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Krasnow Institute > Monday Seminars > Abstracts WHEN EXPLANATIONS REST: "GOOD-ENOUGH" BRAIN SCIENCE AND THE NEW BIOMENTAL DISORDERS Joseph Dumit In this talk I make an exploratory attempt at ethnographically characterizing a set of contested fields I call the New Biomental Disorders. Under this name I include Attention Deficit Disorder (ADD), Chronic Fatigue Syndrome (CFS), Gulf War Syndrome (GWS), Multiple Chemical Sensitivity or Environmental Illness (MCS) as well as Post-Traumatic Stress Disorder (PTSD), Depression, and Schizophrenia. All of these conditions share the following characteristics: 1. They are "biomental": their nature and existence are contested as to whether they are primarily mental, psychiatric, or biological. 2. They are causally undetermined: their etiology is likewise contested as to social, genetic, toxic and personal possibilities. 3. They are "biosocial": persons having these conditions are organized, coordinated, and feel a kinship based on their shared experience. 4. They are legally explosive: each condition is caught up in court battles, administrative categorization and legislative maneuvering. Disability status, for instance, is haphazardly applied. 5. They are therapeutically diverse: the nature and reimbursement of competing therapies, including alternative medicine is wide open. 6. They are cross-linked: each of these conditions has been linked to the other ones as subsets, mistaken diagnosis, and comorbid conditions. 7. Functional brain imaging is contested: brain scans play a significant role in staging the objectivity of each of the first six characteristics for each of these conditions, and is highly contested. The level of medical, social, legal, scientific and economic disorder implied by these seven characteristics must not be underestimated. Each of these conditions is a serious matter not only for the persons afflicted, but also for the thousands of physicians, researchers, corporations, insurance and administrative agencies having to deal with them. Yet, except perhaps for depression, very little mainstream biomedical research has been carried out. The fights over definitions, diagnosis, response and prevention thus depend disproportionately on this small amount of research, much of it underfunded. The fights also depend on the ability to control the questions in the absence of definitive answers. My contribution to this literature here is to survey the volatile, meaningful roles of brain imaging within the ongoing histories of these conditions. Brain imaging functions within each disorder as a "gold standard" of demonstrative proof of neurobiological involvement, and also serves as a site for the intertwining of these various disorders. Most importantly, 1) these scans are used as critical arguments by communities of all of the different biomental disorders. 2) They are often done by the same people. 3) The imaging community is quite divided over this (with most being virulently opposed). 4) Finally, these images are powerful across boundaries. They are recruiting devices, insurance arguments, self-help diagnosis, legitimation, reparations, etc. And control of them is most definitely not in the hands of the researchers who produce them. If I want to underscore anything in this talk, it is the unevenness of objectivity, truth and meaning. By unpacking the nexus of suffering, science and surveillance surrounding these biomental disorders and focusing on how brain imaging --arguably the most ambiguously promising diagnostic technology-- is used, not used and abused in contests over these disorders, I think we can come to understand more about the roles of blame, causation, stigma, biology, nature and personhood. Ultimately, these struggles point to the necessary political economy of science and medicine. There is no real neutral ground.
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