Medicine

The Pharmacy of the Future and You

Will new psycho-pharmaceuticals make a more authentic you?

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One of the perennial concerns of conservative bioethicists like Leon Kass and Francis Fukuyama is that some portion of humanity will rush to adopt various biotech enhancements to their detriment. In his essay "Disenchantment," from Philosophers Without Gods: Meditations on Atheism and the Secular Life, University of Sheffield philosopher David Owens worries about the problems that future neuro-enhancements will pose.

Owens posits this case: You have developed some nagging doubts about your partner's fidelity. Although you sometimes think your doubts are irrational, you remember certain lingering looks at parties, and your happiness is spoiled. You're not the sort to hire a private detective, but you have heard of a new pharmaceutical, the anti-doubt pill, Credon. Credon lulls your suspicious nature, but doesn't make you gullible to car sales people. It works only in the context of intimate relationships. The manufacturer does warn that Credon has sometimes generated excessive trust between lovers. So off you go to "The Pharmacy of the Future" for Credon.

Once there, the conscientious pharmacist confirms that Credon does usually work, but asks if you've considered alternative treatments. For example, why not take the new anti-possessiveness pill Libermine? Patients using Libermine don't care if their partners have an occasional fling. Or why be a couple at all? Solox, the emotional independence pill, enables patients to have a wide and emotionally satisfying circle of friends but liberates them from the tedium of having only one intimate partner. Owens then posits that the price of Credon is about as much as for a candy bar, while Libermine and Solox costs as much as good bottle of wine. So on what grounds do you choose among these options?

Owens suggests that one response might be that it's "normal" to want to be in relationship. The pharmacist reminds you that people born with extra Solox in their brains are just as "natural" as people without it. Surely you would agree that such free spirits should not be regarded as somehow inadequate. Another response is that taking Libermine would so change you that you wouldn't be you anymore. Of course, the whole point of taking Credon is to change you so that you, in some respects, aren't you anymore.

So why not flip a coin? Would that mean that the choice doesn't matter any more to you than choosing between two brands of coffee? Surely one's emotional state and the state of one's most intimate relationship should matter more than choosing between Bustelo and Starbucks.

Let me now quote Owens at length:

"For Trotsky, the better we understand how human beings work, the freer we shall be. But The Pharmacy of the Future suggests that the more we learn about ourselves, the less free we will be. A scientific understanding of man is a threat to our freedom because it undermines our capacity to govern our own lives by making decisions. If man is just a bag of chemicals, once we know what these chemicals are, we can re-mix them at will. And by re-mixing them at will, we can give ourselves whatever character we like. But if we can choose a character at random, our current needs and interests lose their authority as grounds for making any decision. And what other grounds for making decisions are there?"

What other grounds might people use to justify their decisions? "In Western Europe, religious belief used to be the source of those fixed points that make decision making possible," writes Owens. "In the rest of the world, it still is." Owens laments that scientific disenchantment is undercutting the authority of religious belief.

The "fixed points" supplied by religious belief may have been useful guides in earlier, less prosperous times. Before the 20th century, most women who bore children out of wedlock could not earn enough to support them, so religion sanctioned stoning and honor killing to discourage fornication. Another previously "fixed point" in Western Europe was that divorce was not permitted. With prosperity and the advent of effective birth control pills and pharmaceutical abortions, the "fixed points" of religiously sanctioned stoning and marriage-for-life were overthrown. Americans and other modern societies are still working out how the pill and burgeoning prosperity have shifted the battle lines in the immemorial war between the sexes, but stoning as a punishment for fornication is still condoned only in some backwards regions of the world. That will change as the 21st century progresses. So even some guides long-established by religion are not "fixed." (On the other hand, given everyone's interest in the preservation of their bodies, one point that is fixed is that murder is wrong.)

Owens' larger concern seems to be an anxiety about authenticity. Are you the real you? But what is the real you? Were you, you, when you 10 years old? 20? 45? Were you the real you before you had graduated college? Were married? Were a parent? Were you more real when you were shy before you "came out of your shell" after joining the basketball or debate team? Are you the real you when you drink coffee to boost your concentration in order to finish that new sales report? Or are the real you when you take Viagra to boost your sexual performance? Turn the question around: are people who choose to use Viagra, cosmetic surgery, hair-coloring, propranolol to overcome stage fright, fakes? A strong case can be made that people who take advantage modern technologies are seeking to become more authentically who they believe themselves to be. Demands for authenticity turn out to be just a way for other people to impose their views of your proper social status on you.

Owens concludes that religious "beliefs may all be delusions but, as technology advances, the need for such fixed points becomes more, not less pressing." However, as we've seen, such "fixed points" don't really exist. Owens wants to liken the human journey to following the signposts of a well-marked Rand-McNally atlas. Instead, humanity is a team of explorers who constantly push forward into undiscovered territories. With many false starts and dead ends, we chart the map of the future as we go along. Like all analogies, the map analogy is inexact—we not only make the map, we also create the landscape of human possibilities through which we travel.

Another way to think of it is that we are not following a pre-determined blueprint as we build our societies. We are constructing the scaffolding and the edifice as we go along. Sometimes whole wings which housed us for a long time must be dismantled and rebuilt to fulfill our new requirements.

Just as humanity is still learning how to use the contraceptive pill and to handle divorce, so too will we engage in a process of trial-and-error social learning about how to use (or not) new psycho-pharmaceuticals. Not only is that as it should be, it's as it has always been. Nothing could be more human.

Ronald Bailey is
reason's science correspondent. His most recent book, Liberation Biology: The Scientific and Moral Case for the Biotech Revolution, is available from Prometheus Books.

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  1. If I’m not me, who the hell am I?

  2. “Most people don’t know how they’re gonna feel from one moment to the next. But a dope fiend has a pretty good idea. All you gotta do is look at the labels on the little bottles.”

  3. You can’t understand the user’s mind,
    But try with your books and degrees.
    If you let yourself go and open your mind,
    I’ll bet you’d be doing like me.

    And it ain’t so bad.

  4. Please tell me that this guy is at least anti:

    ritalin, anti-depressants, anti-psychotics, etc..

    I think the true Me is one depressed psycho. I’m glad I don’t have to meet him 🙂

  5. I’ll stick to cannabis, wake me up when it’s legal.

  6. I don’t know. There are a lot of things about a person’s personality that that person themselves doesn’t like; maybe they get angrier and say things they regret, or are not patient, or make judgements too soon or not soon enough. Maybe they are slutty, or shy, or socially awkward.

    If personality could be tweaked with precision, I don’t see much problem with an adult doing it to themselves. If a person wants to become more trusting or less possessive, I can imagine it helping a lot more social relationships than it could hurt. I of course see serious problems with it being done to children, or to people against their will, and so long as a technology exists of course it will be abused.

    A concern might be that it would deemphasize the proper development of good character, but character in many cases is simply mastering nasty predispositions and encouraging better ones, and filling in the gaps with ritual politeness. If bravery or diligence came in a bottle, I imagine society would have to reevaluate its placing of value upon the intentions of people when judging their actions.

  7. I want the pill that stops me from increasingly feeling like I just dropped in from a parallel universe. I can’t even watch or read the news anymore. I’m the same species as all these other people? Really?

  8. LMNOP, you say slutty like it’s a bad thing.

  9. Who’s been rubbing the moustaches off Jonah’s Ritalin ?

  10. The book referred to looks like an excellant read for a christian with an inquiring mind like me. Thank you Mr. Bailey

  11. Whoa, reading that article was like having a flashback.

  12. There is no real “you,” just layers of lies, omissions and evasions you create to interact with a world full of people trying to interact with you based on their own sets of lies, omissions, and evasions.

    If drugs like these make it easier to transition between the false fronts of your public face, or tweak that public face so that it is more consistent or easier to manage, then what’s the problem?

    There will be time, there will be time
    To prepare a face to meet the faces that you meet;
    There will be time to murder and create,
    And time for all the works and days of hands
    That lift and drop a question on your plate;
    Time for you and time for me,
    And time yet for a hundred indecisions,
    And for a hundred visions and revisions,
    Before the taking of a toast and tea.

    In Eliot’s terms, drugs like these just give us more time.

  13. Well, I didn’t mean to Nick. I meant only that some people wish they were less so (and some wish they were more) and if a regiment of pills could retool a person’s sex drive or propensity to flirt or respond to flirting, then it would allow people who are trained or genetically predisposed to be sluts to try out being frigid, and vice versa.

    I don’t see that as a bad thing.

  14. Philip of Macedonia, father of Alexander the Great, said “Philip drunk is not Philip sober.” Considering how damn near everything we consume affects us, how can one tell which is the authentic self? I guess you could go on a month-long fast of all chemicals, refined sugar, spicy food, etc., then eat a well-balanced meal washed down with plenty of water (not too much, don’t want water intoxication) and that would be pretty close to who you are without any psychopharmaceutical influences.

    I guess that the real issue, as it is so often, is choice. If we have the tools to change ourselves, does someone else have the right to object? Does someone else have the right to change us against our will? Personally, I agree with Timothy Leary’s two commandments for the Psychedelic Age.

  15. I guess you could go on a month-long fast of all chemicals, refined sugar, spicy food, etc., then eat a well-balanced meal washed down with plenty of water (not too much, don’t want water intoxication) and that would be pretty close to who you are without any psychopharmaceutical influences.

    I guarantee you would rather be around me after the meal than before. Hungry me is a prick.

    Since we are machines made of meat, and everything we do alters the chemical balance of our meat, I would say that the question of “who you are without any psychopharmaceutical influences” is meaningless.

  16. When I worked in a medical school’s anxiety clinic 20 years ago, a company named Reid-Rowell was working on something called neuroleptics, aerosole based medications that would calm down (not knock out) groups of people if introduced into an air supply. I remember that they were talking about using it during prison riots or some such.

    Anyone hear anything about that?

  17. Quiet_Desperation,

    I want the pill that stops me from increasingly feeling like I just dropped in from a parallel universe.

    That would be your basic anti-psychotic

  18. aerosole based medications that would calm down (not knock out) groups of people if introduced into an air supply.

    It was weaponized and marketed under the trade name American Idol.

  19. For ~100,000 years hananity has been stumbling blindly towards the future, our destiny if you prefer. Any new technology, social structure or environment provides us with new problems (usually unforseen) and new solutions (also usually unforseen). The pharmaceutical and gengineering genies are out of the bottle and will change more than any of us can forsee. I have concerns (realistic? paranoid?) about governmental control of mood altering drugs so I’d recommend caution.

    When stumbling blindly it seems prudent to make our way forward slowly. But go forward we must. We can’t stand still, and only disaster will send us backwards.

  20. humanity vice hananity. I even previewed, obviously crappily.

  21. it’s the so called hannatization of mankind?

  22. aerosole based medications that would calm down (not knock out) groups of people if introduced into an air supply

    …this will help calm you down. Thank you for eating at Carl’s Jr. Carl’s Jr.: Fuck you! I’m eating!

  23. Ahh, here’s an article on neuroleptics.

  24. Old RA —

    That isn’t an article so much as an online scare pamphlet.

  25. The real issue here, as it is in the steroids debate, is the issue of suffering. Or, more precisely, the way in which western thinking equates suffering and earning.

    To a certain sentimental way of thinking, the person who labors intently to overcome limited talents to achieve some end has “earned” their accomplishment more than the person who has greater natural gifts and can accomplish difficult things easily. This “Special Olympics” theory of value skews our thinking about most bioethical issues.

    All that the advances we’re discussing will do is make certain things easier to accomplish. The authors Bailey is quoting presumably have no problem with a person overcoming their own shyness through counseling, or reflection and meditiation, or through submitting oneself to painful public episodes to insure oneself to the fear of others, etc. Changing oneself in this way is perfectably acceptable. It’s only if you can change yourself with a medical treatment that it becomes ethically questionable. Just as it’s OK to get big muscles by exercising four hours a day, but not OK to get them by getting a shot and exercising one hour a day. The only reason I can see for this is because humiliating oneself until you forget your own shyness is difficult, and taking a pill is easy. The one method of change is therefore morally OK, and the other one isn’t, because of the differing levels of suffering involved.

  26. LMNOP – the article reads like it was written by psychiatrist Peter Breggin, or someone like him. (He’s a non-Scientologist, btw).

    Neuroleptics are pretty bad drugs, and over-prescribed (libertarian boilerplate here). At any rate, the three Warnings at the bottom of the page aren’t hyperbole, they’re empiric findings on people who have taken neuroleptics.

  27. Preface: I believe that everyone has the right to decide for themselves what they will or will not put in their own bodies…

    That said – what’s wrong with being a little jealous? Or a little angry sometimes?

    Why would we want to live in a white-washed, sterilized, non-confrontational world? Sounds fantastically boring to me…

  28. Why would we want to live in a white-washed, sterilized, non-confrontational world? Sounds fantastically boring to me…

    Pass the Soma…

  29. Authentic you? I would think that if you don’t like stage fright and want to pop a pill to eliminate it, then you are being fully “authentic”.

    Am I “authentic” when I cut my hair or shave my face? I should say so: I am no Nazarene. Yet my natural self continues to grow unwanted hair. hmmm..

    I have a friend who used to have uncontrolled facial tics. First impressions for him were exceedingly difficult and most people thought him kind of “weird” because of them. The wife and I had not seen him in a couple of years (we moved) and I had heard about a new pill he was taking to get the matter under control.

    When he visit recently my wife could hardly believe it. And he’s much happier for the transformation. Is he a more authentic him now? I think so.

  30. I’m not aware of any scientists or major religious groups that advocate the idea that our bodies are perfect and therefore need no alteration…in fact I thought that was one thing we were all in agreement on. You know, that our lives are not always great and we want to improve them. Religions tell us to improve our lives through ceremonies and meditation, and sometimes even diet (a la Buddhists or Jews or Mormons). Scientist make similar cases for therapy, diet, exercise, and parmaceuticals.

    The more I think about the more I think any quest for ‘authenticity’ involves willful alteration of the self.
    David Owens strikes me as quite the luddite.

  31. There is no reason why the development of these drugs would be a bad thing. They are merely a tool for helping us to do what we have been trying to do by force of will alone for so many eons.

    Incidentally, I see no reason why drugs that help couples become more intimate would not also be developed.

  32. Seems like another academic twisting himself into knots in an effort to show that more freedom somehow equals less freedom.

  33. Actually, there is nothing in the Qur’an about dishonor killings. In fact, they pre-date Islam by centuries and are un-Islamic. They are believed to have their origins in misinterpretations of pre-Islamic Arab tribal codes. They have more to do with culture than with faith.

    Ellen R. Sheeley, Author
    “Reclaiming Honor in Jordan”

  34. .. who needs any drugs to alter your personality?? .. try going without a decent night’s sleep for a few months .. you are not a normal person by any means ..

    .. Hobbit

  35. So am I not the real me because I take a mood stabilizer? Despite the fact I am happier, healthier, better able to maintain relationships, etc?

    “Can you see the real me preacher?
    Can you see the real me doctor?
    Can you see the real me mother?
    Can you see the real me?”
    -The Who, “The Real Me”

  36. This argument is, at its origin, quibbling over the definition of “authentic.”

    The compact OED says authentic is “of undisputed origin” and certainly if I change myself chemically via legal or illegal drugs than I know *exactly* what the origin of that change is.

    I don’t wonder after six shots of whiskey how I managed to get drunk.

  37. I think the notion of necessary fixed points is a profound one, one that many of us might not give any thought to (because it is so fundamental to how we create meaning), until someone articulates it. Religion’s staying power has been in providing these frameworks for meaning, but as the number of agnostics and atheists increases every year, we have to wonder what the place of religion in a post-modern society is. I share the concerns of Bailey and other post-ers here and approach the idea of sophisticated neuro-active drugs very carefully. While divine-inspired religions will take something of a back seat in the future, I think we all have to individually form our own secular religions of morals and practices through the use of reason. What other choice do we have? Would we want anything else?

    Lastly, I think this is what Foucault was worried about in his criticism of psychiatry. It was the framework of diagnosis that was too harsh in his opinion that was very pernicious – it made people feel as though their authentic selves was wrong or maladaptive, it can change the norm of what a “good” person is. After all, the culturally supplied idea of a good, productive person informs all of our behavior.

  38. “The tests came back negative so the problem could be psychosomatic – I will prescribe you Cymbalta and I will see you in two weeks”
    In two weeks the patient comes back smiling like a sunshine. “So how do you feel today?” “Wonderful, doc – just wonderful! Thank you – I used to be so depressed, you changed my life!”
    “So your bed-wetting problem has gone away?”
    “No, no, I am still wetting at night – and I am very happy about it!”

  39. Er, side effects, anyone?

    It’s amazing to me that in all this airy, slightly giddy speculation about “personality optimizing,” there’s absolutely no discussion about the incredible number of serious, often dangerous medical side effects that accompany use of SSRIs and other mood brighteners.

    It’s just a fantasy to think that pharmacology is going to come up with a more-perfect, stress-free remedy for all the complex emotions that make us human. Why replace them anyway? Stop playing God! Instead, pay just a little attention to the serious medical consequences of all the meds that millions of Americans have taken. Maybe that will undo some of the damage they’ve already caused.

  40. Having experienced somebody who was suffering from bipolar disorder, I can tell you that the short-acting SSRIs like Celexa do not combine well with bipolar patients and bipolars misdiagnosed and treated for depression is too common occurence. Every goodamned psychologist with MS degree can now do “behavioural therapy” augmented by dishing out the SSRIs (because they are so “safe”) and then we get a troubled kid turning into a frank manic phase and in rage driving a car into a crowd of people or shooting out the whole class. HMOs love to hire witch-doctor psychology therapists because they are lot cheaper than psychiatrists.

  41. “Pharmacy of the Future” is something of a red herring. Owens’ essay actually deals with taking science to its logical conclusion – once science has discovered everything there is to know about nature, body, and mind, what is left to form the basis of human decision making? The “Pharmacy of the Future” is just putting meat on Owens’ question.

    Where I think Bailey goes astray with his review is in denying Owens his “fixed points that are needed to make decision making possible at all”. The title of Owens’ essay is “Disenchantment” – by this he refers to how science disenchants the world by removing such “fixed points”. The implication then is that these “fixed points” are – enchantment. Hardly anything as stable as Bailey’s literal reading. And in that sense, Bailey describes for us how humans have always maintained such fixed points:

    “We are constructing the scaffolding and the edifice as we go along. Sometimes whole wings which housed us for a long time must be dismantled and rebuilt to fulfill our new requirements.”

    Owens’ main concern is that a total scientific understanding of nature, body, and mind may put an end to this process; that is, rob us of our humanity. When Owens takes science to its logical conclusion, it can be downright spooky:

    “The body is a machine that is there to serve our purposes. Once we know how this machine works, we can treat it just as we would our car or house.”

    Apparently, such logical conclusions have a long history (dating back at least to Hume, who Owens uses to bolster his own) – “The world puts no value on the life of a human being; only human beings do that”.

    Another way to phrase Owens’ question is: In a world where scientific knowledge of nature, body, and mind is total and value-free, what will be left for human nature to value? And on this question I’ll have to side with Bailey’s optimism: we’re human – we’ll figure something out 😉

  42. There is a difference between genuine religious beliefs and sanctioned stoning of fornicators by people who claim religious authority to doing so. I seem to remember hearing something to the effect that the philosopher who made this statement was considered to be fairly well grounded in ethics and religious belief.

  43. He says “On the other hand, given everyone’s interest in the preservation of their bodies, one point that is fixed is that murder is wrong”

    I think that’s wishful thinking.

    Individuals murdering individuals is still considered wrong and punished on a case-by-case basis, but government sanctioned killing of the troops of other governments or anti-government organsiations is never punished and often seen as a natural part of life….

  44. This is ancient history, except the Pharmaceutical industry wants its tither. Candy Flipping is taking Ecstacy followed by Nexus (2CB). In old days it was just chewing cocaine when you drank too much booze, so you wouldn’t get too weird. Pot getting you down? Sleep it off with a double dose of Ambien. Girl being unfaithful? Caveman her and get in a fist fight that you throw the first punch of, with her happily married professor. Oops. Lay low a few weeks.

    The question isn’t whether we can instinctively or experimentally tweak our consciousness. It’s whether it will be outlawed or not. Why?

    Because scratch the surface of “dial-a-mood” and you find one mood that society has already MAINTAINED worse jail sentences than for violent criminals or rapists: religious ecstasy and actual free thought creativity.

    In the old school, this was blamed on hawkish warlike leaders who needed kids working to make more bombs and design better nukes. But now that those have already been invented, it just basic “old guy” constipation of the Right, meaning those who didn’t get laid in the 60s, so never really noticed that the who did get laid turned into weird pacifists and New Agers, but actually most turned into classic 80s era ‘yuppies.”

    I was once a chemist. I wanted, like Plato, like AI researchers, like well, *me*, to figure out how consciousness WORKED. I could not do so. Such interests were the “kiss of death” of an academic career. So it was left to the pharmaceutical industry to get to work, and they did a pretty good job, and continue to do so, but they cover up every “general acting” agent they discover.

    Beh. These little tweaky things will change your daily life about as much as the latest $100K jetpack. What is needed is a “chemical vacation” which, upon landing back on Earth, eh hum, makes you enter into the economy with more sober rigor than you ever even could have imagined before.

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