17 January 2009

The Ethics of Prozac

One of the most difficult ethical questions, for me, is this: Are psychotropic drugs immoral?

I'm not referring to recreational drug use. I mean drugs like Prozac, lithium, methylphenidate; drugs used to affect the mind and treat psychiatric disorders.

It seems reasonable to make the claim that taking psychotropic drugs is an act of “bad faith”: this is not taking full responsibility for my behavior; this is a “flight from freedom” and an act of self-delusion as I try to create external restraints to my freedom. It is impossible thus to live authentically. I am not accepting my true nature and confronting it.

I recently spent some time on holiday from Prozac, believing that my attitude, my faith in myself, my hope was enough. Without question my strength in these things was magnified because they were the only things I had. I had to rely on them. It took all my emotional and mental faculties to get through the day. Life was very difficult; it felt barren. I had so little energy. I became more socially paranoid and withdrawn. Then, I returned from holiday: Prozac kicked in, and for a few days I felt – such contrast – euphoric. I was happy. Not only did I have a tempered positive attitude, but also the serotonin to feel something. As I say, it lasted a few days: I became despondent. No matter how much I had tried, I'd never been able to feel happy – not for more than a moment – and I had become enabled, not by my own will, but by something that felt deterministic, fatalist: I needed to take a drug to feel happy.

So why not take it further? Why not develop a super-opiate that forces Heaven onto earth by making the physical body, so inadequate, facilitate the absolute euphoria?

No, that feels wrong.

If it's wrong to force happiness, then how is it right to force even the simple ability to feel happy when the physiological ability is – by nature – lacking?

In a lot of ways life is learning to get along with an animal body. I have the now-adult body of a child who had a “failure to thrive”, and I have to frequently remind myself that something is physiologically off here. People treat me differently, so how could I forget I'm so … twiggy? Until very recently, I've actually been in serious denial about it. Of course, this means I've had it on my mind, and I've had it on my mind while reading about animal behavior. There was a study (by Michael Raleigh) done with a colony of vervet monkeys that strongly suggests serotonin levels are related to hierarchal dominance: give a low-ranking monkey a medication that raises its serotonin levels and a high-ranking monkey a medication that lowers its serotonin levels, and their ranking reverses. I wildly speculate that my physiology is meant to perform a certain social role: the hyper-vigilant, overly-anxious, aggressive runt that is the first to call the alarm when it spots the predator – which also means it gets the predator's attention – but this is okay, as the runt is expendable (they even starve themselves during famine to sacrifice for their betters). I'm like the second egg an eagle lays in case something happens to the first one. Nature's backup plan.

What does this have to do with Prozac? I'll get to that in a moment.

Self-pity is a horrible thing. I endeavor to always eschew it. I am not a victim nor a martyr. I am simply unique, and it is up to me to accept who I am and decide – by living my life, by how I think – to define myself. I believe in Carl Roger's drive to self-actualization. On the way, I will use whatever resources available to me – including Prozac. There is a vital difference between forcing and enabling: one is a flight from freedom, the other is a flight toward it.

There are, among a great many other things, biological elements at play in reality as I know it; the human condition is a mortal condition. I reason that if I were diabetic, I'd allow myself – against the clear destiny chosen for me by Fate – insulin. Blood sugar levels affect cognition, so it's not such a leap to concede that there are conditions, with primarily cognitive symptoms, that can be managed with medication.


Peter McCombs said...

An interesting article.

I haven't thought about synthetic pharmaceuticals in an ethical context until recently.

It really is a question about human artifice in general. When is there a "right" to the artificial? You understand where I am coming from, with my particular view of "Natural Rights." I claim as a principle that we don't have a "natural right" to artificial things. This doesn't mean that all artificial things are immoral, just that we have to become casuists when thinking about ethics and art.

After all, humans "naturally" create, therefore we must have some measure of right to our creations.

With that in mind, I suggest that completely avoiding the consumption of synthetic substances to produce a desired physiological effect would be the ideal.

In the first place, there has to be a recognition that we are more than the sum of our natural parts. There are biological ingredients, but that is not the whole of it.

If you take a pot of water and put it in a freezer, the water inside becomes a different thing than if you were to place that water inside of a furnace or leave it sitting on the table.

If you filter the water through a series of membranes, it assumes different qualities than the same water passed through toxins and heavy metals.

Likewise, environment and causality have a great deal more influence over who we are than perhaps we ware willing to admit.

Rather than taking the popular approach, which is to look at the symptoms and work on a synthetic drug to suppress them, I suggest that there are better problem-based approaches that should be attempted first.

For example, changes can be made to the environment, the relationships, the external stimuli. Sometimes more importantly, the body needs exercise and proper nutrition. The human body is the consummate product of evolution; do we really believe the only solutions to our defects are synthetic ones?

The danger of drugs is that once this path is chosen, it is very difficult to leave. Once synthetic substances have modified us, natural equilibrium will return very slowly. Doctors prescribe drugs with too little concern and too much faith. We should take a healthy dose of skepticism along with every pill we swallow.

Now, if there were a pill that made sleep superfluous... I wouldn't think twice. ;) See how I am?

Dave said...

Thanks for your comments.

I have to admit, I don't really have a lot of faith in the end result of evolution, especially the more I learn about physiology and zoology. The consummate product is far, far from ideal, and probably in some cases, not entirely functional (autism, schizophrenia, and so much more).

I'm also a bit weird in that I feel the more cybernetic we become, the better -- I do not understand someone who says, well, we're interfering with nature's natural course. I believe evolution favors traits that advance an organism more quickly than the very painful and slow process up till now. I say technology *is* evolution, and the race to the stars is an act of Life in its ceaseless expansion. Of course there will be expensive consequences, but I think that progress is unstoppable. There will be drugs to make sleep unnecessary, I'm certain, and the leap to organic machines will change everything again.

You are absolutely correct in what you say about what approaches should be tried first (I've heard it many times from my doctor). This is the art of living life well, which is important -- but I think nature is entirely focused on expanding its capacities to grow and improve in new ways. The individual will always be sacrificed for the masses.

Technology = inexorable act of god that exponentially advances the progress of life.

My views are mostly, however, based on my enjoyment of Gibson novels. It's horrible and bent -- but the possibilities! And who's to claim to know the mind and intent of God?

(I got carried away).

Peter McCombs said...

Today I had the opportunity to stand on the mountainside above the smog and breathe fresh air. It occurred to me that the human being, more than any other animal, chooses to live in his own waste. Looking down into that haze, it seems very plausible to me that, from a viewpoint within this filthy soup, evolution has failed to produce an excellent organism suited to its environment.

But looking from the outside in, it's evident that the environment thrust upon us is an artificial one of our own making, not the one nature raised us to live in. When returned to his natural habitat, I speculate that one may find that schizophrenia and autism are not so much a product of evolution after all, but rather an effect of the misuse and abuse of technology. If history has told us anything about technology, it is that we will use it against ourselves. Do we augment what nature seems to recommend to us? No, we replace it with something "better" and wholly artificial.

Dense cities, warehouses and factories, schools where children are mass produced into one type of citizen; global economies, cubicle farms and bank sinecures, digital lives that replace real ones. It is convenience without responsibility -- reckless and destructive. That's what technology has done for us: Man lives a lengthier span of fat and useless (sometimes hopelessly broken) years while mankind's days are numbered.

Listen to me. I'm a computer programmer of nearly two decades, but I'm a blithering Luddite in three paragraphs.

No, technology isn't the problem. The problem is that we never listened to the people who knew best when it came time to apply our genius. We prefer the pipe dreams of ivory tower socialists and capitalists whose ideologies have shaped our abuses over the years. Two sides of the same cankered coin.

So here we are in this technological machine dystopia, living deliriously in our own waste. We're like ice in a freezer, and the only way we can imagine a return to normalcy is with chemical heat applied every half hour. That's how we'll stay liquid. Nobody ever thinks to open the door and get out of the icebox.

Dave said...

I agree with you completely. Having commuted, having sinus problems when the air settles, and a lifetime of exposure to marketing have given me a healthy loathing of many aspects of modern living.

It's just that my sense of reason thinks the probability of a return to normalcy very unlikely. I see progress at almost any cost (which could well be the perfect formula for extinction.)

Everything is always changing. I think we've gone too far to undo what we've done, although undoubtedly we'll have to sacrifice a lot of what we think we now need just to survive into the future (especially considering our population growth).

I think the only complete return to nature now is a post-apocalyptic scenario.

Also, a study of anthropology and how man in his natural environment lived might change your mind about well-adapted and pleasant life has been. Sure, there are a lot of things that are probably aggravated by artificial living, but I contend the benefits of modern society far outweigh this.

No doubt much of or technology has been mis-applied. Trial and error may see this rectified. My point is, evolution does the same thing, but utterly at random and a million times slower. This might seem absurd, judging God as slow and imperfect and in need of improving -- but I do not see mankind divorced from God. It is ... inevitable. :P