Who decides what’s right, what is socially appropriate, and what is societally acceptable when it comes to the use of things that alter your brain function?
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 (some have even been found to cause death 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).
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.
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.
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?
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