ABSTRACT Title of Document: NARRATIVE AND SELFHOOD IN THE ANTIDEPRESSANT ERA Jeffrey Nicholas Stepnisky, Doctor of Philosophy, 2006 Directed By: Distinguished University Professor George Ritzer, Sociology This dissertation is a study of the relationship between antidepressant medications, self-understanding, and the narrative construction of self. The analysis relied upon two kinds of empirical data. First, advertisements for antidepressants in popular magazines, television, and online promotional websites were collected. Second, interviews were conducted with 23 people who were taking or had taken antidepressant medications. It is argued that antidepressants are components of the larger social processes of risk, biomedicalization, and individualization. In contrast to a narrative view, which conceives selfhood as a dialogical and embodied achievement, the antidepressants participate in a set of discourses that sustain atomistic conceptions of the self. The analysis emphasizes the personal agency that antidepressant users bring to bear upon their use of antidepressants. Chapter one is an introduction to theories of risk, individualization and narrative as well as the ways in which narrative and selfhood are potentially transformed through the use of antidepressants. Chapter two offers an analysis of three theoretical conceptualizations of the relationship between biomedicine and selfhood: naturalism, poststructuralism and the narrative-hermeneutic perspective adopted in the dissertation. Chapter three analyzes the advertising materials emphasizing the manner in which relationships are constructed between selfhood, biology and antidepressant medications. Chapters four, five and six introduce interview materials in order to examine: a) how people learn to use antidepressants and in doing so come to split-off and manage unwanted elements of their selves, b) the ways in which the popular discourse of authenticity (being a “real” self) is transformed in the encounter with antidepressants, and c) the manner in which the antidepressants are taken up in social institutions such as the family. The dissertation concludes with a reflection upon the implications of a shift from a form of selfhood composed in narrative and relationship, to a form of post-social selfhood composed through the use of technologies such as antidepressants. NARRATIVE AND SELFHOOD IN THE ANTIDEPRESSANT ERA By Jeffrey Nicholas Stepnisky Dissertation submitted to the Faculty of the Graduate School of the University of Maryland, College Park, in partial fulfillment of the requirements for the degree of Doctor of Philosophy 2006 Advisory Committee: Professor George Ritzer, Chair Professor C. Fred Alford Professor James Glass Professor Meyer Kestnbaum Professor Laura Mamo © Copyright by Jeffrey Nicholas Stepnisky 2006 Dedication This dissertation is dedicated to my parents, Jerry and Vera Stepnisky, whose continuing love, faith, and support have allowed its completion. ii Acknowledgements I am grateful to the 23 people who volunteered their time and stories to this dissertation. In addition, I appreciate the less formal conversations I’ve had with friends, acquaintances, and colleagues on these matters. They spoke honestly and sincerely about experiences sometimes difficult, oftentimes stigmatized, but always intriguing. I hope that this study captures something of their experience, and offers a meaningful account of their engagement with antidepressants. I am also grateful to the administrative staff in the Department of Sociology who eased my negotiation of the dissertation process. In particular, Wanda Towles was crucial in helping to arrange interview space and tending to unexpected administrative matters. I am also thankful to the family of Milton Dean Havron and the College of Behavioral and Social Sciences who provided funds for completion of this dissertation. Numerous friends and colleagues provided support. Though from a distance, I continue to learn from my friend and mentor Leo Mos at the University of Alberta. His influence is apparent throughout this dissertation. Sean Johnson Andrews showed me how to gain access to the television advertisements so central to chapter three. At the University of Maryland, Jim Murphy, Todd Stillman, Wendy Wiedenhoft, and Anthony Alvarez provided intellectual nourishment from the day that I arrived in the program. As members of a short-lived but important dissertation reading group, Emily Mann, Anthony Hatch and Michelle Corbin, provided feedback and encouragement on early formulations of this dissertation. Members of the Department of Sociology work-in-progress seminar were also helpful in this regard. iii I have been fortunate to study and learn from faculty at the University of Maryland. Richard Harvey Brown, though now departed, guided my early progress through the sociology program. I remember him for his eclectic love of social theory and dedication to his students. My dissertation committee has contributed in ways both tangible and intangible. Jim Glass has offered invaluable intellectual and professional guidance throughout my studies at Maryland. I am grateful to Fred Alford for the numerous conversations we have shared over the past two years. Not only were these intellectually stimulating, but they proved indispensable to the formulation and development of many of the ideas in this dissertation. Laura Mamo was always enthusiastic about this project, but I am especially thankful for the ways that she pushed the dissertation in directions that I could not at first imagine. Meyer Kestnbaum’s passion for ideas and unflagging encouragement have been a much valued constant throughout this process. My advisor and chair George Ritzer has shown a confidence and faith in my intellectual ability that has sustained this study from the beginning. I am forever thankful for his support and wise critical eye. This dissertation could not have been written without the help of family. My father possesses a love of life which I try to emulate in my work and life. My mother’s love, keen intellect, and expertise as a pharmacist have been indispensable in writing this dissertation. The encouragement and interest shown by my brother and sisters – Dave, Laura and Marissa – has helped me greatly. Finally, I thank Michelle Meagher who continues to fill me with joy and comfort. From her I learned the discipline necessary to writing a dissertation. More importantly I have been inspired by her care for others and dedication to a social and cultural theory that can be relevant to life as it is lived. iv Table of Contents Dedication........................................................................................................................... ii Acknowledgements............................................................................................................iii Table of Contents................................................................................................................ v List of Figures................................................................................................................... vii Chapter 1: The Challenge of Biomedical Selfhood ............................................................ 1 The Rise of Antidepressants ......................................................................................... 15 Teresa’s Story ............................................................................................................... 29 Chapter 2: Meta-Theoretical Possibilities......................................................................... 44 Nature’s Self ................................................................................................................. 49 The Deconstructed Self................................................................................................. 59 The Hermeneutic Self ................................................................................................... 73 Plot: Narrative as structure........................................................................................ 86 Catharsis: Narrative as expression............................................................................ 90 Embodiment: Narrative as embodied activity........................................................... 93 Conclusion: A Narrative Theory of Antidepressant Medications................................. 99 Chapter 3: The Language of Antidepressant Advertising............................................... 112 Disease, Biology, and Antidepressant Medications.................................................... 117 The Punctual Self in Antidepressant Advertising....................................................... 129 The Before and After Narrative .................................................................................. 138 Conclusion .................................................................................................................. 149 Chapter 4: The Practice of Using Antidepressants ......................................................... 158 Disruption and Relief.................................................................................................. 166 The Use of Antidepressants ........................................................................................ 176 Tara’s example........................................................................................................ 180 Making distinctions................................................................................................