Science & Technology Studies 2/2012 Enrolling Men, their Doctors, and Partners: Individual and Collective Responses to Erectile Dysfunction Ericka Johnson and Cecilia Åsberg
Using the Pfi zer funded Swedish informational site about erectile dysfunction (ED), www.potenslinjen.se, we examine how potential users, their partners, and medical doctors are enrolled in the process of creating the Swedish Viagra user. Contextualized against other critical work on Viagra, our analysis shows how the commercial discourse embeds the ED patient into a network of actors. Three separate actors are co-constituted and enrolled by this erectile dysfunction information discourse, comprising Viagra marketing material in a country which forbids direct to consumer advertising of prescription medication. Doctors are enrolled to produce the cultural authority of expert medical knowledge, whereas partners are given responsibility for the emotional aspects of a man’s sexuality and encouraged to direct the man toward the relationship-saving Viagra. Throughout, though, the man is the patient responsible for taking Viagra to fi x his dysfunctioning penis. We problematize this individualised solution by contrasting it with the social aspects of the discourse and examining other qualitative and historical studies of impotence. We then ask if the enrolment presented by the Swedish Viagra website could be (mis)used to expand the circle of actors involved in ED, redefi ning the ‘problem’ and opening for a wider variety of treatments. Keywords: Viagra, enrolment, Erectile Dysfunction
Introduction
the Swedish Viagra man. Our analysis builds upon existing literature about the promotion
is article examines how men, their doctors,
of Viagra which addresses the construction
and partners are enrolled by the Pfi zer
of erectile dysfunction (ED) and masculinity
sponsored web site for potential Swedish
in other national contexts, and we therefore
e Swedish language make mention of alternative images and
site www.potenslinjen.se1 (in English, readings in other contexts throughout our ‘potency hot-line’) is framed as a source of
analysis. Like previous critical studies of
information for lay people concerned about
Viagra (Fishman & Mamo, 2001; Marshall,
erectile dysfunction.2 We have examined 2006; Tiefer, 2006; Vares & Braun, 2006), how the site’s text and imagery address we are examining the construction of an diff erent audiences in the construction of
ideal user of Viagra, but we also discuss the
Science & Technology Studies, Vol. 25 (2012) No. 2, 46-60
Ericka Johnson and Cecilia Åsberg
way the enrolment of doctors and partners
pharmaceutical solutions to ED, and lists
serves to position ED in the man and defi ne
the telephone number to a sexual medicine
its treatment as a solitary act of taking a pill
centre at a large hospital in Stockholm that
while simultaneously involving the other receives undirected funds from Pfi zer. Yet, actors to help the medicine function. Our
despite the DTC ban, Viagra fi gures largely
contribution delineates the specifi c roles the
on the website and has fi gured largely in
various subjects are granted, in particular by
the ‘collective psyche’ in Sweden both as a
looking at the invisible work the “passive”
subject of newspaper articles (some reading
female partner is tasked with as she is told
as if they have been taken directly from
to actively guide and support her partner
in the Viagra trajectory. To do this, we use
debate, thanks in large part to the drawn out
discussions and court cases about whether
enrolment, which articulates the roles given
or not Viagra would be subsidized by the
to various actants as they are enrolled into
Swedish health care system (Johnson, 2008;
a network that discursively constructs ED as
Sjögren & Johnson, 2012). Likewise, Viagra
is available in Sweden, but falls outside
Our research can be read against of the state subsidized pharmaceutical
the framework of regulations regarding scheme, which means patients must pay direct to consumer (DTC) marketing of for the drug themselves, creating challenges pharmaceuticals. Th
e legality of DTC for marketing the drug. We argue that this
advertising of prescription pharmaceuticals
challenge has been met in part by enrolling
the man, his doctors and partner in the ways
much of the critical research about Viagra
and its role in the media climate (see Elliot,
2003; Loe, 2004b; Mamo & Fishman, 2001;
this enrolment says about social, rather
Moynihan & Cassels, 2005, Potts & Tiefer,
2006). Our study, looking at Viagra in the
inspiration from early medical sociology
Swedish context which bans DTC advertising
for prescription drugs, confi rms the results
health (Eaton & Weil, 1955) and recent
of much of this work but contributes an qualitative studies of men’s responses to ED important insight to the strength and (Oliff e, 2005; 2006). By exploring alternative fl exibility of Viagra marketing in a globalized
narratives of illness, we suggest that an
ere is a good alternative reading of erectile dysfunction
deal of harmonization between the Swedish
site and other Viagra sites, yet also local
Below, we delineate the interdisciplinary
adaptation (see Åsberg & Johnson, 2009).
conjunctions that shape our approach and
And as we show here, the local adaptation
provide an overview of previous critical
of Viagra marketing that is not considered
Viagra studies3 before detailing the enrolled
DTC advertising relies on the construction
subjects we have identifi ed in our material.
of subjectivities for the man, his doctor, and his partner. Th
Background
informational” about erectile dysfunction (though it is obviously advertising Science and Technology Studies use the Viagra) and therefore has information term enrolment within ANT to denote how explaining what sex therapy can off er men
suff ering from impotence in addition to upon and woven into complicated networks
Science & Technology Studies 2/2012
ough it has been discourse, erectile dysfunction has been
rightly criticised for implying a heroic, articulated as a problem of arousal since entrepreneurial actor in the process of the 1970s, where ED is defi ned as a problem enrolment (Star, 1991), the concept is useful
of attaining and maintaining an erection
for our study because it articulates the sense
that there are actors with specifi c interests
Sexual response models within sex therapy
(here, the pharmaceutical company have taken foremost physiology, but also Pfi zer and its marketing experts) who use
specifi c methods (those described in this
defi ning healthy or non-healthy sex, which
article are discursive strategies) to involve
coloured the term impotence pejoratively,
heterogeneous constellations of human and later replaced it with the term erectile and non-human actants in the construction
dysfunction. However, it was not generally
of a Swedish Viagra man. We will be using
a specifi c web of actants – potential users,
by Pfi zer (see Marshall & Katz, 2002; Loe,
medical doctors, and their partners – are
2004b; Bordo, 1998; see Johnson, 2008 for
woven together by a discrete discourse to
construct an identity and agenda for the narrows the defi nition of what impotence is Swedish Viagra man.
from a condition of the psyche, the emotions,
prescription since its approval in 1998, but,
complaint (Marshall & Katz, 2002; Tiefer,
like the similar drugs Cialis and Levitra, 2006; McLaren, 2007; Johnson, 2008). Pfi zer it is not covered by the national subsidy marketing has also introduced the concept programme for medicines. Th
able to get a prescription for the drug, but
they must pay for it out of their own pockets,
& Mamo, 2001: 181; Marshall, 2002: 139)
which is unusual for the Swedish consumer.
playing on ‘erectile insecurity’ (Tiefer, 2006:
company Pfi zer, Viagra works physically a phenomenon around which multiple in some men and in some situations by diff erent vested interests have gathered to blocking the return of blood fl owing out of
sell it and construct the disease of ED, as
Loe articulately shows in her examination
and blood fl ow to the penis increases, of the US case (Loe, 2004b). Viagra will help keep it there and produce
has reinforced the defi nition of sex as
Discursively, however, Viagra does penetration, and masculinity as the ability to
many other things. Viagra has, for example,
achieve penetration, relying on a reworked
changed our language about impotence (in
e marketing previously had reserved for the female mind:
around Viagra has helped to introduce the “anatomy is destiny” determinism of the the term ED (erectile dysfunction) to the
naturalized body in the construction of the
general public, replacing the more negative
term ‘impotence’ (Bordo, 1998: 90; Potts, of male embodiment boils down to the 2004: 23). Th
e term erectile dysfunction sexual (and not necessarily reproductive)
performativity4 of the visible sexual organ.
1950s (McLaren, 2007: 221). In psychiatric
Ericka Johnson and Cecilia Åsberg
Baglia’s (2005) study of Pfi zer promotional
Materials and Methods
material in the USA has shown, sexual performance is defi ned by a narrow sexual
function model starting with arousal and
progressing through erection, penetration commercially produced informational and ejaculation. As long as a man can material about Viagra available in Sweden: perform this penetrative sex, his masculinity
free pamphlets and booklets which can be
ordered by men or their partners from Pfi zer;
(or at least proves) masculinity reinforces
literature for doctors and other medical
the importance of penetration for both professionals; press coverage in local the sex act itself and the concept of sex-life
expectancy. As sociologist Barbara Marshall
notes, this concept of sex-life expectancy,
about men’s health. We have, for this paper,
with its calls to vigilant self-monitoring focused on the website www.potenslinjen. of healthy practices and appropriate se for a number of reasons: it is produced sexual behaviour, relies on the disciplined
by Pfi zer for a Swedish audience in the
individual taking responsibility for Swedish language; it is easily accessible to managing the risks of lost masculinity (i.e.
lost ability to penetrate) even before ‘old does not require interfacing with a medical age’ (Marshall, 2006: 335). Viagra connects
practitioner; it focuses on impotence and
this individual responsibility to the medical
erectile dysfunction rather than men’s
and pharmaceutical networks within which
health in general; it can be accessed by and
Viagra is active, which also reinforces the
addresses individuals not facing impotence
scientism of sex and the naturalized body,
attaching both to systems of expertise while
Additionally, the web site is a good example
simultaneously assigning responsibility for
of how Pfi zer tweaks its material to localize a
global message for its global product.
In analyzing the text and images on this
three step paradigm of arousal, penetration,
site, we have been inspired by the critical
and ejaculation, and then demands Viagra
studies of Viagra mentioned above as well as
as a solution to (age, stress or illness related)
Foucault’s idea of an economy of discourses
declining sexual performance (Plante, 2006:
380). According to this discourse, a person
(or couple) can maintain a successful sex life
example of an economy of discourses in an
as long penetration is possible, i.e. with the
attempt to articulate “the necessities of their
help of Viagra, an idea which ignores, and
operation, the tactics they employ [and] the
tends to silence, suggestions of alternative
eff ects of power which underlie them and
sexual practices and a sex life that is not
which they transmit” (Foucault, 1987 [1976]:
dependent on penetration (Tiefer, 2006). In
68f ). We also draw inspiration from studies
this narrative, emotions all but disappear.
And where they do play a role, responsibility
for them is given to the partner, as we will
produced since the late 1970s on powerful
ideological processes (cf. Merchant, 1980; Haraway, 1989; Butler, 1990; Martin, 1991; Fox Keller, 1992; McClintock, 1995; Bryld & Lykke, 2000; Franklin, Lury & Stacey,
Science & Technology Studies 2/2012
ese researchers Highlighted on the welcoming fi rst page
have used feminist critiques to investigate
is also the accessibility of an easy and
how science as a discourse and notions of
comforting solution to erectile problems, in
the natural are used to support dominant
of disease associated with erectile diffi
Enrolling Participants in the Viagra Discourse
disease, which will be discussed below), one of the primary tools used to enrol the men is
Examining the Swedish website it becomes
an interactive quiz in which they are asked to
apparent that three diff erent groups of fi rst rate their sexual health (by answering a human participants are enrolled by Pfi zer to
series of fi ve questions), then encouraged to
assist in constructing a subject position for
talk to their doctor. Unlike much of the other
men as potential consumers of Viagra: the
text on this site, the quiz is a short version of
men themselves; medical doctors; and the
the International Index of Erectile Function
(IIEF), and is directly translated from the
the Viagra pill is also enrolled as a non-
US Viagra site6. As Marshall has discussed,
human actor, nearly given a hero’s identity.
this process of inviting quizzes, generous medical advice, and sexual education
Enrolling Men
eff ectively creates an ostensibly benevolent
Men are enrolled through the information on
regime of self-surveillance on the website
the pages that constructs them as potential
for the individual through assisted self-
monitoring and remedial action (Marshall,
the fi rst page in what could be considered
2006: 356; see also Mamo & Fishman, 2001;
a respectful and tactful manner: “Potency
Baglia, 2005). Such a mode of address, and
problems can be a sensitive issue in spite of
ways of enticing and enrolling potential
the fact that many men – and their partners –
consumers of Viagra, can be read as part of
a larger discourse, a sexual regimen of the
attached to the welcome sentence, a photo
of a tanned, grey-haired man in his fi fties
monitoring, to borrow ideas from Foucault,
is centred on male penetration at the Viagra
smiling as he looks up into a blue sky that
website. Given the fl ourishing market for
matches his blue t-shirt, suggests a relaxed,
self-health guides, books, and websites, etc.,
e blue colours of this mode of address is hardly surprising.
clothing and sky seem to allude to the iconic
is website merges the commercial aims of
colour of Viagra and to Pfi zer’s logotype,
a product-selling site with sexual education
and health advice in a manner characteristic
as has been discussed by Loe (2004b) and
Baglia (2005). In the image and text, the of “edutainment” where entertaining cultural stigma of ED is mitigated by such
features such as quizzes and educational
a respectful yet relaxed approach. Further,
imagery blend for accessible, online display
the mode of address to the large number of
(Åsberg, 2005). Health matters are, in such
men and their partners who suff er from ED
normalizes the prevalence of the problem
of consumerism, as detailed in Stacey’s
and works to alleviate the concern the description of self-help literature in her visitor to this site may be experiencing. cultural study of cancer (Stacey, 1997). Th
Ericka Johnson and Cecilia Åsberg
Viagra consumer is enrolled into a mode of
being sustained by the ideal of the self-caring
and about other patients’ experiences.
subject position of a health consumer. In line with Stacey’s work on health consumerism,
this also resonates with what Rose and frame to help him help himself, the website Novas termed ‘biological citizenship’ also reveals the implicit assumption of a shy (Rose & Novas, 2004: 14). Th
e biological Swedish man of few words inferred by such
citizen invests heavily in self-education on
health matters and develops the medical is one who does not easily confi de in his literacy needed to pursue a high-quality, physician, especially not regarding sexually self-suffi
cient, personally and socially related matters, and must be reassured and
‘responsible’ lifestyle (Rose & Novas, 2004:
coaxed to bring up the topic during a health
self-surveillance discourse redefi nes sexual health in a very specifi c, determinist way:
sexual health for men is the achievement
and maintenance of an erection and ability
(particularly the functioning of certain parts
of their anatomy) becomes their destiny.
Perhaps surprisingly, it is not a sexually
surveillance and individual responsibility, it
also provides the tools for individuals to take
on the task of monitoring and disciplining
problems. From this arises a Swedish man who is non-articulate with respect to his
when asking for a Viagra prescription at
interpreted as a defeat in the masculinized
struggle to control the body. Importantly,
on approach of Pfi zer in facilitating the
Enrolling Doctors
Similarly, in a special section called the Medical doctors are also enrolled through Potency Coach, illustrated by an animated
potenslinjen.se website (beyond the infamous drug rep sales techniques (see
Reidy, 2005)). Part way down on the very
interactive patient support that will help
fi rst page, an anatomical sketch of a heart
accompanies a text that reads “Potency
problems – an important warning sign” and
you can also fi nd information about the
Science & Technology Studies 2/2012
be the fi rst “useful” sign of cardio-vascular
erectile dysfunction (and, presumably, for
diseases. It becomes clear that Viagra is not
merely a matter of fl eshy pleasures and an
improved sex life, but that it relates to serious
on other national Viagra sites, also paired
health issues and even has a function as a
fi rst warning sign. Such medical appeals when speaking to their doctors, addressing to cardiovascular health issues as linked the fact that some men may fi nd it diffi
to ED both play to the scientism of the to bring up the subject of sexual dysfunction naturalized body and work to medically during an exam. On the Swedish site, men legitimize Viagra. Swedish men seeking are told, “When you meet your doctor, she medical attention for ED are addressed as
or he will probably interview you and ask
upstanding citizens taking responsibility for
you questions about previous illnesses and
their personal overall-health, and doctors
if you are currently taking any medications.
are encouraged to help them with that. Try to provide as accurate information as Th
is use of medical complaints other than
possible, including if you still have early
ED to legitimate Viagra can be read against
morning erections or if your erectile ability
the eff orts in Sweden to associate Viagra has disappeared suddenly or gradually. with specifi c diseases rather than lifestyle
choices as part of the debate over state issues, but it is completely OK to be subsidies (Sjögren & Johnson, 2012).
e medical dimension of Viagra is used to speaking about these things and
further enhanced with a fi gure of authority
their job is to help you.” In this way the men
that confi rms both the relaxed personal and doctors are also positioned to enrol each tone and the urgency of the matter, namely
other and maintain each others’ investment
a headshot of a physician in scrubs with a
in the Viagra-discourse. We suggest that this
part of the Viagra website seems to connect
the doctor creates a close proximity between
biological citizenship with medical literacy
medical authority and the potential Viagra
consumer in another sense: the ambivalence
of the picture in this setting suggests that even a medical doctor can have a use for
Enrolling Partners
Viagra. Most importantly, however, this On the Swedish site partners are also small photo, emitting medical confi dence
and trust-worthiness, serves a particular men as subjects for whom Viagra is the function within the website: to illustrate a
solution to a waning sex life and/or issues
search engine for fi nding a local, Viagra-
of sexual dysfunction. Potency issues are
friendly doctor. In addition to encouraging
continuously addressed as a joint problem,
doctors to be ‘pro-active’ in asking their for the female partner as well as for the patients about sexual function during man. In a special section of the Swedish routine exams and when taking medical web pages, partners are told about the ways histories8, Pfi zer has included a national ED can aff ect a relationship, above all by database of ‘ED aware’ doctors, or ‘affi
letting coldness, distance and worry creep
experts’ as Loe (2004b) calls them, which
in and replace the sensitivity, nearness
lets visitors to the website submit a query
and trust that had been in the relationship
and generates a list of doctors near them
before. On the connecting pages, partners
who can be consulted for information about
are encouraged to be supportive of their
Ericka Johnson and Cecilia Åsberg
partner, and then to let their partner know
that there are treatments available for the
sexual therapy. She can guide him on his
way, yet he is the doer behind the deed. Th
assumption about heterosexual femininity
ere are medicines as sexual passivity and masculinity as sexual
activity, but more importantly it also points
a doctor’s visit. Apart from medical to the enormous eff ort by the woman that in treatment, sometimes sexual therapy
reality lies behind achieving the “passivity”
which can confi rm his active and valuable
It is good for you as a relative to know
about this and to be able to support and
many subtle manoeuvres, enticing practices
encourage your partner to seek help.
and persuasive, yet-necessarily non-direct rhetorical moves a woman must master in
e partners are also encouraged to order
order to achieve the right amount of sex-
the free brochure, “A man’s best support inspiring passivity. Th
is by his side”, published by Pfi zer with a
smiling, heterosexual couple on its front masculinity. page. Th
A specifi c section of the Swedish website
support the men experiencing ED plays is dedicated to the prescriptive discursive strongly on the assumption that the partner
patterns available to the partner. As the
is steadfastly (unrefl ectively?) consenting to
reproduce certain practices and maintain
suggests, she should ask herself how “Can I
a supportive position within a relationship
help?” to receive the answer, “Speak to and
with the man (cf. Potts et. al., 2003). Th
is also information about how ED makes a man feel and what sorts of ‘normal’
It is best to speak openly with your part-
behaviour it can evoke in one’s partner.
“Many [men with ED] distance themselves
from their partners simply to avoid confl ict
and to avoid situations which can lead to
one fi nds a discussion about how ED and
themselves in their work, or make sure they
don’t go to bed at the same time as their
responses build on feelings of guilt and
partner in the evening. Many consciously
or subconsciously even create confl icts
encouraged to persevere and help their men
to avoid being close to their partner.” As seek help because “When one has received implied by this quote, sexual intercourse help and solved the problem, many discover seems to be an active achievement, where
that their relationship has in fact become
‘success’ needs to be granted. Moreover, the
stronger.” Again, the partner’s discursive
female partner has a supportive rather than
a leading role in this sexual achievement
eff ortless and natural attitude that avoids
which combines the traditional, passive putting pressure on her partner and is recipient of penetration (waiting in the achieved by another rhetorical strategy here bed for her partner with the new hobby)
provided by the Viagra site text, namely the
with an active subject tasked with leading
‘we’. She can address her sexual needs and
Science & Technology Studies 2/2012
his sexual problems if they are addressed as
emotional health of the couple is presented
a ‘we’ issue, enrolling a sexual dyad, a fi gure
It is here, in the partner section, that
Within the Swedish context, it is emotions and feelings are mentioned on
worth noting that pre-Viagra (prior to the website with the references to coldness, 1998) medical advice about impotence distance, worry, sensitivity, nearness, trust, underlined how important it was for doctors
guilt and encouragement. Physiologically,
to warn their patients that merely solving
a man’s ability to produce an erection aroused in the fi rst place, so partners are would not necessarily solve relationship encouraged to help achieve Viagra’s success problems (Olsson et al., 1995), something
by ensuring the necessary feelings are in
the Pfi zer information seems to be belying.
Internationally, this assertion can be read in
aspects of sex, not just the relationship,
light of a Japanese study where a survey on
is also eff ectively given to the partner.
the level of satisfaction derived from using
Partners are reminded that ED is “the man’s
Viagra indicated that while the male patient
symptom, the couple’s shared problem”
was extremely satisfi ed, his partner was so the partner is directed to “speak to and not satisfi ed at all. Women reported their
encourage” the man. She is the one that
husband’s erections as troublesome, that in practice can confi rm his potency. Her they had to use supplements to increase assignment within the Viagra discourse is to vaginal lubrication and in some cases even
manage this talk as she takes the emotional
responsibility for discussing and refl ecting
Vázquez, 2006: 123). Loe (2004a) and Potts et
over the role of sex for their relationship.
al. (2003) also provide examples of women’s
Here, too, emotions come into the discourse
responses to and concerns about Viagra use
but so do the co-constitutive agencies of
in the US, demonstrating a wide diversity in
opinions and practices. Additional studies
Viagra as embodied, chemical eff ect as well
on Swedish women’s accounts of Viagra as an expectation on virile manhood giving would here be needed, but looking at the
website it is clear that the female partner,
are encouraged to learn about ED because,
since heterosexuality becomes further “with knowledge in hand, you will fi nd it implied in the illustrative photos of both easier to speak with your partner. Together older and younger heterosexual couples that
you can discuss your feelings and thoughts,
frame the text, is enrolled as responsible for
and give each other support, and in the end,
the man’s health and for their relationship;
the Viagra-empowered, potent man. At the
website, her task becomes one of ensuring
relationship’s well being to the female
that penetrative intercourse can occur, since
partner enables her to legitimately address
sexual intercourse is what consolidates the problem of ED as a shared issue. Within the relationship and makes it strong. the discourse on the Viagra pages, the tool Th
rough the fi gure of the sympathetic she is often given to solve the problem is the
partner conjured up on the website, the little blue pill, but because of the particularly responsibility not only for the general health
Swedish, legally dictated, ‘informational’
and well-being of the man but also for the
role of the website, the partner is also provided with information about alternative
Ericka Johnson and Cecilia Åsberg
treatments like sexual therapy (even if this
of men with diff erent reasons behind their
information is sparse and even as the site is
branded in a very Viagra-blue). But as we
involvement of partners during treatment,
will discuss below, enrolling the partner in
the ED discourse this way could also open
for alternative solutions and alternative et al., 1995: 313). Th
necessarily benign; the imagined partner was a woman in this (also) very heterosexual
Discussion
discourse, and she was ascribed a narrow position in the discourse: “Men and women
In our analysis, we have identifi ed three
have diff erent ways of expressing themselves
enrolled participants who are addressed by
and therefore misunderstandings can easily
the website to help create a subject position
arise. Women must learn to be clearer and
men to be more receptive” (Olsson et al.,
these is the male patient, for whom anatomy
1995: 313). Her ideal sexuality was also
becomes his destiny, but who can consume
Viagra to control that destiny and discipline
and receptive to her male partner’s desires.
it in line with youthful expectations. Th
e best help for a man with disappointing
second is the doctor, enrolled both to help
erections is, besides his own courage to
ensure the male patient is able to access
Viagra and used to represent scientism, sensual partner who is sexually keen but which legitimates the use of Viagra by not demanding” (Olsson et al., 1995: 314). associating it with networks of scientifi c
However, with the 1998 advent of Viagra,
expertise. And thirdly, the partner of the the medical discourse in Läkartidningen patient is also enrolled in the process of narrowed the defi nition of an impotent creating a subject position for the Viagra
patient to the male penis and removed the
consuming man. Responsibility for his varied social and sexual backgrounds, and emotions is given to his partner, who actors, which had previously been present. simultaneously consents to supporting a Yet, in the commercial discourse, the pharmaceutical solution for the man and
partner and factors like stress and tiredness
e enrolment of these three participants
Despite the stigma attached to impotence
in the commercial discourse creates a and the common assumption that men network of actors who can perform the desire
for, distribution of, and context to contribute
to successful use of a pharmaceutical as a
www.potenslinjen.se implies), qualitative
Viagra discourse is particularly striking when
one considers that they all but disappeared
from the medical discourse around Viagra
with their ED problems alone and in silence.
when it was introduced in 1998. As Johnson
(2008) has examined, the Swedish medical
professionals and partners in their quest
journal Läkartidningen supported a very for a solution (Grace et al., 2006; Oliff e, heterogeneous defi
and impotent patients in the early 1990s,
one which recognized many diff erent types
their impotence (Viagra and similar drugs,
Science & Technology Studies 2/2012
but also injections and vacuum pump contrast to perceiving ED as a disease of the treatments) and some men enrol their penis and the penis alone, and for which partners in both treatment therapies and
responsibility to enact a solution (take a
as discussion partners with whom they pill which will maintain an erection) is the can talk about their diffi
man’s. As we have shown, in the Viagra
alternative sexual practices (Oliff e, 2005). As
discourse, the partner is enrolled to help the
much current research within masculinities
man see how important it is for him to take
studies supports, men’s experience of Viagra. Th
illness, especially a condition as related of work on her part, actively enabling the to masculinity as erectile dysfunction, man to recognize the problem as ED and is infl uenced by how the men and those
the solution as Viagra. An alternative would
around them, i.e. the network of actors be for partners to be enrolled as participants enrolled in defi nition and solution work, who can also defi ne alternative sexual think about and practice masculinity (cf. practices and solutions. Marshal & Katz, 2002; Aucoin & Wessersug,
new, male patients, but also their doctors
suggest that some men who experience and their partners, we were reminded of an sexual dysfunction are already comfortable
early study of mental health by Eaton & Weil
using a network of actors to help them both
(1955), which found that relatively isolated,
defi ne their problem and seek treatment Anabaptist communities’ responses to options.
We ask, then, how this practice and were very diff erent than the response to
these enrolled actors (patients, doctors mental illness found in the wider American and partners) diff er from the enrolment we
society at the time. Rather than isolating
have observed on the Swedish webpage. the individual, institutionalizing him or her, Th
e obvious answer, of course, is that and stigmatizing the patient, the Hutterite
in the conversations detailed in Oliff e
communities tried to help the individual
continue to play a role in the community,
pharmaceutical solutions. But we would contributing and working as best they like to suggest that the type of ‘enrolment’
could, and being cared for by their family
that the men are displaying is also diff erent
during the course of the illness (Eaton &
eir enrolment is an Weil, 1955: 212). Reading this study today,
activity which creates a community of it is obvious that it was written before the people, all of whom can help to defi ne the
medical problem as medical or not and as
the discourse of mental illness, and illness
a problem or not. And, importantly, it is in general. Rather than talking about also a community that seems to at least patient-centred, individualized cures to tacitly recognize that the solution, when illness, the study relied on concepts of there is one, is one that needs to be acted
social cohesion, social structures and group
on and participated in by more than just the
expectations as explanatory models and as
man. In particular, these interview studies
treatment options. It pays special attention
would seem to highlight the partner’s need
to sociological variables, the cultural and
to be active in defi ning the problem, and
social dimensions of health (Eaton & Weil,
also the solution, as co-produced and as
is is in social cohesion and mental health from
Ericka Johnson and Cecilia Åsberg
1955 may be a good way to reinterpret the drug, and Viagra’s reliance on sexual erectile dysfunction. But as a reminder that
desire means that the sexual partner can be
our research material, our observations, important to initiate, develop or maintain and our interpretations are infl uenced by
arousal. What we are asking is: If these three
the paradigm within which we are working,
groups of actors (men, their doctors and
it is very useful. Going back to the material
their partners) can be enrolled to address
we have discussed in this paper, and looking
at the way patients, doctors, partners and
enrolled to address ED without Viagra? How
pills are enrolled in the production of Viagra
would a distributed response to ED place
consumers, we see fi rst that these actors responsibility for dealing with the problem are enrolled to produce consumption as at the family and community level rather a treatment option. Secondly, the men than only by individual? and their partners are not discussed as
ough it may seem Oliff e’s qualitative research on men with
unnecessary to reintroduce the partner as
the source of impotence (for a discussion of
pre-Viagra treatment advice for doctors,
historical, cultural and social explanations
of impotence see McLaren (2007)), this to respond to a health issue does not enrolment can explain what other critical
necessarily mean that the solution needs
research on Viagra has shown; that its to be given to the individual, especially as existence and doctors’ participation in a pill to be swallowed. Rather, enrolling a its prescription practices have created larger network of actors can involve fi nding ED. Social structures (the medicalised and supporting alternative behaviours, framework) and group expectations (of alternative demands, and alternative lifelong sexual activity and successful aging)
expectations, both by and of the ‘individual’
have contributed to the ‘epidemic’ of erectile
dysfunction, and by the people around him
by the enrolled actors. Only then can they
be engaged as a network to (help the man) fi nd a solution. Starting from this insight, we
ask: how these same human actors could be enrolled into creating a diff erent solution?
1 Accessed in October 2007, February and
If Viagra was not available, what solutions
could this cast of characters work together
to fi nd? Who/what else could possibly be
enrolled? And how would the concept of ED
which is framed as an informational site
readership is constructed to legally avoid
traditionally been a situation that is not
direct to consumer advertising of Viagra.
generally fl outed or discussed publically. 3 See the special issue of Sexualities: Th
erefore we fi nd it interesting that the
Viagra solution suddenly enrols a wider 4 We would like to point out that this group of actors to help the man fi nd a
performativity is more directly connected
these other actors; the regulatory framework
discursive performativity often found in
gender studies, i.e. Butler’s (1990) work. Science & Technology Studies 2/2012
Elliott, C. (2003) Better than Well. American
(New York: W.W. Norton and Company).
Fishman, J. & L. Mamo (2001) ‘What’s in a
Disorder: A Cultural Analysis of Medical
Franklin, S., C. Lury & J. Stacey (2000)
is presented on the website http://viagra. References
by Robert Hurley (New York: Penguin Books).
Aucion, M. & R. Wassersug (2006) ‘Th
e Grace, V., A. Potts, N. Gavey, & T. Vares
Viagra’, Sexualities 9(3): 295-314.
throughout history: Implications for Haraway, D. (1989) Primate Visions. Gender, modern day cancer patients’, Social
Science & Medicine 63: 3162-3173.
e Viagra AdVenture. Johnson, E. (2008) ‘Chemistries of Love.
of Sexual Health (New York: Peter Lang).
Viagra in Läkartidningen’, NORMA 3(1):
Bordo, S. (1998) ‘Pills and Power Tools’, Men
Keller, E.F. (1992) Secrets of Life, Secrets of
Bryld, M. & N. Lykke (2000) Cosmodolphins.
Feminist Cultural Studies of Technology,
(Cambridge: Harvard University Press).
Latour, B. (1998) ‘On Recalling ANT‘,
Butler, J. (1990) Gender Trouble: feminism
Sociology, Lancaster University, at http://
and the subversion of identity (New York:
p a p e r s / L a t o u r- R e c a l l i n g -A N T. p d f
of Viagra: Gender, Dysfunction and Loe, M. (2004a.) ‘Sex and the Senior Woman: Reproduction in Japan’, Body and Society
Pleasure and Danger in the Viagra Era’,
Eaton, J. & R. Weil (1955) Culture and Loe, M. (2004b) Th
(New York: New York University Press).
Mamo, L. & J. Fishman (2001) ‘Potency in All
the Right Places: Viagra as a Technology
Ericka Johnson and Cecilia Åsberg
of the Gendered Body’, Body & Society
Marshall, B. & S. Katz (2002) ‘“Forever Potts, A. (2004) ‘Deleuze on Viagra (Or,
Functional” Sexual fi tness and the Aging
What can a ‘Viagra-Body’ Do?)’, Body &
Male Body’, Body & Society 8(4): 3-70.
Marshall, B. (2002) ‘“Hard Science”: Gender
Potts, A., N. Gavey, V.M. Grace, & T. Vares
the “Viagra Age”’, Sexualities 5(2): 131-
experiences and concerns’, Sociology of
e New Virility: Potts, A. & L. Tiefer (2006) ‘Introduction’,
Viagra, Male Aging and Sexual Function’,
Based on Stereotypical Male-Female Rose, N. & C. Novas (2004) ‘Biological Roles’, Signs 16(3): 485-501.
Citizenship’, in A. Ong & S. Collier (eds),
Global Assemblages: Technology, Politics
McLaren, A. (2007) Impotence. A Cultural
Feminist Analysis of Old Age, Masculinity
& Sexuality (Linköping: LiU Tryck).
Sjögren, E. & E. Johnson (2012) ‘Conniving
disciplining drugs. Justifying the denial of
Subsidy for Viagra Use in Sweden’, in M.
Moynihan, R. & A. Cassels (2005) Selling
of the Swedish Welfare State (Basingstoke:
turning us all into Patients (Crows Nest,
Stacey, J. (1997) Teratologies. A Cultural
Oliff e, J. (2005) ‘Constructions of masculinity
impotence’, Social Science & Medicine Star, S. (1991) ‘Power, technology, and the 60(2005): 2249-2259.
Oliff e, J. (2006) ‘Embodied masculinity and
being allergic to onions’, in J. Law (ed) A
androgen deprivation therapy’, Sociology
of Health & Illness 28(4): 410-432.
L. Malmberg, & J. Pedersen (1995) Tiefer, L. (2006) ‘Th
‘Är det Möjligt att bota impotens?’,
Vares, T. & V. Braun (2006) ‘Spreading the
and Male Sexuality in Popular Culture’,
Little Blue Pill Changes Sex in America.
Science & Technology Studies 2/2012
Åsberg, C. (2005) Genetiska Föreställningar:
Åsberg, C. & E. Johnson (2009) ‘Viagra 581 83 Linköping, Sweden
Selfhood: Pharmaceutical Advertising ericka.johnson@liu.seand the Visual Formation of Swedish Masculinity’, Health Care Analysis 17(2):
Dept. of Tema, Interdisciplinary Gender StudiesLinköping University581 83 Linköping, Swedencecilia.asberg@liu.se
65--Health and Medical Supplies Solicitation Number: W90M7903630300Agency: Department of the ArmyOffice: National Guard BureauLocation: USPFO for Utah :Combined Synopsis/SolicitationSynopsis:Added: Mar 22, 2011 4:08 pmThis is a combined synopsis/solicitation for commercial items prepared in accordance with the format inSubpart 12.6, as supplemented with additional information included in this n
Öresundsregionen som Kreativ Metapol Ett treårigt Interreg IV A projekt med målsättningarna att stärka kulturens roll som drivkraft i en hållbar samhällsutveckling samt att stärka dess roll på den politiska agendan lokalt, terregionalt och nationellt. Projektet har 14 deltagande kommuner: Hässleholm, Hörby, Höör, Kristianstad, Lund, Malmö, Simrishamn, Albertslund, Ballerup,