Precipitating Pharmakologies and Capital Entrapments: Narcolepsy and the Strange Cases of Provigil and Xyrem

Abstract

Since the mid-1990s, Americans have been made more aware of chronic sleep deprivation and sleep disorders exacerbated by dominant temporal regimes of work, school, and family life, primarily through increased medical and media attention. Concomitantly, Americans have turned to medical treatments and pharmaceutical cocktails to achieve normalcy rather than attending to the social and cultural causes of sleep sickness. This turn toward pharmaceuticalization is aided in part by the proliferation of medical disorders and the pharmaceuticals marketed to treat them (e.g., “excessive daytime sleepiness” requires treatment once reserved for narcoleptics). These cocktails have explicit and implicit components: the former consist of pharmaceuticals, the latter of capital dependencies, including ties to medical insurance companies, stable employment, and familial networks. In this article, I examine the proliferation of pharmaceutical cocktails through the concept of the pharmakon—something simultaneously remedy and cause—to illuminate the causes and effects of such pharmaceutical regimens in contemporary American society, specifically those relating to sleepiness. Specific cases of this struggle between chemical dependence and normalcy are offered from my ethnographic work with patients who suffer from sleep disorders.

Key Words:

• biopolitics
• pharmaceuticals
• pharmakon
• sleep

ACKNOWLEDGEMENTS

The author would like to thank his various interlocutors who made this research possible both in the sleep clinic and among the patient support networks with whom he conducted my fieldwork. Also his sincere thanks to his academic supporters especially Karen-Sue Taussig and Steve Ferzacca and the anonymous reviewers who read this article in manuscript form. Finally financial support was provided through generous grants from the University of Minnesota and the National Science Foundation's Science & Society directorate.

Notes

My primary fieldsite was a sleep clinic, which I refer to as the Midwest Sleep Disorder Center (MSDC), where I conducted two years of fieldwork. As a group, the physicians at MSDC had become interested in the social and cultural dimensions of sleep, and my working with them often entailed reporting on my ethnographic, ethnologic, and archival research for their edification. Over the two years, I attended weekly staff meetings, local support groups for sleep disorder sufferers, and national professional meetings; each of these sites also served as a mechanism to recruit interviewees, including patients, their bedpartners, clinicians, researchers, and support group facilitators. This, in turn, was succeeded by a year of research in the Chicago area, primarily with sleep disability support groups, and sustained archival research in the Nathaniel Kleitman archive at the University of Chicago (Kleitman was the father of 20th century sleep science and medicine). The interviews which are analyzed in this article are drawn from narcoleptics who participated in an internet support group, Talk About Sleep, and the Narcolepsy Network, a national support group with local chapters.

“Sleep hygiene” is a term that commonly refers to culturally-proscribed sleep-inducing behaviors, e.g. not consuming sugar, caffeine or alcohol 4–6 hours before bedtime, exercising regularly, not napping, employing comfortable bedding, and sleeping with one's alarm clock turned away from the sleeper. See, for example, the website of renowned sleep physician William Dement, http://www.stanford.edu/~dement/howto.html, accessed 11/3/2008.

http://www.forbes.com/home/forbes/2006/0508/094a_3.html, accessed 4/24/2007

See, for example, www.4woman.gov/faq/rohypnol.htm and http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01157.html, accessed 11/23/2006

http://www.provigil.com/patient/sleepiness/definition.aspx, accessed 11/23/2006

http://provigil.com/inrhythm/inrhythm_enewsletter.aspx?t=5; http://www.provigil.com/patient/testimonials/testimonials.aspx, accessed 11/23/2006. Notice her hesitations–the “uh”–have disappeared in her confession about the drug.

PROVIGIL (modafinil) drug fact sheet. West Chester, PA: Cephalon, 2004.

Additional information

Notes on contributors

Matthew Wolf-Meyer

MATTHEW WOLF-MEYER is an Assistant Professor of Anthropology at the University of California, Santa Cruz. He received his PhD from the Department of Anthropology at the University of Minnesota, specializing in medical anthropology and the social study of science and technology. He is currently working on a book manuscript based upon his dissertation research, tentatively titled Nocturnes: Sleep, Medicine and the Production of American Everyday Life, which focuses on sleep in American culture and its historical and contemporary relation to capitalism. Currently he is in the early stages of two projects, one on the history of breathing and its role in the discipline and concept of public health, and the other on the overlaps in practice in contemporary neuroscience and psychoanalysis in American society. He may be reached at the Department of Anthropology, 361 Social Sciences 1, 1156 High Street, University of California, Santa Cruz, CA 95064. E-mail: [email protected]