Neurochemical selves or social prescription? by Pauline Garvey

In an academic article in the early 2000s sociologist Nikolas Rose asks ‘How did we become neurochemical selves? How did we come to think about our sadness as a condition called “depression” caused by a chemical imbalance in the brain and amenable to treatment by drugs that would “rebalance” these chemicals?’^[i]. During the decade from 1990-2000 Rose charts high rates of prescribing psychiatric drugs in Europe, Japan and the United States. In Europe growth in the value of prescription drugs rose by over 125% while growth in sales of similar drugs in the United States rose by over 600%. He notes that a decline in prescriptions for hypnotics and anxiolytics was matched by a rise in prescriptions for anti-depressants of about 200% (2003: 46).

There is, however, another trend that is gathering momentum on the international stage and which couldn’t be more different than the trends that Rose documents.  Social prescription takes an altogether different approach to health and embeds it in social networks and cultural activities. It is defined by the NHS as ‘helping patients to improve their health, wellbeing and social welfare by connecting them to community services which might be run by the council or a local charity^[ii]. In Ireland the Health Service Executive webpage speaks directly to the reader and defines it as a free service that ‘helps to link you with sources of support and social activities within your community. These include Physical activity, Reading groups/books for health, Self-help programmes such as the Stress Control Programme, Men’s Sheds, Community gardening, Arts and creativity’. Social Prescribing is for you if you feel that you need some support to mind your health and wellbeing, you feel isolated, stressed, anxious or depressed, you simply feel you need the service^[iii]

In a comparable project called Local Asset Mapping Project (LAMP) run through St James’s Hospital in Dublin their webpage again addresses the reader directly and conjures the scenario: ‘Imagine visiting your doctor and as well as getting a prescription for a pill, you get an electronic  prescription designed especially for you, with a list of all the local businesses and services around you that might improve your health – that is the vision of LAMP’^[iv]. The LAMP project points out that wellbeing is determined by ‘good health behaviours’ such as exercise, nutrition, minimal alcohol consumption and good social networks, but notes that traditional medical consultation does not address this adequately’.   As if to echo these arguments, just two weeks ago the Irish Longitudinal Study on Ageing at Trinity College Dublin (TILDA) presented their most recent findings regarding ‘Change in life circumstances’ for Ireland’s over 50s between 2009 and 2016. They found that quality of life peaks at 68, and therefore shouldn’t be thought of in a linear way (ie as a steady decline) but also that fundamental to quality of life is social connnectedness. Quality of life improves with age for the majority of their sample, but only if social engagement is strong. ^[v]

As an anthropologist the holistic approach to health and wellbeing makes perfect sense. My respondents do not organise their lives ‘in silos’ (see LAMP), and how one feels ripples into all aspects of life, in the same way that everyday experiences are integral to how people think about their wellbeing, happiness – and age. Some respondents occasionally talk in neurochemical terms -particularly when wondering how to get a good night’s sleep, but the majority of their time and energy is devoted to their busy lives.  One of my informants aged in her early 80s resisted joining Active Ageing groups because she did not consider herself elderly. Another woman said ‘I’m 78 but I feel 60, I feel younger, not older’. In the course of my research I have met some retired men and women who are lonely, isolated or bored but many others take to retirement with vigour and enthusiasm. What interests me is whether these activities such as knitting, writing or meeting friends for coffee are reflected upon as ‘good health behaviours’. What are the social trends that social prescription is tapping into, or indeed leading?  Meanwhile as I conduct me research the benefits of social embeddedness seem clear. As one man told me since retiring from work he has never been so busy.

^[i] Rose, N. (2003) ‘Neurochemical Selves’ Society 41 (1): 46–59.

^[ii] https://www.england.nhs.uk/contact-us/privacy-notice/how-we-use-your-information/public-and-partners/social-prescribing/

^[iii] https://www.hse.ie/eng/health/hl/selfmanagement/donegal/programmes-services/social-prescribing/

^[iv] http://www.ehealthireland.ie/Case%20Studies/Local-Asset-Mapping-Project-at-St-James-Hospital/

^[v] https://tilda.tcd.ie/news-events/2018/1812-w4-key-findings/