The missing work of collaboration: Using assemblages to rethink antidepressant action

The missing work ofcollaboration: Usingassemblages to rethinkantidepressant action

BY KIM MCLEOD

How do antidepressants work? This often-asked question continuesto attract debate. The depressed individual features in many debatesabout antidepressants’ action. With this focus, discussion oscillatesover whether antidepressants work to remedy chemical imbalancesin the brains of depressed people, or produce inauthentic states ofbeing. This article argues shifting the analytic focus away from thedepressed individual and onto the collective body, or assemblage,moves debates about how antidepressants work into more productiveterrain. This provides a new way of looking at how antidepressantswork to facilitate recovery from depression through a series ofcollaborative connections or relationships. Drawing on the charts,photos, and narratives from research encounters with people whotake antidepressants, the article illustrates how medicationfacilitates the creation of active associations in an assemblage offorces. The article concludes by discussing the new ways of thinkingabout depression, medication and recovery suggested by thisunderstanding of antidepressant action.

KEY WORDS: Antidepressants, assemblages, Deleuze, qualitativeresearch, Australia.

Contemporary Drug Problems 41/Spring 2014 109

AUTHOR’S NOTE: The research reported here was funded by a Ph.D. schol-arship (Melbourne Research Scholarship) from the University of Melbourne. Iextend my grateful thanks to the Contemporary Drug Problems reviewers andeditorial staff for their suggestions, which substantially improved the paper.For additional information about this article email: [email protected].

© 2014 by Federal Legal Publications, Inc.

The selective serotonin reuptake inhibitor (SSRI) group ofantidepressants reached the market in the late 1990s. There wasan explosion in prescribing rates at this time. Consumptionremains at mass levels in Western industrialized countries. Forexample, prescribers wrote 13.7 million prescriptions for anti-depressants in Australia in 2010 (Australian Institute of Healthand Welfare (AIWH), 2012). However, the enduring questionsabout how the medication works remain unresolved. Thedepressed individual—or what we would recognise as thefamiliar sovereign subject—is central to most debates. In theseaccounts, the medication acts within the depressed person intwo contrasting ways: first, as a chemical remedy for neuro-chemical insufficiencies in the brain, returning the individual toa proper or well state of being (Beyondblue, 2012). Second, asproducing inauthentic or contaminated states of being (Elliott,2000; The President’s Council, 2003). Since the late 1990s thesecompeting positions on antidepressant action have engaged indebate. Discussions have now reached an impasse due toenduring disagreement over whether antidepressants work in apositive or negative way within depressed people. Focusing onthe depressed individual also constrains the investigation intoantidepressant action. This is because the depressed individualis associated primarily with two kinds of work: the distinct andcompeting modes of pharmacological action and human effort.In addition, the debates can position the depressed individual ashaving a mental illness, or not doing enough to optimize innatehuman capacities. Both these positions have potentially nega-tive connotations for people who take antidepressants. This arti-cle proposes a different approach. It argues for a shift in theanalytic focus away from the depressed individual and onto thecollective body, or assemblage, as a means of moving debatesabout how antidepressants work into a more generative area.Modes of work in addition to linear forms of pharmacologicalaction or human agency can be considered using this strategy.The strategy also produces a way of understanding antidepres-sant action that does not contribute negative commentary aboutpeople who take antidepressants.

110 USING ASSEMBLAGES TO RETHINK ANTIDEPRESSANT ACTION

The first section of the article outlines how the depressed indi-vidual features in key biomedical and sociological debatesabout antidepressant action. Then, French philosopher GillesDeleuze’s assemblage concept, or “assemblage thinking,” isintroduced for its utility in moving analytic attention awayfrom the depressed individual onto the collective body orassemblage, which is composed of both nonhuman and humanelements. The ways in which assemblage thinking wasbrought into the research processes of a qualitative projectexploring the wellbeing of people who take antidepressantsare then outlined. Material generated in encounters withresearch participants (charts, photos and narratives) is drawnon to illustrate how antidepressants work through a series ofcollaborative connections. The paper concludes with a discus-sion of how this way of understanding antidepressant actionenables new ways of thinking about depression, medicationand recovery.

Antidepressant debates and the depressed individual

This section of the article outlines how the depressed individ-ual features in the key biomedical and sociological debatesabout antidepressant action. The conventional biomedicalaccount argues that neurotransmitter deficits occur and manifestin depressive symptoms such as anxiety and agitation. Inresponse, antidepressants directly mediate the balance of neuro-chemicals in the brain and correct the deficient brain chemistryassociated with depression. Western industrialized countries sup-port this explanation of how antidepressants work (Ellis & Smith,2002; World Health Organization, 2010). However, the biomed-ical account also attracts three kinds of debate. The first debatepoints to the undefined neurochemical action of antidepressants.Neuroscientists now consider outdating the highly-marketed“serotonin hypothesis.” They are now investigating how anti-depressants work at the level of the gene (Dreimüller et al.,2012; Vialou, Feng, Robison, & Nestler, 2013). The second areaof debate addresses the extensive non-pharmacological or

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placebo effect identified in antidepressant clinical trials(Kirsch et al., 2008; Vöhringer & Ghaemi, 2011). A thirddebate poses questions about the extent to which antidepres-sants are prescribed for conditions in addition to those forwhich they were originally designed. Most subjects of clinicaltrials are patients with major depression, and a depressivesymptom rating scale is used to measure any clinical improve-ment (Williams & Mulrow, 2000). However, general medicalpractitioners (GPs) write the bulk of antidepressant prescrip-tions in Australia (AIWH, 2012) and most of these prescrip-tions cite the condition “chronic mild depression” (McManus,Mant, Mitchell, Britt, & Dudley, 2003). There are few clinicalstudies that look at the efficacy of antidepressants for milddepression (Ellis & Smith, 2002). The three debates highlighthow the biomedical field sustains a series of open questionsabout how antidepressants work. These questions challengethe sufficiency of the conventional explanation of a linear,pharmacological action within depressed people.

Sociologists bring a different focus to investigating antide-pressants. They examine how antidepressants work in thecontext of everyday life. However, like the biomedical debates,sociological studies mostly retain a focus on the depressedindividual. They articulate how the specifically human capac-ities of thinking and feeling can mediate the experience ofantidepressant use. A key line of inquiry explores how mean-ings are attributed to the medication, such as stigma andambivalence (Barr & Rose, 2008; Garfield, Smith, & Francis,2003; Malpass et al., 2009). Other sociologists (see, for example,Karp, 2006; Smardon, 2008) explore how narratives play apivotal role in the reinterpretation of self that happens whenmedication is prescribed. Sociologists drawing on Rose’s(1998) influential reading of Foucault also articulate howprocesses of self are instigated through medication use.Nikolas Rose (2007) argues molecular science has enabledthe politicisation of life at the level of genes and cells. Giventhis, taking an antidepressant provides an opportunity forpeople to enact self-regulation in relation to biomedical


authority. Such processes of self, in this analysis, includebecoming active in response to the dominant neurochemicaldiscourses (Fullagar & O’Brien, 2012; Rose, 2003). Thedepressed individual is enacted by these studies as an agenticand reflective person. The work to be undertaken by such aperson is often cognitive and located in a rational register ofexperience. Some studies do focus on the emotion workinvolved in a depression diagnosis (see, for example, Fullagar& O’Brien, 2012). Broadly, however, the focus on the depressedindividual perpetuates the distinction between the humanwork of mediating the experience of taking an antidepressant,and the pharmacological action of the medication. This distinc-tion is perpetuated by a well-established sociological debateabout how everyday life has become medicalized through theoverprescription of antidepressants (Healy, 2004; Williams,Gabe, & Davis, 2008).

In Western industrialized countries, producing wellbeinginvolves the recognized mechanisms of pharmacologicalaction or human effort. Antidepressant debates that focus onthe depressed individual lend support to this conventional for-mulation. So, two modes of work are focused on when antide-pressant-related changes are investigated: first, the (highlycontested) neurochemical work of the medication withindepressed people; second, the specifically human work ofagentic individuals, mostly understood in a rational and cog-nitive register of experience. Both modes of work are connect-ed to specific logics about causality. Antidepressant pharma-cological action is explained using conventional causality.According to this reasoning, the inherent properties of themedication interact with other predetermined objects (likebrain chemistry) to generate a predictable range of effects.The work of human effort is attached to a long-standingWestern tradition that regards agency as a human attribute thatresides within each person as a latent or expressed capacity(Bennett, 2010). Effects are generated in a linear way, by peo-ple activating and expressing their human agency. Invest-igation into antidepressant action is limited to discerning lin-

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ear effects when only these framings of agency and causalityare deployed.

Retaining a focus on the depressed individual encourages bina-rised debate about how antidepressants work—as either achemical remedy, or chemical contaminant. The terms of thesedebates create positions for people who take antidepressantsthat are problematic for many. When couched as a chemicalremedy, people who take antidepressants can be positioned asliving with the stigma of a mental illness. Alternatively, whenantidepressant action is seen to contaminate the human form,people are positioned as inappropriately masking everydaysadness and limiting the chance to optimize their human capac-ities. The social science approaches to antidepressants thatretain the rational human agent can also have troubling impli-cations for people who take antidepressants. One example isthe body of studies showing how the pharmaceutical industrycoconstructs the disease of depression and its treatment withantidepressants through “disease-mongering” (Elliott, 2003;Healy, 2000; Rose, 2003). People are characterized as eithersubjected by the dominant neurochemical discourses (“duped”by messages from pharmaceutical companies about the need tomedicate mood states (Moynihan, 2002)), or actively negotiat-ing them. The problematic dimension of this reading is thatconsumer choices are constructed as being subversive and neg-atively placed in relation to the status quo or being subjectedand supportive of the status quo (Sedgwick, 2003). In doing so,it remains attached to a politics of blame.

This review shows how the depressed individual lies at thecenter of key sociological and biomedical debates about howantidepressants work. The depressed individual aligns withparticular ways of understandings of agency, causality andwork. That is, effects are generated in a linear way by pharma-cological agents or through activating human agency. Theseconcepts delimit how antidepressant action is investigated, in adebate that has reached a standstill and which attaches negativeassociations to people who take antidepressants. To progress


investigation into antidepressant action, debate needs to occuron alternative terrain. Conceptual territory open to the possibil-ity of forms of work beyond linear pharmacological action orthe rational agent making cognitive adjustments is required.This line of enquiry has already been taken up in research thatexplores depression and the action of antidepressants as inter-secting systems of biology, culture and society (Kleinman,1986; Wilson, 2006). Keane (2011) identifies how sociologicaldrug research is turning attention towards nonhuman actors inorder to render visible drug subjects in addition to the user. Thespecific strategy pursued in this article builds on this work,shifting analytic attention away from the depressed individual(or the familiar sovereign subject). To do this it turns to the col-lective body or assemblage. The assemblage concept wasselected because it reconfigures agency, causality and labor. Italso enables an investigation that does not contribute to a com-mentary of blame about people who take antidepressants.

Assemblage thinking

This section of the article introduces the assemblage conceptor assemblage thinking and identifies the contribution thisconcept makes to investigation into how antidepressants work.The assemblage concept has been developed by Foucault,Actor-Network Theory, and Spinoza (McFarlane, 2011).Deleuze’s elaboration of the concept is drawn on here (Deleuze& Guattari, 1987; Deleuze & Parnet, 2006). Deleuze(1925–1995) was a French philosopher who understood phi-losophy as the production of concepts. For Deleuze, an assem-blage is a series of heterogeneous elements that are organizedand held together through temporary relations. Assemblagescontinually form, decompose and change in processes, whatDeleuze refers to as “becoming-other.” To examine assem-blages one might ask: how do the elements converge in a waythat allows them to function together? How might the order-ings endure and become stable through habit and repetition?However, this is only one dimension of assemblages. Deleuze

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argues that the forms assemblages take are always open andprovisional. So of equal interest is finding ways to articulatean assemblage’s “expressive potential” (Deleuze & Guattari,1987), or in other words, the capacity of the assemblage totransform into something else. Therefore, the assemblage con-cepts allows exploration of both provisionality (or contin-gency) and structure within events (Marcus & Saka, 2006).

The assemblage concept formulates agency, causality andlabor differently from how they are used in debates focusingon the depressed individual. This produces alternative concep-tual terrain for the exploration of antidepressant action. First,agency is reconfigured as excessive to its conventional anchor-ing in the human subject. In assemblages, agency is not limit-ed to subjects. Matter or material entities such as objects alsohave agency (Bennett, 2010). Different kinds of relations formbetween elements as they come together in temporary configu-rations. The characteristic properties of an element and itscapacity to act—its agency—change depending on the place ittakes up in the assemblage it is configured with (Anderson,Kearnes, McFarlane, & Swanton, 2012; Duff, 2013; McFarlane,2011). Bennett (2010) convincingly makes this point when sheshows how omega-3 fats have diverse actions in different pop-ulations. For drug researchers, disengaging action and agencyfrom the individual human actor is a way of shifting debatesabout drugs from the moralized realm they are often conduct-ed in (Keane, 2002; Wilton & Moreno, 2012).

Second, in assemblages causality does not operate in a linearway. Following the conventional reasoning about causality, apredetermined body and the known properties of the antide-pressant interact to produce expected effects. Duff (2013, p.168) identifies the problematic temptation of this logic toattribute “causal” responsibility to individual actors or factorsin drug use. In contrast, in assemblages very contingent effectsare created through the ways in which different elements inthe assemblage come together. Causation happens withinassemblages, in a nonlinear and emergent way (McFarlane,


2011). The concept of emergent causality has assisted drugresearchers to show how drug effects are dependent on theways in which factors encounter each other in a given situa-tion (for examples of this line of thinking see Duff, 2013;Fraser, 2013; Fraser & Moore, 2011; Race, 2011). FollowingDeleuze’s assemblage concept, agency and causality functionin ways that contrast to their usual deployment in debatesabout antidepressant action.

Assemblage thinking can be used to investigate antidepressantaction in new ways. This includes attending to the elementspresent in the event of antidepressant use and explicating theassociations that exist between them. An additional dimensionof Deleuze’s conception of agency can be used in this kind ofempirical inquiry. Deleuze (1992) stipulates that in addition tospecific elements across an assemblage having differentcapacities to act, an overall assemblage also has agenticcapacity (Deleuze & Guattari, 1987). The shape and structureof assemblages is determined by the kinds of associations thatform between their elements. If an assemblage has organizedsecure and stable relations between entities, the overall assem-blage will have a sharp boundary. The assemblage will have alimited capacity to enter into relations with other collectivebodies or assemblages, a finite capacity to affect other bodiesand be affected by them. The overall assemblage will have asmall degree of affective capacity. In contrast, an assemblagethat is mostly in a process of transformation and has disorderedrelations between elements is characterized by an increasedopenness to interaction with other assemblages and a highdegree of affective capacity. So following Deleuze’s thinking,an assemblage’s agency—the action the assemblage can under-take, the relations it can enter into—is a property emergentfrom the formation of the overall assemblage. The power ofthis action is called “affect,” an intensity or force that exceedsthe subject (Massumi, 2002). Drawing on this dimension ofassemblage thinking provides ways to discern the connectionsbetween the relational structure of an assemblage and theemergent subject forms, affects, collectives and drug “effects.”

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The assemblage concept also expands the terms available tothink about work, or labor. This is the third contributionassemblage thinking makes to shifting the conceptual terrainfor the exploration of antidepressant action. The previous sec-tion of the paper showed how work is often couched in termsof the action of neurochemical agents, or rational agentichumans. In contrast, in assemblages work can be conceived asthe energy expenditure required to assemble the collectivebody, “the on-going labour of bringing disparate elementstogether and forging connections between them” (Li, 2007, p.263). It is individuals in their contexts, for Li, who expendenergy to create the associations between elements. Consistentwith matter having the capacity to act in assemblages, the ener-gy expenditure required for the maintenance of assemblages isextended in this paper to include the action of the nonhuman.The labor of nonhuman and human entities in forming connec-tions to create assemblages is described here as “collaborativeconnective labor.”

Qualitative inquiry into antidepressant action usually usesresearch methods underpinned by a rational human agent. Thisproject required research processes that were consistent withassemblage thinking and actively destabilized the sovereignsubject. In other words, a research design sensitive to theactivity of elements and how associations form between them(Demant, 2009; Duff, 2012; Vitellone, 2013). The followingsection of the article outlines how assemblage thinking wasbrought into the design and processes of a qualitative researchproject with people who take antidepressants.

Assemblages and qualitative research

This component of the paper describes the strategy undertak-en to make the methodology and methods for this project con-sistent with assemblage thinking.* The key strategy was toexperiment with approaching every dimension of the researchprocess as moments when assemblages configure. This orien-


tation was extended to the research encounters with the eightresearch participants in this project. Four men and fourwomen were recruited through Melbourne mental healthadvocacy organisations. All took antidepressants formild–moderate depression. As a group they were diverse interms of age, income and cultural background. However, theyshared some key characteristics. They all were, or had been,professionals and most were tertiary educated. The data forthis project emerged from the research encounters. In keepingwith a Deleuzian approach, I see data as produced through themoment-to-moment configuring between all the componentsof the research events, including the reconfiguring of bothmyself as the researcher and the research participants(Michael, 2012; Stengers, 2000; Thrift, 2003).

A number of materials were included in the research encoun-ters as another strategy to make the research methods consis-tent with assemblage thinking. I wanted to experiment withhow different materials might enable and constrain howassemblages configured, so selected contrasting materials.The first material introduced was a wellbeing chart. At ourfirst encounter the research participants were asked if theywould like to tell me a story about how their wellbeing may ormay not have changed over time. They were also invited todraw a line on a chart to convey how they regarded their lev-els of wellbeing at different times. The chart was a productiveconstraint on the assembling that happened during theresearch encounter. Drawing a line on a chart invited researchparticipants to organize their memories into a logical sequenceover time ( Williams & Keady, 2012). Changes to wellbeingwere attributed to specific life events or the strategies under-taken to mediate wellbeing, one of which was taking an anti-depressant. Experiences of antidepressant use were conveyedusing the conventional framing—that they worked as either abiochemical remedy or contaminant to optimal existence. Theline encouraged a telling of experience that is selectivelyinterpreted, where the subject is “centered” (Jackson &Mazzei, 2013, p. 262; Stephenson, 2005, p. 34). My position

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also moved towards being centered too, as a kind of healthprofessional-researcher able to understand and use of theseways of categorizing experience.

The second material introduced to the research encounterswas participant-generated photographs. At the end of our firstencounter, the research participants were asked if they wouldlike to create some photos to convey to me what was happen-ing in their lives at different points during the timeframe indi-cated on their chart. They undertook this exercise willingly, ontheir own time. Taking the photographs was an affectivelyintense process for the research participants as they visitedplaces and handled objects which evoked memories and feel-ings. This looser, less defined activity included the possibilityof memories proliferating outside their conventional organiza-tion of narrative over chronological time.

The encounters with the photos contrasted starkly to thosewith the wellbeing charts. What mattered here was sharingand performing a range of affective states. Part of this commu-nication was achieved by shaping the visual elements in thephotos. The research participants used brightness and dark-ness to communicate times of high and low levels of wellbe-ing. They also created certain viewing positions for me to takeup in relation to the photos (Lister & Well, 2001, p. 88; G.Rose, 2007, p. 41). During their sharing of the photos andaccompanying story, the research participants did not requireany verbal input from me. The position I moved to in theseencounters was simply to be present, and witness what thephotos conveyed as sensation or force (Csordas, 1994;Massumi, 2002). Images have the capacity to disturb or movethe viewer in unexpected ways (Barthes, 1981). I was certainlytransformed by my encounters with the research participants’photos. This sensitized me to how the contrasting materials inthe research encounters—the charts and photos—enabled dif-ferent kinds of assembling for all coparticipating elements,including my coparticipation as a researcher.


The research participants’ commentaries on the charts werefilled with conventional understandings of depression andantidepressant action. A very different series of relations toantidepressants emerged in relation to the photos. In the fewinstances where a photo featured an antidepressant, researchparticipants conveyed the bodily connections of habit andattachment that formed in the moment of encountering the pilleach day. They also communicated how the pill object evokedaesthetic responses, and the affects of comfort and relief. Thecontrasting ways in which antidepressants assembled in theresearch encounters showed me how the object coparticipatesin the formation of a distinctive range of connections withother elements.

Following assemblage thinking, the analysis of this projectneeded to account for how connections form in assemblages.The analytic strategy was to think through the lens of contigu-ity relations between entities. This approach involves identify-ing the actual connections between things in contrast to thesimilarity–based relations that are predominantly used in qual-itative health research coding strategies (Maxwell & Miller,2010). The analysis of contiguity relations was extended usinga second analytic device for explicating assemblages: modi-fied versions of Clarke’s mapping techniques, as outlined inher approach to a postmodern-inflected grounded theory(2005). Clarke’s situational map (2005) was modified by lim-iting the coparticipating elements—human and nonhuman—tothose in the research encounters. Elements of my coparticipa-tion were included in the maps. This involved drawing on thenotes taken after every encounter, the extended reflectionswritten about each interaction and diary entries from the time.The material elements in the encounters were also emphasized.In addition, the relations between the elements were examinedfollowing Clarke’s advice for making relational maps (2005).Making maps based on a connective analytic strategy allowedfor identification of key elements in the encounters, and thecoproduction of relations between elements.

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The overall analytic then became moving between the compo-nents of the research processes—narratives, photos, specificencounters and theory—and seeing the connections madethrough these movements as generating assemblages. Theanalysis processes became focused on the ongoing explorationand creation of new collective bodies (Jackson & Mazzei,2013). An experimental process was undertaken to find avocabulary to describe formations as they came together. Thisinvolved articulating the coparticipating elements, the rela-tional configuration across the assemblage, and the collectivebodies’ emergent formations and capacities. A series of co-extensive assemblages were described, one of which config-ured during encounters with antidepressants. I called thisassemblage “Becoming-Depressed.” The next part of the arti-cle draws on the charts, photos and narratives from theresearch encounters to illustrate the elements that composethis assemblage, the relational configuration between theelements, and the capacities of its emergent formations. Theproduction of this assemblage was possible due to the specif-ic entities proximate to the research encounters. As I go on toshow, the Becoming-Depressed assemblage generates a sensi-tizing concept, or a way along which to look, at antidepressantaction. Additional empirical investigation would be requiredto determine the explanatory power of this concept in othersituations.

Antidepressants facilitate collaborative connections

The empirical illustrations in this section of the article showthat antidepressants work through a series of collaborativeconnections. They explicate the entities present duringencounters with antidepressants and how relations of logic,habit, aesthetic response, and affective investment proliferatebetween them. Both human and nonhuman elements areshown to coparticipate in the work of forming associationsbetween entities. The entity in the assemblage with the mostcapacity to coparticipate in forming associations is the antide-


pressant object. The assemblage that configures with the anti-depressant, called Becoming-Depressed is described. Thestructure of the overall assemblage and its emergent forma-tions are identified. These forms, it will be shown, constitutethe emergent antidepressant effects.

The research participants in this project all had at least onestage of acute despair. At this time they sought help from a GPor psychiatrist who prescribed them an antidepressant. Thisinvolved engaging with the biochemical thesis of depressionand drawing connections between moods and serotonin levelsin the brain. During our discussion about her wellbeing chartCameron—an energetic, fast-speaking woman in her early30s—used neurochemical terms, definitions, and categories toaccount for her bodily changes over time. Discussing herchart, Cameron describes how her doctor suggested she mightunderstand her despairing state as indicating depression:

I hated Australia, I hated my job, I had no friends, I had a seriousrift with my father at the time. So I basically had nothing to get upfor in the morning. I went to a doctor, in tears, and said, “I don’treally want to live any more. I can’t even see any point in goingon.” I was that despairing of my life basically. He sat me down andsaid: “You are very depressed.”

The medication facilitates Cameron, and her prescriber doingthe work to line up Cameron’s states and her interpretation ofthem, with the terms of the neurochemical framework.Together they take on board the meanings of the neurochemi-cal framework and constrain other explanatory frameworks,undertaking the work that Li describes as “authorizing knowl-edge” (Li, 2007, pp. 273–276). Cameron accepts a diagnosisof depression as an appropriate interpretation of her state offeeling. She then causally connects the diagnosis to her GP’sidentification of lacking serotonin levels in her brain. As sheunderstands herself as having a medically-defined neuro-chemical lack, the next logical step is to take the drug that willremediate this lack. As she says:

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Logic

I mean, if I had diabetes, I’d take insulin. I don’t have serotonin, orI have low serotonin, so this brings me up to the same level aseverybody else. You know I’m not perfect, but I feel like I’m func-tioning like a normal person, not like a neurotic.

The process of accepting a depression diagnosis and a needfor antidepressant treatment has increased the number of log-ical relations Cameron makes between herself, her feelings,the neurochemical framework, and her prescriber. She active-ly engages with an explanatory framework that defines inadvance the problem, the intervention and what will constitutea beneficial result (Li, 2007). Pain and suffering are interpret-ed as an illness requiring chemical treatment, so fixed rela-tions are created between certain states of feeling, andpathology. The terms of a neurochemical framework havealso provided Cameron with a series of categories she can useto understand herself and others: depressed/not depressed;serotonin sufficient/lacking; rational and irrational. Makingand reproducing these dualisms creates difference betweenrelations (Lazzarato, 2006) and again adds to the formation offixed or non-reversible relations. By using the neurochemicalterms, categories and definitions, Cameron has been able tofind a way to articulate her life, and to access means of inter-acting with a social world that recognizes her. Cameronindicates the necessity of retaining some form of connectionto a shared social reality (Deleuze & Guattari, 1987).Facilitated by the encounter with the antidepressant, Cameronand her GP expend energy to form logical relations betweenCameron’s state and the neurochemical framework. The fol-lowing section highlights how in addition to this humanexpenditure of energy, the nonhuman element of the antide-pressant object also coparticipates in the formation of collab-orative relations.

This part of the paper illustrates how the antidepressant objectcocreates relations of habit. A key component of antidepres-sant use is the habitual encounter with the pill each day,demanded by the prescription of daily use. For Steve, a quietly


Habit

spoken retired public servant, forgetting his daily habit of tak-ing the pill in the morning results in visceral reactions by theafternoon, including shakes and tingles in the hands and lightthumping in the head. These symptoms indicate to him that heneeds to take his daily dose, to ease his symptoms. In responseto this unwanted state, Steve has a comprehensive repertoireof strategies to assist him maintain the habit of daily use.Steve indicated while discussing his photos that,

I’ve got them (antidepressants) all over the place. I’ve got them atMum and Dad’s, my sister’s, my girlfriend’s, in the car. Generally if Idon’t stay at home, there’s sort of that little bit different routine in themorning. Say for example on holiday next week. Whilst I’m not goingto have medication out for people to see, it’s something I’ve alreadythought of. I’m very particular about brushing my teeth so I might putsome black tape around the toothpaste or something like that.

In assemblages, the creation of habitual connections works tostabilize both the assemblage and the subject forms that canemerge from it (Delanda, 2006, p. 50). Steve is invested inavoiding the visceral effects of any disruption to the habit ofdaily use.

A feature of habit is that it requires less energy expenditure toenact: Repeated, expected action does not require decisions tobe considered afresh each time (Mol, 2008). Rayna—a wiry,inquiring woman in her early 50s—considers a strategy suchas meditation to work in a similar mode to her antidepressant.Both are effective responses to the states she wants to medi-ate: feeling overwhelmed; having too much chatting in herhead; and being out of control. During her chart discussionRayna said:

Another thing I think I’ve got a bit more in touch with, and I don’tdo it anywhere near as much as I should, is meditating. I do try tobuild up at least a few days of taking 15 minutes out to meditate. Imean, it is powerful but I just can’t drive myself, I can’t disciplinemyself enough to do it.

In comparison to the habit of taking a pill, meditation forRayna requires a significantly increased degree of energy.

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This indicates how habitual contact with the antidepressantobject mediates the collaborative connective labor required ofthe patient to form an association.

Habitual encounters with the antidepressant object involvebodily expenditure of energy. This contrasts to the rationalregister of labor usually examined in sociological studies aboutantidepressant use. When we met for the second time, Steveshared a photo he had taken of his bedside drawer, opened toshow the pharmaceutical products he kept there. Explainingthis photo to me, Steve said:

And in my bedside drawer—looks like its own pharmacy. Any dayyou open it, that’s what you see. Now I’m in a relationship and havebeen for a while, the good thing is she knows everything. So I don’thave to change that at all. For fear of her seeing something I don’twant to, I’m not going to change, and she didn’t want me to.There’s a level of comfort in that. The fact is, that’s my drawer, andfor the foreseeable future that’s how it will be. You know, I canreach in there in the middle of the night in the dark and I can, justby the feel of the packet, I would know what was what.

Steve’s tone is one of quiet conviction as he conveys the senseof certainty and stability generated by having the drawer as anongoing feature in his life. His encounter with the object isregistered bodily—he can identify the drugs in the dark—indi-cating his direct bodily awareness forms a connection with thepill object. Steve’s bodily senses and the materiality of theobject expend energy together to form the collaborative con-nection. Another instance of nonhuman and human elementscoparticipating to form collaborative connections happenswhen aesthetic relations form between the person taking thepill and the antidepressant object.

Rayna took a photo of her antidepressants in their usual posi-tion in her home, sitting on the countertop in her bathroomwith her vitamins and some bracelets she bought on her lastholiday overseas. She explains how the habitual encounterengages her viscerally, through evoking an aesthetic responseto the scene created by the objects.


Aestheticresponses

It’s just funny, it’s just the way it all sits on the bathroom counter-top. You know, just in that arrangement. I sort of like the look of it,the arrangement you know, in a creative way. It’s probably a bit ofan arty arrangement too. Because I just do look at it. I suppose I’ma visual person and I look at the way things balance and, appear.

As an object the antidepressant provokes affects in Rayna—aesthetic pleasure, comfort, and satisfaction. Objects, likeassemblages, have a power of action (affect) or the capacity toact. Things have the vital capacity to connect with other ele-ments and to undertake collaborative connective labor. Accord-ing to Elizabeth Grosz (2008) the materiality of objectsenables their expressive qualities. The materiality of theobjects in this scene expresses something to Rayna. Thisexpression of affect cocreates the relation with Rayna; it ispart of Rayna’s aesthetic response to the objects as they arecomposed on her bathroom counter top. The antidepressantobject shares the vital materiality of the vitamins andbracelets, indicating the scope non-organic objects have tobecome things that are, as Bennett describes, “vivid entities”(Bennett, 2010, p. 6). A respondent in Vitellone’s empiricalresearch on the syringe described the shooting gallery as “aes-thetically pleasing” (Vitellone, 2010, p. 878). Rayna describesa similar response to the configuration of objects in their “artyarrangement.” The syringe and antidepressant objects bothcan be seen to have expressive qualities that present an expe-rience of affect, of aesthetic pleasure.

This final empirical illustration will show how—facilitated bythe encounter with the antidepressant—prescriber and patientundertake work to invest affectively in the treatment. Thiswork again contributes to the proliferation of stable relationsacross the assemblage.

Antidepressants are connected to the competing binary dis-courses that understand antidepressant action as a chemicalremedy, or a chemical pollutant. Rayna is clear about how shepositions herself in relation to these discourses. She indicatesshe is cognisant of the research that debates the biomedical

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Investment

efficacy of antidepressants: “I mean, I still wonder about theantidepressants, you know, the placebo stuff, the variousresearch. And then the research that they don’t do anything.”However in the course of the same conversation she takes upa contradictory position, saying: “Well look, in the end, I don’tcare, you know, if you’ve got heart disease you take medica-tion for heart disease.... if it works for me, that is fine.” Raynais simultaneously invested in, and has a clear position on, howthe medication works to remedy her medically defined illness.

Cameron talks about the processes of developing a sharedinvestment in the medication with her GP:

This time, I actually thought I was doing all right. But he went:“Nah.” It’s interesting how they worked, when I didn’t want them. Idon’t know how that works, psychologically! I resisted them. I said:“I don’t need them.” He said: “Yeah, you do.”

Cameron then accepted her GP’s explanation that it was worthenduring her initial side effects, because the drug was going tomake her feel a lot better. This process further reinforced herinvestment in the treatment. Together Cameron and her GPhave done work Li describes as “forging alignments ... thework of linking together the objectives of various parties to anassemblage” (2007, p. 265). Yet simultaneous with Cameron’sinvestment in antidepressants as providing her a chemicalremedy, is her sense that it would be preferable to not take adrug or need a pill to be happy. She retains an investment inthe idea that taking an antidepressant creates a body that isinferior—more polluted—than a drug-free human form.Mariam Fraser (2003) develops the groundbreaking argumentthat the serotonin hypothesis of depression, usually under-stood as representing a biomedical model of depression,instead participates as an unfinished object in events or assem-blages of continuously changing relations. It is the particularopenness of the hypothesis, she argues, that enables it to con-figure in different ways, in different kinds of events or assem-blages. Rayna and Cameron connect to ideas about the actionof antidepressants which are underpinned by the serotonin


hypothesis of depression in a range of ways, indicating thepartial status of the ideas. The openness around how antide-pressants work enables Rayna and Cameron to form multipleand shifting relations to the serotonin hypothesis of depres-sion. They can invest in a range of contradictory and coexten-sive positions, which increases the extent of their affectiveinvestment in the treatment. In turn, stable relations prolifer-ate across the assemblage.

This part of the article will detail the overall structure of theBecoming-Depressed assemblage and the formations thatemerge from it. The assemblage is entitled Becoming-Depressed because, as I will go on to show, the subject formthat is produced from the assemblage communicates and isrecognized as a “depressed” person. This subject form differsfrom the orthodox understanding of a person who is sufferingfrom depressive symptoms.

The empirical illustrations detailed above show how the anti-depressant medication facilitates relations of affective invest-ment, aesthetic response, habit, and logic. When configured aspart of the Becoming-Depressed assemblage, the antidepres-sant entity works as an “operator” or “assemblage convertor”(Deleuze & Guattari, 1987). That is, as an element with anunusual capacity to contribute towards an assemblage’s trajec-tory. In this case, the relations proliferating around the antide-pressant element create an assemblage that is increasinglyorganized and stable. The prescriber, patient, and object co-participate in practices that accelerate when the antidepressantobject is encountered in the clinic or during daily use. Thelabor of these practices includes: the shared cognitive work ofinterpreting bodily change in relation to the neurochemicalframework; the embodied work of sensing the object duringhabitual encounters; visceral, spontaneous aesthetic responsesto the object; and the effort of affectively investing in compet-ing discourses about antidepressant action. Crucially, theenergy to form associations through these practices does notjust originate from humans. The object also does work to form

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Becoming-Depressed

assemblage

collaborative connections, by evoking affects. The labor ofobjects mediates the degree of energy required by copartici-pating people to form associations.

Following the notion that antidepressants work through a seriesof collaborative connections, in this account antidepressant“effects” are the contingent, emergent formations of the overallBecoming-Depressed assemblage. The proliferation of organ-ized and stable relations creates an assemblage with internalhomogeneity, clear rules, and sharp boundaries. The Becoming-Depressed assemblage has a limited capacity to form relationswith other assemblages and thus a low degree of agentic capac-ity. Consistent with this overall formation, the emergent subjectform is unified and is recognized as a “depressed” person. Low-intensity affects—predominantly comfort and relief—emergefrom the assemblage. Together, these formations constitute theemergent antidepressant effects.

Antidepressant effects are not only contingent upon the for-mation of the Becoming-Depressed assemblage. They are alsosensed in relation to “the multiple assemblages that constitute‘a life’ ” (Anderson et al., 2012, p. 214). After times of acutepain and immobilization, a stable and low-affect formation iswelcomed by the people in this study. The emergent subjectform feels functional and connected to a form of social reali-ty. As Walkerdine (2010) shows, containment is valued whenlife is also characterized by insecure situations. The people inthis study also emerged from assemblages with contrastingaffective capacities. So at times they emerged as enlivened,excited, content, and so on. For these research participants,the Becoming-Depressed assemblage is one in a series of con-tinually changing assemblages. Viewed in this light, it is atransitory, productive and well-regarded formation.

The Becoming-Depressed assemblage continually comes intocontact with other assemblages. Although it has limited capac-ity to interact with other assemblages, the force of an encountercan disrupt the relational configuration of the Becoming-


Depressed assemblage. Steve describes how he was confidenthe was on the “right” antidepressant. But a life event hap-pened—his marriage broke down—which, in his words, “sortof over-rode” the antidepressant “in a sudden and direct drop.”He moved into a time where he attempted suicide. The force ofthis life event destabilized the temporary formation of theBecoming-Depressed assemblage, breaking down the connec-tions between elements. At this time the antidepressant objectis no longer configured with a proliferation of stable relations,so Steve can no longer ascertain antidepressant effects.

The research participants draw on the conventional pharmaco-logical explanation to account for antidepressant effects.Cameron connects the increased stability in her life solely tothe pill’s chemical action. She makes a causal link between herantidepressant’s neurochemical properties and achieving emo-tional control. For Rayna, increasing her antidepressant dose isa way to directly reduce her sense of rawness by “putting a lit-tle bit more of a buffer on it.” Both women make logical con-nections between the action of the medication and changes totheir affective states. In doing so, they are again adding to thenumber of logical connections across the assemblage.

New ways of thinking about medication,depression, and recovery

Shifting the analytic gaze from the depressed individual to thecollective body or assemblage made up of nonhuman andhuman elements has provided fresh insight into how antide-pressants work through a series of collaborative connections.Thinking with assemblages adds the missing work of nonhu-man and human collaboration to the picture of antidepressantaction. The article will now go on to discuss how this under-standing of antidepressant action suggests new ways of think-ing about medication, depression, and recovery.

First, thinking about antidepressant medication. The antidepres-sant action suggested here does not refer back to, or exist within,

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the depressed individual. Antidepressants work through a rangeof relations. The work to make these associations is collabora-tively undertaken by nonhuman and human coparticipants.Human expenditure of energy to form connections is not onlycognitive, but also undertaken through bodily registers of experi-ence. This human coparticipation differs from the predominantlycognitive work of meaning-making and identity-formationpointed to by sociological studies as mediating the experience ofantidepressant use. In contrast to the conventional pharmacolog-ical account, the effects of the antidepressant action described inthis article are not linear, but emergent. Antidepressant effects areassociated with the emergent formations from an assemblagewith stable connections: low-intensity affects, limited affectivecapacity, and an emergent subject form that is unified and recog-nized as a depressed person.

The research participants drew on the orthodox pharmacolog-ical explanation to account for antidepressant-related change.This article suggests antidepressants work through a range ofactions, only some of which can be traced to a pharmacologi-cal agent. Pharmacological agents can cocreate collaborativeconnections in the neurochemical dimensions of the Becoming-Depressed assemblage. However, this is but one aspect of theoverall topography of relations composing the assemblage. Itis insufficient, given the range of labor contributing to the col-laborative connections that form the Becoming-Depressedassemblage, to attribute the emergent effects to pharmacolog-ical agents alone. Wilson (2006) uses a similar network logicto interpret psychopharmacological data on antidepressants.In her view, the pharmacological action of antidepressantsreiterates neurochemical networks that traverse the body andthe world it inhabits. It would be productive to further inves-tigate how collaborative connections form between the social,material and neurochemical entities of the Becoming-Depressed assemblage.

The increasing rates of antidepressant consumption are gener-ally explained as due to escalating rates of depression and


more effective means of diagnosis. The notion that antidepres-sants work through collaborative connections points to analternative explanation: that people are increasingly experi-encing moments when they require stable associationsbetween different aspects of life and the emergence of a (tem-porary) unified subject form. The research participants indi-cated how this is a desired formation after feeling lost to theworld and despairing. The antidepressant object is pivotal tothe proliferation of stable relations, and the formation of theBecoming-Depressed assemblage. However, the object is alsoconnected to a depression diagnosis and the associated neuro-chemical imbalance. The stigma associated with these defini-tions is problematic for many. The article has shown how theBecoming-Depressed assemblage is composed by a range ofelements and different forms of collaborative labor. This rais-es the question: Is it necessary to attribute neurochemical lackand mental illness to create an assemblage with a desired sta-ble structure? The final component of the discussion will goon to explore these broader questions around how recovery isresourced.

A human model of ethics, featuring the intentional moralhuman subject, is usually used to assess interventions likeantidepressants. Drugs effects are assessed as “good” if theyenhance the sovereign body or “bad” if they pollute the indi-vidual. Disconnected from the depressed individual, thisaccount is not concerned with drug effects within individuals.Instead, the material for ethical consideration becomes theformations that emerge from the Becoming-Depressed assem-blage. Shifting attention away from the depressed person tothe collective body or assemblage allows ethical examinationto become “ethological” (Deleuze, 1992, p. 628). That is, thefocus becomes the agentic capacities of the assemblage,instead of the agentic individual. This approach is an exampleof extending bioethical systems of assessment beyond a pure-ly human model of ethics (Buchanan, 1997; Race, 2012;Rosengarten & Michael, 2009).

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Using this approach to ethically assess antidepressants wouldrequire detailed examination of the capacities of theBecoming-Depressed assemblage. Deleuze’s normativity isopen to processes, becoming and differentiation (Braidotti &Pisters, 2012). This does not mean privileging transformativeprocesses in assemblages, but giving careful examination tohow assemblages form, decompose, and change. As Andersondescribes, “a Deleuzean ethic based more on a thoroughlyimmanent attention to the qualitative capacities of assem-blages” (2012, p. 215). In their discussion of the depressionstrategy, Diprose, Stephenson, Hawkins, Mills, and Race (2008)define a healthy body as one that is open to encounters withothers. The authors understand the depression strategy to beharmful, because it limits the degree of openness bodies haveto encounter with other bodies. However, here we see theBecoming-Depressed assemblage—with its limited capacity tointeract with other assemblages or bodies—is welcomed aftertimes of despair. This points to the importance of examiningthe capacities of assemblages as they occur in ongoing bodilyexperience (Anderson et al., 2012; Bissell, 2009).

Deleuze’s ethical stance is that “life itself is a self-emergingprocess that aims at sustainable modes, times and forms ofbecoming” (Braidotti & Pisters, 2012, p. 2). This stance gen-erates productive questions about how to understand andresource recovery processes, such as, how might we best facil-itate sustainable assemblages for people after times ofdespair? In other words, how might the elements and con-nective labor required to produce the Becoming-Depressedassemblage be directed to more effectively maintain wellbe-ing? For example, could a resource like a shared framework tounderstand and describe experience be provided without evok-ing neurochemical pathology? The overall approach called forby this ethical stance brings what McFarlane describes as a“positive orientation” to thinking about how to best facilitatethe formation of temporary stable assemblages. Taking intoaccount the action of matter, this orientation extends to con-sideration of the ethical obligations of nonhuman actants.


Ethological assessment of nonhuman elements looks at the kindsof relations afforded by entities, in the assemblages they are con-figured with. The intervention of providing the antidepressantreceives government support and medical sanction. The antide-pressant is a pivotal cocontributor to the number of stable rela-tions in the Becoming-Depressed assemblage. It also mediatesthe amount of energy required of people to form associations.The relations afforded by the object contribute to the formationof an assemblage with desired capacities, so can be assessedpositively. However, this ethical approach also examines thekind of associations that produce harm (Duff, 2013). Anti-depressants are already connected to a categorization of mentalillness and non-reversible relations between pathology and cer-tain affective states. A positive orientation encourages thinkingthrough the possibility of an object that accelerates stable asso-ciations, without these built-in harm relations. Fraser (2013)illuminates how objects might be actively shaped toward harm-reduction outcomes. She shows it is possible to “design in” thealready-existing social attachments of injecting people to thematerial objects of their equipment. Fraser notes that equipment“that acknowledges and affords different conduct and differentrelations will not guarantee new subjects, but it can make them‘slightly more’ imaginable, slightly more available” (2013, p. 218).Applying this insight to the antidepressant object raises the pro-ductive question: Could the object be reconfigured to make moreimaginable a subject who desperately needs more stable rela-tions in life and seeks a unified subject form, but is not anchoredto ideas about pathology?

If recovery requires the formation of sustainable assemblages,collaborative connective labor is positioned as a crucialresource. This article highlights all the collaborative connectivelabor that goes into the production of the Becoming-Depressedassemblage. The unified subject form, the depressed person,emerges from the Becoming-Depressed assemblage. At thistime, the collaborative connective labour involved in this pro-duction is backgrounded, and relevant institutions confer thedepressed identity via depression diagnosis and antidepressant

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treatment. So, the depressed subject form reinforces and stabi-lizes the institutions associated with depression—and withoutany recognition of the labor required for the depressed subject’sproduction. In addition, the emergent effects” of the Becoming-Depressed assemblage are commonly attributed to the linear phar-macological action of the medication. This in turn reinforces themedication and lends justification to the profits directed towardsthe pharmaceutical and depression industries. A productive orien-tation queries how labor is accounted for in the production of theBecoming-Depressed assemblage. It suggests harnessing collab-orative connective labor towards the formation of sustainableassemblages wherever they are needed or desired. One steptowards this might be to acknowledge that forming stable con-nections plays a crucial role in recovery, and that this can becontributed to by nonhuman elements, as well as people.

Using assemblages to rethink antidepressant action provides away forward from the impasse in the debates about antidepres-sant action that feature the depressed individual. Shifting atten-tion away from the depressed individual and onto the assem-blage contributes fresh insight into how antidepressants workthrough human and nonhuman collaborative connections. Indoing so, a contribution is made to the contested and unresolvedmatter regarding how antidepressants work. This account ofantidepressant action does not enact the depressed individual inits usual form, the sovereign subject. Therefore it also does notcontribute to the problematic positions provided to people whotake antidepressants by the conventional debates about antide-pressant use—the negative associations of having a mental ill-ness or not optimizing human capacities. In addition, new waysof thinking about depression, medication and recovery are sug-gested by this antidepressant action. These lines of enquiry canbe explored using an ethological ethical approach, which doesnot evoke or enact the depressed individual. Qualitative researchprocesses that destabilize the sovereign subject would supportthis approach. These strategies open the possibility of assessinginterventions like antidepressants without further entrenchingthe stigma experienced by those who take the medication.


* This research project was approved by The University of MelbourneHuman Research Ethics Committee (Approval No: 0717717).

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The missing work of collaboration: Using assemblages to rethink antidepressant action

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