Why the Medicalization of Everyday Life is Good

(I've posted this at another journal of mine, but I'm reposting it here.)

It is a common claim that Americans take too many drugs, that we are society that is overmedicated. Conditions like attention deficit disorder and depression are said to be overdiagnosed and drugs like Prozac and Ritalin overprescribed. In short, so it is said, we make the mistake of taking ordinary differences in mental and physical abilities as genuine diseases to be treated medically, instead of problems of character that require more complex solutions.

Not only are all of these claims false, but I will argue the opposite: the medicalization of ordinary life is ultimately a positive development.

It never ceases to amaze me that, in a society that develops and benefits from so much of the technological progress of recent decades, opposition to future technologies runs at such a high level. From stem cell research to genetically modifed crops, Americans (as well as many Western Europeans) incessantly cry "it's unnatural!" and invoke the specters of Brave New World and Frankenstein. (Brave New World is perhaps my least favorite book for this very reason.)

This is not the case everywhere, particularly in Southeast Asia, where increasingly more of the breakthroughs in biotechnology are coming from. According to Ramez Naam, author of the superlative More Than Human: Embracing the Promise of Human Enhancement, while a meager 20% of Americans advocate genetic engineering, 63% of Indians and an astounding 83% of Thais do. All the more reason why nations like China and India will overtake the West in the coming century (and why I may have to move to Asia).

What is interesting is that many Americans oppose augmenting human nature through genetic and cybernetic technologies, but have no issue with medical research to treat and cure diseases. The fact of the matter is, however, that research to treat a disease almost invariably can be used to enhance a normal condition.

Let me give but one example to illustrate. Attention deficit/hyperactivity disorder (ADHD) is commonly treated by the drugs Ritalin and Adderall. However, when "normal" indivduals take these drugs, their ability to pay attention and focus also improves.

Why is this? Part of it is the nature of the disease. Attention, like many human traits, is distibuted among the population along a normal distribution, or bell curve. Thus, most of the population falls near the average, with smaller percentages the further away in either direction.

ADHD, instead of being a condition with distinctive symptoms that one either has or does not (one example of this would be schizophrenia), is defined in a way that will include everyone below a certain point in that distribution. In other words, all it means to have ADHD is to be, say, in the bottom 20% (I'm not sure of the precise number) with regard to attention. This would be like saying that the dumbest fifth of the population suffers from "Intellect Deficit Disorder".

To extend the example of our hypothetical "Intellect Deficit Disorder", giving Ritalin only to those diagnosed with ADHD would be like giving a drug that increased intelligence only to those diagnosed with IDD. Such a thing would be absurd; if anyone could benefit from it, why shouldn't it be accessible to all? Many mental disorders, like depression and social anxiety, fall in the same category as ADHD.

Thus far, I have been giving an argument that would seem to oppose the point I'm trying to make. This is because I see "medicalization" as the means to fostering a wider acceptance of the use of medical treatments to improve human abilities. The more people who are diagnosed with these conditions, the more who take drugs, and the better off society is as a whole.

Why? Well consider what these drugs do. Prozac and other Selective Serotonin Reuptake Inhibitors (SSRIs) can work on both the depressed and the healthy (although the effects are not quite the same for everybody) to increase their happiness. The happiness that comes from an SSRI is not the mindless contentedness of Huxley's idiotic "soma" but a kind of increased energy to get things done and a better resilience to the setbacks that everybody faces from day to day. Not only are the conditions for an individual improved, but our economic productivity as a society increases. (This doesn't necessarily entail an overworked population, the value of which is questionable, because if an individual finishes her work sooner, there's no reason why some of her increased productive energy couldn't be devoted to leisure pursuits, should she so choose.)

The major objection here, would be the negative side effects of drugs, for instance, Prozac's sexual side effects. However, as our understanding of biology improves, increasingly selective drugs are developed that produce fewer adverse side effects. There are more antidepressants on the market today that have fewer or no sexual effects; I'm on two myself and experience no discernible impediments.

Thus, I will be honest; I'm being a bit disingenuous with the title of this post. Medicalization in itself is not the good thing, but rather, the acceptance of technological enhancements to human functioning. Quite frankly, the objections to human enhancement are silly (in part because the distinction between pathology and normality is often completely arbitrary) and basically come down to two: one is that it is "unnatural", the other is that unintended side effects could produce negative, even fatal, results.

The first is merely a prejudice, which I won't bother taking the time to refute here (I've done it elsewhere); the second is largely mitigated by the extensive process of animal and human testing that precedes the approval of any treatment for public consumption. This may not answer every objection, but is sufficient for the purposes of this post.

In short, I ultimately think that it should be up to individuals to decide what treatments or enhancements they want for themselves, and in the case of children, families rather than governments should decide. For this reason, I oppose disastrous and wasteful policies like the so-called "War on Drugs", as well as the efforts of radical rightwing organizations to impede the release of drugs that fail to satisfy their rigid and narrow constraints of what is acceptable behavior for human beings.

And really, like I've said, should the US become even more of a society of Luddites and bioconservatives, we will be all the more quickly and easily surpassed by those who lack our prejudices. The development of these technologies ultimately cannot be stopped, and in the future, like all the progresses of humanity in the modern era, history shall recognize those who opposed them as the truly short-sighted ones.


...and then what?

(I really should be getting onto other things, but I wanted to jot down a few thoughts about something interesting from yesterday.)

The Doomsday Clock was recently moved forward 2 minutes to 11:55. Most people probably don't pay much heed to it--of those who are even aware of its existence, it's probably just to keep their sanity.

In some ways, it's amazing that human civilization has continued since the discovery of nuclear weapons and their mass proliferation. Now, we face other threats like global warming and the depletion of fossil fuels which will likely only make things worse.

I suspect global warming in itself would not be sufficient to wipe out human civilization, but insofar as it will be a spur to other problems--famines, mass migrations, wars over resources, etc.--it will create a more unstable world in which nuclear warfare becomes more probable. Other new weapons technologies pose additional dangers.

In any case, I think it's only a matter of time before humanity either destroys itself or descends into a new Dark Ages. We can only hope this doesn't happen during our lifetime.

I've been fortunate this semester to sit in on a class entitled "Boundaries of the Human in the Age of Robots and Clones," dealing with the implications of future technologies, especially human enhancement and robotics. I've written on such topics before--anyone who knows me is well aware that this is an interest of mine, even if they don't take it seriously.

The other day, the professor leading the class mentioned a roboticist at the university here with whom he has conversed before. When meeting with a previous version of this class, the roboticist was asked what inspires him to do the work that he does. He began by making a statement similar to that I opened this entry with, namely that he's pessimistic about the future of humankind, and thought it a huge shame especially because of the likely scarcity of intelligent life in the universe.

Right now, some roboticists have taken a lesson from biology and are designing robots from the bottom up, creating simpler robots and gradually making them more complex (top-down design has produced very limited results). Right now, we may have robots about as smart as insects. The roboticist's hope is that his life's work will move this along, perhaps producing robots as complex as some simple mammal. Future roboticists, given enough time, may produce something like Commander Data from Star Trek, or perhaps yet greater things.

In short, he sees himself as helping to design a successor species to humanity, one that may survive our destruction and perpetuate the existence of intelligent life, perhaps eventually spreading itself to other parts of the universe. His motives are no different than those of the blue collar worker who spends his life working hard so that his children might go to college and do better than he.

Personally, I have little interest in children--also something I've written about. This is why I'm more interested in human biological (and cybernetic) enhancement, including things like increasing our lifespan. Perhaps it's selfish, but I want to be among those modifying themselves and becoming a part of "post-humanity".

"Human nature" may not be concrete or easily ascertainable, but I think history shows that people never learn from history (perhaps Western Europe's rejection of warring amongst itself is an exception, but such examples are few and far between). We are messing with powers far beyond our understanding or ability to control.

Thus, as I see it, our only hope is to change human nature itself, so that we might be more capable of handling this problems. Wisdom may not be encoded in our genes, but there is certainly a large genetic component to traits like intelligence and empathy. Yes, research into human enhancement (genetic or otherwise) might only exacerbate our current problems, but I don't see any other choice.

Perhaps it's perverse, but this is the only reason for hope I've been able to discover in a world that stands but 5 minutes from destruction.


Leiter on Vanderbilt

I will not comment on this in detail, because I am leaving a public record, and it would be inexpedient to say what I really feel. Nevertheless, some of you will probably find this NYT article on Leiter's Gourmet Report along with Leiter's response, rather interesting.

Here is an excerpt from the latter:

...[W]hat is more appalling is the nonsense about Penn State, Stony Brook, and Vanderbilt. First of all, they don't have good departments, they have weak departments overall (with honorable exceptions etc. etc. etc.), whether you're interested in philosophy of language or ancient philosophy or Continental philosophy. Second, it is simply false that "they do not participate in the ratings." Each of them have been included in the ratings, and each time they fared quite poorly overall, even if they each have some areas of strength.

But most breathtaking is John Stuhr's idiotic comment that Rutgers "doesn't emphasize what we do," where "we" means Vanderbilt. It is true that Rutgers doesn't much emphasize history of philosophy or Continental philosophy (that's why NYU is #1, and Rutgers #2), but how could that explain why Vanderbilt has never been close to the top 50 and barely rates in any historical areas? The difference between Rutgers and Vanderbilt isn't "emphasis": it's that Vanderbilt has a weak faculty, even in most of the areas it purports to "emphasize" like post-Kantian Continental philosophy. (Rutgers, by the way, is obviously much stronger in the history of ancient and early modern philosophy than Vanderbilt; only in American pragmatism does Vanderbilt have an edge.) One would need only ask the dozens of philosophers specializing in those areas who completed the PGR surveys, after all.

Leiter is good enough to malign both my alma mater and my current institution. I must say, though, had I not gone to a school like Penn State, I probably would have never gotten into philosophy. Analytic philosophers have a distinct talent for sapping the life out of even the most exciting topics (see, e.g., an anthology on the Philosophy of Sex that I used a year and a half ago).

Of course, it's unfair to impugn the group as a whole. There are quite a few distinctly analytic philosophers doing interesting work today, not to mention the fact that good historians of philosophy--the ones who read original texts closely and charitably and who know the relevant historical background well enough to avoid anachronistic interpretations--can just as easily come from either "branch" of contemporary philosophy.

I could say more, but I will stop myself before I say anything potentially incriminating.