Lifestyle Drugs and Late Capitalism: A Topography of Harm

Lifestyle Drugs and Late Capitalism: A Topography of Harm Alexandra Hall, Northumbria University, UK Introduction Capitalism is entering a hitherto unknown period of volatility. The recent financial crash highlighted once again that infinite growth is unsustainable in a world of finite resources and socioeconomic instability (Streeck, 2016). As the system reaches its limit it relies more heavily on the development of social needs that require emotional investment to generate value, which in turn depreciates at an increasingly rapid rate (Berardi, 2009; Dean, 2009; Stiegler, 2010). Capitalist productivity – once dependent on labour – now seeps into all aspects of our lives in complex and often detrimental ways. This latest phase of capitalist development, supported by an attendant consumer culture and an evolving technological infrastructure, is affecting the constitution of subjectivity. The individual is now o pelled to e o e a ti e i the e o st u tio of the self a d the p oje tio of the self s i age to others as it faces growing pressure to improve its performance and image to make it more competitive and successful. This has led to significant cultural change and an increase in consumer demand for the products that aid this self-reconstruction, which has in turn triggered the emergence and development of active systems of finance, investment and production in new licit and illicit markets that cater for this demand. The new economy of the self is comprised of a number of products and services, from digitised fitness trackers to workplace wellness schemes (Cederstrom & Spicer, 2015; Kelly, 2016). It includes a booming market in various lifestyle drugs, otherwise referred to as image and performance enhancing drugs (IPEDs) or human enhancement drugs (Van de Ven & Mulrooney, 2017). Lifestyle drugs are consumed through personal choice rather than illness, and often used for non-health matters or matters lying at the margins of health and wellbeing (Hall & Antonopoulos, 2016; Koenraadt & Van de Ven, 2017). Pharmaceutical products are now available to boost sexual performance, speed up weight loss and muscle growth, slow down ageing, and increase physical and mental capacity. Often packaged as promoting wellness, health, fitness and beauty, these products promise the enhancement of the face, body and mind leading to a new and improved self, capable of advancing its interests in all aspects of public and private life. Yet these drugs are also fully embedded in processes of capital accumulation and intensified social control, resulting in complex patterns of benefit and harm (Crary, 2014; Cederstrom & Spicer, 2015). For example, on one hand, the market in lifestyle drugs produces a range of economic benefits for those keen to capitalise on growth industries, from budding entrepreneurs, venture capitalists and private equity investors to the corporate bigwigs of the global pharmaceutical industry (Kelly, 2016). On the other, the global market produces multiple harms, ranging from those evident in unscrupulous working conditions in hubs of pharmaceutical production and distribution to the considerable health risks posed to consumers by the range of illicit lifestyle drugs now flooding the market (Hall & Antonopoulos, 2016). In this chapter I draw on a range of theoretical and conceptual tools to offer a preliminary zemiological analysis of the market in lifestyle drugs. After describing the market in the context of my research, I outline the theoretical framework that underpins my analysis: one that draws on a range of critical criminological perspectives. The next section integrates the theoretical perspectives to analyse the broad spectrum of harm posed to individuals and their environments by the global lifestyle drug industry. This discussion is organised around the functional concepts offered by a deviant leisure perspective, outlined as subjective, environmental, socially corrosive and embedded harms (Smith and Raymen, 2016). My overall aim is to embed the analysis of lifestyle drugs and harm in up-to-date work on late-capitalist ideology, linking both consumer demand and subjectivity to supply-side dynamics and capitalist processes of production and accumulation. Researching the (illicit) trade in pharmaceutical enhancement The global market in illicit pharmaceuticals includes a huge range of counterfeit, falsified, unlicensed and substandard medicinal products. The total global market is worth billions of dollars, which is growing exponentially year on year, with variations in demand determined by nation, culture and type of healthcare system (Hall & Antonopoulos, 2016). In the global South, illicit lifesaving products such as antiretroviral drugs and anti-cancer medication make up the largest market share. In the global North, the market in illicit lifestyle drugs is much larger (Hall et al, 2017). It is difficult to estimate with precise accuracy, but recent figures suggest that steroids, erectile dysfunction, weight loss and hair loss medicines are the most popular illicit pharmaceutical products currently bought and sold in the UK and other parts of Western Europe (Di Nicola et al, 2015; Hall & Antonopoulos, 2016; Hall et al, 2017; Koenraadt & Van de Ven, 2017). Indeed, the supply of and demand for various lifestyle drugs and non-surgical procedures has become hyper-normalised in many western contexts, where the ou da ies et ee t eat e t a d e ha e e t i healthcare continue to blur (Cook & Dwyer, 2016; Berkowitz, 2017). Counterfeiters and illicit traders have taken advantage of the increasing demand to the extent that the consumption of illicit and grey market lifestyle drugs is now seen as a significant public health issue in Europe (Hall et al, 2017; Koenraadt & Van de Ven, 2017). I have been researching the market in illicit medicines since 2013 using ethnography in online and offline contexts to collect rich empirical data on the supply and demand dimensions of the trade. 2016 witnessed the publication of Fake Meds Online (Hall and Antonopoulous, 2016), which exposed a booming market in illicit medicines in the UK. Our work analysed the complex dynamics of the trade, highlighting the crucial roles played by such contributing factors as the hyper-individualisation and commodification of healthcare, the widespread medicalisation of non-medical issues, the appeal of performance and image enhancement, and the development of online pharmaceutical prosumption (see Hall and Antonopoulos, 2016). Throughout the research we found that the cultural drivers for the t ade s ate ial a d fi a ial flo s a e entrenched in the structures of the global political economy and global supply chains, in many respects calling into question our ability to draw a clear distinction between the illegitimate and legitimate industries. As this work progressed it became obvious that it was essential to examine the cultural contexts of lifestyle drugs users in more depth and detail. Since Fake Meds Online, I have been immersing myself in the ever-popular market in cosmetic enhancement technologies such as botulinum toxin (Botox), dermal filler, teeth whitening and tanning products. This work expands on and develops previous work on pharmaceutical markets to examine licit and illicit practices of use and supply. The specific aim is to explore the classed and gendered cultural specificities of image-enhancing drug users and suppliers in a local urban context that contains a thriving leisure-lifestyle economy. Here, cosmetic enhancement drugs are usually consumed as an inherent aspect of commodified leisure pursuits that take place in both online and offline spaces. Participant observation in the night-time economy, gyms and fitness scenes, and via social media sites, has allowed an initial empirical insight into the practices and motivations of cosmetic enhancement drug users and suppliers. Online observations are especially significant to the research. Considering the technologically-mediated images now everpresent in our networked culture – from filtered photos on Instagram to constant Facebook updates – one can see how the culture of bodily enhancement has been efficiently networked and expanded as communications technology has developed throughout the late twentieth and early twenty-first century (see Marwick, 2014). The illicit market in lifestyle drugs can be considered as an extension and product of a wider cultural industry of legitimate but harmful leisure. Alongside the empirical research, I have been collecting a range of theoretical and conceptual tools to help analyse the trade in lifestyle drugs. It is my proposition here that an integrated critical criminological/zemiological framework can be used to begin to understand the broader social harms associated with the lifestyle drug industry. This framework can move beyond socio-legal definitions to position the trade in the context of late-capitalist processes of production and accumulation and interrelated cultural forms and values. Theoretical Framework The question of performance and image enhancement is fundamentally a philosophical one. A thorough theoretical analysis of the use of lifestyle drugs and technologies requires a broader discussion of metaphysics, epistemology, bioethics and aesthetics. It is bound up with human values and normative boundaries relating to selfhood, culture, identity and the body, and how they relate to human drives and desires. There is a long-running debate surrounding the ethics of cosmetic pharmacology that is beyond the scope of this chapter (see Cook and Dwyer, 2016; Berkowitz, 2017; Widdows, 2017). However, it is important to begin to theorise the harms associated with the trade in lifestyle drugs in the context of a number of interacting forces, structures and processes – those of culture, technology, political economy, psychology and biology. Later I will draw upon some terms borrowed from recent advances in continental philosophy and psychoanalysis to offer a discussion of the production and consumption of lifestyle drugs in the late-capitalist context. To begin, I will outline some recent advances in critical criminology that can help with this integrative theoretical approach. Like social sciences in general, critical criminological theorising has changed over time in relation to broader political and philosophical thought. A number of critical perspectives have emerged in an atte pt to a s e i i olog s fu da e tal uestio : h i di iduals o o po ate odies a e willing to risk the infliction of harm on others in order to further their own instrumental or expressive i te ests Hall, 2012: 1). In an attempt to examine the interaction of political economy and culture, work has ranged from Marxism to post-structuralism. However, these traditional schools of thought have tended to base their work on legal definitions of crime. One important strand of thought that has developed in recent years is zemiology. Zemiologists call for the traditional discipline of criminology to be replaced by a perspective focusing on the broader social harms inherent in capitalism that are often not legally defined as criminal (Hillyard and Tombs, 2007; Pemberton, 2015). There are issues still to be ironed out as this framework is constructed. For example, zemiology could benefit from a more thorough discussion of harm and the law with a coherent philosophical underpinning, one which could assist ith the pa ti ula l t ou leso e p opositio that o je ti e ealit Hill a d a d To s, : ; a state e t ith hi h a i e has o i ti s of a u e of predatory violent and sexual offences might beg to differ (see Reiner, 2016: 9). Indeed, this is why a u e of s hola s ha e e e tl alled fo a e i ed ealis o the left, o e that does t e el dissolve real harms into the abstract notion of rule breaking (Reiner, 2016; see also Hall, 2012b). Ha i g said that, i i olog s iti al gaze most certainly benefits from the move toward a general zemiological field of study that questions the unequal power relations that construct and enforce the law. Legal or illegal, the lifestyle drug industry is awash with a great number of harms that can only be adequately examined with a perspective that moves beyond mainstream conceptions of crime and towards a harms-based critique of late capitalism. Can cultural criminology – a framework that analyses new cultural meanings and forms of subjectivity in relation to crime and deviance (Ferrell et al, 2008) – contribute to a new zemiological framework? Like zemiologists, a large proportion of cultural criminologists are social constructionists whose work focuses on acts of transgression and criminality as reactions to dominant norms, values and laws. However, some recent developments in cultural criminology have seen a move away from the assu ptio of t a sg essio to positio ultu e as a ediati g eso fo e i the eoli e al economy (Hayward, 2016; Kindynis, 2016; Smith and Raymen, 2016). This aligns with a similar move away from the predominance of constructivist thinking to a reengagement with the general question of how structural political economy interacts with culture in the social and political sciences more generally. One example is the development of cultural political economy (Jessop & Sum, 2010; Best & Paterson, 2010), an emerging post-disciplinary framework that aims to strike a balance between politi al e o o a d ultu al studies ithout falli g i to soft e o o i so iolog o e o o i determinism (Jessop and Oosterlynck, 2008). Embedded in this updated approach, my research can begin to examine various settings in which both the supply and use of lifestyle drugs have what can be construed as harmful material, social and cultural consequences. Building on this work, innovative research on technology, harm and the image is beginning to develop in critical and cultural criminology (Carribine, 2014; Linneman, 2016; Redmon, 2014; Wood, 2016). Bearing in mind that patterns of drug use and supply have been significantly affected by digitisation, an adequate theorisation of technological developments is fundamental to this analysis of the propensity for harm in the context of the lifestyle drug trade. From its commercialisation in the 1990s, through the development of Web 2.0, to the more recent use of semantic technology, content, commerce and social interaction have changed significantly as the Internet has developed. Alongside these developments new and mutating pharmaceutical cultures and markets have emerged. Previous o k has highlighted the o e tous i pa t the I te et has had o the a ket s e pa sio Hall a d Antonopoulos, 2016). Electronic transfer of money, online banking and shopping, the ease and affordability of building a website, the expansion of user-generated content and the sheer number of people now online are all significant factors that have expanded and proliferated the trade (ibid.). With user-generated content in particular, the once distinct roles of producers and consumers have become blurred by the participatory nature of virtual social interaction. As consumption and production have melded, a process of digital prosumption has emerged in licit and illicit pharmaceutical trading where there is often no clear demarcation between users and suppliers involved in advertising and marketing lifestyle drugs via social media sites (Hall & Antonopoulos, 2016; see also Beer and Burrows, 2010; Ritzer and Jurgenson 2010). Furthermore, illicit lifestyle drug traders now use programmatic advertising, which serves up automatic advertisements to meet the demands of consumers via algorithms (Hall & Antonopoulos, 2015). The prosumer subject, a multifunctional actor entangled in webs of needs, desire, demand, distribution and supply, is a complex new phenomenon. Traditional criminological perspectives lack an adequate understanding of human subjectivity at the biological/psychological level (Hall 2012). With the fear of biological determinism and scepticism towards psychoanalytic theory still looming in the background, the currently dominant left-liberal variant of critical criminology has largely neglected theories of the body and the mind (Kindynis, 2016; Raymen and Smith, 2017). Broader debates in the social sciences most notably position the body in poststructural, feminist and phenomenological frameworks. Here, the flexible and stylized body is an effect of discourse, a potentially resistant victim of patriarchal social power relations, or a site of bodily communication and iterative performances (see for example Butler, 2011; Coffey, 2016; Featherstone et al, 1991). The feminist perspective has shifted from a second wave focus on oppression to a third wave emphasis on liberation (Widdows, 2017). Although it is important to understand how the self might be shaped by systems of cultural and social power, in a broader sense consumer motivation is not solely about power, performativity or the social construction of gender. When we consider the huge variation in pharmaceutical products consumed for enhancement purposes, it becomes clear that consumption practices exist across social boundaries of class, gender and ethnicity. Indeed, there are different contributing factors and specificities at work, some of which additional work stemming from this research will seek to establish. However, it has become increasingly evident that, paradoxically, despite the diversity of cultures and subjects, a homogenised ideal-self is emerging in our global consumer culture (MacCallum & Widdows, 2016; see also Hall et al, 2008). Furthermore, lifestyle drugs, whether transforming the face or improving cognitive ability, have biochemical and physiological effects. Cognitive enhancers, for example, transform the self at the pre-symbolic level of neurobiology. Therefore, a fuller understanding of the consumption of enhancement drugs requires a critical theoretical framework that integrates critical criminology/zemiology with biological sciences (see Hall, 2012). Following in the footsteps of the resurgence of attention in critical theory and continental philosophy based on Lacanian psychoanalysis – particularly because of the light it casts on capitalist ideology and subjectivity – the emerging framework of ultra-realism combines new philosophical and psychosocial conceptual frameworks to analyse the general zemiological field of harm (see Hall and Winlow, 2015). Skeptical of the strict division most frameworks have made between the relatively autonomous agent and its contextual structures and processes, ultra-realists call for a more revealing integration of critical theory and neuroscience. Early work drawing on ultra-realism has examined the controversial subject of biology through the lens of a transcendental materialist theory of the subject (Ellis, 2015; Wakeman, 2017; see also Johnston, 2008; Žižek, 1989). For transcendental materialists, the subject arises from material being already hard-wired to be flexible in various environmental contexts and searching for a coherent meaning-system. In this sense, human subjectivity is not solely a question of performativity or interaction in the symbolic world, but the unconscious psychosocial drives and desires of an anxious subject terrified of its experiences of the unknown – the La a ia ‘eal – and therefore desperately seeking symbolic coherence in relations with others. How consumer capitalism appeases the anxiety of the anxious subject, how it offers sociosymbolic coherence as an escape from the terror of the Real, and how the subject and its community experiences the harmful effects of this process, are key questions for ultra-realists. This new criminological school is keen to explore not only the symptoms but also the underlying causal forces that drive subjectivity and the social world (see Hall and Winlow, 2015). For this analysis of lifestyle drugs, ultra- ealis s o tologi al a d epistemological presuppositions support the need to analyse harm in relation to mediated meanings as well as psycho-social drives and desires attendant to consumer capitalism. For ultra-realists, like critical realists, absence has a causative influence on our lives. Contemporary apitalis , hi h e ui es controlled transformation of ea i g a d a tio i id: 100, italics in original) feeds on our attachment to loss and dissatisfaction in order to continually (re)constitute its core logic of growth. A similar argument can be found in the work of a number of critical scholars, many of whom are influenced by Lacanian psychoanalysis (see Berardi, 2009; Boltanski and Chiapello, 2006; Crary, 2014; Dean, 2009; Johnston, 2008; Steigler, 2010; Žižek, 1989). For example, Todd M Go a s o k o dissatisfa tio , a u ulatio a d the p o ise helps to u pa k ho the sea h fo e ha e e t ith all of the asso iated isks a e theo ised i the o te t of the su je t s attachment to absence and loss. For McGowan, consumer-capitalist ideology is now reproduced by the energy of subjects clinging to their own dissatisfaction and the desire to enjoy attempts to escape it through either capital accumulation or commodity acquisition and display. The subject is invested in the promise of tomorrow – of constant improvement, relief, growth, betterment – and therefore to the fu da e tal logi of a u ulatio at the o e of the apitalist e o o i est e t i the p o ise of the o odit . We ha e a ps hi McGowan, 2016: 14) and when this commodity has a corporeal effect – such as that provided by lifestyle drugs - its function of bringing about a sense of growth, of enhancement, of accumulation, is, as it combines with the appeasement of anxiety in a symbolically incoherent world, further intensified. With slimming pills, anabolic steroids, growth hormones, or facial injectables, subjects can see their body or face physically transformed on a daily basis. Here, a feeling of incompleteness creates desire for consumer items that fill the void of our anxious, insecure and fragile subjectivities. The system sells dissatisfaction because desire never wants to meet its object and die; it is intransitive and therefore inexhaustible. Lifestyle drugs promise to e ha e the su je t s od a d i d i its o ti uous sea h fo satisfa tio th ough dissatisfa tio but can never fully satisfy the underlying sense of lack. This process reproduces the need to continuously search for newer and better products that promise faster and longer-lasting effects. My research with consumers of facial injectables highlights this continuous sense of dissatisfaction, where a atu al p og essio f o Boto to de al fille ofte takes pla e. I itiall , the o su e t ies Boto , which takes effect over a 5-10 day period and has a shelf life of 3-4 months. However, many progress onto more expensive dermal fillers that immediately effect enduring changes to the structure of the face. This sense of immediacy and longevity is becoming increasingly important in the market for a number of image and performance enhancing drugs, including cosmetic technologies and sexual enhancers. It is also noticeable in the desire for perpetual acceleration in our technologically-mediated culture (Virilio, 1998; see also Hill, 2015), all of which is bound up with consumer-capitalist drives and anxieties (McGowan, 2017; see also Kornbluh, 2014). A othe useful La a ia o ept is the ego ideal: the ideal i age of the self i so iet s Lacan (1999), the ego ideal a d so iet s i o puts i i o . Fo e se p essu e o the fu da e tal a iet that underlies the human condition. Neoliberal capitalism valorises unattainable ego ideals via image production disseminated through mass media. Highlighting the need for a renewed understanding of how capitalist ideology functions today (see Hall, 2012a), a newer trend since the development of Web 2.0 is that of subjects producing and consuming and therefore reproducing such unattainable ideals themselves via a process of digital prosumption. Is Facebook or Instagram not the twenty-first century version of the mirror in which the Lacanian subject sees their idealised image through the e es of the othe , feeli g oth e og itio of it a d alie atio f o it? Fa ilitated the su je t s increasing fetishistic relation to technology, capitalism can now move into more areas of our lives (Crary, 2013; see also Dean, 2009). The imagined ideal subject promoted by mass media and social media is always producing, always consuming, enjoying leisure time and working late for the privilege of u i g o odities to o sta tl e o st u t the su je t s self-image. In cyberspace we are now feeding this capitalist drive without the need for a hegemonic project (Fisher, 2009). Individuals buying lifestyle drugs online are not ideologically dupe-like, brainless consumers with no agency; the notion of active/passive consumers is a simplistic dualism. Instead, they are involved in a co-created, technologically facilitated process of capital accumulation. Indeed, as critical work is beginning to expose, it is in cyberspace that capitalism now has access to the attention, desires and nervous systems (Dean, 2009; Fisher, 2009) of subjects who actively solicit their immersion in this symbolic trap (Hall, 2012b). In a twenty-fi st e tu spa e aki to Joh Ca pe te s They Live, we are subjects of pleasure and excess and as such it is important to theorise the trade in lifestyle drugs – and the consumer motivations and economic imperatives driving the market – in the context of the resurgence in Lacanian-i spi ed iti al theo o apitalist ideolog . “la oj Žižek s ork is important here. As Jodi Dean explains, Žižek s e italizatio of ideolog iti ue p o ides a set of o epts useful fo understanding neoliberalism as an ideological formation. Arguing that ideology refers not to what people know, but to the belief u de l i g a d a i ati g people s a tio s, Žižek concerns himself with the ways that ideological formations work as economies of jouissance e jo e t . D a i g f o Ja ues La a , Žižek ie s jouissance as an excessive, intense pleasure-pai , as that so ethi g e t a fo the sake of hi h e do what otherwise seems irrational, counterproductive, or even wrong. We might think here of the difference between friendship and passionate love. Whereas spending time with friends may be pleasurable, falling in love can be agonizing. Yet it is a special kind of agony, one that makes us feel more fully alive than anything else. Jouissance, then, is this excess beyond the useful and measurable that transforms something or someone into an object of our desire (Dean, 2008: 51). Lifestyle drugs offer just this: that something extra, that enhancement of the normal that we all crave. The result is that they transform us into objects of our own desires. When incorporated into a critical theoretical framework that integrates political economy, culture and technology, new Lacanian psychoanalysis in a broader ultra-realist framework is useful for theorising the harms individuals willingly inflict on themselves with enhancement drugs as they enter their bodies and minds. The deviant leisure perspective combines ultra-realism with cultural criminology to offer an issuesbased perspective able to capture normalised harm associated with commodified leisure pursuits in consumer capitalism. For deviant leisure theorists and resea he s, the use of the te de ia t seems to be ironic. A range of leisure pursuits with the potential for harm should not be theorised as de ia t i the sta da d so io-legal way but as motivations, practices and affects that are fully incorporated and culturally accepted in the everyday lifeworld of late capitalism. As Smith and Raymen (2016) poi t out, ultu al i i olog s sta da d a al sis of de ia t leisu e as a a t of politi o- cultural transgression linked to pleasure and thrill seeking should be countered with analyses of commodified forms of leisure – and the range of direct and indirect harms associated with them – that highlight immersion in and obedience to the capitalist system. They propose the following: We take ultra- ealis s fo us o the o ete ealit of li e al- apitalis s ost s ste i social harms (Hall and Winlow, 2015; Winlow and Hall, 2013), while also adopting cultural i i olog s i te est i o tested theat es of ea i g Fe ell, and how situatio s a e defi ed, i di iduals a d g oups a e atego ised, a d hu a o se ue es a e u de stood Fe ell, : . This e a les us to p o ide a de ia t leisu e perspective which can critique how and why the myriad harms of commodified leisure forms have become so culturally accepted and normalized in contemporary culture by positioning them squarely in their cultural meanings and functions to both the individual and the economy in a global age of consumer capitalism (Smith and Raymen, 2016: 14). As I will argue below, the late- apitalist su je t s pu suit of pe fo a e a d i age e ha e e t is not only leisure-based but also embedded in other aspects of the social self and identity. Having said that, these products can be found in booming leisure-lifestyle economies, where new cultural spaces ha e e e ged to soli it the su je t s a ti e e gage e t ith its o sta t i p ovement and transformation. In light of this crucial contextual factor, a deviant leisure perspective is useful to an integrated zemiological examination of the lifestyle drug industry. In the next section, I will draw on the typology offered by Smith and Raymen (2016) to map out the harms associated with the trade. Deviance, Leisure and Lifestyle Drugs: A Preliminary Map of the Harm One way the deviant leisure perspective helps to build a picture of the harms associated with the market in lifestyle drugs is by offering a framework upon which to categorise these harms. Smith and Raymen (2016) argue that distinctions should be made between illegal leisure, spatially contingent harm and harmful leisure. Harmful leisure – leisure practices that are legal but with a tendency to harm – is then broken down into subjective, environmental, socially corrosive, or embedded harms. It would be unhelpful to categorise the use and supply of lifestyle drugs as a form of illegal leisure. Made up of a range of legal, illicit and grey area products, the global market in lifestyle drugs is a prime example of a booming trade that is entrenched in the extralegal and widely dispersed in space (Nordstrom, 2007; Hall & Antonopoulos, 2016). The harms associated with the industry are, however, spatially contingent on various legal and regulatory frameworks that depend on the category and origin of the drug and the geographical location in the global commodity chain in which it is circulated and consumed. Furthermore, the market and its associated harms have become normalised and legitimised by actors in the array of leisure practices that constitute contemporary circuits of capital a u ulatio . I a s su h as this, “ ith a d ‘a e s t polog of ha ful leisu e a e extended to cope with the diversity of harms connected to the industry. However, it is important to reiterate that this analysis is not focused solely on leisure but on the dialectical relationships that exist between use and supply, leisure and work, and between processes of production, distribution and consumption. Bearing in mind ultra- ealist i i olog s etheo isatio of ideology and the consumer su je t, the de ia t leisu e pe spe ti e s s he a of ha s ould be applied to the lifestyle drug market in the ways that follow. Subjective harms are those with an identifiable victim and perpetrator. They include self-harm and harm-to-others such as the effects of risky drug use and physical violence in the night-time economy. They are also evident in the mental ill-health issues that now seem to be proliferating around the subjective insecurities and anxieties that constitute the late-modern condition (Smith and Raymen, 2016). Some of the more obvious subjective harms associated with cosmetic enhancement drug use are the physical harms to individuals that we regularly hear about in the mainstream media as a result of botched non-invasive surgical procedures. Examples include dermal filler causing blindness, allergic reactions to lip filler leaving users with permanent lumpiness and swelling of the mouth, and deaths elated to ste oid use a o g A e i a s e t e e od uildi g o unity (Morris, 2018). As Cook and Dwyer found: Botox injections have been fatal in some patients due to Botox travelling from the injection site to other areas of the body, including paralysing respiratory muscles. Other potential side effects include pain, haemorrhage, infection, drooping eyes, flu-like symptoms, drooling, fever, nausea and headaches (2016: 4). Alongside the more obvious physical harm, there is evidence to suggest that the constant need to keep up appearances is leading to more indebtedness (Horsley, 2015). We are now witnessing lavish expenditure on all sorts of lifestyle drugs and technologies. Many consumers I have spoken to spend beyond their means and an increasingly large amount of money on cosmetic enhancement drugs as part of their everyday beauty regimes. Working-class women have spoken of Botox – once a luxury item only available to elites – as i po ta t as getti g hai o ails do e . As a ast e a ge of products are constantly being introduced, promising better, faster and more enduring cosmetic enhancement, financial investment in the self is also growing. With so much money and emotional energy invested in self-enhancement, consumers may seek to save time and money by choosing cheaper, riskier alternatives. Lax regulation in the market for nonsurgical cosmetic procedures such as Botox and dermal filler has opened up opportunities for unskilled people to administer the drugs in various settings. Ongoing research in a suburb in a Northern city is beginning to unearth a largely unregulated local and online retail market in lifestyle drugs. Risky patterns of consumption associated with cheaper, often substandard and unregulated products and p o edu es a e e o i g o pi a alised i ail salo s a d su ed shops, o at Boto pa ties i the of the ho e. O e of the fi di gs e e gi g highlights the o su e s elu ta e to he k the expertise of those administering facial injectables. A newer trend in prosumption is also developing, where consumers order products such as Botox online and self-inject. This is one example of the broader trend of patient/consumers favouring self-governed and privatised healthcare and beauty regimes (Hall & Antonopoulos, 2016). This echoes similar practices found in previous research on steroid markets in post-industrial spaces, where risky polydrug use and drug injecting practices are common (Antonopoulos & Hall, 2016; see also Morris, 2018). For Roberts and Cremin (2017), contemporary networked capitalism is the context for a new suite of consumer fetishes. Technology fetishism, a growing obsession with self-image, and the desire to modify our bodies and faces to be more productive and perform better in our public and private lives is leading to psychological harm. The online participatory network communicating the use of enhancement drugs is a fetish that is turning us in on ourselves in an endless loop of comparisons, affecting our sense of self and, ultimately, our mental health (see Fisher, 2009). The common notion that feelings of inferiority, anxiety and depression can now be fixed by lifestyle drugs tend to exacerbate rather than appease feelings of lack and inadequacy. The desire to constantly search for a i p o ed et u o tai a le self a edia o u i ati g e ot e satisfied. As a esult, ultu al essages sha ed o so ial ultu al t opes su h as thi spi atio a lead to fetishized eati g disorders and the normalised abuse of slimming pills, as the images of self-harm shared on proanorexia forums suggest (Sugiura et al, 2012). Environmental harms are those that wreak damage on the natural world, especially in developing nations. The market in lifestyle drugs, like the pharmaceutical industry more generally, is highly politi ised a d ou d up ith the spe ulati e e o o i p a ti es at the hea t of eoli e alis s glo al economy (see Rajan, 2017). In the current neoliberal era unregulated wholesale systems, misguided trade barriers, variations in intellectual property laws, and the differential characteristics of producer and consumer economies highlight the embeddedness of licit and illicit processes of pharmaceutical production, transit and distribution in a global capitalist system that can constantly transgress legal and ethical boundaries with relative impunity (Hall & Antonopoulos, 2016). The financial benefits of the lifestyle drug trade are not only accrued by illicit actors but also by the legitimate global pharmaceutical industry on its mission to maximise profit by any means necessary. It has been suggested, for example, that the legal pharmaceutical industry is practicing nothing short of genocide with WTO-imposed patent regimes (Rajan, 2017 . While these p odu ts feed o the o su e s dissatisfaction and anxiety, notions of health and wellbeing are being appropriated by capital, lining the pockets of not only criminal entrepreneurs but also legitimate small-scale entrepreneurs, Wall Street investors and Chinese capitalists (Kelly, 2016). As Rajan (2017) argues, health has now transformed into an abstract category made subject to apital s i te ests. The pharmaceutical industry produces environmental harms experienced across the world. From production hubs in China and India through distribution in special economic zones, hyper-exploitative working conditions are common (Hall & Antonopoulos, 2016). Racialized and gendered class relations are at the heart of the global pharmaceutical industry, where profit maximisation overwhelms the need for decent health and safety standards, a minimum wage and maximum working hours (ibid.). Such economic externalities can be notably exploitative. However, harmful exploitation can also be found beyond hubs of production and distribution. The exploitation of emotional labour in consumer zones has reached new heights as technology fetishism and the culture of self-promotion firmly embeds identity formation in processes of capital accumulation while removing the real processes of production and circulation from our sphere of knowledge and imagination. We do not lack the means of knowing about processes of production on the other side of the world, but we fetishistically disavow knowledge and its means in our everyday lives (Žižek, 1989). We feel far removed from those who are exploited in these processes. We are also alienated from the harms experienced by consumers and patients in parts of the global South, who often rely on counterfeit and substandard medicines for lifethreatening illnesses. Socially corrosive harms are evident in cultures that have replaced mutuality and collectivism with cut-throat competitive individualism, who organise social/economic life as if it were a competitive sport. Lifestyle drugs can be positioned in this context, working in tandem with competitive individualism to naturalise both the display of status through symbols of conspicuous consumption and narcissistic personality traits (Lasch, 1991). To date observations in spaces of image-enhancing drug use and supply have revealed an intensified form of sociosymbolic competition. Subjects compete for attention by conspicuously displaying the desirable pharmaceutically enhanced body in real and virtual social interaction. Daily absorption in the market for enhancement drugs and the (online) display of an enhanced body and face is clearly having a formative effect on subjectivity: our desires, values, beliefs and feelings. The normalisation of this form of emotional and aesthetic labour in the booming health and fitness industry is further evidence of how capitalist ideology attempts to incite anxious, displaced individuals to compete hard in the market for wealth and status symbols, but to eschew physical violence and therefore compete in a rule-bound, pseudo-pacified way (Hall, 2012). Many hours are now spent each day in virtual spaces constructing the correct image of the self to post. Coupled with an increasing effort made in offline presentations of self, especially in spaces with thriving leisure-lifestyle economies, it is safe to assume the late-modern form of social control is married to jouissance and the logic of non-stop consumption and capital accumulation. Drawing on the work of Atkinson and Rodgers (2015), Smith and Raymen position the world of video gaming as a violent hyper-reality. The notion of hyper-reality can also be used to analyse the eal/ i tual lu i g of e t e e odil a d fa ial e ha e e t i o li e spa es. “o ial edia is a ash with images of body transformations. Many people I have spoken to talked of enhancement drugs as a way of filtering and photo-shoppi g thei odies a d fa es i eal life . Co ple lassed, ge de ed and racialized dynamics are at work but they can all be grounded on the common subjective feeling of lack and inferiority that capitalism intensifies and exploits; whether darkening or lightening the skin or cosmetically enhancing breasts or the penis, some sort of ideal body-image is projected and marketed. Whether searching for Insta-fame or attention in a bar, this socio-symbolic competition embedded in beauty practices, ideals and value systems is now inscribed in the mind and on the body. I ps hoa al ti te s, the se se of ei g ali e e feel he pe petuall e ha i g the self subsequently becomes the endogenous object of our desire (Dean, 2008), diminishing our ability to relate to the external, objective world. This leads to symbolic inefficiency, which can be seen in the breakdown of life-stages (Hall et al, 2008; Hayward, 2012; Smith, 2014). As Hall et al suggest, e are seeing the end of both traditional childhood and adulthood; distinct life-course stages that are now melding into a single differentiated consumerist fo 2008: 201). This new culture is manifested in the increasing use of dermal filler and Botox by young adults who are intent on taking preventative anti-ageing measures as early as possible. It seems that those who have not yet reached the final stage of adolescence are already committed to its long extension. Indeed, the enhancement industry targets ever younger populations with the aim of creating lifetime consumers (Berkowitz, 2017). Embedded harms can be categorised as those which are entrenched in conventional, everyday consumer markets. As we have seen, lifestyle drug use and supply in legitimate spaces of consumption is an obvious example. In the evening demarcated leisure zones in luxury late bars flood with men and women looking to stand out from the herd. In the night-ti e e o o s o petiti e ultu e see Winlow and Hall, 2006), spectacular willingness to conform to a certain body image is accepted as a means of not only intensifying the leisure experience but also landing a good job or a rich partner. However, associated and clearly gendered levels of abuse and harm are clear to see in quite unambiguous forms (Widdows, 2017). Embedded harms are also apparent in many aspects of everyday work and home life. From sportspeople, door-staff and models whose professional lives depend on their bodily capital (Antonopoulos & Hall, 2016), through men and women looking to boost their private sex lives, to academics and students looking to enhance their cognitive abilities during the exam and marking period (Bennett & Holloway, 2017), subjects are caught up in the increasing pressure to compete and perform conspicuously well. Lifestyle drug use and their psychological and physical harms have once again become normalised. Current empirical research has found individuals who will use cosmetic enhancement drugs prior to weddings, a night out, or a holiday. What was once considered a luxury market has now become an everyday trade in mundane household essentials (Cook & Dwyer, 2016). The growing demand for lifestyle drugs is the product of a capitalist system in crisis, in which we increasingly see the app op iatio of e o o og iti e a d i ate ial goods that do ot ha e the same limit as natural resources (Marazzi, 2011: 119). Jonathan Crary (2014) argues that sleep – the last remaining frontier of our lives yet to be recuperated by capitalism – has now also been fully subsumed in circuits of capitalist production and accumulation. Highlighting the role played by social media and smart drugs, his argument points to the dark side of new technologies and chemicallyinduced enhancement practices. Similarly, Cederström and Spicer (2015) argue that the pressure to maximise our wellness has now started to make us feel worse, leading to a withdrawal into the self, which also aids depoliticisation. Politics has now been replaced by the search for individual transformation via all manner of commodities, including new drugs and technologies. Hall et al (2008) also a al sed the o su e su je t s a ti e e a e of its o depoliti izatio i the o te t of working-class criminality. Conclusion: Lifestyle Drugs and Late-Capitalist Ideology Late apitalis s de elopi g e o o of the self o i ludes a oo i g a ket i li it a d illi it lifestyle drugs, fuelled by increasing numbers of consumers who use pharmaceutical drugs for nonhealth concerns. In our leisure time, at work and in our sexual relationships, a medicinal product is available with a promise to boost performance and image. This is posing public health issues across Europe. However, patterns of benefit and harm associated with this market are far-reaching and complex, evident in each stage of the global supply chain and its cultural, technological and economic dynamics. This chapter has outlined how the adoption of a preliminary integrated zemiological framework that borrows from a range of contemporary critical criminological frameworks might offer a useful platform for understanding the broad range of harms associated with the trade. If the demand for lifestyle drugs is indeed inextricably linked to late-capitalist processes of production and accumulation, it becomes clear how the logic of continuous yet unattainable growth has entered our psyches, our bodies and our everyday social practices. But this is not some symbolic process of internalisation imposed on the individual by external forces, but actively solicited to appease deep anxieties that are intensified by our experiences of other consuming subjects in everyday life, both virtual and real. The exploitation of labour has become progressively more emotional and aesthetic as it has entered the consumer field. In the realm of consumption, driven by our underlying sense of lack and thirst for libidinal energy, we exploit ourselves, our own minds and bodies (Crary, 2014). This active solicitation of consumer ideology in order to feel alive and bring meaning to our lives can be damaging and harmful on a number of levels. It is ultra-competitive and commodified yet packaged as promoting health and wellbeing. This helps reproduce an understanding of resources as infinitely available, so we disregard environmental and social consequences that will impact on future generations as we continue our endless search to be the best, now, and to present that to the world as we compare ourselves to others in the race to attain unreachable ego ideals. Technology now suppo ts the p o ess that is t a sfo i g us i to a o je t of ou desi e. As Jodie Dea s ok argues, the amplified role played by communication in capitalist processes of production and accumulation allows capital to enter our lives at the psychological and biological level in unprecedented ways. The market in lifestyle drugs highlights how a new economic imaginary has produced subjects that are highly adapted to the current conditions of capital accumulation. Traditional forms of political esista e ha e e eded i to histo , hile the hope of o ga i t a sg essio f o politi al t a sfo ultu al esista e ia su e sio a d age ts has ot li ed up to its p o ise, e tai l atio . Co su e is ot o the ass le el eeded fo s economic imaginary has captured the subject by feeding on our attachment to loss and inferiority, reinforcing a possessive-individualist sense of self and intensifying socio-symbolic competition in our everyday relations with others. Now pharmacologically, culturally and technologically supported, networks of capitalist production and accumulation not only promise enhancement and self-improvement but can also cause quite serious physical, psychological, social and environmental damage. The only real winner is the market and the neoliberal ideology that retains it at the centre of our lives. Bibliography A to opoulos, G.A. a d Hall. A. Gai With No Pai : A a oli -Androgenic Steroids Trafficking i the UK . European Journal of Criminology, 13(6), pp. 696-713. Appadurai, A. (1986) The Social Life of Things: Commodities in Cultural Perspective. Cambridge: Cambridge University Press. Atki so , ‘. a d ‘odge s, T. Pleasu e )o es a d Mu de Bo es: O li e Po og aph a d Viole t Video Ga es as Cultu al )o es of E eptio . British Journal of Criminology, 56(6), pp. 12911307. Bee , D. a d Bu o s, ‘. Consumption, Prosumption and Participatory Web Cultures: An I t odu tio . Journal of Consumer Culture, 10 (1), pp. 3–12. Berardi, F. 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