In the previous blog post, we discussed how the language of ‘side’ effects is part of structuring the illness experience for patients. While biomedicine tends to separate effects into ‘therapeutic’ effects – characterised as lasting, if not permanent – and ‘side’ effects – characterised as temporary and reversible – the reality of ‘side’ effects is much messier. Not only because a ‘side’ effect for one drug, for example, may become the ‘therapeutic’ effect for another or that a temporary ‘side’ effect may become a permanent condition. More so, in this blog post, I focus on ‘side’ effects as being more than a relation to a ‘primary’ effect, and instead explore the argument that ‘side’ effects are relational in a variety of ways, for example, they can be personal, social or cultural, and even political too. In the following, I discuss ‘side’ effects as personal and political.

‘Side’ effects are personal

Rachael Eastham (2016), in her PhD thesis on women’s experiences of using contraception, writes about the profound consequences that contraception can have on a woman’s sense of identity. She writes about how effects of hormonal contraceptive use subverted her interviewees from their ‘normal’ or ‘natural’ self. For example, some women in her study described how irregular bleedings disrupted their otherwise (more) confident and calm selves. It therefore makes little sense, Eastham argues, to categorise and describe ‘side’ effects as simply peripheral effects of hormonal contraceptive use, when they can have profound consequences for women’s personal lives.

Eastham further argues that the cultural context matters too. In Britain and in many other Western and neoliberal societies, the concept of the rational individual who behaves responsibly and makes the ‘right’ choices figures quite strongly. In this story, she writes, the female reproductive self is positioned as doing the ‘right’ thing by engaging with contraceptive technologies, such as the contraceptive pill. Yet, Eastham’s study shows that doing the ‘right’ thing by being intelligible in the female and neoliberal senses of ‘complying’ with a certain contraceptive regime (e.g. being ‘on the pill’) easily come to exist in tension with women feeling disconnected from their identities; who they are.

These findings makes Eastham argue for a re-consideration of the concept of ‘side’ effect that takes account of the importance of ‘side’ effects to women’s sense of self. ‘Side’ effects are not simply peripheral, discrete and measurable events, but instead, Eastham argues, they may cause women to experience what she calls ‘contraceptive dysphoria’. Eastham characterises this phenomenon as ‘a holistic experience resulting in distress, confusion and anxiety about a perceived disconnection from the ‘normal’ self’ (p. 231). As a bodily phenomenon of disconnect, it may then help to explain, Eastham further argues, why some women are liable to stop or switch contraceptive methods, as they seek to ‘return’ to what they understand to be their ‘real’ selves.

‘Side’ effects are political

The political nature of ‘side’ effects can present itself in many ways. The anthropologist Emily Martin (2006), for example, has written about the miniaturization and marginalisation of drug effects through a displacement of ‘side’ effects by pharmaceutical companies into the fine print of packaging and leaflets; whereas the sociologist and psychologist Joan Busfield (2004), in her work on mental health, has written about the labelling of a drug effect as a ‘side’ effect, and how this process is characterised by an imbalance of power.

I would like to focus on the work of the anthropologist Jocelyn Lim Chua (2018), who in her study on the lived tensions and contradictions of psychoactive drugs in and after war, is exploring how veterans’ experiences of drugs and their ‘side’ effects can bring new meanings and values to what it means to make and be in war. In her paper, Chua reports on one veteran’s experiences of psychotropic medication use, having witnessed, during deployment, his sergeant being medicated after her attempted suicide, and himself being prescribed psychiatric medication after leaving the military. Chua’s analysis of his experiences draws on the notion of ‘side’ effects, but not in its biomedical meaning. Instead, she pushes the boundaries of the notion of ‘side’ effect to include moral and political meanings.

In making her argument, she draws on the experiences of her interviewee, who since his deployment and return from Iraq, has been experiencing moral contradictions towards the use of drugs in and after war. Having witnessed what drugs can do to other people and after his own experiences of psychoactive drugs that left him suicidal, he develops a strong resistance towards the US military and its institutional culture. Chua argues that such transformation in himself should be seen as a form of ‘side’ effect. More generally, she views such ‘side’ effects as being ‘collateral’ effects of medication in and after war. Her study then challenges the notion that ‘side’ effects are stable and inherent in drugs themselves, but instead, she argues and concludes that people’s relationships with medications are themselves living things: ‘drugs come alive to those who consume them in ways that may transform as life circumstances, personal values, and subjectivity change’ (p. 19).

What all the studies share is then the recognition and understanding that ‘side’ effects are much more than subordinates to ‘primary’ and intended therapeutic effects – as understood in biomedicine, but that ‘side’ effects can also matter politically and morally in the world.

References

Busfield, Joan (2004), ‘Mental health problems, psychotropic drug technologies and risk’ in Health, Risk and Society 6 (4): 361-375

Chua, Jocelyn Lim (2018), ‘Fog of War: Psychopharmaceutical “side effects” and the United States Military’ in Medical Anthropology 37 (1): 17-31

Eastham, Rachael (2016) Negotiating the Fertile Body: Women’s life history experiences of using contraception. PhD Thesis. Lancaster University, UK.

Martin, Emily (2006), ‘The Pharmaceutical Person’ in BioSocieties 1: 273-288