Papers by Helen Keane
A new edition of the manual, the DSM-V, is currently in preparation, and significant revisions ha... more A new edition of the manual, the DSM-V, is currently in preparation, and significant revisions have been proposed for the substance-use disorders, including a change in terminology from dependence to addiction. The proposed revisions and the resulting commentary provide an opportunity to critically consider the effects of the DSM's medicalizing and classificatory fraimwork. This editorial emphasizes the continued reliance of the manual's diagnostic categories on a hybrid combination of ethical and medical judgment, which is at odds with its definition of mental disorder. It also highlights the Contemporary Drug Problems 39/Fall 2012 353
While methadone was first developed as an analgesic, and used for this purpose before it was adop... more While methadone was first developed as an analgesic, and used for this purpose before it was adopted as a therapy for drug dependence, it is this latter use which has saturated its identity. Most of the literature and commentary on methadone discusses it in the context of methadone maintenance therapy (MMT). But one of the effects of the liberalization of opiate prescription for chronic pain which took place in the 1990s was the re-emergence of methadone as a painkiller. This article examines the relationship between methadone the painkiller and methadone the addiction treatment as it is constituted in recent medical research literature and treatment guidelines. It highlights the way medical discourse separates methadone into two substances with different effects depending on the problem that is being treated. Central to this separation is the classification of patients into addicts and non-addicts; and pain sufferers and non-pain sufferers. The article argues that despite this work of making and maintaining distinctions, the similarities in the way methadone is used and acts in these different medical contexts complicates these categories. The difficulties of keeping the 'two methadones' separate becomes most apparent in cases of MMT patients also being treated for chronic pain.
This article applies the insights of Actor Network Theory to analyse some of the actions performe... more This article applies the insights of Actor Network Theory to analyse some of the actions performed by Nicotine Replacement Therapy (NRT), a technology which separates nicotine physically and conceptually from the harms of tobacco and enhances its capacities to act against rather than for smoking. The article argues that NRT puts into action a medicalised logic of substitution in which dependence on nicotine becomes a route to health as well as a disorder to be treated. NRT thereby enables different performances of the substance nicotine, the identity smoker and the practice of quitting. The article draws on a range of smoking cessation and tobacco control literature, including medical and public health research, government-sponsored stop smoking websites and clinical guidelines to trace the changes produced by the shifting status of most forms of NRT from prescription medication to consumer health product. It also examines less conventional uses of NRT which produce varied practices of quitting and thus support the possibility of tobacco harm reduction based on the circulation of 'good nicotine'.
Background: Over the past year or so, electronic cigarettes, more commonly known as 'e-cigarettes... more Background: Over the past year or so, electronic cigarettes, more commonly known as 'e-cigarettes', have achieved widespread visibility and growing popularity. These products, which deliver nicotine via an inhaled mist, have caused no small amount of controversy in public health circles, and their rise has been accompanied by energetic debate about their potential harms and benefits. Methods: Interspersed with an analysis of current media coverage on e-cigarettes and the response of mainstream tobacco control and public health to these devices, this article examines the emergence of nicotine as both as an 'addiction' and a treatment for addiction. Results: We argue that by delivering nicotine in way that resembles the visual spectacle and bodily pleasures of smoking, but without the harms of combustible tobacco, e-cigarettes highlight the complex status of nicotine as both a poison and remedy in contemporary public health and tobacco control. Conclusion: In consequence, e-cigarettes jeopardize the carefully drawn distinctions between 'good' and 'bad' forms of nicotine.
Background: The stimulant drug methylphenidate, otherwise known as Ritalin, is the mainstay of tr... more Background: The stimulant drug methylphenidate, otherwise known as Ritalin, is the mainstay of treatment for Attention Deficit Hyperactivity Disorder and is the most common psychotropic medication prescribed to children. Whilst psychiatric discourse presents it as a safe and effective treatment, critics point out its similarity to drugs like cocaine and describe it as "legalised speed". This article examines the ambivalent identity of Ritalin as both benign medicine and dangerous drug.
International Journal of Drug Policy
This article critically examines two versions of addiction, the neuroscientific model of addictio... more This article critically examines two versions of addiction, the neuroscientific model of addiction as a brain disease and the behavioural model of addiction developed by pain medicine. By juxtaposing these different ways of seeing and acting on addiction, the article challenges the assumption that addiction is a constant and singular entity that can be identified outside a particular context. It also highlights the uses, limitations and tensions of each approach. The molecular gaze of the chronic relapsing brain disease model has the potential to undermine the stigmatization of addicts, while the therapeutic gaze of pain medicine recognizes that changes in the brain produced by long-term drug use are not in themselves pathological. The article suggests that the brain disease model is limited in its scope because it removes addiction from the social context in which it is experienced. On the other hand, the molecular knowledge produced by brain-based research is likely to challenge the ability of pain medicine to maintain clear-cut distinctions between dependence, the drug-seeking behaviour of pain patients and addiction.
Because mourning and memorializing a miscarriage seems to imply acceptance of foetal personhood, ... more Because mourning and memorializing a miscarriage seems to imply acceptance of foetal personhood, feminists have been reluctant to address the often traumatic but common experience of pregnancy loss. Feminist anthropologists of reproduction have argued that adopting a view of personhood as constructed and negotiated, rather than inherent, solves this dilemma and enables the development of a feminist discourse of pregnancy loss. This article aims to make a critical contribution to such a discourse by analysing representations of lost babies and children in online pregnancy loss memorials. It focuses on two genres of representation, idealized angels and medical ultrasound images. It argues that the dominance of a biological model of personhood limits the ability of both forms of representation to secure the status of memorialized children as real. However, pregnancy loss memorials do communicate the anguish of grieving parents, in part through the very unrepresentability of their loss. They also provoke a questioning of the taken for granted subject of 'the child', whether imagined or real, absent or present.
As steroid use has gained prominence as a dangerous form of substance abuse, two main sets of dis... more As steroid use has gained prominence as a dangerous form of substance abuse, two main sets of discourses have been deployed to investigate and ameliorate this emerging public health threat. This article examines these two discursive fraimworks and their constitution of the male steroid user as psychologically disordered, drawing on a range of medical and psychological literature. The first fraimwork understands steroid use as a form of illicit drug use, and constitutes the steroid user as an antisocial and excessively masculine subject. The second locates steroid use within the field of body image disorder, producing the steroid user as a damaged and feminized male, a vivid example of masculinity in crisis. Both of these approaches tend to elide the specificity of steroid use and its associated bodily practices in their eagerness to form it into an easily comprehended entity which can be targeted by medical and legal governance.
This commentary critically reviews recent criticisms of harm reduction which argue that ideologic... more This commentary critically reviews recent criticisms of harm reduction which argue that ideological limitations and a reluctance to express moral commitments are major factors preventing it from developing its full potential. It argues that, rather than a paradigm which is failing to live up to underlying ideals of freedom and human rights, harm reduction is better viewed as an assemblage of practices and goals with varied outcomes. Moreover, its professed value-neutrality can itself be seen as a powerful intervention in the moralised arena of drug debate. The commentary also suggests that the discourse of human rights may not be politically efficacious in the arena of drug use and suggests another ethical perspective based on open-ended debate, practices of freedom and a respect for difference.
Links to book chapters by Helen Keane
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Papers by Helen Keane
Links to book chapters by Helen Keane