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Biopolitics, surveillance, and the subject of ADHD

Article in Semiotica · October 2014

DOI: 10.1515/sem-2014-0061

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 Semiotica 2014; 202: 301 – 320

Ott Puumeister
Biopolitics, surveillance, and the subject
of ADHD
Abstract: Surveillance is a part of our everyday lives, and it does not include
just the cameras watching over individuals safety and collecting images of them.
Surveillance includes all kinds of techniques of data gathering, for instance, the
keeping of medical histories and the conduct of surveys. Directly related to the
medical sphere is the notion of biopolitics. The aim of biopolitics is to control and
normalize individuals lives by subjecting them to treatments, proposing to them
possibilities of a better life (or death), etc. This paper deals with biopolitics and
its relations to surveillance (it can be said that surveillance is a set of techniques
used to implement biopolitics). To mediate between these two concepts I have
chosen a disorder called Attention Deficit/Hyperactivity Disorder, which is be-
coming ever more prevalent among children and lately also adults. I will investi-
gate how this disorder – which is definitely not an irrefutable medical fact – is
being constructed through surveys and biopolitical techniques and what kind of
a subject ADHD treatment hopes to create.

Keywords: biopolitics, surveillance, subjectivity, ADHD, normalization

DOI 10.1515/sem-2014-0061

1 Introduction
The goal of the following paper is to investigate how an individual human being
is inserted into the larger social order and population through the techniques of
biopolitics and surveillance. Biopolitics is here understood as a governmental
strategy that takes as its main object organizing the life of human beings. We can
now ask how this qualification distinguishes biopolitics from “regular” politics,
since all political practices concern the lives of individuals. The major differ-
ence, as I see it, is the fact that the aim of biopolitics is to form and render hu-
mans” bodies and psyches effective in the context of populations. Bodily and

Ott Puumeister: University of Tartu, Estonia. E-mail: ott.puumeister@gmail.com

302 Ott Puumeister

psychological self-formation practices are governed in relation to the effective-

ness and health of populations.
Surveillance techniques can in many instances be seen as the implementa-
tion and realization of biopower; as concrete practices that are used to create the
knowledge important to the government of populations. I do not, then, under-
stand surveillance as solely the practices of continuous watching (CCTV) and
tracking (GPS), but any kind of data gathering used in compiling profiles and
categories created to classify and manage groups of individuals. Surveillance
includes, for instance, the keeping of medical histories and the conduct of sur-
veys. Statistical analysis creates a new normalized, abstract psychologized body;
and the (idealized) individual is understood through this abstraction. In relation
to these large-scale surveillance techniques, individuals are prone to types of
self-surveillance.
This interplay between the abstract psychologized body created through
surveillance techniques and the individual brings into focus the self-formation
of the human being in the context of biopolitical governance. The individual
is not a natural given or an absolutely fixed entity but a processual one that
is necessarily created in social, political and cultural contexts. A human being
creates her/himself in a continuous and dynamic practice of semiotic self-
formation. Therefore the abstract normalized body of biopolitics plays a huge
part in the individual’s semiotic formation – all the more so because it is
created as a figure of nature which the individual should strive to become. Bio-
political government techniques, then, have a fundamental effect on the indi-
viduals’ relations to themselves. We will see how “life” is produced in the for-
mation of one specific mental disorder, namely, Attention Deficit/Hyperactivity
Disorder.
As far as I know, there have not been any studies of ADHD made from the
semiotic point of view, using semiotic terminology. However, there have been
some studies on the conceptual and social history of ADHD (Rafalovich 2001;
Brock 2010). The theoretical side of biopolitics and its possible semiotic inter-
pretation are touched on for example by Daniele Monticelli (2008, 2012). I will
draw on these studies in what follows, but I hope I will also be able to add
something extra, especially through the conceptualization of surveillance and
ADHD.

2 Biopolitics and biopower

Before we continue, an important distinction needs to be made, a distinction
between “biopower” and “biopolitics” as I use them in the following text (there
 Biopolitics, surveillance, and the subject of ADHD 303

have been many different manners of this differentiation).1 I borrow this defini-
tion from David Hook, who writes:

At a basic level, one might understand bio-power as the generic category of which bio-
politics is a variant . . . Bio-politics can thus be understood as that type of bio-power
that targets collectivities, constituting its subjects as “a people,” “a nation,” “a race” . . .
whereas bio-power begins with the body and its potentials, and seizes life and “living be-
ing” as its objects, bio-politics is always necessarily a form of government, it involves a
government-population-political economy relationship . . . (Hook 2010: 227)

Biopolitics is a collectivizing set of governmental practices in which a human

being is relevant only in as much as he is connected to the overall population; his
conduct is measured against the working of larger collectivities. Biopower, how-
ever, is any kind of intervention in a human being’s bodily practices, in his con-
struction of self as a bodily-psychological being (the most prevalent set of tech-
niques are of course related to medicine and health, for example, dietary regimes
preventing diseases). What we need to note here is that there is no strong line
between the two: the individualizing techniques of biopower may easily be
converted to the working of biopolitics; for example, an individual’s choice of
nutrition can become a question of “public health,” in which case the regime is
already regulated by the government (by illegalizing some products, raising the
taxes of others, advertising, etc.).
Another note I’d like to make is that – following Foucault (see, for exam-
ple 1981), Mouffe (2003), Althusser (1971), and others – a human being is made
into a subject only in social, cultural, and political power relations. This means
that not only through cultural sign systems and their interplay, but through the
practices of constituting and implementation of those sign systems (at the risk
of simplification, we could say that sign systems are basically discourses in
Foucault’s sense). We could then agree to what Nancy Much says about cultural
psychology:

[It] emphasizes the non-discrete and interpenetrating relation between personal psychology
. . . and the symbol systems, institutions, practices and contexts shared by the group and
communicated by other persons . . . there is no longer a sharp distinction between the per-
son and culture. Psychological experience, and the resulting “structure” of psyche and its
potentialities are organized by networks of meaning. (Much 1997: 67)

1 For example, Roberto Esposito in his Bios (2008) understands bio-power as “a life subjected to
the command of politics” and bio-politics as “a politics in the name of life.” For him, then, this is
a distinction between the negative and the positive use of “life politics.”
304 Ott Puumeister

The important thing is to add to the symbol systems the “institutions, practices
and contexts.” Without the latter, we would – in theorizing about and research-
ing politics and society – be left merely with the critique of ideology; but there
is much more to the construction of the subject in society than ideology.2 We
need to see the complex relations between the discursive and the extra-
discursive that condition one another. And an almost perfect extra-discursive
set of practices and techniques of power to investigate in this respect would be
surveillance.3
We can then say that surveillance practices work in concrete connection with
the human: they record, fragment, distribute, (re)organize and (re)assemble the
(abstracted) body, the psyche, and (a profile of) the human being. Surveillance
practices and techniques are forms of biopower and politics that work to produce
certain kinds of life, certain kinds of subjectivities. But, let us first try to concep-
tualize the more general categories of biopower and biopolitics before moving to
surveillance and its influence on life.

2 It is of course important not to think of society as a unitary, homogeneous whole, rather,

following Latour (2005: 108), we could say that “there is no society, no social realm, and social
ties, but there exist translations between mediators that may generate traceable associa-
tions.” There is no “society” that generates individual subjects, but “society” is constructed
through the interactions of individual subjects, social institutions, signs systems, technologies,
etc.
3 However, there might be some confusion about what exactly is this “extra-discursive,” if, like
most contemporary political theorists argue, the political space (even the world) is structured
according to discursive formations. Here I would like to call upon Manuel DeLanda’s view on the
matter: “while pairing a certain category of crime, like stealing, with a certain category of pun-
ishment, like cutting off a thief’s hand, is clearly a discursive practice, the actual act of mutila-
tion is equally clearly a non-discursive one” (DeLanda 2008: 162).
Similarly, we could say that surveillance in itself is non-discursive: the acts of watching,
recording data, etc. The practices of surveillance acquire meaning (become discursive) when
they are inserted within a discourse; that is, for example, when gathered data is connected with
individuals’ conduct and this (already abstracted) conduct becomes one of the signifiers of an
illness or a disorder. Again, treatment with medication is non-discursive, but it is discur-
sively formed knowledge that leads to this treatment. It is the discursive practices of surveillance
that work on the discursive object known as “a human being.” But, of course, non-discursive
materialities are formed and reformed by discursive practices; non-discursive elements are
deeply interconnected with discourse – the two actually could not exist without one another,
which is also why it is so difficult to think there being something “outside” discourse (like an
actual human being standing behind all the deconstructive work of his/her body).
 Biopolitics, surveillance, and the subject of ADHD 305

3 The totalizing function of biopolitics

There is a certain paradox present when dealing with (bio-)politics, the notions of
government and the state. This is the tension between multiplicity and unifica-
tion. In order to govern human beings, they need to be classified, encoded in a
system that enables the government to work on their lives. In short, humans need
to be understood as a species with certain kinds of basic and unchangeable prop-
erties that form the nucleus of what has to be maintained and further developed.
“One has to be classifiable to exist in species terms” (Dillon and Lobo-Guerrero
2009: 5). There exists a very powerful tradition of thinkers (Giorgio Agamben,
Alain Badiou, Jacques Rancière) who – in terms of this encoding – understand
politics and the constitution of a political order as a totalizing practice that sets
up an encyclopedia of knowledges in which the human being has to be thought
of. The political order is a strictly structured (total, in the sense of whole) system.
But at the same time, these very same thinkers all see a kind of remainder (of
life, subjectivity, signification) at the very heart of that system. This remainder
constitutes the impossibility of final totalization, of closing the system. And, of
course, the possibilities of resistance are being sought from this remainder.
The stasis of the state is being counter-positioned by the dynamics of life and its
potentialities. What first come to mind are Giorgio Agamben’s (2005) figure of
“whatever singularity,” Derrida’s différance, and Esposito’s (2008) conceptual-
ization of the “flesh” [chair] as opposed to the totalizing function of the (political)
body. In the words of Dillon and Lobo-Guerrero:

[T]hese authors clarify how the political imaginary of species being demarcates and dif-
ferentiates itself specifically by excluding from its very imagining, the invaluable, the in-
calculable, the un-encodable, the irredeemably opaque, the defiant, and the simply non-
circulating. Theirs is in many ways a preoccupation with the not knowable that contours
every form of knowing. (Dillon and Lobo-Guerrero 2009: 5)

Perhaps the most well-known analysis of this kind of exclusion of the unknow-
able is Agamben’s Homo Sacer (1998 [1995]), of which the central figure is “bare
life.” This is the figure that is both excluded and included in the political order.
Agamben argues that the separation of zoe (bare life) and bios (political life) is
constituted by an “inclusive exclusion” of bare life in politics. Life is postulated as
situating outside of politics (as natural) only to found political practices for pro-
tecting this very same life. For example, let’s take human rights, which are – in
modern democracies – considered to be the original properties of any human
being: every individual is equal in his/her being. But human rights are attributed
to an individual only when s/he is a citizen of some state. “Rights are attributed
306 Ott Puumeister

to man (or originate from him) solely to the extent that man is the immediately
vanishing ground (who must never come to light as such) of the citizen” (Agamben
1998: 76). Politics is envisioned as the protection of life that is the outside of
politics; and so, politics appears to maintain and produce a natural order of
things.
This kind of separation performed only in order to bring together, conflate
politics and nature could be termed a kind “structural secret” of biopolitics. It is
not only the case that the categories that are created as the natural properties of
man are artificial (at least not natural), but, on a deeper level: the very separation
of zoe and bios is in essence a fiction. The “mystification of politics” as Monticelli
(2012) calls it, postulates that it is a necessity that there exist these abstract “nat-
ural” categories over which to govern and that need protecting. What actually is
excluded by this underlying structure of biopolitics is the potential that life could
govern, develop, and act out its own potentialities.4 What is excluded is the pos-
sibility that the remainder of biopolitics (bare life) would ever develop its own
politics – within the biopolitical structure.
What this also means, is that

[t]he true problem is not so much the fragile status of the excluded, but rather the fact that,
at the most elementary level, we are all “excluded” in the sense that our most elementary,
“zero” position is that of being an object of biopolitics, so much so that political and citizen-
ship rights are granted us only as a secondary gesture, in accordance with strategic biopo-
litical considerations . . . (Žižek 2011: 124–125)

At the “zero” position humans’ lives are all potentially excluded, every life that
is included in the political order can potentially be sacrificed, or to put it more
mildly, discriminated. It does not matter which rights the individuals have; once
they are within the biopolitical structure, these rights can be taken away from
them. For Agamben, then, the central issue becomes the decision on life and
death, the decision on the value of life, which is made possible by the biopolitical
totalization of the political order.
Bare life, in this case, can be described as something that exists within the
political order but is excluded from it in the sense that it is postulated as not being
an inherent element of this order. For example: of course we see that poverty and
“the poor” are inherent for liberal-democratic states, probably so much that lib-

4 I like a quote by Žižek (2008: 384) that illustrates the situation rather precisely: “Today, for
example, the true antagonism is not between liberal multiculturalism and fundamentalism, but
between the very field of their opposition and the excluded Third (radical emancipatory poli-
tics).” The focal point is not exactly life, but the structure is represented very accurately.
 Biopolitics, surveillance, and the subject of ADHD 307

eralism could not work without them, but in the imaginary of liberalism, poverty
is the factor to be rooted out, excluded from the political totality. In short, the
poor are described as a foreign element within the normalized system and there-
fore can be acted upon in many different ways.
The (re)production of poverty is obvious for anyone considering the case of
the population of the ghettos in many countries. They are increasingly being
either incarcerated or left on their own, thus erasing them from the accepted
political sphere. Which also means that the welfare institutions and health care
centers and so on are increasingly autonomous organizations for profit (following
the logic of liberalism) – they reproduce themselves instead of “incorporating”
social subjects:

[I]t [the carceral apparatus of the United States] has regained a central place in the system
of the instruments for the government of poverty, at the crossroads of the deskilled labor
market, the collapsing urban ghetto, and social-welfare services “reformed” with a view to
buttressing the discipline of desocialized wage work. (Wacquant 2009: 79)

What I wanted to point out is that the carceral apparatus is not so much the sys-
tem of “justice,” punishment and reformation, but one of exclusion of un-political
life forms, one that helps to “wage war” “on the poor,” rather than “poverty” (see
more Wacquant 2009). This means that the object of state politics is not the social
structure, but the life of its “citizens” (in inverted commas because, basically,
they are deprived of rights, made into bare life). The individual here becomes a
political being only in as much as and how he or she interacts with the norm of
the political body.
From the above example we can see that the possibility of the decision on life
depends on the production of specific life-forms, in this case, the poor. And the
main question becomes how these life-forms are produced. Agamben however
seems here to reduce the whole (bio)political field to the decision that is inherent
in any politics; by searching for the structure of biopolitics, he 1) makes every
political act into a biopolitical one, and thus 2) reduces the immense variety of
power relations and techniques to this one structure. “Political space . . . is re-
duced to a specific mode of the exercise of power: the decision on the value of
life” (Genel 2006: 57).

4 Normalization of life
We have therefore come to understand that we need to move beyond the totaliz-
ing function of biopolitics and its structure of decision in order to 1) differentiate
308 Ott Puumeister

biopolitics from any other politics, and to 2) analyze the specific ways that life is
produced and governed – transformed into the central object of politics.
We therefore need to include the more general concept of “biopower,” of
which “biopolitics” is one variant, one mode of governing. The notions that
become central to the following discourse are “norm” and “normalization.”
Biopower, starting with the individual body, is connected to the biopolitical total-
ization of populations exactly by the norm. Normalization creates the abstract
body that connects the individual to the population. It is worth stressing that
norms do not come to be solely by the decision of the state or the sovereign;
rather, the sovereign needs to govern in terms of those norms established by
much broader practices, techniques and signifying systems situated outside the
reach of sovereign power. These mechanisms of power have been charted by
Michel Foucault, who describes three basic and very broad mechanisms: 1) the
sovereign right, the law; 2) the disciplinary mechanism; and 3) the mechanism of
security. It is useful here to reproduce a lengthy passage in order to describe the
interrelations within this complex:

A good discipline tells you what you must do at every moment . . . In the system of the law,
what is undetermined is what is permitted; in the system of disciplinary regulation, what is
determined is what one must do, and consequently everything else, being undetermined, is
prohibited . . . The mechanism of security works on the basis of this reality, by trying to use
it as a support and make it function, make its components function in relation to each other.
In other words, the law prohibits and discipline prescribes, and the essential function of
security, without prohibiting or prescribing, but possibly making use of some instruments
of prescription and prohibition, is to respond to a reality in such a way that this response
cancels out the reality to which it responds – nullifies it, or limits, checks, or regulates it.
(Foucault 2009: 46–47)

In contrast to Agamben, Foucault places the basic stress on the security mecha-
nism, when talking about biopolitics and biopower. While the law prohibits,
the security mechanism regulates the reality, makes it work as it should work. In
reality, then, there is a randomness that cannot be tolerated, and reality has to be
brought to accordance with its nature. This is the basic goal of normalization:
measuring, establishing, and controlling the specific and stabilized constants
that are natural to the social order. Any deviation from these norms is seen as
pathological, as falling outside of the order – in which case this deviation can be
banned from the social sphere (this is Agamben’s exclusion). Discipline works
with the individual body, it produces the body, divides it into parts and reassem-
bles to make it work better; discipline constructs “docile bodies” to work in com-
pliance with the law and be in accordance to the norm (biopower). Normative
security measures the average of collectivities and defines the relation of the
 Biopolitics, surveillance, and the subject of ADHD 309

norm and deviance; discipline works with the body to match it to the norm, pro-
duces a normalized body; sovereignty has the right to exclude all who do not pass
the measurement.
As much as biopolitics deals with collectivities, it works as a security mecha-
nism in the sense that it tries to regulate the workings of populations, make the
populations effective by producing normal procedures and protecting “the nor-
mal” from “the pathological,” and therefore bring the risk factors to a minimum.
But it is important to note that “[b]iopolitical security practices do not articu-
late a design in nature. They are contingent achievements reflecting the partial
realization of designs which seek to enact ‘natures’ ” (Dillon and Lobo-Guerrero
2008: 267). Biopolitics organizes “natures” in conjunction with some measur-
able phenomena; mechanisms of security work within the complex of power/
knowledge that produces specific forms of life (by establishing profiles, patterns
and probabilities). While the articulations of security practices are contingent
and historically specific, they are brought to bear on life as inherent properties of
populations.
For example, every time we go to the doctor’s we leave behind traces of symp-
toms and diseases that are added to the population databank to better govern its
health status. These personal and highly individual traces are put into relation
with every other trace left by others. The abstracted information is used to mea-
sure the stable situation of health, which is then seen as necessary for one spe-
cific individual.
Actually, the same goes for discipline, although the referent is of a different
level – the individual body: “It is not the normal and the abnormal that is funda-
mental and primary in disciplinary normalization, it is the norm” (Foucault 2009:
57). When we are dealing with discipline and security mechanisms, we are most
importantly dealing with the norm; and the question becomes: how is this norm
produced, using what techniques, what kind of a “normal life” is being produced,
and how this norm is being maintained using the techniques of biopower?
In the context of biopower, the normal and the abnormal are not strictly sep-
arated, it is the measurement of the norm, the stability of forms of life that pro-
duces the abnormal. The norm is here only established with reference to statisti-
cal numbers, which do not take account of individual differences and normativity.
Any deviation from this statistical norm is viewed as an abnormality and opposed
to the normal. And it is this procedure of separation that is established by mech-
anisms of security and discipline as natural, scientific: “Disciplines . . . will nec-
essarily refer to a theoretical horizon that is . . . the field of the human sciences”
(Foucault 2004: 38). It is not the question, at the most basic level of what kind of
life forms are natural and optimal, but that there exists a necessity of the abnor-
mal in order to establish a norm and vice versa (we can say that this is the kind of
310 Ott Puumeister

structural “secret” that Agamben wishes to reveal: we cannot think outside this
structure, although it is artificial).

5 The creation of norms through surveillance

systems
As mentioned earlier, one set of techniques to implement biopower is surveil-
lance, which does not simply mean watching people’s behavior for the purpose of
punishment. Rather, it signifies the constant gathering of information and assem-
bling databases for the purpose of profiling, prediction, marketing, housing, etc.
Security cameras are just one type of surveillance technology. For example, each
day we leave behind traces of our credit card using practices; we log in to websites
and click on icons – these actions are used to profile our shopping habits, to con-
struct suitable commercials for us. Surveillance is a means to produce informa-
tion and knowledge.
In addition to the classical, panoptical surveillance described by Jeremy Ben-
tham (1995) and taken over by Foucault to analyze the disciplinary mechanisms
of modern societies, we have all kinds of cataloguing, identification, and profil-
ing mechanisms that we are not even conscious of. What is of course striking in
today’s Western societies is the proliferation of informational access and the huge
amounts of collected information that cannot possibly be worked through (be it
the years of CCTV footage or health records). But, all the information stored even
need not be worked through; it may simply be categorized and labelled in order to
exclude irrelevant information.
Let’s make a short generalization here. Since, in the following, I am inter-
ested in the (potential) effect of surveillance practices on the formation of “life”
and the individual, I’d like to bring out three very broad ways of relating surveil-
lance and its subject:
1. Surveillance that is perceived by the individual, s/he is conscious of it; for
example in some closed environment with a CCTV system where the cameras
are visible. This is the basis of disciplinary surveillance, where the important
thing is the “visibility of visibility” (Yar 2003: 261) – the awareness of the
subject of her/him being watched, that results in the disciplining of self;
2. The case where surveillance is already widespread, it has reached out the
closed environments of institutions to the public space. In this case there is
no need any more for the visibility of surveillance technology or the surveil-
lant personnel. This is the relation of the unconscious influence and affect-
ing: the subject may act in accordance with rules because he may be under
 Biopolitics, surveillance, and the subject of ADHD 311

surveillance – we may call this the economy of disciplinary power relations:

when surveillance starts to work without anybody even watching;
3. Finally, the individual does come into direct contact with surveillance tech-
nologies and practices, but the data collected is separated from her/him and
therefore the relation is cut. This is the case of forming “surveillant assem-
blages” in which “data doubles” of the individual are produced by profiling
and encoding. The individuals are being formed into a political, social, and
cultural subjects without their presence (see also Puumeister 2011).

Taken together, these relations an individual has to techniques of surveillance

contribute to a new relation to self. The subject is constituted through contact
with surveillance systems and the information that they produce. Concerning
the third relation, the individual may not be aware of any “construction” s/he is
undergoing. What is important is the creation of “data doubles,” these abstract
normalized bodies that are used to categorize and encode human lives.
These “data doubles” are constructed by connecting various surveillance
systems that use different and diverse means of collecting, classifying, and cod-
ing the personal data extracted from individuals. Richard Ericson and Kevin Hag-
gerty call this combination of systems “surveillant assemblage,” which

. . . operates by abstracting human bodies from their territorial settings and separating
them into a series of discrete flows. These flows are then reassembled into distinct “data
doubles” which can be scrutinized and targeted for intervention. In the process, we are
witnessing a rhizomatic leveling of the hierarchy of surveillance, such that groups which
were previously exempt from routine surveillance are now increasingly being monitored.
(Ericson and Haggerty 2000: 606)

For example, the individual’s consuming habits (that are acquired either through
surveys, clicks on the internet, etc.), her/his travelling routes (GPS) can be con-
nected to her/his medical history. From these diverse systems a complex data
double is created that acts as a basis for prediction on the individual’s future
health risks. In this way, her/his potentialities for future action and conduct can
be delimited. The individual is placed at risk and her/his relation to self altered
on the basis of abstracted and reassembled data.
According to Robert Castel (1991: 283) this kind of profiling of the future
necessarily entails unpredictability: “all insane persons, even those who appear
calm, carry a threat, but one whose realization still remains a matter of chance.”
The introduction of unpredictability creates a kind of permanent situation of risk
that has to be regulated through the conduct of an individual: s/he has to act in a
certain way and, more importantly, has to be a certain kind of subject. Nikolas
Rose speaks here of “ethopolitics,” which means that the individual, in order to
312 Ott Puumeister

become a whole and healthy subject, has to choose the “right” kind of techniques
of self-formation:

Thus these new practices for the identification of susceptibilities open a space of uncertain-
ty. This is the expanding realm of the asymptomatically or presymptomatically ill – those
individuals carrying the markers or polymorphisms of susceptibility who are neither phe-
nomenologically or experientially “sick” or “abnormal.” While the calculation of risk often
seems to promise a technical way of resolving ethical questions, these new kinds of suscep-
tibility offer no clear-cut algorithm for the decisions of doctors or their actual or potential
patients. In this space, biopolitics becomes ethopolitics. (Rose 2001: 12)

Ethopolitics, as I understand it, following Rose, could mean a “personalized bio-

power”: an individual internalizes the abstract norms and standards and bases
her/his decisions on how to act, how to be healthy, how to enhance her/his body,
etc. And through these decisions and practices relating the individual to him/
herself is a way of constructing an identity, a social, political, cultural subject.
The constant risk, the danger of probable abnormality renders the norm into the
object of individuals’ desire instead of being only externally imposed (Bruno and
Vaz 2003: 278).
Let us next turn to a specific disorder, namely, ADHD, and see how the social,
medical, scientific, and cultural construction of this complex of symptoms into a
comprehensive diagnostic whole relates to the larger context of creating a kind of
“neurochemical” understanding of life. My hypothesis is that this process is not
in the first place an exclusion from the social and political order but a formation
of another kind of relationship of an individual to her/himself. ADHD is particu-
larly interesting from the perspective of risk and prevention, as it is mainly used
to manage the lives of children and adolescents.

6 Normality through medication: ADHD

Attention Deficit/Hyperactivity Disorder (ADHD) is considered to be one of the
most prevalent mental disorders among US children. It is estimated that about
5.4 million children aged 7–14 have been diagnosed with ADHD and that about
2.7 million (66% of those diagnosed) children receive drug treatment.5 These are
of course only indicative numbers, as “nationally representative data on the prev-
alence and correlates of mental disorders among children are still not available”

5 Data are from 2007; taken from the CDC web page: http://www.cdc.gov/ncbddd/adhd/data.
html (accessed 1 July 2014).
 Biopolitics, surveillance, and the subject of ADHD 313

due to the inability to include children under age 12 in the sample (Merikangas
et al. 2009).
There are, however, other – and probably more important – issues about di-
agnosing and estimating the prevalence of ADHD: the diagnosis consists of symp-
toms like inattention, failure to follow instructions, disorganization of activities,
forgetfulness, fidgeting with hands, blurting out answers before questions are
finished, etc.6 These behaviors are not uncommon and are considered to be part
of a quite normal child when taken separately. This raises more questions about
diagnoses that are performed based on just a few symptoms: can ADHD really be
called an illness, furthermore, an illness that requires pharmaceutical interven-
tion? Whatever the answer, social workers, doctors, drug developers have estab-
lished ADHD as a disorder in need of medication, although no clear biological or
neurological basis has been found (see for example Cohen and Leo 2003). In fact,
medication with stimulants can be viewed as proof of the existence of the dis-
order: while in the case of a “normal” human being stimulants cause hyperactiv-
ity, the human with ADHD is calmed by them (Napolitano et al. 2010).
ADHD can actually be said to be defined with the help of drugs: in 1937
Charles Bradley discovered the positive effects of stimulants (in his case, Benze-
drine) on the behavior and learning abilities of hyperactive children (Brock 2010:
21–23). In 1944, Ritalin (methylphenidate) was synthesized and in 1955 it was
licensed by the Food and Drug Administration to treat various psychological dis-
orders. And this was also the time when the symptoms of ADHD were first de-
scribed as “minimal brain dysfunction” (Anastopoulos et al. 1994). The develop-
ment and marketing of amphetamine-based drugs and the definition of ADHD as
a brain disorder go hand in hand.
The medication of children with an ADHD diagnosis shows an important ten-
dency from the viewpoint of biopower: deviant behavior is understood as having
a cause internal to a person’s body, more specifically, her/his brain. Edward Com-
stock (2011) traces the interesting path of the development of treatment for ADHD.
At first, in the first half of the twentieth century, drugs, “alongside other thera-
peutic techniques were meant to eradicate (deviancy in general). The focus was
on behaviors, conformity, and institutional roles” (Comstock 2011: 52). It was not
a disease that was being targeted but behaviors that needed eliminating. Children
with behavioral disorders were “other children,” the unknown – because not
thoroughly described within medical discourse (Rafalovich 2001: 106). In order to
describe these children as knowable objects of scientific study and medical inter-
vention, researchers turned (starting from 1960s) to the brain, “which ‘functions’

6 http://www.cdc.gov/ncbddd/adhd/diagnosis.html
314 Ott Puumeister

in knowable ways according to a transcendental human program” (Comstock

2011: 58). The behavioral disorders became strictly connected to the individual
and her/his body. They are no longer strictly connected to social and moral devi-
ancy. The stimulants – with their paradoxical effect – can now detect abnormality
within the body.

But perhaps most importantly, because psychotropic drugs replace institutional moral and
juridical norms as the test for this behavior disorder, the new disorder could be found in
anybody and in any behaviors based no longer on these norms but on the reaction to the
drug in relation to a synthetic ideal of behavior. (Comstock 2011: 61)

The basis for confirmation of the diagnosis and the reality of the illness is no
longer social deviancy but the processes within the individual – the processes
altered by the stimulants (see for example Napolitano et al. 2010 and Volkov et al.
2007 for neurological research on dopamine production effects in ADHD).7 The
practices of medical surveillance play an important role in this confirmation and
formation of the illness. The practice of population health statistics makes it nec-
essary that any normal and abnormal condition be encoded; every condition has
to be classifiable in order to form a coherent image of the population’s bios, a
figure of the healthy “social body.” The prescription of drugs requires that one is
diagnosed with a specific disorder, and every diagnosis is registered and entered
into the population data bank. While the drugs themselves in the case of ADHD
are one of the bases of the disorder’s reality, we see here a complex structure
which forms this disorder. The interplay between biopower (intervention into the
conduct of individuals), surveillance (the collection of data), drug developers,
psychiatry and broader cultural knowledge forms this reality that is ADHD.
This is not to say that the knowledge produced by medical practices and drug
developers are immediately “subjectifying”8 individuals in societies. Rather, by
creating a discourse with the help of surveillance techniques, human sciences,
existing social institutions, the formation of complex wholes such as ADHD pro-
duce a kind of “life” that is separated from actual individuals. This “normalized

7 It should be emphasized however that none of these researches can pin down the exact neuro-
logical cause(s) of ADHD, which makes the treatment through drugging more problematic. ADHD
is composed of very heterogeneous symptoms and using stimulants to alter brain activity should
be viewed as an over-simplification.
8 Derek Hook (2010: 31) makes a distinction between 1) “subjectification”: “the promotion and
elaboration of a thoroughly individualizing set of knowledges about the singular subject who is
effectively normalized and psychologized as a result”; and 2) “subjectivization”: “the feeding
back of such knowledges to a subject who comes to apply such notions, to understand and expe-
rience themselves in the terms of subjectification.”
 Biopolitics, surveillance, and the subject of ADHD 315

life” is attributed to the healthy social body, an abstract entity that represents the
state of affairs for which the management of individuals is supposed to govern the
population. The production of such “life” is important to notice, because, as Ivan
Illich (1994) noted, “ ‘A life’ is amenable to management, to improvement and to
evaluation in a way which is unthinkable when we speak of ‘a person.’ ” “Life”
can be mapped down “scientifically,” its processes predicted, the latter can be
intervened and prevented.
What is important, then, is not the fact of surveillance, the collection of data
itself, but the social meaning making practices that are built upon this data. A
concrete individual might not even have any connection with the data that is used
to create a norm and define the deviance from it, considering that medical popu-
lation statistics are usually compiled by surveys and previous diagnoses – that
cover a rather small part of the population. Through statistics and the marketing
of medications, an illness like ADHD is constructed as a social fact and as a prob-
lem for the population as whole; that is, a concern for each individual. Therefore,
in addition to concrete medical and medication practices, the construction of
ADHD – or any other similar mental disorder – faces concrete individuals with
a new kind life, which has to be internalized as part of the cultural signifying
system. Adding to the “scientific” basis of this “life” is its basis in biological-
neurological treatment with medications, thus creating an understanding of the
individual as a “neurochemical self” (Rose 2003).9
The development of drugs and the refinement of psychiatric and psychologi-
cal language that helped to integrate different behaviors into a heterogeneous
whole, have then profound effects on the individual’s formation of her/his iden-
tity; it alters the relation the individual has with her/himself. And this shifting of
relation is highly problematic because the biological cause of the disorder is not
definite – the diagnoses do not so much discover as construct it. The creation of
the normalized social body and the encoding of even the minor disorders in terms
of neurological activity put the individuals in a constant risk of deviancy and in
a position of self-surveillance with regard to their conduct and action, their self-
production. “An ethics is engineered into the molecular make up of those drugs,

9 The dream of immortality in this world and the exile of death to the sterilized walls of hospitals
– the erasure of death from everyday life – may in part be explained by the vision of “life” as
wholly manageable, controllable:
[A]long with the increasing corporeality of the concept of self-preservation, there may also
have been a corresponding transformation of the concept of immortality itself, a shift which
is just beginning to become noticeable. While the claims of medicine are still couched in the
usual terms of self-preservation . . . out on the edge there has appeared a worldly, corporeal
vision of immortality, complete with a liquid-nitrogen limbo. (Tierney 1999: 252)
316 Ott Puumeister

and the drugs themselves embody and incite particular forms of life in which the
‘real me’ is both ‘natural’ and to be produced” (Rose 2003: 59).
One of the major effects of the types of medications as the stimulants used for
ADHD on the semiotic level of self-formation is definitely the conflation of “natu-
ral” and “cultural”; the view of one’s body as producible through one’s conduct.
The body is viewed as being in constant risk when the individual is “behaving
badly.” But this “bad” is no longer so much in relation to societal norms as in
reference to one’s own body, which is decaying and getting out of shape if the
individual does not treat it right. For example, a whole field of literature on self-
help has emerged that teaches the individual to live a good and healthy life. The
individual has to work on her/himself to become “natural,” that is, healthy.
But this working with the self means increasingly that one needs to be a good
patient. Good conduct in this context does not simply mean that one needs to
behave according to social and moral rules. Rather, it means doing and taking
what the doctor(s) have prescribed to the patient – it means to let oneself be gov-
erned. That is, one needs to follow medical, not simply behavioral rules; one has
to let the prescribed substances work on his/her biology in order to become an
acceptable citizen. Here we come to the question of treatment adherence, that is,
“the extent to which a person’s behavior – taking medication, following a diet,
and/or executing lifestyle changes, corresponds with agreed recommendations
from a health care provider” (World Health Organization 2003: 3). In the case
of ADHD adherence usually refers simply to taking the prescribed stimulants
(Chacko et al. 2010: 2417), that is, altering one’s brain activity and through this,
altering one’s behavior. Chacko et al. (2010: 2420) propose, in order to improve
adherence, various interventions are necessary; for example, parent-training,
students’ education, “tailoring medication to the profile of the youth and family”
– that “target environmental constraints to adherence . . . address habitual and
automatic processes that may influence adherence behavior, and improve patient
self-efficacy in taking medication.”
What the above texts show is that patients’ behavior is being considered
mainly in relation to the taking of medications and following the regulations pre-
scribed by the doctors. Failure to adhere to treatment could be read as a sign of
ADHD-related behavior: it is a failure of willingness to alter one’s biological func-
tions in accordance with social norms. The view that the maximization of adher-
ence to medication is the best way to treat ADHD confirms the hypothesis that
ADHD is seen as a bodily/biological disorder, which causes socially aberrant be-
havior. As a neurochemical disorder, it enables the institutions (e.g., schools,
clinics, but also the family) to code individuals as biological organisms who need
governing; and this government is implemented as much through medical and
governance practices (drugs, surveillance of adherence) as through discursive
 Biopolitics, surveillance, and the subject of ADHD 317

normalization. The individual is subjectified as a “natural” and biological entity

that needs to act according to social norms in order to attain his/her “nature.”
We see then that in the case of ADHD the individual is a proper object of
biopower and that this biological normalization is as much linked to social norms
as before. Moreover, the fact that an individual’s behavior can be termed a dis-
order simply on the basis of the influence of medications renders the relations of
social and bodily norms even more complex. The infinite sets of rules that are
written and talked about on how to live draw out a very refined field on which to
act. Having a certain kind of a disorder can be – and usually is – related to the
moral code, the code of conduct. If the body is a site of conscious production, it is
immoral to “let yourself go,” be inattentive, disturb others, not take drugs, etc.
The creation of a common cultural knowledge and governmental, medical,
social practices applying that knowledge of the “life” that is manageable through
medication is vital in order for the individuals to subjectivize themselves accord-
ing to this figure of life. As it seems, this production of life has for the present
moment gained the status of truth in today’s societies, forming the individuals’
(in case of ADHD especially the children) self-image in relation to deviancy with-
in the body itself that can be “normalized” using medication. As said earlier, an
estimated 2.7 million children in the US are growing up being normalized by the
alteration of their brain activity.

7 Conclusion
I would not like to close on such a grim note, however it must be said that ADHD
is a work of fiction used to control children and, increasingly, adults; to margin-
alize them from the social sphere as if the individuals themselves had no self-
control. Self-creation always takes place in a cultural and social field of norms
and regulated conduct but that does not mean that individuals have no freedom
to creatively use those norms, to conduct themselves in other ways than pre-
scribed by social normativity. Self-creation works through semiosis and thus
always entails the specific subjective relation to societal norms. Here I can also
see that further studies using exactly semiotic methods and understanding to an-
alyze the self-creation, subjectification of individuals and groups would be abso-
lutely fruitful and necessary. For example, the semiotic concept of autocommuni-
cation would enable us to study the formation of the social, medical subject from
the viewpoint of the individuals themselves.
This is also why I tried to step outside of the biopolitical structure of inclu-
sive exclusion described by Agamben: to theorize individuals as capable of self-
normativity. The construction of ADHD as a large-scale problem has achieved
318 Ott Puumeister

the definition of very heterogeneous behaviors into one homogenizing totality

and transformed the self-relation of millions of individuals who probably would
not need to be treated by medication. But this does not mean that ADHD and the
medication of children is an inevitable part of society and culture. On the con-
trary, this seeming inevitability stems from the work of continuous promotion of
drugs, definition of deviant behaviors, and shifting the focus from social norms to
the bodily norms. It is said about mental disorders: the first step to recovery is
recognizing that you have a problem. Maybe we could ask the people searching
for disorders where maybe there are none to recognize that there is a problem in
the way that ADHD is sometimes clearly over-diagnosed and children too easily
over-medicated. Maybe one aspect of the problem is not inherent within the
bodies of citizens but the way that society describes them?

References
Agamben, Giorgio. 1998. Homo sacer: Sovereign power and bare life. Stanford: Stanford
University Press.
Agamben, Giorgio. 2005. The coming community. Minneapolis: University of Minnesota Press.
Althusser, Louis. 1971. Ideology and ideological state apparatuses. In Lenin and philosophy
and other essays, 127–186. New York: Monthly Review Press.
Anastopoulos, A. D., R. A. Barkley & T. L. Shelton. 1994. The history and diagnosis of attention-
deficit/hyperactivity disorder. Therapeutic Care and Education 3(2). 96–110.
Bentham, Jeremy. 1995. The panopticon writings. London: Verso.
Brock, Justin Douglas. 2010. The medicalization of hyperactivity and inattentiveness: A social
history and theoretical perspectives on ADHD. Huntington: Marshall University thesis.
Bruno, Fernanda & Paulo Vaz. 2003. Types of self-surveillance: From abnormality to individuals
“at risk.” Surveillance & Society 1(3). 272–291.
Castel, Robert. 1991. From dangerousness to risk. In G. Burchell, C. Gordon & P. Miller (eds.),
The Foucault effect: Studies in governmentality, 281–298. Chicago: University of Chicago
Press.
Chacko, Anil, Jeffrey H. Newcorn, Nicole Feirsen & Jodi Z. Uderman. 2010. Improving medication
adherence in chronic pediatric health conditions: A focus on ADHD in youth. Current
Pharmacological Design 16. 2416–2423.
Cohen, David & Jonathan Leo. 2003. Broken brains of flawed studies? A critical review of ADHD
neuroimaging research. Journal of Mind and Behavior 24(1). 29–56.
Comstock, Edward J. 2011. The end of drugging children: Toward the genealogy of the ADHD
subject. Journal of the History of the Behavioral Sciences 47(1). 44–69.
DeLanda, Manuel. 2008. Deleuze, materialism, and politics. In Ian Buchanan & Nicholas
Thoburn (eds.), Deleuze and politics, 160–177. Edinburgh: Edinburgh University Press.
Dillon, Michael & Luis Lobo-Guerrero. 2008. Biopolitics of security in the twenty-first century:
An introduction. Review of International Studies 34. 265–292.
Dillon, Michael & Luis Lobo-Guerrero. 2009. The biopolitical imaginary of species being.
Theory, Culture & Society 26(1). 1–23.
 Biopolitics, surveillance, and the subject of ADHD 319

Ericson, Richard V. & Kevin D. Haggerty. 2000. The surveillant assemblage. British Journal
of Sociology 51(4). 605–622.
Esposito, Roberto. 2008. Bios: Biopolitics and philosophy. Minneapolis: University of
Minnesota Press.
Foucault, Michel. 1981. The order of discourse. In Robert Young (ed.), Untying the text:
A post-structuralist reader, 48–78. Boston: Routledge & Kegan Paul.
Foucault, Michel. 2004. Society must be defended: Lectures at the Collège de France 1975–76.
London: Penguin.
Foucault, Michel. 2009. Security, territory, population: Lectures at the Collège de France
1977–78. New York: Picador.
Genel, Katia. 2006. The question of biopower: Foucault and Agamben. Rethinking Marxism
18(1). 43–62.
Hook, David. 2010. Foucault, psychology, and the analytics of power. Basingstoke: Palgrave
Macmillan.
Illich, Ivan. 1994. Brave new biocracy: Healthcare from womb to tomb. New Perspectives
Quarterly 11(1). 4–9.
Latour, Bruno. 2005. Reassembling the social: An introduction to actor-network-theory.
New York: Oxford University Press.
Mouffe, Chantal. 2003. The democratic paradox. London: Verso.
Merikangas, Kathleen R., Shelli Avenevoli, E. Jane Costello, Doreen Koretz & Ronald C. Kessler.
2009. The national comorbidity survey adolescent supplement. Journal of the American
Academy of Child and Adolescent Psychiatry 48(4). 367–369.
Monticelli, Daniele. 2008. Wholeness and its remainders: Theoretical procedures of totalization
and detotalization in semiotics, philosophy, and politics. Tartu: Tartu University Press.
Monticelli, Daniele. 2012. Poliitika ja/kui sõprus. Agambeni mis-tahes-singulaarsused ja nende
tulev kogukond [Politics and/as friendship. Agamben’s whatever singularities and their
coming community]. Vikerkaar (1–2). 149–165.
Much, Nancy C. 1997. A semiotic view of socialization, lifespan development, and cultural
psychology: With vignettes from the moral culture of traditional Hindu households.
Psychology Developing Societies 9(1). 65–106.
Napolitano, Francesco, Alessandra Bonito-Oliva, Mauricio Federici, Manolo Carta, Francesco
Errico, Salvatore Magara, Giuseppina Martella, Robert Nisticò, Diego Centonze, Antonio
Pisani, Howard H. Gu, Nicola B. Mercuri, Alessandro Usiello. 2010. Role of aberrant striatal
dopamine D1 receptor/cAMP/protein kinase A/DARPP32 signaling in the paradoxical
calming effect of amphetamine. Journal of Neuroscience 30(33). 11043–11056.
Puumeister, Ott. 2011. Subjekti konstrueerimine järelevalvesüsteemides [The construction
of the subject in surveillance systems]. Acta Semiotica Estica 8. 51–73.
Rafalovich, Adam. 2001. The conceptual history of attention deficit hyperactivity disorder:
Idiocy, imbecility, encephalitis, and the child deviant, 1877–1929. Deviant Behavior 22.
93–115.
Rose, Nikolas. 2001. The politics of life itself. Theory, Culture & Society 18(6). 1–30.
Rose, Nikolas. 2003. Neurochemical selves. Society 41(1). 46–59.
Tierney, Thomas F. 1999. The preservation and ownership of the body. In Honi Fern Haber & Gail
Weiss (eds), Perspectives on embodiment: The intersections of nature and culture,
233–261. New York: Routledge.
Volkov, Nora D., Gene-Jack Wang, Jeffrey Newcorn, Frank Telang, Mary V. Solanto, Joanna S.
Fowler, Jean Logan, Yeming Ma, Kurt Schulz, Kith Pradhan, Christopher Wong, James M.
 320 Ott Puumeister

Swanson. 2007. Depressed dopamine activity in caudate and preliminary evidence of

limbic involvement in adults with Attention-Deficit/Hyperactivity Disorder. Archives of
General Psychiatry 64(8). 932–940.
Wacquant, Loic. 2009. Prisons of poverty. Minneapolis: University of Minnesota Press.
World Health Organization. 2003. Adherence to long-term therapies: Evidence for action.
http://apps.who.int/medicinedocs/pdf/s4883e/s4883e.pdf (accessed 12 June 2014).
Yar, Majid. 2003. Panoptic power and the pathologization of vision: Critical reflections on the
Foucaultian thesis. Surveillance & Society 1(3). 254–271.
Žižek, Slavoj. 2008. In defence of lost causes. London: Verso.
Žižek, Slavoj. 2011. Living in the End Times. London: Verso.

Bionote
Ott Puumeister (b. 1985) is a graduate student at the University of Tartu <ott.
puumeister@gmail.com>. His research interests include biopolitics, political
semiotics, semiotics of culture, and non-identificational politics. His publications
include “Review: Michel Foucault’s care of the self in the context of power and
knowledge” (in Estonian, 2011); “The construction of the subject in surveillance
systems” (in Estonian, 2011); “The subject’s self-creation in power relations:
Agamben’s, Badiou’s and Foucault’s theories of subjectivity from the semiotic
point of view” (in Estonian, 2012); and “Biopolitics as a power over life and as
life’s own power” (in Estonian, 2012).

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