Culture, Medicine, and Psychiatry

, Volume 38, Issue 2, pp 182–196 | Cite as

Promise and Deceit: Pharmakos, Drug Replacement Therapy, and the Perils of Experience

  • Todd MeyersEmail author
Original Paper


The problem of lying as a feature of medication compliance has been well documented in anthropological and clinical literatures. Yet the role of the lie—its destabilizing effects on the continuity of drug treatment and therapy, as a technology of drug misuse, or as a way to understand the neuro-chemical processes of treatment (pharmacotherapy “tricking” or lying to the brain)—has been less considered, particularly in the context of opioid replacement therapy. The following paper is set against the backdrop of a three-year study of adolescents receiving a relatively new drug (buprenorphine) for the treatment of opiate dependency inside and outside of highly monitored treatment environments in the United States. Lies give order not only to the experience of addiction but also to the experience of therapy as well. In order to better understand this ordering of experience, the paper puts the widely discussed conceptual duality of the pharmakon (healing and poison) in conversation with a perilously overlooked subject in the critical study of pharmacotherapy, namely the pharmakos or the personification of sacrifice. The paper demonstrates how the patient-subject comes to represent therapeutic promise by allowing for the possibility of (and often performing) deceit.


Addiction Adolescents Lies Pharmaceuticals United States 



I would like to thank Michael Oldani for his persistence in organizing this special issue of Culture, Medicine & Psychiatry; otherwise, I would have likely neglected the topic of lies for many more years. I appreciate the generous insights of Hermann Herlinghaus, particularly with helping me wrangle the tricky dimensions of pharmakos and its vast genealogy. I would also like to thank Annette Leibing, Johanne Collin, and the members of the MÉOS Research Group (Médicament comme Objet Social) at the Université de Montréal for their feedback on an earlier iteration of the paper. The paper benefited greatly from suggestions made by two anonymous readers. The majority of this research was conducted under a training fellowship from the National Institutes of Health/National Institute on Drug Abuse [F31-0202039—Sponsor: Dr. Jonathan M. Ellen, Johns Hopkins University, School of Medicine, Department of Pediatrics]. The Johns Hopkins University, Homewood Institutional Review Board approved the research [HIRB No. 2006021 “Therapeutic Contexts for Substance Abusing Adolescents”]. The names of the informants are pseudonyms.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of AnthropologyWayne State UniversityDetroitUSA

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