In the times of social networking, the Internet, and personal information everywhere being made public, there is no question that we are experiencing a loss of privacy left and right.  One might say that the last bastion of privacy – our own thoughts – is all we have to hold onto (although some people, driven by the age of Twitter, have taken to publishing all of those, too).

But a segment on 60 Minutes last year brought to light that even these private thoughts are up for grabs, with brain scanning technologies “making it possible for the first time in human history to peer directly into the brain to read out the physical make up of our thoughts, some would say, to read out minds.”  Functional Magnetic Resonance Imaging (fMRI for short) enables us to scan and see the metabolic activity inside the brain, allowing researchers to begin to identify where thoughts occur, and what they might look like, by measuring changes in blood flow and oxygenation in the brain and linking it with certain mental states.  The implications – for the law, for our notions of privacy, for our conceptions of free will– are profound.  “We all take as a given that we’ll never really know for sure, that the content of our thoughts is our own.  Private, secret, unknowable by anyone else,” Lesley Stahl, 60 Minutes correspondent says.  “Until now, that is.”

“Reading Your Mind,” this segment on 60 Minutes which aired last March, walks us through just how these brain scans are being used for “thought identification,” and raises some interesting questions about how these new technologies might be used in the future. Below, I’ll bring up some thoughts it raised for me:

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How does it work?

To summarize some of the video, Marcel Just’s work shows the capability of fMRI technology to identify the areas in the brain associated with thinking about certain objects; for example, you could show a subject a series of pictures – a screwdriver, an igloo — and have the subject think about those objects; then, when you present a pair of objects and ask the subject to think about one of them, the computer can identify which object you were thinking of by tracking which areas of the brain light up.

When you think about an object like a screwdriver, similar parts of the brain are likely to fire — the parts implicated in holding a tool, the parts associated with what you use a screwdriver for, the parts implicated in twisting an object, and so on.  By piecing these bits of data together, the computer (and thus, the researcher) can identify which object you were thinking about by seeing which neurons fire, and where.

These studies are indeed remarkable.  Though the thoughts they can identify are exceedingly basic – showing that a person is picking “screwdriver” from the options of “screwdriver” and “igloo” is a far cry from reading a complex emotion like anger, motive, or jealousy–it certainly opens the door for some interesting issues to consider in the field of “reading minds.” Some implications of this technology are still theoretical, and depend on how advanced our technologies get; yet some are much more immediate and able to be implemented now, or at least in the very near future.

So what are the current implications of this work? One of the parts of the segment I found the most fascinating is considering the implications of thought recognition in the court of law.  In his article “The Brain on Stand,” Jeffrey Rosen elaborated on some potential applications as well:

-One of the ways this technology could be used is to identify “recognition” patterns that might implicate someone in committing a crime.  For example, if you can prove that a person is familiar with the scene of a crime or with a murder weapon by tracking which parts of their brain fire when they are exposed to these things – because the area of the brain that lights up with “recognition” is different than the area that lights up in a novel situation — you might be able to prove that they were involved with the crime. For example, as mentioned in the video, you might be able to tell if someone has been in an Al Qaeda training camp before, perhaps by exposing them to photos of the camps and seeing what happens in their brains; or perhaps you could show them a list of names and see if his or her brain “lights up” with recogntion.  In fact, a case of this very technique was reported in India, when a woman was convicted and sentenced after an EEG allegedly showed she was familiar with the circumstances around the poisoning of her ex-fiancé.

-Another application of this technology is that it could be used in a line-up scenario, allowing a witness to scan the potential criminals and have the brain scan identify if he or she recognizes anyone, and use the brain recognition patterns to identify the criminal — even if the witness can’t consciously remember who the criminal is or what they look like. Rosen explains, “The brain stores memories both explicitly and implicitly.  Assemble a standard police line up and a person may not be able to explicitly remember who was the attacker in question; but perhaps the brain “recognizes” the face on some implicit level, and lights up when looking at one of the attackers and none of the others.  This method literally reads a person’s mind, gathering information that the victim may not have even been able to explicitly recall on his or her own.”

-Another potential use? Advanced versions of lie detection are a big area being pursued.  “Current lie detectors use biological cues to assess if someone is lying: pupil dilation, stress signals, and the like,” Rosen explains.  “The future of lie detection, some think, will be peering into the brain.  It might light up differently in the brain if you committed the action than if you watched it happen.” Indeed, two companies outlined in the video, Cephos and No Lie MRI, have already capitalized on this trend. And who would stop at criminal defense? “ I have two teenage daughters,” Paul Root Wolpe, the ethicist from Emory interviewed in the video jokes. “I come home one day and my car is dented and both of them say they didn’t do it.  Am I going to be able to drag them off to the local lie detection agency and get them put in a scanner?”

All of these techniques, Rosen says, could also lead to pre-emptive screening – if you could look into someone’s brain and see that they have “reduced glucose metabolisms, faulty amygdalas, disinhibition in the prefrontal cortex,” Rosen says, you might be able to better predict criminal behavior.  “You could require counseling, surveillance, G.P.S. transmitters or warning the neighbors,” Henry Greely adds, in Rosen’s article. “None of these are necessarily benign, but they beat the heck out of preventative detention…Even with today’s knowledge, I think we can tell whether someone has a strong emotional reaction to seeing things, and I can certainly imagine a friend-versus-foe scanner. If you put everyone who reacts badly to an American flag in a concentration camp or Guantánamo, that would be bad, but in an occupation situation, to mark someone down for further surveillance, that might be appropriate.”

Sound a little too much like Big Brother yet?  “I always tell my students there is no science fiction anymore,” Wolpe said. “All the science fiction I read in high school, we’re doing.”

Further Implications

Brain scans may be used in a variety of ways in the court of law; but more deeply, they raise some very important questions about the fundamental ways we understand ourselves. Will these brain scanning technologies enable us to see into the brain and predict, explain, and determine everyone’s behavior? If we are able to determine that we are just the biology of our brains–and not in control, in a sense, of what we do– then does that mean we don’t possess free will?  If we are just the biological substrates of our thoughts, are we really, in any meaningful philosophical sense, responsible for our actions?

In their article “For the Law, Neuroscience Changes Nothing and Everything,” Joshua Greene and Jonathan Cohen from Princeton University take the view that as neuroscience uncovers more and more about the inner workings of the mind, these technologies will provide us with a biological explanation for all human behavior, and that our conceptions of ourselves will be redefined as a result:

“At some time in the future,” they write, “we may have extremely high-resolution scanners that can simultaneously track the neural activity and connectivity of every neuron in a human brain, along with computers and software that can analyze and organize these data.  Imagine, for example, watching a film of your brain choosing between soup and salad.  The analysis software highlights the neurons pushing for soup in red and the neurons pushing for salad in blue.  You zoom in and slow down the film, allowing yourself to trace the cause-and-effect relationships between individual neurons – the mind’s clockwork revealed in arbitrary detail.  You find the tipping-point moment at which the blue neurons in your prefrontal cortex out-fire the red neurons, seizing control of your pre-motor cortex and causing you to say, “I will have the salad, please.”

Greene and Cohen continue:

At some further point this sort of brainware may be very widespread, with a high-resolution brain scanner in every classroom.  People may grow up completely used to the idea that every decision is a thoroughly mechanical process, the outcome of which is completely determined by the results of prior mechanical processes. What will such people think as they sit in their jury boxes?  Suppose a man has killed his wife in a jealous rage.  Will jurors of the future wonder whether the defendant acted in that moment of his own free will?  Will they wonder if it was really him who killed his wife rather than his uncontrollable anger?  Will they ask whether he could have done otherwise? Whether he really deserves to be punished, or if he is just a victim of unfortunate circumstances?

We submit that these questions, which seem so important today, will lose their grip in an age when the mechanical nature of human decision-making is fully appreciated.  The law will continue to punish misdeeds, as it must for practical reasons, but the idea of distinguishing the truly, deeply guilty from those who are merely victims of neuronal circumstance will, we submit, seem pointless.”

Indeed, with advancement in our understanding of neurobiology, and our ability to explain certain thoughts and behaviors based on activity in the brain, some predict a new type of defense argument emerges: “It wasn’t me, ladies and gentlemen of the jury. My brain made me do it” — in which a person is no more responsible for his or her actions than a car with faulty brakes is for an accident, says Stanford neuroscientist Robert Sapolsky.  And from this deterministic perspective, Cohen and Greene extrapolate a much broader philosophical shift:

“Free will, as we ordinarily understand it, is an illusion.”

Now, Greene and Cohen’s argument may appear to take neuroreductionism to its extreme – but an extreme that many neuroscientists, rationalists, and “science-can-explain-everything-ists” make the jump too as well.  What would this mean for our society, and for how we view ourselves?  It might mean that people could blame their behaviors on faulty brain wiring; that we could predict bad behavior from bad brains; that a person isn’t any more responsible for their actions than they are for having a defective heart or malfunctioning kidneys.  This, of course, would radically change the way we treat criminal behavior and the type of punishment we put forth, which as Cohen and Greene argue, would have to shift from a retributivist (punishing someone because they deserve it, from the point of view of justice) to a consequentialist one (punishing someone to prevent them from committing more crimes, from the point of view of utilitarian tradition):

“We maintain that advances in neuroscience are likely to change the way people think about human action and criminal responsibility by vividly illustrating lessons that some people appreciated long ago.  Free will, as we ordinarily understand it is an illusion generated by our cognitive architecture…  At this time, the law deals firmly but mercifully with individuals whose behavior is obviously the product of forces that are ultimately beyond their control.”

Another Perspective

Still, many challenge this presumption, saying Cohen and Greene’s argument, along with any other that presumes that behavior is caused soley by a mere brain state, confuses causation.  Emotions and decisions are not necessarily caused by the brain, resulting in behavior that “is obviously the product of forces ultimately beyond their control,” but rather may be created and then manifested in the brain; in other words, if the area of my brain lights up because of a decision I make, it is because I made that decision, not because my brain made it for me.  Rosen offers an example: “If you are told your mother has died,” he explains, “your dismayed comprehension of the fact, which is a subjective mental event, will cause an objective physiological change in your brain.”

Similarly, if someone commits murder out of rage, it may not be the brain that caused the rage, but rather a person who experienced rage and decided then to act on it.  In his article, “Does Neuroscience Refute Free Will?”  the blog writer Lucretius elaborates,

“To say that we are victims of neuronal circumstances is to say that we are victims of ourselves.  The underlying assumption is that we have no control over “neuronal circumstances,” just as we have no control over “external circumstances.” But this assumption (a newly bottled behaviorist assumption) entirely contradicts our knowledge that the brain is a self-organizing and self-regulating biological system, not merely a step in the transformation of some external stimulus to behavioral output.”  In other words, they assume we are not in charge of our own brains; that “our brains commit crimes,” But “we remain innocent.” This division is unfounded.  Our choices may elicit neuronal firing, not the other way around.”

Indeed, this jump to say that brain scans, because they show thoughts taking place then explain where those thoughts comes from, could be viewed as unfounded.  Brain scans and associated technologies, Matthew Crawford says, in his article “The Limits of Neuro-Talk,” don’t provide the evidence of how a thought is taking place, just that it is taking place: “With such signs (as fMRIs), we do not have a picture of a mechanism. We have a sign that there is a mechanism.” In other words, we are seeing that the brains works in a given way, not how or why.  Declarations of the denial of free will, when considered under this paradigm, naturally feel a bit overzealous.

But for a neuroreductionist who assumes that the brain is a force beyond on our own control, that we are pawns and our brains the players, the notion of free will is indeed an illusion.  But is this perspective reliable?  Are we really not in control of our thoughts and actions, and simply automatons acting out the neuronal messages of our brains?

Many recent findings in neuroscience would challenge this view, showing in fact that the brain is highly capable of being under one’s own control and amenable to conscious influence–that people’s conscious decisions have an effect on the way the brain functions and wires itself.  Indeed, the discovery that the brain has neuroplasticity – that it can be rewired based on experience, and that new neural pathways can be formed and old ones deconditioned based on one’s choices and practices — puts a big thorn in this “everything is determined” perspective.  In his book, “The Brain That Changes Itself,” Norman Doidge shows how much influence people have over their own brain patterns, citing research in which people overcome what were once thought to be unchangeable biological constraints — traumatic brain injuries, mental illness — by literally changing the structure and function of the neural networks in their own brains.  He chronicles stories of stroke victims regaining use of their limbs by using conditioning techniques to rewire their brains so that they can learn to control their limbs with new areas that weren’t subjected to neuronal death, people who overcome learning disabilities and even people who are missing entire portions of their brain as a result of injury or disease who are able to build new neural networks that allow them to function.  And all these examples beg the question: if we can control the outcome of our brains — if our brains are plastic, and amenable to biological restructuring based on conscious effort — then how could it be said that we don’t have responsibility for the actions we decide to take?  If we can control our brains, then aren’t we exercising a measure of free will?

To be sure, “neuroplasticity” is not a panacea for all brain impairments, and does mean that all activity of the brain can be shifted with conscious attention.  There’s no denying that certain brain pathologies — a damaged amygdala, or a tumor pressing on a part of one’s brain — can lead to irrational, unpredictable, and sometimes violent behavior, and that a person in this position may not be responsible for their actions in a strict sense, in the same way that someone who is criminally insane elicits different treatment by the law.  But does this mean that we should make the leap that Cohen and Greene make — that all behavior can be attributed to a similar uncontrollable brain activity?  I think to say that everyone who acts out of anger is free of blame because their amygdala is overactive seems to be confusing terms.  Many people feel anger and their amygdalas are activated accordingly, and still they don’t commit acts of violence or crime.  And Stephen J. Morse, professor of law and psychiatry at UPenn adds, “Even if (one’s) amygdala made him more angry and volatile, since when are anger and volatility excusing conditions?  Some people are angry because they had bad mommies and daddies and others because their amygdalas are mucked  up.  The question is: When should anger be an excusing condition?”  ”Brains do not commit crimes,” Morse says, making an interesting distinction. “People commit crimes.”

And still, one wonders why, even if we do identify the brain is “at fault” for causing criminal action, does it somehow justify behavior?   One view is that whether it was the brain or a person’s upbringing or the Twinkies that they ate in excess — it doesn’t even matter when it comes to responsibility for one’s actions. Morse says,

“So what if there’s biological causation? Causation can’t be an excuse for someone who believes that responsibility is possible. Since all behavior is caused, this would mean all behavior has to be excused.”

And the question remains, Do these pictures into the brain provide a biological excuse for behavior, or merely just a biological explanation for it?

How much do we really know?

The questions of free will and consciousness are deep philosophical debates that have been taking place for millennia, and will likely not soon be resolved. But with new technologies, whether they be a telescope or a brain scan, often come new views, perspectives, and philosophies about the world.  Trying to place what these technological findings tell us about the physical world into our philosophical frameworks is indeed a fascinating undertaking.

Are we in control of our own thoughts, actions, and lives, or is there some force that determines everything for us, regardless of our motives?  Is every action we take biologically predetermined, or do we have a say in which paths we go down? These questions are somewhat timeless, and yet  it’s interesting to see how technologies have reframed the debate.  To be sure, determinists believe they are finding strong ground to stand on with advances in neuroscience that everything to be explained about human beings will be explained through our understanding of the brain.  They see fMRIs as allowing us access into what we currently conceive of as the central part of our being – our brains – and project that these images will likely be the key to answering many questions about why we are the way we are, and why we act the way we do.  And why wouldn’t we, with the ability to see into our own brains, feel like we’ve finally gained access to the true answers of existence?  We once thought the heart to be the center of the human experience, and perhaps considered someone like Shakespeare most likely to articulate our human purpose.  Now, we live in the age of the brain, where we expect technology to show us, as Marcel Just says, ‘the essence of who we are.’

But new technologies often have a way of convincing us that we have finally figured out why things work the way they do, and we seem to cling to each technological development as if it is finally the one that will offer the answers.  An important question I would pose would be: How much can we really learn about a person from these technologies? And what happens if we assume we can know more than we really do?

Limitations to fMRI Technology

Though these scans are certainly amazing technologies that bring about much fruitful research, in general, we seem to currently overstate our ability their ability to reliably identify thoughts and patterns in the brain.  The scans are limited in and of themselves, from a technical standpoint, writes Norman Doidge: “The current generations of brain scans…detect bursts of activity that last one second in thousands of neurons.  But a neuron’s electrical signal often lasts a thousandth of a second, so brain scans miss an extraordinary amount of information,” he writes.  NPR’s Jon Hamilton adds that there a number of often undisclosed deficiencies with these scans, in his article, “False Signals Cause Misleading Brain Scans.” He interviews neuroscientist Chris Baker, who says, “The problem with functional imaging is that the signals we’re trying to get at are quite weak, and there’s a lot of noise.” And Hamilton adds: “The “noise” is in the form of false signals. These can come from the scanning equipment itself, but a lot of it comes from the person being scanned. Every heartbeat affects the flow of blood, which changes the signal. Every tiny head movement blurs the image.”

Bearing out this point, the scans can often pick up on signals that are inaccurate; one study at Dartmouth, to showcase this point, put a dead salmon in an fMRI scan, showed it pictures of emotional situations just like they would have a human subject (for humor’s sake), and recorded the results. Interestingly, the fMRI “picked up on signals” from the dead salmon’s “brain activity” — of course, when there was clearly no activity at all.  “By complete, random chance, we found some voxels that were significant that just happened to be in the fish’s brain,” the researcher Craig Bennett said. “And if I were a ridiculous researcher, I’d say, ‘A dead salmon perceiving humans can tell their emotional state.’”

So what does all  of this mean?  It means that there’s a lot of white noise, static, and unmeasurable (or perhaps even unknowable) activity in the brain that gets overlooked, dismissed, or unprocessed in the duration of a brain scan.  It means that these pretty pictures we see in magazines and articles may not be as easily color coded as we think they are.  It means that while we may be able to find the correlation for “screwdrivers” in the brain, we may be a long way from identifying that someone committed murder, that someone harbors terrorist-ideologies, or that someone “subconsciously” recognizes a burglar or rapist in a line-up.

But more importantly, it raises the question whether these technologies –or any technologies– are really capable of answering all our questions. We seem to have a tendency to like reductionist explanations for things, and to hear that science has proven something to be true and then to shut out other explanations for phenomena.  But this tendency can be a trap, particularly when our science is not as good as we claim it to be. And it also begs the question: are there aspects to being human that science can simply not explain?

Judging from the trend of neuroscience, nothing is off-limits for a scientific explanation — anger, romantic love, and even belief in God have been chalked up to nothing more than neurons firing in certain parts of the brain. (Indeed, every month, dozens of studies are published claiming to have found the areas of the brain responsible for various phenomena — “‘The God Spot’ is found in the brain,’ reads one article, “Watching New Love As It Sears In The Brain” reads another.)  A person falling in love is reduced to surging dopamine in the caudate nucleus, and belief in God is described as excessive firing of neurons in the temporal lobe.  Excessive rage that leads to murder is attributed not to some intangible motive of retribution or anger but to an overactive emotional center in the brain. And we tend to be transfixed by these findings, even if they are, when examined closely, extremely broad generalizations based on a limited amount of data.   We have a tendency to see explanations of things that invoke terminology about the brain as more convincing than other explanations, simply because, as Rosen’s article points out, “we have prettier pictures and it appears more scientific.”  In his article “Brain on Stand,” Rosen writes about our tendency to over-exaggerate our brain findings as being more meaningful than they are, calling it “Brain overclaim syndrome.”

The bright lights and science-looking pictures appeal to our inner rationalists; we believe articles that say things have been proven by brain scans simply because it seems so convincing, so solid, so technologically sound.A fascinating study published in the Journal of Cognitive Neuroscience showed that people are “seductively allured by neuroscientific explanations” for things, excessively more likely to believe data when it is preceded by the words “brain scans indicate,” even when the data or research findings are very obviously faulty or illogical. (In other words, present a person with two sets of data that say exactly the same thing, even if it’s not very believable, and they are much more likely to believe the data “proven” by brain scans.)  Crawford writes, “These findings suggest that we are culturally predisposed to surrender our own judgment in the face of brain scans. More generally, we defer to the mere trappings of “science.” We automatically assume the words “brain scans” assert some measure of influence, even if the findings go against our better judgment.  Essentially, we are seduced by the pretty pictures of brain scans, as we often are by new and exciting technologies.

What does this say about our tendency to see technology as the answer to all our questions, even at the expense of our own better judgments?  From a practical standpoint, what implications does this have for jurors in the courtroom, who are likely to be influenced by these pictures, much like the subjects of the study mentioned above? And more generally, what happens, one wonders, for a future where these technologies may be used to try to prove you are thinking something and you insist you are not, but the brain scans insist you are?  Will we come to trust technology more than we trust ourselves?

And more broadly, the question seems to be this: can we really make the jump from identifying basic item recognition to saying that these machines can read our “essences”?  Will these types of neuroscientific discoveries that help explain biological mechanisms of the brain necessarily lead to a comprehensive picture of consciousness?  Or are we overestimating our own technological capabilities, and our own abilities to use technology to really read something as complex as the mind? And furthermore, what are the risks to thinking we can predict behavior when we can’t? — in this assumption that our technologies will answer questions whose answers might be more complicated than we are giving them credit for?  What would happen if we start condemning someone for their “predispositions”, and not their actual actions?  If we start basing convictions of someone based on “subconscious recognition”?  The potential for harm, and for infringement on civil liberties, seems profound.

But perhaps the more interesting question is to consider why we trust science so much more than anything else.  In his influential essay, “The Question Concerning Technology,” the philosopher Heidegger argued that technology, by revealing the world through a technological framework, will increasingly shut out other ways of seeing the world — ways of understanding the world and ourselves through art, for example, or through the humanities.  Has this transition already taken place? Is it already impossible to see the world, and our place in it, through other ways than the technological and scientific?  By presuming these scans provide more reliable evidence of who a person is than his or her actual actions — by thinking they show the “essence” of who someone is, as Just says — are we concealing other aspects of the human condition that may be accessible only through non-technological avenues?

Jonah Lehrer presents this idea articulately in his article, “The Future of Science is…Art?”  where he writes about the limitations of viewing the world solely through a scientific lens, calling for a need for art to explain the things which science cannot:

“The standard response of science is that…art is too incoherent and imprecise for the scientific process. Beauty isn’t truth… If it can’t be plotted on a line graph or condensed into variables, then it’s not worth taking into account. But isn’t such incoherence an essential aspect of the human mind? Isn’t our inner experience full of gaps and non-sequiturs and inexplicable feelings? In this sense, the messiness of the novel and the abstraction of the painting is actually a mirror. As the poetry critic Randall Jarrell put it, “It is the contradictions in works of art which make them able to represent us—as logical and methodical generalizations cannot—our world and our selves, which are also full of contradictions.”

Great novelists like Virginia Woolf “have constructed elegant models of human consciousness that manage to express the texture of our experience, distilling the details of real life into prose and plot.  That’s why their novels have endured: because they feel true.  And they feel true because they capture a layer of reality that reductionism cannot.”

“The arts are an incredibly rich data set, providing science with a glimpse into its blind spots,” he adds. ”No scientific model of the mind will be wholly complete unless it includes what can’t be reduced.”

Lehrer’s point seems critical: does measuring one’s rising serotonin and dopamine levels in the caudate nucleus, associated in many studies with the feeling of love in the brain, truly capture the feeling a love in any meaningful way?  Don’t the volumes of Neruda’s poetry or a Shakespearean sonnet capture it better? Might a novel, a poem, a painting, even a simple conversation, provide more of a window into someone’s essence than a brain scan?  (“It is quite possible—overwhelmingly probable, one might guess—that we will always learn more about human life and personality from novels than from scientific psychology,” Lehrer quotes Noam Chomsky saying.)  Surely pictures of our brains can provide us with important and interesting information about ourselves, but can they explain everything, eliminating the need for all other modes of understanding?  Is there any room in this view of a person for the concepts of a soul, of a spirit, of a mind that is ethereal, and not purely biological?

So the very basic question underlying this whole debate might be summarized as follows: are we, or are we not, reduceable to scientific premises? Is there room for any other explanations for the human condition than scientific ones? And though a neuro-reductionist would say it’s only a matter of time until everything can be explained through that scan, my question is, is this true only if we accept it to be? Are we assigning technology this power, and  thereby deciding to shut off other ways of seeing human beings?

Conclusion

This issue, to me, has two layers: one is considering the actual implications of these technologies – in the court room, and in society—and the second is what this issue says about our quest to understand who we are, and about what science can explain, and what it can’t.

Cohen and Greene represent a reductionist view of the brain, thinking that we will be able to explain everything about how and why we behave the way we do through neuroscience, and that the law  – and how we hold people accountable for their actions –should be adjusted accordingly.

However, I am less convinced that we are far along the path of finding out where all motives and behaviors exist in the brain.  Instead, I identify with Matthew Crawford’s perspective in his article “The Limits of Neurotalk,” in which he calls for “Respect for the machine” saying “The human brain, everyone agrees, presents complexity that is simply colossal by comparison—by one estimate, the number of possible neuronal pathways is larger than the number of particles in the universe.”

Technology, it seems, always presents itself as the answer to all our questions; however, we may overinflate the ability of our technological tools to explain everything there is to know. Much like genetic determinists, neuro-reductionism is enticing as a way to explain, down to a basic unit, what a human being is and why he or she acts the way she does.  But many geneticists explain that learning more about our own biology has brought awareness not to its simplicity and reducibility, but rather to its immense complexity.  Though we once predicted that we would locate genes for all behavior, we have in fact identified, for the most part, single genes are not wholly predictive: rather, it is the complex interplay of many genes, along with the influence of environmental factors, that determine behavior — and even then it can be a total crapshoot as to how a person develops.  Two twin sisters with precisely the same genome can have vastly different “epigenomes” – one can develop cancer, while the other does not; one can be temperamental and angry, the other placid and calm.  An attempt to “standardize” our predictions of the brain and try to gain understanding based on what the lighting up on one person’s amygdala might mean and what the recognition of something might indicate will likely fail in trying to capture the brain’s immense complexity.  And an attempt to do so, particularly in these early stages of technological capabilities, I would worry, would probably result in more harm than good.

But more importantly, we might challenge the idea that science and technology can offer answers to all of our questions.  Lehrer writes:

“The history of science is supposed to obey a simple equation: Time plus data equals understanding.  One day, we believe, science will solve everything…But the trajectory of science has proven to be a little more complicated.  The more we know about reality – about its quantum mechanics and neural origins – the more palpable its paradoxes become.  As Vladimir Nabokov, the novelist and lepidopterist, once put it, “The greater one’s science, the deeper the sense of mystery.””

…”The fundamental point is that modern science has made little progress towards any unified understanding of everything. Our unknowns have not dramatically receded.  In many instances, the opposite has happened, so that our most fundamental sciences are bracketed by utter mystery.

Then concludes:

The epic questions that modern science must answer cannot be solved by science alone…The struggle for scientific truth is long and hard and never ending. If we want to get an answer to our deepest questions—the questions of who we are and what everything is—we will need to draw from both science and art, so that each completes the other.”

So the issue comes down to this: can we really reduce the brain to its component parts?  A person to his or her biological substrates?  Neuroreductionists would say biology is everything; there is no free will.  We are our biology: “all mental and behavioral activity is the causal product of physical events in the brain.”  As Marcel Just says in the video, “we are biological creatures, you know, our limbs we accept are muscles and bone and our brain is a biological thinking machine.” These scans, therefore, “ reveal the essence of who we are as a person.” Is this true — can science and technology ultimately explain everything there is to know about human beings? And if so, are we only a few technological advancements away from understanding the human condition – why we act the way we do, why we make the decisions we make – and from dispelling the notions of free will altogether?

I, for one, highly doubt it.  I reject the idea that science is the only portal through which to understand the human condition – leaving no room for the arts, or for philosophy, or other modalities of understanding.

As Lehrer points out in his article, “The sciences must recognize that their truths are not the only truths.  No single area of knowledge has a monopoly on knowledge.”

Technology and science seek to explain, to reduce, the human experience, down to the most basic unit of understanding, and often present themselves as the only ways of understanding the world.  But perhaps there are aspects of the human experience science cannot grasp; perhaps we cannot be explained in ‘basic units.’ Perhaps, as poet Wendell Berry says, “We should not mislead ourselves.  There is more to the world, and to our own work in it, than we are going to know.”

Questions

Consider the use of fMRI technologies in the courtroom: should we embrace the use of these scans for use in lie detection? In confirming eye witness testimony? In identifying “thoughts” when the person claims to be thinking or is saying something different?  In using them to “preemptively screen” who might commit criminal behavior? What do you think about more commercial uses for these scans, such as between parents and children, romantic partners, or employers and workers, for the sake of lie detection and thought identification?

What are some of the broader metaphysical implications of these technologies? Do you agree with Cohen and Greene that neuroscience refutes free will?  Will these scans explain everything there is to know about human beings, and reveal our “essences”? Or are there aspects to human beings that cannot be explained through the scientific and technological?  Do agree with Jonah Lehrer that we need art and the humanities to have a comprehensive picture of the human condition?  How do our views of technology influence this debate?

With the high availability of so-called “cognitive enhancing drugs” like Ritalin, Adderall, and Provigil on college campuses, students everywhere are facing the choice of whether or not to take non-prescribed medications to help them “perform better” in school. Studies show that anywhere between 20-35% of college students have used one of these medications without a prescription in their college career, but an informal survey would likely reveal an even higher percentage, as the use of these medications is on the rise.  Many claim these drugs help them concentrate, study longer, and juggle more tasks by creating more productive hours in the day.  Others rely on them in a crunch, during midterms, finals, or the night before a big test, when the clock is ticking and assignments are due, and there doesn’t seem to be enough time –or brain power–to get everything that needs to get done, done.

The question of whether to use these “cognitive enhancing drugs” poses many ethical concerns– some rooted in the very immediate and direct impact of these drugs on the developing brains of young people, and some rooted more in what these drugs say philosophically about the direction our society is headed in.  And with the rate of use tripling within the past ten years, along with the fact that dozens of new cognitive stimulants are currently in the pharmaceutical pipeline, it seems an important issue to examine.  Should we embrace the use of these drugs, in hopes of them making us smarter, more efficient, and more productive?  Or should we be wary of using them, concerned with the risks that they pose not only to our brains, but to our own personal and societal values?

I think before launching into the ethical arguments surrounding the use of these medications, it’s important to consider the context within which they are used, particularly on college campuses. Why do students feel compelled to take these stimulants, and why has there been such a boom in their use? What kind of environment fuels the perceived need for these medications, originally developed for disorders of attention, but now so widely used by the general public?

One idea to consider is the general trend our society is taking towards having attentional problems across the board.   Cognitive stimulants like Adderall and Ritalin were originally developed to treat Attention Hyperactivity Disorder, a disorder characterized in part by inattentivity, distractibility, and trouble staying focused; but in our era of technological multi-tasking, where everyone’s attention seems strained, are we all suffering from an attention deficit?

In his article “In Defense of Distraction,” Sam Anderson suggests we are experiencing a “crisis of attention”: and that “A quintessentially Western solution to the attention problem—one that neatly circumvents the issue of willpower—is to simply dope our brains into focus.”

Yet, no one needs an article or even an official decree from a psychologist to identify our deteriorating attention spans.  Just look around: most of us can hardly sit for any sustained period of time without checking our cell phones and our e-mail; we like things to be fast, and when they aren’t, we get frustrated. We expect instant communication and instant feedback; we even start getting antsy a few minutes into that YouTube video.  Our technologies have conditioned us to expect small bits of information, in quick surges, whether it be through Twitter, Facebook status updates, or one or two-sentence e-mail responses quickly transcribed on a Blackberry or iPhone. Even our news is increasingly transmitted in these small, quick packages. Across the board, technology is making things quicker and faster, causing us to spend less attention on each individual thing as we try to spend our attention on more things.

Indeed, we are currently experiencing an explosion of information in today’s “information age” where our cognitive loads are being challenged more than they ever have before.  Could this be said to drive the need for these medications? Just consider what an average student might be doing while trying to study: surfing the internet, checking e-mail, text-messaging, breezing through Facebook updates, listening to music, checking out a YouTube video and (let’s not forget) trying to study. With all of these inputs vying for our attention, with so much information to master, is it any wonder that we have a hard time staying focused?

Other factors surely contribute to this trend: the need for stimulants likely also stems from the immense amount of pressure students feel to get their work completed, in a time when school is more and more competitive, people are more high achieving, and there seems so much to do, and not enough time to do it in. Overwhelmed with school projects, balancing a social life, and the pressure to memorize all those Biology terms by your midterm can be daunting– sometimes, it might even seem impossible to get by without a little bit of help.  A student from a medical school chat forum went as far as to say it’s impossible to juggle school these days without the help of these drugs and live a normal life:

“The only people who get through the (med school) program I’m in either use stimulants or have no social life whatsoever. There is no other way. This is just the natural outcome of students being expected to memorize everything. The choice we’re being given is use drugs or fail.”

The pressure to juggle all of this academic pressure is certainly one driving force in the use of these drugs; but other students may use the medications less as a way to be a top, high-achieving student and more as a way to manage the day to day life of being in college, doing, well, everything college students do. In her article “Brain Gain” for The New Yorker Margaret Talbot interviewed a Harvard student with the pseudonym Alex, who said:

“I don’t think people who take Adderall are aiming to be the top person in the class…At the most basic level, they aim to do better than they would have otherwise.” He went on, “Everyone is aware of the fact that if you were up at 3 A.M. writing this paper it isn’t going to be as good as it could have been. The fact that you were partying all weekend, or spent the last week being high, watching ‘Lost’—that’s going to take a toll.”

Another student from the medical school chat forum chimed in,

“People use these medications because they’re lazy, and because they have no study habits. They’re a crutch for people who need a last minute way to get work done, fast.”

These examples seem to represent poles of a spectrum of students who take these medications – those who are seeking a high level of achievement and competitive edge, and those who are scrambling to get their papers done after slacking off all quarter – and of course, there is everyone in between, looking for a brain boost and a quick-fix way to get some help getting their work done.  In each case, the medication seems to offer a way of helping the student’s manage their workloads – including school, extra-curriculars, and even our attention-straining technologies – by giving them the opportunity to cram more work into their day.  But regardless of the reason, it is clear from the demand for these medications that there are people increasingly looking for ways to keep up – to pay attention, to stay on top, or even just to keep afloat.  And so the question one might ask, from an ethical perspective, is: “If there is a medication out there that might make it a little bit more manageable, why not take it?”

There are a number of arguments to consider when trying to address this question:

Are stimulants a tool for achievement?

In the scientific journal Nature in 2008, Director of The Center for Law and Biosciences at Stanford University Henry Greely and his colleagues published an article entitled, “Towards The Responsible Use of Cognitive Enhancing Drugs by the Healthy,” promoting the view that using medications like Ritalin and Adderall would allow us to become more focused, productive, and attentive, and that we should therefore embrace their use, not for people suffering from ADHD but for anyone who is looking for a cognitive kick.

“We should welcome new methods of improving brain function,” Greely wrote.  “In a world in which human work spans and life spans are increasing, cognitive enhancement tools – including the pharmacological—will be increasingly useful for improved quality of life and extended work-productivity, as well as to stave off normal and pathological age-related cognitive declines.  Safe and effective cognitive enhancers will benefit both the individual and society.”

“Why would you want an upper limit on the intellectual capabilities of a human being?” Nicholas Selzter, interviewed in Margaret Talbot’s article, adds.  “Think about the complexity of the intellectual tasks that people need to accomplish today.  If we had a tool to enable more people to understand the world at a greater level of sophistication, how can we prejudice ourselves against the notion?”

Indeed, some studies have demonstrated the benefits these drugs can provide.  Yesavage et al showed that pilots performed better during a month long trial of 5 mg of donepezil (Aricept, a stimulant) in flight simulation tasks, particularly in responding to emergencies. Other studies have shown that these drugs can, in some cases, help people learn better: “Amphetamines in small doses can promote neural plasticity and accelerate motor learning,” notes  Anjan Chatterjee, in his article “Cosmetic Neurology” and other stimulants have been shown to increase performance on memory and learning tasks.  Chatterjee poses the question, “Could they be used in normal subjects at the time of skilled motor learning, such as swimming, playing piano, or skiing, to increase learning potential?”

When Hank Greely presented his argument at Santa Clara last year, he put forth the idea that these drugs should be viewed as “tools” that can help people perform better, much like other tools we use to think better, for example, like a computer can serve as an instrument to help execute tasks more readily and efficiently and eyeglasses can help people see better. Some external tool that provides a leg up in studying, he says, is not much different from a medication that does the same thing; and if both can help us think, memorize, and perform better, than why close off the option of Ritalin just because it’s a “drug”?

“No one gets very worried if I enhance my eyesight by using binoculars, or if I enhance my memory using writing,” he said. “We don’t worry about “Google” as somehow an inappropriate enhancement.  We get more worried when we are changing our bodies and our changing our brains, but I’m not really sure we should be.  No one gets bent out of shape about the idea that people are using reading glasses as an evil enhancement because they are a tool.”

Greely suggests that we condone other types of “neural enhancement” with no moral problem. He writes, “research has identified beneficial neural changes engendered by exercise, nutrition, and sleep as well as instruction and reading…. cognitive enhancement drugs seem morally equivalent to other, more familiar enhancements.”

And later, puts forth the question directly: “Given the many cognitive-enhancing tools we accept already, from writing to laptop computers, why draw the line here (at giving medication), and say, thus far but no further?”

Greely’s argument essentially asks us to consider, why should influencing the brain directly using medication be considered different from using other external aids to help you study?

I think the argument is an interesting one, for it asks us to determine which technologies we consider appropriate to use to help us be more efficient and productive, and which ones we don’t.  Are we to view cognitive enhancing drugs merely as a tool that aids with a task like focus or memorization in the same way a tutor or making flashcards can help us memorize information?  And if these medications are merely a tool, should they be allowed in the same way students are permitted to use other types of study aids?  Should students come to rely on these medications with the same familiarity and comfort level that they rely on using a calculator on a math test?  Should they then be readily available to all students who want to use them?

His argument also raises the question, Why do we accept some forms of enhancement and not others?  Why do we condone a laptop or calculator as an appropriate tool, but not a medication? Does it have to do with the differences in their direct impact on the brain?  If so, then is there a moral difference between using a prescription medication and using large amounts of caffeine, which could elicit similar mental and physiological effects?

Another argument related to this idea of using stimulants as tools for achievement is whether it is “fair” for people to enhance their thinking using these drugs.  Is taking medications to achieve better simply another way to get one’s work done, or is it a form of cheating?

Would it be fair? Is taking a stimulant a form of cheating?

Do cognitive stimulants give an unfair advantage to some students over others?  Does it create an unjust environment where those who can afford or are willing to take the drugs are given an unfair leg up over those who don’t?  Is it “fair” that some students can afford to purchase such enhancements when others can’t?

In her article Brain Gain, Margaret Talbot writes,

“At many colleges, students have begun calling the off-label use of neuroenhancers a form of cheating. Writing last year in the Cavalier Daily, the student newspaper of the University of Virginia, a columnist named Greg Crapanzano argued that neuroenhancers “create an unfair advantage for the users who are willing to break the law in order to gain an edge. These students create work that is dependent on the use of a pill rather than their own work ethic.”

The question about cheating inevitably draws an analogy between using cognitive steroids to boost the mind and using steroids in athletic to boost physical strength. We generally acknowledge that using steroids in sports is unfair — it’s even illegal: so is doping our minds and different from doping our bodies?

Scientist Anders Sandberg says there should be no distinction, and that “cognitive doping” should be treated much like steroids are treated in sports: “If the goal of education is a competition for high grades, then the drugs would be a kin to doping and only add an unfair positional advantage to users…”

Yet others disagree, claiming that taking these medications is no different from other techniques students use to try to do better in school – invoking an argument similar to Greely.  One student writing about this topic said,

“Taking a study drug, while unhealthy and risky, should neither be considered illegal nor unethical…it’d be akin to saying studying for extra hours is somewhat unfair. How a person stays up has always been private business and varies person to person…Taking a study drug (should be) no more illegal than taking caffeine. Those who can afford to do more, get more. This is far from cheating, which is getting what you didn’t work for.  Debating whether drugs are fair is to debate whether we should compete at all.”

I think this argument is important to consider. Would the advantage given to those who are willing to take the drug be unfair over those who are unwilling to take the drugs? And would people start feeling coerced into taking the drugs if that was the only way to achieve at that level, much like athletes feel the pressure to take steroids in order to compete at the same level?  Extending it out, one might ask, what would happen from a distributive justice perspective if wealthy people have access to these cognitive drugs but people who can’t afford them don’t?  Would the gap between the rich and the poor widen?

Is there value in hard work that is undermined by using these drugs?

Another interesting perspective to consider is what role these drugs play in our conceptions of personhood. Have you ever had the experience of working so genuinely hard on something, and reaping the great rewards as a result of your genuine hard work?  Would this experience be undermined if you had relied on an artificial method of enhancement – a drug – in order to complete it?

Anjan Chatterjee’s article “Cosmetic Neurology” raises this concern, questioning what impact cognitive stimulants have on our concepts of character.  He takes the view that taking cognitive stimulants is indeed cheating, and therefore that taking these medications would erode our character. “Getting a boost without doing the work is cheating,” Chaterjee puts forth.  “And cheating cheapens us.”

Chatterjee also raises another interesting point, which is that these medications challenge the principle of accomplishing something on one’s own good will. Just like we don’t like it when athletes break records doped up on steroids, Chatterjee says, shouldn’t we hold the same judgment when someone “performs well” on a stimulant? We have long adopted the view that struggling builds character, and that eliminating pain altogether erodes that character.  In other words, the genuine hard work we put into things is important, and avenues that circumvent that hard work or augment them unfairly, undermines the entire achievement.  This issue seems particularly relevant in academia, where the analogy with steroid use in sports seems apt: would you respect a person less knowing they use a drug to enhance their thinking, much like we are disappointed by an athlete who engages in artificial enhancement?  If someone earns an A on a paper written on medication, are they as “worthy” of that A as they would be if they hadn’t taken it?

And one wonders, too, about the value of hard work, and whether it is lost in the midst of a stimulant-driven haze: is it really as valuable an experience to crank out a 10 page paper in one night on Ritalin as it is to work on it over time, sit with it, and truly learn from it?

Another question to consider in regards to personhood and values involves looking more generally at what types of thinking these medications encourage, and whether they are the types of thinking we want to be promoting. If we are to embrace the use of these drugs, then what value judgments are we placing on the idea that this type of alert productivity is necessarily the best type of thinking?

We automatically call medication that stimulates alertness “cognitive enhancement” – but should we?  It is well known that stimulants help people to focus, be more attentive, and more alert; yet, calling this type of thinking “cognitive enhancement” is not a technical term but rather a value judgment. Are there “cognitive trade-offs”  to these drugs — other valuable ways of thinking that these medications shut out? In creating a focused, attentive state of mind, what cognitive capacities might these drugs be undermining?

Indeed, many neuroscientists suggest that in promoting this type alert, “efficient” thinking, other types of thinking are de-emphasized in the brain.  Talbot notes:

“Cognitive psychologists have found that there is a trade-off between attentional focus and creativity. And there is some evidence that suggests that individuals who are better able to focus on one thing and filter out distractions tend to be less creative,” adding, stimulants “facilitate a pinched, unromantic, grindingly efficient form of productivity.”

Jonah Lehrer, a neuroscientist and author of “How We Decide,” adds that these cognitive stimulants can negatively impact creativity and prevent the type of thinking that leads to insightful breakthroughs.  To achieve better focus, he says on his blog The Frontal Cortex, there can be a trade off of more creative ways of thinking:

“While it’s commonly assumed that the best way to solve a difficult problem is to focus, minimize distractions, and pay attention only to the relevant details, this clenched state of mind may inhibit the sort of creative connections that lead to sudden breakthroughs.”

Many students may relate to this point: those who take these medications talk about how the papers they write on Ritalin or Adderall are long-winded, and obsessive about certain points, perhaps indicating this certain type of thinking that these drugs emphasize over others.  The student Alex interviewed in Talbot’s article said, “Often, I’ve looked back at papers I’ve written on Adderall, and they’re verbose.  They’re belaboring a point, trying to create this airtight argument, when if you just got to your point in a more direct manner it would be stronger.  With Adderall I’d produce two pages on something that could be said in a couple of sentences.”

So, while these drugs may help with memorization and focus, are they limiting the type of thinking that can enhance analysis, creativity, and open-mindedness? Might a student, in thinking they are creating better work on stimulants, actually be cutting themselves off from different, more creative ways of approaching their assignments?  And what does it say about a society that is placing value on shutting out these more creative types of thinking, in favor of what Talbot calls “a grindingly efficient form of productivity?”

One wonders if in trying to gain one type of thinking, we would be losing out on another.  Hasn’t everyone had the experience of a stroke of insight while falling asleep or taking a shower – times when the mind is not “pinched and attentive”, but precisely the opposite?  What effect would medicating the “wandering mind” have on insights that come precisely because the mind is wandering?

Do the risks justify the gains?

A final point to consider is the risks these drugs pose, which are an important feature to examine when looking at any technological tool. Indeed, the argument that stimulants could benefit society should not be presented without a fair look at how they could also limit or pose a risk to society as well.  So do the risks of these medications justify the gains?

It is generally accepted that there is a difference between therapy and enhancement — in other words, that there is a moral difference between giving someone a treatment to alleviate suffering caused by a disease and giving someone treatment when they are healthy in order to make them even better. For those who take these medications for attentional disorders, the risks of these medications are considered in balance with the disorder the person is suffering from; one assesses the risks of the medications with the severity of symptoms of ADHD and decides that it is worthwhile to manage the side-effects if the medication alleviates the symptoms of the disorder. But if we proliferate these medications to the general “healthy” public, are the potential benefits of alertness and attentiveness –which don’t necessary to alleviate suffering in any strict sense but are rather just a preferred or “enhanced” way of functioning– worth the potential harm?  Is it ethical to take these drugs, intended to treat disorders, purely for the sake of enhancement?

Another idea to consider is at what cost we are willing to enhance ourselves — and whether we accurately assess that cost when pursuing new modes of enhancement.  It seems that often when looking at new technologies the potential benefits are lauded and the risks are downplayed, and this issue is no different. Hank Greely’s argument, for example, suggests that we shouldn’t necessarily view Adderall and Ritalin any differently from the way we view glasses that correct our vision: what makes them different, if they are both tools to make us better?

The somewhat obvious response to Greely’s argument is that there are potentially far greater risks to taking these medications than there are to using eyeglasses, or a laptop, or calculators.  Indeed, stimulants known side effects include nervousness, headaches, sleeplessness, decreased appetite, and cardiac problems, and are classified as having a high potential for abuse.   Increased risk of ideations of suicide, as well as increased cases of cardiac arrest that have led to death have been reported, and have led to the FDA instituting a “black box” warning on most stimulant medications.  Many students who take these medications experience abnormal sleep and eating patterns, some not sleeping or eating anything substantial for long periods at a time, and can experience increased anxiety and even stimulant-induced psychosis.  And while some who use stimulants casually do so with few side effects, these more serious effects should not be overlooked: for those students who have experienced them, or for parents whose children suffered cardiac deaths or suicide, these effects are not exaggerated or embellished but very real, and important to bring to light.

There  seems to exist a view, both because the medications are so popular and because they are not “street drugs” but prescription drugs, that these medications are generally safe to take without one’s own prescription; but this is a powerful misperception. Indeed, prescription medications are not safe merely because they are available through prescription; drugs, prescribed or not, carry with them risks and side effects that can vary from person to person, and in some cases may have drastic effects.  Furthermore, taking a prescription medication for which you yourself don’t have a prescription –sharing a prescription with a roommate, or selling pills at the library– can be a dangerous undertaking, particularly when mixed in with a college lifestyle of alcohol and perhaps even other drugs. The toxicity of stimulants increases significantly when mixed with alcohol; and without a proper discussion with a doctor, a student is at risk to experience these dangers without a proper avenue set up to assess his or her own safety.

Moreover, if we are to advocate the proliferation of these drugs in the widespread population, we must acknowledge that the effects of cognitive stimulating medications in the healthy has never been formally studied.  We simply don’t know how these drugs are metabolized by these “healthy,” non-ADHD individuals, for whom these stimulants were unintended and remain untested.  And given that we are essentially the first generation of people who are using these medications so widely and for such long periods of time, the long-term risks are still unknown.   As Margaret Talbot writes, the effects of these drugs are being discovered “furtively, amongst the increasing number of Americans who are performing daily experiments on their own brains.”

So where do the risks of these drugs factor into the ethical debate? And in light of these issues, it seems important to ask, it is ethical to present the idea that these medications can be a tool for an achievement without acknowledging these very real drawbacks?  Advocating the use of these drugs based on the premise that there is no substantive difference between them and a laptop or a pair of eyeglasses, particularly in a school setting, seems not only misinformed, but irresponsible.  And one wonders, what impact does promoting these drugs as simply “tools for achievement” without a full acknowledgement of these risks have on a student’s perceptions of taking these medications?

Ultimately, is the argument really simply between choosing to take these medication to become “smarter”, and choosing not to take them and staying the same?  Or should it really be presented as a cost-benefit, where the idea of taking these medications to achieve attentiveness and focus is posed alongside the potential for these very real side effects?

Each of these issues – what effect these medications would have for academic competition, what effects they might have on concepts of personhood and thinking, and what the risks are, converges on one question: What might a neuro-enhanced society look like?

If Greely and others are to be believed, we have the opportunity to become smarter, more productive, and more focused by embracing the use of cognitive stimulants.  Why try to do less, when we could medicate ourselves to be able to do more?  Who, as Nicholas Selzter said, would want an upper limit on productivity?

Yet from a critical perspective, consider some of the potential fall out: might we imagine a time when employers expect—or even require – employees to take these drugs to achieve better? Could hospitals require doctors to take drugs in order to be more alert on their late night shifts?  Pilots to take the drugs for long trips?  Would the people undergoing surgery, or flying on the planes, come to expect these professionals to take them as well? Could it lead to an environment where students feel coerced or compelled to take drugs to perform better, in the same way some athletes may feel compelled to take steroids to keep up with competition?  Would we live in a society where, as Margaret Talbot writes, “we give children academic steroids along with their daily vitamins”?

The idea that we need to ‘enhance’ ourselves is certainly a persuasive one: it is clear we have increasing demands not only on our cognition but on the amount we are physically expected to accomplish in a given day — and it makes sense that we would feel the drive to need to keep up.   But as Paul McHugh, a psychiatrist at Johns Hopkins says in Talbot’s article, “Maybe it’s wrong-footed to fit people into the world, rather than trying to make the world a better place for people.”

A perspective to consider is this: to what future are we committing ourselves?  If we continue the effort to achieve, accomplish more, produce more, compete more, the cycle of needing to modify our brains to keep up will continue. It’s almost certain that in ten years from now, the debate will have moved on from the ethical issues of cognitive stimulating medications to the ethical implications of brain implants, or other types of even more invasive brain modifications. Will we want to continue the road to increasing our brain function indefinitely, to keep up with our own technological demands?  Is there a point at which we should decide we are busy enough, productive enough, and smart enough now?   In reality, the expectations placed upon students and those in the workplace – the demands for a non-stop, blackberry fueled workday, or the barrels of homework on top of extra curricular activities and day-to-day life – will only continue to grow if we as a society allow it too.  And our pursuit towards keeping up – whether it be with medications now, or brain implants down the line–will have to continue as well.

I would argue that the use of cognitive stimulants – a technological tool in and of themselves– is intricately tied to our relationship with the increasing use of technology in all areas of our lives, and that to look at the issue of “cognitive enhancement” one would need to examine what effect all of this technology could be said to be having on our lives in general: on our attention spans (those attention spans which we feel compelled to take pills in order to get a handle on); on the belief that a better society is one that is more productive, efficient, and fast; and on the idea that if we can do something, we can always do it faster, and better.

I think Talbot makes an interesting point in her article, about what road we may be paving for ourselves:

“All this may be leading to a kind of society I’m not sure I want to live in,” she writes. “A society where we are even more overworked and driven by technology than we already are and where we have to take drugs to keep up.”

Conclusion

As technology continues to develop, more medications that can influence our brain chemistry –and eventually, more technologies, whether they be brain implants or currently inconceived of brain modifications — will be marketed as the next big thing in cognitive enhancement.  One could either say these scenarios present an opportunity to create more advancements using technology, or take the view that we have created a problem through technology that we are trying to solve using more technology.  Either way, it seems important to establish firm ethical guidelines about how we are to handle these issues.  If not, the use of these technologies will continue to be dictated by social pressure, rather than by principle.

It’s hard to separate out the “ethical” uses of these drugs form their neurological risks; the philosophical principles raised by this issue– as with many issues in technology and health — are somewhat separate from the real life risks these technologies pose. I think it’s important to acknowledge though, particularly in light of articles such as Greely’s which praise “smart drugs” but somewhat dismiss their risks, that the use of cognitive stimulants amongst people – amongst children, students, and those in the workplace– is an ongoing, uncontrolled experiment.   And moving forward, it seems important that we frame the argument appropriately.  Cognitive stimulants are not “smart pills”– indeed, no one takes Ritalin and becomes Einstein, or learns their entire Biology textbook instantaneously.  Rather, cognitive stimulants are drugs that manipulate brain chemistry in a way that, in many people – but certainly not all – increases their ability to focus and pay attention, and often to sleep less and work more.  Choosing to encourage the use of these medications is not promoting becoming “smarter,” necessarily, but promoting a type of brain state associated with these effects, among other, less desirable ones as well.

But the question at hand is not merely about whether students, or people in general, should take drugs to become “smarter.”   Perhaps the question we should be asking ourselves is whether the pursuit of these “cognitive enhancing drugs” would really be enhancing our lives at all.  Might we look deeper into this debate, and challenge some of the assumptions upon which it rests?  Maybe we should challenge the idea that these drugs are enhancing the way we think, by making us more alert and more “grindingly efficient.”  Maybe we should challenge whether this type of uber-efficient, speed-driven, hyper-productive society is really the type of society we want to be promoting.  Maybe we should focus not so much on the question of whether students should take these medications, but on where the perceived need for these medications arises — on what it says about an academic environment where there is so much pressure to focus, to be more productive, and to get more work done that students feel they need medications just in order to keep up.  Maybe we should reframe the debate, and ask ourselves whether it is our conception of what it means to be “enhanced” that is really what needs to be modified.

Questions

Consider some of the ethical arguments surrounding the issue of cognitive stimulants: is taking a cognitive stimulant without a prescription unethical?  Does it constitute cheating? Should it be viewed as “cognitive doping,” akin to using steroids in athletics?  Does it undermine one’s ‘personhood’ by helping one to avoid the challenges of discipline and failure? Do the risks of the medications justify the gains?

What role do societal pressures — academic, social, and technological — play in this debate? How does our relationship with technology factor into our approach to the use of cognitive stimulating medications?

Watch a CBS News segment called “Adderall U” featuring an interview with two students who take cognitive stimulants:

Part 2:

It’s interesting to consider how we decide what the rules are about which drugs are deemed socially acceptable and which ones are not.  We condone (not only condone, but actively rely on) certain substances like caffeine, guzzling down cups of coffee and cans of Red Bull without a second thought about their “ethical implications.”  We condemn marijuana as illegal but allow a much more dangerous drug – alcohol – to be consumed at will after the age of 21.  We think it’s permissible to use coffee and chain-smoking cigarettes to pull an all nighter to complete work but would gape at someone snorting a line of cocaine for the same reason.  How are these lines we draw–the ones that call a certain brain-altering substance taboo and another one completely embraceable– determined?  Do they involve a careful assessment of their effects on the brain?   A standardized measure of risks?  Do they come from some subjective evaluation grandfathered in by socially determined forces?

I raise this point because this post is a response to an article from the scientific journal Nature published in 2008 called “Towards The Responsible Use Of Cognitive Stimulants In The Healthy,” an article which gathered together reputable academics from elite institutions across the country and declared that cognitive stimulants like Adderall and Ritalin should not only be permissible to use in the normal, healthy population, but that their use should be encouraged.  A society of individuals taking these cognitive stimulants would be more smarter, more efficient, and more productive, they said, and therefore we shouldn’t shy away from these drugs, but should embrace them.  The article states:

“Cognitive enhancement has much to offer individuals and society…We should welcome new methods of improving our brain function.  In a world in which human work-spans and life spans are increasing, cognitive enhancement tools – including the pharmacological—will be increasingly useful for improved quality of life and extended work productivity, as well as to stave off normal and pathological age-related cognitive declines.”

Hank Greely, a law professor who directs the Stanford Center for Law and the Biosciences and spearheaded this article, makes the point firmly: If we can manage the risks of these medications, he writes, why wouldn’t we pursue a future of widespread “cognitive enhancement”? A future where we could be smarter, more focused, and more alert?  And admittedly, when put this way, Greely’s argument sounds pretty convincing: no one can deny that being smarter and thinking faster would be a net-net gain for our society.

But maybe that’s a faulty assumption.  As with any ethical issue, there is a powerful counter-side to consider to this “faster = smarter = better” paradigm.  In his guest post below, Santa Clara Graduate Psychology adjunct lecturer Dr. Sean Hatt challenges Greely and his colleagues conclusions, outlining a number of reasons why the encouragement of these drugs is a worrisome path to head down.  Indeed, these so-called “smart drugs” are not a panacea for our wandering minds; they come at a real cost, a cost that Greely’s article, one could say, blithely glazes over and ignores.  The risks and effects of these medications can be substantial, particularly for the young populations who take them (one study even found increased death rates in children); and in ‘focusing’ our minds, the use of these drugs can stifle more creative types of thinking.

Dr. Hatt also raises an important question about what promoting these medications says about the types of values we are fostering as a culture.  Is advocating for drugs that enable people to do everything faster and more efficiently really cultivating the type of human beings we want to be? Read his post and consider the idea: what is the symbolic meaning of the pursuit of cognitive stimulants?  What does it say about who we are as human beings, about what we want, and what we value?  Why do we consider these types of drugs – which Margaret Talbot described as facilitating “a pinched, unromantic, grindingly efficient form of productivity,” cognitive enhancement?

Dr. Sean Patrick Hatt is an adjunct lecturer in the Graduate School of Education, Counseling Pyschology, and Pastoral Ministries at Santa Clara University.  He wrote his doctoral dissertation on the social construction of Attention-Deficit/Hyperactivity Disorder in Poor African American And Affluent White American Families, which can be read on his website, www.seanpatrickhatt.com.

Cognition Enhancing Drug Use: Sacrificing Depth for Speed

Guest Blog Post by Sean Patrick Hatt, Ph.D.,

Department of Counseling Psychology
Santa Clara University

As a scholar and clinician interested in the social construction of Attention-Deficit/Hyperactivity Disorder as well as other mental illnesses more generally, I was asked to render a brief opinion regarding the use of prescription stimulants like Ritalin and Adderall by otherwise healthy people simply for the purpose of getting better grades, or working faster or more efficiently.

At the surface, it seems fairly benign. After all, we have been giving these drugs to our young school-aged children for decades to help stem disruptive behaviors or address difficulties in focusing attention in the classroom. In fact, the National Institutes of Mental Health (NIMH) recently published research touting the possible efficacy of stimulant medication in children as young as three years of age (Greenhill, et al., 2006).

That all makes it understandably easy for people to wonder how dangerous these drugs could possibly be. And, if they do promise to help healthy, responsible, intelligent people get far more work done, more quickly and with fewer distractions, what’s the harm? How different is this from drinking coffee or an energy drink?

If you find yourself nodding in agreement as you read, you have company in some very reputable places. In a recent issue ofNature, which is widely recognized the world over as one of our more prestigious scholarly publications, clinicians and scholars from Harvard Medical School, Stanford University Law School, the University of Cambridge, the University of Manchester, UC Berkeley, and the University of Pennsylvania collaborated on an article advocating the “responsible use of cognitive enhancing drugs by the healthy” (Greely, et al., 2008).

Greely's Article, From Nature

While exploring the question is almost certainly a worthwhile endeavor, this article, and the idea it seeks to advance, concerns me for a number of reasons, particularly given its rather authoritative status. Acknowledging the brevity of this forum, allow me to elaborate upon three of them, and then offer another way of thinking about this issue.

First, the article frames the subject in terms that scarcely anyone would take issue with. Who wouldn’t support “cognitive enhancement?” After all, isn’t that why people attend a University in the first place? I believe special care should be taken to employ more neutral language to frame a debate like this so as not to unduly bias the conversation, or even marginalize dissenting voices before they can be heard. As a community of teachers and researchers, let us respect the power inherent in our positions as constructors of new knowledge, and take particular care not to unintentionally cloak what may be a wolf in a sheep’s clothing.

This brings me to my second point: The article barely acknowledges the potential health risks of taking the drugs in question, and only touches upon the topic in rather general terms. In my opinion, this only serves to further support the apparently innocuous nature of this proposal.

These are powerful pharmaceuticals that carry a long list of potentially serious risks, particularly in young people with still-developing brains

Allow me to fill in the blanks on this latter point with a few specifics. In spite of their seemingly ubiquitous presence, drugs used to treat ADHD are not at all similar to the caffeine in coffee or energy drinks. These are powerful pharmaceuticals that carry a long list of potentially serious risks, particularly in young people with still-developing brains. Adverse drug reactions in stimulant formulas include impaired growth (Swanson, et al., 2007), insomnia, agitation, hypomania, mania, seizures, physical withdrawal, rebound effects, dependence (Breggin, 1999a, 1999b), and even psychosis (Breggin, 2000). Non-stimulant formulas also present safety problems, and their manufacturers were recently ordered by the United States Food and Drug Administration (FDA) to include a “black box” warning regarding the potential for increased suicidal ideation in adolescents (Carey, 2005). The black box was also subsequently ordered by the FDA for some popular stimulant formulas given an increased risk of sudden death (Pettypiece & Blum, 2006).

Third, the article focuses upon only one family of “enhancements” as if they are all that might be possible or desirable—speed, memory and attention. It makes this idea sound every bit as simple as upgrading to a new computer with a faster microprocessor, more RAM and a bigger hard drive. A growing minority in the scholarly community who have been studying the legitimate therapeutic uses of a variety of other psychoactive substances—like MDMA (Parrott, 2007) for example—would have much to say about this limited definition of enhancement. If the scholarly community at large wishes to open the question of the legitimacy of “cognitive enhancement through drug use” for a comprehensive hearing, why not include these substances and what they may offer as well?

I raise that potentially controversial point as a way of leading into what for me is the heart of the matter. It’s not about advocating for all drugs equally. It’s about questioning what this says about our culture. Should we allow the pharmaceutical industry, corporate-owned media, allopathic medicine, the academy, and the Law decide for us what is worthy of enhancing and the means by which we should seek to do so?

Allow me to explain further. Greely and colleagues (2009) talk briefly about the issue of fairness, which I think is salient here, but mainly as a means of focusing in upon this deeper thread of the conversation. Specifically, they compare the use of cognitive enhancing drugs by some students and not others with the notion of some being allowed to use calculators on a math exam while others are limited to pencils and scratch paper. Further, they wonder how this divide might show up as a function of access given socio-economic status. Whatever the case, the authors imply that allowing the use of cognitive enhancing drugs by some may amount to a form of indirect coercion whereby students feel they have no choice but to take the drugs in order to compete. While those are all worthy points from both sociological and psychological perspectives, this begs an even more fundamental question the authors fail to address: Compete for what, and to what ends?

Paul Tillich (1999) framed a convincing case that our culture increasingly tends to overemphasize what he called  “the horizontal dimension” of life. I see this showing up in how we relate to our world as a place filled with objects that are separate from us—including, ironically enough in this case, our own brains. These detached objects exist only to be exploited, acquired, shaped, produced, controlled or manipulated, with ever more efficiency, and for ever increasing personal gain.

The result of unconsciously proliferating such cultural practices is a loss of the dimension of “depth” in our discourse and in our lives

The result of unconsciously proliferating such cultural practices is, sadly, a loss of the dimension of “depth” in our discourse and in our lives. Tillich (1999) maintains that losing depth amounts to a disconnection from Spirit at the most universal level: namely, “the ability of man to ask passionately the question of the meaning of our existence.” To my mind, that’s where an education at a place like Santa Clara University strives to set itself apart, and often does. So the question for me becomes, “Do we want to risk losing that?”

I’m not suggesting that we ought to ignore the acquisition of skills and excellence in academic performance in the “horizontal” sense of their meaning in the world. What I am suggesting is that we needn’t emphasize or “enhance” them at the expense of students’ concerns for their own Being, or the state of Human Being more broadly.

In my opinion, that is the hidden price tag attached to “cognitive enhancement” as long as it’s all about speed—both literally and more symbolically.

In closing, the awe inspiring opportunity which lies before each of us is to creatively and authentically engage the tension between the horizontal and the deep, to the best of our God-given abilities, as professors and students and staff alike. When we do, we will co-create an education that develops heart and mind, body and soul, cognitive power and depth of feeling, efficiency and creativity. Best of all, such an education will en-courage us all to embody as a whole community what I have come to understand as foundational values of the Jesuit tradition: the sacred union of intellect, wisdom, skillful means, and love, as expressed in service to all of Humankind.

Now that is the sort of enhancement I can fully support.

References

Breggin, P. R. (1999a). Psychostimulants in the treatment of children diagnosed with ADHD: Part 1–Acute risks and psychological effects. Ethical Human Sciences and Services, 1(1), 13-33.

Breggin, P. R. (1999b). Psychostimulants in the treatment of children diagnosed with ADHD: Part II–Adverse effects on brain and behavior. Ethical Human Sciences and Services, 1(3), 213-242.

Breggin, P. R. (2000). Confirming the hazards of stimulant drug treatment. Ethical Human Sciences and Services, 2(3), 203-204.

Carey, B. (2005). F.D.A. orders new warning on Attention-Deficit drug. The New York Times.com. Retrieved from http://www.nytimes.com/2005/09/30/health/30drug.html?ex=1157169600&en=a11a780cbe726cd4&ei=5070

Greely, H., Campbell, P., Sahakian, B., Harris, J., Kessler, R. C., Gazzaniga, M., et al. (2008). Towards responsible use of cognitive-enhancing drugs by the healthy. Nature (December 2008), 702-705.

Greenhill, L. L., Kollins, S., Abikoff, H. B., McCracken, J. T., Riddle, M., Swanson, J. M., et al. (2006). Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 45(11), 1284-1293.

Parrott, A. C. (2007). The psychotherapeutic potential of MDMA (3,4-methylenedioxymethamphetamine): an evidence-based review. Psychopharmacology, 191, 181-193.

Pettypiece, S., & Blum, J. (2006). Glaxo, Shire stengthen risk warnings on ADHD drugs. Bloomberg.com. Retrieved from http://www.bloomberg.com/apps/news?pid=20601085&sid=alBMR22v6xpI&refer=europe

Swanson, J. M., Elliott, G., Greenhill, L. L., Wigal, T., Arnold, L. E., Vitiello, B., et al. (2007). Effects of stimulant medication on growth rates across three years in the MTA follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 46(8), 1015-1027.

Tillich, P. (1999). The essential Tillich: an anthology of the writings of Paul Tillich. Chicago: University of Chicago Press.

Questions:

Professor Hatt raises important critiques about Greely’s article, highlighting the oft-downplayed risks of the medications, and asking a more fundamental question about what the pursuit of these drugs says about our culture, in which we are emphasizing competition and speed while not promoting other parts of being.  Do you agree with him that these medications promote one type of ‘being’ at the expense of others?  What types of thinking — of being — are de-emphasized as a result of these medications?

Considering both Greely’s and Dr. Hatt’s arguments, do you think the use of cognitive stimulants by the general public would benefit or detract from society?

“Neuroscience is a rapidly evolving field in which anatomy, physiology, chemistry, genetics, neurology, psychology and psychiatry, have united…The brain sciences can chart the intricate cellular changes that affect and reflect behavior. They can go further to pinpoint where and how thought, affection and action arise and respond to environment and external stimuli…

“Bioethics has simply not caught up with this rapidly expanding field of study. Although philosophers have reflected on the meaning of mind and consciousness, in light of neuroscience, they rarely engage the ethical implications of advances in the neurosciences.”

The Technological Citizen is a forum to explore and exchange ideas about the issues that arise from modern technologies. A wide variety of topics will be explored, including the ethics of cognitive enhancement, genetic testing, and biotechnologies, as well as the way in which technology impacts our relationship with other people, the environment, and ourselves.

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