Pharmaceutical Reason

Knowledge and Value in Global Psychiatry

When a French biotechnology company seeks patients in Buenos Aires with bipolar disorder for its gene discovery program, they have unexpected trouble finding enough subjects for the study. In Argentina, the predominant form of mental health expertise – psychoanalysis – does not recognize the legitimacy of bipolar disorder as a diagnostic entity. This problem points to a broader set of political and epistemological debates in global psychiatry. Drawing from an ethnography of psychiatric practice in Buenos Aires, Andrew Lakoff follows the contested extension of novel techniques for understanding and intervening in mental illness. He charts the globalization of the new biomedical psychiatry, and illustrates the clashes, conflicts, alliances, and reformulations that take place when psychoanalytic and biological models of illness and cure meet. Highlighting the social and political implications that new forms of expertise about human behavior and thought bring, Lakoff presents an arresting case study that will appeal to scholars and students alike.


"A brilliant account of the globalization of diagnoses of mental illnesses, brought about by the pharmaceutical industry and the genetic code. A French gene-hunting company pays a poor mental hospital in Buenos Aires to send blood samples from patients with bipolar disorder. But the doctors do not make that diagnosis there! Now they must: the hospital cannot afford not to. A truly thick description of the interface between two systems of thought, and its impact on patients and staff. This is the best sort of medical anthropology, both sensitive to real people, now, and pregnant with implications for the future." - Ian Hacking, College de France

"At once ethnographically detailed and theoretically incisive, Lakoff's book is an important watershed for studies of pharmaceutical culture. Provocatively and convincingly, he challenges the ascendancy of biological psychiatry in Europe and the US by tracing the different history of psychoanalysis and biological psychiatry in Argentina. This book will greatly reward anyone interested in the social context of psychotropic drugs, the comparative history of mental illness, or the cultural understandings that imbue contemporary concepts of mind and brain." - Emily Martin, New York University

"Pharmaceutical Reason sets a high standard for future work... Its close ethnographic exemplary." - Paul Brodwin, Anthropological Quarterly

"Pharmaceutical Reason is exemplary in its demonstration of the benefits conferred by cross-cultural research on the evaluation of 'universal' categories of understanding, and more pertinent here, the process by which this universality is asserted and either adopted or resisted." - Kalman Applbaum, American Journal of Sociology

"...a brilliant study combining scholarly historical analyses with a close monitoring of highly technical scientific controversies..." - Michel Callon, Contemporary Sociology

"Over the past 25 years, I have frequently called for more anthropological attention to the production and marketing of pharmaceuticals and their linkage to health and health care. Lakoff's ethnography is a convincing response to that call. From this book, I learned that there is even more the development and marketing of antipsychotic drugs than I had imagined." - Sjaak van der Geest, American Ethnologist

"One of the most exciting and beautifully written contributions to the study of psychiatry and pharmaceutical use in recent years, Lakoff's analysis may prove deeply influential for a range of disciplines, as he continues to develop the wider significance of his insights." - Science as Culture

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