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A Pink Pill Daily: Curing, Styling and Hacking Sexual
Desire with the Lust Enhancing Pill for Women
Maaike Hommes rMA Thesis Cultural Analysis
Graduation Date: April 28th 2017.
Universiteit van Amsterdam Supervisor: dr. M. Aydemir Second Reader: dr. N. Martin.
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Introduction 4
Chapter One: CURING: Where Medicine and Disease meet Normality 13
Charmaine’s Story 13
HSDD: The Formulation of a Disorder 16
Flibanserin: Cure to a Disorder 17
Thought Caught in Matter 20
Penetration and the ‘Molecular Rationale’ 22
Localizations and Articulations 24
The Good Life 25
The Normal Life 28
Chapter Two: STYLING: A Pink Pill Named Desire 29
Amy’s Story 29
Technologies of Sexiness 34
Losing Something, Wanting Something 36
Each Tiny Oval: Sign, Meaning and Consumerism 37 Wanting to Be Undone: Styling Sex with Addyi 40
Chapter Three: HACKING: Techno-biopower and Dispersed, Extended Sex 43
Whose Story? 43
Molecules of Nootropics 47
Viagraborgs and Extended Sex 50
Drugged Self-Perseverance 53
Hacking Into Dispersity 56
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To Tristan, who opened up desire in all its vitality, destruction and ambivalence, and showed how it all related to love. For, in Butler’s words:
Let's face it, we're undone by each other, and if we're not, we're missing something. (Precarious Life 23)
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Introduction
“Meet Addyi, the first of her kind.” With this gendered slogan, Sprout Pharmaceuticals promotes their so-called Pink Pill, which is the first officially approved lust-enhancing drug available for women. Until the fall of 2015, there were no fewer than twenty-six varieties of ‘Viagra’ prescribed for men. By contrast, there were no medicines intended to treat sexual problems in women. Numerous companies have sought to fill this gap in the market of lust-enhancing medication for women, and competed in the race for FDA approval. In August 2015, Sprout Pharmaceuticals won the race and went to market with flibanserin. Dubbed the ‘Pink Pill’ by the North-American media, flibanserin is sold under the sexier brand name of Addyi.
In various media outlets, the pill is referred to as ‘female Viagra’ (BBC; Forbes). However, flibanserin works quite differently than its male counterpart, for it does not merely enable the flow of blood to the genitals but instead targets the brain chemicals that are, according to Cindy Whitehead, CEO of Sprout Pharmaceuticals, known to facilitate sexual activity. Women have to take the pill daily, and the effects are only noticeable after roughly a month. This stands in stark contrast to Viagra, which according to its
commercials in the 1990s, is only taken ‘when you need it’. Flibanserin requires a longer commitment from its users. Therefore, it is mainly targeted to women in long-term relationships.
More specifically, according to Addyi’s website, flibanserin is prescribed for pre-menopausal women who suffer from ‘Hypoactive (i.e. low) Sexual Desire Disorder (HSDD) who have not had problems with low sexual desire in the past, and who have low sexual desire no matter the type of sexual activity, the situation, or the sexual partner. Women with HSDD have, according to Sprout’s statement, “low sexual desire that is troubling to
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them” (Addyi). According to the Diagnostic and Statistical Manual of Mental Disorders-IV (2000), HSDD is a persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity, which causes marked distress or interpersonal difficulty. Additionally, the definition requires that the instance of low sexual desire cannot be accounted for by another Axis I disorder, and is not exclusively due to the direct
physiological effects of a substance (e.g., drug abuse or medication) or a general medical condition. As a disorder, HSDD is grouped under the larger heading of ‘Female Sexual Dysfunction’, covering a wide range of sexual issues such as painful intercourse, the inability to achieve orgasm, and low sexual desire.
Multiple psychological studies on HSDD state that the disorder is the most commonly reported form of sexual dysfunction in women (Carvalho and Nobre 1807 ; DeRogatis 566 ; Segraves 408 ; Arnow et al. 484).1 In a study funded by Sprout
Pharmaceuticals, it was found that 24% of premenopausal women aged 20 -49 reported persistent low desire or reduced interest in sex (Thorp and Palacois 1328). While these studies stress the pervasiveness of the disorder, the guidelines for clinicians lack a precise demarcation (Beck 919 ; Segraves 414 ; Carvalho and Nobre 1813). Furthermore, the
conceptual haziness surrounding the notion of sexual desire, which is an essential part of the disorder in the DSM-based definition, continues to thwart a clear delineation of the disease
1 Six out of the eight articles written by psychologists on HSDD that I reviewed for this thesis reported a conflict of interest and were sponsored by a pharmaceutical company, either Pfizer, Sprout Pharmaceuticals or Boehringer Ingelheim Pharmaceuticals. All of the studies supported by pharmaceutical companies stress the need for a deeper understanding of HSDD as a neglected area of research (Maserejian et al. 3440; Arnow et al 500; DeRogatis 566; Clayton 305; Kingsberg 817; Thorp and Palacois 1328), and most do so in regards to physiological (Kingsberg 817; Thorp and Palacois 1328) and neurological (Arnow et al. 484; Clayton 305) accounts of sexual desire. The other authors point to the difficulty of clinical (or chemical) treatment following the immeasurability of sexual desire (Masereijian 2446; DeRogatis 566). This shows how, when sexual desire is believed to be based in physiology or neurology, it is considered to be explained fully. The authors who wish to look at HSDD itself and factor in relational or emotional contributors to the loss of desire have not yet found an exhaustive approach.
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(Brotto 221 ; McCabe and Goldhammer 1074 ; Meana 104). Sexual desire, it seems, is not easy to catch. Where sexual desire is ephemeral and fleeting, these scientific approaches try to catch and pin it to the functions of the brain. The influence of the loss of desire on quality of life is compared to “that seen in women with diabetes or chronic back pain” (Thorp and Palacois 1321). Sexual desire then becomes a matter of simple physiology.
In response to Viagra, critical studies in the humanities and social sciences have tried to trace the complex history of the "quick fix erectile dysfunction drug" (Loe 97). Since the 1990s, these studies have extensively addressed the ways in which physiological accounts within 'hard science' (Marshall 131) have combined with normative accounts of sexual function and dysfunction, to influence the public’s views on sexual health. This line of inquiry points to an emerging discourse of "broken masculinity" (Loe 109), to be fixed by the Viagra-Machine (Potts “Deleuze on Viagra” 18), which re-instates potency in "all the right places" (Mamo and Fishman 13). The drug has become a fruitful case study to explore the socio-cultural impact of the medicalization of sexuality on the intersection of biomedical practices (the hospital, 'hard science' and the pharmaceutical industries), technological means of governance (biopower) and consumer culture.
With Addyi, roughly the same scripts and structures emerge, except that this time, the little Pink Pill targets desire, situated in the brain, as the locus of female sexual activity. In this clearly gendered discourse, male sexual disorder is securely situated in the penis (I feel like it but I can’t get it up) while the female counterpart is located in the brain (I don’t need to get it up but I don’t feel like it).
The study of female sexuality has seen many historical transformations. While the penis has served as the essence of masculinity since antiquity, for some reason, the vagina has not provided such an easy marker. Scientists have struggled with the exact biological location of the “essence of femininity” (Oudshoorn 8). The site of female sexuality has
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travelled from the one-sex model (an inverted male), to the uterus (baby oven), to the ovaries (control center of reproduction), to sex hormones, arriving at its most recent residence in the chemistry of the brain (See Oudshoorn Beyond The Natural Body especially 18-36 ; Laqueur, Making Sex especially 149-81).
For Foucault, who criticized the isolated claims of the medical sciences, the main organs of modern sexuality are the mouth and the ear (Berlant, Desire/Love 67).2 Different
‘truths’ about sex are used as means to uphold a certain norm (heterosexuality and the celebration of the nuclear family). Sexual desire presents one of the most personal ways of being affected, while (most of the time) being first and foremost directed outwards, and projected onto something other than itself. When the possibility to modify desire is added to the biomedical regulation of sexuality, it gradually expands the space to monitor and
measure the very relationality of being. Where this interiority and exteriority of being intertwine, a politics emerges. This is a biopolitics, which “deals with the population as a political problem,” and ‘deals with it’ through the technologies of power offered by science, biology and neoliberalism (Foucault, Society Must Be Defended 245).
‘Techno-biopower’ is a term suggested by Donna Haraway to address these
“multiple partnerships” and the way that they work to reconstitute the world in commodity forms (149). The human has become cyborg. Meddled with - as we always are - but this time through genome modification and chemical alteration (pharmaceutics). As these matters interfere with experience, Haraway showed us, yet again, how all kinds of unconscious
2 In the first volume of the history of sexuality, Foucault notes how the term ‘sexuality’ belongs to what he calls scientia sexualis. This discourse about sex, which emerged in the nineteenth-century Western world, set out to formulate the “uniform truth about sex” (69).
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processes are at work that “aren’t about choice” (149).3 Rather, they are about relations,
interactions and multiple ways of being affected.
The interconnectedness of biological and social accounts of the body has been a central concern in feminist theory ever since biological determinism was contested by social constructivist theories on sex and gender. However, as social constructivism proved, in Rosi Braidotti’s words, a ‘necessary antidote to fascism,’(“Nomadic Feminist Theory in a Global Era.”) 4 recent feminist theory tries to return to ‘the organic.’5 This emphasis on the
materiality of the body allows an entrance into understanding the entanglement of matter with meaning. As multiple and expanding biomedical and technological possibilities enter the arena of biopower, feminist scholars can no longer afford to simply distrust or dismiss ‘the biological’. Instead, there should be a critical attempt to understand the ways in which biology can be mobilized to assist certain structures. This linking is indebted to Feminist Cultural Studies of Technoscience, which analyses technoscience as cultural activity (see Lykke 12).
3 Haraway is more optimistic than Foucault and cites Virginia Woolf’s words that have been turned into the active feminist slogan “think we must” (Staying With The Trouble 36; see also: Stengers and Despret., Women
Who Make A Fuss 27-31). Citing Arendt’s notion of the ‘banality of evil’, Haraway mobilizes Valerie Hartoumi’s
reading of Arendt to point not to the evil of disciplinary knowledge, but to the possible horrors followed by thoughtlessness. Thus, it “matters what thoughts think thoughts. It matters what knowledges know knowledges. … It matters what worlds world worlds.” And, most relevant to the inquiry into the Pink Pill’s usage: “It matters what stories tell stories” (Staying With The Trouble 35).
4 “How does one keep from being fascist?” Foucault asks in the preface to Anti-Oedipus (Deleuze and Guattari xiii). Taking Deleuze and Guattari’s project of multiplicities to mean an ethical project, Braidotti answers this question in her ‘Nomadism’, where complexity is the key to understand the “multiple affective layers that frame our embodied existence” (Nomadic Subjects 25). Without the possibility to view multiple layers the body is in danger of being homogenized in an authoritarian fascist regime of biopower.
5 See for example Elizabeth Wilson’s writing on feminism and pharmaceuticals, in which she attempts to “foster feeling for the organic in feminist academic writing” (“Organic Empathy” 390). For Wilson, an empathy, rather than a distrust of biology can generate fresh ways of thinking. (See also Wilson, Psychosomatic,
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In this thesis, I wish to frame Addyi’s chemical re-creation of desire within the multiple entanglements of the biological and the social. To do so, I identify three narratives in which female sexuality is either cured, styled or hacked with the help of Addyi. In what follows, I analyze these distinct modes of usage, and how the pill is promised to satisfy a specific need. The stories correspond to the three chapters that make up the thesis.
In the first chapter, we meet Charmaine, who uses flibanserin to cure HSDD and save her marriage. As I review this account of a woman who participated in the test trials for flibanserin and told her story in Shape Magazine, I analyze her usage of flibanserin in relation to the discourses of health and disease that are intertwined with normative ideas of what a normal life should be like. Commenting on the chemical narrative of desire as put forward by Sprout Pharmaceuticals, I draw attention to the way in which a claim on neurology works to reduce Charmaine’s experience of low libido to a mere ‘health issue’. With the help of Bruno Latour’s argument against reductionism, and Lauren Berlant’s and Sara Ahmed’s theories on the politicization of normativity, I hope to show how the
placement of sexuality in the brain goes hand in hand with a neurologically-assisted reductionism that reinstates a limited version of normality on the basis of molecules.
In the second chapter, I address the way in which this version of normality is important to aspects of styling an individual identity in consumer culture. Analyzing an article in Vogue, in which freelance writer Amy Gamerman sets out on an adventure with Addyi, I examine the author’s usage of the pill as a product to assist in fashioning a sexually savvy and postfeminist lifestyle. Drawing on Baudrillard’s theory of consumption in relation to the Lacanian conception of desire, I aim to connect the neoliberal mandate to be oneself to the desire of desire. In this sense, the wish for desire emerges more strongly than the ‘physical need’ to want sex, and desire becomes a mere vehicle for identity formation.
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Building upon this notion, where sexual desire is a tool, which channels something beyond its own need, in the third chapter I consider the creative potential of chemicals to assist in hacking human consciousness. Here, it is not a woman’s account of the drug, but the drug’s pure potential that is the object of analysis. I start with a story that comments on contemporary drug use as a practice of productivity and ‘enhancement’. With this, I draw attention to the interplay between a culture and its chemicals. By reviewing a Reddit-thread in which a user suggests the off-label use of flibanserin to treat anxiety, I explore the
possibilities for the Pink Pill outside of official medical or commercial frames. What is flibanserin’s potential as a tool? In what ways does the tool assist sexual desire? Here, I deploy a Deleuzian and immanent notion of desire to comment on the usage of drugs within techno-biopower and on flibanserin’s possibilities outside a moralizing and limited discourse of normative sexuality.
Throughout this inquiry into chemically-assisted desire, there are two main strands of theory which are indebted to Michel Foucault and Donna Haraway respectively. The former concerns the accompanying dynamics of the many normative narratives through which people determine their own well-being. The latter concerns the critique of techno-biopower, with which I am mainly concerned in chapter three. By tying these strands together, I hope to contribute to an understanding of the scattered contemporary and technologically-mediated instances that frame the notion of contemporary female sexuality.
At times, my analysis of the stories may come across as speculative. I have chosen to focus on the pill in three different stories as I believe that allows me the most direct and multifaceted entry into the wishes and experiences surrounding the Pink Pill. In these stories, the characters are (loosely) based on real-life women. Charmaine, whose story sets up the first chapter, is based on an anonymous interview with a woman in Shape Magazine. In naming her, I have made Charmaine into a half-fictional character who helps to describe
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an attachment to the pill that focuses on its promise to cure a distinct disorder. A similar dynamic exists with ‘Amy’ in chapter two. Based on an article in Vogue written by Amy Gamerman, I only refer to her as ‘Amy’ insofar as she comes to define the woman who consumes Addyi. In a certain sense, coming up with a half-fictional character to function as an example for one’s own theory is the most treacherous behavior for the cultural analyst. Therefore, I want to stress that I use the different stories not as objective examples, but as means to engage with distinct mode of usage of the pill to disclose its different modalities.
In this thesis, neoliberalism emerges as the driving force connecting the demands on the heavily individualized subject to the larger structures within medicine and consumption, but my analysis of this process will be measured. Lauren Berlant located a danger in simply critiquing neoliberalism as a system in which people only seem to behave freely, but are invariably figured as slaves in a capitalist system that measures merit on the basis of objectified knowledge and quantifiable production. Rather than turning neoliberalism into such a “world homogenizing sovereign” (Berlant, Cruel Optimism 15), or granting science the power (Latour 225), I aim to follow Berlant’s warning and stay with the messiness of
experience. Drawing inspiration from Karen Barad, I am interested in the extent to which reading and writing can be seen as an ethical practice (Dolphijn and Van der Tuin 49). As I follow the accounts of different women who engage with the drug in specific contexts, I comment on the ways in which materiality is interlaced with meaning. Through this approach, I want to stich these together, while I—at the same time—hope to paradoxically disentangle modes of attachment that contribute to the creation of desire, to the feeling of lust, or sometimes, being horny.
What is it to want something? I am afraid that the ‘what’ of this question shall not be answered. Rather, with these stories in which the Pink Pill shifts as object of desire, I show that the wish to define desire is what creates the most trouble. Lauren Berlant and Lee
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Edelman have noted how sex confronts us with “our limit in ourselves or in another” (Sex, or the Unbearable vii). Along these lines, and between these limits, I am interested in discovering which notions are mobilized by the drive to bring back lust and boost desire with the Pink Pill. Since these stories lack lust, there is little sex to be found in this thesis. What we do find are brain scans, hopes and wishes, and an assortment of drugs and
chemicals, intertwined with a fair dose of mystery. All of those are mobilized in the wish for desire’s return and the ‘need’ for more sex.
13 CURING: Where Medicine Meets Normality
Charmaine’s Story
They met in college and the sexual chemistry was amazing. In an interview in Shape Magazine conducted by Kaitlin Menza (2015), which appeared online under the headings of ‘Lifestyle,' and ‘Sex and Love,' an anonymous woman (who I will call Charmaine) recounted how she and her husband would have sex multiple times a day, every day of the week. Sex was one of the most wonderful parts of their relationship and a key aspect of Charmaine’s identity.
It all changed after the birth of her first son. Not only was she too tired after feeding the baby until 3 a.m., but she just felt no need to have sex again. She tried to make love every two weeks or so, but did so more out of obligation than desire. When her husband started to feel more like a co-worker than her lover, she contemplated a divorce. However, in the end, they did not want their marriage to fall apart, and Charmaine started to
experiment with herbal supplements, antidepressants and testosterone injections to help rejuvenate her sexual desire. Sadly, none did the trick.
When Charmaine and her husband found out about a series of clinical trials for flibanserin, which was to be a new lust-enhancing drug for women, she did not think there was ‘a chance in hell this was going to work’, but by this time she had promised her husband that she would try anything to save the relationship. Upon signing up, she half-expected to be rejected for the trials because her lack of libido had occurred after giving birth to two sons. Charmaine thought ‘clearly’ that was the issue, not her body. However, the doctors in the test trials selected her and she was diagnosed with HSDD (Hypoactive Sexual Desire Disorder). After roughly a month on flibanserin, she felt renewed energy. She started running and lost a few pounds. Feeling sexy again, Charmaine then realized that she and her husband had had sex twice in one week. It might be the drug after all, Charmaine said, “It wasn't as if I was suddenly horny around the clock. We weren't doing it on the kitchen
14 table, or missing work. I just felt like myself again -a woman who enjoys sex and is
attracted to her husband. It was normal life” (Menza). For Charmaine, regaining her desire was regaining normal life: a re-claiming of her identity as a normal woman who is attracted to her husband.
Part of the trial studied the effects of withdrawal, and within a month of stopping flibanserin use, Charmaine and her husband returned to their old pattern of occasional sex every few weeks. After these trials, it took the FDA (Food and Drug Administration of the United States) five years to approve the drug. Charmaine was crushed. Even so, the drug proved to the couple that Charmaine had not been lying. She did love and want to be with him; she was still attracted to him. Her relationship did suffer, however it was not because of their wonderful sons, but because something had happened to her chemically.
For Charmaine, this placement of the loss of desire in specific substances belonging to the chemistry of the brain clearly brought about relief. At first, she almost could not believe there was “an actual name for this.” Now she was not simply ‘bad at life and bad at marriage’ but rather “just had this health issue”—a health issue that allowed her to hold on to an identity as a sexual being, if a disordered one.
In this chapter, I analyze Charmaine’s relief by connecting it to discursively constructed views on normality and abnormality in relation to health and medicine. These notions, the interconnectedness of which has been of great relevance ever since Foucault’s Birth of the Clinic (1963), have acquired a new significance in the age of the neurosciences. According to Nikolas Rose and Joelle Abi-Rached in Neuro (2013), the advancement of the neurosciences has led to a growing popular belief that “the brain holds the key to who we are” (1). When Foucault characterized the shift taking place in medicine in the nineteenth century, he did so by describing a change in a type of question. Doctors no longer asked, ‘what is the matter with you?’ but rather ‘where does it hurt?’ (Birth of the Clinic xviii). In 2015, Charmaine’s answer is ‘in my brain.’ Framed as a ‘health issue,’ her lack of desire is
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not an integral affliction or a disease of the soul, but the result of a simple, limited and malfunctioning organ.
In this case, the organ is the brain. And that changes things. Rose and Abi Rached note how, by emphasizing the influence of brain functions as an explanatory factor, the neurosciences have effectively reshaped the way we think about ourselves, our social relations, and ethical values, grounding them in “that spongy mass of the human brain” (1). For Charmaine, this material grounding of her lack of desire has two main consequences: it constitutes her disorder while offering, at the same time, a comforting and explanatory function.
This chapter is an attempt to discern the structures that conjoin in Charmaine’s relief. I review their conditions along the lines of systematization, reductionism and the practices of biopower on the biomediated body. On a theoretical level, I understand her relief to take place through three different instances that accumulate in intensity. The first is the localization of female sexuality in the brain, which I consider by giving a brief account of physiological research on the sexual body conducted in the 1960s, as well as by analyzing the visualization of brain scans in an article authored by Sprout Pharmaceuticals (the
company that makes and markets flibanserin). The second instance concerns the
neuromolecular gaze, which penetrates individual experience in a reductionist manner. By drawing upon this term, coined by Rose and Abi Rached, and following Bruno Latour’s argument against reductionism as developed in "How to Talk about the Body" (2004), I connect a more differentiated view of the body to Charmaine’s simplified ‘health issue’. In doing so, I consider the possibility that Charmaine’s ‘cure’ is facilitated by this reductionism, as this simplification of desire relieves some of the tension around her loss. Following up on this, the third instance through which I explore Charmaine’s relief concerns a normative dimension. Why does she feel that marriage is a job one can be good or bad at? How does sex fit into this scheme and what is its relation to what Charmaine calls ‘normal life’?
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Taking up Lauren Berlant and Sara Ahmed in their related accounts of the intimate political way that attachments are shaped, I finally explore Charmaine’s experience of relief as an attachment to a conventional good-life fantasy.
By bringing medicine and neuroscience together with the affective conditions of Charmaine’s description of normality, I hope to discover exactly what, for Charmaine, is gained with the placement of the loss of desire in her brain, and what might be lost through this reduction.
HSDD: The Formulation of a Disorder
When Charmaine learned from television that the drug had been approved, she and her husband looked at each other with delighted glints in their eyes. However, they were annoyed by the way people talked about it. “The female viagra! As if women were just lacking an erection this whole time. Please. There is so much more to this drug than being horny, and there's so much more to sex than having an erection” (Menza). Observing that half of all marriages fall apart, Charmaine noted how many say the turning point was when they had children. Before her experience with flibanserin, Charmaine would have agreed. However, after being diagnosed with HSDD, she realized that she wasn't horny because "something has happened to her chemically" (Menza). Apparently, the 'so much more' that there is to sex can also be easily and exactly described in chemical terms.
According to Lori Brotto, the formulation of sexual desire disorders is still largely based on the research conducted by Masters and Johnson in the 1960s (221; see also Ross 2). This infamous physiological study on what happens to the body during sex resulted in the formulation of the four-phase sexual response cycle, moving from excitation and plateau to orgasm and resolution. In the 1970s, Helen Singer Kaplan revised this strictly
physiological ordering of sexual response to incorporate the state of sexual desire as well. For Kaplan, who was a well-known sex therapist in the 1970s, desire was ultimately rooted in the brain, while excitement and orgasm involved autonomic reflexes of the
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genitals (Hypoactive Sexual Desire 3). These genital reflexes can be observed objectively and can therefore be accurately described and defined. In contrast to this data, the
measurements regarding a ‘normal’ libido in men and women are incomplete and largely anecdotal (Women’s Sexual Experience 3). In other words, the physiology of desire cannot be precisely delineated. For Kaplan, however, this was mainly a problem related to our
incomplete state of knowledge (4). When desire is definitely rooted in the brain, all we have to do is get to an understanding of how this works, and then all problems with desire can be solved.
This research laid the groundwork for the two main consequences for Charmaine that I have highlighted above. It shows both the hope that is invested in neuroscience (capturing desire and measuring its contents) and the way in which the localization of desire allows for the formulation of a new disorder. With Kaplan's reformulation of Masters and Johnson’s four-phase cycle into a ‘triphasic’ one (desire, excitement and orgasm) (Women’s Sexual Experience 3), desire becomes the main element of female sexuality.6 When desire is
rooted in the brain, sexual motivation becomes a conscious affair of the mind, rather than the physiological drive for pleasure or a bodily instinct.
Flibanserin: Cure for a Disorder
Following Kaplan’s research in the 1970s, contemporary scientists working on flibanserin have continued to localize female desire in the brain. When Sprout
Pharmaceuticals announced that they were resubmitting the drug for FDA approval, they circulated a press release on PR Newswire (a news agency that allows companies to
distribute their own content). The neurological basis of sexual desire was repeatedly asserted:
6 This triphasic sexual response cycle, centered on desire, serves as the basis for the categorization of sexual disorders in the DSM. These are clustered as Sexual Desire Disorders, Sexual Arousal Disorders and Orgasm Disorders. Within this scheme, a malfunctioning in the course of, or the disability of successfully completing, the cycle can become disorders.
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‘The brain plays an important role in regulating a woman's sexual desire, and one of the root causes of persistent and recurrent low sexual desire, or HSDD, stems from an imbalance of neurotransmitters in the brain,’ said Stephen Stahl, … ‘flibanserin is
believed to work by correcting this imbalance and providing the appropriate areas of the brain with a more suitable mix of brain chemicals to help restore sexual desire.’ (Sprout Pharmaceuticals)
Since the press release raises notions of ‘imbalance’, ‘correction’, and ‘restoration’ it works to construct a language of right and wrong brain chemistry. These are visualized on brain scans, as seen in figure 1. Sprout Pharmaceuticals suggests that there are two types of brains: those in which the yellow or greenish bits light up when there is sexual stimulation, and those which remain dark and inactive. The latter are said to qualify for the label HSDD.
Figure 1
The apparent explanation for a lack of desire can be perceived on the scans. Hence, those places where desire manifests itself in the brain need to be helped by way of flibanserin: the chemical cure that will make the right parts yellow.
Supplementing this account is a video, posted along with the press release, in which a narrator says:
Sexual stimulation typically shuts down the parts of the brain involved with information analysis, the parts that keep up with your day to day tasks. Shutting down these parts of the brain allow women with healthy sexual desire to focus on the sexual experience. This sensory deactivation, or ‘cooling off’, is what you see here in blue. A dramatic contrast
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occurs in the brain of a woman with HSDD. Her brain does not deactivate. She is not able to shut down the distractions that would allow her to focus on the sexual experience the same way as her healthy counterparts. You see clearly the limited deactivations. Less cooling, less blue. (Sprout Pharmaceuticals)
When we hear the narrator speaking of healthy sexual desire, we see happy white couples making love (fig. 2 & 3). This is the functional brain (the blue one). The dysfunctional brain, (the red one), is not able to shut out distractions (fig. 4 & 5). She is the busy mom, or the career woman who is more concerned with email than with her husband. These images tend to portray that dysfunctional distraction consists of paying attention to one’s child or being focused on work. Of course, this marketing does not promise to turn women into sex-crazed beings who neglect their children and leave their jobs, rather it promotes the medicalization of low libido.
Together, this material shows first, how a lack of sexual desire is problematized and medicalized, and second, how this lack is localized in the brain, according to the idea that managing the appropriate type and amount of focus denotes healthy sexual desire. Being
Figure 2 Figure 3
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less calculating, less concerned with information analysis and other distractions, while allowing yourself to be fully immersed in the sexual experience is shown to be the healthy way. The video also works to reaffirm the version of 'normal life,' to which Charmaine so much wanted to return: a normality in which women are not busy but attain the proper focus on their husbands. I will return to this last notion later in the chapter. First, I wish to have a closer look at the way in which desire is pinned down chemically.
Thought Caught in Matter
The issue of localization is addressed by neuroscientists John Van Horn and Russell Poldrack, who comment on the frequent misuse of fMRI scans in the media. For them, the exciting possibility of examining the brain ‘in vivo’ leads to the tendency to believe that certain patterns reveal more than that is actually possible to measure (3). In simply localizing a physical marker of brain activity, you have not yet understood its dynamics. According to the authors, there are well-known examples of cases in which “regions that are activated during a task are not necessary for the task" (4).
In relation to the ‘limited deactivations,’ stressed by Sprout Pharmaceuticals, Van Horn and Poldrack’s observation is an interesting one. The fact that certain parts of the brains of women experiencing low sexual desire are not activated, does not mean that we have captured the physiology of desire. Rather, the ‘limited deactivations’ could just be among the physical markers of what can happen in a body during sex, comparable to a leg or an arm that needs to be in a specific position in order to perform. Like a leg, the brain is not an actor on its own. To assume that an imbalance of neurotransmitters is the root cause of recurrent low sexual desire is, therefore, a causal misunderstanding, which tries to separate the chicken from the egg.
To avoid such confusion, I will take a brief look at the chemistries involved in sex. In 2004, Michael Lemonick published an article in Time magazine, in which he spells out the chemistry of sexual desire. He describes how in men, a hormone directs the expansion and
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contraction of smooth muscles.Another chemical, called nitric oxide, activates the muscles that control the expansion and contraction of blood vessels.“When the mind is in the mood – or when you pop a nitric-oxide-boosting drug such as Viagra … the body responds.” Without testosterone, however, none of these chemicals works. Meet interaction number one.
So far for the hydraulics and onto chemical messengers. As we have been taught, testosterone is what makes a man and estrogen is what defines a woman.7 According to
Lemonick, empirical research has shown that when testosterone levels go down, sexual desire declines with them. This is not only observed in men. When a woman experiences decreased desire, increasing levels of estrogen will not boost her libido, but the
administration of testosterone will (Lemonick).8 Furthermore, Lemonick notes that for men,
higher levels of estrogen also trigger desire. This suggests that the merging of the
hormone-based categories of ‘man’ and ‘women’ could be the foundation for a kind of hyper-desire. A hybrid interaction of both sexes could boost desire in some sort of post-gender chimera of horniness. Meet interaction number two.
There are still more chemical messengers involved in this process. Hormones like testosterone and estrogen also trigger neurotransmitters like dopamine (a pleasure-triggering substance), serotonin (involved with feelings of satisfaction) and oxytocin (“the cuddle hormone”). Being high on dopamine can increase arousal, while the administration of serotonin alone (as used in antidepressants) can limit the ability to achieve orgasm.
7 This hormonal basis for the explanation of sex differences is contested by scholars such as Nelly Oudshoorn and Celia Roberts, pointing to the biological essentialism with which these hormonal categories are fixed (Oudshoorn 21-3; Roberts 21). Furthermore, Anne Fausto Sterling already argued for the understanding of sex as a “vast infinitely malleable continuum” in 1993 (21). Even so, popular speech and writing still constructs the male/female dichotomy on the basis of testosterone vs. estrogen.
8 This creates the (rather suggestive) situation in which more of what makes women ‘women’ does not get them more aroused: more men in women does.
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However, dopamine and serotonin (pleasure and satisfaction) “interact with each other in a complicated way to impact desire.”(Lemonick). One needs the other. Meet interaction number three.
Much more can be said about the chemistry of desire, but as this brief excursion shows, even popular scientific writing understands that the mapping of the brain is the mapping of a complex network. For things to exist, they need to exist simultaneously. It is at this point that the chemical narrative used to describe flibanserin specifically misses the point. In an attempt to localize and simplify female sexuality, Sprout Pharmaceuticals has not described the workings of sexuality in the brain, but merely given an incomplete account of physiology.
Penetration and the ‘Molecular Rationale’
In itself, such incompleteness is of no importance. We cannot always account for the whole network of relationality. However, as Sprout Pharmaceuticals’ narrative makes claims on ‘imbalanced’ brains that need to be ‘restored,’ we enter a different arena. Here, we are not only dealing with physiology, but with an accompanying account of normativity.
The tendency to systematize human sexuality, separating it from the totality of human existence, is something that Masters and Johnson already problematized in the 1960s. “Without the context of the total being and his environment," they write, “a sex history would be as relatively meaningless as a heart history or a stomach history” (Human Sexual Inadequacy 24). It is ‘relatively meaningless,’ because while it provides us with some knowledge of physiological functions, it fails to give an account of sex in its entangled complexities.
However, for Masters and Johnson, when any area of clinical investigation is constituted, “standards must be devised in the hope of establishing some means of control over clinical experimentation” (1). Following Masters and Johnson's account, the
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methodological order, and the ways in which knowledge production demands a certain control over its object. Different aspects of sexuality can be studied in various disciplines such as neurology, psychology, and psychiatry. At the same time, however, the
inseparability and interconnectedness of biology and what we name ‘the social’ calls for a different approach—one that maps interactions and complexities.
Even though brain research opens up a new bodily conception of networks, chemical messengers, neuronal paths and linkages, Nikolas Rose and Abi Rached note how the current popularity of the neurosciences does not allow for a thinking of complexity, instead leading to a new kind of reductionism. A new ‘molecular rationale’ has been developed, in which an organism is seen as “reducible to traits, behaviors, cells, genes and brain processes” (“Birth of Neuromolecular” 24). This type of neuroscience has led Rose and Abi Rached to coin the term neuromolecular gaze, which describes the neurological clinical way of looking that penetrates the individual all the way down to the molecular level. 9
In their warning against a reductionism that dissects the human into molecular parts, Rose and Abi-Rached's concept signals the correlation between manners of looking and the formation of normative constructs of identity. This reductionist gaze functions as a material reification of the separation between the healthy and the diseased. These manners of looking are the technologies of biopower about which Foucault had already warned us, and whose possibilities have only increased with scientific advances. To heed this warning
9 In obvious reference to Foucault’s medical gaze, Rose and Abi Rached’s neuromolecular gaze stresses the contemporary molecular underpinning of this way of looking. What it takes from Foucault is that such an epistemological shift was made possible through institutional building (Foucault, Birth of the Clinic 17) and, most importantly, how it allows for a new kind of governance. As technological means develop, the possibilities for governance over life itself increase, leading to the necessity of new concepts, myths and narratives that adequately answer to this new and techno-logical society. (See Rose, Politics of Life Itself; Braidotti, “The politics of Life as Bios/Zoe”).
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and to counterbalance the neuromolecular grip on sexual desire, I now turn to Latour's political epistemology as a possible ‘counter-biopower.’
Localizations and Articulations
Since Latour comes from a wine family, he knows about the multitude of words one can have for similar things. While sampling, spitting, mumbling, and drafting, one develops a vocabulary to describe a particular taste, sight or phenomenon. In doing so, the body learns to be affected and to register differences. It becomes sensible to the ways in which a particular wine is unlike the others, and that particular feeling is a different one.
For Latour, expanding the language to talk about the body is an essential exercise of free speech in a time of bio-power (206, 227). Instead of wishing for direct access into objects ‘as they are,’ Latour argues for a way of relating to the world that is embodied and articulated. Through more words and more controversies we can become sensible to more differences (212). Contrary to clinical investigation as argued for by Masters and Johnson, categorical labeling does not produce new knowledge but merely attempts to repeat an original in a model.10
With regards to the social/biological split that is crucial to many feminist theorists and other theories of emancipation, Latour’s view of learning as training the body to become sensible allows for a way of including different experiences without objectifying them. What I take to be crucial in this approach is the way in which Latour stresses the impossibility of
10 Latour’s call for more words—which includes a risky, brave and self-reflective attitude—is grounded in his political epistemology, in which science is denied the status of simply subtracting phenomena from the world (227), a view that resonates with his other writings on the social construction of scientific facts. Latour’s ‘material-semiotic approach’ in his Actor-Network Theory (ANT) and the STS tradition is also to a certain extent shared by Donna Haraway. However, in an interview with Lykke et al., Haraway states that she considers other contributors more important in her feminist version of the story of science studies (39). Rather than staying with Affect Theory or Haraway’s works on the deconstruction of fixed categories, in this chapter I called upon Latour, because his argument against reductionism allows a better entrance into the articulations of a rich bodily capacity.
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the reductionism that is often present in the natural sciences by stating that when the body enters a new realm of knowledge—such as the neurosciences—it is not reduced to that strand of thinking, but only becomes richer and better articulated. "Far from being less, you become more"! (227).
This attitude, which resists the molding of subjective experiences into frameworks of knowledge, is crucial in understanding human sexuality. As sexuality exists somewhere at the intersection between the biological, social, political and affective realms of being, Latour’s argument shows how the reduction to a locality of the brain can only be counterproductive. When 'captured' in something, the means with which to understand something expands, rather than decreases.
When applied to Charmaine’s ‘health issue,’ such an approach would look at the way in which desire is located in the brain as part of the story, but not as its main explanation. With this in mind, we can return to her story. Why does the attribution of Charmaine's low libido to HSDD grant relief?
The Good Life
Before she started taking the pills, Charmaine recoiled every time her husband tried to touch her. Even when it was just to cuddle or show affection, Charmaine was no longer drawn to physical contact. Her husband felt rejected, and she felt incredibly guilty. They were pleasant to each other, Charmaine states, but their romance was over.
The fact that their once passionate marriage had turned into a child-raising facility, where they only communicated about schedules and daycare, accounted for a large part of Charmaine's considerable distress. She really did not want her marriage to fall apart. More than anything else, it was this wish that led her to experiment with different remedies. As we saw in the beginning of this chapter, when Charmaine found her cure in flibanserin, she felt like her normal self again: a woman who enjoyed sex and was attracted to her husband. Her attachment to sex was an attachment to her idea of a normal life.
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Now there is no shame in wanting to be normal. And to feel abnormal certainly feels off. However, as Lauren Berlant argues in Cruel Optimism (2008), there are things you may desire that at the same time provide an obstacle to your well-being. Berlant explains these kinds of attachments by separating the story I can tell about wanting to be near x, from the emotional habit I have constructed as a condition for having x in my life (25). Certain habits or ideals can get stuck in our heads. For Berlant, the emotional construct follows the fact that x (in this case: sex) is in one's life. This is a crucial notion, for it shows how such a construct is not bound to x (having sex) in any inevitable or fortified manner. If certain desires do not contribute to our well-being, why do we remain invested in them?
The specific nature of an attachment and the assumed causality between an object and a feeling is also stressed and politicized in Sara Ahmed's writings on happiness. Ahmed shows how we tend towards certain objects rather than others when we believe they embody 'the good life' (33). Both for Ahmed and Berlant, the fantasy or promise of lively, durable intimacy (Cruel Optimism 3) and marriage (Promise of Happiness 6) are big
contributors to that idea of the good life. However, the good life is not always lived.
Sometimes we 'fail' to dwell within happiness, or to live the good life. Sometimes we are confronted with what might be called 'the reality of life' as opposed to the good life fantasy. This is where, sometimes, marriage fails. Sometimes we are not up for it. Passion fades. It is only sometimes, but when those moments arise, Ahmed urges us to attend to bad feelings as well. "Not in order to overcome them but to learn by how we are affected by what comes near, which means achieving a different relationship to all our wanted and unwanted feelings ... " (217).
To learn to be affected by what comes near is to also make room for the unhappy. Maybe Charmaine simply does not want sex anymore. But instead of making room for an unwanted feeling, or blaming her children for the lost desire, the neurological reductionism offered by Sprout Pharmaceuticals allows Charmaine to blame it on the brain.
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Of course, this reductionism is not the fault of a single pharmaceutical company, but rather part of a larger system of attachments in which normal life is bound up with
expectations of sex, durable intimacy and lasting passion. Letting go is not always easy. Berlant notes how people “often choose to ride the wave of the system of attachment that they are used to, to syncopate with it, or to be held in a relation of reciprocity,
reconciliation, or resignation that does not mean defeat by it”(28). To let go of the system of attachment is a risky task. It involves jumping onto another wave in the spirit of flexibility and self-reflection. But, for Berlant, the pain of paying attention pays one back in the form of eloquence; it is "a sound pleasure" (123).
The way in which the acknowledgment of bad feelings—the ones that divert, and wander off from the 'good life—involves, for Berlant, a pleasure of eloquence, reminds us of the call for more words and better articulations in Latour's political epistemology. Where Latour is concerned with scientific knowledge, Berlant speaks out against the ideology of a capitalist and heteronormative ideal of the ‘good life’. However, both are focused on finding a way to expand our articulation of reality. Rather than positing a homogenized subject, both in regards to the body in science, and to the wishes and demands of culture, theirs is a shared plea for more words to enable us to describe the diversity of our experiences.
In Charmaine’s use of flibanserin, both of these homogenizing tendencies come together. Therefore, the possibility of a language outside scientific or culturally normative frameworks would allow her to relate to her loss of desire in a richer manner. It would perhaps release her from the disorder, or help to lighten the burden she experienced marriage to be. Why do we feel we need to ‘have it all,’ and feel diseased when we do not?
With the placement of her loss of desire in the brain, Charmaine also loses the potential for a richer and more articulate version of her experience. She loses the possibility of being affected in different ways. “What happens when the fantasy of the good life starts to fray?” Berlant asks (2). Where biomedical neurological reductionism meets a
28 heteronormative attachment to durable intimacy, a medicine is developed to cure abnormality.
The Normal Life
Charmaine is not alone in finding relief in her diagnosis. In a series of interviews that writer Katherine Sharpe conducted with people who take antidepressants, she found that about half responded to the diagnosis of depression with tremendous relief (67). Some specifically acknowledged that they took comfort in the biomedical view that facilitated their diagnosis. The concrete physicality of mental states allowed people like Charmaine to reframe their suffering as just a ‘health issue,’ enabling them to say, ‘It’s not my fault!’
This attribution of an unwanted feeling to a biological process recalls the traditional separation of mind and body. If it is my faulty brain, then maybe I am not to blame?
Charmaine’s expression of relief shows how a limited account of neurobiology and a
normative account of the good life combine to provide a reductive explanation for a feeling. Charmaine’s understanding of her low libido as a simplified ‘health issue’ reduces it to a normatively and neurologically underpinned dis-order, which needs to be put in its right place by way of flibanserin. Thinking back on Foucault’s shift in the question that defines modern medicine, the current age of techno-biopower takes control over a different type of subject—a neurological and molecular being.
For Charmaine, the localization of her lacking libido in faulty brain chemistry helped to regain her relation to normalcy. However, in reducing her lost desire to simplified brain chemistries, she lost the possibility to relate to her feeling outside the possibly oppressive and constraining limitations of biomedicine. And while Charmaine resides comfortably in her filbanserin-assisted version of normalcy, this might be less suited to a more
unconventional person. Therefore in chapter three, I will explore the ways in which the pill could possibly resist its curative function. Before doing so, in the next chapter, elaborate on the attachment to desire. Here the pink pill signifies a fashionable desire for rapture.
29 STYLING: A Pink Pill Named Desire
Amy’s Story
She speaks of the mystique of Addyi—the possibility of “eros regained”—and she can think of no possession more thrilling. She keeps it tucked away in her purse, yet close enough for her fingertips to graze its contours throughout the day, “each tiny oval a
potential golden ticket.” Such is the language with which Addyi is described on the website for Vogue. In this article, published in 2015, Amy Gamerman, a freelance writer for Vogue and The Wall Street Journal, “takes the new Female Viagra for a spin.”
Gamerman’s story is a familiar one. After years of marriage and four children, her desire for sex slowly moved to the distant background. She was still having sex with her husband—whom she describes as the man she loves—and she enjoyed it. But she no longer craved it. She wanted to find her way back to the place Tennessee Williams wrote about, where you “get the colored lights going,” to recapture even a fraction of those times when she and her husband would spend the entire day in bed with the same CD playing over and over on repeat.
She yearns to yearn. This is where Amy’s adventure with Addyi begins. However, as adventures go, there was no easy start. The prescription could only be filled by a specialty pharmacy located 200 miles from her home. Still she managed to get her hands on the drug. (Addyi is exclusive.) Even when the pharmacist warned her about possible side effects, like dizziness and fainting, and the dangers of combining the drug with alcohol, Amy could not wait to start taking the drug. (Addyi is dangerous.)
In her first weekend on the drug, which is said to take a month before reaching its promised effects, Amy hints at a few sensual moments: noticing a yoga teacher’s hand on her back and an awareness of her husband’s body; not bad. She ponders what her brain
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might look like in the grip of desire—a little comma-shaped hub. At last, she has proof that her diminished libido was a “true neurobiological condition.” In the second week on Addyi, random fantasies distract her from work. When she sets off on a date night with her
husband the next weekend, Amy’s expectations are high. Despite the pharmacist’s warnings, they flirt over a bottle of Saint-Emilion. But back at home, the alcohol overcomes a desire that never arrives and she falls fast asleep. The next morning, while watching her husband make breakfast, she finds herself wanting sex with him. “Simple as that.”
After a few more satisfying marital sexual experiences, she notes how through their sex, the sharp edges of daily life melt “just a bit.” And then, four weeks into the experiment, a distinct shift takes place. She wants more sex because she is enjoying it more, which in turn makes her want it more. Such is the cycle of Addyi’s boosting of desire.
In highlighting the potential danger and exclusivity of Addyi, Amy mythologizes the drug. She speaks of:
… the mystique of Addyi, a peach-colored pill that offers women the possibility of eros regained. Its arrival marks the culmination of years of trial, development, and
controversy. The first medication ever approved for female sexual dysfunction in premenopausal women, Addyi has been called the ‘pink Viagra.’ The label is erroneous. Viagra is a tool designed for a man’s faulty hydraulics. Addyi aspires to the metaphysical, targeting a woman’s brain chemistry in order to boost her desire. (Gamerman)
Amy’s emphasis on exclusivity, danger, the mystery of the brain (visualized in a comma-shaped hub), the years of trial, and the drug’s status as the first of ‘her’ kind11, all suggest
that Addyi does not simply offer the solution to a “health issue.” Something else is at stake. Where Charmaine in the previous chapter kept plainly referring to the drug as “the pill,”
11 “Meet Addyi, the first of her kind” (Addyi). This is not only a gendered slogan, as I pointed out in the introduction, this statement also anthropomorphizes the drug as woman.
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Amy’s reference to Addyi (its sexier brand name) signals something different, as it “aspires to the metaphysical.”
Alongside the blunt description of male hydraulics (and their faults), we find female sexuality as a mystical feature, located in brain chemistry rather than genital plumbing. Strikingly, the fact that female desire can be located in the brain does not grant Amy relief, as it did for Charmaine, but only adds to the mystery of desire. Unlike Charmaine, Amy is not troubled by her loss of desire, but fascinated by the possibility to recover and boost it.
The neurological localization of sexual desire affectionately becomes a “comma shaped hub,” romanticized by the possibility of changing its manifestation and shape, leading to what she calls “eros regained.” While it is medically unlikely that any effects occur in the first days on the drug, this is of little importance to Amy whose sensual moments quickly increase. Her mesmerizing language shows how the medical realm is not the right framework within which to understand Amy's relation to Addyi. Her “adventure with Addyi” effectively resists the drug's function as a neutral cure to a limited disorder and instead advertises the drug as an exotic, dangerous and mystical product.
As famously addressed by Jean Baudrillard in his early work, the commodity not only exists as an economic utility, but also as a sign in a social system of signification (System of Objects 201). Commodities are bought as much for their sign value as for their use value. This aspect is captured by the familiar image of the Ferrari, parked in front of a house, or the watch that just slips out under the sleeve. Showing off.
Where Addyi is concerned, the pill’s potential use-value exists on a chemical level, as the drug alters functions of the brain to open up the space for desire to emerge. Amy,
however, already knew what it was to want. She was willing and able to have sex with her husband, so there was no condition or disease to cure. She just did not crave sex like she
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used to. She missed what she knew; therefore she yearned to yearn. What pinpoints the particularity of Amy’s case is the desire for desire.
This paradoxical, or layered situation is at the core of the present chapter and brings forward its main concerns: desire, connection and commodification. I aim to understand desire’s desirability by focusing on the ways that Amy consumes Addyi. Since the main attraction to the pill lies in the promise of desire, I ask how this consumption of chemically-assisted desire assists to style a specific version of sexual identity. What value do we attach to desire such that we desire its content?
From the outset, I connect Amy’s relation to Addyi as a ‘technology of sexiness,’ a concept developed within recent feminist sexuality studies to describe a certain managerial and rational approach to sex. Next, I comment on Amy’s adventurous account in Vogue by pointing out the ways in which she mystifies Addyi’s alteration of brain chemistry to make the drug even more special. Subsequently, I draw upon Baudrillard to review the ways in which the sexually liberated woman (like Amy) attempts to ‘style’ her own sexuality within a consumerist system. In Baudrillard’s terms, a consumption relation eventually turns toward abstraction. To understand the implications of such an abstract relation to desire, I draw further attention to the ways in which identity formation and desire are believed to intertwine. Therefore, I engage with psychoanalytic theory—notably the Lacanian concept of desire rooted in lack—as I hope to untangle the way in which Addyi may function as a means to style the self.
Why are we driven towards certain objects and not others? What forces act upon the creation of our desires and how? As Judith Butler has so beautifully reminded us, in neoliberal times the “I” does not exist independently, but “the attachment to you is part of what composes who I am” (Precarious Life 22). In the same text, Butler describes grief as something that displays the thrall in which our relations to others hold us. In losing
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someone and mourning that loss, I not only mourn the loss, but also lose something of myself.
In the vein of this account of relationality, conceived as the tie by which self and other are differentiated (22), where ‘possession’ and loss are crucial for our understanding of ourselves, I explore Amy’s yearning to yearn within these dynamics of self and other. In wishing to hold something, we wish to be hold close to that something, and wish for it to become a part of ourselves. In psychoanalytic terms, our (Oedipal) desire for connection, recognition and relationships are at the core of all of our motivations. When we then lose desire, or only experience a fraction of what it once was, we lose the possibility for
connection and therefore also lose a relation to the self.
This relation to loss can be described by the term aphanisis. When it was first coined by psychoanalyst Ernest Jones, it described the fear of the loss of desire. Lacan takes up the term to identify the movement in which the subject manifests itself in disappearance (FFCP 208).12 I consider this fading movement to be crucial to this chapter, as it hints at the way in
which the self is always constituted through both its losses and wishes.
With Addyi’s consumption, chemically assisted desire offers the potential to
counteract such a disappearance. Amy’s description shows how the pill becomes a possibility to buy into a new level of excitement. In this case, it is sexual excitement that works to style the self, while desire becomes commodified in a wish for sex (or connection).
12 In reaction to the Freudian notion of the castration complex (that only concerns men), Jones terms aphanisis as a common denominator for the fear of losing desire in both men and women. Ultimately, the sexes dread the same thing: aphanisis (Jones 24): “the fear of the total extinction of the capacity for sexual enjoyment” (Jones 23). For Lacan, Jones’ usage of the word is “Rather Absurd” (FFCP 207). As there is, for Lacan, ‘no such thing as a sexual relationship,’ aphanisis becomes for him a term to describe the relational character of loss, and the effects it has on the subject. To understand the implications of the loss of desire for Amy, and the strategies used to bring it back, I return to the notion of aphanisis at the end of this chapter.
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Let me be clear on this: sex is not always already paired with the wish to be loved. However, in psychoanalysis, all sexual desires are very closely connected to the wish for recognition, and the wish to overcome the existential loneliness of existence. Following such a framework, the double bind of Amy’s desire for desire quickly emerges as such a wish, or even a romantic attempt to fill our big (Lacanian) lack. To see whether this is at stake in Amy’s usage of Addyi, I first explore the connection between the meanings that are attached to sex and contemporary consumer culture via the concept of technologies of sexiness.
Technologies of Sexiness
After the years of clinical trials highlighted by Gamerman in her article for Vogue (2015), Sprout Pharmaceuticals fought a public campaign for FDA approval, accusing the institution of being gender-biased. Gamerman quotes Marta Hill Gray, whom she describes as a women’s-health advocate,13 saying, "many women have not caught up with men in
claiming their right to have a fulfilling, satisfying sex life." The campaign was launched from a website called Even the Score: For Women’s Sexual Health Equity. The site continues to exist after Addyi's approval by the FDA to advocate the notion that “the same standards are applied to approve safe and effective treatments for the most common form of women’s sexual dysfunction as have been for men.”
13 Contrary to Amy's description in Vogue, on her own website, Gray calls herself a strategist with “success and experience in marketing, branding, media, and promotion” to give her clients “every benefit and resource to achieve their goals.” Following the description on her website, Marta's knack for strategic thinking enables her to take on many roles as a “brain for hire” (MartaGreyMatters.com). The mobilization of strategic marketing, relying on feminist claims to sell their product was precisely what Addyi’s campaign was criticized for. This selective appropriation of feminism fits Rosalind Gill’s description of the presence of contemporary feminism in popular media, where feminism is better described as a ‘sensibility’ that moves in and out of traditional feminist goals (149, 153). The drug makes you nauseous, but it might increase your desire to have more sex. In this case women’s ‘sexual liberation’ (or rather the meanings attached to it) seems to be valued over the care for women’s bodies.
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Addyi's lobbyists fought for FDA-approval by mobilizing feminist claims of equality. In their investigative story for The Cut (2016), an online magazine belonging to New York Magazine, Jennifer Block and Liz Canner found that although the drug was not necessarily good for women's bodies (because of strong side effects like dizziness, drowsiness, nausea and low blood pressure), it was still being promoted through the claim of improving women's health. Here, health was not so much conceived of as freedom from nausea or dizziness, but rather as experiencing the ‘right’ levels of desire. In other words, you have to want to crave sex.
This image of the 'up-for-it,' liberated woman is described through the concept of technology of sexiness, first coined by media theorist Rosalind Gill. Adrienne Evans and Sarah Riley took up the term to describe contemporary female sexuality as a “technologically mediated and consumer oriented subjectivity” (118). They located a contemporary shift in public discourse from a heterosexual femininity constituted through passivity towards an active and confident version of female sexuality (115). Heterosexual postfeminist women dress sexy because they want to. They insert a deliberate mistake in a text message to show that they don't care, and leave the man wanting more because it makes themselves feel powerful.
For Gill, postfeminist culture has an intimate relation with neoliberalism, in which the individual is constructed as a rational, calculating and self-regulating being (163). This managerial and autonomous subject stands at the basis of the sexually savvy, confident and empowered woman who deploys a technology of sexiness and articulates sexuality as a trick to be mastered. As subjectivity is constructed within media culture, notions of agency, autonomy and the passive consumer meet at a complex intersection. Here, the technology of sexiness produces the figure (or ideal) of the 'sexually savvy' and active woman for whom sex is stylish as well as a means for individual fulfillment.
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One might conclude that this account of active female sexuality suggests freedom from the constraints placed on female desire in previous centuries. However, the neoliberal imperative to manage one’s sexuality poses a new problem for female subjects for whom desire no longer exists. When desire is presented as a constitutive aspect of women’s liberation, how to deal with losing it?
Losing Something, Wanting Something
Amy explains how Addyi works by citing a study from 2009, in which a team of doctors mapped physiological response by tracking both neurological and physiological changes in thirty-six women who were in stable relationships. When viewing erotic videos, blood flow to the genitals increased in most of the women, but the MRI-scans told a
different story. In the brains of the ‘sexually healthy’ women, the ‘comma-shaped’ entorhinal cortex lit up. “This is where emotional memories - including the happy ones created during satisfying sex - are captured and processed” (Gamerman). In the brains of the women with low sexual desire, the “comma barely flickered” (Gamerman).
After returning to an account of her own experience and finding herself more
enthusiastic and less distracted during sex, Amy asks, "Has the Addyi flipped a switch in my entorhinal cortex?" The question almost seems disillusioned: is that all it takes? She calls in the help of a scientist:
More likely, the drug is helping to create ‘a good neurochemical environment’ for desire, according to Jim Pfaus, Ph.D., … Mindfulness training, sensate exercises, and talk therapy could probably achieve the same result, given enough time and energy. But as Pfaus points out, “You can’t take a trip to Cozumel every weekend.” (Gamerman)
Where the exotic calm of the island of Cozumel, situated in the Gulf of Mexico, could probably do the same, Addyi's alternative offers a quicker and more effective alternative to the consumer. This is economics, where the expensive ‘natural’ option is effectively substituted with a cheaper ‘chemical’ version, like powdered milkshakes and
