The everyday lives of
contemporary youths are awash with drugs to boost pleasure, moods, sexual
performance, vitality, appearance and health. This paper examines pervasive
practices of chemical ‘self-maximization’ from the perspectives of youths
themselves. The research for this paper was conducted among male, female and
transgender (male to female, so-called waria) sex workers in Makassar, Indonesia. It presents the
authors’ ethnographic findings on how these youths experiment with drugs to
achieve their desired mental and bodily states: with the painkiller Somadril to
feel happy, confident and less reluctant to engage in sex with clients, and
contraceptive pills and injectable hormones to feminize their male bodies and
to attract customers. Youths are extremely creative in adjusting dosages and
mixing substances, with knowledge of the (mostly positive) ‘lived effects’ of
drugs spreading through collective experimentation and word of mouth. The paper
outlines how these experimental practices differ from those that have become
the gold standard in biomedicine...
These ethnographic case studies have revealed the
pervasiveness of young sex workers’ desires to feel attractive, happy and
confident; how they experiment with different drugs and modes of administration
to achieve their desired effects; how experiential knowledge circulates through
youth networks; and in the case of Somadril, how youths pool their resources to
support their drug habits. Among the key findings is that the authors’
informants ‘try out’, or in their own words ‘coba’,
different drugs and techniques to assess the effects on their bodies and minds
in what may be called collective youth-led drug
experiments.
The experiments involve the ‘off label’ use of prescription
pharmaceuticals – that is, for purposes other than their official indication.
Such experimentation is not unique to the sex workers at Losari Beach and the waria at Karebosi. The
ethnographic fieldwork in Makassar revealed similar patterns of experimentation
among other groups of youths. Construction workers mixed energy drinks and
potency products; hard-core drug users injected a veritable cocktail into their
veins in search of new highs. Students were also found to use Somadril in all
kinds of different mixtures, but only on weekends and mainly to enhance sexual
pleasure (Hardon, Idrus, and Hymans 2013).
How does the accumulation of knowledge by youth through
trial and error differ from knowledge production in biomedicine? There are five
main differences: first, biomedical experiments have pre-defined endpoints.
Randomized controlled trials measure the effects of specific chemicals on
individual bodies, with the ‘double-blind’ method ensuring that both the
subjects of the experiment and those administering it do not know whether the
active ingredient or an inert substance is ingested. The group receiving the
inert substance is called the control group (Goldstein 2012). The authors’ informants feel no need
for a control group; they evaluate the efficacy of products through
self-observation, before and after use.
In the youth-led experiments, the subjects further determine
their own desired ‘endpoints’: the development of hard tissue and a base for
breasts in the case of contraceptive steroids, feeling confident in the case of
Somadril. These ‘endpoints’ emerge out of the sharing of experiential knowledge
on what specific drugs can do to alter their minds and bodies. The endpoints
are specific to their everyday needs and desires. The wariainformants want to
feminize their bodies; freelance sex workers need to be confident to approach
clients.
The youth-led experiments differ from biomedical
research in how they apprehend a drug's adverse effects. Biomedical researchers a priori define
adverse effects and then measure them in trials. Safety and efficacy data are
submitted to regulatory agencies, which then weigh the drug's benefits and
risks for market approval. It is well known in pharmacology that unexpected
side-effects can occur once the drug is used in routine medical practice. In
contrast, youths in this study appeared unconcerned about side-effects before
trying a drug for the first time. They simply tried it and observed what
happens.
A fourth difference between how youth experiment with drugs
and biomedical research pertains to how drugs are administered. Drugs in
laboratory experiments are tested in isolation, in fixed dosages to allow for
the standardized measurement of effects. Youths continuously ‘try out’
different dosages and forms of administration, mixing substances with drinks, foods
and other drugs in their quest for better, stronger or faster effects.
Finally, in the biomedical measurement of drug effects,
efficacy is situated in the drug's active pharmaceutical content – if substance
A is proven to be effective in population B, it is assumed to work identically
in population C as well. In assessing the positive and negative effects of
substances in their bodies, youths in this study time and again made use of the
relational notion of cocok. A drug is cocok if
there is a ‘fit’ between the drug and the person taking the drug. A comparable
personification of efficacy can be seen in the biomedical discipline of
pharmaco-genomics, which shows how drug effects vary depending on individual
genetic makeup. Such knowledge, however, still has no place in standard
clinical experiments on new drugs which are generally funded by pharmaceutical
companies; too much diversity would limit the market for specific drugs....
aAmsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
bUniversity of Hasanuddin, Anthropology, Makassar, Indonesia
aAmsterdam Institute for Social Science
Research, University of Amsterdam, Amsterdam, the Netherlands
bUniversity of Hasanuddin, Anthropology,
Makassar, Indonesia
