Few people would argue against treating the traumatic psychological effects of war or violence. But what about taking a drug to lessen the pain of our common daily struggles, such as the end of a relationship or anxiety about one’s job? Is this a “cosmetic” enhancement of human life, even a danger to character, or is it an ethical choice? For guidance, the author looks to the history of treating physical pain and argues that, despite growing knowledge of the biological basis for psychological pain, many find it hard to find a consistent principled position when it comes down to specific instances of alleviating human suffering.
We are all familiar with —and many are troubled by—athletes who use medications, legal or otherwise, to enhance their performance. This practice is an early indication of a much larger trend. As neuroscience advances, we are getting better at treating cognitive and emotional disorders, and we are also learning how to improve cognition and modify emotions in basically normal, healthy people—for example, by increasing alertness or lessening fear. I have coined the term “cosmetic neurology” for this practice.1
Cosmetic neurology raises four major ethical concerns. First is a concern about safety. We weigh the potential risks and side effects of a new medication for a disease against the potential benefits. In health, are any risks worth taking? For example, musicians often use beta-blockers to dampen tremors and anxiety associated with public performance. Occasionally, however, beta-blockers are associated with a life-threatening anaphylactic (allergic) reaction in which a it’s not always clear that an individual would be better off without the drug. What some might see as a dubious or even dangerous enhancement, others believe is an ethical means of relieving suffering. person’s blood pressure drops and breathing stops. Is the better concert worth this risk? Second is a concern about distributive justice: If cosmetic neurology succeeds in making people smarter and happier, will these enhancements be available disproportionately to the affluent? Third is a concern about coercion. Will healthy people be or feel forced to take such medications, either because it would serve a greater good (for example, airline pilots being required to take a drug to increase alertness if that made flying safer) or because of competitive pressures?
Finally—and this is the focus of this article—ethicists and others have expressed a subtle but deep concern about ways in which manipulating our emotional lives might erode character, both individually and communally. This was a fundamental concern raised by the Presidential Commission on Bioethics and highlighted in its 2003 report, Beyond Therapy.2 If, as many religions and philosophies argue, struggle and even pain are important to the development of character, does the use of pharmacological interventions to ameliorate our struggles undermine this essential process?
The widespread practice of cosmetic neurology seems inevitable, and resolving this concern will not be easy. Many people share an underlying discomfort with how things might play out. But when we consider specific instances of using a medication to affect emotion and treat psychological pain, it’s not always clear that an individual would be better off without the drug. What some might see as a dubious or even dangerous enhancement, others believe is an ethical means of relieving suffering.
In my view, the history of the treatment of physical pain, including “natural” pain, anticipates the treatment of psychological pain. Similar tensions are certainly at play. This claim is predictive, not prescriptive—I am neither advocating nor decrying the use of cosmetic neurology. I am, instead, pointing out how deeply difficult it is for anyone, ethicists included, to adopt a consistently principled position on the problem of pain.