Choose Your Pill
Operations of Capital, Psychiatry, and the Construction of Gender
In his book Testo Junkie , Paul B. Preciado provides us with a provocative, original reading of contemporary capitalism, conceived as a pharmacopornographic regime. This term refers to “the processes of biomolecular (pharmaco) and semiotic-technical (pornographic) government of sexual subjectivity” that, although possibly rooted in the nineteenth century, became visible as a new paradigm only after World War II. Relying on the growing importance of pharmaceutical technologies and pornographic imaginaries in the formation of neoliberal subjects, Preciado borrows from Foucault in claiming that this kind of capitalism does non produce things, but subjects. He also adds, echoing at the same time Spinoza, Reich, Deleuze and Guattari, that pharmacopornographic capitalism no longer relies on the exploitation of work, but of potentia gaudendi, a sort of primordial “orgasmic force” existing before and beyond any further characterization (neither human nor animal, neither female nor male, neither animate nor inanimate). This potentiality cannot be reduced to private property, but always exists “as an event, a relation, a practice, or an evolutionary process.” However, capital’s biopolitical control tries to convert such an orgasmic force “into merchandise, into an object of economic exchange, into work” – and, according to Preciado, femininity is the quality expressed by the conversion, referring to both female and male bodies. The very invention, starting in mid-20 thcentury, of the specific category of gender, assumes in Preciado’s framework a fundamental role, allowing for a final paradigm shift in the continuum from sovereign power to disciplinary power to pharmacopornography — the last being a reformulation of Deleuze’s control societies expanded by “notions inspired by both Burroughs and Bukowski.” While he recognizes that the third regime has not completely eradicated the previous ones (and that pharmacopornographic production is not the most quantitatively significant in today’s world econom), Preciado claims that it has become “the model of all other forms of production.”
This interpretative framework is as intriguing as it is puzzling — and the very structure of Testo Junkie, part counter-cultural autobiography and part philosophical provocation, seems conceived precisely to discourage an analytical understanding of it: the book appears as designed to be deeply loved or deeply hated by the reader, and its iconoclastic posture may well discourage anything in between. In what follows, I will try to explicitly refute these narrow options, by demonstrating on the one hand the text’s lack of theoretical stability and, on the other, the validity of some of its intuitions even beyond Preciado’s own view.
To begin with, it is not exactly clear why pharmaceutical and pornographic industries should be taken as the key elements of the contemporary capitalist system. Preciado’s claim that the sex market is the most profitable market on the internet, already dubious when the Spanish edition of Testo Junkie came out in 2008, is all the more questionable nowadays. As shown by authors such as Nick Srnicek , the so called digital economy is dominated by platforms — that is, by material and immaterial infrastructures devoted to monopolize, extract, analyze and use increasingly large amounts of data. The wide galaxy of porn websites now available is just one of the many instantiations of this wider phenomenon: the most important pornography providers, indeed, do not sell sex (as their contents are ‘for free’), but they sell advertising space and huge amounts of customers’ data.
Preciado’s thesis that pharmacopornographic production shapes all the other kinds of production seems also fragile: why should we prefer his proposal to, for example, those locating the most pervasive capitalist tendencies in financialization and indebtedness or the Capitalocene ? More generally, the idea that post-Fordist capitalism could be defined by a unique tendency – as industrialization was to Fordism – appears intrinsically questionable. Nancy Fraser, among others, describes capitalism as an institutionalized social order based on a variety of forms of expropriation and exploitation, and relying on a number of background conditions of possibility , ranging from (gendered) unpaid reproductive labor to the extraction of natural resources, to evolving modalities of racialization.
In a similar vein, Sandro Mezzadra and Brett Neilson have developed the notion of operations of capital “to multiply empirical points of entry and to complexify the conceptual framework for the critical analysis of contemporary capitalism.” Regarding operation as a moment of connection and capture that exhibits the materiality of even the most ethereal forms of capital, they put it to work in linking together recent changes in the fields of finance, logistics and extraction — yet leaving open the possibility of different operations intersecting with them. In this connection, I would like to argue that pharmacopornography does indeed point to two other relevant operations of capital within a wider context. In particular, I claim that there is an especially influential operation that, although not explicitly addressed by Preciado, makes pharmacopower a key element of the post-Fordist scenario. 
Although he offers a long and powerful chapter on pharmacopower in Testo Junkie — developing, among other things, an impressive criticism of the contraceptive pill and its violently colonial and sexist origins — Preciado does not devote a particular attention to psychiatric drugs or treatments nor to their role in the production of a kind of subjectivity in line with the needs of contemporary capitalist accumulation.  However, during the timespan of what he labels pharmacopornographic regime, such a role has become exponentially important — and in a way that directly calls into question the topic of gender identity.
After World War II, psychiatry in the US (the main context of Preciado’s investigation of pharmacopower) was articulated into two branches: professionals working in universities and private practices, and psychiatrists working in state hospitals. While the former relied on a mainly psychanalytical methodology, the latter mostly recurred to the prescription of drugs or shock treatments, as Jonathan Metzl details in Prozac on the Couch . Both categories were composed almost exclusively by men, and both were deeply imbricated in patriarchal stereotypes and behaviors — sexual relations with and harassment against the women engaged in psychoanalysis were quite frequent practices, while the (largely female) population of psychiatric hospitals was most of the time hospitalized against their will, often at a husband’s request . These phenomena were inextricably related to the then current state in capitalist accumulation: the development of the first psychotropic wonder-drug, Miltodown, in the second half of the 1950s, went hand in hand with a pathologizing of women’s desire to work outside the home, as well as their purported ‘frigidity.’ The spectacular diffusion of products such as Miltdown contributed to a sexual policing of the boundaries of the family-wage model on which Fordism was based (boundaries not challenged, but reinforced, by the almost contemporary development of family assistance programs at the federal level , which in a way secured the foundations of a system based upon a huge amount of unpaid social reproductive labor).
In the seventies, US psychiatry experienced what is usually called a biological revolution: psychoanalytic methodology was overturned in favor of ‘organic’ explanations of identity grounded on neurochemistry, genetics, and psychopharmacology. While the mainstream narrative of this shift assumes that it also implied a complete discarding of the patriarchally charged sexual politics of psychoanalysis, that was not the case — as Metzl’s detailed study of the gendered (psycho)dynamics of pharmaceutical adverting during the period 1964-1997 has compellingly shown. In particular, the politics of advertisement and prescription over that timespan (with its obsessive and performative focus on married white women as the ideal type of psychiatric patient and its pathologization of radical feminism) contributed to sustaining the ideological role of the nuclear family in a period when the latter was at the center of both neoliberal and neoconservative anxieties.
What would change over the thirty years analyzed by Metzl and the two following decades, were the kinds of wonder drugs dominating the political economy of pharmacopower — in line with the concurrent modifications in capitalism. Indeed, if Valium, which registered a boom in the 1970s, was mainly an anxiolytic drug, Prozac, which through its heirs is still dominating the pharmaceutical market, is the anti-depressant par excellence. The last three decades have seen an unprecedented (and, on diagnostic terms, hardly justifiable) broadening of the category of pathological depression,  in line with the progressive neoliberalization asking individuals to find “ biographical solutions to systemic contradictions .” This is why depression becomes perfectly functional to capitalism in its neoliberal variant: on the one hand, it allows huge profit margins to be obtained precisely from the treatment of the psychological repercussions of its structural dynamics; on the other, by pathologizing social malaise, it stimulates further introjection of a dynamic of individualized guilt . An integral part of this entanglement between depression and contemporary capitalism is its gender imbalance: the nearly double percentage of women being diagnosed with this condition (as opposed to men) is most likely connected not only to endocrinal reasons, but also to environmental and social factors. Precarious forms of employment, particularly frequent among women, seem to be correlated with higher levels of depression . Racialization should be taken into account here, too, since the discourse of strength usually developed around black women contributes to normalizing even high levels of depression in their case.
Preciado’s claim that pharmacopornography is the main tendency of contemporary capitalism seems not particularly convincing – as post-Fordism is characterized by a plurality of operations, some of which also appear to be more pervasive than the ones analyzed by him. However, as I have tried to show, pharmacopower may well be a particularly important operation in the building of neoliberal subjectivity, to an extent that Preciado himself has not fully acknowledged. Specifically, the evidence briefly reviewed here points to the fact that psychotropic medications, and especially anxiolytics and antidepressants, are fundamental to understand the intertwining of capitalism, gender identities, and racialization. Far from being a work that could only be enthusiastically endorsed or harshly refuted, Testo Junkie offers, in my view, some important – though incomplete – intuitions for an analysis of post-Fordism.
Franco Palazzi is a graduate student in Philosophy at NSSR. His latest published work is “Reflections on Little Rock and Reflective Judgment”, in Philosophical Papers 46(3), 2017.
 Jason W. Moore defines Capitalocene as follows: «Capitalocene names capitalism as a system of power, profit, and re/production in the web of life. It thinks capitalism as if human relations form through the geographies of life. Far from refusing the problem of political economy, however, it highlights capitalism as a history in which islands of commodity production and exchange operate within oceans of Cheap – or potentially Cheap – Natures. Vigorous accumulation depends on the existence – and the active production – of human and extra-human natures whose costs of reproduction are kept ‘off the books’» (“The Capitalocene, Part I: on the nature and origins of our ecological crisis”,The Journal of Peasant Studies 44:3, 2017, p. 606).
 Although I have no room to address it in the main text, at least another theoretical difficulty of Preciado’s approach deserves to be mentioned. One of the most plausible ways of making sense of his challenging text is to read it as an attempt to criticize the idea of cognitive capitalism formulated within the tradition of Autonomous Marxism. Proponents of cognitive capitalism are explicitly accused by Preciado of stopping biopolitical production «at the belt» (p. 37), disregarding the role of sex work in the production of subjectivity (p. 46), and maintaining a desexualized view of the biopolitical body (p. 293). These remarks constitute, quite clearly, a misinterpretation. As early as 2006, Antonio Negri, often referred to by Preciado as one of the main theorists of this current, wrote: «In reality, the new face of productive labor (intellectual, relational, linguistic, and affective, rather than physical, individual, muscular, instrumental) does not understate but accentuates the corporality and materiality of labor. […] We offer neither apology nor enthusiasm for this transformation of labor: who would argue that the fatigue of a call center operator is less (albeit absolutely different) than that of a steel worker of a century ago? Who would argue that the nurse working in a computerized hospital asks less of her body than did a coal miner?» (See A. Negri, Response to Pierre Macherey). In a foundational text for the current debates on this topic, Christian Marazzi went as far as to consider the human body as constant capital, therefore blurring any clear boundary between body and machine (see “L’amortissement du corps-machine,” Multitudes 27(4), 2006, pp. 27-36). Besides, some of the leading thinkers of cognitive capitalism have been forcefully advocating for now more than a decade in favor of the overcoming of any sharp separation between mind and body,living labor and dead labor, constant capital and variable capital – and their timely recognition of the biological and biotechnological implications of such a shift from previous categories led them to speak of bio-cognitive capitalism (see. A. Fumagalli, Bioeconomia e capitalismo cognitivo. Verso un nuovo paradigma di accumulazione , Rome: Carocci, 2007, especially pp. 185-192 and Idem, Economia politica del comune. Sfruttamento e sussunzione nel capitalismo bio-cognitivo , Rome: DeriveApprodi, 2017, especially chaps. 1 and 3). Finally, claiming, as Preciado does, that the notion of feminization of labor (strictly connected with cognitive capitalism) omits to consider sex work – the «cum shot», in his words (p. 49) – contributes to the obliteration of an entire field of scholarship which aims to combine cognitive capitalism and feminist critique. Feminization of labor, in which «the fragmentation of the service provided and the complexity of the dependence/absorption which women have experienced at various times in the labor market, ends up becoming a general paradigm irrespective of gender» (C. Morini, “The feminization of labor in cognitive capitalism”, Feminist Review 87(1), 2007, p. 43), is indeed a concept that anticipates many of the concerns addressed in Testo Junkie. As made clear by Cristina Morini in a dense analysis of cases ranging from sex workers to freelancers, from reality show participants to care workers, cognitive capitalism implies the total subsumption not only of cognitive faculties, but of the whole body, too – from such a perspective, in contemporary capitalism the centrality of the body is even increased (C. Morini, Per amore o per forza. Femminilizzazione del lavoro e biopolitiche del corpo, Verona: Ombre corte, 2010, chap. 3).
 For some cursory references see pp. 33; 34-35; 39; 52; 165; 210; 237; 276 in Preciado. Twice in the book he comes close to recognizing the importance of psychotropic medication for his argument (pp. 60-61; 120), but he does not pursue such a path.
 See. A.V. Horwitz and J.C. Wakefield, The Loss of Sadness. How Psychiatry Transformed Normal Sorrow Into Depressive Disorder, New York: Oxford University Press, 2007 and J.C. Wakefield, “DSM-5: An Overview of Changes and Controversies,” Clinical Social Work Journal 41, 2013, pp. 148-149. For some stimulating reflections aimed at de-pathologizing and politicizing depression see A. Cvetkovich, Depression. A Public Feeling, Durham: Duke University Press, 2012.