Methadone Maintenance Treatment: Making up People

2015

Barad cites Ian Hacking’s Representing and Intervening as an inaugurating text for critiques of representationalism in science studies (). The phrase for which Hacking is best known, however, is ‘making up people’, and the project of historical ontology is one of his elaborations of that phrase (). Historical ontology describes ‘ways in which the possibilities for choice, and for being, arise in history. It is not to be practiced in terms of grand abstractions, but in terms of the explicit formations in which we can constitute ourselves’ (). Making up people is a process where new kinds of being are created, both through the actions of people ‘from below’ and the effects of expert discourses ‘from above’. The identity categories of homosexuality and heterosexuality are very well-known examples of this process: before the nineteenth century, people did not identify and were not identified as heterosexual or homosexual, because those categories were not available. There were of course practices and desires that can be retrospectively identified as homosexual, but to map a gay or lesbian identity onto them is anachronistic. Identity is not formed only through practices and desires; it does not exist until it is an object of study and a means by which the self can constitute itself as that identity. Equally, to retrospectively diagnose a Crimean War soldier as suffering from post-traumatic stress disorder is to misrecognise the power of identity categories, expert knowledge and biomedical technologies in forming individual experience. Along with others influenced by Foucault, a number of Hacking’s projects examine what creates the conditions of possibility for individual subjectivities and experiences. Hacking’s examples include child development (we understand children as developing entities) and trauma (we understand that abuse of children occurs and has severe and longstanding effects). A very important element of this is a feedback effect, or

the looping effect of human kinds. People classified in a certain way tend to grow into the ways that they are described; but they also evolve in their own ways, so that the classifications and descriptions have to be constantly revised.

(Hacking, 1995: 21)

There are a couple of points to emphasise from this. First, the processes in question may circulate around the discourses of experts or other forms of authority, they may emerge from science or from self-help, they may happen during transient historical moments and pass away or emerge and remain in place. However, they all ― if only eventually ― act upon the conditions of possibility for individual subjectivity, and are not experienced as impositions on fully constituted persons. They refer to the historical conditions not of particular representations of people but of particular ontologies. Second, saying that it is possible to historicise the emergence of conditions of possibility for individual experience is not the same thing as saying those experiences are inau-thentic or fabricated. That is, arguing that the identity category of child abuse survivor did not exist until quite recently is not arguing that such an identity is contrived or that its impact on individual experience is somehow artificial. The truth claims of these arguments, in fact, work in the opposite direction: these conditions of possibility are empirically verifiable and entirely real, and it is important to understand their historical formation precisely because they have such an impact on people’s lives and selves.

Does methadone maintenance treatment count as an instance of ‘making up people’, in the sense used by Hacking? Insofar as it is a particular drug treatment for opiate addiction, probably not. This is a difficulty with Hacking in that his exclusion criteria are a bit opaque. Insofar as it is concerned with the category of ‘drug addicts’, almost certainly. Drug addiction, a historically specific, and historically locatable, condition that is an established part of medical taxonomies and a recognisable cultural stereotype could surely be a part of any project of historical ontology. The domain of drug treatment is a specific, contemporary enactment of this. As a treatment program that operates on addiction and is often undergone for a considerable length of time, it enacts in particular ways those relationships between clients/consumers and coercion/consent that feature in many analyses of contemporary biomedicine. On the one hand, most contemporary drug treatments situate addiction in the domain of illness rather than criminality; on the other, medicine itself is constituted through technologies of regulation, surveillance and ‘responsibilisation’ (). An effect of this, as we will argue shortly, is the constitution of clients as unreliable and immature, in need of moral guidance and social structure. In this respect, methadone maintenance treatment operates as an instantiation of the broader phenomenon of ‘biopower’ as well as a specific technology of managing addiction.