug (Hillman, 2008). From there the social acceptability of alcohol has wavered through time, with a hard stigma now seeming overdue, after an extended period of liberal acceptance in most communities and the personal, economic, and social devastation that has ensued. Perhaps the attention alcohol now receives is diminished because other drugs have been headlined in the news for so long. With its illicit implications, and lingo like “war on drugs,” the word “drug” has become so loaded and provocative. We have seen a marked rise in prescription medication abuse recently – something on the order of a 400 percent increase from 1998–2008 (SAMHSA, 2010). This rise is at least partially attributable to the fact that there were stricter port regulations after the 9/11 attacks. This made smuggling much more difficult and so it seems quite predictable that individuals would turn to what is more readily available, and, in the U.S., an easy substitution is pharmaceutical medicine.4 Because of the often chaotic patterns of over-stimulation and information overload endured through modern media use, there may be an unprecedented inability to be alone for a considerable length of time, to sit with oneself without some form of media stimulation. This mode of life has been shown to lead to confusion, depression, and anxiety which are easily remedied by more media use and/or substance abuse. Everything from excessive viewing of television, to Internet use, to the almost incessant sending and receiving of text messages many young people engage in today (with 9000–12,000 texts a month not uncommon in some teens – equating to a text message being processed, on average, every 90–120 seconds or so, day in and day out). Interdisciplinary approaches may not cure our present ills in one fell swoop, but they will help us begin to fill in the gaps in our understanding of the relationship between drugs and media as personal and cultural palliatives.

Television I would like to address some of the roles played by communication technologies in a bit more detail. Let’s take television, still the most ubiquitous media form in American culture. Can television be considered a drug? Television and medications do have similarities. Television seems addictive, it causes an almost immediate alteration of one’s state of mind, it desensitizes one to the environment, and it has a fairly dangerous side-effect profile. John Steinbeck wrote of television in The Reporter (1955):

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I have observed the physical symptoms of television-looking on children as well as on adults. The mouth grows slack and the lips hang open; the eyes take on a hypnotized or doped look; the nose runs rather more than usual; the backbone turns to water and the fingers slowly and methodically pick the designs out of brocade furniture. Such is the appearance of semiconsciousness that one wonders how much of the ‘message’ of television is getting through to the brain.

TV changes neurophysiology by slowing brain waves, and changing from left hemisphere dominance to the right hemisphere, as demonstrated by Krugman (in 1971 and 1977, respectively). TV can even be used to numb pain, according to this study with children (Bellieni et al., 2006). Researchers demonstrated that children who watched television experienced less pain when getting their blood drawn. Three groups were randomly divided from the 69 participants. One control group (C), one group who were distracted by their mothers (M), and one group that watched television cartoons (T). The results were that pain levels rated by the children were 23.04, 17.39, and 8.91 for the C, M, and TV groups, respectively. Pain levels rated by mothers guess at child’s pain were 21.30, 23.04, and 12.17 for the C, M, and TV groups, respectively. It makes sense that perhaps the endogenous endorphins are being activated here. Music can similarly reduce pain, as shown in various studies, such as MacDonald et al. (2003), Michel and Chesky (1996), and Mitchel et al. (2007). Researchers have even suggested that television alters biochemistry in such predictable ways that one can target certain parts of your brain the way pharmacologists target certain drug receptors (Ray and Batra, 1982).5 I’ll go so far as to say that TV is, indeed, addictive. There is some solid evidence and good reason for this sort of assertion. As Kubey and Csikszentmihalyi discuss in “Television Addiction is No Mere Metaphor” in Scientific American (2002): The term “TV addiction” is imprecise and laden with value judgments, but it captures the essence of a very real phenomenon. Psychologists and psychiatrists formally define substance dependence as a disorder characterized by criteria that include spending a great deal of time using the substance; using it more often than one intends; thinking about reducing use or making repeated unsuccessful efforts to reduce use; giving up important social, family or occupational activities to use it; and reporting withdrawal symptoms when one stops using it.

This is an interesting linguistic constraint. Television is physical in nature; it is not a substance per se. Can we start to talk about media abuse, or symbol abuse, and its functional equivalence to exogenous drugs?

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All these criteria can apply to people who watch a lot of television. That does not mean that watching television, per se, is problematic. Television can teach and amuse; it can reach aesthetic heights; it can provide much needed distraction and escape. The difficulty arises when people strongly sense that they ought not to watch as much as they do and yet find themselves strangely unable to reduce their viewing. Some knowledge of how the medium exerts its pull may help heavy viewers gain better control over their lives. (Kubey and Csikszentmihalyi, 2002)

Blended with human users, TV lessens one’s response to other stimuli in the environment. It is so seductive – the image – that it hardly matters what’s on the screen. Indeed, the medium is the message. Watching television causes physical changes such as headache, droopy eyes, inability to sleep, and can even lead to back aches and/or neck aches depending on how TV is consumed. It may also cause or be intrinsically linked with ADHD as revealed by Christakis et al. (2004), and obesity as shown in numerous studies such as Gortmaker et al. (1996), Hancox et al. (2004), and Klesges et al. (1993). Television grabs your attention, causing a bizarre link between observable reality, and a sudden change in biochemistry. It seems to be the moving images that trigger these effects; this is known to cause a change in biochemistry called the orienting response. The orienting response, or orienting reflex, is our immediate response to change, whether it is visual, auditory, or anything that grabs our attention. This orienting response was demonstrated in a study by Diao and Sundar (2001) looking at the effect of web pop-ups as opposed to banners. Diao and Sundar concluded that pop-ups, in particular, elicit the orienting response. Thorson and Lang (1992) conducted research to determine if there is an orienting response while watching teleconferences, and if there was, how it might affect recall, as opposed to being physically present at the lecture. They measured the response by monitoring “phasic decelerative heart-rate patterns,” clearly showing a biological effect produced by the media. The orienting response was real, but was only beneficial if the material was familiar. If it was unfamiliar, then study participants had lower recall. This seems to indicate that excitatory transmissions are occurring in the brain, but may end up inhibiting deeper thinking.6 Given all of this, it can be argued, rather convincingly, that if television were in fact a drug it would be outlawed, probably very quickly. Imagine a drug where the average American spends 4 to 5.5 hours per day using it and “getting high,” falling into a stupefied hypnotic slumber, and which is akin to anesthetics in its ability to lower brain activity, with additional side-effects including risk of causing ADHD and obesity. I think it would be deemed illegal rather quickly. Terence McKenna articulates his view of television in Food of the Gods (1992: 220):

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No drug in history has so quickly or completely isolated the entire culture of its users from contact with reality. And no drug in history has so completely succeeded in remaking in its own image the values of the culture that it has infected.

And further… Television induces a trance state in the viewer that is the necessary precondition for brainwashing. As with all other drugs and technologies, television’s basic character cannot be changed; television is no more reformable than is the technology that produces automatic assault rifles.

Herbert Krugman demonstrated in 1971 that brain-wave patterns change from beta form (which indicate awareness and in deep thinking) to alpha (daydream state, indicating lack of attention), amazingly within 30 seconds. He later showed that while consuming television the human brain switches from left brain dominance to the right (1977). As this transpires the logical analytical left hemisphere of the brain tends to shut down and the right hemisphere takes over (again, the side most responsible for the experience of emotions and non-linear thought). The brain is reacting to television, simultaneously producing and reacting to changes to endogenous endorphins and neurotransmitters to create very sudden and powerful changes to the human brain (Singer, 1980), but nonetheless changes that are not always as apparent or obvious. What we often see is a sudden change in state of mind, which goes virtually unnoticed by the viewer. Krugman states “that the mode of response to television is more or less constant and very different from the response to print… That is, the basic electrical response of the brain is clearly to the medium and not to content difference,” echoing McLuhan’s “The medium is the message.” When there is a switch of primary processing from the left neocortex to the right, endorphins spike. As stated earlier, endorphins are endogenous opioid peptides (endogenous morphine) which act on opioid receptors in the brain. We might then wonder: is there a difference that makes a difference between exogenous opioids and endogenous opioids? Endogenous opioids are structurally identical to opium and opium/morphine derivatives. Functionally speaking, an opioid receptor doesn’t “know” the difference. It is activated either way. These transmitters put the user at ease, into a comfortably numb state of mind. One idea is that this rise of endogenous dopamine from TV leaves less available for other activities, causing ADHD. This point remains controversial however. Furthermore, when you see a child diagnosed with ADHD watching TV, you notice that they don’t have trouble at all paying attention to the screen.

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Of course, another explanation might be that the TV is desensitizing them to the experience of real life. Put simply, this over-stimulation that is often apparent in the screen might just make them bored with ordinary life. TV is pretty much always a novel experience. It never happens the same way twice, and with lots of moving images playing their part as the proverbial “bells and whistles.”

Conclusions Sitting in peace and quiet is a situation seldom encountered by most these days. This is evidenced nicely by my 15-year-old daughter who gets in the car and within seconds wants to turn on the radio. Sitting without some kind of media entertainment seems to make her extremely uncomfortable. I can see her squirm in agony from something like stimulation deprivation. Not to be confused with sensory deprivation. In fact, it may be that she starts experiencing some sort of reality-driven sensory overload, without any media to “numb” her. Perhaps this is media withdrawal? David Zweig wrote the novel Swimming Inside the Sun (2009), in which he postulates a theory called Fiction Depersonalization Syndrome, to explain the etiology of the dissociative condition known as depersonalization. This theory states that fiction, defined in this context as media, especially observable media, such as regular television consumption, repeated updates to one’s “profile” in social media platforms, extensive daily exposure to the Internet and other media, are taking over our sensorium, as opposed to TAPPING our embodied phenomenological experience. Zweig explains, with a nod to the concept of neuroplasticity, that excessive immersion in a mediated environment “rewires” the brain. Submersion of the human mind, basically living inside modern visual media such as television, computer gaming, etc. is a new phenomenon for Homo Sapiens. The result of this is that we are now “living in an observational reality as opposed to an experiential reality.” And that, ultimately, we are destined to view ourselves rather than be ourselves (Zweig 2009). Zweig’s statements lead us to wonder whether we could gain insight and understanding – possibly even control – over where our media are taking us, or if this is a runaway train. There’s no reason to think that we could or should have a complete understanding of our situation or where we are going. We are primates, with what appears to be the same brain hardware and hence no recognizable cognitive advantage over our ancestors that existed 100 years ago, or even 100,000 years ago besides the compiling of information, knowledge, philosophies, inventions, and technologies provided by our culture. Our knowledge bank is simply astonishing, but understanding our own predicament and having the insight to follow the best course of action has more to do with wisdom than the compiling of information.

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The human species has created incredible feats, and amazing systems of thought, but if Einstein lived 100,000 years ago I think he would have been lucky to invent the wheel. As Isaac Newton said, “I stand on the shoulders of giants,” meaning he built upon prior knowledge. This statement pretty much summarizes all human accomplishments. Are we, as McLuhan said, driving into the future using only the rear-view mirror? What are the effects of media on our minds? Do we possess the insight to understand the effects? Have we completely lost our way due to our artificially-created sensorium? Or, to borrow from Katherine Hayles, “are we still human?”

Notes 1 See Robert MacDougall’s chapter in this volume entitled “Perceptual Amplifiers and Inhibitors,” where he describes some parallels between media and drug use for more on both multiple-realizability and context-dependence. 2 Opioid receptor subtypes are currently classified as: delta (δ), kappa (κ), mu (μ), and the nociceptin receptor. Different receptor subtypes are located in different parts of the brain and have different actions. Examples include the following: delta, kappa, and mu are all involved with analgesia, delta also has antidepressant effects, kappa is known to cause dysphoria, while mu is known to cause euphoria, kappa and mu cause miosis (pupil constriction), while the nociceptin receptor is thought to cause anxiety and depression. Morphine and other opioids predominantly work on the mu receptor of which there are three established subtypes (although ten are known to exist). The classified subtypes are mu1, mu2, and mu3. Most is known about the mu1 subtype, with little known thus far about mu3 (Fine and Portenoy, 2004). 3 It is interesting to note that reading, knitting, having sex and watching television have all been shown to have GABA agonistic effects (see Ramakrishnan and Scheid, 2007). 4 Weil and Rosen (1983) are certain there is a large segment of the population which always has, and maybe always will, try to alter consciousness by whatever means is available to them. This goes for drugs, media, and any workable combinations imaginable. Creating intentions and consuming in balance are what we should strive for, and “creating intentions” and “consuming in balance” are skills that can be easily taught, but are lacking in our schools. Creating the right environments to accomplish this can have a great impact in our modern world. 5 This very review has shown, for example, that researchers attempting to monitor affective activity via brain waves should tap not just left-right

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hemisphere differences, but front-back ones too, and that in gauging the affective impact of advertising one should tap not just the pleasantness dimension but also the ones relating to motivation (did the ad make you want the product?) Perhaps because of an increase in alpha waves activity and decrease of beta wave activity, as explained by Krugman’s section on p. 285?

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Cutler, H. C. and H. H. Dalai Lama (1998). The Art of Happiness. New York: Penguin Group. Dennett, D. C. (1991). Consciousness Explained. Boston: Bay Back Books. Diao, F. and S. Sundar (2001). “Orienting Response and Memory for Web Advertisements: Exploring Effects of Pop-Up Window and Animation.” Communication Research 31 (October): 537–67. Fine, Perry G. and Russell K. Portenoy (2004). “Chapter 2: The Endogenous Opioid System”. In A Clinical Guide to Opioid Analgesia. McGraw Hill. Glennon, R., M. Dukat and R. Westkaemper (2000). “Serotonin Receptor Subtypes and Ligands.” http://www.acnp.org/g4/GN401000039/Ch039.html Gortmaker, S. L., A. Must, A. M., Sobol, K. Peterson, G. A. Colditz and W. H. Dietz (1996). “Television Viewing as a Cause of Increasing Obesity among Children in the United States, 1986–1990.” Archive of Pediatric and Adolescent Medicine 150(4): 356–62. Grim, R. (2009). This Is Your Country on Drugs: The Secret History of Getting High in America. Hoboken, NJ: John Wiley & Sons. Hancox, R. J., B. J. Milne and R. Poulton (2004). “Association between Child and Adolescent Television Viewing and Adult Health: A Longitudinal Birth Cohort Study.” The Lancet 364: 257–62. Hillman, D. C. A. (2008). The Chemical Muse: Drug Use and the Roots of Western Civilization. New York: Thomas Dunne Books. Himmelheber, A. M., M. Sarter and J. P. Bruno (2000). “Increases in Cortical Acetylcholine Release during Sustained Attention Performance in Rats: Brain Research.” Cognitive Brain Research 9(3): 313–25. Jones, B. E. (2005). “From Waking to Sleeping: Neuronal and Chemical Substrates.” Trends in Pharmacological Sciences 26(11): 578–86. Klesges, R. C., M. L. Shelton and L. M. Klesges (1993). “Effects of Television on Metabolic Rate: Potential Implications for Childhood Obesity.” Pediatrics 91(2): 281–86. Krugman, H. E. (1971). “Brain Wave Measures of Media Involvement.” Journal of Advertising Research 11.1: 3–9. Krugman, H. E. (1977). “Memory without Recall, Exposure without Perception.” Journal of Advertising Research 17(4): 7–12. Kubey, R. and M. Csikszentmihalyi (2002). “Television Addiction is No Mere Metaphor.” Scientific American, February 23. http://www.commercialalert.org/issues/culture/television/ television-addiction-is-no-mere-metaphor Leff, P. (1995). “The Two-state Model of Receptor Activation.” Trends in Pharmacological Sciences 16(3): 89–97. MacDonald, R. A. R., L. A. Mitchell, T. Dillon, M. G. Serpell, J. B. Davies and E. A. Ashley (2003). “An Empirical Investigation of the Anxiolytic and Pain Reducing Effects of Music.” Psychology of Music 31(2): 187–203.

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McEntee, W. and T. Crook (1993). “Glutamate: Its Role in Learning, Memory, and the Aging Brain.” Psychopharmacology 111(4): 391–401. McKenna, T. (1992). Food of the Gods: The Search for the Original Tree of Knowledge. New York: Bantam Books. Memorandum for the Secretary of Defense (1977). http://www.dod.mil/pubs/ foi/02-A-0846RELEASE.pdf Michel, D. E. and K. S. Chesky (1996). Music and Music Vibration for Pain Relief: Standards in Research. Music Medicine 2. Saint Louis, MI: MMB. Mitchel, L. et al. (2007). “A Survey Investigation of the Effects of Music Listening on Chronic Pain.” Psychology of Music 35(1): 37–57. Nichols, D. E. and C. D. Nichols (2008). “Serotonin Receptors.” Chem. Rev. 108(5): 1614–41. Pert, C. (1997). Molecules of Emotion. New York: Scribner. Purves, D., G. J. Augustine, D. Fitzpatrick, W. C. Hall, A. S. LaMantia, J. O. McNamara and L. E. White (2008). Neuroscience (4th ed.). Sunderland, MA: Sinauer Associates. Ramakrishnan, K. and D. C. Scheid (2007). “Treatment Options for Insomnia.” American Family Physician 76: 517–26, 527–28. Rang, H. P. (2003). Pharmacology. Edinburgh: Churchill Livingstone. Rang, H. P. (2006). “The Receptor Concept: Pharmacology’s Big Idea.” Br. J. Pharmacol. 147 Suppl 1: S9–16. Rapport, M. M., A. A. Green and I. H. Page (1948). “Serum Vasoconstrictor, Serotonin; Isolation and Characterization.” J. Biol. Chem. 176(3): 1243–51. Ray, M. L. and R. Batra (1983). “Emotion and Persuasion in Advertizing: What We Do and Don’t Know About the Affect.” In A. Tybout and R. Bagozzi, Advances in Consumer Research, vol. X. Ann Arbor: Association for Consumer Research. Rudgley, R. (1998). The Encyclopedia of Psychoactive Substances. New York: St. Martin’s Press. SAMHSA (Substance Abuse and Mental Health Services Administration), Office of Applied Studies (2010). The TEDS Report: Substance Abuse Treatment Admissions Involving Abuse of Pain Relievers: 1998 and 2008. Rockville, MD. Shulgin, A. T. (1975). “Drugs of Abuse in the Future.” Clinical Toxicology 8: 405–56. Sicherer, S. H. (2006). Understanding and Managing Your Child’s Food Allergy. Baltimore: Johns Hopkins University Press. Singer, J. L. (1980). “The Power and Limitations of Television: A CognitiveAffective Analysis.” In The Entertainment Function of Television, ed. P. Tannenbaum. Hillsdale, NJ: Lawrence Erlbaum Associates Steinbeck, John. (1955). “The Benefits of Limiting TV.” The Reporter, March 10. Tamminga, C. A., K. Tuniomoto and T. N. Chase et al. (1987). “PCP-induced Alterations in Cerebral Glucose Utilization in Rat Brain: Blockade by Metaphit, a PCP-Receptor-acylating Agent.” Synapse 1: 497–504.

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Thayer, R. (1989). The Biopsychology of Mood and Arousal. New York: Oxford University Press. Thorson, E. and A. Lang (1992). “The Effects of Television Videographics and Lecture Familiarity on Adult Cardiac Orienting Responses and Memory.” Communication Research 19 (June 1): 346–69. van Duijin, C. M. and A. Hofman (1991). “Relation between Nicotine Intake and Alzheimer’s Disease.” British Medical Journal 302(6791): 1491–94. Weil, A. and W. Rosen (1983). Chocolate to Morphine: Understanding Mind-Active Drugs. Boston, MA: Houghton Mifflin. Zarate, C. A., J. B. Singh, P. J. Carlson et al. (2006). “A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-resistant Major Depression.” Archives of General Psychiatry 63(8): 856–64. Zweig, D. (2009). Swimming Inside the Sun. New York: Second Guess Media.

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Chapter Thirteen

Environmental Engineering for Ecological Balance Robert C. MacDougall

“On Spaceship Earth there are no passengers; everybody is a member of the crew.” – Marshall McLuhan (1967)

My mobile phone lost its marbles a few months ago. The phone portion of the “phone” still seemed to work well enough, but who has time for that? More pressing was the fact that I couldn’t view anything but the first line of incoming text messages, and was unable to send anything at all – not even a tweet (something to do with a memory cache glitch). While I’ve experienced some serious withdrawal symptoms when my phone was lost or damaged or malfunctioning in the past, on this occasion I wasn’t too upset about it. It was winter break, and I was staying around the house most of the time reading, writing, and watching TV so I just didn’t need my little digital appendage as usual. But I had to get it fixed soon enough since this was my only phone, and school and life and work would be starting up again in a week or so. And the fact is that text messaging happens to be the primary means of communication my wife and I just sort of fell into regarding most logistics having to do with our then ten-month-old son. So I made the trip down to the local Verizon store (a brand new one, the latest, it had only been open for a month or so).1 If you haven’t seen one lately, big-name mobile service provider shops are interesting places – vaguely church-like. They can take up about as much square footage as your average suburban Gap or Abercrombie, but the layout is sparse. 295

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Lots of open floor space for people to roam around. Along the perimeter, and maybe in a few islands out in the middle, you’ll find this season’s best gadgets and gizmos. The way those sleek and shiny appliances are set up on their pedestals – there is something religious about it. And then I noticed two iPads standing out there on their very own island, with special accent lighting. They looked a bit erudite – or maybe snobbish? – there above the plebian Samsungs and HTCs and Motorolas. The clerk who signed me in suggested I “go play with one” while the queue dissolved. And so that’s what I did. Two things struck me as I waited for my droid to get fixed. First, there was only one person working behind the tech desk. That didn’t make sense either, as there were a few people in front of me waiting for help, and the guy being serviced was not happy – not at all. His droid had “shit the bed.” That’s what he said. He said a lot of other things too, but I became so engrossed in the flat screens flashing the latest ads and looping promos that I missed most of the additional expletives, quips and complaints. And then the second thing hit me. The ads themselves were really impressive – I’d even call them George Lucas impressive. The first loop I walked up to featured the latest Motorola Droid. A deep, serious-sounding voice said “Feed your need with awesome apps,” and “Feast on web and video content with the scarily capable Adobe Flash 10,” and then “Tear through the web with stone cold efficiency” and finally “Power through the marketplace and give your machine more muscle.” As I walked up to another screen something which might be best described as a targeting symbol scanned the edges of the massive LCD. Around it went, as a video clip edited in hyperkinetic fashion showed a young man doing cool maneuvers at a skateboarding park. The “target” also dotted around the park, and then back to the edges of the screen, and then it stopped on the side of the screen where I was standing. The words “Advanced Life Form Detected” started flashing. I glanced around – pretty sure it wasn’t referring to me. And then, sure enough, the latest droid model appeared. Other ads around the store were on static display. At the time of this writing the latest Verizon campaign was called “Rule the Air,” and one of the standard ads features a facsimile of the Earth rendered in a mosaic composed of thousands of tiny phone screens. Later that same day I noticed a full-page spread on the back of the Economist (not at the Verizon store, they don’t do magazines as far as I can tell). The ad features a just-less-than-life-size shot of a man’s face. In casual shirt and tie, he looks straight into the camera. He is beaming. The all-caps text span the page, from his forehead to his chin: I CAN BE PREPARED FOR THE BEST AND WORST, SIMULTANEOUSLY. I CAN BE LIBERAL WITH MY IDEAS AND CONSERVATIVE WITH MY CASH.

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I CAN EXPAND MY BUSINESS OVERSEAS, OVERNIGHT. I LAUGH IN THE FACE OF OBSOLESCENCE. THE FUTURE IS MY FRIEND. I CAN TURN WISHFUL THINKING INTO A BUSINESS PLAN. I HAVE CLOUD POWER.

The message in this Microsoft Cloud Power advertisement is geared toward small-business owners. The company promises “The most comprehensive solutions for the cloud. On Earth.” And indeed, just about anything seems possible in this scene. But while Microsoft may have found something useful for consumers that its chief competitor Google has also been working on at a feverish pace, it is unlikely that either corporation will help us learn anything about how we might strike a balance between home and office, work and play, here and there, and now and then. Marshall McLuhan suggested that advertisements can offer some of the keenest insights into the essence of a culture’s values. In all of these ads just described, the core values seem to be efficiency, power (of computation and connection), and multitasking. And sure enough, these end up being the things so many of us worry about on a daily basis. Perhaps we are getting a sense of what it’s like to be an electron? Almost as fast as light. This way of thinking about my self-in-theworld might account for that nasty little bad habit of waiting until the last minute to accomplish some earthly task – like printing out a bunch of hard copies, or running to a meeting, or driving across town to pick up the kids from school. These are all symptoms of time sickness. Something about the way our perception of time is changing as a result of the acceleration of daily life. There is never enough time. Or there never seems to be anyway. However, we get a sense that our latest tools can help us solve such problems. It’s easy to see why. A recent mobile “phone” advertisement I’ve seen on TV features the HTC Evo – a 4G device with all the bells and whistles. The ad depicts a desert scene, perhaps those famous salt flats out West, where an ancient wheel first rolls across the surface, left to right. It hits up against an old steam-powered train, and then a whole cascade of technologies sweep across the screen: a phonograph, microscope, typewriter, electric light bulbs, a telephone, film reels and projector, an automobile, a television, airplane, and rocketship. And the scale again reduces: calculators, audio tapes, video tapes, old clunky-looking cell phones, some outmoded PDAs and then, finally, the little HTC EVO 4G. I know it’s just an ad, but is this really the height of human technological achievement? These ads beg for speculation regarding the kinds of beings we are on course to becoming, and the kind of worlds that will be required to sustain us along the way. In the prologue to this book I offered several definitions for terms employed throughout. Along with drug, medicine, medium and culture,

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one definition was for nostrum remedium, an old Latin phrase that means “our remedy.” Most often preparations, but sometimes also procedures that were supposed to solve a certain problem; anything from a sour stomach or headache, to drowsiness, perceived memory problems, even lackluster love life – you name it, there was probably somebody, somewhere, selling a solution. At times they seemed to work; other times, well, maybe not so much. More often perhaps, their biggest effect was probably a placebo effect, an impression, a psycho-somatic sign that something was improved. It ends up that a lot of our remedies today, like these “remedies” of the past, may often prove ineffectual toward alleviating the condition for which we seek a cure.

‘Giveth and Taketh Away’ For example, ever since we started dreaming them up, computers have held the promise of labor, time and space savings. They are the devices that would free us up from many of the drudgeries associated with repetitive tasks, record-keeping, computation, and clerical duties of various kinds. Of course, computers work very well for many such things and plenty more too. However, and counter-intuitively for many folks perhaps, accompanying the quick and steady diffusion of computer technology in our culture in all its guises is the steady evaporation of “down time.” By this I mean the temporal and physical spaces (and places) that allow for mindfulness, reflection, imagination and rest. All three take time, and tend to be facilitated by cleared spaces and places, two things our digitally-enabled “attention economy” (Davenport and Beck, 2001) does not afford with its pop-ups, news crawls, 360-degree displays and the like. In such environments, information overload is the default condition. And we’ve been upping the attention ante for a while now. Along with all the media conduits filled with margin ads, 30-second spots, and pop-ups, we have billboards, “painted” buses, placard cabs, etc. In addition to all of this advertising and promotional material insinuating themselves into the periphery of awareness, we must also contend with those silly “third brake lights,” misfiring car and house alarms and the like. It is not at all surprising that we are increasingly attention deficited. Signs and signals are everywhere. They are incessant. In the midst of all this cacophony, 24/7 portable connectivity provides an everincreasing number of Americans the capacity to “go it alone.” And this too chips away at our ability to attend. But it chips away at something else as well, something proving increasingly difficult to find. Ray Oldenburg (2000) dubbed them third places. He points to those sacred-like places so many of us seek – somewhere between the home and office space – where down-time is encoded into the very substrate. Oldenburg mentions the neighborhood restaurant, diner and pub as the archetypal third place. But they come in many guises.

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Of course, something notable has changed since Oldenburg wrote the first edition of his book more than twenty years ago. Today, so many restaurants and pubs now ring the perimeters of their primary spaces with video screens. This is not to mention the screen above the urinals in a growing number of men’s bathrooms in such establishments.2 Other venues, like the new student center at my school has a mock-up pub (minus the draught-pulls and pints). It has a smaller number of screens projecting outward from a central node, again allowing 360-degree viewing that realizes, more or less, a functionally equivalent analog to the perimetered version. Over the last several years I’ve also noticed that many gas stations along the interstate (and now a few in my own neighborhood) feature video screens at the pump so I can watch the news and sports channels while filling up. And now my favorite supermarket sports 17-inch flat screens flashing away at customers in the check-out aisles.3 Like the “standard equipment” that includes our eyes, ears and skin, how many of us now come equipped with a smart phone that offers the Internet, email, and text messages “on tap”? This might not, then, be so obviously a question of disease, or illness or even self-control or impulse control, as these devices become de facto components of the self, or mind-body. Functionally they are transparent. But transparency in this case does not mean the ability to see into or through clearly. As with language, we see through it, and so tend to also develop an inability to see how the thing carries, colors and constitutes us. The connections with many of our devices and drugs have become so habituated, so seamless and apparently natural, that the language of self-control and self-restraint does not adequately capture the nature of our relationships with them. Consider, in this light, the whole “on demand” phenomenon. We can link up to 500+ channels and 5000+ movies and shows via Xfinity, FiOS and Direct TV. Like the good erection or good mood now afforded by many of our latest drugs, the Internet is also available direct and on-demand, in place or on-the-move. But it might not be the direct and immediate effects of these demands and satisfactions that alter us most. Indeed, what are the unintended consequences and side-effects of these latest couplings? It seems ironic, perhaps, that we seek intimacy and immediacy through drugs and media today. Directness and connection through the in-between. But are we becoming alienated from each other in this urge to connect?4 Hegel (and Plato before him) perhaps said as much, but evidence for a peculiar new kind of anti-social tendency associated with many of our new tools seems to mount daily. Some media and some drugs too might be giving us the impression that we are getting what we want immediately and it does appear to be the case that many folks are “encouraged by a cultural discourse that disdains the unpredictable” (Abram, 1996: 59). So many of our new tools promise increased control and

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predictability. Drugs like Viagra, Ritalin and Abilify flatten irregularities encountered in the environment; they make things more consistent and predictable, and so add an element of control to action and experience. The birth-control pill does much the same for women.5 However, if we look just a bit more closely, we find that some things are not what they seem. There is something about our new media interactions that betrays an unmistakable impulsiveness and a certain lack of control. Consider the Pavlovian-like response so many of us exhibit these days when an email chime, or a text or twitter alert triggers our new appendages to rattle and buzz in our purses, pockets and palms, or vibrate across our desks. Almost like breathing, it can indeed feel quite autonomic to respond with a glance toward the screen. The days of delayed responses and satisfactions are evaporating fast. In any case, most of the folks I communicate with about these issues admit to having much less tolerance for that sort of thing. Like infants, we demand and almost always get instant gratification. If we can imagine it, we can get it. We try to save time by “multitasking.” We want things here and now. We get impatient at the drop of a hat. A few seconds’ delay while our email opens, or a document loads, or a picture appears is often disconcerting. We expect a 4+ gigahertz processor to work even faster than it already does. Will photon computers that operate at or near the speed of light turn the trick? The emerging ethos today suggests that to wait is to waste. Standing in line betrays one’s bad taste. But whether this is becoming a kind of meta-systemic autonomic function, or merely a reflexive/automatic impulse, not waiting can become habitual. It can even develop into a sort of natural instinct to behave in this way. McLuhan recognized the electric technology and the still primordial computer technology of his day for what it was – direct extensions of the human nervous system. Today, the negative consequences of some of our cyborgian couplings, and the behaviors they engender, are just now beginning to be taken seriously. If our nervous and sensory systems are, in fact, so tightly interlaced with those of our latest machines, how can we avoid the dis-ease that accompanies them? While we can’t completely “unplug” or get off the grid, perhaps we can choose not to enter, or even abstain, from components of the system that has been built around us. To this end, new computer applications available for free or for fee like Freedom, Antisocial, Isolator, and Leechblock are indicative of the powerful, quasi-natural couplings some users develop with their tools – digital, mechanical, and chemical too. In the same way it is hard not to use our “habits” of memory, hearing, and vision, or even our habits of hand and of foot; these new programs are the functional equivalents of a plugged ear, a patched eye, or a bound or amputated limb. As one of my students diagnosed with bi-polar disorder suggests,

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Abilify (like Freedom, Antisocial and their ilk) frees her up from what she describes as the “pressures of living an unfiltered life.” The parallels between this and the “information overload” experienced by computer users connected to an unfettered Internet are probably more than just mere appearances. In light of this, much of the contemporary conversation around media addiction and disease seems methodologically suspect and is probably an impoverished, if not entirely too simplistic way of characterizing these new situations. It might be better to talk about living along a series of experiential continua created by these new couplings set up between ourselves and the worlds we inhabit – those amendments, attachments, augmentations and tactile embraces with our media and many of our drugs too.

Dealing with our Dis-ease Whether a “pathology” with biophysical tracings and rooted in something real, or merely perceived, it makes no difference; our media maladies have practical consequences. Like the placebo effect, just about any psycho-somatic effect can be as real and as consequential as any material or physical effect from the perspective of the user. Magnitude-scale increases in psychotropic drug prescriptions over the past thirty years suggest that anxiety and dis-ease are becoming the norm in the United States at least. In addition to maintaining a respectable Gross ? Product, it’s high time we build our Gross National Happiness by attending to the role played by environments of various scales in offering sustenance to the organisms inhabiting them.6 Feelings of contentedness and satisfaction come, more than anything else, from a sense of peace or the absence of anxiety. Along with fairly balanced proportions of sugar and salt and meat and vegetables, we are discovering that a relatively dis-ease-free condition also emerges out of careful balances between sitting still and moving about, between the fast and the slow, and work and play. This is not to forget also careful measures of loud and quiet, light and dark, attention and inattention, reason and emotion, city and wood, wet and dry and hot and cool. It can’t happen overnight. Indeed, it will need to be a generational project since so many of us are, already (in a word – or two) off kilter. Instead, the primary lesson to parents and teachers might be: expose your kids to many modes. A multimodal life would certainly be part of the new prescription for growing minds worth having. I’ll close this section with an informal ode: These “new” kinds of kids would be those Natives now all the rage – and analog aborigines too. They might live in the city, but know well the woods.

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They’d start with linguistic immersion, via page first, not screen. By 2, perhaps 3, they’d blend words with image both moving & still. At 7 or 8 they could follow a straight line or a loop, jump from this onto that, and see clear from whence up to hence. They’d fully inhabit but make it a habit to look beyond the body. Since they’d always trade “either/ors” for “if/thens” and becauses not just ands, they would stand in the now and have a leg up on the ’morrow.

Extending Media Ecology: Ecological Engineering Mitsch (1993, 1996) describes ecological engineering as an emerging science integrating ecology and engineering. It is concerned with the design, monitoring and construction of stable ecosystems that symbiotically integrate human society with the natural environment. Ecological engineering (sometimes also referred to as environmental engineering) is the human concomitant to niche construction in the animal world (see especially LaLand and Brown, 2006, and Odling-Smee, LaLand and Feldman, 2003). In the introduction to this book, with the help of Neil Postman, Christine Nystrom and Lance Strate, the basic contours of media ecology as a field of inquiry were laid out. We discover, however, that media ecology is still primarily a descriptive approach and just one facet of an emerging science of intentional environmental design. Later in his life McLuhan was pointing in the direction of a more active enterprise though. As with the biological necessity of striking balances between light and dark, hard and soft, hot and cold and all the rest, this new enterprise is about finding balances between the abstract and the concrete, between percepts and concepts, between words and images and pages and screens. It’s about intentional environments, about brain-mapping, and body and mind-mapping. It concerns the careful design of experiential contexts, of media ecologies and systems of thought and action that can prompt and enable better relations: sustainable relations with ourselves, with each other, between atoms and electrons, and between cities and towns, and with the natural environment that ultimately sustains all of it. Such a set of moves may not put us firmly in the driver’s seat, but an active approach to ecological engineering, informed by a system’s view, certainly moves us closer to the windscreen – giving us a front seat, a better vantage from where we can offer

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some navigational clues and cues concerning where and how to steer this crew called Humanity on this spaceship called Earth. Ecological engineering, writ large, is undoubtedly consequential to the trajectory of our species and all others on board too. Perhaps it was easier to get a more balanced perspective in earlier times when there was no veil [occluding our awareness of the intimate relation between mind, body and world], when the environments were relatively simple, long before electronic media and jet travel, long before the printed word, before the empire, and ahead of the city-state. It must have been easier to sense the life within, when the brain provided a lopsided view in the opposite direction, tilted toward the dominant representation of the internal states of the organism. If it ever was like that, perhaps at some magic brief time between Homer and Athens, lucky humans would have perceived in an instant that all their amusing antics were about life and that underneath every image of the outside world, there stood the ongoing image of their living bodies. Or perhaps they would not have perceived as much because they lacked the frame of reference that current knowledge about biology provides us. Be that as it may, I suspect they were able to sense more about themselves than many of us, the unforewarned, are able to sense these days. I marvel at the ancient wisdom of referring to what we now call mind by the word psyche which was also used to denote breath and blood. (Damasio, 1999: 29–30)

Borrowing the notion of psyche Damasio resurrects from the past, it is not so much a psycho-social fix we’re after here. It is a kind of ongoing psyche-social design and redesign that’s needed and which gives new attention and direct intention to the notion of continuous improvement. It’s about building a better beast, a human being sometimes “designed” to be slow, linear and logical, and perhaps one who stays in-context – an embedded, embodied being. But this is also about learning to re-cognize the self for what it is – an appended, extended cyborg life-form always coupled to information systems of various kinds. It is a simple yet subtle set of realizations we’ll have to make. Like seeing how an iPhone or Droid or Blackberry in the living-room most often brings the office (among other things) there as well. Along with a still dispersed collection of grassroots efforts now underway, this is an emerging project with clear specifications just waiting to be applied at much larger scale.

What Kind of World? Can we imagine a world where the internal combustion engine never was, or perhaps was the primary means of propulsion for just a few decades? What

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if those early 20th-century electric cars and the battery technology powering them had been followed up by a century’s-worth of serious research and development? I’ve spent a little time ruminating with my students on the history of fire, including the internal combustion engine’s role in our society, our economic and political systems, and our natural environment. I periodically ask a similar question regarding the impact of computers on the natural world. While a shift “from atoms to electrons” in certain areas of human interaction might assuage some of our environmental woes, will it be the “game-changer” so many have hoped for? One facet of this issue might be the following, apparently straightforward question: do computers save paper? We discover, however, that a quick and easy answer to this apparently obvious question is hard to find. The initial, knee-jerk response I get from many of my students is something like the following. They suggest, citing word-processing, and email, and Facebook (instead of letter writing and picture printing, etc.), that the answer tends to be “yes.” Now it is probably the case, for people who are adept and well-adapted computer users, that the answer could be: yes, computers save paper, and trees from which pulp is derived, and so they cut down on all of the industry associated with the paper manufacturing process. Recycling efforts are certainly taking the edge off. There is evidence that we are impacting the pulp industry by prompting less demand. But if we look around just a bit (at our paper piles and waste and recycling bins), it appears that this longstated benefit of computer and word-processing technology may not cash out in our actual interactions with all of the technologies involved in word processing. Recycling policies and procedures impact some of this equation, but one larger side-effect of word processing has been a new aspiration of “printed perfection.” In the past, when one or two typos were noticed in a “finished product,” the correction ribbon or “white out” was used to solve those problems. Today, even one missed character tends to initiate a perfunctory re-printing of an entire page for most users. By most accounts we now consume more paper, work more than ever before, and consume more electricity with these paper-saving, laborsaving and resource-saving devices on our lap and desk tops.7 Can we cut paper completely out of our word-processing activities? Do we really want to?

What Kind of People? Media ecologists such as Marshall McLuhan, Elizabeth Eisenstein and Walter Ong have suggested that the phenomenological features of lone reading – including a quiet, contemplative habit characterized by sequential, propositional thought patterns – became a norm for many in the newly industrializing world.8 Not to confuse what he termed the “hot,” visually-biased information focus of the print

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medium, with the spread of literacy McLuhan also described the cooling down of the modern human. This referred to the instigation of a detached, rational mind, a more “cool and collected” person, one less prone to perfunctory actions, kneejerk reactions and emotional outbreaks. But with the advent of film and electric audiovisual media, the reading stoic immersed in linguistic concepts recedes to the fringes of our culture. And now our “natures” may be changing once again. Along with careful attention to the food and drugs we consume, and a mix of sedentary and active living, we’re discovering that it takes a careful balance of media forms as well to produce those other components of a healthy, fit human being. We’re discovering that the myriad technological artifacts we ingest, inject, hook up with and inhabit are part and parcel of who we are. Perhaps drugs and media have always been constitutive in this way, but we are just now discovering that they may have much more of a “say” in what we are becoming than previously figured. For this reason, any new set of prescriptions will have to be considered with the understanding that they can be, to varying degrees, consequential to those elsewhere and yet unborn.

Notes 1

If you haven’t seen one lately, big-name mobile service provider shops are interesting places – vaguely church-like. They can take up about as much square footage as your average suburban Gap or Abercrombie, but the layout is sparse. Lots of open floor space for people to roam around. Along the perimeter, and maybe in a few islands out in the middle, you’ll find this season’s best gadgets and gizmos. The way those sleek and shiny appliances are set up on their pedestals – there is something religious about it. And then I noticed two iPads standing out there on their very own island, with special accent lighting. They looked a bit erudite – or maybe snobbish? – there above the plebian Samsungs and HTCs and Motorolas. 2 As far as I can tell, men’s toilets are still conspicuously absent the screens. Are the women’s rooms ahead of the curve? It sure would be nice to sit down and watch for a spell. 3 Amber Case, a self-described “cyborg anthropologist,” has also fashioned herself as a kind of digital environment engineering consultant. Connecting us to the attention economy, Case refers often to the portable, always on, always available media system as part of our new “panic architecture” that has been put in high gear over the past decade or so. 4 During a talk at USC in Los Angeles in the fall of 2010, Bill Nye (“The Science Guy”) fainted on stage with hundreds of students in attendance. When Nye collapsed no one helped. Instead, many in the throng took pictures and messaged and tweeted for several minutes until he came to on his own. A

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day before Nye’s fainting spell, in an equally bizarre though infinitely more tragic event, comedian Anthony Barre (aka Messy Mya) was gunned down on the street in New Orleans. Eye-witnesses reported how two onlookers approached Barre as he was bleeding to death on the ground. One person supported his head for the next and final “shot” while the other recorded Barre’s last gasps with a mobile phone camera. Some commentators have theorized that Alexithymia (problems feeling and reporting emotions), and a systematic loss of empathetic behavior, are emerging in the “digital generation.” Of course, mere correlation should never imply causation, and we’ve already considered the non-linear relations our new media environments entail, but events like these should give us pause. It is unfortunate, for instance, that McLuhan’s allusions to a kind of harmonious, tribal/communitarian subculture enabled by “electric” technology (McLuhan, 1969) is not coming to pass. Indeed, the opposite, a kind of lethargic, desensitizing ennui, seems to be in the works. The bystander effect should probably be re-evaluated now that being all alone together characterizes many more people’s everyday experience than ever before. 5 Valerie Peterson offers a compelling take in this regard on the “pill,” and Corey Anton refers to a number of other drugs as “tight” drugs (both in this volume). Tight drugs are drugs with very particular aims and quite predictable effects. They are akin to linear technologies perhaps, or hot media (like text and texting). Tight drugs, like hot media, facilitate the aims of modern science: explanation, prediction, and control. They all form part of a lineage that includes Kroc’s hamburger factory, Ford’s assembly line, and Gutenberg’s moveable-type press. On the other hand, drugs like alcohol, marijuana, heroin, MDMA and ayahuasca (and several other drugs discussed by Ronan Hallowell, also in this collection) are loose drugs, perhaps akin to cool media like film and TV. They are open texts, to borrow Umberto Eco’s phrasing. These are drugs of the less predictable sort, more amenable to the context-sensitive subtleties of experience and interpretation. 6 The notion of Gross National Happiness (GNH) springs from an effort to define an indicator that measures quality of life, or social progress in more holistic terms than Gross Domestic Product (GDP) entails with its narrow focus on the bottom line. Grassroots movements to enhance the quality of life at the level of system are being bolstered by more top-down efforts. GNH was coined in 1972 by Bhutan’s former King, Jigme Singye Wangchuck, but the idea is now starting to penetrate the global policy arena. “In 2008 France’s president, Nicolas Sarkozy, asked two Nobel-prizewinning economists, Amartya Sen and Joseph Stiglitz, to come up with a broader measure of national contentedness than GDP. Then last month, in a touchy-feely gesture not typical of Britain, prime minister David Cameron announced that the British government would start collecting figures on

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well-being” (Economist, December 2010). One of the survey questions includes an anxiety measure. It would not be at all surprising if more balanced media use emerges as one of the leading indicators of GNH. On a related note, a state-sponsored environmental analysis conducted in the UK in 2011 revealed that “green space” affords Britons billions in health benefits alone. “The natural world is vital to our existence, providing us with essentials such as food, water and clean air – but also cultural and health benefits not always fully appreciated because we get them for free,” said Environment Secretary Caroline Spelman regarding findings published by the National Ecosystem Assessment. “The UK NEA is a vital step forward in our ability to understand the true value of nature and how to sustain the benefits it gives us” (http://www.bbc.co.uk/news/science-environment-13616543). 7 Industrialized nations, with 20 percent of the world’s population, consume 87 percent of the world’s printing and writing papers (Toepfer, 2002). Right around the year 2000, according to the Organisation for Economic Co-operation and Development, global production in the pulp, paper and publishing sector is expected to increase by 77% from 1995 to 2020 (OECD, 2001, 215). It is important to note that the pulp and paper industry is the single largest consumer of water used in industrial activities in OECD countries and is the third greatest industrial greenhouse gas emitter, after the chemical and steel industries (ibid, 218). In other words, the theory of computers-as-paper-saving-devices seems to miss something important when it comes to accounting for the real-world behavior of a relatively new kind of being called the electronic-print-enabled-humancomputer hybrid. 8 McLuhan’s description of the modern, rational stoic characterizes one possible consequence of literacy, and it is easy to see why the lack of a kinetic, visual display in the traditional reading context tends not to “rag doll” us in the same way. Consider how one rarely sees readers grimacing, gawking and guffawing the way screen viewers do. The fact that our new visual-based media tap more sensory modes may be the simple reason such media forms help us construct surrogate situations that are so effective and feel so real. This seems to explain the immense power of the parasocial relationship – the modern exemplar of the vicarious social experience. The kind of “intimacy at a distance” originally described by Horton and Wohl (1956) suggests there is also the possibility for enhanced social affect through image-based communication media of various sorts. Consider an avid fan of, say, Jon Stewart, or Ellen Degeneres, who is tuning in as usual – here we’ll often find an affective equivalence across various “social environments” – the same condition of response through disparate channel conditions.

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References Abram, D. (1996). The Spell of the Sensuous. New York: Vintage Books. Damasio. A. (1999). The Feeling of What Happens: Body and Emotion in the Making of Consciousness. New York: Harcourt-Brace & Company. Davenport, T. and J. Beck (2001). The Attention Economy: Understanding the New Currency of Business. Cambridge, MA: Harvard Business School Press. Horton, D. and R. Wohl (1954). “Mass Communication and Para-social Interaction: Observations on Intimacy at a Distance.” Psychiatry 19: 215–29. LaLand, K. N. and G. R. Brown (2006). “Niche Construction, Human Behavior, and the Adaptive Lag Hypothesis.” Evolutionary Anthropology 15: 95–104. McLuhan, M. (1969). “The Playboy Interview: Marshall McLuhan.” In Eric McLuhan and Frank Zingrone (eds), Essential McLuhan. Toronto: Anansi, 1995. Mitsch, W. J. (1993). “Ecological Engineering: A Cooperative role with the Planetary Life-support Systems.” Environmental Science & Technology 27: 438–45. Mitsch, W.J. (1996). “Ecological Engineering: A New Paradigm for Engineers and Ecologists.” In P. C. Schulze (ed.), Engineering Within Ecological Constraints, pp. 114–32. Washington, DC: National Academy Press. Odling-Smee, F. J., K. N. LaLand and M. W. Feldman (2003). Niche Construction: The Neglected Process in Evolution. Princeton: Princeton University Press. OECD (2001). Organisation for Economic Co-operation and Development Environmental Outlook. Found at: http://www.oecd.org/ dataoecd/33/38/1863523.pdf Oldenburg, Ray (2000). Celebrating the Third Place: Inspiring Stories about the “Great Good Places” at the Heart of Our Communities. New York: Marlowe & Company. Toepfer, Klaus (2002). Executive Director, United Nations Environment Programme. Keynote Address, UNEP’s 7th International High Level Seminar on Cleaner Production, April 29-30.

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Epilogue: Epigenetics, Mirror Neurons, and a Few New Prescriptions on the Horizon Robert C. MacDougall

This book began with a brief discussion of some key terms and their definitions, including drug, medium, and culture. It was noted that the “disease model” of addiction probably stymies our efforts to understand the roles drugs and media play in our lives. Throughout the book commentators suggest that a triple reduction has prefigured our collective understanding of what it means to be addicted to something. The following three explanations constitute, respectively, ontological, epistemological, and methodological framings regarding what exists, and what we currently know, and has implications with respect to what might potentially be done about what has been described in the popular press lately as “media addiction.” These three framings inform the more generic drug-centered disease model of addiction that has insinuated itself into many contemporary discussions of problematic media use as well. They are the Cartesian explanation (a rigid mind-body separation), the Darwinian explanation (an autonomous genetic account), and the Biochemical explanation (a belief that the lower levels of analysis are where the most important action is taking place). They are, in fact, closely related outlooks, and all three are starting to lose traction in many segments of the scientific community.1 Despite these sea-changes underway, the recent buzz about drug and media addiction and disease (and all associated syndromes and aberrations) still fails to recognize the intimate relationship between humans and their tools: chemical, mechanical, digital or otherwise. This failure may be an inability to recognize, or 309

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perhaps an unwillingness to admit, the intimate relationship – indeed, the very tight fit – that has always existed between humans, the tools they use, and the environments we build and inhabit in the process. J. J. Gibson’s (1979) insight concerning the relationship between organisms and their environments is worth repeating here. Gibson suggests that “[t]he words ‘animal’ and ‘environment’ make an inseparable pair. Each term implies the other. No animal could exist without an environment surrounding it. Equally, though not so obvious, an environment implies an animal to be surrounded” (p. 8). Gibson’s insight is crucial to understanding the intimate, ongoing interactions between humans and their environments and is being bolstered by emerging details about our native architecture (i.e. the way we are built), without falling back on a reductionist account.2 Whether we built them or not (though especially when we do build them), human beings and their environments are, on this view, mutually constituting and mutually sustaining. We’re finding, however, that it might not always be an effective or sustainable enterprise we are engaged in for some of the reasons presented in previous chapters. It seems tenable even, as David Abram (1996) has noted, that the primary dis-ease of the modern human is rooted in a problematic “relation between human community and the natural world” (p. 21). If Abram also sometimes subscribes to a somewhat over-constrained duality in his characterization of nature and civilization – or that which is found and that which is made – his basic insight jibes with the general outlook of media ecology. Like media ecologists, Abram is concerned with how we relate to the world, and, specifically, what means we use to relate to that world. Like McLuhan, in other words, Abram seems to subscribe to the notion that the medium is the message. As humans have become more modern and technologically sophisticated, we haven’t necessarily improved our means of relating to and thinking about our world. We might even be headed in the wrong direction in terms of understanding our place in nature. Perhaps like the tenacity of oil in our collective consciousness, we have gotten hung up on several other things too that are primary in helping shape the individual, society, and world. In an attempt to separate the science from the media-hyped mythology, the basic conclusion in Nelkin and Lindee’s The DNA Mystique: The Gene as a Cultural Icon (1996) is that by the end of the 20th century we were paying an unprecedented and unwarranted degree of professional and popular homage to the gene as the “master/information molecule.” It was all nature, or that which could be found through computational biology, including the data produced by the powerful DNA sequencers at our disposal. An extension to the genome map seemed to be in the news every week as the year 2000 approached, and as the Human Genome Project, in both public and private guise, continued crunching the numbers. Our collective fates were being distilled,

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and the essence of who and what each of us is stood as a glittering promise on the horizon. Nelkin and Lindee combed the popular press, including everything from cartoons to child-care manuals in their content analyses. Regarding the latter, the authors noted a series of rhetorical shifts prodded in large measure by DNA’s powerful ethos at the time. One example they highlight is a shift in many leading child-rearing manuals from offering advice to parents on how to maximize a child’s potential, to learning to adapt to whatever genetic traits he or she was born with. Fifteen years later, the foundation of DNA’s commanding ethos has barely quivered in many segments of the popular mind – professional and public. Indeed, despite Nelkin and Lindee’s efforts to get the word out, we have not seemed to learn all that much in the interim.

Epigenetics As detailed in the introduction to this volume, we know that a system-theoretic view is the analytic underpinning of media ecology. A system’s view suggests that the line between nature and technology is not so easily drawn. Animals are part of Nature (ie. the “natural world”) yet they also produce artifacts. Richard Dawkins, the modern bulldog of Darwin’s postulates, also subscribes to this basic identity. Dawkins refers to beaver dams – much like bee’s nests and termite cathedrals – as gene-driven (instinctual), animal-made artifacts that constitute part of those particular animals’ “extended phenotype” (Dawkins 1982). They are, in short, part of the environment and indeed part of Nature according to Dawkins. However, despite significant impacts on the behavior and life of the animal most responsible for any particular artifact, and despite the often significant impacts on other organisms living in the niche during the time these artifacts are constructed and exist, Dawkins does not see instantiations of the extended phenotype as particularly consequential to the evolutionary trajectory of anything but the constructing organism itself.3 Epigenetics (epi – literally “above” or “after” – genetics) is the study of how open, living systems can alter their genetic code after that code has been imprinted. It is an emerging branch of biology that moves beyond the more linear conceptions of inheritance that typify most interpretations of Darwin’s general theory.4 The continued elaboration of epigenetics is notable in that it suggests how the modern interpretation of Darwin may itself be a kind of side-effect informed, in large measure, by the analytical tools employed over the past half-century or so in what has become known today as computational biology. Some material objects, but also metaphors and concepts of the past, can be skeuomorphic in this way – where a hint of their essence or function is brought forward and gets bound up in contemporary artifacts. But again, skeuomorphs needn’t be limited to the

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physical domain. Some of the new tools of computational biology (we might call them skeuomorphic artifacts of orthodox Darwinism), including everything from inferential statistics to fMRI machines are also skeuomorphs worth worrying about. If “read” the more common way that accepts an orthodox interpretation of Darwin’s postulate, they certainly have the potential to occlude our ability not only to see but also think about the ways we’re discovering nature might actually work (Gessler, 1998).5 While still very much in its infancy, Epigenetics is a modern articulation of Jean Baptiste Lamarck’s core thesis. Essentially, Lamarck was suggesting that genetic changes could be prompted and enacted during the life cycle of a single individual, and then given to one’s offspring. Darwin assumed, in contrast, that genetic alterations were always already given (as in being present or inherent) in the parent organisms when they were born, and if these individuals survived long enough to pass on their genetic material, then those features would be more likely to manifest in offspring. To be fair, Darwin said natural selection is “the main, not the sole mechanism of evolution” in the Origin of Species. However, epigenetic researchers are revealing that natural selection might not even be the main mechanism. Dr. Rachel Yehuda, a neuroscientist and Director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine, studies the relationship between epigenetics and post-traumatic stress disorder (PTSD). “This is about how nurture transforms nature…the environment is a critical player in how your genetic endowments work” (Yehuda, quoted in Spinney 2010). Predictably, perhaps, Richard Dawkins doesn’t think much of epigenetics. He suggests, instead, that while they are perhaps real effects, epigenetic effects aren’t significant and “do nothing to make the foundations of Darwinism quiver” because they do not result in permanent change. As Dawkins puts it, “the change must not simply decay, it cannot just be a transgenerational effect. It must be a permanent change” (Dawkins, 2009).6 But then again, considering the larger sweep of evolutionary history, is any genetic mutation ever really a permanent change? At a large enough timescale nothing is permanent. There is only change – from genetic codes to linguistic codes. Keeping that larger sweep of evolution and speciation in mind, we should remain aware of the fact that the effects of tool use, while always a phenomenon rooted in the here and now, is not limited to immediate effects. The use of tools can be consequential to people and things elsewhere and at other times. From cars, to crack cocaine to cell phones – for good or ill, we’re learning that the way we design and use media (and drugs and any technology really) can have demonstrable longitudinal effects along a continuum spanning synapse to social system. They are, in other words, effects that often fly far beyond the contours of individual tool users and the local environments they inhabit and operate in.

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Photosynthesis, tectonic and volcanic activity, and the impacts of meteorites are probably four of the most powerful forces contributing to the emerging composition and organization of the planet and atmosphere. These forces went on to alter the composition and organization of the biosphere, allowing millions of species to develop and thrive. Of course, especially where volcanoes and giant meteorites are concerned, periodic mass extinctions have been triggered as well, and will probably do so again many times. But unless one subscribes to creationism or the closely associated doctrine of intelligent design, no purposive “planetary engineering” took place as yet. It was all, more or less, the product of contingency and happenstance. Of course, our story on Earth does become purposive; it just might not be the story one remembers. And here is where we must seriously consider what many in the scientific community are now arguing for: the long over-due passage from the Holocene epoch into the Anthropocene.7 Consider the following thought experiment. We’ll leave aside the great ideas, the inspiration and insights of philosophers, and most of history’s consequential content-providers, and engage in an unabashedly materialist enterprise for the moment. What sort of evolutionary roles have been played, and continue to be played by the likes of Gutenberg, Darwin, Curie, Morse, Ford, von Neumann, Turner, Groves, Gates, Jobs, Wright, Berners-Lee, Bezos, Bryn and Page, and Zuckerberg too? Regarding most on this very abbreviated list, had these particular individuals not invented and/or run with their particular innovations, it is very likely that somebody else probably would have in short order. But as genius or luck would have it, these are some of our environmental engineers. Their inventers are ecological hacks (and hackers!) altering, with various degrees of directness, the composition and organization of the planet (geosphere), of life (the biosphere), and of thought (the noosphere) today.8 It is becoming clear that the genetic account of inheritance alone will not reveal where we have come from, nor offer reliable insight into where we might be headed. It is counter-productive to hold on to that story at the expense of epigenetic, behavioral, and symbolic factors that are clearly contributing to human evolution (Jablonka and Lamb 2005).9 Consider the case of symbolic inheritance. Language is a symbolic artifact that is passed on via rote learning and socialization and which persists through millennia. To stay “alive” languages must evolve and change, however, the base code tends to remain stable – much like our genetic code. If human beings could be described as over-active makers of artifacts, they are artifacts that in many instances become de facto components, part and parcel of our ways and modes of being, and the newly altered environments which sustain those ways and means. Consider language, conceptions of time and space, modes

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of transportation, cities, and other built-environments. Consider as well all kinds of communication technologies that envelop and enable us in various ways. For better or worse, we are extraordinarily busy “ecological engineers” (Mitsch 1996) constantly mediating, creating, and recreating what we mean by “Nature” or “natural.” Thus, we discover, as Corey Anton notes in this volume (citing McLuhan and Nevitt, 1972), that “a more apt summation of the general principle of mediation is: humans are ‘an extension of nature that re-makes the nature that makes the humans.’” This condition (may we now call it a fact about us?) has significant implications with respect to the way we think about the evolution of our species. For one, it moves us from the passive roles of recipient or passenger or neutral medium, to the more active roles of engineer, builder and navigator. Of course, it’s never all up to us. We are always and already in some measure passive recipients – the product of multiple inheritances. At conception we get a genotypic offering from our parents that manifests in a wholly unique physical or phenotypic form. That’s still all part of the “central dogma,” or the still current Darwinian orthodoxy. Depending on the particular geographic/ecological niche we are born into, however, we also get a collection of genomes in the microbial communities that take up residence in our digestive tract. These little “bugs” are also part of us, and they alter aspects of the phenotypes our ancestors bequeathed to produce a variety of ecto, meso, and endomorphic bodies that then respond to selection pressures in the environment in different ways. But all of that still falls within the realm of Darwin’s original theory. The Human Genome Project (HGP), we had hoped, was going to answer all of these questions regarding what we might become. However, it would seem that 30,000 or so genes are not nearly enough to account for all of our uniqueness. This is only part of the story of who and what we can become. Depending on the particularities of the primary culture we are each reared in, our physio-socio-psycho-epistemological type is further altered and “fixed” accordingly.10 If chromatin regulation and methylation are two means that have received a lot of attention recently, researchers are discovering that epigenetic changes can be triggered in a number of other ways too.11 We have always lived in a world of multiple cause and equifinality, with such modifications being triggered by anything from changes in diet and exercise, to toxic exposure, to the experience of stress or trauma. Studying Holocaust survivors in an effort to determine the strength and duration of stress and famine-induced epigenetic effects, Dr. Yehuda’s team discovered that the children of concentration camp survivors were also prone to stress, exhibiting reduced levels of cortisol (a stress modulating hormone) and even showed clear signs of PTSD.12

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If certain human-made conditions persist over time (such as ubiquitous screens, 24/7 media services, mobile devices, decade-long prescriptions to powerful medications of various sorts, and other components of our modern media environments that allow ongoing, automatic access to those same features), should they count as examples of Dawkin’s extended phenotype? Do these “outerings” of our nervous system alter us and those who follow us in significant ways? “Cyborg anthropologist” Amber Case coined the term panic architecture to characterize the current state of life for many and this seems to capture something important about the dis-ease, that phenomenological feel of many participants’ immersion in the digitally-enabled attention economy. A future media-based epigenetic inquiry might look into the possibility of digital-stress-related phenomena (like PTSD symptoms, or lowered cortisol levels) being passed on to unborn children. Likely research participants would be those tenacious texters, Web surfers, smart phone users and other inhabitants of the always-on digital domain who are pregnant or trying to get pregnant (both male and female). We might even be well-served to investigate changes to the genome within a single human life-span given some of the more prominent drug and media habits today. Having considered the potential for tool use to impact the genome in real-time, and over time, we are now in a position to review something of a parallel development in the neurosciences which, like epigenetics, blurs the distinction between nature and nurture – that increasingly fuzzy line drawn between natural selection and human-techno-cultural effect. Mirror Neurons Research concerning the nature and function of a putative “mirror neuron” system is further perforating the line drawn between the individual and the environment, and might soon require us to rethink what it means to be an autonomous actor in the world. Mirror neurons might explain part of our apparent inability to control how we perceive and attend to stimuli, and this may be a more accurate reflection of the way things work in both the “natural” and human-made worlds. But here again, while it is certainly tempting to look inward when biological terminology is deployed, we should remember that a genuinely biological account does not mean simply to reduce to the constituent components of the body. To the contrary, taking the “biological” seriously invites us to reach out, for we are finding that the environments within which we dwell are causally potent and, like us, often play active roles in guiding the outcomes of both thought and behavior. On this view, the environments we inhabit often trigger what amount to automatic processes in us.13 Bolstering McLuhan’s media-as-extension idea, evidence for the intimate roles played by environments (and the “tools” embedded in them) vis-à-vis the human

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somato-sensory system has been gathering gradually over the past half-century in psychology and cybernetics research in particular (Gibson 1966, 1979; Simon 1969; Minsky 1987). Advocacy for the significant role environments entail in the lives of primates in particular has increased dramatically in the cognitive and neurosciences as of late with the discovery of specialized neurons in the pre-frontal lobe in the mid-1990s by a group of brain researchers headed by Giacomo Rizzolatti and Marco Iacoboni in Italy. The skeptics are noisy though, with the central critique perhaps being that experiments and methodologies informing mirror neuron research is too reductive and, as such, can never provide an adequate picture of mind and cognition, let alone address that murky question of consciousness. As with the Cartesian illusion, however (indeed, in large measure because of it), we find a fundamental misapprehension informing many of these same concerns. Take the practice of brain mapping using functional magnetic resonance imaging (fMRI) technology. fMRI apparatuses look deep into the brain to detect polarizations of iron atoms in hemoglobin (the oxygen-carrying part of our blood). When our brains cells consume oxygen, the changes in position of the hemoglobin molecules are detected by the powerful magnetic field produced inside the machine where the patient is positioned. So it’s easy to see how some theorists and practitioners might want to start offering accounts of behavior and action that find root in the neuronal activity detected in these procedures. However, this methodology does not, in and of itself, imply a reductionist view. On the contrary, other practitioner-theorists working in the neurosciences, like V.S. Ramachandran and Antonio Damasio have noted that these physical structures found in our brains are central components – though just components – of a dynamic total body system that incorporates non-physical, meta-mental looping or couplings between the organism and its environment. The mirror neuron systems is, in other words, a system that affords a great deal of meaningful symbolic exchange to occur between different organisms and suggests why the nonverbal component of the human signaling system can be so robust and meaning-full. It has been suggested that mirror neurons might even bind members of the same species in ways hitherto reserved for the murky postulates of astral projection, telepathy, ESP and other similar approaches to understanding human communication, the self, cognition and consciousness. Experiments involving the “mapping” of mirror neuron activity in humans and other primates using fMRI continues at a feverish pace. But while there are many who remain interested in a reductive story that promises to locate one-to-one correspondences between external stimuli and these microscopic structures in the neocortex, this is not what is really in the offing here. What’s emerging is a much broader story that posits many more functions for these neurons than was initially

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believed. Mirror neurons may be instrumental to everything from the triggering of emotions, the experience of a self-concept, to the recognition of intention in both self and other. Providing some neurological backing for JJ Gibson’s “ecological approach” to perception (1966, 1979), Iacoboni et al. (2005) argue that mirror neurons help us “know” our relationship to things. Here again, the general argument can be deceiving, and is sometimes glossed in the mainstream press to suggest a very reductive story that may prompt the more casual reader to think that mirror neurons themselves know things, hold beliefs, have intentions, etc.14 For instance, in articulating his theory of affordances, Gibson (1979), pointed out how a step ladder only affords the act of climbing to an organism that can stand on two legs and walk. Of course, some well-trained dogs and cats can “climb” ladders too, but this same artifact has no real meaning to an infant who, as yet, only crawls because it offers no such function or action potential for the human child. While the ladder example clearly hinges upon the physical state of an organism, the psychological state also matters, and suggests how affordances only have meaning in relation to particular organisms. “Most objects give rise to more than one affordance, with the particular affordance influencing behavior depending on the perceiver’s current psychological state. Thus, a hungry person will perceive the affordance of edibility when presented with an orange and so it eat, whereas an angry person may detect the affordance of a projectile and throw the orange at someone” (Eysenck and Keane, 2005, 113) To reiterate, from this view meaning equates to use or function (even potential use or function), and is based upon the unique relationship each organism has with its environment. However, not all things have the same meaning (i.e. can be used in a particular way) by all organisms. The recognition of meaning, use and function is first and foremost then, an integrated perceptual process that is primarily of-the-body or of-the-environmentally-embedded-body to be more exact. It is not a conceptual process embedded somewhere in the brain. As Damasio puts it, “[y]ou simply cannot escape the affectation of your organism, motor and emotional most of all, that is part and parcel of having a body” (Damasio, 1999; p. 148). The problem is that many of the new communication tools we are employing create situations where we can muffle the voice of the body by more or less circumventing the built-in redundancies inherent to our total perceptual apparatus.15 Damasio only begins to allude to the functional role of external artifacts as defacto components of a brain-body-world system sporadically throughout Descarte’s Error (1994) and The Feeling of What Happens (1999) by postulating an “as-if body loop.” He still limits this device to the contours of the brain however (1994, p. 209). In these two books Damasio does not yet make the leap to fully consider the information processing or meaning-making role played by the many tools humans employ. As it happens, he was writing about such matters early on,

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before the swell in mirror neuron research. Indeed, the next few years puts the mirror neuron squarely in the middle of Damasio’s thinking. He submits, writing this time with his wife Hanna, that: “[m]irror neurons are, in effect, the ultimate ‘as-if body’ device. The mirror neuron system achieves conceptually what we hypothesized as the ‘as-if body loop’ system; the simulation in the brain’s body maps, of a body state that is not actually taking place in the organism. The fact that the body state the mirror neurons are simulating is not the subject’s does not minimize the power of this functional resemblance” (Damasio and Damasio, 2006; 19, italics added). This all suggests that the kind of disembodiment or re-embodiments now made possible through electronic media tend to reconfigure the way the brain-body “talks” to itself, and to the world. In other words, while Damasio’s postulated “as-if body loop” allows for the possibility of some accurate (mediated) simulations of the experiences of the embodied, in-context organism, there may be some hazards built into our new contexts – and especially when the cognizer is out of them.16 Humans appear to be equipped with a mirror neuron system that is much more developed than in other primates, and this probably contributes to our advanced social abilities. However these abilities often have less to do with conscious thought, actions and behavior than we might think. “We are exquisitely social creatures, our survival depends on understanding the actions, intentions and emotions of others,” explains Rizzolatti, “[m]irror neurons allow us to grasp the minds of others not through conceptual reasoning but through direct simulation. By feeling, not by thinking” (quoted in Blakeslee, 2006). Rizzolatti’s research associate Marco Iacoboni (2008) presents data on mirror neurons that suggests their role in intersubjectivity may be more accurately described as allowing interdependence.17 This interdependence shapes the social interactions between organisms, where the concrete encounter between self and other takes on shared existential meaning that connects them deeply. All of this bolsters the utility of the phenomenological tradition in philosophy (in particular, the approach highlighted in the latter investigations of Merleau-Ponty), and really should count as a kind of watershed development for the formal study of psychology, sociology, and human communication as well. We’re looking in (indeed, down to the level of neurons), only to discover that even before conscious thought occurs, the brain/body is already looking out. Given this, we’ll need to redraw the territory that delineates communication studies so that it incorporates the total field spanning social system to synapse, and back again. This means the inclusion of any number of engineered extensions to our current neuro-biological “componentry.” Constituting the third phase of Teilhard’s triumvarite (geosphere, biosphere and noosphere), human consciousness in all its varieties and forms may be, as philosopher David Chalmers (1996) has suggested, a “fundamental

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element” in the world. The way mirror neurons appear to function suggests that symbolic exchange and interaction (i.e. the communication process itself) might be the wellspring of consciousness. Indeed, an early pioneer in the formal study of human communication, George Herbert Mead was waving his hands in the direction of some yet-to-be-discovered somatic mechanism (perhaps like the mirror neuron system) well before the science pointed in that direction. “McNeill (1992) suggests that ‘the crucial shift in the function of mirror neurons occurred when they began to respond to significances other than the actions themselves,’ and refers explicitly to Mead who argued that ‘[g]estures become significant symbols when they implicitly arouse in an individual making them the same response which they explicitly arouse in other individuals’ [40, p. 250]. Hence, meaningfulness emerges from the ability to activate a social reaction of another in yourself, a way of reacting in your own actions similarly to the actions of others, which McNeill denotes Mead’s loop” (in Lindblom and Ziemke (2008, p9). Mead, however, did not appear to recognize the quasi-autonomic nature of the process, nor that communication media of various kinds have likely been enabling human consciousness to expand out into the world for millennia. What amounts to Mead’s theory of mind (via other minds and significant symbols in one’s environment) described above is also bootstrapped by this recent empirical work. We do indeed appear to be social/environmental beings “by nature” and this insight should prompt new inquiries into the neurophysiological effects of many extant media practices. A theory of mind is also percolating just beneath the surface in McLuhan’s notion of media-as-extensions-of-the-organism, with electronic media in particular functioning as extended or exogenous components of the human nervous system. The potential for immediate gratification prompted by a host of new drugs and media tug and prod us in profound ways. In light of how these artifacts alter intention, action and the wider causal structuring of our worlds, could we be witnessing a reconfiguration of what has historically been a tendency to commune in humans?18 Much like quarks, tachyons and blackholes, mirror neurons still occupy that liminal ontological place that straddles the line between necessary theoretical construct and bona-fide natural phenomenon. Having said that, the mirror neuron apparatus seems to suggest that we are wired equally well for real or simulated experience, and tuned in particular to register empathy. Reminiscent of Mead in many ways, Iacaboni points out that when I see someone fall, many of the neurochemical reactions that occur in them also occur in me, along with a similar hormonal cascade throughout my body. That is to say, these things should occur in me if I am wired correctly. However, due to the apparent visual bias of mirror neurons, it’s seems likely that some media practices (like texting and

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twittering) may short circuit or circumvent the mirror neuron system, making it harder for us to empathize with others. In the previous chapter I discussed some recent events in the news that should give us pause, where hundreds of onlookers did little or nothing when a popular speaker collapsed on stage. In another tragic example ripped from the headlines, one onlooker picked up the head of a mortally wounded man – not to help or ease his suffering, but to snap his “final headshot” on a mobile phone. Are we changing nature, in effect rewiring ourselves through our ongoing interactions with these new tools? Like memory, muscle and bone (and many other systems and structures in the body), if we don’t use ‘em, we tend to lose ‘em. The same mantra likely applies to the mirror neuron system too. If so, a potential problem emerges in these new contexts. Electronic media (and some could argue many of our new drugs too) require us to regularly engage in decontexting and recontexting behaviors that may debilitate certain aspects of who we are – or, at least, who we have currently evolved into – as embodied beings adapted to function in social systems populated by other beings of a similar sort. So many of us who are connected to the electronic and digital communication infrastructure are progressively and often quite sporadically being driven both out of place and out of time in our interactions with others, and with ourselves.19 Such perturbations may systematically short-circuit or by-pass some of the built-in redundancies of the body argued for by McLuhan (1964), Gibson (1966, 1979), Damasio (1999), and Damasio and Damasio (2006).20 An imbalanced sensory existence cultivated by a relatively new kind of unrootedness enabled by some drugs and media can systematically wrench us out of our naturally embodied way of being-in-the-world. Exemplifying some of the best and most productive contemporary research in cognitive science and robotics, we are now seeing nascent artificial intelligence constructs being taught to interface with their surrounding environments in much more active and robust ways than their human counterparts. Consider the instance in which a “young” robot is getting to know an apple by picking it up, feeling its heft, squeezing it, an even listening to it, as has been the case at MIT for years now (see esp. the Ripley construct and other cognitive machine precursors). We now know that this kind of “sensory redundancy” is the hallmark of good sense-making. In stark contrast, consider the young human child in school or at home these days who is often merely being shown the image of an apple while sitting in front of a screen. Lacking most of the rich interfacing and redundancies enabled by embodied experience, it is likely that these impoverished perceptual contexts will not serve us well as we seek to make sense with and come to know the world around us. Several contributors to this volume point to the ways many popular drugs (anti-anxiety, depression and sexual-dysfunction drugs in particular), do much

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the same. They enliven some senses and deaden others. They seem to pry at those interfaces with the environment that the human somatosensory apparatus seeks. Mundane experiences and activities are being considered in a new light, and mirror neurons may be part of the story that will help us understand the extended phenomenological dynamics of our everyday lives. These specialized brain cells suggest that we are simulators by nature; quite literally wired to respond in “as if ” fashion to the varied, and multiply-realizable surrogate situations we confront – the non-physical realities made available to us through language, dreams, and “travel” via electronic and digital means.21 Many things can alter our body and brain chemistries in similar ways: a yoga session, a sunny day, a vigorous run, even a vigorous drive in a car (or maybe even a vigorous drive in a virtual car). Word of a friend’s new born child, or new job, and a host of mood-altering drugs can do much the same. Given the way these events and artifacts can intervene on lower-level biological process (keeping synapses variously drained or teeming with a variety of neurotransmitters like serotonin, norepinephrine, dopamine, and acetycholine, or spiking hormones such as cortisol and epinephrine), we have to begin taking seriously the multiplerealizability of somatosensory effects and the wider brain-body states associated with them. However, so much attention continues to be paid to just the symptomology of our phenomenal experience, with the more nuanced etiological story often given short shrift (cf. Healy, 2004; Horwitz and Wakefield, 2007). Headache remedies and cold medicines are well-known examples of “linear” technologies that offer a quick fix or direct effect by cutting straight to the symptoms and numbing the attendant sensations. The reality of multiple-realizability and our cultural tendency to deal with the salient symptom goes a long way toward explaining why mood-altering and mood-stabilizing drug and media use has become so ubiquitous today. Whether they help us deal with the very real psycho-somatic effects that often accompany our being propelled into and out of different experiential contexts remains an open question. Nonetheless, one fact about the human animal seems clear. For better or worse, we are natural simulators primed for living in virtual environments.22 Whether experienced face-to-face and in-person or through some other communicative conduit, the mirror neuron system is part of a perception chain that very often begins with the eyes. We can think of this as the mirror neuron system’s own bias for percepts over concepts. Thus, one important implication for the study of human communication in a digital age is that either a “real” or a “virtual” experience might prompt functionally equivalent emotional-quabodily responses triggered by the act of, say, simply seeing a smiling face. In both cases these are “as-if ” experiences because they are, for all intents, vicarious

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experiences that are triggered exogenously (ie. from “without”). This suggests that the most basic “face-to-face” event – merely seeing some other person doing or experiencing something – is a kind of inter-subjectively mediated interaction. Emotions, however instigated, can therefore prompt simulated body states in others. Extending Damasio’s “as-if-body loop” construct, and filling out Clark’s “metamental loop,” the mechanism that allows such processes to occur might more fully consist of an “as-if brain-body-world loop.” In other words and (for now) in sum, mirror neurons seem to comprise just one small but crucial part of a brain-body-world system that allows empathy-quaunderstanding to occur in a spontaneous way under “normal” conditions. If the research bears out, one significant consequence will be the dissolution of a longstanding distinction in communication studies, as well as a core assumption in the field of psychology: the existence of separate inter-personal and intra-personal realms. To be sure, the inclusion of “intrapersonal events” under a unified systems understanding of interpersonal phenomena is in the offing. And yet, as we continue to move more deeply into virtual worlds made possible by a host of new drugs and media, there is some indication that many people resist engaging in this kind of holistic, in-depth communication-qua-communion with others. . .or, even with “themselves” for that matter. These developments seem fully in line with a media ecological outlook and suggests that part of the media investigator’s new enterprise will be to draw up a new map that subsumes the intra- under the inter-personal, acknowledges the reality of “psychosomatic effect,” and puts drugs and communication media center stage as brain-body tools: technologies and extensions of our nervous systems forming the inbetween that makes all of our connections possible and completes the brain-body-world circuit.

Conclusion: A New Beginning Any undergraduate student majoring in communication should know that as much as ninety-five percent of the message potential embedded in a face-toface exchange spins out of the nonverbal components of that interaction. As the previous discussion suggests, the human animal comes equipped with a sophisticated feedback/looping capacity that affords us a great deal of communicative bandwidth.23 Increasingly, however, many of us find ourselves engaging in mediated contexts that systematically preclude the introduction of this rich array of sensory data. Consider some of the more popular media today: email, instant messaging (IM), and other asynchronous and quasi-synchronous text-based forms including text messaging. From a functional vantage these media forms produce effects that are

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similar to some drugs (like anesthetics and analgesics) in what once was a tightly coupled, naturally embedded somatosensory system. Especially where their media use is lop-sided or biased toward some of these more popular forms, the modern-mediated human inhabits environments that progressively strip them of the wide band-width capacities we evolved and adapted to through time. The fact of brain plasticity, and the emerging reality of epigenetic effects suggests there are real consequences to our media selections – indeed, a new level of responsibility regarding communicative practice applies when we consider the contemporary pace and scale of digital communication technology diffusion. Especially if the tentative epigenetic story now being told develops into something more firmly grounded, the onus will rest firmly on our collective shoulders to figure out just where it is we’d like to go next as a species. As media ecologists have been suggesting for more than half a century, we’re discovering that different media/cultural groups can and often do bequeath their symbolic legacies to future generations. They do so in the form of the non-physical structures of natural language, the physical infrastructure of our text-based, electronic and digital information ecologies, the chemical infrastructure created by various drugs, and by way of ideological and conceptual structures bound up in the different modes of perception each entails.24 We need to prepare for a total revolution in the way we think about ourselves and the environments we inhabit.25 The developments described briefly in this final chapter suggest a new level of responsibility concerning our empirical work, but also more armchair inquiries concerning the nature of the relationship between media use, brain-body structure, environment, and evolution. Taken as a whole, the observations, arguments and speculations presented in this volume suggest that we have immense power to cultivate different ways of seeing and being in the world; ways that spring from different methods of information and energy exchange, including spoken language, diet, physical activity, media and drug use, and a host of additional modes of symbolic and physical interactions with the environments we inhabit. Indeed, we are all, individually and in sum, still very much in the works.

Notes 1

For instance, underscoring problems associated with a strict reliance upon either the genetic code or socialization as the root cause of various psychosocial aberrations in human beings, Richard Restak, in his book The New Brain: How the Modern Age is Rewiring your Mind (2003), cites Antonio Damasio. Damasio, then head of neurology at the University of Iowa Carver College of Medicine, points out that “[i]t’s not at all just a simple

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result of a bad environment on the one hand or bad genes on the other. It’s a very complicated system that we’re trying to understand. We’re really in a quandary because we’re entering uncharted waters” (in Restak, 2003: 211). Restak continues, borrowing a line from bioethicist Paul Wolpe, regarding additional quandaries these uncharted waters represent, including “a whole series of physico-technologies that are being incorporated into our very flesh, that will become a part of who we are” (ibid.). Now, while Restak offers some powerful insights concerning the various ways human beings are being altered by new technologies, he makes a fairly rigid identification between brain and mind (i.e. mind and body) not only in his title, but throughout his book. What’s more, in appearing satisfied with Wolpe’s thinking that there will be a big difference in what we are becoming once we start to breach the skin barrier, Restak seems to cut an equally rigid line between self and world. In just seven years a lot has happened. For one, Damasio moved to Los Angeles to head up USC’s Brain and Creativity Institute. More importantly, two areas of inquiry have exploded onto the scene. Epigenetics, an update and qualification of conventional Darwinian-based genetics, and mirror neuron research, a component of neurophysiology that has mainstream brain scientists collectively looking beyond the brain in serious ways for the first time. 2 Cf. the “brain-body loop” (Damasio, 1999), “meta-mental loops” and “surrogate situations” (Clark, 2003), “mirror neurons” (Blakeslee, 2006; Iacaboni et al., 2005; Iacaboni, 2008; Iriki, 2006), and “Mead’s loop” (McNeill, 1992, in Lindblom and Ziemke, 2008: 9). 3 This is not to mention the fact that many animal-made artifacts persist in the environment for countless generations. Consider, for instance, rabbit holes, termite cathedrals and even beaver dams. At the human scale this would include the great wall of China, the Pyramids, and language, though Dawkins might feel compelled to suggest that these are not genedriven artifacts and therefore do not count as components of an extended phenotype. 4 If Charles Darwin (1809–1882) is considered the founder of evolutionary theory and the father of modern genetic science, the name Alfred R. Wallace (1823–1913) could just as easily come down to us had certain historical contingencies been dealt with differently. Indeed, the two men were working in parallel, and often collaborated in their research. While there are subtleties to each of their assumptions, it is really their dual theory of natural selection and the notion of fitness that is most commonly interpreted as: the given abilities an individual organism has to respond to the selection pressures of their environment. The more “fit” pass their genetic particularities on to succeeding generations. On this view, personal intentions and behaviors are not particularly consequential. The organism has no real “say” regarding what sort of genetic information they come to possess, or bequeath to their

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offspring. They are, more or less, passive conduits, carriers, or neutral media that simply send along the same genetic information they were given. But we are learning that fitness is also a matter of considering both the intentional moves organisms make in their efforts to achieve a comfortable fit with their environments, as well as the way they deal with the contingent flux of those physical and social environments along the way. For the human animal, this might include the consumption and use of certain foods, drugs, media, and any number of psycho-physical habits enacted in an attempt to adjust to environmental stressors. From 9/11 to natural cataclysms like Katrina or the Haitian or Japanese quakes, to a death in the family, to something as apparently small as a lost pet, a broken engagement, a broken heart or a broken smart phone – it turns out that much of this other story about fitness is not entirely new. Jean Baptiste Lamarck (1744–1829) formally described the intentional efforts of individual organisms seeking to enhance and extend their existence in particular environments. Learning the ins and outs, and (at the right times) reaching food, being able to find the wet and the dry, the light and the dark, the cool and the warm, etc. – even for the lowliest of creatures, fitting in or integrating with their environment in this way seems to be what survival has always been about. It’s more likely that the moves we make are highly consequential to not only who and what we can become as individuals, but those moves affect our progeny as well. 5 The hub caps found on many late-model cars with non-functional spokes, the “laces” on a pair of Velcro-fastened shoes, digital representations of buttons, dials, switches, pages and other mechanical controls on the flat, smooth surface of touchscreen devices – these are all skeuomorphs. 6 Dawkins cites empirical work showing that epigenetic changes do not persist generation after generation. Indeed, most epigenetic changes expire after two or three generations. Dawkins complains that these are not “permanent” changes. There is evidence that epigenetic changes have lasted as much as 13 generations (Jablonka and Raz, 2009). Granted, the 13 generation outcome was discovered in fruit flies, but to date drosophilia have been a good litmus for genetic effect in humans so there is no reason to think they will not continue to be so where epigenetic effects are concerned. 7 Some experts suggest the Anthropocene epoch began some 8,000 years ago with the advent of farming. But as Zalasiewicz et al. (2008) argue, it probably makes more sense to say we exited the Holocene epoch near the beginning of the 19th century, when a series of major changes in husbandry, agriculture, manufacturing, transportation, and technology started to take hold in a manner that was biospherically unsustainable. “Since the start of the Industrial Revolution, Earth has endured changes sufficient to leave a global stratigraphic signature distinct from that of the Holocene or of previous Pleistocene interglacial phases…[t]hese changes, although likely only in their initial phases, are sufficiently distinct and robustly established

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for suggestions of a Holocene–Anthropocene boundary in the recent historical past to be geologically reasonable” (Zalasiewicz et al., 2008: 4). These scaled-up methods and means reached a tipping point, creating systemic effects many orders of magnitude beyond that which the human animal had, previously, been capable of exerting on the surrounding environment. An enhanced “night time” satellite image from geostationary orbit is often persuasive for the remaining skeptics. 8 We may even find they are proving consequential to the composition and organization of the biosphere and geosphere as well, though their roles there might not be what we think. 9 For new insight on the central role of the latter three especially, see Jablonka and Lamb (2005). 10 By primary culture, I want to point to the structural features of the physical, chemical and symbolic niches we inhabit and acclimate to. These include our communication environments, and they tend to comprise a mix of media and drugs of various sorts. 11 The most common mechanism seems to be methylation, whereby the normal expression of the gene is suppressed by the addition of a methyl group (a carbon molecule with some extra hydrogen atoms) to the histones, the protein structures around which the DNA strands are coiled. Methylation essentially tightens the coiling of particular molecules along a gene strand, rendering them silent or unreadable for the duration. Methylation can be undone during the lifespan, but may also be passed on to progeny for an as yet unspecified number of generations. 12 Were these children experiencing stress through repeated exposure to their parents’ retelling of stories? It was not at all clear. Then an event occurred. In probing “just how early in life this kind of programming could happen, Yehuda studied a different group of survivors: women who had been at or near the World Trade Center in New York City at the time of the September 2001 attacks, and who had been pregnant at the time. The advantage in their case was that their babies’ cortisol levels could be tracked from an early age. Of the 38 women who were studied, about half had developed PTSD, and these had lower cortisol levels than the rest. More significantly, so did their 9-month-old babies” (Yehuda, in Spinney 2010). Unlike the children of Holocaust survivors, the researchers could rule out storytelling as a mechanism. “Whatever was happening was  happening very early, in preverbal infants. But, because the babies were only tested at 9 months old, it was not possible to say whether the effect resulted from something in the womb, or in their first months of life” (ibid.). 13 The notion of an environment, like medium, is broadly construed throughout this collection of essays to include physical artifacts that sometimes function as behavioral constraints, like clothing, walkways, roads, buildings and machines; or communicative constraints like books, radio, computers, the

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Internet and other communication media; or purely symbolic/conceptual constraints that include laws, rules, codes of ethic, etiquettes and language itself. An ecological view indeed problematizes the ideal conception of the human being as an animal possessing free will who is unconstrained by instinct and environmental pressures. In fact, just about any environmental niche alters in some fashion the causal structure of that animal’s world, prompting actions and therefore siphoning off intentionality and generally doing much to constitute, control, and sustain us. 14 The urge to anthropomorphize subcomponents of the brain or parts of the body or otherwise imbue them with intentions or belief states has a long history in many cultures. From the intestines to the liver, to the heart, to the pituitary gland, to a homunculus residing somewhere inside the skull, it’s a hard habit to kick. What’s more likely is that there’s no little man in there, the pituitary gland regulates growth and certain other somatic functions, the heart is an impressive pump, and the liver and intestines are just fancy filters. It’s likely too that mirror neurons don’t have intentions or know anything in and of themselves. They are, however, components of a brain-body-world system that does seem to know something, including an uncanny ability to gauge the relationship that particular system/organism has to itself and to other things and people in its world. The theory of mirror neurons suggests that an apparatus for enhancing the utility of visual percepts evolved in animals long ago, and that the meaning of things is always the product of a systemic equation. In other words, not every thing has the same perceived relationship to every organism, or to the same organism in different situations (i.e. different temporal and spatial contexts). 15 One implication Damasio draws out is that all memory really has to be a kind of emotional memory and, by extension, ultimately a bodily memory. The only suggestion I’ll make here is that it is in having a certain kind of body (and one connected to certain kinds of things) that we alter these affectations, perceptions, memories, even the possible “intentions” or potential actions associated with each. This illustrates what Damasio calls the somatosensory system at work. But here again, the concept can be misleading. “Unfortunately, what most often comes to mind upon hearing the words somatic or somatosensory is the idea of touch or the idea of muscle or joint sensation. As it turns out, however, the somatosensory system relates to far more than that, and is actually not one single system at all” (ibid, p149). 16 It has been observed (cf. Damasio and Damasio, 2006) that simply reading about another person doing or feeling something can also trigger activity in the mirror neuron system. The question is, to what extent, and to what effect? It may be the case that reading mitigates emotional responses by biasing activity in left hemisphere and other rational centers of the brain. No doubt, the jury is still out, and investigators will need to look much further into these questions.

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17 The mirror neuron system may have originally developed as a purely instinctual survival mechanism actuated by affordances, those most discernible patterns of organization found in the surrounding environment, including the difference between, say, a smile and a grimace, and all kinds of material objects, like caves, sharp sticks, large predators with sharp teeth, etc. Here again we are seeing empirical support for a key point made by McLuhan almost fifty years earlier – that the power of the percept often over-rides conceptual experience, or conscious thought. Indeed, it must have been very beneficial to be able to tell just slightly ahead of time, and with some reliability, if a neighbor was picking up a long stick to hand it over, or thrust it through one’s midsection. This all suggests that there is a lot of multi-way feedback (looping), and other pre-conscious/automatic perceptual processes and interactions taking place between brains, bodies and the environments they inhabit. 18 The failure of the video phone to take hold over the past forty years is a sobering reminder of a trend under way for some time now (the video phone was introduced to the world twice early on, at Expo ‘64 and Expo ’67 in New York and Montreal respectively). It is also notable that of the couple dozen or so new iPhone owners I know, only one or two at the time of this writing has even bothered with the two-way video chat function called facetime. It is conceivable that our apparent need for efficiency and control afforded us by these technologies with progressively narrowing bandwidths (like traditional telephone, email, and text messaging) are overriding the need to know others as well as our own interest in letting others see and know us better. One might think that the adoption of the newest communication media affording the richest bandwidth (like video phones and video chat) would be growing exponentially now that mobile broadband services have become more reliable. 19 In The New Brain (2003) Richard Restak begins the third chapter “Attention Deficit: the brain syndrome of our era” suggesting “[t]he plasticity of our brains, besides responding to the people and training to which we expose it, also responds, for good or bad, to the technology all around us: television, movies, cell phones, e-mail, laptop computers, and the Internet. And by responding, I mean that our brain literally changes its organization and functioning to accommodate the abundance of stimulation forced on it by the modern world” (p. 38). Restak goes on to suggest that this technologically driven change is likely the “biggest modification in the last 200,000 years.” He then considers what really amounts to the neuro-phenomenological nature of the news crawler: “Until recently crawlers were used to provide early warning signs for hurricanes, tornados and other impending threats. Because of their rarity and implied seriousness, crawlers grabbed our immediate attention no matter how engrossed we were in the television program playing out before our eyes. Crawlers, in short, were intended

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to capture our attention and forewarn us of the possible need for prompt action. But now, the crawler has become ubiquitous, forcing an ongoing split in our attention, a constant state of distraction and divided focus” (p. 39). 20 Fruitful research paradigms in cognitive science, robotics, and human computer interaction (HCI) have long been converging around an embedded, task-orientation that eschews more closed, narrow, and localized representational theories of mind, for more extended, open, or “widecomputational” approaches that put the cognizing system back in-the-world in a more fully immersive, ongoing process of give and take. Such work is revealing incredible plasticity and functional successes in both machine and human. The problem is, outside of these research endeavors, we tend to miss a lot of the more subtle and certainly less measurable effects and side-effects of the use of certain tools by people in mundane circumstances and all walks of life. For instance, the relatively narrow perceptual fields provided by television or text messaging may not only sap our ability to attend, it’s likely that when over-used, they undermine or weaken essential holistic perceptual mechanisms. In so doing, they may disable valuable social skills that evolved in humans over millennia. As Gibson was fond of saying, the typical modern human tends to live a fairly “boxed in” life (Gibson originally pointed to the television as the pre-eminent box). It would be interesting to know what he might have thought of those little portable screens we seem so enamored with these days. The disuse and potential for atrophy associated with the disuse of these perceptual mechanisms embedded in the human brain-body may very well be disrupting our ability (and/or our interest) to empathize with others. But is there more than just a neutralization of interpersonal affect potentially at work here? With legions now IMing, texting and twittering through their day, can we predict an alexithymia epidemic in the population? Alexithymia describes, among other things, an inability to express feelings or emotional content with words, with specific problems communicating feelings consciously via verbal and non-verbal channels. 21 Sandra Blakeslee, a science writer for the New York Times makes the case that “[m]irror neurons reveal how children learn, why people respond to certain types of sports, dance, music and art, why watching media violence may be harmful and why many men like pornography” (Blakeslee, 2006). Blakeslee cites several recent empirical studies that offer compelling evidence for an important cognitive role played by mirror neurons. In one study it was established that “[s]ome mirror neurons respond when someone kicks a ball, sees a ball being kicked, hears a ball being kicked and says or hears the word kick” (ibid). These seem to be examples of multiple-realizability and equifinality. In these cases we are talking about perceptual equivalencies enabled by varying stimuli. While this does not necessarily mean that the same or equivalent brain-body state results from different stimuli, it does suggest from the perspective of the mirror neuron

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system at least, that each of the “kick” examples carry the same or very similar information such that the sentient organism experiences a rough functional equivalency. Again, whether a similar brain-body state also results is another question altogether, but such equivalencies raise all kinds of compelling questions regarding the role of mirror neurons in the larger process of perception, especially in conditions of differential media use – a fairly typical set of conditions these days. So while this can at times create dis-ease in the organism, it is not a bad habit, addiction or disease we are dealing with here. It is, rather, the new baseline or “natural” condition, an integral part of the ongoing relationship one has with the world. 22 The mirror neuron system responds to both real (physical) and virtual stimuli, though it’s not yet clear if there is an isomorphic function when, say, an actual person in front of us smiles, and when we see that same person smiling in a still or moving (media) image. While similar, it is likely that these different conditions do not elicit the same response. If this is the case, our forays into virtual worlds of various kinds may be systematically shutting these parts of our selves down, or at least causing them to function differently from the way they were designed. We may be, in effect, short-circuiting the integrating tendency of our bodily mechanism. To consider a fairly well-known example in the field, communication researchers have been describing the facial feedback hypothesis for decades now (see Adelmann and Zajonic, 1989 for an early treatment). New research in the neurosciences reveals that the feedback effect involves the activation of these unique neurons in the parietal lobe of the prefrontal cortex that relay information to different regions of the body so that we are able to not only know what others feel, but also gain a better sense of what we feel in the process (cf. Iacaboni, 2008). “[M]ost people can easily read the emotions of others from facial expression, tone of voice, and other body language. It seems rather likely this is because our mirror neurons simulate the muscular activity that underlies these kinds of emotion-expressing behaviors. Further, if one tries to imitate facial expressions associated with emotional states (like fear, sadness, joy, etc.), one actually feels at least a little bit of the emotion itself ” (Blakeslee, 2006). 23 A constant flood of meaningful information is made available to the human sensorium during what seems to be one of the simplest forms of communication: a conversation between two co-present people. However, research in artificial intelligence and robotics is revealing that the face-to-face condition ends up being one of the most difficult things to model and process in machine intelligences. 24 With epigenetics, it seems, our media choices may alter our genotypical legacy as well. Epigenetics and media ecology both suggest that our progeny are given predispositions via genomic regulation, neuro-physical plasticity, and ongoing processes of enculturation and socialization by way of the

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media we employ. These employments then recapitulate certain physical, symbolic and epistemological forms. 25 If the 2010 Behavioral Epigenetics Conference that occurred recently in Boston, and the 2010 Neuroscience conference in San Diego are any indication, then epigenetic investigations, and discoveries, are here to stay.

References Abram, D. (1996). The Spell of the Sensuous: Perception and Language in a More-Than-Human World. New York: Vintage Books. Blakeslee, S. (2006). “Mirror Neurons Cells that Read Minds.” http:// scienceandreason.blogspot.com/2006/02/mirror-neurons.html Clark, A. (2003). Natural Born Cyborgs. Oxford: Oxford University Press. Damasio, A. (1999). The Feeling of What Happens: Body and Emotion in the Making of Consciousness. New York: Harcourt-Brace & Company. Dawkins, R. (1982). The Extended Phenotype: The Gene as the Unit of Selection. Oxford: W.H. Freeman and Company. Dawkins, R. (2009). “Purpose of Purpose.” Lecture delivered at the University of Minnesota Twins Cities, Northrup Auditorium, March 4. Gessler, Nicholas (1998). “Skeuomorphs and Cultural Algorithms.” Lecture Notes in Computer Science 1447: 229–38. Gibson, J. (1979). The Ecological Approach to Visual Perception. Boston: Houghton Mifflin. Iacaboni, M. (2008). Mirroring People: The New Science of How We Connect with Others. New York: Farrar, Straus & Giroux. Iacoboni, M., I. Molnar-Szakacs, V. Gallese, G. Buccino, J. C. Mazziotta et al. (2005). “Grasping the Intentions of Others with One’s Own Mirror Neuron System.” PLoS Biol 3(3): e79. doi:10.1371/journal.pbio.0030079 Iriki, A. (2006). “The Neural Origins and Implications of Imitation, Mirror Neurons and Tool Use.” Current Opinion in Neurobiology 16(6): 660–67. Jablonka, E. and Marion J. Lamb (2005). Evolution in Four Dimensions: Genetic, Epigenetic, Behavioral, and Symbolic Variation in the History of Life. Cambridge: MIT Press. Jablonka, E. and G. Raz (2009). “Transgenerational Epigenetic Inheritance: Prevalence, Mechanisms, and Implications for the Study of Heredity and Evolution.” Quarterly Review of Biology 84(2): 131–76. Lindblom, J. and Tom Ziemke (2008). “Interacting Socially through Embodied Action.” In F. Morganti, A. Carassa and G. Riva (eds), Enacting Intersubjectivity: A Cognitive and Social Perspective on the Study of Interactions, pp. 49–63. Amsterdam: IOS Press. McLuhan, M. and B. Nevitt (1972). Take Today: The Executive as Dropout. New York: Harcourt Brace Jovanovich.

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McNeill, D. (1992). Hand and Mind. Chicago: Chicago University Press. Mitsch, W. J. (1996). “Ecological Engineering: A New Paradigm for Engineers and Ecologists.” In P. C. Schulze (ed.), Engineering within Ecological Constraints, pp. 114–32. Washington, DC: National Academy Press, Nelkin, D. and S. Lindee (1996). The DNA Mystique: The Gene as a Cultural Icon. New York: WH Freeman. Restak, R. (2003). The New Brain: How the Modern Age is Rewiring your Mind. Emmaus, PA: Rodale. Spinney, L. (2010). “Born Scared: How your Parents’ Trauma Marks your Genes.” New Scientist 2788, December 4. http://www.newscientist.com/article/ mg20827881.700-born-scared-how-your-parents-trauma-marks-your-genes. html Zalasiewicz, J., M. Williams, A. Smith, T. L. Barr, A. L. Coe, P. R. Bown, P. Brenchley, P. Cantrill, D. Gale, A. Gibbard, G. Philip, F. John, M. W. Hounslow, A. C. Kerr, P. Pearson, R. Knox, J. Powell, C. Waters, J. Marshall, M. Oates, P. Rawson and P. Stone (2008). “Are We Now Living in the Anthropocene?” Geological Society of America Today 18(2): 4–8.

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List of Contributors

Corey Anton (PhD, Purdue University) is Professor of Communication Studies at Grand Valley State University. He is past-editor of the journal Explorations in Media Ecology, and Past-Chair of the Semiotics and Communication Division of the National Communication Association. A Fellow of the International Communicology Institute, he currently serves on the Board of Trustees for the Institute of General Semantics. His books include: Selfhood and Authenticity (SUNY Press, 2001), Sources of Significance: Worldly Rejuvenation and Neo-Stoic Heroism (Purdue University Press, 2010), Communication Uncovered (IGS, 2011) and the edited collection: Valuation and Media Ecology: Ethics, Morals, and Laws (Hampton Press, 2011). Jonah Bossewitch  holds an MA in Communication and Education at Teachers College (2007) and graduated from Princeton University (1997) with a BA Cum Laude in Philosophy and certificates in Computer Science and Cognitive Studies. He works  full-time as a technical architect for Columbia’s Center for New Media Teaching and Learning (CCNMTL). He is a doctoral candidate in Communications at Columbia’s School of Journalism where he is investigating the politics of memory at the intersection of corruption in psychiatry and pharma. Jonah also has over a decade of experience as a professional free software developer. He is an advocate for free software/culture, mad pride, and social justice. He blogs at http://alchemicalmusings.org.  Brecken Chinn Swartz (PhD, University of Maryland) is an Assistant Professor of Communication at Curry College in Milton, MA, also serving as the Executive Director of HandReach, an international nonprofit providing medical relief and rehabilitation for child trauma survivors in the developing world. A former international broadcaster, she has worked with dozens of journalists in Washington, 333

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London, and Beijing to develop grounded methods for explicating and understanding communication values across cultures. She is the author of Strategies in International Broadcasting (VDM Verlag, 2007) and currently teaches courses in Intercultural Communication, Gender Communication, Fundamentals, and Media Ethics. Ronan Hallowell is an educator and interdisciplinary scholar. He serves as Co-Investigator for the 2011–2014 NASA funded project “Beautiful Earth: Experiencing and Learning Science in a New Way” (beautifulearthproject.org). Ronan is currently a doctoral student in educational psychology at the USC Rossier School of Education in Los Angeles ([email protected]). Cristina Hanganu-Bresch (PhD, University of Minnesota, Twin Cities) is an Assistant Professor of writing at the University of the Sciences in Philadelphia. Her current research focuses on the visual rhetoric of psychopharmaceutical advertising, the construction of depression through the genre of the mood memoir, and the history of psychiatry. Robert C. MacDougall (DA, University at Albany) is Professor of Communication and Media Studies at Curry College in Milton, MA. His teaching and research centers on the cognitive, social, and epistemological roles played by communication media and technology. His publications include Cultural Technics (VDM Verlag, 2009); a book about the use of email by a group of Mohawk Indians, Digination: Identity, Organization and Public Life in an Age of Small Digital Devices and Large Digital Domains (Rowman and Littlefield, 2011), and well as numerous journal articles and book chapters. His most recent investigations incorporate the use of EEG technology to study the effects and side-effects of multimedia use in the brain-body system. In addition to his teaching and research on media, he is a cyclist, snowboarder, gardener, an avid member of the Media Ecology Association, and father of two willful boys who sometimes wish their parents would be willing to watch a great deal more television. Ainsley Moore (MD, MSc, CCFP) is an Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ontario. She has practiced for 13 years as part of a large family health team, an experience that has allowed her to pursue her interest in caring for complex, frail seniors, as well as to appreciate team-based approaches to care. Since joining McMaster in 2007, she has focused on understanding how the primary care system will respond to the challenges of aging in Canada, and how collaborative multidisciplinary initiatives

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are ideally suited to address such complex health problems. To that end, she has developed an interprofessional shared care program for improving the care of seniors, a description of which is forthcoming in the World Health Organization Publication: Good Practice in Interprofessional Collaboration and the journal Canadian Family Physician. Her research has also appeared in Akademik Geriatri Dergisi (2009) and Chiropractic and Osteopathy (2010). The Canadian Institute of Health Research recently awarded her a fellowship in Bridging Scientific Domains in Medication Safety and Effectiveness. Valerie V. Peterson is Associate Professor of Communication and the author of Sex, Ethics and Communication (Cognella, 2011). Other published works include 20+ scholarly articles, book chapters, encyclopedia entries, and popular writings on such topics as rhetorical and communication theory, visual rhetoric, argument and identity, Sophistic thought, interdisciplinarity, pedagogy, sexual politics, and popular culture (e.g., the Ellen TV sitcom, The Joy of Sex, and the Kama Sutra). She was managing editor of Explorations in Media Ecology (2008–2010) and teaches at Grand Valley State University (BA and MA University of Virginia, PhD University of Iowa). Brett Robinson is an assistant professor of communication at Saint Vincent College in Latrobe, PA where he teaches courses in advertising, public relations and media writing. He credits the contemplative spirit of the resident Benedictine monks for inspiring his research interest in the relationship between communication technology and theology. His article, “A Theology of Media Change: Religious Imagination and the Evolution of Electronic Media” (2009) chronicles the historical relationship between new media technologies and shifting religious sensibilities. He previously taught courses at Duquesne University and in the University of Georgia’s New Media Institute. Phil Rose (PhD, York University) currently teaches in the department of Communication Studies at York University in Toronto. His research and teaching interests include: the evolution and history of technology, symbol systems and communications media (from the origins of symbolic thought to the most recent technological developments); topics related to popular music; social and cultural issues related to literacy; and concerns pertaining to technology and violence, particularly in relation to the mimetic theory of René Girard. Among his most recent publications are an interview with the octogenarian Girard for the journal Contagion, and a piece titled “Digital (A)literacy”, published in E-Learning and Digital Media. He is also author of the book Which One’s Pink? The Concept Albums of Roger Waters and Pink Floyd (Collector’s Guide Publishing, 1998),

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a project for which he extensively interviewed the creative leader of the classic British rock group. John P. Skinnon is a pharmacist by profession with internships focused on psychiatric disorders and hospice settings. He is also a philosopher of mind at heart with interests in both Eastern and Western traditions. Some of Skinnon’s recent investigations include the relationships and differences between science, the humanities, mysticism, and meditation as they contribute to an understanding of neurochemistry. He is a close reader of Alan Watts, Alfred North Whitehead, Pierre Teilhard de Chardin, Jiddu Krishnamurti, Carl Jung, and Terence McKenna. These thinkers have led to a late “discovery” of Marshall McLuhan and the Media Ecological approach to understand our minds-in-the-world. Lance Strate is Professor of Communication and Media Studies at Fordham University, and author of On the Binding Biases of Time and Other Essay on General Semantics and Media Ecology, and Echoes and Reflections: On Media Ecology as a Field of Study. He has co-edited several anthologies, including The Legacy of McLuhan (Hampton Press, 2005), and Communication and Cyberspace: Social Interaction in an Electronic Environment (Hampton Press, 2003), and has been editor of several journals, including the General Semantics Bulletin, the Speech Communication Annual, and Explorations in Media Ecology. One of the founders of the Media Ecology Association, he served as the MEA’s first president for over a decade, and remains a member of its Board of Directors, and he also has served a three-year term as Executive Director of the Institute of General Semantics.

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Index Abilify 2, 66, 148, 300, 301 Abram, David 53, 57, 60, 247–8, 310 acetylcholine 269, 270, 277 Adderall 2, 13, 66, 68–9 addiction 55, 56, 220, 231, 267, 281, 283, 301, 309 ADHD see attention deficit hyperactivity disorder advertising 7, 10, 11, 23, 55, 97, 99, 102, 104, 107, 108, 109, 110, 124, 125, 128, 130–2, 134, 146, 148, 151, 153, 166–91, 212, 221, 298 affordances 53, 61, 63, 67, 317 agonists 268–9, 271, 272, 273, 275, 277, 278 alcohol 4–5, 6, 20, 22, 23, 31, 37, 40, 44–5, 46, 47, 66, 87, 91, 114, 123, 152, 171, 267, 275, 282 alexithymia 66 Allen, David 64 antagonists 268, 269, 271, 272, 275, 276, 277 Anthropocene epoch 12, 244, 313 antidepressants 11, 92, 166, 181, 182, 267 antipsychotics 147, 148, 151, 166 Antisocial 301–2 as-if body loop 317, 318, 322 attention deficit hyperactivity disorder (ADHD) 2, 148, 273, 284, 285 “attention economy” 298, 315 automated dispensing 11, 194, 198, 199, 201–2, 204–5, 213 ayahuasca 12, 238, 239, 240–1, 243, 251–7, 259–60, 278 Bateson, Gregory 58, 59, 240 Bergson, Henri 60, 63, 279 Berman, Jennifer 106, 107–8 Bertalanffy, Ludwig Von 4, 15, 53, 54 “biological bottleneck” 65 biopower 159 bi-polar disorder 300 birth control 9, 23, 40, 41, 42, 43, 83–93, 300 Blackberry 303

brain-body concept 56, 318, 321, 323 brain-body-world concept 52, 56 causal structure 62 Celexa 66, 123 Chalmers, David 268, 318 chemical mediation 8, 36, 37, 39–42, 43, 45, 46, 47 choice 103, 152, 157, 158, 204, 221, 223, 224, 225, 226, 229, 230, 232 Cialis 9, 84, 88, 91, 97, 98, 99, 101, 103, 111, 115 Clark, Andy 56, 58, 59, 61, 62, 63, 67, 210, 322 codeine 266, 277 cognition 9, 58, 59, 73, 225, 237, 238, 240, 247, 269, 316 cognitive science 9, 52, 56, 242, 268, 320 commodification of sex 98, 115 consumers 91, 102, 122, 131, 199, 223, 224, 225, 229, 232, 297 context-dependence 54 cortisol 272, 279, 314, 315, 321 creativity 223, 244, 245, 246, 253–8, 281 culinary metaphor 223, 229 cybernetics 316 cyborgs 62, 300, 303, 315 “daily feed” 11, 223–4, 232 Damasio, Antonio 57, 67, 303, 316, 317, 318, 320, 322 Darwin, Charles 311, 312, 313 Dawkins, Richard 63, 311, 312 decontextualization 57, 178 depression 13, 23, 47, 66, 102, 108, 111, 112, 123, 149, 153, 156, 166–72, 174, 176–82, 185, 187–91, 197, 267, 271, 273, 282, 320 Descartes, René 56, 67, 70 designer drugs 68, 102 diet 38, 46, 69, 99, 123, 221, 225, 228, 229, 230, 232, 247, 314, 323 disembodiment 57, 64–5, 318

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338 Index dispositional representation 57, 67, 68 DNA 240, 280, 310, 311 dopamine 12, 129, 269, 270, 272, 273, 274, 285, 321 dosage 2, 44, 45, 69, 179, 197, 201, 205, 277 droids 67, 296, 303 drug analog 269 DSM 148, 151, 152, 181 dynamic coupling 59 eBay 6 ecological engineering 13, 295–305 Ecstacy 114 ED see erectile dysfunction Eisenstein, Elizabeth 12, 304 emergence 4 enactive cognition 16 environmental engineering 13, 295–305 epigenetics 309–23 epinephrine 269, 270, 272, 273, 274, 321 equifinality 5, 6, 53, 314 erectile dysfunction (ED) 9, 47, 83, 88, 90, 91, 98, 106, 123 etiology 99, 101, 171, 286 evolution of consciousness 12, 37, 38, 238, 254 existential cognition 16 extended cognition 16, 59 extended mind 56, 59, 63, 64 extended phenotype 63, 311, 315 extensional orientation 8, 27, 28, 31, 32 Facebook 3, 6, 54, 60, 304 feedback 26, 28, 57, 58, 65, 322 Fiction Depersonalization Syndrome 286 Fight or Flight Syndrome 269, 272, 273 flow concept 252 fMRI 67, 312, 316 food 11, 20–1, 22, 59, 84, 113, 201, 219, 220, 221, 223–4, 225, 226–9, 230–1, 232, 247, 305 Foucault, Michel 100 freedom 153, 180 GABA 270, 275, 276, 278 gatekeeping 224–6 Gates, Bill 63, 226, 313 general semantics 27, 28, 30, 31, 60 Gibson, J.J. 16, 52–3, 56, 61, 63, 67, 310, 317 Giurgea, Corneliu 15 glutamate 270, 275, 276, 277 Google 6, 63, 65, 152, 297 GPS 3, 69 GTD (Getting Things Done) 64 Gutenberg, Johannes 65, 313 hallucinogens 240, 251, 257, 260, 276 Hebb, Donald 276

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Hebbian theory 276 heroin 47, 55, 68, 266, 267, 279, 282 HGP see human genome project Hippocratic Oath 109 holism 14, 39 Homo sapiens 57, 286 hormones 54, 88, 266, 270–2, 273, 314, 321 Horton, Donald 55 HTC 296, 297 human genome project (HGP) 314 Hume, David 63, 279 Iacaboni, Marco 319 illicit drug use 20–1, 267, 280–2 impulse control disorder 13 indigenous ways of knowing 249–50, 251 individuation 97 intentional objects 61, 67 internal milieu 57, 68, 271 iPhone 67, 123, 125, 303 iPod 1, 2, 3, 10, 66, 121–39 Isolator 300 “Just Say No” 37 Korzybski, Alfred 8, 26–8, 29, 30–1, 60 Kramer, Peter 56, 102, 103, 190 Krugman, Herbert 283, 285 Lamarck, Jean Baptiste 312 lateral thinking 241, 254 laws of media 6–7, 87, 194, 203 LCD 296 Leechblock 300 Levitra 9, 84, 88, 91, 97, 99, 101, 102, 103, 115 ligands 272 loose drugs 8–9, 36, 42–6 LSD 45, 46, 47, 68, 122, 123, 124, 125, 126, 128, 130, 133, 134, 136, 137, 138–9, 259, 281 MacCoby, Eleanor 55–6 madness studies 146 McKenna, Terence 38, 271, 280, 284 McLuhan, Marshall 1, 6, 8, 13, 19–20, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 36, 39, 40, 42, 43, 45, 53, 55, 56, 60, 61, 63, 66, 68, 69, 86–7, 88, 129–30, 146, 193, 194, 203, 222, 225, 238, 248, 279, 280, 297, 300, 302, 304–5, 310, 314, 315, 319, 320 MDMA 47, 68, 104 Mead, George Herbert 26, 62, 76, 319 MedCentre 11, 194, 195–212, 213 media ecology 3–6, 9, 12, 30, 52, 86, 87–8, 98, 128, 146, 159, 232, 237–40, 243, 259, 302–3, 310, 311 media mix 53

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Index medical establishment 21, 99, 100, 109, 113, 114 medicine 8, 21, 28, 47, 84, 86, 87, 98, 99, 100, 150, 154, 166, 182, 183, 193, 194, 199–200, 204, 208, 209, 210, 266, 271, 273, 274, 275, 276, 278, 282, 297, 321 metamental loop 59, 61, 62, 322 methylation 314 Meyrowitz, Joshua 70 Microsoft 63, 297 mind tool 3, 8, 9, 52, 53, 59, 61, 68 mind-body problem 56, 98, 101–6, 268 Minsky, Marvin 57–9, 70 mirror neurons 62, 309–23 morphine 41, 47, 124, 221, 266, 268–9, 274, 285 Motorola 296 multifinality 54 multiple-realizability 53, 54, 321 multitasking 57, 64–5, 66, 297, 300 music 2, 10, 42, 121–39, 156, 240, 253, 259, 283, 329 nature/nurture 63, 111, 315 NE see norepinephrine neurological diversity 153 neurons 62, 67, 268, 271, 274, 276, 309–23 neuropeptides 274 neuroplasticity 286 neuroscience 57, 64, 279, 315, 316 neurotransmitters 12, 182, 266, 268–78, 285, 321 niche construction 302 NMDA 276, 277, 278 norepinephrine (NE) 269, 270, 272, 273, 274, 321 normalization 46 nostrum remedium 298 numbing agent 60 Nystrom, Christine 4, 210, 302 Ong, Walter 52, 129, 238 opiates 266, 268 opium 41, 122, 266, 285 orienting response 284 panic architecture 315 pathologizing risk 149, 153 patient information data bases 11, 195, 198 Paxil 66, 102 pediatric bipolar 10, 145–60 peptides 268, 274, 285 perceptual amplifiers 9, 52–70 perceptual inhibitors 9, 52–70 pharmaceutical industry 20, 21, 22, 88, 97, 98, 108, 166, 167, 208 phenomenology 101, 124, 138 phenotype 63, 311, 314, 315 physical dependence 267

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physician prescribing for profit 209, 211, 212 physiology 104, 266, 267 placebo 22 placebo effect 5, 22, 298, 301 Plant, Sadie 114 post-traumatic stress disorder (PTSD) 312, 314, 315 prodromal 150, 151, 152, 153 proof 37, 45, 157 Prozac 2, 11, 47, 56, 66, 102, 103, 114, 123, 127, 168, 181–9, 190, 191, 270, 271 psyche 27, 29, 98, 103, 113, 115–16 psychiatry 24, 146, 147, 149, 150, 151, 153, 154, 158, 167, 169, 175, 176, 178, 179, 181, 183, 212, 239 psychodynamics 61 psychopharmacology 167, 181 psychotic risk syndrome 150 psychotropic substances 3, 11, 12, 63, 68, 111, 147, 156, 159, 171, 174, 191, 267, 301 PTSD see post-traumatic stress disorder quality of life 99, 123, 180, 306 Ramachandran, V.S. 316 reduction 24, 29, 190, 309 reductive outlook 111 remote drug dispensing 11, 205, 212–13 remote pharmaceutical counseling 11, 193–213 responsibility 29, 57, 221, 226, 230, 245, 323 Ritalin 1, 2, 13, 23, 47, 66, 68, 69, 145, 149, 300 ritualization 173 Rizzolatti, Giacomo 316 Sapir-Whorf hypothesis 26, 61 Second Life 66, 76 semiotics 28 sensorium 52–3, 55, 60, 68, 123, 128, 130, 238, 286, 287 sensory apparatus 52, 56, 136, 321 serotonin 12, 102, 111, 123, 181, 182, 241, 257, 269, 270, 271, 272, 321 sexuality 10, 90 simulation 104, 113–16, 182, 318 “smart drugs” 23, 30 social system 112, 157, 249, 312, 320 sociotechnical system 6 somatosensory system 321, 323 SSRI 102, 108, 181 surrogate situation 59, 61–3, 64, 66, 67, 307, 321 surveillance 146, 152, 153, 155 sustainable future 12 synapse 5, 111, 157, 190, 271, 276, 312, 318, 321 synaptic plasticity 276–7 syntony 239, 241, 242, 252, 255, 258–60

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340 Index systems theory 24, 39, 53, 251 “systems view” 3, 6, 25 taste 10, 11, 22, 29, 223, 227, 229, 230–1, 232, 300 technology 3, 4, 6, 8, 11, 13, 22, 23, 24, 25, 26, 28, 30, 60, 61, 62, 63, 66, 69, 70, 86, 87, 115, 121, 122, 124, 125, 129, 131, 133, 138, 179, 194, 195, 196, 197, 199, 201, 202, 203, 212, 213, 220, 240, 243, 244, 245, 250, 266, 281, 285, 298, 300, 304, 311, 312, 316, 323, 328 technosphere 245 telemedicine 193–4, 199­–200, 204, 206, 212 telepharmacy 11, 194, 197, 200, 202, 205, 206–7, 213 television 3, 12, 22, 24, 42, 55, 56, 68, 103, 132, 220, 231, 266–8, 282–6, 297 tensegrity 8, 32 tetrad 6–7, 13, 87, 93, 205 “third place” 298 “tight” drugs 8 transactionalism 39 Twitter 3, 64, 300, 320 Two State Receptor Theory 272

Verizon 295, 296 vertigo 30, 65 Viagra 2, 9, 24, 84, 88, 91, 97, 98–106, 108, 109, 111, 112, 113, 114, 115, 300 Vinci, Leonardo Da 62 virtual reality (VR) 20, 66, 182 Vitruvian Man 62 VR see virtual reality vulnerability 9, 84–6, 88–90, 91, 92, 93 Wallace, Alfred 324 “War on Drugs” 21, 282 Weil, Andrew 36, 281 Wellbutrin 66 Whitaker, Robert 5 Wohl, Richard 55, Wolf, Maryanne 69 Wurtzel, Elizabeth 102 Yehuda, Rachel 312, 314 Zoloft 66, 102 Zweig, David 286

Verdansky, Vladimir 14 Verghese, Abraham 101, 103, 115

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