In search of certainty: risk management in a biological age
| DOI | https://doi.org/10.1108/17465729200500020 |
| Date | 01 September 2005 |
| Pages | 14-22 |
| Published date | 01 September 2005 |
| Author | Nikolas Rose |
| Subject Matter | Health & social care |
Nikolas Rose
Professor of
Sociology/Director,BIOS
Research Centre
London School of
Economics and Political
Science
Correspondence to:
Nikolas Rose
BIOS Centre
London School of
Economics and Political
Science
Houghton Street
London WC2A 2AE
n.rose@lse.ac.uk
GENETICS
14 journal of public mental health
vol 4 • issue 3
©Pavilion Publishing (Brighton) Ltd
Few can doubt the pervasiveness of ‘risk
thinking’ in contemporary western societies.
This is especially so in areas of health and, of
course, it takes a particular form in relation to
mental health. There was a time when risk
taking was admirable. The greatest rewards came to
those who were prepared to take the greatest risks. The
persona of the capitalist, the entrepreneur, was that of
the risk taker.Some of this positive valuation of risk
lives on, of course. A greetings card sent to me a year or
so ago has as its slogan ‘Risk: the loftier your goals, the
higher your risk, the greater your glory’ (see also Simon,
2002). Some marvel and celebrate the risk-taking
character of those who engage in extreme sports or set
themselves the challenge of walking alone to the South
Pole. But for most of the time most of us live under the
shadow of a different idea of risk: one that carries an
entirely negative connotation. Risk is danger,hazard,
exposure to the chance of injury, liability or loss. Risk
also carries a performative injunction: something to be
guarded against, avoided, managed, reduced, if not
eliminated. The demands of the precautionary principle
– to be seen to act to avoid an imagined future potential
harm, despite lack of scientific certainty as to its
likelihood, magnitude or causation – seem hard to
escape. Note that this is a demand about perceptions
and actions in the present; it is not about outcomes.
Public health medicine has involved a statistical
kind of risk thinking since the 19th century.But risk
thinking in medicine takes a particular form in western
‘pharmaceutical’ societies. Consider, for example, the
most prescribed drugs in the US in 2002 (see
http://www.rxlist.com/top200.htm). The most
prescribed drug was hydrocodone, a pain reliever. Lipitor
(Atorvastin), for the treatment of hyperlipidemia, was
second. Atelonol, a beta-blocker used for the treatment
of high blood pressure, angina and recurrence of
myocardial infarction, was third. Synthyroid for the
treatment of thyroid deficiency – a condition
characterised by general lethargy and lack of activity –
was fourth. Premarin, for the treatment of symptoms of
the menopause (hormone replacement therapy), was
fifth. Viagra came in at only 41, up six places from 1999.
As for psychiatric drugs, Alprazolam (Xanax), for the
management of anxiety disorders, was the most used, at
eleventh, sertraline (Zoloft) was at number 13, and
paroxetine (Paxil) was fifteenth.
Afew things stand out from this list. First, obviously,
these best sellers are drugs that are prescribed
chronically rather than acutely. Second, these are drugs
that do not so much treat an illness as manage the
troubles inherent in human life. Third, many of these
drugs do not treat diseases at all: they are targeted at risk
itself. The treatment of risk itself emerges, initially,from
In search of certainty:
risk management in a
biological age
The combination of heightened emphasis on risk and its management in mental health, the
precautionary principle, the idea of genetic susceptibility, advances in screening technology, and the
promise of preventive pharmaceutical intervention is highly potent, especially in a world in which
preventive prescription of psychiatric medication has become routine. Psychiatric professionals are
given the obligation of governing,and being governed, in the name of risk, and in a political and public
sphere suffused by the dread of insecurity.But there are risks in seeking to govern risk in a biological
age. In this paper1Nikolas Rose argues that the public, politicians and professionals alike might do
better to refuse the demands of risk, and learn to live with uncertainty.
Key words:
risk management
biological psychiatry
psychiatric medications
psychiatric professionals
preventive prescription
1This is a revised version of a paper given as the opening keynote address to the Faculty of Forensic Psychiatry, Royal College of Psychiatrists’ Annual
Conference, 4 February 2004.
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