Dumit – Is It Me or My Brain?

Is It Me or My Brain? Depression and Neuroscientific Facts

by Joseph Dumit

[Dumit, Joseph. 2003. “Is It Me or My Brain? Depression and Neuroscientific Facts.” Journal of Medical Humanities 24 (1–2): 35–47.]

Points

  • Wittgenstein says that there are certain points about which we no longer ask for an explanation or a test of its truth, and explanations come to an end:
    • “Giving grounds, however justifying the evidence, comes to an end; —but the end is not certain propositions’ striking us immediately as true, i.e. it is not a kind of seeing on our part; it is our acting” (On Certainty, p. 204) (39).
  • We might call the set of acts that concerns our brains and our bodies deriving from received-facts of science and medicine the objective-self”
    •  The objective- self consists of our taken-for-granted notions, theories, and tendencies regarding human bodies, brains, and kinds considered as objective, referential, extrinsic, and objects of science and medicine. That we “know”we have a brain and that the brain is necessary for our self is one aspect of our objective-self” (39).
  • “Furthermore, objective-selves are not finished but incomplete and in process. With received-facts we fashion and refashion our objective-selves.
    • Thus it is we come to know our bodies as endangered by poisons like saccharine, our brains as having a “reading circuit,” and humans as being either mentally ill or sane or borderline.
    • I call this “objective-self fashioning” to highlight our own activity in encountering “received-facts.”
    • I emphasize “received-facts” rather than just “facts”to highlight the activity of translation that has taken place in order for the results of a scientific or medical project to reach us.
      • Each of these movements of facts from one media to another is also necessarily a transformation of the fact. Science studies scholars Bruno Latour and Michel Callon call this process “translation,” a term connoting both movement and change in meaning. We all know that a fact established in a lab is not known immediately by everyone, everywhere. It must travel through specific channels” (39).
  • “Each of the aspects of our objective-selves has this personal history (of coming-to-know via received-facts) and also a social history. (39-40)
    • “Some human kinds that we are starting to take for granted, e.g., depressives, require attending to broader social and institutional forces in order to understand how it is that we look to the brain for an answer” (40).
    • “These social histories enable and constrain science at every level of fact conception, experimentation, publication, and dissemination and reception, but this does not imply that science is culture. Science produces facts in spite of and because of these constraints—laboriously, continuously, and creatively” (40).
    • “And we fashion our objective-selves with the fruit of this labor in the form of received-facts in our own continuous and often creative manner, no matter how skeptical we are. This way of living with and through scientific facts is our form of life” (40).

 

  • Examining sufferers of mental illness pints Dumit to a type of selfhood he wants to “a pharmaceutical self whose scale is one of days and weeks.
    • Contrary to a Heideggerian phenomenology in which one is passively thrown into moods, here one’s abnormal neurochemistry actively throws one into depression or mania. Sometimes one can respond to this by taking drugs that, days or weeks later, throw you into yet a third state—not normal, but better.”
  • This pharmaceutical Self brings forth “three critical aspects of objective-self fashioning for our purposes.”
    • First, there is a tremendous flexibility and openness of explanation of the objective-self”
      • Even in the face of specific received-facts about ourselves such as brain images, there is room for negotiation and redefinition. Sociologists and anthropologists of psychology have called this the “pandemonium” of folk psychology. But they also note that even as we can play with mind and brain, motivation and behavior, we also ultimately must satisfy local common sense” (44).
    • “The second aspect … is the need for a nuanced, complex cultural, historical and institutional as well as scientific or biomedical understanding of context.
      • Objective-self fashioning is an ongoing process of social accounting to oneself and others in particular situations in which received-facts function as particularly powerful resources because they bear the objective authority of science” (44).
    • “The third critical aspect of objective-self fashioning is the fundamental connection between the brain as objective-self and one’s own personal identity.
      • When genes are invoked as the cause of one’s objective-self and aspects of one’s personality they can become synecdoche for one’s identity. If one has a gene for depression, one can fear becoming depressed.”
      •  “We can note here that brain images further confuse the part with the whole—even though brain images only show a slice of the brain, they show the slice as representing the whole brain, which in turn is the person” (44).
  • “Individual sufferers are trying to both understand their illness and live with it. These are activities that are not necessarily compatible. Using the notion of the pharmaceutical self, I would suggest that they have entered into a relationship with their brain that is negotiated and social” (46).

 

Terms

objective-self—our taken-for-granted notions, theories, and tendencies regarding human bodies, brains, and kinds considered as objective, referential, extrinsic, and objects of science and medicine (39)

objective-self fashioning—”an ongoing process of social accounting to oneself and others in particular situations in which received-facts function as particularly powerful resources because they bear the objective authority of science” (44)

identification— borrowed from psychology and semiotics, “we can characterize our relationship to culture as identification.In Kenneth Burke’s definition, identification includes the “ways in which we spontaneously, intuitively, even unconsciously persuade ourselves” (Burke, 1966, p. 301)” (36)

 

Abstract

This article considers the roles played by brain images (e.g., from PET scans) in mass media as experienced by people suffering from mental illness, and as used by scientists and activist groups in demonstrating a biological basis for mental illness. Examining the rhetorical presentation of images in magazines and books, the article describes the persuasive power that brain images have in altering the understanding people have of their own body—their “objective self.” Analyzing first-person accounts of encounters with brain images, it argues that people come to understand themselves as having neurotransmitter imbalances that are the cause of their illnesses via received facts and images of the brain, but that this understand- ing is incomplete and in tension with the sense that they are their brain. The article concludes by querying the emergence of a “pharmaceutical self,” in which one experiences one’s brain as if on drugs, as a new form of objective self-fashioning.”


Annotation Summary for: Dumit – Is It Me or My Brain

Page 1, Highlight (Cyan):
Content: “PERSUASIVE IMAGES”

Page 2, Highlight (Cyan):
Content: “In1983, Voguepublishedits first brainimages inanarticleentitled“High-TechBreakthrough in Medicine: New seeing-eye machines …look inside your body, can save your life”with a simple graphic accompaniment: three similar, oval-like blobs filled with dissimilar patterns of bright colors (Hixon, 1983)”

Page 2, Highlight (Cyan):
Content: “blobs filled with dissimilar patterns of bright colors (Hixon, 1983). Underneatheach shape is a white word in bold font standing out from the black background: NORMAL, SCHIZO, DEPRESSED. ”

Page 2, Highlight (Cyan):
Content: “Presumably, these brains belong to different people, three different kinds of persons because their brains are not the same.”

Page 2, Highlight (Cyan):
Content: “Borrowing a term from psychology and semi- otics, we can characterize our relationship to culture as identification.In Kenneth”

Page 2, Underline (Magenta):
Content: “Borrowing a term from psychology and semi- otics, we can characterize our relationship to culture as identification.In Kenneth”

Page 3, Highlight (Cyan):
Content: “Burke’s definition, identification includes the “ways in which we spontaneously, intuitively, even unconsciously persuade ourselves”(Burke, 1966, p. 301).5”

Page 3, Underline (Magenta):
Content: “Burke’s definition, identification includes the “ways in which we spontaneously, intuitively, even unconsciously persuade ourselves”(Burke, 1966, p. 301).5”

Page 3, Highlight (Cyan):
Content: “.5 As inanalyses of ideology, the rightness of facts seems to emerge from our own expe-rience.6 This notion of self-persuasion helps us keep in mind both the persuasiveaction of received facts (e.g. from a magazine), and the form in which we often(but not always) incorporate themas facts. ”

Page 3, Highlight (Cyan):
Content: “Facing the brain images in Vogue, for instance, there appears to be something intuitivelyright about a brain-imagingmachine beingable toshowus the difference between schizophrenic brains and normal ones.”

Page 3, Highlight (Cyan):
Content: ” The images with their labels are part of the process of normalizing the assumption of difference, even though rationally we maystill remember that this is acategorymistake, asubstitutionof somedifferences seen in difficult-to-interpret scans for the categorical assumption of differences inkind.”

Page 3, Highlight (Cyan):
Content: “Consider this first relationship to brain images as what Sander Gilman de- scribes as the desire to have madness be markedly different from us, who are thereby normals (National Commission on the Insanity Defense, 1983).”

Page 3, Underline (Magenta):
Content: “at Sander Gilman de-scribes as the desire to have madness be markedly different from us, who are thereby normals (National Commission on the Insanity Defense, 1983). ”

Page 3, Underline (Red):
Content: “Sander Gilman (National Commission on the Insanity Defense, 1983).”

Page 3, Highlight (Cyan):
Content: ” AsecondrelationshipI will consider reads the difference betweenthe brains of mental illnessand normality as biological and therefore positive. Depression and schizophreniaare thus real, objective diseases and normal problems. Finally, I will sketch outhow some people who suffer from mental illness symptoms come to see theirsymptoms as the expression of an illness, and as a brain disease. But while they”

Page 4, Highlight (Cyan):
Content: “find this biological presentation exciting, it is not ultimately helpful for living with illness.”

Page 4, Highlight (Cyan):
Content: “OBJECTIVE-SELF FASHIONING”

Page 4, Highlight (Cyan):
Content: “Wittgenstein’s exploration of the boundaries of the meaning of a priori brings him to culture: we know these things because we have read them in textbooks and heard them from adults who we trust.”

Page 4, Highlight (Cyan):
Content: ““How do we know,” he was fond of asking, “that we have a brain, if we have never seen it?” We have, he suggests, a kind of certainty that seems a priori, intuitively self-evident, “of course, it must be like that. This kind of certainty would be learned (because we aren’t born knowing about our brains), and yet logical.”
Page 5, Highlight (Cyan):
Content: ” At certain points (and not others) we no longer ask for an explanation or a test of its truth, and explanations come to an end: “Giving grounds, however justifying the evidence, comes to an end; —but the end is not certain propositions’striking us immediatelyas true, i.e. it is not a kind of seeing on our part; it is our acting, which lies at the bottomof the language game”(On Certainty, p. 204).8 We might call the set of acts that concerns our brains and our bodies deriving from received-facts of science and medicine the objective-self.9 ”

Page 5, Highlight (Yellow):
Content: “objective-self.9″

Page 5, Highlight (Cyan):
Content: ” The objective- self consists of our taken-for-granted notions, theories, and tendencies regarding human bodies, brains, and kinds considered as objective, referential, extrinsic, and objects of science and medicine. That we “know”we have a brain and that the brainis necessary for our self is one aspect of our objective-self. ”

Page 5, Stamp (Star (Frame, Red))

Page 5, Highlight (Cyan):
Content: ” Furthermore, objective-selves are not finished but incomplete and in process. With received-facts we fashion and refashion our objective-selves. Thus it is we come to know our bodies as endangered by poisons like saccharine, our brains as having a “reading circuit,” and humans as being either mentally ill or sane or borderline. I call this “objective-self fashioning” to highlight our own activity in en- countering “received-facts.” I emphasize “received-facts” rather than just “facts”to highlight the activity of translation that has taken place in order for the results of a scientific or medical project to reach us”

Page 5, Highlight (Yellow):
Content: ““objective-self fashioning”

Page 5, Highlight (Cyan):
Content: “s. Each of these movements of facts fromone media to another is also necessarily a transformation of the fact. Science studies scholars Bruno Latour and Michel Callon call this process “translation,”aterm connoting both movement and change in meaning. We all know that a fact established in a lab is not known immediately by everyone, everywhere. It must travel through specific channels.”

Page 5, Underline (Red):
Content: “Bruno Latour Michel Callon”

Page 5, Highlight (Cyan):
Content: “Each of”

Page 5, Underline (Magenta):
Content: “Each of”

Page 6, Highlight (Cyan):
Content: “the aspects of our objective-selves has this personal history (of coming-to-know via received-facts) and also a social history.”

Page 6, Underline (Magenta):
Content: “Some human kinds that we are starting to take for granted, e.g., depressives, require attending to broader social and institutional forces in order to understand how it is that we look to the brain for an answer. the aspects of our objective-selves has this personal history (of coming-to-knowvia received-facts) and also a social history. ”

Page 6, Highlight (Cyan):
Content: “In the case of the brain, the social history includes how it came to be an object of study in the first place, and what factors—conceptually, institutionally, and technically—were part of its emergence as a fact. When did it first become possible to think of the brain as having dis- tinct areas that can break or malfunction? How and when did the brain come to have “circuits”? What techniques and technological metaphors (like telegraphsand electricity) were needed to make the problemposeable? What disciplinary and institutional funding mechanisms were available to make the poseable questions answerable?10 Some human kinds that we are starting to take for granted, e.g., depressives, require attending to broader social and institutional forces in order to understand how it is that we look to the brain for an answer.”

Page 6, Highlight (Cyan):
Content: “These social histories enable and constrain science at every level of factconception, experimentation, publication, and dissemination and reception, butthis does not imply that science is culture. Science produces facts in spite of andbecause of these constraints—laboriously, continuously, and creatively”

Page 6, Highlight (Cyan):
Content: “And we fashion our objective-selves with the fruit of this labor in the formof received-facts in our own continuous and often creative manner, no matter howskeptical we are. This way of living with and through scientific facts is our formof life.11”

Page 6, Underline (Magenta):
Content: “And we fashion our objective-selves with the fruit of this labor in the formof received-facts in our own continuous and often creative manner, no matter howskeptical we are. This way of living with and through scientific facts is our formof life.11”

Page 6, Highlight (Cyan):
Content: “BRAIN IMAGES AS ARGUMENTS AND AS FACTS”

Page 7, Highlight (Cyan):
Content: “Jamison’s appropriation of the PET images emphasizes how side-by-side it is clear that there are very big differences in brain metabolism between manic and depressed states. We do not have to suspect the accuracy of the underlying experiments in order to recognize that the visual appearance of “graphically”different brain-type images is produced in part by a choice to visualize the data as very different in color.”

Page 7, Highlight (Cyan):
Content: “Comparative images are one of the most powerful, persuasive presentations of brain-type data.”

Page 7, Highlight (Cyan):
Content: “Jamison’s argument is explicitly aligned with such popular, activist groups as the National Alliance for the Mentally Ill (NAMI), which are dedicated to lobbying for increased research into mental illness, improving the care of the mentally ill, and combating stereotypes and the stigma of madness.”

Page 7, Highlight (Cyan):
Content: “Mother-blame combined with an anti-eugenic stance helps explain how passing a gene for schizophrenia to your child involves no blame but instead is an anti-stigma claimin which a malevolent biology inflicts mental illness upon an innocent and otherwise normal human being.”

Page 7, Highlight (Cyan):
Content: “EMBODIMENT: FACINGFACTS”

Page 8, Highlight (Cyan):
Content: “Faced with the fact of her brain being sick, Thompson is caught. In some very real sense, she knows too much about her brain. The solution Thompson eventually discovers is not to disavow either alter- native, but to create a new type of human, a depressed human, who is also a type of brain, a depressed brain.”

Page 8, Highlight (Cyan):
Content: “she forges a positive iden- tification with her own brain-illness. Sheis a depressed person because she has a depressed brain.”

Page 9, Highlight (Cyan):
Content: “These sufferers’ accounts point toward a particular kind of self I want tocall a pharmaceutical self whose scale is one of days and weeks. Contrary to a Heideggerian phenomenology in which one is passively thrown into moods, here one’s abnormal neurochemistry actively throws one into depression or mani”

Page 9, Highlight (Cyan):
Content: “Sometimes one can respond to this by taking drugs that, days or weeks later, throwyou into yet a third state—not normal, but better.”

Page 10, Highlight (Cyan):
Content: “These accounts illustrate three critical aspects of objective-self fashioning for our purposes. First, there is a tremendous flexibility and openness of explanation of the objective-self.”

Page 10, Underline (Blue):
Content: “These accounts illustrate three critical aspects of objective-self fashioning for our purposes. First, there is a tremendous flexibility and openness of explanation of the objective-self.”

Page 10, Highlight (Cyan):
Content: “Even in the face of specific received-facts about ourselves such as brain images, there is room for negotiation and redefinition. Sociologists and anthropologists of psychology have called this the “pandemonium” of folkpsychology. But they also note that even as we can play with mind and brain, motivation and behavior, we also ultimately must satisfy local common sense.13”

Page 10, Stamp (Star (Frame, Red))

Page 10, Highlight (Cyan):
Content: “The secondaspect of objective-self fashioningwe needtohighlight is the need for a nuanced, complex cultural, historical and institutional as well as scientificor biomedical understanding of context. Objective-self fashioning is an ongoing process of social accounting to oneself and others in particular situations in which received-facts function as particularly powerful resources because they bear the objective authority of science”

Page 10, Underline (Blue):
Content: “The secondaspect of objective-self fashioningwe needtohighlight is the need for a nuanced, complex cultural, historical and institutional as well as scientific or biomedical understanding of context.”

Page 10, Highlight (Yellow):
Content: “Objective-self fashioning”

Page 10, Underline (Magenta):
Content: “Objective-self fashioning is an ongoingprocess of social accounting to oneself and others in particular situations in whichreceived-facts function as particularly powerful resources because they bear theobjective authority of science.”

Page 10, Stamp (Quote!)

Page 10, Highlight (Cyan):
Content: “The third critical aspect of objective-self fashioning is the fundamental con-nection between the brain as objective-self and one’s own personal identi ty. When genes are invoked as the cause of one’s objective-self and aspects of one’s per-sonality they can become synecdoche for one’s identity. If one has a gene for depression, one can fear becoming depressed. ”

Page 10, Underline (Blue):
Content: “The third critical aspect of objective-self fashioning is the fundamental con-nection between the brain as objective-self and one’s own personal identit”

Page 10, Highlight (Cyan):
Content: “We can note here that brain images further confuse the part with the whole—even though brain images only show a slice of the brain, they show the slice as representing the whole brain, which in turn is the person.”

Page 10, Underline (Red):
Content: “13“We play with the terms of, but also ultimately satisfy, Western (cultural) common sense” (Lutz, 1992, p.185).”

Page 11, Highlight (Cyan):
Content: “The relationship between Thompson, Stephen or Jamison and their brainsappears to be a form of embodiment, but one not well studied in anthropology.Research on embodiment and the medicalized body have tended to oppose thetwo, with the lived, active body in opposition to the passive, objective, medicalbody (Merleau-Ponty, 1964). In the case of the brain in biomedical America,PET scan brain-types reveal a medicalized but active, unruly and almost alwaysirrational brain. ”

Page 11, Highlight (Cyan):
Content: “Objective-selves, received-facts, and brain-types are thus “not terms that avoidambiguity, but terms that clearly reveal the strategic spots at which ambiguities necessarily arise”(Burke, 1945, pp. xix, xviii, emphasis in original).”

Page 11, Highlight (Cyan):
Content: “A key point to remember here is that thefacts of biology that these groups are organizing around are not necessarily fullyestablished within the scientific community”

Page 12, Highlight (Cyan):
Content: “Individual sufferers are trying to both understand their illness and live with it. These are activities that are not necessarily compatible. Using the notion of the pharmaceutical self, I would suggest that they have entered into a relationship with their brain that is negotiated and social.”

Page 12, Underline (Red):
Content: “Althusser, L. (1984). Essays on ideology. London: Verso.”

Page 13, Underline (Red):
Content: “Lutz, C. (1992). Motivated models. In R. G. D’Andrade & C. Strauss (Eds.),Human motives and cultural models (pp. 181–190). Cambridge: Cambridge University Press.”

Page 13, Underline (Red):
Content: “Martin, E. (1994). Flexible bodies: Tracking immunity in American culture from the days of polio to the age of AIDS. Boston: Beacon Press.”

Page 13, Underline (Red):
Content: “Merleau-Ponty, M. (1964). Signs. Evanston, IL: Northwestern University Press.”

Page 13, Underline (Red):
Content: “National Commission on the Insanity Defense. (1983). Myths &realities: Hearing transcript of the Na- tional Commissiononthe Insanity Defense. Sponsoredbythe National Mental HealthAssociation.”

Page 13, Underline (Red):
Content: “Poovey, M. (1998). A history of the modern fact: Problems of knowledge in the sciences of wealth and society. Chicago: University of Chicago Press.”

Page 13, Underline (Red):
Content: “Porter, T. (1995). Trust in numbers: The pursuit of objectivity in science and public life. Princeton, NJ: Princeton University Press.”

Page 13, Underline (Red):
Content: “Shapin, S., & Schaffer, S. (1985). Leviathan and the air-pump. Princeton, NJ: Princeton University Press.”

Page 13, Underline (Red):
Content: “Whitehead, A. N. (1957 [1938]). Modes of thought. New York: The Macmillan Company.”

Page 13, Underline (Red):
Content: “Wittgenstein, L. (1958). Philosophical investigations, Part I. Oxford: B. Blackwell. Wittgenstein, L.(1991). On certainty. San Francisco: Arion Press.”

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