Brave New World of the Brain

In April of this year, I read a New Yorker article by Margaret Talbot entitled “Brain Gain.” The article examined the growing trend of using prescription dugs and over-the-counter supplements for neural enhancement. I was aware of the widespread use of stimulants by college students, but the fact that other people were seeking to enhance their brainpower was new to me. As someone who has struggled with depression for many years, I have devoted a vast amount of time, energy and money to normalizing my brain. The thought that one might go beyond normalization was thrilling, and maybe just a little bit alarming. I began looking into this phenomenon, and found that one of the first drugs used in this controversial way was Prozac.

Prozac was, both chemically and culturally, an entirely new kind of drug. For 30 years, the standard pharmacological treatment for depression was tricyclic antidepressants such as imipramine, amitriptyline and desipramine. These were considered “dirty” drugs—affecting many systems at once. The tricyclics, along with the MAOIs more commonly used in the U.K., had side effects that often led patients to conclude that the cure was worse than the disease. Prozac was the first “clean” antidepressant, and its relatively benign side-effect profile led psychiatrists to prescribe it far more often than previous antidepressants—most significantly to patients with milder forms of depression.

Peter Kramer, in his highly influential book Listening to Prozac, recounts his increasing awareness that not only was Prozac successfully treating his patients’ depression, it was also, in many cases, altering what they had thought of as their personalities. One patient reported that although his sex-drive was undiminished, he no longer found himself drawn to hard-core pornography. (Although he continued to view it, rather than admit to his disapproving wife that he had lost his taste for it!) This patient described himself as not only cured, but “better than well.” Other patients found themselves become less compulsive about household tidiness or more assertive in their personal and professional lives. Kramer began to wonder—at what point does personality become a treatable condition?

Hippocrates taught that man was ruled by humors: phlegm, blood, yellow bile, and black bile. An excess of black bile was thought to produce a “melancholic” temperament. The idea of the melancholic temperament has persisted throughout history. Until the melancholy of an individual interfered with his daily functioning, this temperament was considered within the expected normal range of behavior. Indeed, there has been a persistent link in the societal imagination between melancholy and creativity, even genius.

For the first time, Prozac gave us the means to change this basic personality type. Humans are enhancement-driven animals. We have become accustomed to altering not only our environment, but also ourselves—both in important and trivial ways. Our tireless efforts at self-improvement have altered our bodies: we live longer than our ancestors, reach puberty earlier, and enjoy better health. We alter our appearance as well, with cosmetics, hair dye, flattering clothes, and even cosmetic surgery. It seems both natural and inevitable that we should seek to transform our minds as well.

Altering our brains’ functions with drugs is, of course, nothing new. Coffee, tobacco, coca leaves—all have been used for centuries, and are still used, to “speed up” the mind and enable us to think more quickly and clearly. For several years now, we have heard stories of neurotypical college students popping illegally obtained stimulants such as Ritalin and Adderall to enhance their ability to concentrate. A 2002 study at one small college showed that more than 35% of its students had used stimulants in this manner during the preceding year.

Off-label stimulant use is not without risk. Amphetamines like Adderall can be highly addictive, and possibly lead to serious cardiac problems. Additionally, a student taking high doses of stimulants may not take adequate care of his body, neglecting to get sufficient food and sleep. More important, perhaps, is the societal implication: if half of your fellow students are artificially enhancing their ability to study, where does that leave you? You must decide whether to jump on the bandwagon and accept the possibility of side effects, addiction, and illegality, or abstain in the knowledge that you are relinquishing what may have been a crucial competitive edge.

Students seeking enhanced cognition through drug use are not confined to college. Middle and high-school students taking legitimately prescribed stimulants report being approached by fellow students wishing to buy their medications. And while the use of the stimulant caffeine to improve alertness and cognition is a time-honored habit of adults and adolescents, the relatively new delivery systems such as energy drinks and caffeinated gums and candies are bringing caffeine to younger consumers. KickStart SMART™ is a drink containing 60 mg of caffeine per serving (20 mg less than a serving of Red Bull) that is marketed for use by children as young as four, with marketing copy that includes phrases like “enhances mental energy and focus.” It doesn’t take much of a leap to imagine a child whose intake of these drinks is unregulated consuming a dangerous amount of caffeine. If our hypothetical child does continue to grow and thrive, he will no doubt have a wicked caffeine habit. And what kind of competitive environment will he and his peers find themselves in as adults?

Neurologist Anjan Chatterjee wrote in a 2007 paper, “Many sectors of society have winner-take-all conditions in which small advantages produce disproportionate rewards.” In 2008, Nature took an informal online poll to see if its readers used stimulants such as Ritalin and Provigil to improve their “focus, concentration, or memory.” 20% of responders said they did. If half your colleagues are artificially enhancing their ability to work longer and more productively, where does that leave you?

Unlike the ethical questions posed by still-in-the-future scenarios like cloning and “designer” babies, the questions raised by cosmetic psychopharmacology cannot be put off to a later date. The neural revolution is upon us, whether we like it or not. Regardless of our approval, elementary students are, aided by coaches and parents, using caffeine to enhance their performance in sports and studies. Older students are using illicitly obtained stimulants. And adults are using not only off-label prescription stimulants, but also supplements such as piracetam, which is not FDA approved for any condition, but which users believe improves blood flow to the brain. Due to the proliferation of prescription-included drug purveyors and supplement suppliers online, it would be impossible to keep people from obtaining and experimenting with these substances.

There is an undeniable glamour to these “psychonauts.” Humans have always been explorers, and what could be more exciting to explore than the marvelous complexities and potential of the human brain? I do not believe can honestly say that they would not want any improvement in their cognition, their speed, or their memory. How can we say that people should not be able to choose to alter their brain chemistry? Surely there is nothing that belongs to us so completely and exclusively as our minds.

But as utopian as that might sound, the growing popularity of neural enhancement has the potential, in my opinion, to ultimately weaken us at a societal level. Kramer’s Listening to Prozac received a great deal of criticism. There are those, who Kramer calls “pharmacological Calvinists,” who revere the “natural” state of the human brain and feel that it ought not be tampered with when avoidable. This is not, however, my concern.

My fear for us is that we are concentrating too much on one particular kind of enhancement. Unlike the psychedelic drug experimenters of the 60s, we are not seeking new ways of thinking and seeing. We do not seek to expand our consciousness, but rather to enhance one small area—productivity. I do not wish to live in a society that values rote productivity over creative advancement. (I do not use creativity here to mean solely the arts, but to also include the types of creative problem solving that lead to advancements and discoveries in physics, chemistry, education, etc.)

If we become more productive in existing tasks, the primary beneficiaries are our employers. While certainly it is a good thing to perform one’s job well, surely that should not be humanity’s ultimate goal? I fear that cognitive enhancement will come to be encouraged, even expected by employers. I fear that employees who comply with that expectation will find themselves valued for what they do over who they are even more than is now the often regrettable case. I fear that anxious parents, eager to give their offspring every possible advantage, will come to see dosing their children with “good worker drone” drugs as normal, even admirable. I fear that in our quest to become more, we will end up becoming less.

Do I think that cosmetic psychopharmacology should be banned? Ultimately, I do not. Despite the high potential for abuse, on both personal and societal levels, I believe that my brain belongs to me. Just as I have the right to abuse my brain with potentially harmful legal drugs like alcohol and caffeine, so I must retain the right to choose which functions of my brain are most important and useful to me, and the right to act accordingly.

In conclusion, I would like to quote Ray Fuller, one of the developers of Prozac:
“If the brain were simple enough for us to understand, we would be too simple to understand it.” We must continue to explore our brains, but we must not do so without examining what we learn in all possible contexts. We must strive to be less simple.