Advice about Vice


In Conclusion

The basic thing nobody asks is why do people take drugs of any sort?
Why do we have these accessories to normal living to live?
I mean, is there something wrong with society that's making us so pressurized, that we cannot live without guarding ourselves against it?

- John Lennon (1940-80)

Tobacco, coffee, alcohol, hashish, prussic acid, strychnine, are weak dilutions; the surest poison is time.

- Ralph Waldo Emerson

From my journal Tuesday 12 October 93 (we were on Lady Fair somewhere between the US and Tahiti):

Excerpts from The Wall Street Journal "Letters to the Editor" (1993, month and day unknown):

The state may enjoin a crime because it is the intentional act of an individual against the property or person of another.  Every citizen has a stake in making sure that crime does not undermine the system of liberty and property necessary for society to function.  Vices, on the other hand, are acts by which an individual harms his own interests in a misplaced attempt to find happiness.  Taking drugs (for example) implies no malice toward others and is therefore a vice, not a crime.  The state has no basis to regulate the drug user's pursuit of happiness if the act does not meet the criminal criteria of intentionally harming others.  (After all, the US fought a revolution for the right to pursue happiness.)

The war on drugs is a moral outrage; it is being waged against people whose main sin is that they lack self-control or have fallen victim to the curiosity of youth.  It is the domain of the clergy, not the government's, to save lost souls.  Throughout history, the perpetrators of mankind's greatest evils have been governments committed to using a collective approach to attain salvation.

Personally, I've always thought the War on Drugs was something of a smoke screen to divert public attention from covert government policies and activities.  As a matter of fact, Terence McKenna, the author I met because I reviewed his book, states:

In the United States, the federal government's zeal to appear to wish to eradicate drugs is directly linked to the degree to which the government has been co-opted by the values of fundamentalist Christianity.  We entertain the illusion of the constitutional separation of church and state in the United States.  But in fact the federal government, when it acted to prohibit alcohol during Prohibition, when it interferes with rights to reproductive freedom, or with the use of peyote in Native American religious rituals, and when it attempts unreasonably to regulate foods and substances, is acting as the enforcing arm for the values of right-wing fundamentalism.

I found McKenna (who has, sadly, since died of a brain tumour) a bit rabid on the subject.

How about a pinch of psychology?  From an advertisement for the book, Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self

Julia takes Prozac because she doesn't know who she is; when Sam takes the drug, it makes him feel "better than well."  Four and a half million Americans [including ex-President Bush] have taken this antidepressant since it was first introduced, and many have become more confident, popular, mentally nimble, and emotionally resilient.

(It doesn't guarantee reelection, though!)

What does it mean when a capsule with breakfast makes a shy person outgoing?  When a pill alters what we think of as personality, not illness?  Does transforming medication interfere with necessary self-examination?  Is it a coincidence that when American society wanted women at home, the drug of choice was Valium, and now that we value assertiveness, it's Prozac?  Are we entering an era of "cosmetic pharmacology" when we can take a drug to enhance our personality?  What is the self?

What do they think alcohol has been doing at parties for hundreds of years if not enhancing personality?

Our bodies are chemical machines.  Even our thoughts are chemically expressed for us "know" them.  Hormones circulating in our system constantly affect our behaviour and even our abilities.  (For example, œstrogen makes females more docile; testosterone makes males more aggressive.  See The Inevitability of Patriarchy in the section on Society and Culture for more information on the chemical nature of our attractions to each other.)

Everything, from Prozac to steroids to hormone replacement therapy to caffeine to all manner of designer drugs is an attempt to alter our internal chemistry from without for various reasons.  It is partly the reasons, not just the acts that matter.  Giving morphine for control of pain in a terminally ill cancer patient doesn't seem so wrong.  Giving it to a teenager in a back alley so he can forget his abused, impoverished life seems quite different.  Giving a small amount to a musician so he can keep playing with a slightly cracked wrist bone (when the rest of the band is depending heavily on him being there) or to the executive so he can attend the meeting without being distracted by his infected tooth seem different again.

It appears to me in general that if a drug is taken to bring you up to a certain minimum standard, then its considered okay.  (Prozac and Viagra are examples.)  However, if long term effects will cause you to fall below a minimum standard, then it isn't so okay (methamphetamine and nicotine are examples of this).  If a drug is taken to give you an advantage over the norm, then, particularly in competitive situations, it isn't okay.  Steroids are an example of this.  Is propranolol?

Say you're a musician and you've entered a prestigious contest.  If you seize up from stage fright - or even find that stage fright keeps you from doing your best - you can take propranolol (a beta blocker which slows the heartbeat) to control your performance anxieties.  (I read recently where more than 50% of professional musicians take propranolol to enhance performance!)  Does this give you an unfair advantage in a music competition?  (What if a bodybuilder takes steroids not to win, but just so he can enter without embarrassment?  Should only winners be tested for banned substances?)

I think in a lot of cases, it comes down to one of the most basic components of our lives: money.  What will it ultimately cost me if you do or don't take this or that drug?  (See Turn Out the Lights in the section on Society and Culture for a report on the drugging into docility of kids in foster care.  Also see Happy at All Cost in the section on Lifestyles if you think the ultimate goal of civilisation is to maximise the role of human happiness - a job almost certain to require drugs.)

Better Playing Through Chemistry

Ruth Ann McClain lost her job for recommending beta blockers.

by Blair Tindall

Ruth Ann McClain, a flutist from Memphis, used to suffer from debilitating onstage jitters.  "My hands were so cold and wet, I thought I'd drop my flute," Ms McClain said recently, remembering a performance at the National Flute Convention in the late 1980's.  Her heart thumped loudly in her chest, she added; her mind would not focus, and her head felt as if it were on fire.  She tried to hide her nervousness, but her quivering lips kept her from performing with sensitivity and nuance.

However much she tried to relax before a concert, the nerves always stayed with her.  But in 1995, her doctor provided a cure, a prescription medication called propranolol.  "After the first time I tried it," she said, "I never looked back.  It's fabulous to feel normal for a performance."  Ms McClain, a grandmother who was then teaching flute at Rhodes College in Memphis, started recommending beta-blocking drugs like propranolol to adult students afflicted with performance anxiety.  And last year she lost her job for doing so.

College officials, who declined to comment for this article, said at the time that recommending drugs fell outside the student-instructor relationship and charged that Ms McClain asked a doctor for medication for her students.  Ms McClain, who taught at Rhodes for 11 years, says she merely recommended that they consult a physician about obtaining a prescription.

Ms McClain is hardly the only musician to rely on beta blockers, which, taken in small dosages, can quell anxiety without apparent side effects.  The little secret in the classical music world - dirty or not - is that the drugs have become nearly ubiquitous.  So ubiquitous, in fact, that their use is starting to become a source of worry.  Are the drugs a godsend or a crutch?  Is there something artificial about the music they help produce?  Isn't anxiety a natural part of performance?  And could classical music someday join the Olympics and other athletic organisations in scandals involving performance-enhancing drugs?

Beta blockers - which are cardiac medications, not tranquilisers or sedatives were first marketed in 1967 in the United States for disorders like angina and abnormal heart rhythms.  One of the commonest is propranolol, made here by Wyeth Pharmaceuticals and sold under the brand name Inderal.  By blocking the action of adrenaline and other substances, these drugs mute the sympathetic nervous system, which produces fear in response to any perceived danger, be it a sabre-toothed tiger or a Lincoln Center audience.  Even the most skillful and experienced musicians can experience this fear.  Legendary artists like the pianists Vladimir Horowitz and Glenn Gould curtailed their careers because of anxiety, and the cellist Pablo Casals endured a thumping heart, shortness of breath and shakiness even as he performed into his 90's.  Before the advent of beta blockers, artists found other, often more eccentric means of calming themselves.  In 1942, a New York pianist charged his peers 75 cents to attend the Society for Timid Souls, a salon in which participants distracted one another during mock performances.  Others resorted to superstitious ritual, drink or tranquilisers.  The pianist Samuel Sanders told an interviewer in 1980 that taking Valium before a performance would bring him down from wild panic to mild hysteria.

Musicians quietly began to embrace beta blockers after their application to stage fright was first recognised in The Lancet, a British medical journal, in 1976.  By 1987, a survey conducted by the International Conference of Symphony Orchestra Musicians, which represents the 51 largest orchestras in the United States, revealed that 27% of its musicians had used the drugs.  Psychiatrists estimate that the number is now much higher.  "Before propranolol, I saw a lot of musicians using alcohol or Valium," said Mitchell Kahn, director of the Miller Health Care Institute for the Performing Arts, describing 25 years of work with the Metropolitan Opera orchestra and other groups.  "I believe beta blockers are far more beneficial than deleterious and have no qualms about prescribing them."

But use of drugs is still largely secretive.  "Inderal is like Viagra," a woodwind player at a major orchestra said.  "No one admits to using it because of the implication of weakness."  Robin McKee, the acting principal flutist of the San Francisco Symphony, agrees, saying, "It's too bad we're reluctant to talk about using such a great tool."

Indeed, the effect of the drugs does seem magical.  Beta blockers don't merely calm musicians; they actually seem to improve their performances on a technical level.  In the late 1970's, Charles Brantigan, a vascular surgeon in Denver, began researching classical musicians' use of Inderal.  By replicating performance conditions in studies at the Juilliard School and the Eastman School in Rochester, he showed that the drug not only lowered heart rates and blood pressure but also led to performances that musical judges deemed superior to those fuelled with a placebo.  In 1980, Dr Brantigan, who plays tuba with the Denver Brass, sent his findings to Kenneth Mirkin, a frustrated Juilliard student who had written to him for help.  "I was the kid who had always sat last-chair viola," said Mr Mirkin, whose bow bounced from audition nerves.  Two years later, he won a spot in the New York Philharmonic, where he has played for 22 years.  "I never would have had a career in music without Inderal," said Mr Mirkin, who, an hour before his tryout, took 10 milligrams.

For the last two decades, such use of beta blockers has generally met with approval from the medical establishment.  "Stage fright is a very specific and time-limited type of problem," said Michael Craig Miller, the editor of The Harvard Mental Health Letter.  Dr Miller, who is also an amateur pianist, noted that beta blockers are inexpensive and relatively safe, and that they affect only physical, not cognitive, anxiety.  "There's very little downside except whatever number you do on yourself about taking the drugs."

But now that the drugs have established themselves as a seemingly permanent part of the classical music world, some musicians and physicians are beginning to question the acceptability, safety, efficacy and ethics of using them.  One concern is that many musicians use beta blockers without proper medical supervision.  The 1987 survey of orchestra musicians revealed that 70% of musicians taking beta blockers got them from friends, not physicians.  Mr Mirkin, the Philharmonic violist, first obtained Inderal from his father, who took it for angina.  Others buy it while touring countries where they are sold over the counter.

Stephen J Gottlieb, a professor of medicine who published a study on the effects of beta blockers in The New England Journal of Medicine in 1998, says beta blockers should be obtained only after a medical examination, since people with asthma or heart disease could develop problems like shortness of breath or a slowing of the heart rate.  "One-time use of low doses of beta blockers should be safe in healthy people," Dr Gottlieb said, adding that the fatigue, hallucinations, tingling and vivid dreams listed as side effects in Physicians' Desk Reference would be unusual in those using Inderal only occasionally.  The risks are far more serious for those who use beta blockers consistently and take up to 700 milligrams of Inderal a day.  Musicians typically take 5 to 20 milligrams in isolated doses.

But some performers object to beta blockers on musical rather than medical grounds.  "If you have to take a drug to do your job, then go get another job," said Sara Sant'Ambrogio, who plays cello in the Eroica Trio.  Chemically assisted performances can be soulless and inauthentic, say detractors like Barry Green, the author of The Inner Game of Music, and Don Greene, a former Olympic diving coach who teaches Juilliard students to overcome their stage fight naturally.  The sound may be technically correct, but it's somewhat deadened, both men say.  Angella Ahn, a violinist and a member of the Ahn Trio, remembers that fellow students at Juilliard who took beta blockers "lost a little bit of the intensity," she said.  Ms Ahn doesn't use the drugs, she said: "I want to be there 100%."

Indeed, the high stakes involved in live performance are part of what makes it so thrilling, for both performers and audiences.  A little onstage anxiety may be a good thing: one function of adrenaline is to provide extra energy in a threatening or challenging situation, and that energy can be harnessed to produce a particularly exciting musical performance.  Performance anxiety tends to push musicians to rehearse more and to confront their anxieties about their work; beta blockers mask these musical and emotional obstacles.

Some musicians are also grappling with the ethics of better performing through chemistry.  In auditions, which are even more nerve-racking than regular performances, do those who avail themselves of the drug have a better chance of success than those who do not?  Should drug testing apply to performers, as it does to some athletes and to job applicants at some companies?  "If you look at the logic of why we ban drugs in sport, the same should apply to music auditions," said Charles Yesalis, a professor at Pennsylvania State University who studies performance-enhancing drugs.  But the issue receives little attention because, unlike athletes, classical musicians are seldom called on to represent big business ventures.  "If Nike offered musicians ad contracts," Dr Yesalis said, "more people would pay attention."

Speaking from the Athens Olympics in August, Steven Ungerleider, a sports psychologist and the author of Faust's Gold, said that beta-blocking medications are prohibited for some events, like riflery, in which competitors use the drug to slow the pulse so that they can fire between heartbeats to avoid a jolt.  The drugs are banned in a number of other sports, including motorcycling, bobsledding and freestyle snowboarding.  But Dr Miller, the Harvard physician, points out that beta blockers differ significantly from steroids, which use testosterone to increase muscle mass, strength and speed.  Inderal enables rather than enhances, by removing debilitating physical symptoms; it cannot improve tone, technique or musicianship, or compensate for inadequate preparation.

As Ms McClain's firing demonstrates, the use of beta blockers by students is a particularly delicate issue.  Those who openly use the drugs believe they have a responsibility to mention them to students suffering from severe stage fright.  "If I'm looking out for the welfare of my students, I cannot in good conscience not tell them about beta blockers," said Ms McClain, adding that she would be more careful about how she represented the information in the future.  Some teachers believe that coping with performance anxiety is an essential part of a classical music education and that early use of beta blockers deprives students of the chance to confront their stage fright.  Robert Barris, a bassoonist and a co-chairman of the music performance studies faculty at Northwestern University, encourages students to address the roots of their anxieties while avoiding psychological dependence on chemicals.  Unlike previous generations of musicians, these students can draw on a rich array of nonchemical treatment options.  The new field of performing-arts medicine includes some 20 centers across the country, many of which treat stage fright with therapies that range from Inderal to more holistic approaches like hypnosis, yoga and aerobic exercise.

But several musicians interviewed for this article expressed impatience with these treatments, which can seem slow and uncertain compared with the instant gratification and convenience offered by the beta blockers.  "Holistic solutions take work and time to be effective, whereas Inderal is a quick fix," Mr Barris confirmed.  As it happens, he takes Inderal by prescription for a heart ailment, and he said that he works to combat any soporific effects the drug might have on his musicianship by putting extra energy into his concerts.  "No one wants to listen to a secure, accurate but disconnected performance," he added.

Jim Walker, a former principal flutist of the Los Angeles Philharmonic who has recorded more than 400 movie soundtracks, says that preparation is the best medicine.  Still, he describes himself as an Inderal advocate, with the caveat that the drug be approved by a physician.  Some of his best students at the University of Southern California, he said, are too nervous to deliver a representation of how well they really play and might stand to benefit from beta blockers.  "It's absolutely legitimate to recommend Inderal to a student who's unable to perform because of nerves," he added.  "If I'd never heard the story about Ruth Ann McClain, I'd be far more blatant in recommending it."

Blair Tindall, a professional oboist, is writing Mozart in the Jungle for Grove/Atlantic Press.  Elaine Aradillas contributed reporting for this article.

Source:  for the Record Sunday 23 October 2004 photo credit Rollin Rigg

I suffer from severe performance anxiety myself.  Though I learned to play several musical instruments in my teens, I couldn't consider a career in music because of my terror of being judged.  (Why?  I haven't a clue.  Music was the only thing that seemed to invoke it - speaking before a group or taking tests didn't bother me at all.  I assumed it was because I never felt I was best at music.)  Propranolol was unknown at the time.  My mother dosed me with her tranquilisers, but I couldn't tell they had any effectIt never occurred to me that my taking a tranquiliser might have any impact on anyone but myself.  But what if, drugged, I had played well enough to snatch a music scholarship from some otherwise-more-deserving student - one who played with no chemical help at all?  In my case, it didn't matter - there were lots of things I would much rather do than become a musician.  But that won't be true for everyone.  I'm afraid my sympathies still lay with the miserable rather than the merely talented.  A lot of otherwise fantastic students turn away from music because they have no way to overcome debilitating stage fright.  No one wins when that happens.

Better than Well

by Jonathan Rauch

John Sperling, a man who has been called the Howard Hughes of biotechnology, has $3 billion and a dream: to retard aging and extend human longevity.  According to a recent article in Wired magazine, he intends to found an endowment generating at least $150 million a year for biotech research.  "I am 100% for human enhancement!" he told the magazine.  "The more you can get, the better!  What do we want?  To improve the quality of human life to maximiae happiness, right?"  His dream is the worry of President Bush’s Council on Bioethics, which is headed by Leon R Kass.

Worrying is this council’s job description.  "The benefits from biomedical progress are clear and powerful," states the council in its recent report, Beyond Therapy: Biotechnology and the Pursuit of Human Happiness.  "The hazards are less well appreciated, precisely because they are attached to an enterprise we all cherish and support and to goals nearly all of us desire."  The council’s determination to peer relentlessly into the darker side of human biological enhancement might have made for 300 pages of the sort of grandiloquent droning for which federal blue-ribbon commissions are renowned. Instead, Beyond Therapy is a kind of miracle.

Anyone who has worked in Washington, DC knows that, upon receiving a government report, the first thing to do is flip to the end and read the angry minority dissent.  But the council’s report, the work of its 17 members and Kass, is unanimous.  The second thing to do with normal government reports is skim the obligatory recommendations for reform.  But this report includes not even one recommendation.  Well, then, surely the report must be pabulum.  But to the contrary, it is a work of uncommon distinction - not least for literary merit.  In its ability to turn a phrase, to touch profundity without pomposity, it astonishes time and again.  "Pleasure follows in the wake of the activity and, as it were, lights it up into consciousness."  When was the last time you read a sentence like that in a government report?  Read this passage aloud: "A flourishing human life is not a life lived with an ageless body or an untroubled soul, but rather a life lived in rhythmed time, mindful of time’s limits, appreciative of each season and filled first of all with those intimate human relations that are ours only because we are born, age, replace ourselves, decline, and die - and know it."  If bureaucratic Washington can produce such eloquence, there is yet hope for us all.

More impressive still is the report’s intellectual audacity.  The council brushes aside all three of Washington’s defining approaches to biotechnology.  Libertarians think the only important issue is making sure that individuals, rather than the state, control the uses of biotech.  As long as no one is coerced, what’s the problem? Liberals think the only real issue is ensuring equitable access to biological enhancement.  As long as the benefits are spread fairly, what’s the problem?  Lawyers and policy wonks believe it is process that counts most.  As long as there are rules and lawsuits and 87 layers of appeal, what’s the problem?  But, as the authors of Beyond Therapy point out, individuals can make thoughtless or short-sighted decisions, and a dangerous technology can be all the more perilous for being broadly available, and we cannot regulate well without knowing what it is we should seek to do.  So the report insists on drilling down, deep down, into the bedrock ethical questions and dangers that inhere in the technology itself.

What, exactly, are those?  The report takes up an assortment, but its varied worries share a common structure, one rooted in a particular notion of what being human means.  The report turns out to be about not technology but humanity.

To be human, for the council, is to cope with certain limits and tradeoffs.  Human excellence or distinction is achieved in the encounter with life’s limits.  Inherent in achievement, in living well, is the idea of doing things for and as yourself - occasionally, with luck, surpassing yourself.  And this is possible only if you are yourself.  "What matters is that we produce the given result - the objects that we make - in a human way as human beings, not simply as inputs who produce outputs."  What matters is "our best performance as human beings, not animals or machines."

Our essential limits define us in many ways.  For example, our physical abilities are limited.  Athletes who modify their bodies, not through personal effort but as passive recipients of biological enhancement, become less like athletes and more like machines, receptacles of technology.  Their accomplishments become less admirable even as they become more impressive.  The council warns that already, in American sports, "the line between person and equipment may be eroding."

Another kind of limit is that we do not choose our children; they, so to speak, choose us.  If parents intervene directly to select or enhance a child, they become less like parents and more like breeders or manufacturers, with potentially profound consequences for intergenerational relations.  Human aging and mortality represent another important limit.  Surely, everyone wants to add years to his life and life to his years.  But what if half of life becomes old age: How would society change, and what would become of the natural rhythm of life?  Alternatively, what if we slow the aging process and spend twice as many years reaching maturity?

Then there is the question of our happiness and its limits.  Suppose a drug could hand us happiness on a silver platter.  That might seem wonderful, but it might blur or even obliterate the line between personality and medication.  The pangs of conscience, the despondencies of failure, the reveries of grief, even personality itself might all become pathologies to be treated.  "Nothing hurts," warns the council, "only if nothing matters."

This is all quite troubling, but it is also only the beginning.  One cannot understand the full extent of the potential hazards, according to Beyond Therapy, without appreciating the problem’s dynamic dimension.  For there is a last crucial limit that biotechnology endangers: the limit on breaking all other limits.

The trouble is that medical technology, individual aspirations, and social pressures may all interact to produce an accelerating flight from humanness.  Competition for top schools and top jobs may make artificial enhancement seem indispensable for success, as it already is in some sports.  At the same time, biotech companies, galvanised by new profits and markets (think of Prozac and Ritalin), will spend untold billions selling biological quick fixes.  As enhancement becomes more widespread, even those who are reluctant will feel pressure to conform.  Children may ask for growth hormone or memory enhancement the way they once asked for braces and bikes, and what doting parent would refuse?  As the council puts it:

Our desires to alter our consciousness or preserve our youthful strength, perhaps but modest to begin with, could swell considerably if and when we become more technically able to satisfy them.  And as they grow, what would have been last year’s satisfaction will only fuel this year’s greater hunger for more.

Some day humanity may awaken to find itself a changed species, without ever having stopped to understand what it was doing.  We may enhance our performance by denuding our character; and then, finally, we may lose our grip on the very idea of character.  We may, at last, become our own interventions.  Instead of giving man control over his biological destiny, technology may steal it away.

Again and again the council’s report cautions that it is not predicting, only worrying.  "In offering our synopsis of concerns, we are not making predictions; we are merely pointing to possible hazards, hazards that become visible only when one looks at the ‘big picture.’"  Fair enough, and the report does indeed raise all the right questions.  Yet those who are familiar with Kass’s work and temperament know he is something of a pessimist, deeply influenced by Aldous Huxley’s dystopic fantasy in Brave New World.  That makes him the right man for the job he is doing.  Mercifully, however, there are reasons to think the council may have overlooked a much more heartening prospect.

At its core, the council’s fear is that biotech is a slippery slope with no bottom.  Yet there are already all kinds of enhancement tools that most people forgo.  Cosmetic surgery is readily available and fairly inexpensive.  But it remains very much a minority taste, showing no sign of becoming the norm.  For that matter, Americans could live longer, look better and even feel happier by exercising vigourously for a few hours a week.  Most don’t.  What is surprising is not how much people will do to make themselves "better than normal," but how little.

Is expense the obstacle?  Probably not.  Most people who could afford a face lift or tummy tuck still do not have one.  Laziness or apathy?  Are people less concerned about their health, happiness, and success than Beyond Therapy supposes?  Also possible.  But most people care a great deal about these things.  The appeal of self-enhancement may be self-limiting for deeper reasons.

One is that there is no free lunch.  Exercise is tiring and time-consuming; plastic surgery is painful and risky.  Likewise, all known biotechnological interventions cause side effects.  Beyond Therapy mainly dismisses the problem of side effects.  Over time, the council assumes, the technology will become more effective and less risky, until eventually side effects will be reduced to triviality.  Geneticists and pharmaceutical companies will be able to offer what amount to magic bullets.  In order to reach the ethical problems of biotechnology in their purest form, the council conjures up a perfect biotech: drugs that edit out bad memories without also smudging good or useful ones, or drugs that make their users feel better than normal without also making them feel less than themselves.  But technology, like humanity, probably has its limits.  Drugs and genetic therapies will improve, no doubt, but they will always entail trade-offs.  The magic bullet will remain magic.  Thus the market for artificial enhancement, like the market for regular exercise or cosmetic surgery, may remain self-limiting.  Most people will not want to take the trouble or assume the risks that inhere in manipulating one’s genes and body chemistry.

Moreover, and more important: Instead of running out of control, biotechnology may be subject to a natural restraining principle, a natural equilibrium.  That possible equilibrium is what we call "wellness."  The report makes brisk work of the notion of wellness, or, as the council calls it, the "therapy versus enhancement" distinction.  For one thing, people disagree on where therapy ends and enhancement begins.  For another, many technologies that make people well (therapy) can also make people better than well (enhancement); and many people will want to be better than well; and as more people become better than well, they will redefine the baseline upward; and so the notion of wellness itself may tumble down the slippery slope.

But most people do not in fact want to be better than well during most of their lives.  (Professional football players are not most people, and the Olympics are not most of life.)  People are happy to be well, and they know wellness when they see or feel it.  In fact, as any public-health nag will confirm, persuading people to do anything that might make them "better than well" is like persuading a cat to swim.  That is why so many people take up exercise only after their heart attack.  Most people will do almost anything to become well, and practically nothing to become better than well.

Wellness is not as hard to define as some claim.  For most people wellness means, simply, the state of not thinking about how one feels.  Of course, one could construct enjoyable paradoxes concerning hypochondriacs who do not feel well and cancer patients who do.  But what most of us want is to get on with our lives without worrying about our health; and when we are well, that is what we do.

A bodybuilder on anabolic steroids may be in some sense enhanced, but he is also likely to be obsessed with his health, spending a lot of time and money monitoring himself for side effects and modulating his drug regimen.  In that respect, he resembles less a well person than a diabetic on insulin therapy.  And, significantly, he will usually try to get "off the juice" as soon and as often as he can.  Similarly, one hears often about people who did well on antidepressants but who nonetheless risked, and then experienced, serious relapse in order to try life without the drugs.  Though they benefited from the medicine, they did not really like it; and though they felt better when medicated, they did not feel fully well.

If it is true that most humans naturally seek wellness rather than perfection and know wellness when they’ve got it, then we have much less to worry about than Beyond Therapy fears.  Some people, like Michael Jackson, might stop at nothing to "improve" themselves; but those people would remain a minority, more pitied than envied, cautionary lessons rather than exemplars.  The distinction between therapy and enhancement would hold for most people, most of the time.  In fact, the weird effects of future biotechnological enhancements - which could make Michael Jackson look normal in comparison - might make wellness more appealing than ever.  The idea of being better than normal may prove a bigger flop than the Edsel.

That is where I would put my money.  But let us count our blessings for the council’s worrying, because it is wise and eloquent and humane.  It is also a magic-bullet antidote for smugness.  One sure way to enhance the human mind and character - guaranteed free of side-effects - is to read this report.  It is a thing of wonder.

*Reagan Books. 328 pp. $28.95.

Jonathan Rauch is a writer in residence at the Brookings Institution and a senior writer for National Journal

Source:  Fall 2004

Enhancing Human Traits: Ethical and Social Implications

edited by Erik Parens
review by David Gems

As biomedical science progresses, ever more effective medical technologies are devised to treat illnesses, and this is, of course, a good thing.  But how do we feel about the use of such such technologies by people who are healthy to start with but who want to become more than healthy?

Many such enhancement technologies are already widely available.  Cosmetic surgery is used for √¶sthetic enhancement of the body.  Beta blockers are taken by musicians to block the physical symptoms of performance nerves, and the antidepressant Prozac is used as an agent of what Peter Kramer has called cosmetic psychopharmacology, or alteration of personality, to make people less shy, less compulsive, more confident.  We must assume that, with time, many more enhancement technologies will become available, employing surgery, genetics, pharmacology and heaven knows what else, directed in particular at cognitive function and longevity.

Are enhancement technologies a good thing?  We regard self-development through education and exercise as a virtue, almost a duty.  Why not pursue these ends by means of enhancement technologies?  Yet to many people, enhancement technologies evoke visions of eugenics, Nazi conceptions of the superman, and Aldous Huxley's Brave New World.

Enhancing Human Traits represents a landmark in the discussion of these thorny issues.  It is the product of a project coordinated by the philosopher Erik Parens at the Hastings Center in New York, and has brought together thinkers from various fields, including philosophy, law, sociology, theology and women's studies, to discuss the rights and wrongs of biological enhancement.

The book contains 13 very different essays on distinct facets of this complex subject.  They involve two sorts of discussion of enhancement.  The first focuses on the distinction between treatment and enhancement, and concerns what doctors should and should not do, and what health-care systems should and should not provide.  The second deals with the broader issue of the enhancement technologies per se.  As Parens puts it, the first discussion of enhancement concerns the goals of medicine, the second the goals of society.

On closer inspection, the treatment/enhancement distinction is problematic in various ways.  To a degree, what counts as illness is culturally constructed.  Until recently, being gay was regarded as an illness; likewise, among the Punan Bah people of Borneo, giving birth to twins is regarded as a dreadful misfortune.  Some of these nosological problems can be overcome by defining health as the full expression of species-typical function.  However, as Anita Silvers points out in her contribution, this approach falls down when confronted with the functionally different, yet richly rewarding ways of life of many disabled people.  Some members of the deaf community sarcastically label people who can hear as "signing impaired."

Of the contributing academic disciplines, the clearest analyses of the most worrying aspects of enhancement technologies come from women's studies, particularly from Margaret Little and Susan Bordo.  If current experience of cosmetic surgery is a good indication of how other enhancement technologies will come into use in the future, we have plenty to worry about.  Particularly alarming is the convergence of enhancement technologies and capitalism.  It is only too easy to create markets for cosmetic surgery by convincing people that they possess defects that only surgery can repair.  This marketing of ersatz illness has created a Newspeak of inadequacy: a woman with little breasts becomes "micromastic," and the dimples on her thighs become "cellulite" - conditions requiring treatment.  Legislation may be necessary to guard against such insidious, market-driven medicalisations.

A more awkward problem involves what Little calls the ethics of complicity.  Consider a plastic surgeon approached by a woman who is discriminated against because of her large breasts or African appearance and who is seeking breast reduction or de-Africanisation √† Michael Jackson.  As Little points out, by agreeing to operate, the surgeon becomes complicit with harmful conceptions of normality - in this case, norms that are oppressive to women, or racist.  On the other hand, the suffering of those seeking cosmetic surgery - including that resulting from oppressive standards of normality - may be very real.  Little suggests that the surgeon may act ethically by performing the surgery, but only if she also works elsewhere to fight the system of unjust practices and attitudes.

The significance of enhancement technologies is also discussed by reference to ideas about what makes life meaningful and worth living.  As theologian Ronald Cole-Turner points out: "Technologies such as psychopharmacology and human genetic manipulation fit very well within the broad program of Western religions and philosophy."  In this context, philosopher Carl Elliott expresses concern that drugs such as Prozac could be used to "treat" alienation or existential anxiety - or, as contributor Gerald McKenny puts it: "To relieve the human condition."  To Elliott, seeing this sort of unhappiness as a psychiatric issue represents a category error, "like seeing Holy Communion as a dietary issue."

One way to see what is so disturbing about, say, a happy, smiling August Strindberg on Prozac is that he might no longer be Strindberg.  Elliott refers to what the philosopher Charles Taylor has called an ethics of authenticity: the idea that our lives can only have meaning insofar as we are true to ourselves, and on this basis develop our own life project.  Thus, altering one's personality by means of Prozac may potentially be an act of self-betrayal resulting in a seemingly happy, yet phony and pointless life.

This is a fascinating, challenging and important book, and a major achievement by Parens.  Although the contributions are written by academics, by the style of most of them they are obviously meant for a broader audience, and use clear and accessible language - Dan Brock's essay in particular.  I predict that this book will open a debate that will play a significant role in shaping our culture for years to come.

David Gems is in the Galton Laboratory, Department of Biology, University College of London, London NW1 2HE, UK

Source: Nature Vol 397 21 January 1999

See also:

bulletEven at Work, Pretty People Advance Faster than Plain (in the section on Working) - For decades, psychology research has shown that attractive people have a better chance at getting hired, getting promoted, getting the permission of bosses to embark on ambitious projects, landing more clients and getting a fatter paycheque...
bulletRules of Attraction (in the section on Money and Politics) - Is it worthwhile to lose weight?  Consider this: In 1992, the individual net worth of an obese woman (defined as having a "body mass index" of more than 35) was, on average, 40% lower than that of a woman of "normal" weight, after adjusting statistically for factors such as age, education, professional status, marital status and health.  By 1998, the economic penalty for being fat had increased: the net worth of the obese woman was 60% less than that of her slimmer sisters...
bulletBad News for the Plain and Ordinary (in the section on Society and Culture) - With every man vying for the attention of the most beautiful women, an averagely attractive man was almost as likely to be lumbered with Miss 900 as he was to get Miss 200 in his top 1,000 list...
bulletHouston, We Have a Big Problem (in the section on Lifestyles) - "Yes, Houston is fat, but so is every other city.  We are a fat society.  Period."  In fact, 61% of Americans weigh too much, and about 27% of them are obese - 30 pounds or more over a healthy weight, according to federal statistics.
bulletTechnology and the Pursuit of Happiness (in the Science section) - What if there were a way to achieve the same "high" sensation as one can get from illegal drugs, anytime, anywhere, and without the chemical side effects and criminal motivation?  Such a technology does exist, and has seen limited use in humans for several decades.  The practice is known as evoking pleasure by Electrical Stimulation of the Brain (ESB)...

Psychology Should Be in Dialogue with Bioethics

by Thomas H Murray


[In] one of the first studies in which I became involved when I arrived at The Hastings Center, the National Science Foundation funded a proposal to study ethical and conceptual issues in non-therapeutic drug use.  Half of the inquiry focused on so-called "drugs of abuse."  My half, in contrast, looked at drugs used not to treat or ameliorate disease but rather to enhance performance.  Where do people use drugs as performance enhancers?  Setting aside for now the caffeine in my coffee that keeps me alert, the most widespread and best documented use of performance enhancing drugs was in sport, especially high-level sport such as the Olympics and professional leagues such as the NFL.

As a psychologist, I listened carefully to the athletes themselves, their coaches, trainers, and physicians.  Athletes were not taking drugs as glorious declarations of their transcendent freedom.  They took drugs because they believed their competitors were taking them.  They took drugs because they had devoted their lives to achieving excellence in their sport, and they feared they would become also-rans, losing to people they could have bested had the playing field been level.  Those who took performance enhancing drugs often felt they had no option, sometimes because their coaches or national federations, as in the former East Germany, ordered them to take the drugs or lied about what they were taking, or more commonly, because they suspected that their competitors were gaining an unfair and unearned advantage.  Other athletes refused to use drugs.  Some of those dropped out of the competition; some continued to compete.  Some who persevered won, but fewer than if the playing field had been truly level.

The key insight was to recognise the contribution of social knowledge - about organisations, hierarchies, life plans, reference groups, persuasion, conformity, culture, expectations - to moral discernment.

The project on performance enhancing drugs in sports may have been the first time that I saw the complementary power of psychology and moral philosophy.  It would not be the last as my work wandered into other issues such as organ transplantation, genetics, reproductive technologies, and cloning...

Thomas H Murray is President of The Hastings Center, an interdisciplinary organisation devoted to exploring the ethical and social dimensions of medicine and life sciences.  Murray received his doctorate degree in social psychology from Princeton University.

Source: from the American Psychological Society Observer, Presidential Column, February 2002, Volume 15, Number 2 © 2002 American Psychological Society, all rights reserved

The ethics of performance enhancement isn't an easy subject.  Judicious moderation of "enhancement technologies" (which includes cosmetic surgery and all types of drugs) through self control may be an ideal, but will never universally exist in my lifetime.  At least, not without the miracle of chemistry.  (But then it isn't self control, is it?)

William N Morris, the author of Mood: The Frame of Mind, uses the word "mood" to refer to "a tendency to retrieve a skein of thought."  Moods are affective states that do not stimulate the relatively specific response tendencies we associate with "emotions," but instead are pervasive and global.  Mood can influence a broad range of thought and behaviour, depending on the degree to which it is in or out of focal attention.

Moods insinuate themselves, influencing what we remember of the past, perceive in the present, and expect from the future - they are, quite literally, our "frame of mind."  Crossing the threshold of awareness often causes the mood to alter.  Thus, "mood results from the inhibition of emotional responding."  Perhaps this is why work - where one deals with annoying co-workers, bosses, or clients while inhibiting true emotional responses - causes so many bad moods in commuters at the end of the day.

Researchers T A Wehr and A Wirz-Justice, writing in Pharmacopsychiatria, suggest that it is necessary to be awake during a certain part of the day (determined by circadian rhythms) to avoid becoming depressed (defined here as experiencing a low rate of positive reinforcement and/or a high rate of "punishment").  Indeed, some depression is successfully reduced by judicious application of bright light.  Other ways to improve a bad mood include:

bulletself-reward (like shopping for new clothes)
bulletdistraction (such as thought control or escapist television shows)
bulletalcohol or food (which usually decrease negative feelings - at least briefly - rather than increasing positive ones)
bulletmanagement of expressive behaviour (dramatic facial expressions intensify mood while expressive body movements help reduce it)

These things signal our moods to others in our environment and, sometimes, this activates our social support network.

Interestingly, mere observation of something negative happening to someone we really don't like can produce intense enjoyment.  (Even the memory of a past occurrence can produce a smile.)  Finding out others are doing worse than you can also alleviate depression.

Studies show that people in a bad mood are more likely to offer help when asked than are people in a good mood.  (Unfortunately, a common response by a person in a good mood to people whose suffering he cannot conveniently remedy is to denigrate them.  That way, he does not experience empathetic distress as we're less distresses by the suffering of those we find unattractive.  Why "bring down" a good mood?)  When queried, depressed people seem to prefer immediate smaller rewards - perhaps to ameliorate their current feelings - over more distant larger rewards.  (I think they pessimistically believe larger reward will never come and they'd better take what they can get.)

Alcohol appears to interfere with the ability to think "self-relevant" thoughts, and thus can be an effective mood regulator for an introspective person (as one cause of depression is simply the "inability to distract oneself").

If control of one's "reality" must be imposed, and administered, from without it will always entail great cost to administer because the number of people who need controlling is always quite large.  "Drugs"?  Here to stay.  "War on drugs?"  Far too selective to be fair to anyone.  Politicians and lawmakers?  Grow up.


Source: Funny Times July 2001 - find them on the web at

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