Cognition-Enhancing Drugs: Can We Say No?

A recent book on health care rationing in the US, Can We Say No?, worries that political pressures for health spending will ultimately bankrupt the US economy. This idea of a spending ratchet is a commonplace of the health care finance literature. Less well-covered has been a creep toward performance-enhancing drugs. Though less of a threat to the public till, they raise fundamental questions about individuals' capacity for autonomous reactions to technological trends.

Consider a recent discussion in Edge, a fascinating online salon/magazine which asked 151 luminaries "What Will Change Everything"? Marcel Kinsborne predicts a growing market for "neurocosmetics" which translate the benefits of cosmetic surgery to the social world:

[D]eep brain stimulation will be used to modify personality so as to optimize professional and social opportunity, within my lifetime. Ethicists will deplore this, and so they should. But it will happen nonetheless, and it will change how humans experience the world and how they relate to each other in as yet unimagined ways. . . . We read so much into a face — but what if it is not the person's "real" face? Does anyone care, or even remember the previous appearance? So it will be with neurocosmetics.

Consider an arms race in affability, a competition based not on concealing real feelings, but on feelings engineered to be real. Consider a society of homogenized good will, making regular visits to [a] provider who advertises superior electrode placement? Switching a personality on and then off, when it becomes boring? . . .

We take ourselves to be durable minds in stable bodies. But this reassuring self-concept will turn out to be yet another of our so human egocentric delusions. Do we, strictly speaking, own stable identities? When it sinks in that the continuity of our experience of the world and our self is at the whim of an electrical current, then our fantasies of permanence will have yielded to the reality of our fragile and ephemeral identities.

It's one thing to read these imaginings in the fiction of a Houllebecq, Franzen, or Foster Wallace; it's quite another to see them predicted by a Professor of Psychology at the New School for Social Research. I have also predicted an arms race in the use of personality optimizing drugs, but I believe such an arms race would defeat, rather than reveal, humanity's true nature. My difference with Kinsborne suggests a technophilic bias at the heart of Edge's inquiry: an implicit belief that certain technologies will inevitably change us, rather than being changed or stopped by us.

We need to understand that it's a conception of the self that is driving the acceptance of new technologies of self-alteration here, rather than vice versa. Consider eHarmony consultant Helen Fisher's acceptance of the arms arms race metaphor in the same issue of Edge:

As scientists learn more about the chemistry of trust, empathy, forgiveness, generosity, disgust, calm, love, belief, wanting and myriad other complex emotions, motivations and cognitions, even more of us will begin to use this new arsenal of weapons to manipulate ourselves and others. And as more people around the world use these hidden persuaders, one by one we may subtly change everything. [emphasis added]

In a recent editorial in Nature entitled Towards responsible use of cognitive-enhancing drugs by the healthy, distinguished contributors have endorsed a "presumption that mentally competent adults should be able to engage in cognitive enhancement using drugs." Against various Luddites who worry about the rat races such drug use could spark, the editorialists argue that cognitive enhancement is here to stay: "From assembly line workers to surgeons, many different kinds of employee may benefit from enhancement and want access to it, yet they may also need protection from the pressure to enhance." Instead of the regulation encouraged by Francis Fukuyama, they would have us rely on robust professional standards to guide "appropriate prescribing of cognitive enhancers."

But it's easy to see where this arms race can lead. Perhaps at some point we'll all end up like those apostles of reductionist philosophy Patricia and Paul Churchland, who, rather than acting out, expressing, or displaying emotions, appear to prefer to refer to their supposed chemical determinants:

One afternoon recently, Paul says, he was home making dinner when Pat burst in the door, having come straight from a frustrating faculty meeting. "She said, 'Paul, don't speak to me, my serotonin levels have hit bottom, my brain is awash in glucocorticoids, my blood vessels are full of adrenaline, and if it weren't for my endogenous opiates I'd have driven the car into a tree on the way home. My dopamine levels need lifting. Pour me a Chardonnay, and I'll be down in a minute'."

Nicholas Carr has noted that "institutionally supported programs of brain enhancement [may] impose on us, intentionally or not, a particular ideal of mental function." Fisher, Kinsborne, and the Churchlands suggest the metaphysical foundations of self-mechanization. It's a vision of the self as "multiple input-multiple output transducer," which, as I said in this article, follows a long line of reducing "soul to self, self to mind, and mind to brain." This last step of understanding what the brain is as what it does is a functionalism that begs the question Bourne used to put to Dewey: what exactly is the point of this pragmatic deflation of our self-understanding?

In a recent series of posts at PopMatters, Rob Horning has explored the psychology of consumerism, a condition we are endlessly told by elites to consider the linchpin of global development, economic growth, and domestic order.

[Harry Frankfurt] calls attention to “second-order desires”, or the desires we have about our primary desires. These are what we want to want and, according to Frankfurt, make up the substance of our will . . . . [W]e often have multiple sets of preferences simultaneously, which foils the more simplistic models of neoclassical economics with regard to consumer demand. . . .

The persuasion industry is seeking always to confuse the communication between our first- and second-order desires; it’s seeking to short circuit the way we negotiate between the many things we can conceive of wanting to come up with a positive will to want certain particular things at certain moments. It seeks to make us more impulsive at the very least; at worst it wants to supplant our innate will with something prefabricated that will orient us toward consumer goods rather than desires that are able to be fulfilled outside the market.

The neurocosmetics forecast in Edge have the same place in the social world that marketing has in the worlds of goods and services. For example, the complex mixture of ennui, detachment, skepticism, and embers of warmth in office life limned in Joshua Ferris's And Then We Came to the End could be flattened into the glad-handing grin of an unalloyed will-to-succeed. Horning suggests that "consumerism makes the will and ability to concentrate seem a detriment to ourselves:"

Dilettantism is a perfectly rational response to the hyperaccessibility of stuff available to us in the market, all of which imposes on us time constraints where there was once material scarcity. These time constraints become more itchy the more we recognize how much we are missing out on (thanks to ever more invasive marketing efforts, often blended in to the substance of the material we are gathering for self-realization).

Similarly, neurocosmetics promises to relieve the mental effort of crafting a genuine response to events from the welter of conflicting emotions they generate, leaving only the feeling induced by drugs.

In a world of neurocosmetics, emotions lose their world-disclosive potential and moral force. Rather than guiding our choices, they are themselves one among many choices. The industrial possibilities are endless, and I'm sure some rigorous cost-benefit analyses will prove the new soma's indispensability to such varied crises as aging, unemployment, and gender imbalances.

I shudder at such a world, but I doubt economic analysis can provide any basis for rejecting it. Neurocosmetics and consumerism are but two facets of the individualist, subjectivist, economic functionalism that's become our default language for judging states of the world.

If I were asked to participate in Edge's salon, I think I'd flip the question and ask "what kind of common moral language do we need to stop random technological developments from changing everything?" Philosophers like Langdon Winner and Albert Borgmann have started answering that question as they consider technology and the character of contemporary life. Borgmann notes that "simulations of reality can lead to disastrous decisions when assumptions or data are faulty." Perhaps we should start thinking of neurocosmetics as a faulty source of emotional data about our responses to the world around us. As Ellen Gibson reported at Businessweek, autonomous decisions to compete on can adversely affect everyone's identity:

Dr. Anjan Chatterjee, a neurologist at the University of Pennsylvania Hospital, raises [a] red flag. Creative insights often arise when the mind is allowed to wander, he says. If drugs that sharpen concentration become widespread in the workplace, they may nurture "a bunch of automatons that are very good at implementing things but have nothing to implement."

From autonomy to automata: a provocative possibility.