Journal of the Society for

Psychological Anthropology

PORTRAITS OF PHARMACEUTICAL TRANSFORMATION 257

Childrens Sense of Self in Relation to Clinical

Processes: Portraits of Pharmaceutical
Transformation
Elizabeth Carpenter-Song

This article presents in-depth accounts of pharmaceutical transformation from the perspective of two
children diagnosed with behavioral and emotional disorders. These portraits provide the basis for an
examination of the complex interrelation between self and clinical processes. Narrative data were collected in the context of a 13-month anthropological study of the lived experiences of children diagnosed
with behavioral and emotional disorders and their families living in the northeastern United States.
Participating families (N 5 20) were from diverse racial/ethnic (African American, Euro-American, and
Latino) and socioeconomic backgrounds. Psychiatric diagnoses and pharmaceuticals present tangible
constraints in the lives of children that call attention to otherwise fluid and ephemeral self processes.
These accounts suggest that psychiatric diagnoses and psychotropic medications present dilemmas for
childrens developing sense of self, revealing limitations to biopsychiatric pharmaceutical promises.
[children, self processes, subjective experience, psychiatric disorder, pharmaceuticals]

I cant handle my own self without

the medicine handlin me.
F12-year-old African American boy

Understanding the impact of illness and clinical treatments on persons is an enduring

interest within social studies of medicine. In this article I examine how psychiatric disorders
and pharmaceutical interventions shape childrens subjective experience. I present the
experience-near accounts of two children diagnosed with behavioral and emotional disorders to illuminate how alterations of self processes, including behavior, emotion, and
cognition, through pharmaceutical technologies facilitate transformations in childrens
sense of self.
In a classic formulation of the sick role Parsons (1951) theorized changes individuals undergo as a consequence of illness and medical treatment. This original formulation spawned
decades of subsequent research seeking to delineate behaviors associated with illness
(Mechanic 1962; Suchman 1965; Kasl and Cobb 1966a, 1966b); document variations in how
sick roles are adopted (Twaddle 1969); and examine ethnic, cultural, and class variations in
illness behavior and help seeking (Gordon 1966; Koos 1954; McBroom 1970; Zborowski
ETHOS, Vol. 37, Issue 3, pp. 257281, ISSN 0091-2131 online ISSN 1548-1352. & 2009 by the American Anthropological
Association. All rights reserved. DOI: 10.1111/j.1548-1352.2009.01053.x.

258 ETHOS

1952; Zola 1966). From an anthropological perspective, the Parsonian tradition is limited
by its focus on an ideal type.1 Although the analysis facilitates examination of intertwined
individual and clinical processes during treatment, it leaves unaddressed the matter of
everyday lived experience.
Recognizing this theoretical and methodological gap, Conrad (1990) has contrasted outsider perspectives, including sick role, illness behavior, and sickness career, with insider
perspectives on the experience of illness. The former approach, in Conrads view, tends to
train analysis on institutional encounters, providerpatient interactions, and patienthood.
But, as Conrad observes, individuals with chronic illnesses spend little of their lives as
patients in clinical settings. As a result, he advocates a focus on the subjective experience and
management of illness in the context of peoples everyday lives. Attending to the ways in
which individuals and families navigate through clinical interventions in their lives is only
possible by engaging with the always distinctive character of local moral worlds that
encompass illness related distress (Kleinman 1988:5, 1995).
In contrast to a beliefs and behaviors theoretical orientation, experiential approaches
center instead on questions of meanings and experiences (Good 1994:5; Good and Good
1981, 1982). This reflects a sea change in culture theory more generally toward lived experience, individual agency, and intersubjectivity (Jenkins and Barrett 2004:78). Kleinmans
(1988) Illness Narratives is exemplary in its engagement with personal and cultural meanings
associated with illness and the bodily experience of suffering. Here, the inadequacy of a
model such as Parsonss (1951) is fully revealed. Self and illness cannot be parsed; one does
not don the role of patient and just as easily cast it aside. An orientation to experience engages the immediacy of pain, shame, hope, and fear as constitutive elements in the landscape
of chronic conditions.
The experiential approach that I adopt in this article aligns with recent theoretical concerns
with subjectivity (Jenkins and Barrett 2004) reflecting a growing recognition of the need to
engage simultaneously with inner psychological states as well as institutional, political, and
economic structures of power. In this vein, Good and colleagues argue that, subjectivity
denotes a set of critical issues for anthropologists working in contemporary societies, issues
different than those raised by classic studies of self, or person and emotion (Good et al.
2007:2). Specifically, the conceptual landscape of subjects and subjectivity impels consideration of the dynamics of power in ways that studies of self and personhood do not (cf. Good
et al. 2007; Biehl et al. 2007). A highly elastic category, subjectivity embraces the ensemble
of modes of perception, affect, thought, desire, fear, and so forth that animate acting subjects as well as the cultural and social formations that shape, organize, and provoke those
modes of affect, thought and so on (Ortner 2005:31).
It is this very elasticity that comprises both the principal strength and potential Achilles heel
of subjectivity. Although the fluidity of the term transcends the analytic dangers of ossifying
the individual and culture, the risk is that the term may prove overly inclusive and ambigu-

PORTRAITS OF PHARMACEUTICAL TRANSFORMATION 259

ous in its application. Here, Fischers (2007) recent proposal seeking different registers of
subjectivity is useful. Fischer suggests viewing subjectivity across four registersFthe political, psychological, linguistic, and biologicalFthat loop back on one another such that [t]his
feedback between the linguistic, personal, sociopolitical, and biological . . . allows nothing
to be taken at face value or at first sight (2007:424). Borrowing from Fischers terminology,
I am principally concerned in this article with interactions between psychological subjectivity
and the biological subject, that is, between ones sense of self and bodily processes, as mediated
through pharmaceutical technologies. Yet I have deliberately chosen to employ the vocabulary of self as I find it comparatively more experience-near than subjectivity in the cultural
context of the contemporary United States.
With respect to the self as an etic category, psychological anthropologists have dispelled
notions of a universal, unitary, stable construct and have instead emphasized cross-cultural
variability (Geertz 1983; Kirkpatrick 1983, 1985; Levy and Rosaldo 1983; Lutz 1988; Myers
1986; Rosaldo 1980; Shweder and Bourne 1984). Scholars working at the juncture of
narrative and self have argued that narrative processes constitute an essential resource in
the struggle to bring experience to conscious awareness (Ochs and Capps 1996:21) and a
fundamental human way of giving meaning to experience (Garro and Mattingly 2000:1;
Mattingly et al. 2008). This body of scholarship advocates a view of fragmented, multiple
selves that are connected in part through webs of personal narrative (Ochs and Capps 1996),
thereby emphasizing self processes as malleable and open to change across time and space.
However, the stress on the multiplicity and subjunctive (Good 1994) character of self
processes potentially clouds the concept and Hallowells classic formulation of the self in its
behavioral environment may offer a conceptual mooring. Hallowells concept of self
is grounded in self-awareness, in what he views as the fundamental human capacity for
discriminating between self and other as an object in a world of objects (1955:75). This
reflexive self-awareness is shaped in part by culturally specific parameters that together
provide the fundamental means of orienting oneself in the world. Scholars have observed
that Hallowells conception of self marks it as both universal and culturally specific as it links
perceptual processes with social constraints and cultural meanings (Csordas 1994:6;
Garro 2003). This view privileges first-person, experiential perspectives over cultural
models of self and personhood such that the scholarly imperative becomes examining how
cultural models of the self are taken up as a matter of everyday lived experience in specific
cultural contexts (Hollan 1992; Garro 2003).
The contemporary shift toward exploring biological bases for psychiatry and pharmaceutical intervention has resulted in new cultural models of the self in relation to mental health
problems. In particular, the transnational marketing and delivery of pharmaceuticals opens
spaces to reimagine certain ways of thinking, feeling, and acting as constituting neurological
problems with biochemical solutions. In this vein, Rose (2003) notes the emergence of
neurochemical selves and psychopharmacological societies. This cultural imaginary is a
realm of wonder drugs that promises better living through chemistry (Jenkins 2005),

260 ETHOS

rupturing assumptive existential worlds by necessitating that subjects make explicit otherwise tacit, ephemeral self processes and engage vigilantly in monitoring subjective
experience. We live in a culture in which self-formation has become more and more of a
conscious mission, instead of something pre-given (Svenaeus 2007:163). Psychotropic
medications are increasingly a part of this project of self-formation insofar as being on
drugs for life is becoming a normal condition in the United States (Dumit 2002).
Cultural studies of medications have attended well to the global marketing and consumption
of Western pharmaceuticals (Petryna et al. 2006) and have emphasized how pharmaceutical
companies shape global psychiatric practice by continually creating new markets for their
products through the commodification of health (Applbaum 2006; Vuckovic and Nichter
1997). Yet, as Jenkins (2005) notes, there remains a substantial disconnect between cultural
studies of medications and the subjective experience of medications. In the research that
forms the basis for this article, I have opted to bracket concerns with the globalization of
pharmaceuticals in favor of attending to the meanings and experiences of psychiatric disorders and treatments for individuals and families in the context of daily life. As such, I
position this article as a contribution to an emergent anthropology of pharmaceuticals
and, in particular, to a growing body of scholarship concerned with the lived experiences of
psychotropic medications (Biehl 2005; Jenkins and Carpenter-Song 2005).
I examine pharmaceutically mediated self transformation through the experiences of two
children who were diagnosed with, and medicated for, behavioral and emotional disorders,
including bipolar spectrum disorders and/or attention-deficit hyperactivity disorder
(ADHD). Children and adolescents in the United States are coming of age in a cultural
context marked by the historically and culturally unprecedented consumption of pharmaceuticals (Jenkins 2007). Within the United States, rates of diagnosis and pharmacological
treatment for a range of psychiatric disorders in youth have skyrocketed.2 According to
national estimates, 913 percent of children and adolescents in the United States are
diagnosed with serious emotional and behavioral disturbances (U.S. Department of Health
and Human Services 1999) and nearly five percent of U.S. children ages 417 were prescribed medication for behavioral and emotional difficulties during 200506 (Simpson et al.
2008). Yet childrens perspectives on psychiatric illness and pharmaceuticals have rarely
been considered. Daley and Weisner (2003) observe that youths explanatory models of
cognitive and social impairment have received scant attention and Floersch (2003) argues
that scholars have not examined how youth make sense of treatment with psychotropic
medications. Such observations reflect a more general neglect of attention to youth within
the medical social sciences (Davis et al. 2000; Fabrega and Miller 1995; Mayall 1998).
For children, the pursuit of mental health services and the taking of medications occur from
the structurally disadvantaged social position of youth. Although there has been a shift
toward advocating for patient-centered care and the sharing of clinical decisions in mental
health services generally, such paradigms appear to hold little relevance for how children
themselves engage with mental health care. Decisions to seek treatment, which providers to

PORTRAITS OF PHARMACEUTICAL TRANSFORMATION 261

see, what forms of intervention will be utilized, and when (and if) to terminate services are
under the purview of adultsFparents, teachers, mental health professionalsFin the lifeworlds of children. These patterns mirror decades of scholarship examining nonpsychiatric
pediatric medical encounters that find children are rendered silent or passive in the context
of interactions with clinicians (Silverman 1981; Strong 1979; West 1984).
A central thrust of the recent resurgence of interest in children and childhoods within
anthropology is an emphasis on childrens agency (Bluebond-Langner and Korbin 2007).
Western cultural assumptions that children are unable to engage meaningfully with and
become active participants in matters of health and illness have been shown to be erroneous.
Children exhibit detailed knowledge of their medical conditions often in spite of adult
efforts to conceal such knowledge from them (Bluebond-Langner 1978), develop complex
explanatory models of disability (Daley and Weisner 2003) and mental health (Armstrong
et al. 2000), employ creative coping strategies for the daily management of chronic conditions (Dell Clark 2003), and can make informed judgments in decisions concerning the
course of treatment (Alderson 1993; Miller et al. 2004). Matters of health and illness are
neither beyond the interest nor the comprehension of children.
Following from these studies, the present analysis begins from the stance that youth are
active stakeholders in their health, a position that aligns with an emphasis on the active
engagement of subjects in cultural construction that is characteristic of experiential
approaches. Thus, the recent medicalization of childrens behavioral and emotional distress
demands knowledge of childrens own perspectives and offers the possibility of tying
psychological anthropologys long-standing interest in self processes and medical
anthropologys concern with illness experience together with an interest in childrens
everyday lived experience. Understanding how psychiatric disorders and psychotropic
medications mediate self processes is an increasingly important arena for investigation and
contributes to scholarship concerned with the interrelation between self and chronic illness
or disability (Ablon 1984; Charmaz 1983; Edgerton 1993; Estroff 1989; Estroff et al. 1991;
Jenkins and Carpenter-Song 2005; Kleinman 1988; Lester 1997; Murphy 1990).

Description of the Study and Ethnographic Setting

The two children considered in depth in this article were participants in a 13-month
anthropological study of the lived experiences of behavioral and emotional disorders among
children and families. These children and families lived in a midsize metropolitan area of the
northeastern United States. At the time of data collection in 200506, the city was ranked as
the poorest large city in the nation and had the most children living in poverty (U.S. Census
Bureau 2006). Although the study sample as a whole ranged from low to high income, the
two children in this article were alike in coming from low-income backgrounds. The racial
ethnic diversity of the larger study sample is reflected in the children in this article, who selfidentified as African American and Euro-American, respectively.3 Participating families

262 ETHOS

were recruited from two sites: (1) a community mental health center serving a predominantly African American and lower-income population, or (2) a research university hospital
setting serving a largely Euro-American and middle-income population.4
Of the children in the study,5 19 were diagnosed with bipolar spectrum disorders and/or
attention-deficit hyperactivity disorder (ADHD).6 Diagnoses were made as part of another
research study titled, Improving the Assessment of Juvenile Bipolar Spectrum Disorder,
(5R01 MH066647, PI: E. Youngstrom) and were assessed using the K-SADS-PL Plus, an
adapted version of the Schedule for Affective Disorders and Schizophrenia for School-Age
Children-Present and Lifetime version (K-SADS-PL; Kaufman et al. 1997) conducted with
youth and parent or guardian. Most of the children (n 5 15) in the study were taking one or
more psychotropic medications, including stimulants (n 5 14), antidepressants (n 5 3), anticonvulsants (n 5 3), atypical antipsychotics (n 5 7),7 and an antihypertensive drug used for
behavioral problems (n 5 2).8
Meanings and experiences of mental health treatment were explored through convergent
methods of ethnographic interviewing and participant observation. The Subjective Experience
of Illness and Medications in Youth (SEIMY) interview was administered to all parents and
children in the study. The SEIMY is a semistructured interview adapted from the Subjective
Experience of Medications Interview (SEMI) used in a study of adults diagnosed with schizophrenia-related disorders (NIMH R01 MH-60232; PI: J. H. Jenkins). Interviews took place in
participants homes and were conducted over multiple sessions. The interviews were audiotaped for verbatim transcription and analysis. The length of the interviews varied and the
number of research contacts with individual families ranged from two to twelve, reflecting
variations in interactive and communicative styles of families. In total, 102 home visits were
made to complete SEIMY interviews. A subset of eight families from the overall sample participated in more intensive participant observation across home, community, and clinical
contexts. All research protocols were reviewed and approved by the Institutional Review Board
of the university and participants gave their informed consent (adults) or assent (children) to be
involved in the research. In keeping with this protocol, all names used herein are pseudonyms.
Narrative data were analyzed with the aid of Atlas.ti, a qualitative coding software program
(using Atlas.ti, ver. 5.0). Using a hermeneutic approach, transcripts were reviewed for concepts of interest, producing a combination of researcher-driven and inductively derived
analytic categories. Broad themes such as explanatory model, power/control over problem, and medication experiences were gradually made more specific through iterative
review of the narratives for emergent details and subtleties.

Portraits of Pharmaceutical Transformations

To illuminate how psychiatric diagnoses and psychotropic medications mediate childrens
senses of self, I turn now to the experiences of Latasha Lewis, a 13-year-old African

PORTRAITS OF PHARMACEUTICAL TRANSFORMATION 263

American girl, and Brent Martin, an 11-year-old Euro-American boy. In a future article I
intend to examine childrens understandings of behavioral and emotional problems more
broadly across the participating families. For most children in the larger study, mental
health concerns remain muted in their lives.9 In fact, only five children in the study used
diagnostic labels in their interviews. The present analysis examines two children for whom
psychiatric diagnoses and mental health interventions were more fully thematized in everyday experience. I have chosen to use ethnographic portraits as a means to preserve the
wholeness of the childrens experiences. Other analytic strategies may offer the advantage of
a more comprehensive view across participants, but are limited by the tendency to shatter
the data and disembody narrative passages from the person and their lived-in contexts of
daily life (cf. Conrad 1990). Furthermore, thick description of subjects aligns with the
experiential theoretical and methodological orientation adopted as the basis for this article.
Latasha and Brent both gave extensive accounts of subjective transformations produced, in
large part, by their respective psychotropic medications. Attending to these accounts of subjective experience brings to the fore radically different orientations toward psychotropic
medicationFLatashas being quite negative and Brents overwhelmingly positive. Looked at
more closely, however, both accounts at times reveal conflicting perspectives. Although substantially different in tone, these accounts each speak to a deep-seated ambivalence regarding
the practice of ingesting pills everyday to remain focused, keep quiet, or stay out of trouble.

Latasha Lewis
Latasha Lewis lived with her mother, Michelle, and four siblings in a predominantly African
American neighborhood on the outskirts of the city. The family had moved to this neighborhood from another part of the city two years earlier when Michelle purchased a home
here. During my visits the house bustled with people as extended family members, neighborhood children, and friends would drop by unannounced to hang out and catch up on the
latest gossip. Michelle appeared to enjoy her house as a hub for family and friends, perhaps
especially because it kept her own children close to home in a neighborhood notorious for
drug activity and violence. Even so, Michelle had been unable to fully protect against the
incursion of drugs and violence into her family. Her eldest daughter regularly used alcohol
and drugs and was badly scarred from a fight in which a neighbor had slashed her cheeks
with a razor blade. Latasha preferred their previous neighborhood because it was a quiet
place and . . . like if you live out here you gotta watch your back . . . like its not bad in [our
previous neighborhood], but down here its bad.
Michelle worked two jobs and although the familys income was modest, the children were
treated to stylish clothes, cell phones, and eating out at local fast food restaurants. With a
smile, Latasha observed, Yeah, were spoiled. For Latasha, her cell phone was her lifeline
to friends and I frequently found her hunched over the tiny screen with her thumbs busily
tapping out text messages. At home, after she finished her chores of tidying the kitchen or

264 ETHOS

cleaning the bathrooms, Latasha enjoyed watching music videos with her sisters, showing
off new dance steps, playing video games with her younger brother, and writing poems in
her journal. She was active in the school choir and dreamed of becoming a pop singer. Like
several other girls in the study, she characterized herself as a tomboy, explaining to me that,
I dont really do all that girly stuff, before proudly flexing her well-defined bicep muscle.
She loved to run and would often dash into the house flushed and out of breath from playing
with friends outside.
When I arrived at the Lewiss house one February afternoon, Latashas mood appeared in
sync with the dreary weather outside. I sat with Latasha and her mother at the cramped
kitchen table as Michelle tried to get her daughter to explain why she was upset. Latasha
remained slumped in her chair, her eyes downcast. She was currently on punishment at
home because she had gotten in trouble for talkin and being disrespectful at school. At
this point, Michelle asked her daughter, What part of this has to do with your illness? to
which Latasha replied, Nothin. Michelle used this as an opening to educate and reinforce
Latashas knowledge of her diagnoses:
Michelle: What are you diagnosed with?
Latasha: What, like my medicine?
Michelle: No, what is your illness called?
Latasha: Bipolar and attention deficit.
Michelle: Scuse me?
Latasha: Bipolar and attention deficit.
Michelle: Attention deficit disorder with what? [pause] Hyperactivity. Can you say that?
Latasha: Hyperactivity.
Michelle: Can you say that one word, attention, can you say the whole thing?
Latasha: Attention deficit with hy-hyperactivity.
[...]
Michelle: What do you think bipolar is?
Latasha: Um, a lot of energy.
Michelle: What is attention deficit?
Latasha: I dont really know what attention deficit is, but all I know is that bipolar is
hyper, like provide me wit energy.

PORTRAITS OF PHARMACEUTICAL TRANSFORMATION 265

Michelle: Well hyperactivity, your attention deficit is your attention span, how you stay
focused. Your hyperactivity is you bein hyper. Your bipolar is your mood change.
Member us talking bout that? One moment youre happy, one moment youre sad.
One moment you wanna do some things, next you dont. Remember us talkin bout
that? Scuse me?
Latasha: No.
Michelle: And youre saying that your having problems is not because of your illness.

Such explicit education regarding psychiatric diagnoses was rare among the families in the
study. She was one of the few children in the study who described behavioral and emotional
problems using clinical language: I know about, like I got bipolar and attention deficit and
all that. In addition to her mothers efforts to encourage her daughter to memorize the
names of her disorders, Latashas facile use of diagnostic labels was also facilitated by the fact
that she had been receiving various forms of mental health services since the age of three.
Given her long history in the mental health system and her mothers openness regarding
mental health problems, it is somewhat surprising that Latasha did not have a well-elaborated
illness identity. In the exchange above, for example, she makes it clear that she does not
attribute her recent difficulties at school to an illness. Her understandings of ADHD and
bipolar disorder overlap with normative expectations for tween behavior: I just say like I
got a lot of energy and Im active a lot. Slippages between medicalized and normalized views
of her experience occurred throughout her narratives. Although at times she would make
reference to having a disease for which she was not at fault, in the next breath she was likely
to turn the tables and explain how much she enjoyed being hyper and having a lot of energy.
Latasha was adamant that she was no different from other children, a stance that was
supported by her family and friends who just act like Im a normal kid. Echoing Harry
Stack Sullivans (1962) characterization of persons with schizophrenia, Latashas diagnoses
appeared to render her only much more a kid. She maintained that all children have a lot of
energy and described those with bipolar disorder as just a little bit different [because] we
got more energy than other kids. In this respect, her psychiatric diagnoses appear to minimally impact her sense of self. She moves adeptly between viewing her experience as a
disease and as normal high energy, ultimately positioning herself as the same as other
people, with the exception that most of em [with bipolar disorder] gotta take medication.
Psychotropic medicationsFnot the diagnosesFtake on significance as the site and source
of difference. Latasha was prescribed methylphenidate HCl (Concerta), an extended-release
stimulant medication; risperidone (Risperdal), an atypical antipsychotic; and divalproex
sodium (Depakote), an anticonvulsant often prescribed for the treatment of bipolar disorder. By her account, the stimulant medication is for my behavior in the morning and for the
whole day; she takes the other medications together at night for my sleeping. She noted
that, when I dont take my medicine I be doin the bad things and I dont be focused. I just

266 ETHOS

talk a lot. By contrast, the medications make me not run around and talk off at the mouth.
Latasha only identified behavioral effects of her medications and, despite her diagnosis of a
bipolar spectrum disorder, never described affective changes resulting from her medications.
Latashas descriptions of the bodily effects of her medications align with the intended consequences of psychostimulants, namely to improve focus and inhibit motor (over)activity.
But, in Latashas case, such consequences are not experienced as welcome phenomenological changes. Explaining to her mother why she disliked taking her medications, she
described a cognitive transformation: Its like I dont be thinkin about nothing. Another
time, she elaborated on how the stimulant medication makes her too quiet:
I dont wanna eat or I just dont wanna be bothered. I just sit there and play with my
hands. I dont do anything. . . . I dont get to play or nuttin. I just sit there. . . . Okay, say
everybodys playin and they just ask me like, Do you wanna play? And I just say,
No, and then they come back another time and ask me again and I just say, No . . .
Ill just sit there.

By her account, the medication has reduced her energy to such a degree that Im just like a
statue. I just sit there and dont do nothing. By diminishing her playful energy, the
medications radically alter the way in which Latasha engages with the world. As she stated
forthrightly, I dont do nothin like I usually do. I dont act like myself. In short, the
medications have made her feel like a different person:
Yes, it has happened to me. I just feel like a different person. Like one day I took the
medicine and I just didnt feel like myself . . . I take my medicine and I just change to a
whole nother person, I just quiet all the time.

Elaborating on the difference between the two Latashas at my request, she explained that
The other person is like Im runnin around and playin and jumpin around and all that.
Latashas experience of feeling like a different person because of taking psychotropic
medications challenges the assertions of her normality. The medications present a dilemma,
demanding that she negotiate competing discourses: at once insisting that she is like everybody else while at the same time feeling fundamentally not like herself. In what could
be interpreted as an attempt to assert and reclaim herself, about two months into the study
Latasha stopped taking risperidone altogether and resorted to hiding pills in the sofa cushions because she felt it was slowing her down too much. Her strong sense of personal
agency was also evident when she called into question the necessity of taking medications:
Sometimes I think that I can do it without taking my medicine. Most of the time I can
just do it without takin my medicine because most of the time I dont take my medicine
I just do it by myself.

The negotiation of the triadic constellation of self-illness-medications is made doubly difficult

if we expand the analysis to consider the social field of taking medication. Although her peers

PORTRAITS OF PHARMACEUTICAL TRANSFORMATION 267

may not treat her differently on account of having problems or issues with her behavior,
she feared that others might make fun of me if they found out about her medication:
Latasha: . . . people dont really mess wit me about it. They might mess with me about
bein on medications, but they dont mess wit me about none of that.
Ethnographer: What do they say about the medication?
Latasha: That I take pills and that I used to take Ritalin.

Similarly, at one point she explained what she disliked the most about taking psychotropic
medications in connection with her psychiatric diagnoses:
Latasha: . . . the most thing that I dont like about it is I gotta take medication for it.
Because everybody gonna act like, just sayin things to me.
Ethnographer: About the meds?
Latasha: Uh huh. [nods yes]
Ethnographer: What do they say about it?
Latasha: Like Im on pills and I take medication and they make fun of me.
Ethnographer: How does that make you feel?
Latasha: Sad.

Not surprisingly, Latasha was cautious about to whom she revealed that she took medication.

Brent Martin
Brent Martin lived with his mother, Cassie, in a modest house on a suburban street of similarly modest homes. They shared a home with Cassies partner, Christine, and Christines
grandmother. The houses in the Martins neighborhood were all built equidistant from the
road, overlaying symmetry and order to an otherwise rundown tableau of pothole-pocked
streets, overgrown lawns, and peeling paint. Just a year earlier, Cassie Martin had moved
with her son and partner to this city from the northwestern United States after inheriting
the house from her grandfather. When I would arrive for a visit my presence was always
announced by the insistent squawking of the familys pet cockatoo. Although the house was,
in Cassies words, dated and, in Brents words, crappy, the atmosphere inside was comfortable and welcoming. The Wall of BrentFan assemblage of blue ribbons, certificates
of achievement, and school photosFformed the visual focus of the living room.
Brent enjoyed spending time with his family members, especially his grandmother because,
as he explained, the older they are the less time youre going to have em. He spent the

268 ETHOS

hours outside of school doing homework, helping with yard work, playing with friends, and
watching sports on television. He readily characterized himself as a jock. His family
members were all avid sports fans and, when money allowed, they enjoyed attending baseball games at the local stadium. To pay for such treats the family earned money from odds
and ends jobs like collecting scrap metal on the weekends. Family finances had been tight
ever since Cassie developed a chronic illness rendering her unable to work. In the wake of
her disability, the family had been forced to rely on a monthly governmental assistance
income of a few hundred dollars.
I was surprised to learn that Brent was 11 years old as he could have easily passed for 13 or
14. Physical size was not the sole contributor to this impression. Brent appeared at ease with
himself and his deliberate manner of speaking and vast vocabulary all lent him an air of
social control and sophistication that was unrivaled among the other boys in the study. He
described himself as a people person, elaborating that I like to hang out with friends.
I was not surprised to hear of the numerous academic awards he had received or of his
popularity among his peers. Academically, Brent had always performed well and he told me
that, second semester this year was the first time I ever got a B. Social interactions
appeared to come easily for Brent and, with pride, he told me that although he had only
recently moved to the area he had already befriended half of the school.
As we spent more time together it was difficult to reconcile this calm, well spoken, thoughtful
boy with the inattentiveness and hyperactivity taken to be hallmark signs of Brents diagnosis
of ADHD. Yet when we first met, Brent was grounded and he indicated that getting in
trouble was not uncommon: I usually dont go a week without being grounded. He readily
acknowledged being bad at times and having difficulty controlling my actions. Unlike
the concealment and silence surrounding matters of diagnosis and treatment that I commonly observed among other families in the study, the Martins openly incorporated mental
health concerns as a dimension of everyday discourse. Brent spoke matter-of-factly about his
diagnosis of ADHD, and like Latasha, was one of few children in the study to refer to problems using a diagnostic label. For Brent, ADHD was just meant to happen and he casually
stated that, This is just how I am. Although ADHD-related behaviors such as being hyper may cause him to get in trouble at school and to get grounded frequently at home, such
behavior was not discursively positioned as contrary to Brents sense of himself. Instead, he
appeared to recognize multiple possibilities in himselfFfor good and bad.
Psychotropic medicationsFin this case, psychostimulantsFfigured prominently in Brents
account of his everyday experience. Brent was first diagnosed with ADHD at age 4 and was
initially prescribed methylphenidate (Ritalin). Over the years, Brents medications had been
switched in response to negative side effects as well as outgrowing the dosage. Nearly
all of the available medications indicated for ADHD had, at one time or another, been
prescribed for him. He was currently taking methylphenidate HCl (Concerta), an extendedrelease form of methylphenidate that is marketed as a once-daily medication. In Brents
case, however, he took two daily doses of 36 milligrams that his pediatrician had informed

PORTRAITS OF PHARMACEUTICAL TRANSFORMATION 269

him constituted the maximum allowable dosage. Brent took his second dose at school,
which was unproblematic except for the fact that his trip to the school nurse cost him
precious minutes of time at lunch.
Overall, Brents account of the subjective experience of taking psychostimulants was overwhelmingly positive. He described having trouble concentrating and being very hyper
without the medication: I would literally be bouncing off the walls. The medication
helps me control my actions and since taking it Im the smartest person in the entire fifth
grade at my school. I won an award for it. Brent was adamant that he needed the medication: without my pills I cant do anything about my behavior, at least anything right. In an
interesting entanglement of personal agency and pharmaceutical effects, he credited the
medication with helping him to be more accountable for his actions:
Before I took it, Id get upset because I always kept getting in trouble but now I know
that when I go get in trouble, I know its my fault that I couldnt control my actions.

Despite having a well developed sense of having ADHD, the disorder did not render him
different from his peers. Like Latasha, a strong and recurrent theme throughout Brents
account was that others see him as normal and not any different. He explained that
others dont really know about the problem and they dont see anything wrong with me.
Yet there is a crucial difference in their respective accounts. Whereas Latashas discourse of
normality stems from her strategy of downplaying the disorder, concealing her medications,
and recasting her symptoms as desired aspects of her personality, medication plays the
primary role in enabling Brent to be a normal kid. To that end, Brent credited the medication with helping me feel like Im normal, so that I just fit in with all the other kids.
Rather than calling attention to a problem, Brent gives voice to the power of medications to
erase or render imperceptible his behavioral problems. When asked what he would tell
others about the medication, Brent responded assuredly:
youll feel like a normal person. Youll feel like theres nothing wrong with you because
when you take it there really is nothing wrong with you.

Overall, Brent felt better since taking the medication because Im with the crowd:
when I take this medicine and Im better, Im not bad so youre not singled out as one of
the bad people at school.

Being with the crowd not only helped to keep him out of trouble with teachers but also
was crucial for maintaining relationships with his peers as he observed that no one really
wants to be friends with the bad kids. Moreover, he believed that the medication was
responsible for making him:
more motivated to do what I wanna do because without it I feel because Im so bad I
cant reach my goals, but with it I feel normal enough or smarter that I can achieve my
goals.

270 ETHOS

Overall, Brent felt that he was getting better, which he described as relieving. However,
his sense of improvement and the effects of the medication are short lived:
Ethnographer: Do you think youre getting better?
Brent: Thats what it feels like when I take the medication, but when it wears off, no.

In spite of his incredibly positive endorsement of medication, Brent nevertheless identified

substantial drawbacks. Ideally, he would prefer not take medication at all and disliked
always havin to take em. He was especially concerned that he was building a tolerance to
the medication:
because all my life Ive been on a narcotic that now because it gets worse and worse
I need more and more and more and thats the maximum dosage [current dose], so I
think that its like strong and powerful but its just barely holdin on.

He also worried about the long-term:

Sometimes Im scared that Im gonna have to take it my whole life . . . I dont wanna
wake up when Im 35 and have to take a pill. I mean, to me thats just sad that a 35-yearold adult cant control his actions.

However, he seemed resigned to this fate, observing reluctantly that I probably cant
function without it.
In addition to his personal concerns of becoming dependent on the medication, Brent also
placed the negative aspect of taking medication in a broader social context. He painted a
vivid picture of the challenges of navigating his peer social world:
Youre either the cool kids, the kids that no one wants to be friends with, or the
annoying kids so in order to be one of the cool kids you have to do other stuff
. . . otherwise youll be one of those annoying kids that keeps buggin, Can I play? Can I
play? Can I play? . . . You have to know when to do stuff. Like you have to know
when to hit someone but I dont. I havent participated in that yet. You have to know
when to say something. You cant say something at the wrong time. Um, you just have to
know, you have to know when, where, how, and what to say to keep your reputation
good.

Brent had so far been successful at maintaining his cool position in the school
pecking order but he was keenly aware of the fragility of this social status. Against this
backdrop, Brent vigilantly guarded knowledge of his diagnoses and that he takes medications, revealing this information only to his two closest friends (one of whom was also
diagnosed with ADHD). The social danger of this information is made clear in the exchange
below:

PORTRAITS OF PHARMACEUTICAL TRANSFORMATION 271

Ethnographer: How do you think other people in your life would act or think if they
knew [about your diagnosis and medications], like the ones that dont know?
Brent: I wouldnt have, Id probably only have a quarter of the school as my friends.
Ethnographer: Okay. So you think most of them wouldnt want to be your friends
anymore?
Brent: Well no, Im just sayin that half of the people that are my friends probably
wouldnt because theyFI know some of my friends and some of them they like to pick
on people with problems, so if they knew I had problems, they probably wouldnt be my
friends.

Discussion
In the remainder of the article I wish to reflect on insights offered by the experiences of
Latasha and Brent. First, mental health treatment offers contexts in which children assert
agency as they actively construct meanings of their experience in relation to psychiatric
diagnoses and treatment. Second, pharmaceuticals catalyze attention to self processes
through phenomenological transformations. In this regard, childrens experiential accounts
are poised to offer a vivid critique of contemporary psychiatric discourses that locate distress
in accidents of brain chemistry.

Children as Agents of Consumption in Pharmaceutical Families

Although I have foregrounded the voices of Latasha and Brent as individuals, it is necessary
to situate their accounts more broadly as culture theorists emphasize that selves are constituted through intersubjective processes (Csordas 1994; Hallowell 1955; Sapir 1949).
Particularly germane, Oldani (2006) calls attention to the intersubjective ties that bind
pharmaceutical consumption within the intimate space of family life. Whereas most children in the study were denied knowledge of their diagnoses and information regarding their
treatment, Latasha and Brent were coming of age in families in which chronic illness,
disability, and pharmaceuticals were substantial threads in the fabric of daily life. Both
families espoused strongly medicalized perspectives on behavioral and emotional distress.
In line with Ochs and Cappss observation that children are often overhearers of their
own experience (1996:34), the relative silence or openness regarding matters of mental
health and treatment in families speaks to variation in how children are socialized through
family discursive practices that may either discourage or facilitate the acquisition of illness
identities.
Addiction formed a core dimension of Latashas mothers self-presentation. Michelle was
proud of her lengthy sobriety from alcohol and drugs and remained active as a sponsor in
Alcoholics Anonymous and Narcotics Anonymous. In addition, mother and daughter were

272 ETHOS

both prescribed stimulant medications and Michelle empathized with her daughters struggles with reduced appetite, a common side effect of these medications. At one point, she
implored Latasha, We gotta help each other. Even if we dont feel like eating, weve gotta
help each other to eat. Similarly, Brents mother, Cassie, emphasized the intersubjective
quality of medication practices in her family. At one point, she explained to me that the
entire family takes their pills together:
You know we all take medicine cause we need it so hes just one of us and hes totally fine
with it. Hes, he thinks its kind of cool he gets to set up his medicine weekly like we do
cause he has um the morning pill, weekends he has the afternoon pill, and then he has
vitamins too. Hes totally, hes totally digs it. Its not a problem.

Like Latasha, Brent was growing up in a family in which chronic illness and matters of
mental health were a part of the ebb and flow of daily life. His mothers days were structured
around physical therapy sessions and appointments with various doctors. Brent was also
privy to the fact that his mothers partner, Christine, was diagnosed with bipolar disorder
and ADHD. Brent and Christine frequently butted heads and Cassie understood this
dynamic in relation to their psychiatric disorders: Its really hard for two ADHD people to
get along.
Although the families orientations to chronic illness and pharmaceutical interventions
provide a backdrop against which Latasha and Brent are developing understandings of
mental health problems and treatment, both children offer perspectives that differ from
adult orientations to these problems. Latasha most obviously strays from her mothers
staunch acceptance of a medical model by offering alternative, nonpathological interpretations of her own experience. Although Brent does appear to accept medicalized
perspectives, he nevertheless illuminates deeply troubling personal and social aspects of
taking medications that call into question his mothers assertions that he totally digs
medications and that its not a problem. Especially in contexts in which engagement with
mental health services is wholly adult-driven, the stances taken by Latasha and Brent offer
further empirical support for childrens agency in general (Bluebond-Langner and Korbin
2007; James and Prout 1996) and in matters of health and illness specifically (BluebondLangner 1978; Dell Clark 2003). Childrens accounts offer crucial knowledge of the lived
experience of psychiatric disorders and mental health treatments. Attending closely to childrens experience we become privy to the complex ways in which children are working to
develop understandings of their diagnoses and treatments and actively situating themselves
at the dynamic nexus of self-illness-pharmaceuticals.

Psychiatry and the Project of Self Transformation

Diagnoses and pharmaceuticals present tangible constraints in the lives of children that call
attention to otherwise fluid and ephemeral self processes, a point supported by van der
Geest and Whyte (1989) who argue that the power and popularity of Western pharmaceuticals is attributable to their concreteness. Medicines, put simply, are thingsFaccessible,

PORTRAITS OF PHARMACEUTICAL TRANSFORMATION 273

convenient, ready-to-use substances that facilitate the concretization of illness and treatment
by linking shifting, ambiguous sensations to physical problems with a physical remedy:
By applying a thing, we transform the state of dysphoria into something concrete, into
some thing to which the patient and others can address their efforts. Medicines thus fit
logically into biomedicine and most other medical traditions. Practicing medicine, after
all, is the art of making dis-ease concrete. [van der Geest et al. 1996:154]

In a related vein and specific to psychopharmaceuticals, Rose argues that the ascendance of
neurological discourses has shifted the sense of self from psychological being toward
somatic individuality:
To be a somatic individual, in this sense, is to code ones hopes and fears in terms of
this biomedical body, and to try to reform, cure or improve oneself by acting on that
body. At one end of the spectrum this involved reshaping the visible body, through diet,
exercise, and tattooing. At the other end, it involves understanding troubles and desires
in terms of the interior organic functioning of the body, and seeking to reshape
thatFusually by pharmacological interventions. [2003:54]

By concretizing otherwise ambiguous experiences and inscribing distress on the body, biological psychiatry and pharmaceuticals offer the promise of taming uncertainty. The brain is
configured as the site and source of pathology. Especially in the context of ADHD and
pediatric bipolar disorder, psychodiagnostic entities that remain fundamentally ambiguous and
highly contested, scientific explanations and interventions are all the more alluring as an appeal
to both certainty and legitimacy. Yet at the level of lived experience, such pharmaceutical
promises fall away as the daily ingestion of psychotropic medications becomes fraught with
ambivalence and worry. As the portraits of pharmaceutical transformation suggest, rather
than allaying anxieties by inscribing boundaries on problems, psychiatric diagnoses and psychotropic medications appear to present dilemmas for childrens developing sense of self: What
does it mean if I need to take medication everyday to be normal? Why does a medication that
is supposed to make me feel better instead make me feel like a different person? If I need to
take medications for a disease that is not my fault, why do people still make fun of me?
Biological psychiatry holds out the possibility of self transformation through pharmaceutical
technologies; by altering behavior, cognition, and emotion psychopharmaceuticals drive to the
very heart of what it means to act, think, and feel in the world. The nexus of self, illness, and
psychopharmaceuticals is a site replete with possibility: for some, medications may enhance or
facilitate the emergence of a truer or better self; others fear that medications may dull dimensions deemed fundamental to self and style of engagement with the world. Latashas
experience illuminates the crucial point that pharmaceutical self transformations are not always
in the direction of improvement or self-enhancement whereas Brents experience shows that
even when medication-induced phenomenological changes are welcomed,10 full transformation may remain elusive.
Latashas account of her pharmaceutical transformation points to how the bodily effects of
medication may profoundly implicate ones sense of self. Pharmaceuticals produced a subjec-

274 ETHOS

tive sense of not me by slowing her down, tempering her otherwise high energy that constituted a fundamental dimension of her sense of herself. In Brents case, his pharmaceutical
transformation might, at first blush, seem unambiguously positive. For Brent, medication appears to open the door to an awareness of an improved self. But running through his account is
also an anxious awareness of the fragility of this balance between good kid and bad kid, normal
and abnormal. Brent is vividly aware of the impermanence of this better me, which exists
only so long as the chemicals remain at the proper concentration in his bloodstream. Moreover, below the pharmaceutical poster child veneer is a deep worry over what the future
holds. His imagined need to take medication as an adult strikes him as just sad and runs
counter to his expectations for adulthood. For these children, taking psychotropic medications
entails deep personal risk, altering their sense of self and posing a challenge to feeling normal
or to their expectations for the future.
Beyond personal sacrifices, the experiences of Latasha and Brent strongly suggest that
children must tread cautiously through their social fields. Rather than mitigating stigma,
medicalized models of problems and pharmaceutical treatments appear to hold substantial
social danger in the peer worlds of children. Latasha and Brent fear being ostracized on
account of having problems and, especially, because they take pills. As a result, both
remain on guard and must be cautious about to whom it may be safe to reveal such information about themselves. Childrens perspectives thus expand notions of risk in relation to
diagnosis and treatment of behavioral and emotional disorders. It is clear that risks are not
limited to troublesome pharmaceutical side effects or to the danger of misdiagnosis. Moreover, expanding the analysis to include the social worlds of children is a crucial means of
illustrating situational and relational qualities of self formation.
On a more sanguine note, it is also the case that the challenges presented by psychiatric
diagnoses and pharmaceutical treatment may present opportunities for children to actively
assert a sense of who I am or to envision possibilities for who I (dont) want to be.
Latasha is resilient in the face of substantial challenges, employing strategies of normalization and resistance to counter pathologizing discourses and unwelcome effects of
medications. Her refusal to take medication takes on significance beyond non-compliance
and may be read as a means of preserving her sense of self. Brents assertions of his normality
and equality to others may also be understood as a creative discourse of resistance to limitations imposed by diagnoses. Rather than lowering expectations for himself on account of
ADHD, Brent speaks with pride of his ability to exceed and to be the smartest kid in fifth
grade. Such forms of resistance exemplify the effort and reflexivity that Csordas (1994)
deems fundamental as characteristics of the self.
The triadic relationship of self-diagnosis-medications is dynamic, producing multiple selves
through complex personal negotiations. Although Latasha appears to strongly reject
pathological readings of her experience, it is nevertheless the case that she also readily
invokes clinical language and diagnostic labels. Recalling Estroff and colleagues (1991)
articulation of I have versus I am illness statements, Latasha occupies both positions:

PORTRAITS OF PHARMACEUTICAL TRANSFORMATION 275

I have ADHD and bipolar and I am a high energy kid. In her case, I am statements perform the dual function of incorporating a central symptom of bipolar disorder (high energy)
as an aspect of self and recasting the symptom as normal. Likewise, Brent may pathologize
disruptive behavior and appears to readily accept his diagnosis of ADHD. Yet in his case the
pathology disappearsFhe becomes normalFwhen he takes his medication. The very
thing that would seem to mark him as different is repositioned as that which conceals his
problem and thus makes him the same as others. However, this highly desired sameness is
tenuous and dependent on Brents ability to keep secret the fact that he takes medication and
has problems. In these struggles we can hear echoes of the central dilemma put forth by
Goffman: the stigmatized individual defines himself as no different from any other human
being, while at the same time he and those around him define him as someone set apart
(1963:108109). For Latasha and Brent, pathology and normality commingle, revealing
a multiplicity of possibilities for conceptions and experiences of self.

Concluding Remarks
Dominant psychiatric discourses have recast self transformation as both possible and desirable through the consumption of psychopharmaceuticals to correct faulty brain
chemistry. As a result, self transformation has been repositioned as independent of personal
and cultural resources. The experiential accounts of Latasha and Brent offer a corrective to
such potentially reductive biopsychiatric discourses by illuminating a realm in which transformation may be undesired or exist on an ever-elusive horizon. If biological etiologies have
the consequence of removing personal agency from the experience of mental illness
(Jenkins and Carpenter-Song 2005:405), the accounts of Latasha and Brent underscore the
irrepressibility of personal efforts to construct meanings that disrupt dominant cultural
discourses favoring presumed imbalances of brain chemistry as sites of pathology. By providing a glimpse into the ways in which psychiatric diagnoses and treatments take on
significance and hold consequences on both a personal front and within fragile networks of
peer relationships, the experiences of these two young subjects expose limitations to biopsychiatric approaches as pharmaceutical promises fall away in the lived realities of
ambivalence, uncertainty, and anxiety.
ELIZABETH CARPENTER-SONG is a Postdoctoral Research Fellow at the Dartmouth Psychiatric Research Center, Dartmouth Medical School, and a Visiting Research Fellow in the
Department of Social Medicine, Harvard Medical School.

Notes
1. Many scholars have identified additional limitations to the Parsonian framework, noting especially its inappropriateness for chronic (Kasselbaum and Baumann 1965) and psychiatric (Blackwell 1967; Denzin and Spitzer 1966;
Petroni 1972) conditions.

276 ETHOS

2. As recently as the mid-1990s, bipolar disorder was one of the least frequent diagnoses among children hospitalized with psychiatric conditions; by 2004, it was the most common diagnosis in this population (Blader and
Carlson 2007). The number of children diagnosed with ADHD also increased dramatically in the 1990s. The
number of office-based visits documenting a diagnosis of ADHD increased from 947,208 in 1990, to 2,357,833 in
1995 for U.S. children ages 5 to 18 (Robinson et al. 1999). There have been substantial increases in pharmaceutical
interventions for these types of disorders. Results of a 10-year study of community treatment data on nearly 900,000
youth in two U.S. health care systems found that total psychotropic medication prevalence for youths increased
two- to three-fold and included most classes of medication (Zito et al. 2003). Office visits resulting in a psychotropic
prescription increased from 3.4 percent in 199495 to 8.3 percent in 200001; by 2001, one out of 10 office visits by
adolescent males resulted in a prescription for a psychotropic medication (Thomas et al. 2006). The number of
office-based visits by youth that included antipsychotic treatment in the United States is estimated to have increased
from 201,000 in 1993 to 1,224,000 in 2002 (Olfson et al. 2006).
3. The 20 families with whom I worked included families that self-identified as African American (n 5 9), EuroAmerican (n 5 10), and Latino (n 5 1) backgrounds.
4. Among the families in the study, more African Americans came from lower-income and working class backgrounds and more Euro-Americans had middle to high incomes. However, there was socioeconomic heterogeneity
within the sample, with low to upper-middle income Euro-Americans and low-to-middle income African Americans recruited to the study.
5. ADHD diagnoses included hyperactive/impulsive, combined, or inattentive type. Bipolar spectrum disorders
included strict DSMIV diagnoses of bipolar I, bipolar II, cyclothymia, or bipolar NOS where the youth either
shows one too few symptoms but adequate durationFconsistent with Lewinsohn et al. (1995), or an adequate
number of symptoms but with briefer episode durationFconsistent with Findling et al. (2001) or Leibenluft et al.
(2003).
6. Because of an error in the diagnostic database used for recruitment, one child who had been classified as ADHD
at the time of recruitment was, on more recent examination, diagnosed only with Oppositional Defiant Disorder
(ODD).
7. An atypical antipsychotic medication was introduced in the course of the study to four children.
8. When I first met them, five children in the study were only receiving nonpharmacological mental health treatment, eight children were only receiving pharmacological treatment, and seven had a multitiered approach to
treatment incorporating therapy and medications. Four children had been in therapy in the past and, in the
course of the study, therapy was added to the treatment regimen of one child.
9. In some families, parents actively sought to conceal knowledge regarding diagnoses and treatments from children by, for example, calling psychotropic medications vitamins or referring to therapists as teachers. My
ability to work with one family was contingent upon multiple assurances that I would not reveal their sons diagnosis
to him. For others, a diagnosis or the daily practice of taking pills was simply not the basis for reflection, as 11-yearold Matthew stated, I dont really think about it, with a casual shrug of his shoulders. And for children in some
families, the struggles of daily lifeFparents out of work or taking care of younger siblingsFfar overshadowed the
salience of formal mental health concerns.
10. Kramer (1997) has perhaps most famously written about the transformative powers of psychotropic medications in his bestselling Listening to Prozac in which he examines the phenomenon of patients feeling better than
well as a result of taking fluoxetine.

PORTRAITS OF PHARMACEUTICAL TRANSFORMATION 277

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