What is that makes an act subject to either praise or blame? The question has often been taken to depend entirely on the free will debate for an answer, since it is widely agreed that an agent’s act is subject to praise or blame only if it was freely willed, but moral theory, action theory, and moral psychology are at least equally relevant to it. In the last quarter-century, following the lead of Harry Frankfurt’s (1971) seminal article “Freedom of the (...) Will and the Concept of a Person,” the interdisciplinary nature of the question has been emphasized by various authors. Going beyond the boundaries of the traditional free will debate, they have attempted to describe the requirements for agent accountability by appeal to theories of personality, rational agency, and ethical choice. The approach has been a breath of fresh air in the often-stagnant free will debate, bringing new considerations to bear and provoking new lines of argument, and it is an approach that we will adopt in this paper. In the following pages, we hope to show that an under-noticed phenomenon of moral psychology, inverse akrasia, exemplified by Huckleberry Finn, has something to contribute to the understanding of agency and accountability. After presenting the phenomenon in section I, we will move in section II to a quick survey of a family of Frankfurt-inspired views and a critique of them based on the phenomenon in sections III and IV. A new theory will be offered in section V, and potential objections addressed in the final section of the paper. (shrink)

: The idea of enhancing our mental functions through medical means makes many people uncomfortable. People have a vague feeling that altering our brains tinkers with the core of our personalities and the core of ourselves. It changes who we are, and doing so seems wrong, even if the exact reasons for the unease are difficult to define. Many of the standard arguments against neuroenhancements—that they are unsafe, that they violate the distinction between therapy and enhancements, that they undermine equality, (...) and that they will be used coercively—fail to show why the use of any such technologies is wrong in principle. Two other objections—the arguments that such changes undermine our integrity and that they prevent us from living authentic lives—will condemn only a few of the uses that are proposed. The result is that very few uses of these drugs are morally suspect and that most uses are morally permissible. (shrink)

The profound changes in personality, mood, and other features of the self that neural interventions can induce can be disconcerting to patients, their families, and caregivers. In the neuroethical debate, these concerns are often addressed in the context of possible threats to the narrative self. In this paper, I argue that it is necessary to consider a dimension of impacts on the narrative self which has so far been neglected: neural interventions can lead to a loss of meaning of actions, (...) feelings, beliefs, and other intentional elements of our self-narratives. To uphold the coherence of the self-narrative, the changes induced by neural interventions need to be accounted for through explanations in intentional or biochemical terms. However, only an explanation including intentional states delivers the content to directly ascribe personal meaning, i.e., subjective value to events. Neural interventions can deprive events of meaning because they may favor a predominantly biochemical account. A loss of meaning is not inherently negative but it can be problematic, particularly if events are affected one was not prepared or willing to have stripped of meaning. The paper further examines what it is about neural interventions that impacts meaning by analyzing different methods. To which degree the pull towards a biochemical view occurs depends on the characteristics of the neural intervention. By comparing Deep Brain Stimulation, Prozac, Ritalin, psychedelics, and psychotherapy, the paper identifies some main factors: the rate of change, the transparency of the causal chain, the involvement of the patient, and the presence of an acute phenomenological experience. (shrink)

This paper presents a functional genealogy of essentialist authenticity. The essentialist account maintains that authenticity is the result of discovering and realizing one’s ‘true self’. The genealogy shows that essentialist authenticity can serve the function of supporting continuity in one’s individual characteristics. A genealogy of essentialist authenticity is not only methodologically interesting as the first functional genealogy of a contingent concept. It can also deepen the functional understanding of authenticity used in neuroethics, provide a possible explanation for the prevalence of (...) the idea of an essentialist true self and justify the use of the ideal of authenticity. First, essentialist authenticity is defined and explained through the work of Jean-Jacques Rousseau. Second, a general need to have steady characteristics is derived from basic human practices. Third, circumstances that make it more challenging to steady oneself are identified and shown to have become more prevalent in the age of modernity when the ideal of authenticity emerged. Finally, it is shown how essentialist authenticity helps to steady the self. (shrink)

Entry on "Neuroenhancement" in the Routledge Encyclopedia of Philosophy Online.

This chapter addresses the claim that, as new types of neurointervention get developed allowing us to enhance various aspects of our mental functioning, we should work to prevent the use of such interventions from ever becoming the “new normal,” that is, a practice expected—even if not directly required—by employers. The author’s response to that claim is that, unlike compulsion or most cases of direct coercion, indirect coercion to use such neurointerventions is, per se, no more problematic than the pressure people (...) all find themselves under to use modern technological devices like computers or mobile phones. Few people seem to believe that special protections should be introduced to protect contemporary Neo-Luddites from such pressures. That being said, the author acknowledges that separate factors, when present, can indeed render indirect coercion to enhance problematic. The factors in question include lack of safety, fostering adaptation to oppressive circumstances, and having negative side effects that go beyond health. Nonetheless, the chapter stresses that these factors do not seem to be necessary correlates of neuroenhancement. (shrink)

Timothy Brown invites us to think about the ways in which people who are being treated with deep brain stimulation might come to interact with their devices. He suggests that a framework of relational agency can help us to understand both the benefits and the challenges of DBS because DBS systems are, while not full fellow agents, more than mere props; users must sometimes "negotiate and collaborate with their stimulators". We agree that it is important to develop conceptual frameworks that (...) both do justice to the ways that individuals respond to using DBS and give them new ways to think about the device, their relationship to it, and its role in their lives. In this commentary, we consider three... (shrink)

The ethical debate about neurotechnologies—including both drugs and implanted devices—has been largely framed around the questions of whether and when these technologies could damage or promote authenticity. Patients can experience changes in mood, behavior, emotion, or preferences—seemingly, changes in character or personality. Some describe such changes by saying they feel like different people; that they have become either more or less themselves; or that they feel as though some of their moods, behaviors, emotions or preferences are not their own. These (...) kinds of statements are used to describe both changes that a drug or device is... (shrink)

Entry on "Authenticity" for the fourth edition of the Encyclopedia of Bioethics, edited by Bruce Jennings. Discusses the concept in the context of end-of-life decision-making, human enhancement, and the treatment of mental disorder.

Durch den rasanten Fortschritt in den Neurowissenschaften ergibt sich ein bidirektionales Implikationsverhältnis zwischen Ethik und Neurowissenschaften: Einerseits haben neurowissenschaftliche Erkenntnisse epistemische Implikationen für anthropologisch-ethische Grundkonzepte, andererseits haben ethische Kriterien normative Implikationen für neurowissenschaftliche Interventionen. Die Neuroethik untersucht diese normativen Implikationen systematisch auf der metaethischen, der theoretischen und der praktischen Ebene. Um eine spezifische und differenzierte ethische Analyse der einzelnen neurowissenschaftlichen Interventionen zu ermöglichen, soll hier eine bereichsspezifische, neuroethische Kriteriologie vorgestellt werden. Durch exemplarische Anwendung ihrer einzelnen Kriterien auf gegenwärtige und zukünftige (...) neurowissenschaftliche Forschungs- und Interventionsmöglichkeiten soll gezeigt werden, dass sie eine systematische und zugleich praktisch anwendbare Möglichkeit bietet, einen normativen Orientierungsrahmen für Neurowissenschaften und Neurologie zu gewinnen. Insofern sie auf weitgehend konsensfähigen ethischen Prinzipien basiert, kann sie zudem als ethische Grundlage für einen breiten klinischen und wissenschaftlichen Diskurs dienen. (shrink)

Gilbert et al. have raised important questions about the empirical grounding of neuroethical analyses of the apparent phenomenon of Deep Brain Stimulation ‘causing’ personality changes. In this paper, we consider how to make neuroethical claims appropriately calibrated to existing evidence, and the role that philosophical neuroethics has to play in this enterprise of ‘evidence-based neuroethics’. In the first half of the paper, we begin by highlighting the challenges we face in investigating changes to PIAAAS following DBS, explaining how different trial (...) designs may be of different degrees of utility, depending on how changes to PIAAAS following DBS are manifested. In particular, we suggest that the trial designs Gilbert et al. call for may not be able to tell us whether or not DBS directly causes changes to personality. However, we suggest that this is not the most significant question about this phenomenon; the most significant question is whether these changes should matter morally, however they are caused. We go on to suggest that neuroethical analyses of novel neuro-interventions should be carried out in accordance with the levels of evidence hierarchy outlined by the Centre for Evidence-Based Medicine, and explain different ways in which neuroethical analyses of changes to PIAAAS can be evidence-based on this framework. In the second half of the paper, we explain how philosophical neuroethics can play an important role in contributing to mechanism-based reasoning about potential effects on PIAAAS following DBS, a form of evidence that is also incorporated into the CEBM levels of evidence hierarchy. (shrink)

Ethical analyses of the effects of neural interventions commonly focus on changes to personality and behavior, interpreting these changes in terms of authenticity and identity. These phenomena have led to debate among ethicists about the meaning of these terms for ethical analysis of such interventions. While these theoretical approaches have different criteria for ethical significance, they agree that patients’ reports are concerning because a sense of self is valuable. In this paper, I question this assumption. I propose that the Buddhist (...) theory of no‐self offers a novel approach to making ethical sense of patients’ claims following deep brain stimulation. This alternative approach is based on the value of insight into patterns of cause and effect among mental states and actions. (shrink)

Some philosophers and theologians have argued against the idea of Human Enhancement, saying that human beings should not play God. A closer look, however, might reveal that the question of who is playing Whom is far from being so clear-cut. This chapter will address the idea of human enhancement from the standpoint of theistic theology, arguing that human enhancement and theistic theology may not be so very incompatible, after all.

In this article, we explore how deep brain stimulation (DBS) devices designed to “close the loop”—to automatically adjust stimulation levels based on computational algorithms—may risk taking the individual agent “out of the loop” of control in areas where (at least apparent) conscious control is a hallmark of our agency. This is of particular concern in the area of psychiatric disorders, where closed-loop DBS is attracting increasing attention as a therapy. Using a relational model of identity and agency, we consider whether (...) DBS designed for psychiatric regulation may require special attention to agency. To do this, we draw on philosophical work on relational identity and agency, connecting it with reports from people using first-generation DBS devices for depression and obsessive-compulsive disorder. We suggest a way to extend a notion of relational agency to encompass neural devices. (shrink)

Philosophers have identified a number of principles that characterize morality and underlie moral judgments. However, philosophy has failed to establish any widely agreed-upon justification for these judgments, and an “error theory” that views moral judgments as without justification has not been successfully refuted. Evolutionary psychologists have had success in explaining the likely origins and mechanisms of morality but have also not established any justification for adopting particular values. As a result, we are left with moral nihilism -- the absence of (...) any unarguable values or behaviors we must or should adopt. The philosophical and psychological implications of this nihilism suggest accepting shared, non-absolute values as “good enough”; a revised, humbler view of moral and other value judgments; and the possible acceptance of the hard truth of a value nihilism. (shrink)

In this paper, I focus on a kind of medical intervention that is at the same time fascinating and disturbing: identity-changing interventions. My guiding question is how such interventions can be ethically justified within the bounds of contemporary bioethical mainstream that places great weight on the patient9s informed consent. The answer that is standardly given today is that patients should be informed about the identity effects, thus suggesting that changes in identity can be treated like ‘normal’ side effects. In the (...) paper, I argue that this approach is seriously lacking because it misses important complexities going along with decisions involving identity changes and consequently runs into mistakes. As a remedy I propose a new approach, the ‘perspective-sensitive account’, which avoids these mistakes and thus provides the conceptual resources to systematically reflect on and give a valid consent to identity-changing interventions. (shrink)

A long tradition of psychological research has explored the distinction between characteristics that are part of the self and those that lie outside of it. Recently, a surge of research has begun examining a further distinction. Even among characteristics that are internal to the self, people pick out a subset as belonging to the true self. These factors are judged as making people who they really are, deep down. In this paper, we introduce the concept of the true self and (...) identify features that distinguish people’s understanding of the true self from their understanding of the self more generally. In particular, we consider recent findings that the true self is perceived as positive and moral, and that this tendency is actor-observer invariant and cross-culturally stable. We then explore possible explanations for these findings and discuss their implications for a variety of issues in psychology. (shrink)

Many critics of medicalization express concern that the process privileges individualised, biologically grounded interpretations of medicalized phenomena, inhibiting understanding and communication of aspects of those phenomena that are less relevant to their biomedical modelling. I suggest that this line of critique views medicalization as a hermeneutical injustice—a form of epistemic injustice that prevents people having the hermeneutical resources available to interpret and communicate significant areas of their experience. Interpreting the critiques in this fashion shows they frequently fail because they: neglect (...) the ways in which medicalization may not obscure, but rather illuminate, individuals’ experiences; and neglect the testimony of those experiencing first-hand medicalized problems, thus may be guilty of perpetrating testimonial injustice. However, I suggest that such arguments are valuable insofar as they highlight the unwarranted epistemic privilege frequently afforded to medical institutions and medicalized models of phenomena, and a consequent need for greater epistemic humility on the part of health workers and researchers. (shrink)

In bioethics, the first decade of the twenty-first century was characterized by the emergence of interest in the ethical, legal, and social aspects of neuroscience research. At the same time an ongoing extension of the topics and phenomena addressed by neuroscientists was observed alongside its rise as one of the leading disciplines in the biomedical science. One of these phenomena addressed by neuroscientists and moral psychologists was the neural processes involved in moral decision-making. Today both strands of research are often (...) addressed under the label of neuroethics. To understand this development we recalled literature from 1995 to 2012 stored in the Mainz Neuroethics Database (i) to investigate the quantitative development of scientific publications in neuroethics; (ii) to explore changes in the topics of neuroethics research within the defined time interval; (iii) to illustrate the interdependence of different research topics within the neuroethics literature; (iv) to show the development of the distribution of neuroethics research on peer-reviewed journals; and (v) to display the academic background and affiliations of neuroethics Researchers ... (shrink)

In recent years, neuroscience has been a particularly prolific discipline stimulating many innovative treatment approaches in medicine. However, when it comes to the brain, new techniques of intervention do not always meet with a positive public response, in spite of promising therapeutic benefits. The reason for this caution clearly is the brain’s special importance as “organ of the mind”. As such it is widely held to be the origin of mankind’s unique position among living beings. Likewise, on the level of (...) the individual human being, the brain is considered the material substrate of those traits that in combination render each person unique. In view of this preeminent significance of the brain, it is understandable that, in general, interventions into the brain are considered a delicate issue and that new techniques of intervention are scrutinised with particular care. However, in doing so it is important not to go to the opposite extreme and shy away from promising new therapeutic approaches for debilitating disorders of the brain. With respect to the new techniques of brain intervention a broad interdisciplinary perspective is required to discern irrational fear from justified concern. Hence, the Europäische Akademie established a project group consisting, on the one hand, of experts from different fields of medicine who have got first-hand experience of applying the techniques at issue and, on the other hand, of philosophers and a legal expert. The task of this team was to review the state of the art with respect to each single technique of intervening in the brain, to indicate future developments, and to address the ethical and legal issues common to all of them. The project’s outcome is the book at hand. (shrink)

The availability of a range of new psychotropic agents raises the possibility that these will be used for enhancement purposes (smart pills, happy pills, and pep pills). The enhancement debate soon raises questions in philosophy of medicine and psychiatry (eg, what is a disorder?), and this debate in turn raises fundament questions in philosophy of language, science, and ethics. In this paper, a naturalistic conceptual framework is proposed for addressing these issues. This framework begins by contrasting classical and critical concepts (...) of categories, and then puts forward an integrative position that is based on cognitive-affective research. This position can in turn be used to consider the debate between pharmacological Calvinism (which may adopt a moral metaphor of disorder) and psychotropic utopianism (which may emphasize a medical metaphor of disorder). I argue that psychiatric treatment of serious psychiatric disorders is justified, and that psychotropics are an acceptable kind of intervention. The use of psychotropics for sub-threshold phenomena requires a judicious weighing of the relevant facts (which are often sparse) and values. (shrink)

The biopsychosocial (BPS) model has been of considerable utility to those researching health and illness. This has been particularly the case for critical realists and those with a systemic orientation to their work. Whilst the strengths of the model are conceded in this article, its limitations are also examined. These relate to its ontological sophistication being compromised by its proneness to epistemological naivety. It is a model to explain the emergence of disease and disability, not a reflexive theory applicable to (...) the whole field of health research. This tension is linked to the emergence of a re-orientation of medical knowledge away from bio-medical reductionism. From the outset the model was not about a general critique, or a grand theory, of health and illness. Instead it was a useful intervention, on the part of medical practitioners, like George Engel and Adolf Meyer, to create a reformed medical model on behalf of their profession. Case studies of the problematics of diagnosis and medicalization are offered to illuminate the limitations of the BPS model for health researchers. (shrink)

Durch den rasanten Fortschritt in den Neurowissenschaften ergibt sich ein bidirektionales Implikationsverhältnis zwischen Ethik und Neurowissenschaften: Einerseits haben neurowissenschaftliche Erkenntnisse epistemische Implikationen für anthropologisch-ethische Grundkonzepte, andererseits haben ethische Kriterien normative Implikationen für neurowissenschaftliche Interventionen. Die Neuroethik untersucht diese normativen Implikationen systematisch auf der metaethischen, der theoretischen und der praktischen Ebene. Um eine spezifische und differenzierte ethische Analyse der einzelnen neurowissenschaftlichen Interventionen zu ermöglichen, soll hier eine bereichsspezifische, neuroethische Kriteriologie vorgestellt werden. Durch exemplarische Anwendung ihrer einzelnen Kriterien auf gegenwärtige und zukünftige (...) neurowissenschaftliche Forschungs- und Interventionsmöglichkeiten soll gezeigt werden, dass sie eine systematische und zugleich praktisch anwendbare Möglichkeit bietet, einen normativen Orientierungsrahmen für Neurowissenschaften und Neurologie zu gewinnen. Insofern sie auf weitgehend konsensfähigen ethischen Prinzipien basiert, kann sie zudem als ethische Grundlage für einen breiten klinischen und wissenschaftlichen Diskurs dienen. (shrink)

This article explores contemporary biopolitics in the light of Michel Foucault's oft quoted suggestion that contemporary politics calls `life itself' into question. It suggests that recent developments in the life sciences, biomedicine and biotechnology can usefully be analysed along three dimensions. The first concerns logics of control - for contemporary biopolitics is risk politics. The second concerns the regime of truth in the life sciences - for contemporary biopolitics is molecular politics. The third concerns technologies of the self - for (...) contemporary biopolitics is ethopolitics. The article suggests that, in these events, human beings have become `somatic individuals': personhood is increasingly being defined in terms of corporeality, and new and direct relations are established between our biology and our conduct. At the same time, this somatic and corporeal individuality has become opened up to choice, prudence and responsibility, to experimentation, to contestation and so to a politics of `life itself'. (shrink)

The current experiments examine mental health clinicians’ beliefs about biological, psychological, and environmental bases of the DSM‐IV‐TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians’ beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by having clinicians list what (...) they thought were the specific causes of nine familiar mental disorders and rate their bio–psycho–environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena. (shrink)

Biomedical technologies can increasingly be used not only to combat disease, but also to augment the capacities or traits of normal, healthy people – a practice commonly referred to as biomedical enhancement. Perhaps the best‐established examples of biomedical enhancement are cosmetic surgery and doping in sports. But most recent scientific attention and ethical debate focuses on extending lifespan, lifting mood, and augmenting cognitive capacities.

The point of psychotherapy has occasionally been associated with talk of ‘life’s meaning’. However, the literature on meaning in life written by contemporary philosophers has yet to be systematically applied to literature on the point of psychotherapy. My broad aim in this chapter is to indicate some plausible ways to merge these two tracks of material that have run in parallel up to now. More specifically, my hunch is that the connection between meaning as philosophers understand it and therapy as (...) psychotherapists ought to practice it is much closer than is suggested by the field of existential psychotherapy, which expressly addresses the topic of life’s meaning and appeals to ideas from classic philosophers such Søren Kierkegaard, Martin Heidegger, and the like. I instead proffer the claim that psychodynamic and humanistic therapy, clinical psychology, and counselling psychology as such, not a particular branch of them, are best understood as enterprises in search of meaning in life, in the way many present-day philosophers understand this phrase. In this chapter, I spell out what I mean by this bold hypothesis and provide some good reason to take it seriously. (shrink)

Using medical advances to enhance human athletic, aesthetic, and cognitive performance, rather than to treat disease, has been controversial. Little is known about physicians? experiences, views, and attitudes in this regard. We surveyed a national sample of physicians to determine how often they prescribe enhancements, their views on using medicine for enhancement, and whether they would be willing to prescribe a series of potential interventions that might be considered enhancements. We find that many physicians occasionally prescribe enhancements, but doctors hold (...) nuanced and ambiguous views of these issues. Most express concerns about the potential effects of enhancements on social equity, yet many also believe specific enhancements that are safe and effective should be available but not covered by insurance. These apparently contradictory views might reflect inherent tensions between the values of equity and liberty, which could make crafting coherent social policies on medical enhancements challenging. [Supplementary materials are available for this article. Go to the publisher's online edition of American Journal of Bioethics for the following free supplemental resource(s): An additional table (Table 5) referred to on p. 5]. (shrink)

Working through the lens of Donna Haraway's cyborg theory and directed at the example of Prozac, I address the dramatic rise of new technoscience in medicine and psychiatry. Haraway's cyborg theory insists on a conceptualization and a politics of technoscience that does not rely on universal “Truths” or universal “Goods” and does not attempt to return to the “pure” or the “natural.” Instead, Haraway helps us mix politics, ethics, and aesthetics with science and scientific recommendations, and she helps us understand (...) that (without recourse to universal truth or universal good) questions of legitimacy in science come down to local questions of effect and inclusion. What, in the case of my example, are the effects of Prozac? And for whom? Who is included and empowered to create legitimate psychiatric knowledge? Who is excluded and why? And, what political strategies will increase the democratic health of psychiatric science and practice? (shrink)

‘Cosmetic psychopharmacology’ is a term coined by Peter Kramer in his 1993 best‐seller, Listening to Prozac. It has come to refer to the use of psychoactive substances to effect changes in function for conditions that are either normal or subclinical variants. In this paper, I ask: What distinguishes an existential ailment from clinical depression, or either of those from normal depressed mood, melancholic temperament, dysthymia or other depressive disorders? Can we reliably distinguish one from the other? Are the boundaries of (...) illness and disorder really so distinct? If not, how can we know that treatment of ‘depression’ with Prozac in any given instance constitutes a cosmetic as opposed to, say, a medical or clinical use of psychopharmacology – a distinction that seems to turn on our ability to clearly differentiate the clinical from the cosmetic. If we cannot reliably distinguish between such conditions, can we even have a cosmetic psychopharmacology that is not a form of malpractice, broadly speaking? What if we unplugged Prozac from all the amplitude and hype that resulted in Listening to Prozac becoming an instant best‐seller and simply asked whether or not we can clearly distinguish an appropriate cosmetic use of Prozac for ‘depression’ from an inappropriate cosmetic use of Prozac, and both of those from Prozac's appropriate clinical, that is, non‐cosmetic uses? If we cannot make these distinctions, perhaps it is too early to say there can be such a thing as a cosmetic psychopharmacology. (shrink)

Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)

Persons have a curious dual nature. On the one hand, they are subjects, whose actions must be explained in terms of beliefs, desires, plans, and goals. At the same time, however, they also are physical objects, whose actions must be explicable in terms of physical laws. So far no satisfying account of this duality has been offered. Both Cartesian dualism and the modern materialist alternatives (reductionist and antireductionist) have failed to capture the full range of our experience of persons. I (...) argue that an exciting new approach to this difficulty can be found by considering developments in clinical psychology. The clinical debate between those endorsing biological models of mental illness and those endorsing psychodynamic models mirrors broader debates in the philosophy of mind. The possible resolution of this debate through the development of integrated psychobiological models suggests a promising way to reconcile the dual nature of persons in a far more appealing way than any yet proposed. (shrink)

In a future highly technological society it will be possible to modify the personality using different kinds of technological tools. Consequently, we could become buyers and consumers of personality. As such, personality, which is a core aspect of the self, could turn into a commodity. This article intends to address the following questions: 1) How can new technologies modify personality? 2) Why might personality become a commodity? 3) What is wrong with turning personality into commodity?

Since Prozac emerged on the market at the end of 1987, there has been a dramatic increase in antidepressant use and in its discussion by popular media. Yet there has been little analysis of the gendered character of this phenomenon despite feminist traditions scrutinizing the medical control of women’s bodies. The authors begin to fill this gap through a detailed content analysis of the 83 major articles on Prozac and its “chemical cousins” appearing in large-circulation periodicals in Prozac’s first 12 (...) years. They find that popular talk about Prozac and its competing brands is largely degendered, presented as manifestly gender neutral, yet replete with latent gendered messages. These are about women with neurochemical imbalances but also about the need to discipline elite female bodies, to enhance their productivity and flexibility. This new form of female “fitness” mirrors demands of the New Economy and indicates how psychiatric discourse contributes to the historically specific shaping of gendered bodies. (shrink)

Scientific progress in recent neurofeedback research may bring about a new type of moral neuroenhancement, namely, neurofeedback-based moral enhancement; however, this has yet to be examined thoroughly. This paper presents an ethical analysis of the possibility of neurofeedback-based moral enhancement and demonstrates that this type of moral enhancement sheds new light on the moral enhancement debate. First, I survey this debate and extract the typical structural flow of its arguments. Second, by applying structure to the case of neurofeedback-based moral enhancement, (...) I examine the ethical, legal, and social issues to show that this technique is unique and traditionalist, which makes it compatible with almost all our conservative notions, so that it, accordingly, can be seen as an ethically acceptable option. Third, by rejecting the premise in the moral enhancement debate that bio/neuro-enhancement has its unique ELSI that traditional methods would never create, I demonstrate that, by virtue of its traditional or conservative features, neurofeedback-based moral enhancement can be incorporated into the traditional moral education network. Finally, I conclude that, being a part of the traditional moral education network, neurofeedback-based moral enhancement can be a unique and ethically acceptable option of moral neuroenhancement. (shrink)

In 1997, David Foster Wallace published “The Depressed Person,” a short story about a privileged, deeply unhappy woman dedicated to exploring and recounting the texture and etiology of her chronic depression. This essay argues that “The Depressed Person” challenges the long-standing assumption that narrativizing the pain of depression is crucial to overcoming it, and the contemporary view that empathic responses from others promote recovery of the depressed. Taken together, these two critiques inform Wallace’s portrayal of chronic depression as an interactive (...) phenomenon that is articulated, sustained, and regenerated through problematic contexts of interaction. Written at a time when public knowledge of and talk about depression was surging, “The Depressed Person” holds an important, if presently under-recognized place, in the expansive corpus of depression texts that emerged in the 1990s. (shrink)

This article begins with arguments evident at the time of writing about the 5th revision of the Diagnostic and Statistical Manual of the American Psychiatric Association. The historical lineages of those arguments are international and not limited to the USA. The concern with psychiatric diagnosis both internationally and in the USA came to the fore at the end of the Second World War with the construction of the American Psychiatric Association’s Diagnostic and Statistical Manual and the World Health Organization’s classification (...) of ‘Diseases, Injuries and Causes of Death’. However, the linkage between categories of morbidity, assumptions about natural biological categories and treatment specificity with ‘magic bullets’ emerged in the middle of the 19th century in physical medicine. This article explores the legitimacy of current psychiatric diagnoses in the light of that international, not national, history of medical knowledge. In conclusion it explores judgements about current cultural imperialism and an older picture of Eurocentrism, which is now being refracted in more recent globalizing knowledge-claims about mental disorder. (shrink)

This study brings together socio-theoretical and ethnographic approaches to psychiatry, demonstrating the role of the clinic as a major consolidator of ideologies as well as the site where personal miseries are registered as markers of social failure. It focuses on innovation in psychiatric taxonomies, changes in the figurative language of the emotions, changes in conceptualizations of the self and how all of these relate to changing socio-economic events and circumstances.

Presents the author's evolving views of the best current positions on certain core philosophical and psychological problems as they developed over time. These positions together suggest a skeptical or nihilist perspective modified by evolutionary psychology and contemporary philosophy that embraces our desire to live as best we can and the relative and psychological reality of values, free will and other phenomena while recognizing limitations on their foundations and our understanding. The below makes no claims to originality for most of the (...) ideas expressed, drawing on a range of mostly unreferenced texts that will be familiar to philosophers and psychologists working in this area. (shrink)

. Cognitive science challenges our understandings of self and freedom. In this article, adapted from a chapter in Minding God: Theology and the Cognitive Sciences , I review some of the scientific literature with regard to issues of self and freedom. I argue that our sense of self is a construct and heavily dependent on the kind of brain that we have. Furthermore, understanding the issue of freedom requires an understanding of the findings of cognitive science. Human beings are constrained (...) to be free; our biology in no small way determines the kinds of freedom that we are able to have. (shrink)

In this chapter, I propose the mechanism of cognitive enhancement based on studies of cognitive-enhancing drugs and behavioral training. I argue that there are mechanistic differences between cognitive-enhancing drugs and behavioral training due to their different enhancing effects. I also suggest possible mechanisms for cognitive-enhancing drugs and behavioral training and for the synergistic effects of their simultaneous application.

Ist es moralisch verantwortbar, Menschen mit technischen Eingriffen zu verbessern? Der Aufsatz versucht diese Frage zu beantworten, indem zwei Gefahren für Verbesserungswillige beleuchtet werden: der Verlust der Menschlichkeit und der unerwünschte Wandel der individuellen Persönlichkeit. Sodann wird ein „Liberalismus mit Auffangnetz“ als Lösung des Problems vorgestellt, die eine unterschiedliche Bewertung von reversiblen und irreversiblen Eingriffen vornimmt. Im letzten Schritt wird überprüft, wie weit diese Konzeption auch anwendbar ist, wenn Eltern ihre Kinder verbessern lassen wollen, also ein „informed consent“ nicht vorausgesetzt (...) werden kann. Dabei werden Argumente zurückgewiesen, die Habermas gegen eine Verbesserung von Kindern vorgebracht hat. (shrink)

In this paper, I offer one moral reason to eschew antidepressant medication in favor of cognitive therapy, all other things being equal: taking antidepressants can be a form of self-objectification. This means that, by taking antidepressants, one treats oneself, in some sense and some cases, like a mere object. I contend that, morally, this amounts to a specific form of devaluing oneself. I argue this as follows. First, I offer a detailed definition of “objectification” and argue for the possibility of (...) self-objectification on this definition. I then explain why this form of self-objectification is morally problematic. (Morally problematic does not mean morally impermissible. It means, instead, that there is a moral reason opposing the activity in question). After, I describe how taking antidepressants can count as self-objectifying. Finally, I defend my thesis against a key objection offered by Levy. Thus, assuming that antidepressants and cognitive therapy are equally efficacious, and that all other things are equal, the self-objectifying character of antidepressants is a compelling reason to regard cognitive therapy as a first-choice treatment for depression. (shrink)

The extra-therapeutic use of psychotropic drugs to improve cognition and to enhance mood has been the subject of controversial discussion in bioethics, in medicine but also in public for many years. Concerns over a liberal dealing with pharmacological enhancers are raised not only from a biomedical–pharmacological perspective, but particularly from an ethical one. Within these ethical concerns, there is one objection about the normative differentiation between “natural” and “artificial” enhancers, which is theoretically indeed widely discredited in bioethics, which has, however, (...) entrenched itself in such a persistent way in everyday moral consciousness that it keeps a crucial influence on the assessment of pharmacological enhancers made by the public and medical professionals. This paper tries to first show why a normative differentiation between “natural” and “artificial” enhancers is highly problematic. In a second step, the resulting implications for our current dealing with pharmacological enhancers shall be examined. In a specific comparison of synthetic pharmaceuticals (modafinil, SSRIs) with phytopharmaceuticals (ginkgo biloba, St. John’s wort) and other already established enhancers (alcohol, caffeine), argumentative inconsistencies are pointed out which, at least partly, result from a rationally untenable preference for the “natural” over the “artificial”. Therefore, it is conclusively argued the case for an unprejudiced assessment of pharmacological enhancers beyond a “natural”–“artificial” dichotomy, which equally takes into account biomedical and ethical aspects. The goal is to reach a coherent dealing with pharmacological enhancement in the long run. (shrink)

This paper provides a brief visual history of the ways women patients, and specifically women patients whose marital status is identified in conjunction with their illness, have been constructed as abnormal in the images of advertisements designed to promote psychotropic medications to an audience of psychiatrists. The advertisements I discuss come from the two largest circulation American psychiatric journals, The American Journal of Psychiatry and Archives of General Psychiatry, between the years 1964 and 2001. I use the ads to focus (...) on two concomitant narratives. On one hand, I show how the advertisements situate the rise of wonder drugs in the context of an era described as the golden age of psychopharmacology, during which time drug treatments helped revolutionize the diagnosis and treatment of anxiety, depression, and other outpatient mental illnesses in the United States. On the other hand, the advertisements also illustrate the ways in which these new scientific treatments could not function free of the culture in which they were given meaning. In the space between drug and wonder drug, or between medication and metaphor, the images thus hint at the ways psychotropic treatments became imbricated with the same gendered assumptions at play in an American popular culture intimately concerned with connecting normal and heteronormal when it came to defining the role of women in civilization. (shrink)