Thursday, March 24, 2005

Mind drugs and enhanced normalcy

I have interested for quite some time in performance-enhancing drugs for the mind, and the recent attention to steroid use by athletes has gotten me thinking about it some more. Several newer drugs, most famously Prozac and relatives, but also Provigil and others to come, target specific brain systems > and seem to have fewer side effects than anything which has come before. Thus there is a possibility that these drugs could be taken without risk by a wide range of people. It's very difficult to restrict one's writing about this topic, as it readily sends offshoots toward complex medical and public policy issues. I just want to pinch off the idea that the way the increased availability of these drugs is presented ends up somehow impugning the undrugged, "normal" mind.

At least since Listening to Prozac , and more explicitly last weekend with Kate Zernicke's article in the New York Times , it has been noted that people take neuroactive drugs not just in moments of distress, but also to enhance their everyday lives, either for specific reasons (pulling an all-nighter; in-law's visiting) or as a lifestyle choice. As Zernicke points out, newer drugs such as Ritalin and Provigil are part of a continuum of drugs including caffeine, beta-blockers, or alcohol, which, used moderately, help smooth life's bumps with minimal side effects. Zernicke furthermore quotes Arthur Caplan that this type of drug consumption is just another form of technological advance, like a PDA or a spreadsheet, which enhance capabilities and even competitiveness. What's the big deal?

Without going into detail, I think it's likely that excessive ingestion of anything, from super-sized fries to crack cocaine, will have measurable health effects. Thus I think the health-care industry might have a financial stake in knowing who's taking what.(For an idea of the potential complexity of this question, see here for actuarial considerations for smokers.) A second social concern with brain drugs is the idea that these drugs, if available to only some people, will give them an unfair advantage. The only concrete example I have is standardized entrance exams, where standardization is precisely the purpose of the exam. (It would be equally unfair to compare students subjected to random loud noises with those taking a test in silence; or to allow calculators for only half the class in an arithmetic exam.) This is essentially doping, which has been discussed to death with respect to competitive sports. After all the posturing is over, I do expect some kind of framework to emerge for running fair sports competitions. These standards could be ported over to mind drugs.

Professionals will always have enormous incentives to enhance their performance. What interests me more is the prospect of ordinary people taking these drugs. I think neither of the two concerns I mentioned above forms an absolute barrier to "lifestyle" use of mind enhancing drugs. Moreover, I have to note here that I drink 3 cups of coffee a day, in part because of the mental buzz. What I find more weird is the undertone of dissatisfaction with normal brain function, and in fact an effort to slight normalcy, which seems to be stoked by discussion of these little pills. One can see the trend, in another context, in the article in this week's New York Times about hypomania , a recently described mental state comprising increased, but controlled, brain activity. I think the accompanying figure says it all. People are running around in the middle of the night, writing, painting, succeeding. And all of them smiling:

At some point, almost everyone encounters them - restless, eager people, consumed with confident curiosity. Researchers suspect that their mental fever shares some genetic basis with that of bipolar disorder, known colloquially as manic depression, a psychiatric disorder characterized by effusive emotional highs and bouts of paralyzing despair.


As one psychiatrist put it, Dr. Kessler said, "The goal in life is constant hypomania: you never sleep too much; you're on; you keep going."

Besides the idiocy of wishing everyone's setpoint to be 110% (shades of Spinal Tap), this attitude glosses heavily over the real struggles of people with bipolar disorder. The ones I know and love have no wish to hold on to their manic episodes. But look at the words surrounding hypomania: eager, curiosity, confidence. Did someone forget abrupt, irritable, can't hold a conversation? In the absence of a fuller portrait of abnormally elevated brain activity, the decision of normals to forego drugs which result in a simliar state somehow becomes technophobic. Moreover, there is a conceptual problem first noted by the great philosopher Syndrome of the Incredibles, if everyone is special, then no one will be. If use of the drugs becomes sufficiently widespread, than hypomania will be the new normal.

So my final problem with this trend becomes a cultural one, namely, who the hell cares if my teeth are sparkly white? Why should it be my goal to be hypomanic? I enjoyed this paragraph from Neela Thirugnanam very much:

Happiness void of repercussions is no more contained within a Prozac capsule as it is (sic) with any other drug. ... Prozac may call to us as the savior of those with minor depression, but its overuse can drown difference in sea of medicated sameness.

What people want is to be happy. Maybe we should start with that.

UPDATE: Via email from Andy Miah at Bioethics and Sport, a whole book about cosmetic pharmaceuticals Better than Well by Carl Elliot. Check out Dr. Andy's site!

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