Friday, May 18, 2012

Prescription Drugs, Digital Media and Soft Programming

The use of drugs as a form of human programming is a favorite trope of speculative fiction. The denizens of Alduos Huxley’s genetically stratified Brave New World are kept complacent by a euphoria-inducing pill called ‘soma.’ More recently, Joss Whedon explored concepts of indoctrination and exploitation in his series Dollhouse, where entire personalities are literally loaded into human dolls through a combination of bio-chemical meddling and neurological inscription. Like all dystopias, these are both warnings by way of caricature. The programmatic potential of systematic drug-use is obviously exaggerated. Our current understanding of chemistry, biology and psychology is thankfully too limited and fallible to code a person’s behavior with the same precision as a computer.

Consequently, prescription drugs modify our behavior in a far more subtle and complex manner. People who take a prescription for one condition often need a second prescription to reach the desired outcome. For example, Mood Stabilizers are often paired with anti-depressants to prevent dangerous mood swings. In other cases, prescriptions require people to come up with coping strategies to deal with side effects. A person taking a pill causing dry mouth might start to carry a water bottle with her everywhere.

This leads to a type of second-order behavioral adjustment and habit formation I refer to as “soft programming.” Soft programming does not exist in a binary with more traditional types of programming, but rather on a continuum. When there is a direct correlation between technological interaction and desired behavior with a minimum of unintended side-effects, programming can be described as ‘hard.’ Examples of harder programming include computer programming (particularly at more fundamental levels like binary and assembly code), anesthetization, knock-out gas, and traffic signals. Examples of softer programming include psychoactive prescriptions, reward structures (like sales commissions and point evaluations), social networking sites and text corrections. Soft-programming is not only negotiable, but inherently collaborative, unstable and contextually contingent.

In this essay, I will present examples of soft programming that exist in prescriptions, and modern digital media, and how effects of these two different technologies often parallel each other.

The soft programming that occurs with most prescriptions does not actually begin with a psychological condition, but with advertising. In 1997, pharmaceutical giant Pfizer ushered in the modern era of direct to consumer marketing with the help of former senator and presidential candidate Bob Dole in their advertisement of Viagra. The senator would urge television viewers to over-come their shyness and talk to their doctors about getting the little blue pill. Anti-depressants Prozac and Zoloft were soon to follow. Decongestants like Claritin and Zyrtec were next in line. Then came the sleep aids like Ambien and Lunesta. Now, heart medications are being marketed on television, accompanied by grave warnings about diseases and conditions that exhibit no visible symptoms with an implicit “Until it is too late.”

All of these advertisements begin by presenting viewers with a choice: continue living life undesirably, or start medication. Perhaps the best example of what the prescription drug represents as a technological medium lies with anti-depressant commercials, whose broadly drawn questions like “Are you sleeping irregularly?” or “Have you not felt like yourself lately?” With the publicly advertised prescription drug, the consumer is invited to invent his ideal self, regardless of the limitations and constraints of his actual self. Living with impotence, or sadness become lifestyle choices in the face of pharmaceutical intervention. A prescription is the reification of a diagnosis.

Of course, the majority of soft programming that results from prescriptions stems from the physiological interactions of the drugs themselves. These chemical changes can make people feel happy or more functional. They may make them hopelessly dependent on an external resource. They may also incite side-effects which force the prescribed to gradually learn the ebb and tide of their dosage, and devise second-order coping strategies that allow them to function more efficiently. Sometimes one drug necessitates several others. In each of these processes, there is an undercurrent of refinement and specialized adjustment. In theory and intention, drugs help people live life according to a design that runs contrary to nature.

One way to think of soft programming is as a type of automatic mask, or filter that affects behavior. Once a psychoactive drug is taken, it serves as a constant filter, automatically adjusting the way the user thinks about and responds to the world, rather than inserting specific thoughts into the users head, as per Sci-fi mind control. This is similar to the way the smart phones text auto-corrections compensate for our individual flaws, and nudge us toward perfection, or at the very least, a sort of agreeable universal standardization. The aggressive corrections away from vulgarity may strike people as the most obvious form of soft-programming that occurs with the iPhone’s auto-correct, and there is something of the anti-utopia about it. When taken to its conceptual extreme, we can imagine a society slipping down the slope of censorship, where our benevolent smart phones first refuse to let us swear, and then start censoring every potentially offensive phrase.

These tame corrections can be considered as extensions of existing social norms however, and they are less fascinating than other subtler implications stemming from auto-correction. Auto-correction can be repurposed to serves as auto-completion. Texters typing “nourishment,” in their iPhones need only get so far as the “m” before they can hit the spacebar to produce the completed word. Consequently, there are circumstances where slower, or even less accurate texters will be able to complete words faster than more precise texters. Deliberate misuse can be leveraged for expediency, and deficiency becomes a means of empowerment.

A similar dynamic of soft-programming characterizes the dynamic between people with attention-deficit hyperactivity disorder (ADHD) and stimulant medications. While sufferers of ADHD are stereotyped as hyperactive, their disorder is paradoxically treated with stimulants. These stimulants gradually increase certain neurotransmitter levels in the brain, generally dopamine and norepinephrine. In non-ADHD individuals, taking similar stimulants often results in mania, excessive energy and occasionally obsessive behavior. For people with ADHD lower neurotransmitter levels however, the increased chemicals a therapeutic effect: Instead of seeking to simulate themselves with excessive ‘activity,’ the stimulant satisfies their need for the deficient neurotransmitter. Stimulants have other potentially beneficial side-effects however, like appetite suppression and increased energy. These ‘perks’ can also help medicated ADHD sufferers work more efficiently than those who do not suffer from a disorder at all.

Just as auto-correct can frustrate texters with various subtle subversions, prescriptions can have adverse effects on the people who take them. People can become over-reliant on the spelling corrections of auto-correct (or similar systems like MS Word’s spellcheck) in a comparable fashion to the way that daily use of a prescription can potentially lead to drug dependency and abuse. Prescriptions can also inconvenience or distract their users through unintended side-effects like muscle twitches, heartburn and increased libido, just as auto-corrections can inconvenience or completely sabotage the intended meaning of messages by inaccurately correcting misspelled words or dropping intentional but unorthodox contractions.

Mundane carelessness can also lead to trouble with both auto-correction and prescription. Sending a message hastily often results in unintended auto-corrections, and taking a medication absentmindedly can lead to accidental over-dosages with severe side-effects. Anti-anxiety medications, for instance, can actually induce anxiety attacks if their recommended dosage is exceeded.

Another digital artifact whose soft programming mirrors prescriptions is Facebook. All social networking sites structure users’ behavior in a few obvious ways. They are platforms for sharing (and monetizing) personal information among a network of people. Again, this detail alone is enough for us to envision a hard programmed dystopia, where popularity becomes a literal currency and introverts or even people who desire a greater degree of privacy, are reduced to impoverished pariahs. In fact, this distortion of reality seems far more plausible than Orwell and Huxley’s outlandish worlds and some cynics would argue that we are already most of the way there. Like over-zealous anti-profanity phones though, the social network anti-utopia is less interesting than the existing “mechanics” that suggest it.

To borrow media theorist’s Marshall McLuhan favorite phrase, the medium of is the message. The actual content of what Facebook users post on their walls, photo albums, or send in their private messages is far less important than the way that content is organized and quantified. Every time an active user logs into Facebook, they are presented, or rather rewarded with three red numbers. The first keeps track of new friend requests. The second keeps track of personal messages. The third number tallies public correspondence, “likes,” and photos tagged with the user. The quantification of relationships, conversations and interests actually mirror many coping strategies assigned to sufferers of social anxiety.

Most psycho-active prescriptions are paired with monthly meetings with a psychiatrist to ensure that the drugs are functioning as intended. During these meetings, Psychiatrists often recommend habits to supplement the drugs being taken. People suffering from anxiety disorders are often encouraged to keep track of their accomplishments in a notebook. Parents of ADHD children were encouraged to assign points to tasks, and award children for achieving a certain milestones, long before the word “gamification” was coined to describe it.

Visual representation of numerical increments appeals to a very fundamental human desire. It creates the illusion of progress and a sense of accumulated value. Many users have noted and bemoaned the lack of a “dislike” button to counter-act the “like” button. The simple explanation for its absence is that it would be potentially bad for business. If a person logged into Facebook and found that they had suffered a negative number; a loss of friends, “likes,” and communication, they would receive a negative motivation to return to the site. For this reason, the Facebook network deliberately ignores loss of friends, deleted posts, and refuses to adopt a “dislike” button. Even before likes, comments and photos were all streamlined into a single number, people use to keep score on social networking sites through their number of friends.

There are other ways in which Facebook behaves like the soft-programming of drugs. Many sufferers of social anxiety find it easier to interact with people through text, where they do not have to worry about subtleties such as inflection and expression, or saying something foolish without time to reflect on their words and censor themselves accordingly. In this case, the screen acts as the ‘filter’ mediating social interactions. Certain channels of communication are masked online. Many anti-anxiety medicines also serve as dulling filters. Valium does this by relaxing patient’s central nervous system.

Other users, who find it easier to express themselves through cooking, illustration, dance and photography, use Facebook as a social portfolio that simultaneously broadcasts and records their latest project through pictures and video. Blogs fulfill a similar function, which accounts for the introduction of Facebook’s note feature, allowing for longer notes than a typical “wall post.” This behavior does not mirror the effects of drugs, but it does mirror the type of soft programming exercises that doctors prescribe in addition to psychoactive medicine. In both cases, the content recorded, either in a journal or online, is less significant than the fact that the user is making a note of it. This sort of soft programming encourages patients to consider, or at least acknowledge their accomplishments.The social component of Facebook, is arguably an even more effective tool than journal writing, as it invites the patient’s friends to consider their accomplishments as well.

There is another prescription and digital media pairing that deserves brief mention: performance enhancing drugs. Unlike ADHD students leveraging the side-effects of stimulants to their advantage, performance enhancing drugs, like stimulants and steroids are almost always expressly prohibited by law, or socially condemned. One could make the argument that this illegality precludes performance enhancers from being considered in the same light as prescriptions. Yet, if we look at the soft programming that results from their usage, we can see that they are quite similar. Steroid use in particular covers all the bases of prescription drug use, save for the element of social acceptability. Athletes trying to bulk up must take steroids according to a scheduled regime. Furthermore, steroid use often results in side-effects that require coping strategies. Most importantly, they are usually recommended (or prescribed) by another more experienced person; typically a fellow player or a coach. Finally, these recommendations are accompanied by other suggested exercises (such as weight training and specific diets) to maximize their use.

One digital 'drug' that parallels steroid use is auto-tune: an audio processor that blends pitches to disguise off-key frequencies. It is now standard equipment for professional recording studios, and a regular part of the recording process for many artists. It was originally designed to serve as another layer of polish by blending pitches to the nearest semi-tone, though certain artists, most notably T-Pain, have used the effect to produce a synthesized aesthetic, and other artists have even started relying on the program as a live performance aid. In this context, Autotune functions like a steroid, and it has stirred up similar controversy in the music industry as steroid-use has caused in major-league baseball. Some performers assert that using Autotune ensures that audiences will be able to see artists at the top of their game, while others believe the practice encourages laziness, erodes artistic integrity and stifles creativity due to homogenization.

This tension teases another potential anti-utopia; a world where ‘normal’ people are pressured to augment themselves with drugs or technology in order to compete or merely keep up with those who have been altered. This second-order social pressure, where peoples’ identities and habits are structured by technology regardless of whether they interact with it, constitutes the softest form of soft programming. Under this broad definition, all forms of technology from thimbles to thermonuclear warheads carry the potential for soft programming.

There is also a tendency for hard programming to soften over time and under scrutiny, at both a physiological and psychological level. Our biology naturally adapts and accumulates tolerance for drugs, gradually transforming drug use into a negotiation between recommended dosage and desired effect. We gradually become more dexterous as we type or play an instrument, allowing for a greater degree of negotiation between technology and intention. The hard rules of traffic signals (“always stop at a red light”) gradually become qualified by context and experience (“unless I am making a right turn” “unless I am in a huge rush” “unless it is 2 AM and I will not get caught”). Consequently, a useful way to begin analyzing soft-programming that I have tried to demonstrate here is to consider a medium through the lens of a conceptually limited dystopian extreme. By beginning with a world that has been hard-coded by technological determinism, the most prominent subtleties and qualifications make themselves apparent.

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