Awakening expectations: exploring social and ethical issues surrounding the medical and non-medical uses of cognition enhancing drugs in the UK

The aim of this thesis is to explore the social and ethical issues surrounding the use of neurotechnologies to control sleep and enhance cognition in British society. Empirically, the project is based on a case study of the wake-promoting drug modafinil. Data analysis involved the study of a corpus of 77 UK news articles and 40 semi-structured interviews with three stakeholder groups: scientists and clinicians, shift workers and students. The analytical framework used was informed by previous work in both medical sociology and bioethics and developed using key concepts drawn from Science and Technology Studies. Conceptualising modafinil as a sociotechnical object, different discourses surrounding sleep, cognitive enhancement and pharmaceutical use were explored to assess how sociotechnical spaces for ‘therapy’ and ‘enhancement’ are being constructed and negotiated in different domains of social life. The analysis of the ways in which modafinil use was positioned and of how various uses were negotiated in both media and stakeholder discourse shows how different groups can conceptualise the same technology in very different ways depending on who is doing the defining, how the users are imagined and the specific context of use. It was apparent that drugs contain not only technological scripts for how and by whom they are to be used, but also strong cultural scripts relating to legitimacy and acceptability of when, where, for what purpose they should be used. Importantly, it demonstrates that although norms may overlap to some degree, there is no universal set of norms defining and delimiting how modafinil should be used in contemporary society. The adoption of an STS perspective, which takes a critical stance towards both technology and users, has shown how the adoption of a therapy-enhancement distinction devoid of context oversimplifies the debate around the use of drugs such as modafinil and does not capture the reality of stakeholder perspectives