What’s Happening in Philosophy of Psychiatry Archive
These five columns were written for the Philosophy News
Service in 1999 and 2000.
Christian Perring, Ph.D.
Dowling College, Long Island, New York, USA.
Note that these are the versions of the columns I
submitted, not the ones published after editing by Richard Jones.
____________________________________________________
Conferences featuring Philosophy of Psychiatry
August 1999
Related
Links:
·
MIT Press Philosophical Psychopathology
Series
·
The 1999 International Conference on Persons
·
European Society for Philosophy and
Psychology
·
Renaissance 2000: Madness, Science &
Society
In the last year, philosophy of psychiatry has started to
achieve noticeably more recognition from the academic philosophical
establishment. In the US, during the
summer of 1998. The National Endowment for the Humanities funded a six-week
institute on Mind, Self, and
Psychopathology, at Cornell University.
Run by Jennifer Whiting of Cornell and Louis Sass of Rutgers, it
featured about 10 well-known philosophers and psychiatric researchers engaging
in discussion of philosophical problems in interpreting dissociation and
multiple personality, autism, and schizophrenia. About 25 participants were
drawn from many fields of academic life, including philosophy, psychology,
history, and law. It was a brave if not
totally successful attempt to foster serious interdisciplinary dialog.
This summer the European Society for Philosophy and
Psychology devoted its opening symposium to Philosophy and
Psychopathology. The meeting, held at
the University of Warwick in Britain this July, as a whole featured such
notable philosophers as Fred Dretske of Stanford and John Campbell of
Oxford. The session on psychiatry
consisted of talks by George Graham (University of Alabama, co-editor with Owen
Flanagan of the MIT Press series Philosophical
Psychopathology), Jose Bermudez of the University of Stirling in Scotland
(author of The Paradox of
Self-Consciousness), and Joelle Proust of CREA, France. Here I will briefly outline the talks to
give a flavor of what kinds of issues preoccupy philosophers of psychiatry.
Graham talked about multiple personality and the
self. He said that it is in this area
that some of the most interesting work in philosophical psychopathology has
been done. He explained that he is a
realist about selves, although the
conception of the self that he believes in is austere. Here he sets himself in opposition to
theorists like Daniel Dennett, who advocate the view that the self is a
fiction. Graham argued that once we
realize that the self can be fuzzy, we can accept its existence. This is a relatively interesting idea,
although it still raises many questions about what we mean by the “self” and
what function the concept serves for us, and whether the term “the self” gets
used in ordinary talk in the same way as it does when talking about the selves
in multiple personalities. More
interesting to me was a brief comment that Graham made about his experience of
writing his book (co-authored with his colleague Lynn Stephens) When Self-Consciousness Breaks
(forthcoming from MIT Press). He said
that they had started out planning to write a grand synthesis of philosophy and
psychopathology, but they found that this was too ambitious an aim. Finally, with the book two years overdue,
they were ready to settle for a few relatively unadventurous philosophical
claims. This reflects how difficult it
is to do good philosophical work in psychiatry, since it requires so much
empirical knowledge and so many interdisciplinary skills.
This touches on a theme explored by Joelle Proust, who
raised the issue of the relation of philosophy and psychopathology. A naïve way of thinking about their
relation, which Proust called the “Orthodox View,” is that we have
philosophical theories of the mind and we can test them through the study of
psychopathology. Associated with this
view is that idea that philosophy can help psychological and psychiatric
researchers to make conceptual distinctions.
Furthermore, philosophers may, on this view, be occasionally able to
suggest new empirical theories about causal connections between phenomena.
Proust raised two main problems for the Orthodox
View. First, she claimed that the study
of psychopathology is not a science.
She gave several reasons to justify this claim, including the
problematic inheritance of psychoanalysis and the uncertain taxonomy of the
Diagnostic and Statistical Manual, with its focus on symptoms rather than
syndromes. Her second objection to the
Orthodox View is what she referred to as the interpretive plasticity or
ambiguity of clinical data. The
phenomena of psychopathology are not described, and may not be describable, in
a theory-neutral way. The descriptions
of what is sometimes called “phenomenological psychopathology” are already
laden with theoretical and philosophical assumptions. Therefore, it is not possible to simply “read off” the
philosophical implications of clinical data.
The philosophical assumptions of the observer need to be examined and
questioned before we can even begin to grasp the intricate relation between
philosophical theories and psychopathological descriptions.
Finally, Proust warned against the danger that
philosophers making implicit empirical assumptions in their investigation of
psychiatry. She suggested that
philosophers like to propose unwarranted causal hypotheses in the explanation
of the phenomena of psychopathology. In
particular, she thought that philosophers want to explain mental phenomena by
reference to the beliefs and desires of the patient, what she called
explanation at the personal level, as
opposed to explanation at the subpersonal
level, which would include brain modules and neurochemistry. Take, for example, the voices that a
paranoid schizophrenic hears. The
subpersonal explanation says that these are simply malfunctions of the
brain. Proust is suggesting that some
philosophers, like psychoanalysts, insist that there must be more to the
phenomenon than that, and that the voices must be at least an expression of the patient’s beliefs and
desires, and they might even be caused
by the patient’s beliefs and desires.
Her point about this is that philosophers are mistaken when they think
that there must be an explanation of
phenomena at the personal level.
Sometimes problems, often classified as psychiatric, are simply
malfunctions at a lower level of the brain.
Bermudez’s paper discussed some of the same themes as
Proust, although from a very different angle.
It was also the most technical of the three, and I suspect that most
conference participants were as unfamiliar as I was with much of the
psychiatric research literature he mentioned.
His initial focus was on the distinction between neuropsychiatry and
psychiatry. He said that it is often
assumed that psychiatry is characterized by breakdowns in rationality, i.e. as
problems at the personal level, while neuropsychiatry is concerned with
breakdowns at the subpersonal level.
With this as his background, he went on to discuss how to understand
what happens in schizophrenia. Is
schizophrenia best understood as a breakdown at the personal level or the
subpersonal level? This is a very
difficult question, and this is partly because it is so difficult to
characterize accurately what makes a schizophrenic delusion a delusion. There have been many attempts, and Bermudez
was partly showing the inadequacy of some recent attempts. These attempts distinguish between the
positive and negative symptoms of schizophrenia, and link them to a distinction
between epistemic and procedural rationality.
In the short time available, it was not possible for me, nor I suspect,
many other attendees, to fully grasp, let alone assess, the ideas he was
setting out.
Other philosophy and psychology conferences this year
also address issues from psychopathology.
For instance, at the University of Copenhagen last May, there was Problems of the Self: Philosophical and
psychopathological perspectives on self-experience. This August, there is the 1999 International Conference on Persons,
featuring Louis Sass as keynote speaker, talking about his specialty,
understanding schizophrenia as hyperreflectivity. The big conference to look forward to next year is Madness, Science and Society, to be held
in Florence, in August of 2000.
Sponsored by a number of different European organizations, it should be
an important event for philosophy of psychiatry, with its focus on shaping the
future of the field.
____________________________________________________
What’s Philosophical About Psychotropic Drugs?
September 1999
Links:
·
The Enhancement Technologies Group
·
Peter Breggin's Center for the Study of Psychiatry and Psychology
·
Conference on the Science and Ethics of Human
Enhancement
This is only my second “monthly update” on philosophy of
psychiatry, but I am already pondering that philosophy tends to move at a
glacial pace, and a “yearly roundup” might be more appropriate. Despite my qualms, and in an effort the aid
the integration of philosophy into the information age, this month I focus on a
non-traditional arena of philosophical discussion, popular culture.
The media know what interests the public, and so they
give plenty of attention to psychotropic drugs. Is Ritalin overprescribed?
Are doctors and psychiatrists giving out too many antidepressants? Or are too many people with depression going
untreated? I see reports on these
topics often on the evening news, in the health section of my newspaper, and on
the major health web sites. The
publishing industry also knows that the public has an appetite for these
issues: in addition to the usual flow of self-help books and memoirs of therapy
and mental illness, there are also books highly critical of the
psychopharmaceutical industry. Most
notable is the psychiatrist Peter Breggin, who manages to write a book every
year or so. In recent years he has
produced Toxic Psychiatry, Talking Back to Prozac, Talking Back to Ritalin, and
most recently, Your Drug May Be Your Problem (a title which strikes me as
slightly comic—I can’t work out why though).
Other authors have written antipsychiatry-flavored books with titles
such as Running on Ritalin and Ritalin Nation.
The question of when to take psychotropic drugs might
seem to be straightforwardly medical.
Medicine, and the branch of medicine we designate as psychiatry,
identifies pathological conditions and provides ways of ending the conditions
or at least reducing their symptoms.
Nevertheless, in fact the debate that continues to focus on these issues
is not purely empirical: it involves profoundly philosophical issues.
Even standard medicine can be the proper subject of
ethical scrutiny, for many sorts of reasons.
Individual physicians sometimes act unethically, succumbing to temptations
of personal gains at the expense of the patients. Furthermore, whole health care systems can be subject to ethical
criticism, if they fail to live up to proper expectations. For example, much good work has been done
showing how biased medicine has been with respect to gender.
These criticisms tend to operate from an internal
perspective: they don’t challenge the fundamental aims of medicine, but rather
they say that these aims are not being carried out in a fair way. Doctors are too ready to perform radical
hysterectomies on women, ignoring how much effect his has on women and ignoring
options that are more conservative.
Maybe doctors in the US are too ready to recommend removal of the
prostate in men with prostate cancer, when more conservative options are
equally effective.
These internal criticisms can point to more global
criticisms of medicine. It is a
commonly made point that doctors can often focus too much on the disease rather
than the patient, and in doing so they neglect the quality of life of the
patient. By doing so, they start to
forget what the whole point of medicine is.
It is here that philosophical debates about the definition and ultimate
purpose of medicine enter into the discussion.
The whole discussion becomes more philosophical.
The sorts of worries concerning psychotropic drugs raised
by the media tend to be internal. Is
psychotherapy being denied to patients by their health maintenance
organizations even when it would be the most effective treatment, because it is
cheaper to prescribe drugs instead?
Should talk therapists without medical degrees have the authority to
prescribe psychotropic drugs to patients, or is a medical degree necessary for
someone to be competent to prescribe drugs?
Why is the rate of depression and suicide increasing in children?
However, we are now at a stage where we could move on to
more global concerns about psychotropic drugs in psychiatry. It’s here that philosophy is in danger of
missing its cue. This month’s update
serves a prescriptive as well as descriptive function in discussing what’s
happening in philosophy. Journals in
medical ethics rarely discuss psychopharmacology. (I might mention here in shameless self-righteousness and
self-promotion that I published a piece on prescribing Ritalin to children in
Bioethics in 1997.) I have seen the
issue discussed more at bioethics conferences, but still it gets far less
attention than the more traditional debates over reproductive technology and physician-assisted
suicide. It was a book by the
psychiatrist Peter Kramer, Listening to Prozac, that has so far given one of
the most thoughtful and philosophical discussions of these issues. Medical ethics does show some sign of
addressing these issues under the general heading of human enhancement as
concerns about genetic therapy and cosmetic surgery grow. Issues in psychopharmacology do certainly
overlap with these other issues, but we need to remember that they also have
some unique aspects.
Philosophical issues arising from psychopharmacology get
even less attention in the more traditional journals such as The Journal of
Philosophy, Ethics, Philosophy and Public Affairs, and Philosophical
Review. This may reflect a general
attitude of disinterest or even disdain concerning medical ethics from the
philosophical establishment. Issues
concerning medicine and psychiatry often get written off as “applied ethics,”
which carries the implicit implication that real philosophers do pure ethics,
who leave it to others to think through the implications of their abstract
theories for the real world. It must be
said that medical ethics often fuels this sort of disdain through a severe lack
of quality control both at conferences and in journals. However, a look at the issue of
psychopharmacology shows how wrongheaded this viewpoint is.
The philosophical issues that arise around
psychopharmacology are certainly not purely moral in a narrow sense. Most obviously, we need to ask how we decide
what should count as a pathological condition requiring treatment. How much unhappiness should count as
clinical depression? How much
restlessness and lack of concentration should count as attention deficit
hyperactivity disorder? While some
(mostly in the medical profession) still believe that these are purely medical
questions, most recent discussion has agreed that criteria of mental disorder
essentially involve value judgments.
Social values and pragmatic considerations do and must enter into the
deliberations both in drawing up the diagnostic criteria, and also in doctors
deciding whether their patients meet those criteria.
Furthermore, larger questions soon enter into the
discussion. Is the concern about
psychotropic drugs based purely on their uncertain side and long-term
effects? Clearly not: many people say
that to live with one’s behavior and emotions regulated by a drug is to be less
of oneself. The idea is that one’s
personal identity is altered by these drugs.
This is a metaphysical (in a non-pejorative sense!) claim, and belongs
firmly in the camp of metaphysics and epistemology. Yet, philosophers have hardly scratched the surface of this
issue.
Often philosophers like to see themselves at the vanguard
of debate, asking difficult questions that the general population would prefer
to ignore, yet need to face. It is
therefore striking and a little ironic to see mainstream philosophy lagging
behind popular debate in areas such as psychopharmacology. It is in editorials, magazine articles, and
other discussions in popular culture that these important issues are being
discussed. It is time for professional
philosophers to add their expertise and careful methods to this debate.
____________________________________________________
Surgeon General Makes
Descartes Error
Links:
·
Mental Health:A Report of the Surgeon General
·
RENÉ DESCARTES AND THE LEGACY OF MIND/BODY
DUALISM
·
Lisa Shapiro: Faculty Biographies 1999-2000
The US Surgeon
General recently published a report on Mental Health. It's actually an impressive 458 page book, with chapters on
children, adults, older adults, the structure and financing of mental health
services, confidentiality, and the future of the mental health profession.
I expect to be
covering several aspects of this important report in future WHiP columns, but
what first struck me about it was its laying blame in its Introduction on
Descartes for our western dualism of mind and body and the stigma of mental
illness. It refers to "the misguided
split between mind and body first proposed by Descartes," (p. 6) and says,
"This partitioning ushered in a separation between so-called 'mental' and
'physical' health, ..." (p. 5).
Coming, as it does,
under the imprimaturs of the Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration, Center for Mental Health
Services, National Institutes of Health, and National Institute of Mental
Health, this report is set to be influential and has the ability to perpetuate
myths. This view about Descartes smacks
of stereotyping of a sophisticated philosopher.
Of course, the
Surgeon General is simply repeating what has become a standard view. For instance, the very title of
neuroscientist Antonio R. Damasio's best-selling book *Descartes' Error:
Emotion, Reason, and the Human Brain* refers to such a view. Nevertheless, even a little thought about
the issue shows that Descartes should not be painted as a villain here.
For one thing,
Descartes was certainly not the first to suggest that there is a split between
mind and body. The idea dates back at
least to Plato, who argued that not only is the mind a radically sort of entity
than physical matter, but also that our knowledge of the mind and its contents
is very different from our knowledge of the physical world. Subsequent philosophers were certainly
influenced by Plato, and it is a standard observation that early Christian
theology had strong Platonic elements.
Indeed, any religious view that holds that persons can go on living
after their bodies have ceased to exist needs to have some account of
personhood as logically independent of the body.
Furthermore, I wonder
what ground there is for saying that Descartes had such a profound influence on
western medical thought. Is it not more
plausible to blame Christianity as the more powerful social force? It's easy to imagine that history would be
little different if Descartes had never written a word of philosophy, but it is
hard to know what our society would like if Christianity had never caught
on.
But from a
philosophical point of view, maybe what is most important is that this view
perpetuated by the Surgeon General misunderstands Descartes. I'm no scholar of early modern philosophy,
so I asked Lisa Shapiro, Assistant Professor of Philosophy at Hampshire
College, to give her expert opinion.
Her Ph.D. dissertation at the University of Pittsburgh was on "The
Union of Mind and Body: Descartes' Conception of a Human Being," and I
have heard her reaction on previous occasions when Descartes was held
responsible for our seeing mind and body as radically split. Here's what she wrote:
"While
Descartes does claim that mind and body are separable, he also claims that
these two substances are united in a human being and through this union they
have the power to affect one another.
Indeed, he thinks that we experience this union everyday, in the course
of leading our lives, just in having the sensations we do, and feeling the
passions we do. While Descartes is often assigned a Platonic view, wherein the
mind is lodged in a body like a sailor in a ship, he explicitly distances
himself from this view in both the _Discourse on the Method_ and the
_Meditations_. He does not think that
that model can explain the quality of our sensations, for it is clear that we
do not have the kind of knowledge of our bodies that angels would have. Moreover, it is clear from his
correspondence with Princess Elizabeth of Bohemia that he does think that mind
and body are tightly connected. He
diagnoses her chronic illness as an effect of depression due to family
problems, such as the beheading of her uncle Charles I of England. And admits to her that certain diseases can
impair our free will and with it our capacity to reason well. The view about the radical separation of mind
and body usually assigned Descartes is perhaps due to the philosophical
problems he faces in articulating the union. Descartes was influential in
shaping modern medicine, insofar as he, like Harvey and others who followed (La
Forge, Malebranche, La Mettrie), was committed to describing the human body as
a machine. But describing the human
body in this way raises real questions for the status of the human mind. Are we
do think of it as a feature of the machine as well (like Hobbes was inclined
to)? If not, how are we to explain the relation of mind (non-material,
non-mechanical) and body? The rise of mechanist science, and the application of
that mechanism to biology then gave rise to a dilemma: We could deny that mind and body were two
different things, and so be materialists. This option presents problems for the
Christian doctrine of the immortality of the soul, however. To preserve the
doctrine of the immortality of the soul, and the view of ethics and
responsibility associated with it, we could preserve the distinction between
mind and body, and to avoid the difficulties of explaining how they relate to
one another assert that the well-being of one did not affect the well-being of
the other. I would see Descartes as trying to steer a middle course between
these two. Critics have shown him not to have been successful in doing so.
History has shown him unsuccessful in getting credit for trying."
____________________________________________________
Rationality, Psychopathology, and Emotions.
Links:
Twelfth Annual Meeting of the Association for
the Advancement of Philosophy & Psychiatry
Books of relevance:
The Sources of Moral Agency : Essays in Moral Psychology
and Freudian Theory by John Deigh
Emotions & Reasons : An Inquiry into Emotional
Justification by Patricia S. Greenspan
This year's annual conference of the Association for the
Advancement of Philosophy and Psychiatry was on "Rationality & Mental
Health." As usual, it met just
before the huge American Psychiatric Association meeting, which this year was
in Chicago. Many different psychiatric
groups meet at the larger conference, and the financial power of pharmaceutical
companies is apparent, for instance in their provision of rather lavish tables
of food for these different groups.
Unfortunately, or perhaps fortunately, the funding of AAPP is modest by
comparison, and we mostly made do with cups of coffee, although there was some
very good cheese and fruit available at the Saturday reception.
This was one of the most successful annual meetings AAPP
has had, due to a thematic unity among the papers and more time left for
discussion of each paper, which also meant that there were fewer papers, and
thus that the average quality of papers was higher.
Broadly speaking, the papers divided into two groups:
those that addressed the relation of emotions and rationality, and those that
did not.
A few papers did not address the issue of emotions at
all: my own paper discussed whether principles of charity in the interpretation
of others required by prominent philosophers of mind such as Daniel Dennett and
Donald Davidson placed conceptual limits on how extreme psychopathology can
me. Louis Berger gave an interesting
discussion of to what extent the transaction between a psychotherapist and a
client can be captured in any model, and argued that the main theories of
psychotherapy indeed do not entail or fully describe what happens in
psychotherapy. In the question period,
it became clear that he was committed to an even more radical view, that no
human behavior can be fully modeled with a theory. David Graves, despite jet lag, breathtakingly set out an
ambitious theory of "modular rationality," which drew on a number of
different ideas from cognitive science and elsewhere.
James Phillips gave a wonderful paper on the problems of
defining the psychiatric concept of delusion.
It is often mistakenly thought that a delusion can be simply defined as
a belief system strongly divorced from reality, but Phillips showed some of the
problems inherent in such an approach, and made his own suggestions about a
more promising approach -- among his ideas was that the definition of delusion
does need to bring in a concept of affect.
Neither of the keynote addresses were particularly
concerned about emotion. Drew Western,
a Harvard psychiatrist, outlined the relevance of cognitive neuroscience for
our understanding of rationality. Of
greater philosophical interest was John Deigh's paper on "Moral Agency and
Criminal Insanity," which gave both a very useful history of the insanity
defense, and a careful study of the moral psychology of irrational action. It was a paper that tended to split the
audience: the analytic philosophers delighted in the careful distinctions,
while others seemed to feel it was hair splitting. Deigh concluded with a discussion of to what extent we can be
considered morally responsible for our actions that are due to mental
disorder. This theme was taken up by
Sarah Hamady in her Harry-Frankfurtian discussion of external desires and
self-defeating behavior. She engaged
the issue of how we can transform ourselves and accomplish a unity of goals and
desires.
Many papers did focus on philosophical issues concerning
emotion. Some of them were traditional
philosophical issues such as the relation between rationality and affectivity:
to what extent is it rational to have emotions, when are emotions irrational,
and what emotions are. More innovative
were the papers that drew stronger connections to psychopathology and
psychotherapy, although still focusing on emotions. Some papers discussed whether various forms of mental disorders
involved problems with rationality or problems with emotions; others discussed
the goal of psychotherapy, and cognitive-behavioral therapy (allied with
rational-emotive therapy).
I'll mention three of the papers on emotion. In one of the more continental papers of the
conference, George Agich argued that models of mental illness put too much
emphasis on the idea of failures of rationality and autonomy. He urged that we need to understand the
importance of affect in mental disorder.
Patricia Greenspan, one of the program co-chairs, took a slightly
unusual step considering her position, and criticized the assumption she saw of
the division of rationality and emotion in the Conference's Call For
Papers. She argued, continuing the
research project she has pursued for several years, that emotions can be
rationally evaluated. York Gunther gave
one of the more technical and challenging papers of the conference. He claimed, and here I quote from his
abstract, that "Emotional contents ... are unique because they resist
inferential structure and generally fail to take binary connectives." In order to show this, he considered in some
detail what one is rationally committed to in having an emotion. He used this to conclude that emotions
cannot be specified independently of their attitudes, which is to say that
emotions cannot be identified purely propositionally. With a wry smile, Gunther admitted that his method harkened back
to the heyday of ordinary language philosophy, and was eager to learn of other
methods that could help him reach the same conclusions.
Reflecting on the conference, I am struck by how the
divisions between analytic philosophers, continental philosophers and
clinicians seemed much less significant and problematic than they have at
previous such conferences. Of course
these divisions still existed, but on the whole participants did not seem to
divide up neatly into rather predictable groups, as so often happens at such
interdisciplinary events. Rather, the
discussion managed to find common ground, or at least to explore the strengths
and weaknesses of individual ideas without resorting to standard "party
lines." The most heated exchange,
between a psychiatrist and an academic psychologist, was about the role of drug
companies in the modern profession and the extent to which "scientific
studies" of therapy and drugs are fair and unbiased. The conference as a whole was provocative
and interesting, and could serve as a model for interdisciplinary work.
____________________________________________________
Philosophers on Drugs (Again)
Links:
ENHANCEMENT TECHNOLOGIES GROUP
Books:
Listening
to Prozac, by Peter Kramer
The
Antidepressant Era, by David Healy
Erik Parens, Editor Enhancing Human Traits: Ethical
and Social Implications
One of the latest issues of The Hastings Center Report
has a number of short articles on "Prozac, Alienation, and the
Self." The authors are Carl
Elliott, Peter D. Kramer, David Healy, James C. Edwards, and David
DeGrazia. Of this group of writers,
three are professional philosophers, and psychiatrist Kramer’s book Listening to Prozac was surprisingly
sensitive to philosophical issues.
Healy, another psychiatrist, is author of a number of social/historical
books on psychopharmacology; of these, The
Antidepressant Era, published by Harvard University Press, has gained the
most attention.
The standard worry about Prozac is that it is used too
much and for the wrong sorts of reasons; specifically some worry that people
who are not seriously depressed, but merely want a crutch to help them deal
with life use it. Such a life is
thought inauthentic; the happiness of such a life would be a result not of
flourishing, but rather a result of chemical manipulation. Furthermore, there may be some circumstances
where happiness is inappropriate, and a sense of alienation is a better
reaction. Elliott embraces this sort of worry about Prozac, and more generally
about the individualistic approach of psychiatry: if modern culture is
alienating, he suggests that the best response is not to feel better by taking
Prozac; it would be better to examine our values and change the way we live.
Peter Kramer expresses doubt, in response to Elliott,
that modern alienation is a reaction to social conditions. Furthermore, he suggests that we have a
cultural preference for the melancholic over the sanguine, identifying the
perfectionism, pessimism and sensitivity of melancholy with intellectual
traits.. He does not necessarily
endorse this preference, and does not think it provides a strong reason to be
suspicious of Prozac. Prozac could help
as much as hinder social change: “If Prozac induces conformity, it is to an
ideal of assertiveness.” Kramer wants
us to be at least open to the possibility that melancholy is not necessary for
critical stance towards our surroundings, and that we should indeed question
our attachment to melancholy. That is
to say, he thinks a person can engage in a profound philosophical questioning
and still be happy. With deliberate provocation, Kramer questions what he sees
as a philosopher’s prejudice, the idea that “melancholy is appropriate to
modernity.”
The most straightforward critique of psychopharmacology
in the journal comes from Healy. He emphasizes
the power of the pharmaceutical corporations.
He casts doubt on the empirical date supporting the effectiveness of
Prozac in treating depression. He
states flatly that Prozac does not work for severe depression. Ultimately he calls into question the
“pseudoscientific” mystique that has grown up around Prozac, and suggests that
the abstract philosophical debate about Prozac and alienation is missing the
most important questions.
Edwards gives the mildest suggestion of the group. Using the framework of Foucault and
Heidegger, Edwards considers the source of our worries concerning the use of
Prozac as mood enhancer. He suspects
that we are suspicious of happiness that is not earned through suffering – there
is a virtue in bearing pain. Edwards
tries to separate out two attitudes towards technology, one that embraces it
and another that eschews it. He
suggests both are worth thinking about and we need to understand what
assumptions are built into each, and most importantly, we should realize that
we don’t have to be swept up in the frenzy for technological progress.
DeGrazia, in the last article of the collection,
emphasizes that one’s self is partly created, rather than merely discovered, by
oneself. He argues that Elliott does
not sufficiently appreciate this point, and that Elliott’s criticism of an
enhanced life on Prozac as inauthentic assumed that the self is static and
given. Instead of Prozac creating a
false self, mismatched with one’s real self, it might be possible to identify
with one’s new self. A central question
for DeGrazia then is just how malleable the self is. He quickly distances himself from the extreme view of Sartre that
we are entirely self-creating and utterly malleable. It takes only a little reflection to see that people have limits
and that they cannot always become whatever they want. He points out that one long-standing form of
self-creation is psychotherapy, and this mode of self-change hasn’t been
accused of creating inauthentic selves.
Given that, why should the use of drugs like Prozac be any more
troublesome than psychotherapy?
DeGrazia can see no legitimate difference between these modes of
self-change vis-à-vis authenticity. He
ends by acknowledging that there may be reasons for qualms about the prospect
of a society in which most people use self-enhancing drugs. Nevertheless, he argues, it should not be up
to individual psychiatrists to refuse medication to their patients if their
reason is such use of medication is not good for society as a whole. It is not for the psychiatric profession to
impose its grand vision of the good life on society: patients themselves should
make such decisions.
I’m hopeful that the debate about performance-enhancing
and mood-enhancing drugs will gather momentum, especially as it becomes clearer
how much it overlaps with debates about genetic technology and the increasing
use of computers in the body, sometimes known as "cyborg
technology." Kudos to the editor
of The Hastings Center Report for taking one of the early steps to
advance this debate in medical ethics and the rest of philosophy.