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The Moral Life of Adderall: Health, Empowerment, and Responsibility in the Era of Pharmaceuticalization

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The Moral Life of Adderall: Health, Empowerment, and Responsibility in the Era of Pharmaceuticalization THE MORAL LIFE OF ADDERALL: HEALTH, EMPOWERMENT, AND RESPONSIBILITY IN THE ERA OF PHARMACEUTICALIZATION By Tazin Karim Daniels A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of Anthropology – Doctor of Philosophy 2016 ABSTRACT THE MORAL LIFE OF ADDERALL: HEALTH, EMPOWERMENT, AND RESPONSIBILITY IN THE ERA OF PHARMACEUTICALIZATION By Tazin Karim Daniels My dissertation is an ethnographic exploration of how pharmaceutical morality is challenged, negotiated, and reconstructed across the social life of prescription stimulants. It is situated within the modern American university, where students are experimenting with drugs such as Adderall and Vyvanse in an attempt to improve academic performances. Sanctioned for the treatment of Attention Deficit/Hyperactivity Disorder (ADHD), these powerful medications require a doctor’s prescription to access legally. However, studies indicate that they are commonly circulated among peers, leading to proscribed consumption rates of up to 43% in some college populations. Existing research focuses primarily on the motivations of the illicit user and describes their pharmaceutical choices according to neoliberal logics. I build on this work by also considering the moral logics that students rely on to rationalize their controversial behaviors. Moreover, I examine how these logics are translated and absorbed as they filter through the economic, medical, and academic landscapes that circumscribe the user experience. This includes questions of safety, fairness, legality, and efficacy posed by pharmaceutical advertisers, heath service providers, and drug dealers – many of whom contribute to definitions of “responsible” stimulant use in the university setting. Data for this project was based on ethnographic fieldwork conducted from 2012 to 2014 at a large public institution, which I refer to as “American State University.” It is centered around semi-structured interviews and participant observations with 45 undergraduates, aimed at explicating the the complex set of values and concerns that are associated with Adderall in the college environment. I interacted with these individuals over 12 to 24 months in various capacities as they avoided, procured, distributed and consumed stimulants in public and private settings. To provide context for these student-centered experiences, I also conducted a critical discourse analysis of select direct-to-consumer (DTC) pharmaceutical marketing campaigns and interacted with medical and educational professionals on and around campus. In combination, these methods provided key insights into how discourses around responsible stimulant use were constructed and diffused by these various actors during their interactions with students. My findings suggest that engagements with prescription stimulants have become a fundamental part of how numerous students construct themselves and are constructed by others as healthy, empowered, and responsible individuals. In particular, the flexibility of Adderall as a medication, enhancement, and recreational drug allowed both users and providers to mold its symbolic meaning into a form that would complement or enhance their moral sense of self. However, my data illustrates how flexibility can lead to instability as students struggled to make sense of the social and chemical implications they experienced during circulation and consumption. I argue that this instability triggered what Zigon (2007) describes as “moments of moral breakdown” which were based in concerns over medical non-compliance, malingering, social stigma, drug dealing, academic dishonesty, and addiction. My multi-methodological approach allowed me to document the strategies informants developed to preclude and respond to these moments of moral breakdown, and the multiple functions of Adderall within these rationales. As a result, my research provides ethnographic evidence to better understand how students manage the double-edged flexibility/instability of prescription stimulant use in order to operate unreflectively in an increasingly pharmaceuticalized environment. ACKNOWLEDGEMENTS This dissertation would not have been possible without the support of so many individuals and institutions that I have had the honor of working with during my time at Michigan State University. First and foremost, I would like to thank my advisor, Dr. Heather Howard, for all of her efforts in helping me complete this project. She has pushed me to think about my work in new and creative ways that have significantly impacted the intellectual value of this research. Through her mentorship, she has also taught me how to be a better writer and anthropologist, and instilled skills that will carry me far beyond this degree. I would also like to thank the rest of my committee for their continued compassion and pragmatism throughout the research and writing processes. I would like express my gratitude to Dr. Mindy Morgan, who has supported my work from the beginning and taught me how to maintain a critical and thoroughly anthropological perspective in everything I write. My dissertation has benefited greatly from Dr. Linda Hunt’s theoretical and methodological expertise and keen analytical eye. I am also grateful for the contributions of Dr. Christina DeJong who has been a wonderful mentor and supporter throughout my graduate career. There are also a number of individuals from Michigan State University whose advice and guidance have made my time in graduate school incredibly fulfilling. I would like to specifically acknowledge Ethan Watrall, Julie Libarkin, Stephen Thomas, Gabe Ording, and Melissa McDaniels for providing me with so many opportunities to improve my scholarship. I am also in debt to the Department of Anthropology, as well as the Centers for Integrative Studies for General Sciences and Social Sciences for their support through various assistantships and fellowships. I am especially grateful for the contributions of the Wenner-Gren Foundation for iv Anthropological Research, who awarded me with a dissertation fieldwork grant in support of this project. I would also like to thank the professional mentors who have contributed to the intellectual development of this dissertation and my own development as an anthropologist. I would especially like to thank Gilbert Quintero, Michael Oldani, Joseph Dumit, William Garriott, and Mark Nichter for helping me think through this project and navigating the exciting field of pharmaceutical anthropology. I am grateful for the overwhelming support and encouragement of my colleagues from the Alcohol, Drugs and Tobacco Study Group (ADTSG) who have pushed me to see the value of my work across academic boundaries. This includes but is not limited to Roland Moore, Juliet Lee, Kristen Ogilvie, Daniel Lende and Bryan Page. I am also grateful for the wisdom and encouragement of Eileen Anderson-Fye, Helena Hansen, Mimi Nichter, Eugene Raikhel, Anita Hardon and Todd Meyers. This research represents the collaborative efforts and success of several dedicated undergraduate research assistants whom I have had the pleasure of mentoring over the course of this project. I am particularly indebted to the hard work and encouragement of Breanne Casper, Shivani Pandya, Breanne Block, Erin Mobley, Nick Flagga, Mariah Hall, Joey Podrasky, Stephen Sullivan, and Max Van Oostenburg. I continue to be in awe of their self-motivation and professionalism and hope their experience on this project will serve them in their future academic and professional careers. Finally, I would like to express my profound gratitude to my friends and family for their relentless support and encouragement throughout this process. Thank you to my writing group: Rowenn Kalman, Becca Muenick, and Heather Yocum – and a special thank you to Fredy Rodriguez-Meija for being a dedicated partner through this last year. I would also like to v recognize my dear friends Diane Duvall, Michael Baron Jeffrey, Adam Haviland, Ashley Sanders, Danya Fast, and Seven Mattes for their personal and professional support. I am grateful for my friends who have helped me maintain a healthy and productive life both inside and outside of graduate school. I am particularly grateful to my colleagues from the Macias Athletic Club and East Lansing Soccer for giving me an excuse to get out of my office. Last but not least, I would like to thank my parents and younger brother who have instilled in me a love for knowledge and learning and supported me in every step towards this degree. And to my incredible husband, best friend, and life partner, Ryan Daniels – I love you. We did it. vi TABLE OF CONTENTS LIST OF TABLES ........................................................................................................................ x LIST OF FIGURES ..................................................................................................................... xi CHAPTER 1: INTRODUCTION ................................................................................................ 1 1.1 PHARMACEUTICAL MORALITY.................................................................................... 3 1.1.1 Anthropology of Morality .............................................................................................. 4 1.1.2 Anthropology of Pharmaceuticals .................................................................................. 9 1.1.3 Moral Frameworks ......................................................................................................
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