Today, when people have grown up following the adventures of superheroes in comic books, movies and television, it is not surprising that people have begun to turn to certain medications to feel powerful in their daily lives. In his 1993 bestseller, Listening to Prozac, Peter Kramer dubs this phenomenon “cosmetic pharmacology” and discusses the ethical implications of using psychoactive medications to change the personalities of mentally healthy individuals to help them become more successful. Kramer’s work focuses mainly on the effect of a drug called Prozac (generic name fluoxetine).
Fluoxetine is an SSRI (selective serotonin reuptake inhibitor, a class of drugs used as antidepressants) typically used to treat Major Depressive Disorder and OCD. By inhibiting the serotonin reuptake mechanism, SSRIs cause an overall increase of serotonin in the nervous system. The neuroenhancing effects of Prozac noted by Kramer included enabling people who are shy to be more self-confident and assertive. For example, one patient initially had an unsuccessful dating life but, after taking Prozac, began to have three dates a week. This same patient even became more assertive at work, which led to a promotion. These remarkable effects lead Kramer to coin the term “cosmetic pharmacology.” The idea was that people would be able to take medications to rid themselves of personality traits they deem undesirable. However, marketing drugs that can be used to enhance a person’s natural mental state can have serious ethical issues.
Objections to the use of neuroenhancers can be made in the name of fairness. Using Prozac would give people an edge in their daily business meetings and test taking and in attracting mates, which puts those who do not use Prozac at a disadvantage. This is similar to the objections made regarding the use of performance enhancing drugs in sporting competitions because they provide an unfair advantage. However, this argument does not adequately address our inherent reluctance about the use of Prozac by mentally healthy individuals. For even if Prozac (or a similar drug) were made safe, easily available and commonly used, most would still feel uncomfortable with its usage as a neuroenhancer. Writing for the President’s Council on Bioethics, Michael Sandel argues that the use of neuroenhancers is morally troubling because they represent a kind of hyper-agency, a Promethean aspiration to remake nature, including human nature, to serve our purposes and satisfy our desires. The problem is not the drift to mechanism but the drive to mastery. And what the drive to mastery misses and may even destroy is an appreciation of the gifted character of human powers and achievements.
Sandel fears a type of post-humanistic existence where people are consumed by the hubris of their domain over nature. It is neither the effect nor result of neuroenhancement that gives Sandel pause; it is the means through which it is accomplished. He contends that it is deeply troubling when humans try to improve certain traits because “it represents the triumph in our time of willfulness over giftedness, of dominion over reverence, of molding over beholding.” In short, Sandel believes that gifted traits should be admired, not created. When traits are created, we lose our sense of awe and admiration of human achievement.
What seems to be lacking from this discussion is a sense of context. Are we able to make a distinction between people who need to take medication and those who do not? According to Kramer, neurosis is a blanket term that psychiatrists use to describe various states of compulsions and disorders in their patients; this term does not necessarily adhere to a specific diagnosable condition. For many patients, taking Prozac is essential to their normal function. While the drug does improve their natural state, boosting their productivity and performance, without it they cannot function normally and are at risk of suicide. The moral issues lie with the psycho-normative population. Kramer also argues that Prozac doesn’t change the personality of those who take it, it merely restores the true self that a pathology has hidden. It follows from this that medication should only be taken when there is pathology.
A critic of Sandel might say his approach would suggest that we should not try to cure illness at all since that would be an attempt to establish “dominion over nature.” However, this misses the point of Sandel’s argument. He claims that human experience in arts and culture should not be enhanced because it shifts our focus from praise of the person to praise of the drug. Striking a home run after taking steroids is not a testament of remarkable human ability; rather it is a testament to the properties of the drug and the skills of the chemist.
Therefore, it seems that only in such a case of a pathology or disorder would medications like Prozac be advisable. A society obsessed with “cosmetic pharmacology” would constitute a moral failing, a shift from true human achievement to a fraudulent utopia. Life has an added richness through daily emotional upheaval and the triumph of effort over difficulty. When complacency replaces challenge, we lose not only our sense of human achievement, but our sense of dignity as well.