Dungeons and Druggings

"Biopolitics" refers to the monitoring and regulation of human populations "on the basis of [their] biological processes," to use Michel Foucault's original mid-1970s definition, including "births and mortality, the level of health, life expectancy and longevity, with all the conditions that can cause these to vary." Over the past decade or so, the concept has slipped free of its strictly academic moorings and made its way into wider exchanges over public policy. Admittedly it's unlikely that Chuck Todd will grill his guests on Meet the Press about biopolitics anytime soon, but I wouldn't rule out the possibility altogether. The 2020 census seems as concrete a matter of biopolitics in action as anyone could want.

As formulated by Foucault -- mainly in lectures only prepared for publication some years after his death in 1984 -- the concept of biopolitics frames questions about social organization as irreducibly physical. The body politic has a corporeal aspect; governance entails the tracking and control of actual bodies. And here the taking of a census provides not just a tangible instance of biopolitics but one of Foucault's primary examples. Populations are not counted for the sake of posterity. Demographic information feeds into the state's ongoing efforts to monitor and regulate those within its territory and to plan accordingly. And deciding what categories of data are gathered and how they are interpreted is a quintessentially biopolitical process. Here's hoping the president doesn't learn that, or he'll never stop bragging about it.

The proposed citizenship question on next year's census is pretty blatant in its effort to surveil and police the populace. But the biopolitical issues taken up by Anthony Ryan Hatch in Silent Cells: The Secret Drugging of Captive America (University of Minnesota Press) are in many ways more disturbing. Over the past few decades, Hatch writes, the United States has conducted "the most unscientific natural experiment in the history of biomedicine: What happens when you give large quantities of often powerful mind-altering substances to large-scale human populations?"

The author, an associate professor in the Science in Society program at Wesleyan University, was drawn to the question in particular through the use of psychoactive drugs as part of the public policy approach called "technocorrections," which refers to "the strategic application of new technologies in the effort to reduce the costs of mass incarceration and minimize the risks that prisoners pose to society." But other groups have become guinea pigs as well: children in foster care, soldiers facing repeated deployment, immigrants in detention and the warehoused elderly. They share the status of being "people [who] exist, if not in actual prison cells, in spaces they are not exactly free to leave."

The extensive use of antidepressants and antianxiety medications in the wider population is by now a given; one recent estimate is that 16.7 percent of adult Americans (one out of six) take at least one psychopharmaceutical, with 80 percent of them doing so on a long-term basis. With populations "not exactly free to leave," the percentages tend to be higher. "Somewhere between 15 percent and 70 percent of children in foster care are drugged," Hatch writes, "and prescriptions for individuals in this population have been increasing over time across the United States. Indeed, evidence from statewide samples of fostered youth shows that anywhere from 13 percent to 41 percent are prescribed more than one psychotropic at the same time." Those living in group homes "were 1.8 times more likely to take psychotropics than were those living in foster homes with families."

At the other end of the spectrum of age, a study of "more than 12,500 nursing homes between 1996 and 2006 documented a doubling in the proportion of residents receiving psychotropic prescriptions: from 21.9 percent in 1996 to 47.5 percent in 2006," while another study "found that more than half of new nursing home residents were prescribed psychotropics within two weeks of their admission." There is a growing tendency to prescribe "atypical antipsychotic medications to elderly patients in nursing homes for off-label uses, despite increased risk of stroke, neurological problems and death," with evidence of well over half of them not "being given the drugs in accordance with prescribing guidelines." Indeed, up to a quarter of nursing home residents may be taking psychotropics "despite a lack of evidence of mental illness.”

The pharmacopeia also spills into the U.S. military. "From 2005 to 2011," Hatch reports, "there was a 76 percent increase in all psychotropics prescribed to active-duty troops: orders for antipsychotics increased by 200 percent, antianxiety drugs by 170 percent, antiepileptics by 70 percent and antidepressants by 40 percent." The Defense Logistics Agency "spent $2.7 billion on antidepressants between 2002 and 2012."

Early in his research, Hatch says, he determined that statistics of comparable breadth or specificity about the use of psychoactives among prisoners were scarce: "Even the Bureau of Justice Statistics, the government agency responsible for producing and compiling data on criminal justice in the United States, had produced only a few official reports, based on limited prison surveys, on the subject of psychotropics, and these left many questions unanswered." In part, this reflects the variety of institutions holding people in custody -- the carceral system is a mixture of local, state and federal facilities, including prisons run by private companies. But the available evidence suggests similarities with the populations already mentioned. An audit of Utah’s Salt Lake County Adult Detention Center found that psychoactive drugs "accounted for more than half (58 percent) of all medication costs" from December 2000 through May 2006, while other research finds "institutional use of psychotropics … to be positively related to increasing levels of confinement: in 2000, 95 percent of maximum/high-security state prisons distributed psychotropics, compared to 88 percent of medium-security prisons and 62 percent of minimum/low-security prisons."

Incarceration is the last stop for some who might once have ended up in state psychiatric facilities, and solitary confinement is known to damage the mental health of many prisoners. But something is conspicuously absent from the scraps of information Hatch has located: any data that might reveal how many prisoners are receiving psychoactive drugs, not on the basis of a diagnosed mental illness or as part of any sort of treatment, but strictly to subdue the prison population. Taking a census is one mode of biopolitics; turning large populations of people into pacified detainees through techniques directed at their neurosystems is another. And the institutions where drugging has become the norm are "all in crisis, and … all linked together," Hatch writes:

Consider the following connections. Parental deployment as part of military service, parental imprisonment and serious mental illnesses all contribute to the numbers of children who end up in the child welfare system and foster care. An alarming number of recently returned military veterans find themselves involved with the criminal justice system, as do many adults who, as kids, spent time in the child welfare system. Following deinstitutionalization, nursing homes quickly became primary receptacles for formerly hospitalized mentally ill people and then rapidly expanded due to the fact that Medicaid financed much of these residents’ care. Beginning in the 1970s and continuing to the present, direct links can be traced from psychiatric hospital closures to lack of adequate inpatient treatment options to increases in the proportions of jail and prison populations with mental illness.

Biopolitics is not the proper concept for institutions that condemn those under their remit to a kind of zombielike status. For that, Hatch champions a more recent neologism: necropolitics, a system for managing the socially dead.