Biopolitics, Surveillance and the Subject of ADHD

Semiotica 2014; 202: 301 – 320

Ott PuumeisterBiopolitics, surveillance, and the subject of ADHD

Abstract: Surveillance is a part of our everyday lives, and it does not include just the cameras watching over individuals” safety and collecting images of them. Surveillance includes all kinds of techniques of data gathering, for instance, the keeping of medical histories and the conduct of surveys. Directly related to the medical sphere is the notion of biopolitics. The aim of biopolitics is to control and normalize individuals” lives by subjecting them to treatments, proposing to them possibilities of a better life (or death), etc. This paper deals with biopolitics and its relations to surveillance (it can be said that surveillance is a set of techniques used to implement biopolitics). To mediate between these two concepts I have chosen a disorder called Attention Deficit/Hyperactivity Disorder, which is be-coming ever more prevalent among children and lately also adults. I will investi-gate how this disorder – which is definitely not an irrefutable medical fact – is being constructed through surveys and biopolitical techniques and what kind of a subject ADHD treatment hopes to create.

Keywords: biopolitics, surveillance, subjectivity, ADHD, normalization

DOI 10.1515/sem-2014-0061

1 IntroductionThe goal of the following paper is to investigate how an individual human being is inserted into the larger social order and population through the techniques of biopolitics and surveillance. Biopolitics is here understood as a governmental strategy that takes as its main object organizing the life of human beings. We can now ask how this qualification distinguishes biopolitics from “regular” politics, since all political practices concern the lives of individuals. The major differ-ence, as I see it, is the fact that the aim of biopolitics is to form and render hu-mans” bodies and psyches effective in the context of populations. Bodily and

Ott Puumeister: University of Tartu, Estonia. E-mail: [email protected]

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psychological self-formation practices are governed in relation to the effective-ness and health of populations.

Surveillance techniques can in many instances be seen as the implementa-tion and realization of biopower; as concrete practices that are used to create the knowledge important to the government of populations. I do not, then, under-stand surveillance as solely the practices of continuous watching (CCTV) and tracking (GPS), but any kind of data gathering used in compiling profiles and categories created to classify and manage groups of individuals. Surveillance includes, for instance, the keeping of medical histories and the conduct of sur-veys. Statistical analysis creates a new normalized, abstract psychologized body; and the (idealized) individual is understood through this abstraction. In relation to these large-scale surveillance techniques, individuals are prone to types of self-surveillance.

This interplay between the abstract psychologized body created through surveillance techniques and the individual brings into focus the self-formation of the human being in the context of biopolitical governance. The individual is not a natural given or an absolutely fixed entity but a processual one that is neces sarily created in social, political and cultural contexts. A human being creates her/himself in a continuous and dynamic practice of semiotic self- formation. Therefore the abstract normalized body of biopolitics plays a huge part in the individual’s semiotic formation – all the more so because it is created as a figure of nature which the individual should strive to become. Bio-political government techniques, then, have a fundamental effect on the indi-viduals’ relations to themselves. We will see how “life” is produced in the for-mation of one specific mental disorder, namely, Attention Deficit/Hyperactivity Disorder.

As far as I know, there have not been any studies of ADHD made from the semiotic point of view, using semiotic terminology. However, there have been some studies on the conceptual and social history of ADHD (Rafalovich 2001; Brock 2010). The theoretical side of biopolitics and its possible semiotic inter-pretation are touched on for example by Daniele Monticelli (2008, 2012). I will draw on these studies in what follows, but I hope I will also be able to add something extra, especially through the conceptualization of surveillance and ADHD.

2 Biopolitics and biopowerBefore we continue, an important distinction needs to be made, a distinction between “biopower” and “biopolitics” as I use them in the following text (there


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have been many different manners of this differentiation).1 I borrow this defini-tion from David Hook, who writes:

At a basic level, one might understand bio-power as the generic category of which biopolitics is a variant . . . Bio-politics can thus be understood as that type of bio-power that targets collectivities, constituting its subjects as “a people,” “a nation,” “a race” . . . whereas bio-power begins with the body and its potentials, and seizes life and “living be-ing” as its objects, bio-politics is always necessarily a form of government, it involves a government-population-political economy relationship . . . (Hook 2010: 227)

Biopolitics is a collectivizing set of governmental practices in which a human being is relevant only in as much as he is connected to the overall population; his conduct is measured against the working of larger collectivities. Biopower, how-ever, is any kind of intervention in a human being’s bodily practices, in his con-struction of self as a bodily-psychological being (the most prevalent set of tech-niques are of course related to medicine and health, for example, dietary regimes preventing diseases). What we need to note here is that there is no strong line between the two: the individualizing techniques of biopower may easily be converted to the working of biopolitics; for example, an individual’s choice of a nutrition can become a question of “public health,” in which case the regime is already regulated by the government (by illegalizing some products, raising the taxes of others, advertising, etc.).

Another note I’d like to make is that – following Foucault (see, for exam-ple 1981), Mouffe (2003), Althusser (1971), and others – a human being is made into a subject only in social, cultural, and political power relations. This means that not only through cultural sign systems and their interplay, but through the practices of constituting and implementation of those sign systems (at the risk of simplification, we could say that sign systems are basically discourses in Foucault’s sense). We could then agree to what Nancy Much says about cultural psychology:

[It] emphasizes the non-discrete and interpenetrating relation between personal psychology . . . and the symbol systems, institutions, practices and contexts shared by the group and communicated by other persons . . . there is no longer a sharp distinction between the per-son and culture. Psychological experience, and the resulting “structure” of psyche and its potentialities are organized by networks of meaning. (Much 1997: 67)

1 For example, Roberto Esposito in his Bios (2008) understands bio-power as “a life subjected to the command of politics” and bio-politics as “a politics in the name of life.” For him, then, this is a distinction between the negative and the positive use of “life politics.”

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The important thing is to add to the symbol systems the “institutions, practices and contexts.” Without the latter, we would – in theorizing about and research-ing politics and society – be left merely with the critique of ideology; but there is much more to the construction of the subject in society than ideology.2 We need to see the complex relations between the discursive and the extra- discursive that condition one another. And an almost perfect extra-discursive set of practices and techniques of power to investigate in this respect would be surveillance.3

We can then say that surveillance practices work in concrete connection with the human: they record, fragment, distribute, (re)organize and (re)assemble the (abstracted) body, the psyche, and (a profile of) the human being. Surveillance practices and techniques are forms of biopower and politics that work to produce certain kinds of life, certain kinds of subjectivities. But, let us first try to concep-tualize the more general categories of biopower and biopolitics before moving to surveillance and its influence on life.

2 It is of course important not to think of society as a unitary, homogeneous whole, rather, following Latour (2005: 108), we could say that “there is no society, no social realm, and social ties, but there exist translations between mediators that may generate traceable associa-tions.” There is no “society” that generates individual subjects, but “society” is constructed through the interactions of individual subjects, social institutions, signs systems, technologies, etc.3 However, there might be some confusion about what exactly is this “extra-discursive,” if, like most contemporary political theorists argue, the political space (even the world) is structured according to discursive formations. Here I would like to call upon Manuel DeLanda’s view on the matter: “while pairing a certain category of crime, like stealing, with a certain category of pun-ishment, like cutting off a thief’s hand, is clearly a discursive practice, the actual act of mutila-tion is equally clearly a non-discursive one” (DeLanda 2008: 162).

Similarly, we could say that surveillance in itself is non-discursive: the acts of watching, recording data, etc. The practices of surveillance acquire meaning (become discursive) when they are inserted within a discourse; that is, for example, when gathered data is connected with individuals’ conduct and this (already abstracted) conduct becomes one of the signifiers of an illness or a disorder. Again, treatment with medication is non-discursive, but it is discur-sively formed knowledge that leads to this treatment. It is the discursive practices of surveillance that work on the discursive object known as “a human being.” But, of course, non-discursive materialities are formed and reformed by discursive practices; non-discursive elements are deeply interconnected with discourse – the two actually could not exist without one another, which is also why it is so difficult to think there being something “outside” discourse (like an actual human being standing behind all the deconstructive work of his/her body).


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3 The totalizing function of biopoliticsThere is a certain paradox present when dealing with (bio-)politics, the notions of government and the state. This is the tension between multiplicity and unifica-tion. In order to govern human beings, they need to be classified, encoded in a system that enables the government to work on their lives. In short, humans need to be understood as a species with certain kinds of basic and unchangeable prop-erties that form the nucleus of what has to be maintained and further developed. “One has to be classifiable to exist in species terms” (Dillon and Lobo-Guerrero 2009: 5). There exists a very powerful tradition of thinkers (iGiorgio Agamben, Alain Badiou, Jacques Rancière) who – in terms of this encoding – understand politics and the constitution of a political order as a totalizing practice that sets up an encyclopedia of knowledges in which the human being has to be thought of. The political order is a strictly structured (total, in the sense of whole) system.

But at the same time, these very same thinkers all see a kind of remainder (of life, subjectivity, signification) at the very heart of that system. This remainder constitutes the impossibility of final totalization, of closing the system. And, of course, the possibilities of resistance are being sought from this remainder. The stasis of the state is being counter-positioned by the dynamics of life and its potentialities. What first come to mind are Giorgio Agamben’s (2005) figure of “whatever singularity,” Derrida’s différance, and Esposito’s (2008) conceptual-ization of the “flesh” [chair] as opposed to the totalizing function of the (political) body. In the words of Dillon and Lobo-Guerrero:

[T]hese authors clarify how the political imaginary of species being demarcates and dif-ferentiates itself specifically by excluding from its very imagining, the invaluable, the in-calculable, the un-encodable, the irredeemably opaque, the defiant, and the simply non- circulating. Theirs is in many ways a preoccupation with the not knowable that contours every form of knowing. (Dillon and Lobo-Guerrero 2009: 5)

Perhaps the most well-known analysis of this kind of exclusion of the unknow-able is Agamben’s Homo Sacer (1998 [1995]), of which the central figure is “bare life.” This is the figure that is both excluded and included in the political order. Agamben argues that the separation of zoe (bare life) and bios (political life) is constituted by an “inclusive exclusion” of bare life in politics. Life is postulated as situating outside of politics (as natural) only to found political practices for pro-tecting this very same life. For example, let’s take human rights, which are – in modern democracies – considered to be the original properties of any human being: every individual is equal in his/her being. But human rights are attributed to an individual only when s/he is a citizen of some state. “Rights are attributed

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to man (or originate from him) solely to the extent that man is the immediately vanishing ground (who must never come to light as such) of the citizen” (Agamben 1998: 76). Politics is envisioned as the protection of life that is the outside of politics; and so, politics appears to maintain and produce a natural order of things.

This kind of separation performed only in order to bring together, conflate politics and nature could be termed a kind “structural secret” of biopolitics. It is not only the case that the categories that are created as the natural properties of man are artificial (at least not natural), but, on a deeper level: the very separation of zoe and bios is in essence a fiction. The “mystification of politics” as Monticelli (2012) calls it, postulates that it is a necessity that there exist these abstract “nat-ural” categories over which to govern and that need protecting. What actually is excluded by this underlying structure of biopolitics is the potential that life could govern, develop, and act out its own potentialities.4 What is excluded is the pos-sibility that the remainder of biopolitics (bare life) would ever develop its own politics – within the biopolitical structure.

What this also means, is that

[t]he true problem is not so much the fragile status of the excluded, but rather the fact that, at the most elementary level, we are all “excluded” in the sense that our most elementary, “zero” position is that of being an object of biopolitics, so much so that political and citizen-ship rights are granted us only as a secondary gesture, in accordance with strategic biopo-litical considerations . . . (Žižek 2011: 124–125)

At the “zero” position humans’ lives are all potentially excluded, every life that is included in the political order can potentially be sacrificed, or to put it more mildly, discriminated. It does not matter which rights the individuals have; once they are within the biopolitical structure, these rights can be taken away from them. For Agamben, then, the central issue becomes the decision on life and death, the decision on the value of life, which is made possible by the biopolitical totalization of the political order.

Bare life, in this case, can be described as something that exists within the political order but is excluded from it in the sense that it is postulated as not being an inherent element of this order. For example: of course we see that poverty and “the poor” are inherent for liberal-democratic states, probably so much that lib-

4 I like a quote by Žižek (2008: 384) that illustrates the situation rather precisely: “Today, for example, the true antagonism is not between liberal multiculturalism and fundamentalism, but between the very field of their opposition and the excluded Third (radical emancipatory poli-tics).” The focal point is not exactly life, but the structure is represented very accurately.


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eralism could not work without them, but in the imaginary of liberalism, poverty is the factor to be rooted out, excluded from the political totality. In short, the poor are described as a foreign element within the normalized system and there-fore can be acted upon in many different ways.

The (re)production of poverty is obvious for anyone in the case of the pop-ulation of the ghettos in many countries. They are increasingly being either in-carcerated or left on their own, thus erasing them from the accepted political sphere. Which also means that the welfare institutions and health care centers and so on are increasingly autonomous organizations for profit (following the logic of liberalism) – they reproduce themselves instead of “incorporating” social subjects:

[I]t [the carceral apparatus of the United States] has regained a central place in the system of the instruments for the government of poverty, at the crossroads of the deskilled labor market, the collapsing urban ghetto, and social-welfare services “reformed” with a view to buttressing the discipline of desocialized wage work. (Wacquant 2009: 79)

What I wanted to point out is that the carceral apparatus is not so much the sys-tem of “justice,” punishment and reformation, but one of exclusion of un- political life forms, one that helps to “wage war” “on the poor,” rather than “poverty” (see more Wacquant 2009). This means that the object of state politics is not the social structure, but the life of its “citizens” (in inverted commas because, basically, they are deprived of rights, made into bare life). The individual here becomes a political being only in as much as and how he or she interacts with the norm of the political body.

From the above example we can see that the possibility of the decision on life depends on the production of specific life-forms, in this case, the poor. And the main question becomes how these life-forms are produced. Agamben however seems here to reduce the whole (bio)political field to the decision that is inherent in any politics; by searching for the structure of biopolitics, he 1) makes every political act into a biopolitical one, and thus 2) reduces the immense variety of power relations and techniques to this one structure. “Political space . . . is re-duced to a specific mode of the exercise of power: the decision on the value of life” (Genel 2006: 57).

4 Normalization of lifeWe have therefore come to understand that we need to move beyond the totaliz-ing function of biopolitics and its structure of decision in order to 1) differentiate

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biopolitics from any other politics, and to 2) analyze the specific ways that life is produced and governed – transformed into the central object of politics.

We therefore need to include (include) the more general concept of “bio-power,” of which “biopolitics” is one variant, one mode of governing. The no-tions that become central to the following discourse are “norm” and “normaliza-tion.” Biopower, starting with the individual body, is connected to the biopolitical totalization of populations exactly by the norm. Normalization creates the ab-stract body that connects the individual to the population. It is worth stressing that norms do not come to be solely by the decision of the state or the sovereign; rather, the sovereign needs to govern in terms of those norms established by much broader practices, techniques and signifying systems situated outside the reach of sovereign power. These mechanisms of power have been charted by Michel Foucault, who describes three basic and very broad mechanisms: 1) the sovereign right, the law; 2) the disciplinary mechanism; and 3) the mechanism of security. It is useful here to reproduce a lengthy passage in order to describe the interrelations within this complex:

A good discipline tells you what you must do at every moment . . . In the system of the law, what is undetermined is what is permitted; in the system of disciplinary regulation, what is determined is what one must do, and consequently everything else, being undetermined, is prohibited . . . The mechanism of security works on the basis of this reality, by trying to use it as a support and make it function, make its components function in relation to each other. In other words, the law prohibits and discipline prescribes, and the essential function of security, without prohibiting or prescribing, but possibly making use of some instruments of prescription and prohibition, is to respond to a reality in such a way that this response cancels out the reality to which it responds – nullifies it, or limits, checks, or regulates it. (Foucault 2009: 46–47)

In contrast to Agamben, Foucault places the basic stress on the security mecha-nism, when talking about biopolitics and biopower. While the law pro hibits, the security mechanism regulates the reality, makes it work as it should work. In reality, then, there is a randomness that cannot be tolerated, and reality has to be brought to accordance with its nature. This is the basic goal of normal ization: measuring, establishing, and controlling the specific and stabilized constants that are natural to the social order. Any deviation from these norms are seen as pathological, as falling outside of the order – in which case this deviation can be banned from the social sphere (this is Agamben’s exclusion). Discipline works with the individual body, it produces the body, divides it into parts and reassem-bles to make it work better; discipline constructs “docile bodies” to work in com-pliance with the law and be in accordance to the norm (biopower). Normative security measures the average of collectivities and defines the relation of the


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norm and deviance; discipline works with the body to match it to the norm, pro-duces a normalized body; sovereignty has the right to exclude all who do not pass the measurement.

As much as biopolitics deals with collectivities, it works as a security mecha-nism in the sense that it tries to regulate the workings of populations, make the populations effective by producing normal procedures and protecting “the nor-mal” from “the pathological,” and therefore bring the risk factors to a minimum. But it is important to note that “[b]iopolitical security practices do not articu-late a design in nature. They are contingent achievements reflecting the partial realization of designs which seek to enact ‘natures’ ” (Dillon and Lobo-Guerrero 2008: 267). Biopolitics organizes “natures” in conjunction with some measur-able phenomena; mechanisms of security work within the complex of power/knowledge that produces specific forms of life (by establishing profiles, patterns and probabilities). While the articulations of security practices are contingent and historically specific, they are brought to bear on life as inherent properties of populations.

For example, every time we go to the doctor’s we leave behind traces of symp-toms and diseases that are added to the population databank to better govern its health status. These personal and highly individual traces are put into relation with every other trace left by others. The abstracted information is used to mea-sure the stable situation of health, which is then seen as necessary for one spe-cific individual.

Actually, the same goes for discipline, although the referent is of a different level – the individual body: “It is not the normal and the abnormal that is funda-mental and primary in disciplinary normalization, it is the norm” (Foucault 2009: 57). When we are dealing with discipline and security mechanisms, we are most importantly dealing with the norm; and the question becomes: how is this norm produced, using what techniques, what kind of a “normal life” is being produced, and how this norm is being maintained using the techniques of biopower?

In the context of biopower, the normal and the abnormal are not strictly sep-arated, it is the measurement of the norm, the stability of forms of life that pro-duces the abnormal. The norm is here only established with reference to statisti-cal numbers, which do not take account of individual differences and normativity. Any deviation from this statistical norm is viewed as an abnormality and opposed to the normal. And it is this procedure of separation that is established by mech-anisms of security and discipline as natural, scientific: “Disciplines . . . will nec-essarily refer to a theoretical horizon that is . . . the field of the human sciences” (Foucault 2004: 38). It is not the question, at the most basic level of what kind of life forms are natural and optimal, but that there exists a necessity of the abnor-mal in order to establish a norm and vice versa (we can say that this is the kind of

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structural “secret” that Agamben wishes to reveal: we cannot think outside this structure, although it is artificial).

5 The creation of norms through surveillance systems

As mentioned earlier, one set of techniques to implement biopower is surveil-lance, which does not simply mean watching people’s behavior for the purpose of punishment. Rather, it signifies the constant gathering of information and assem-bling databases for the purpose of profiling, prediction, marketing, housing, etc. Security cameras are just one type of surveillance technology. For example, each day we leave behind traces of our credit card using practices; we log in to websites and click on icons – these actions are used to profile our shopping habits, to con-struct suitable commercials for us. Surveillance is a means to produce informa-tion and knowledge.

In addition to the classical, panoptical surveillance described by Jeremy Ben-tham (1995) and taken over by Foucault to analyze the disciplinary mechanisms of modern societies, we have all kinds of cataloguing, identification, and profil-ing mechanisms that we are not even conscious of. What is of course striking in today’s Western societies is the proliferation of informational access and the huge amounts of collected information that cannot possibly be worked through (be it the years of CCTV footage or health records). But, all the information stored even need not be worked through; it may simply be categorized and labelled in order to exclude irrelevant information.

Let’s make a short generalization here. Since, in the following, I am inter-ested in the (potential) effect of surveillance practices on the formation of “life” and the individual, I’d like to bring out three very broad ways of relating surveil-lance and its subject:1. Surveillance that is perceived by the individual, s/he is conscious of it; for

example in some closed environment with a CCTV system where the cameras are visible. This is the basis of disciplinary surveillance, where the important thing is the “visibility of visibility” (Yar 2003: 261) – the awareness of the subject of her/him being watched, that results in the disciplining of self;

2. The case where surveillance is already widespread, it has reached out the closed environments of institutions to the public space. In this case there is no need any more for the visibility of surveillance technology or the surveil-lant personnel. This is the relation of the unconscious influence and affect-ing: the subject may act in accordance with rules because he may be under


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surveillance – we may call this the economy of disciplinary power relations: when surveillance starts to work without anybody even watching;

3. Finally, the individual does come into direct contact with surveillance tech-nologies and practices, but the data collected is separated from her/him and therefore the relation is cut. This is the case of forming “surveillant assem-blages” in which “data doubles” of the individual are produced by profiling and encoding. The individuals are being formed into a political, social, and cultural subjects without their presence (see also Puumeister 2011).

Taken together, these relations an individual has to techniques of surveillance contribute to a new relation to self. The subject is constituted through contact with surveillance systems and the information that they produce. Concerning the third relation, the individual may not be aware of any “construction” s/he is undergoing. What is important is the creation of “data doubles,” these abstract normalized bodies that are used to categorize and encode human lives.

These “data doubles” are constructed by connecting various surveillance systems that use different and diverse means of collecting, classifying, and cod-ing the personal data extracted from individuals. Richard Ericson and Kevin Hag-gerty call this combination of systems “surveillant assemblage,” which

. . . operates by abstracting human bodies from their territorial settings and separating them into a series of discrete flows. These flows are then reassembled into distinct “data doubles” which can be scrutinized and targeted for intervention. In the process, we are witnessing a rhizomatic leveling of the hierarchy of surveillance, such that groups which were previously exempt from routine surveillance are now increasingly being monitored. (Ericson and Haggerty 2000: 606)

For example, the individual’s consuming habits (that are acquired either through surveys, clicks on the internet, etc.), her/his travelling routes (GPS) can be con-nected to her/his medical history. From these diverse systems a complex data double is created that acts as a basis for prediction on the individual’s future health risks. In this way, her/his potentialities for future action and conduct can be delimited. The individual is placed at risk and her/his relation to self altered on the basis of abstracted and reassembled data.

According to Robert Castel (1991: 283) this kind of profiling of the future necessarily entails unpredictability: “all insane persons, even those who appear calm, carry a threat, but one whose realization still remains a matter of chance.” The introduction of unpredictability creates a kind of permanent situation of risk that has to be regulated through the conduct of an individual: s/he has to act in a certain way and, more importantly, has to be a certain kind of subject. Nikolas Rose speaks here of “ethopolitics,” which means that the individual, in order to

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become a whole and healthy subject, has to choose the “right” kind of techniques of self-formation:

Thus these new practices for the identification of susceptibilities open a space of uncertain-ty. This is the expanding realm of the asymptomatically or presymptomatically ill – those individuals carrying the markers or polymorphisms of susceptibility who are neither phe-nomenologically or experientially “sick” or “abnormal.” While the calculation of risk often seems to promise a technical way of resolving ethical questions, these new kinds of suscep-tibility offer no clear-cut algorithm for the decisions of doctors or their actual or potential patients. In this space, biopolitics becomes ethopolitics. (Rose 2001: 12)

Ethopolitics, as I understand it, following Rose, could mean a “personalized bio-power”: an individual internalizes the abstract norms and standards and bases her/his decisions on how to act, how to be healthy, how to enhance her/his body, etc. And through these decisions and practices relating the individual to him/herself is a way of constructing an identity, a social, political, cultural subject. The constant risk, the danger of probable abnormality renders the norm into the object of individuals’ desire instead of being only externally imposed (Bruno and Vaz 2003: 278).

Let us next turn to a specific disorder, namely, ADHD, and see how the social, medical, scientific, and cultural construction of this complex of symptoms into a comprehensive diagnostic whole relates to the larger context of creating a kind of “neurochemical” understanding of life. My hypothesis is that this process is not in the first place an exclusion from the social and political order but a formation of another kind of relationship of an individual to her/himself. ADHD is particu-larly interesting from the perspective of risk and prevention, as it is mainly used to manage the lives of children and adolescents.

6 Normality through medication: ADHDAttention Deficit/Hyperactivity Disorder (ADHD) is considered to be one of the most prevalent mental disorders among US children. It is estimated that about 5.4 million children aged 7–14 have been diagnosed with ADHD and that about 2.7 million (66% of those diagnosed) children receive drug treatment.5 These are of course only indicative numbers, as “nationally representative data on the prev-alence and correlates of mental disorders among children are still not available”

5 Data are from 2007; taken from the CDC web page: http://www.cdc.gov/ncbddd/adhd/data.html (accessed 1 July 2014).


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due to the inability to include children under age 12 in the sample (Merikangas et al. 2009).

There are, however, other – and probably more important – issues about di-agnosing and estimating the prevalence of ADHD: the diagnosis consists of symp-toms like inattention, failure to follow instructions, disorganization of activities, forgetfulness, fidgeting with hands, blurting out answers before questions are finished, etc.6 These behaviors are not uncommon and are considered to be part of a quite normal child when taken separately. This raises more questions about diagnoses that are performed based on just a few symptoms: can ADHD really be called an illness, furthermore, an illness that requires pharmaceutical interven-tion? Whatever the answer, social workers, doctors, drug developers have estab-lished ADHD as a disorder in need of medication, although no clear biological or neurological basis has been found (see for example Cohen and Leo 2003). In fact, medication with stimulants can be viewed as proof of the existence of the dis-order: while in the case of a “normal” human being stimulants cause hyperactiv-ity, the human with ADHD is calmed by them (Napolitano et al. 2010).

ADHD can actually be said to be defined with the help of drugs: in 1937 Charles Bradley discovered the positive effects of stimulants (in his case, Benze-drine) on the behavior and learning abilities of hyperactive children (Brock 2010: 21–23). In 1944, Ritalin (methylphenidate) was synthesized and in 1955 it was licensed by the Food and Drug Administration to treat various psychological dis-orders. And this was also the time when the symptoms of ADHD were first de-scribed as “minimal brain dysfunction” (Anastopoulos et al. 1994). The develop-ment and marketing of amphetamine-based drugs and the definition of ADHD as a brain disorder go hand in hand.

The medication of children with an ADHD diagnosis shows an important ten-dency from the viewpoint of biopower: deviant behavior is understood as having a cause internal to a person’s body, more specifically, her/his brain. Edward Com-stock (2011) traces the interesting path of the development of treatment for ADHD. At first, in the first half of the twentieth century, drugs, “alongside other thera-peutic techniques were meant to eradicate (deviancy in general). The focus was on behaviors, conformity, and institutional roles” (Comstock 2011: 52). It was not a disease that was being targeted but behaviors that needed eliminating. Children with behavioral disorders were “other children,” the unknown – because not thoroughly described within medical discourse (Rafalovich 2001: 106). In order to describe these children as knowable objects of scientific study and medical inter-vention, researchers turned (starting from 1960s) to the brain, “which ‘functions’

6 http://www.cdc.gov/ncbddd/adhd/diagnosis.html

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in knowable ways according to a transcendental human program” (Comstock 2011: 58). The behavioral disorders became strictly connected to the individual and her/his body. They are no longer strictly connected to social and moral devi-ancy. The stimulants – with their paradoxical effect – can now detect abnormality within the body.

But perhaps most importantly, because psychotropic drugs replace institutional moral and juridical norms as the test for this behavior disorder, the new disorder could be found in anybody and in any behaviors based no longer on these norms but on the reaction to the drug in relation to a synthetic ideal of behavior. (Comstock 2011: 61)

The basis for confirmation of the diagnosis and the reality of the illness is no longer social deviancy but the processes within the individual – the processes altered by the stimulants (see for example Napolitano et al. 2010 and Volkov et al. 2007 for neurological research on dopamine production effects in ADHD).7 The practices of medical surveillance play an important role in this confirmation and formation of the illness. The practice of population health statistics makes it nec-essary that any normal and abnormal condition be encoded; every condition has to be classifiable in order to form a coherent image of the population’s bios, a figure of the healthy “social body.” The prescription of drugs requires that one is diagnosed with a specific disorder, and every diagnosis is registered and entered into the population data bank. While the drugs themselves in the case of ADHD are one of the bases of the disorder’s reality, we see here a complex structure which forms this disorder. The interplay between biopower (intervention into the conduct of individuals), surveillance (the collection of data), drug developers, psychiatry and broader cultural knowledge forms this reality that is ADHD.

This is not to say that the knowledge produced by medical practices and drug developers are immediately “subjectifying”8 individuals in societies. Rather, by creating a discourse with the help of surveillance techniques, human sciences, existing social institutions, the formation of complex wholes such as ADHD pro-duce a kind of “life” that is separated from actual individuals. This “normalized

7 It should be emphasized however that none of these researches can pin down the exact neuro-logical caus(es) of ADHD, which makes the treatment through drugging more problematic. ADHD is composed of very heterogeneous symptoms and using stimulants to alter brain activity should be viewed as an over-simplification.8 Derek Hook (2010: 31) makes a distinction between 1) “subjectification”: “the promotion and elaboration of a thoroughly individualizing set of knowledges about the singular subject who is effectively normalized and psychologized as a result”; and 2) “subjectivization”: “the feeding back of such knowledges to a subject who comes to apply such notions, to understand and expe-rience themselves in the terms of subjectification.”


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life” is attributed to the healthy social body, an abstract entity that represents the state of affairs for which the management of individuals is supposed to govern the population. The production of such “life” is important to notice, because, as Ivan Illich (1994) noted, “ ‘A life’ is amenable to management, to improvement and to evaluation in a way which is unthinkable when we speak of ‘a person.’ ” “Life” can be mapped down “scientifically,” its processes predicted, the latter can be intervened and prevented.

What is important, then, is not the fact of surveillance, the collection of data itself, but the social meaning making practices that are built upon this data. A concrete individual might not even have any connection with the data that is used to create a norm and define the deviance from it, considering that medical popu-lation statistics are usually compiled by surveys and previous diagnoses – that cover a rather small part of the population. Through statistics and the marketing of medications, an illness like ADHD is constructed as a social fact and as a prob-lem for the population as whole; that is, a concern for each individual. Therefore, in addition to concrete medical and medication practices, the construction of ADHD – or any other similar mental disorder – faces concrete individuals with a new kind life, which has to be internalized as part of the cultural signifying system. Adding to the “scientific” basis of this “life” is its basis in biological- neurological treatment with medications, thus creating an understanding of the individual as a “neurochemical self” (Rose 2003).9

The development of drugs and the refinement of psychiatric and psychologi-cal language that helped to integrate different behaviors into a heterogeneous whole, have then profound effects on the individual’s formation of her/his iden-tity; it alters the relation the individual has with her/himself. And this shifting of relation is highly problematic because the biological cause of the disorder is not definite – the diagnoses do not so much discover as construct it. The creation of the normalized social body and the encoding of even the minor disorders in terms of neurological activity put the individuals in a constant risk of deviancy and in a position of self-surveillance with regard to their conduct and action, their self- production. “An ethics is engineered into the molecular make up of those drugs,

9 The dream of immortality in this world and the exile of death to the sterilized walls of hospitals – the erasure of death from everyday life – may in part be explained by the vision of “life” as wholly manageable, controllable:

[A]long with the increasing corporeality of the concept of self-preservation, there may also have been a corresponding transformation of the concept of immortality itself, a shift which is just beginning to become noticeable. While the claims of medicine are still couched in the usual terms of self-preservation . . . out on the edge there has appeared a worldly, corporeal vision of immortality, complete with a liquid-nitrogen limbo. (Tierney 1999: 252)

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and the drugs themselves embody and incite particular forms of life in which the ‘real me’ is both ‘natural’ and to be produced” (Rose 2003: 59).

One of the major effects of the types of medications as the stimulants used for ADHD on the semiotic level of self-formation is definitely the conflation of “natu-ral” and “cultural”; the view of one’s body as producible through one’s conduct. The body is viewed as being in constant risk when the individual is “behaving badly.” But this “bad” is no longer so much in relation to societal norms as in reference to one’s own body, which is decaying and getting out of shape if the individual does not treat it right. For example, a whole field of literature on self-help has emerged that teaches the individual to live a good and healthy life. The individual has to work on her/himself to become “natural,” that is, healthy.

But this working with the self means increasingly that one needs to be a good patient. Good conduct in this context does not simply mean that one needs to behave according to social and moral rules. Rather, it means doing and taking what the doctor(s) have prescribed to the patient – it means to let oneself be gov-erned. That is, one needs to follow medical, not simply behavioral rules; one has to let the prescribed substances work on his/her biology in order to become an acceptable citizen. Here we come to the question of treatment adherence, that is, “the extent to which a person’s behavior – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider” (World Health Organization 2003: 3). In the case of ADHD adherence usually refers simply to taking the prescribed stimulants (Chacko et al. 2010: 2417), that is, altering one’s brain activity and through this, altering one’s behavior. Chacko et al. (2010: 2420) propose, in order to improve adherence, various interventions are necessary; for example, parent-training, students’ education, “tailoring medication to the profile of the youth and family” – that “target environmental constraints to adherence . . . address habitual and automatic processes that may influence adherence behavior, and improve patient self-efficacy in taking medication.”

What the above texts show is that patients’ behavior is being considered mainly in relation to the taking of medications and following the regulations pre-scribed by the doctors. Failure to adhere to treatment could be read as a sign of ADHD-related behavior: it is a failure of willingness to alter one’s biological func-tions in accordance with social norms. The view that the maximization of adher-ence to medication is the best way to treat ADHD confirms the hypothesis that ADHD is seen as a bodily/biological disorder, which causes socially aberrant be-havior. As a neurochemical disorder, it enables the institutions (e.g., schools, clinics, but also the family) to code individuals as biological organisms who need governing; and this government is implemented as much through medical and governance practices (drugs, surveillance of adherence) as through discursive


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normalization. The individual is subjectified as a “natural” and biological entity that needs to act according to social norms in order to attain his/her “nature.”

We see then that in the case of ADHD that the individual is a proper object of biopower and that this biological normalization is as much linked to social norms as before. Moreover, the fact that an individual’s behavior can be termed a dis-order simply on the basis of the influence of medications renders the relations of social and bodily norms even more complex. The infinite sets of rules that are written and talked about on how to live draw out a very refined field on which to act. Having a certain kind of a disorder can be – and usually is – related to the moral code, the code of conduct. If the body is a site of conscious production, it is immoral to “let yourself go,” be inattentive, disturb others, not take drugs, etc.

The creation of a common cultural knowledge and governmental, medical, social practices applying that knowledge of the “life” that is manageable through medication is vital in order for the individuals to subjectivize themselves accord-ing to this figure of life. As it seems, this production of life has for the present moment gained the status of truth in today’s societies, forming the individuals’ (in case of ADHD especially the children) self-image in relation to deviancy with-in the body itself that can be “normalized” using medication. As said earlier, an estimated 2.7 million children in the US are growing up being normalized by the alteration of their brain activity.

7 ConclusionI would not like to close on such a grim note, however it must be said that ADHD is a work of fiction used to control children and, increasingly, adults; to margin-alize them from the social sphere as if the individuals themselves had no self- control. Self-creation always takes place in a cultural and social field of norms and regulated conduct but that does not mean that individuals have no freedom to creatively use those norms, to conduct themselves in other ways than pre-scribed by social normativity. Self-creation works through semiosis and thus always entails the specific subjective relation to societal norms. Here I can also see that further studies using exactly semiotic methods and understanding to an-alyze the self-creation, subjectification of individuals and groups would be abso-lutely fruitful and necessary. For example, the semiotic concept of autocommuni-cation would enable us to study the formation of the social, medical subject from the viewpoint of the individuals themselves.

This is also why I tried to step outside of the biopolitical structure of inclu-sive exclusion described by Agamben: to theorize individuals as capable of self- normativity. The construction of ADHD as a large-scale problem has achieved

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the definition of very heterogeneous behaviors into one homogenizing totality and transformed the self-relation of millions of individuals who probably would not need to be treated by medication. But this does not mean that ADHD and the medication of children is an inevitable part of society and culture. On the con-trary, this seeming inevitability stems from the work of continuous promotion of drugs, definition of deviant behaviors, and shifting the focus from social norms to the bodily norms. It is said about mental disorders: the first step to recovery is recognizing that you have a problem. Maybe we could ask the people searching for disorders where maybe there are none to recognize that there is a problem in the way that ADHD is sometimes clearly over-diagnosed and children too easily over-medicated. Maybe one aspect of the problem is not inherent within the bodies of citizens but the way that society describes them?

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BionoteOtt Puumeister (b. 1985) is a graduate student at the University of Tartu <ott. [email protected]>. His research interests include biopolitics, political semi otics, semiotics of culture, and non-identificational politics. His publications include “Review: Michel Foucault’s care of the self in the context of power and knowledge” (in Estonian, 2011); “The construction of the subject in surveillance systems” (in Estonia, 2011); “The subject’s self-creation in power relations: Agamben”s, Badiou’s and Foucault’s theories of subjectivity from the semiotic point of view” (in Estonian, 2012); and “Biopolitics as a power over life and as life’s own power” (in Estonian, 2012).


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Biopolitics, Surveillance and the Subject of ADHD