The Battle for Your Brain

Science is developing ways to boost intelligence, expand memory, and more.
But will you be allowed to change your own mind?
By Ronald Bailey

February 2003

"Weıre on the verge of profound changes in our ability to manipulate the
brain," says Paul Root Wolpe, a bioethicist at the University of
Pennsylvania. He isnıt kidding. The dawning age of neuroscience promises not
just new treatments for Alzheimerıs and other brain diseases but
enhancements to improve memory, boost intellectual acumen, and fine-tune our
emotional responses. "The next two decades will be the golden age of
neuroscience," declares Jonathan Moreno, a bioethicist at the University of
Virginia. "Weıre on the threshold of the kind of rapid growth of information
in neuroscience that was true of genetics 15 years ago."

One manıs golden age is another manıs dystopia. One of the more vociferous
critics of such research is Francis Fukuyama, who warns in his book Our
Posthuman Future that "we are already in the midst of this revolution" and
"we should use the power of the state to regulate it" (emphasis his). In May
a cover story in the usually pro-technology Economist worried that
"neuroscientists may soon be able to screen peopleıs brains to assess their
mental health, to distribute that information, possibly accidentally, to
employers or insurers, and to Œfixı faulty personality traits with drugs or
implants on demand."

There are good reasons to consider the ethics of tinkering directly with the
organ from which all ethical reflection arises. Most of those reasons boil
down to the need to respect the rights of the people who would use the new
technologies. Some of the fieldıs moral issues are common to all biomedical
research: how to design clinical trials ethically, how to ensure subjectsı
privacy, and so on. Others are peculiar to neurology. Itıs not clear, for
example, whether people suffering from neurodegenerative disease can give
informed consent to be experimented on.

Last May the Dana Foundation sponsored an entire conference at Stanford on
"neuroethics." Conferees deliberated over issues like the moral questions
raised by new brain scanning techniques, which some believe will lead to the
creation of truly effective lie detectors. Participants noted that scanners
might also be able to pinpoint brain abnormalities in those accused of
breaking the law, thus changing our perceptions of guilt and innocence. Most
nightmarishly, some worried that governments could one day use brain
implants to monitor and perhaps even control citizensı behavior.

But most of the debate over neuroethics has not centered around patientsı or
citizensı autonomy, perhaps because so many of the fieldıs critics
themselves hope to restrict that autonomy in various ways. The issue that
most vexes them is the possibility that neuroscience might enhance
previously "normal" human brains.

The tidiest summation of their complaint comes from the conservative
columnist William Safire. "Just as we have anti-depressants today to elevate
mood," he wrote after the Dana conference, "tomorrow we can expect a kind of
Botox for the brain to smooth out wrinkled temperaments, to turn shy people
into extroverts, or to bestow a sense of humor on a born grouch. But what
price will human nature pay for these nonhuman artifices?"

Truly effective neuropharmaceuticals that improve moods and sharpen mental
focus are already widely available and taken by millions. While there is
some controversy about the effectiveness of Prozac, Paxil, and Zoloft,
nearly 30 million Americans have taken them, with mostly positive results.
In his famous 1993 book Listening to Prozac, the psychiatrist Peter Kramer
describes patients taking the drug as feeling "better than well." One Prozac
user, called Tess, told him that when she isnıt taking the medication, "I am
not myself."

One Pill Makes You Smarter...

Thatıs exactly what worries Fukuyama, who thinks Prozac looks a lot like
Brave New Worldıs soma. The pharmaceutical industry, he declares, is
producing drugs that "provide self-esteem in the bottle by elevating
serotonin in the brain." If you need a drug to be your "self," these critics
ask, do you really have a self at all?

Another popular neuropharmaceutical is Ritalin, a drug widely prescribed to
remedy attention deficit hyperactivity disorder (ADHD), which is
characterized by agitated behavior and an inability to focus on tasks.
Around 1.5 million schoolchildren take Ritalin, which recent research
suggests boosts the activity of the neurotransmitter dopamine in the brain.
Like all psychoactive drugs, it is not without controversy. Perennial
psychiatric critic Peter Breggin argues that millions of children are being
"drugged into more compliant or submissive state[s]" to satisfy the needs of
harried parents and school officials. For Fukuyama, Ritalin is prescribed to
control rambunctious children because "parents and teachers...do not want to
spend the time and energy necessary to discipline, divert, entertain, or
train difficult children the old-fashioned way."

Unlike the more radical Breggin, Fukuyama acknowledges that drugs such as
Prozac and Ritalin have helped millions when other treatments have failed.
Still, he worries about their larger social consequences. "There is a
disconcerting symmetry between Prozac and Ritalin," he writes. "The former
is prescribed heavily for depressed women lacking in self-esteem; it gives
them more the alpha-male feeling that comes with high serotonin levels.
Ritalin, on the other hand, is prescribed largely for young boys who do not
want to sit still in class because nature never designed them to behave that
way. Together, the two sexes are gently nudged toward that androgynous
median personality, self-satisfied and socially compliant, that is the
current politically correct outcome in American society."

Although there are legitimate questions here, theyıre related not to the
chemicals themselves but to who makes the decision to use them. Even if
Prozac and Ritalin can help millions of people, that doesnıt mean schools
should be able to force them on any student who is unruly or bored. But by
the same token, even if you accept the most radical critique of the drug --
that ADHD is not a real disorder to begin with -- that doesnıt mean
Americans who exhibit the symptoms that add up to an ADHD diagnosis should
not be allowed to alter their mental state chemically, if thatıs an outcome
they want and a path to it theyıre willing to take.

Consider Nick Megibow, a senior majoring in philosophy at Gettysburg
College. "Ritalin made my life a lot better," he reports. "Before I started
taking Ritalin as a high school freshman, I was doing really badly in my
classes. I had really bad grades, Cs and Ds mostly. By sophomore year, I
started taking Ritalin, and it really worked amazingly. My grades improved
dramatically to mostly As and Bs. It allows me to focus and get things done
rather than take three times the amount of time that it should take to
finish something." If people like Megibow donıt share Fukuyamaıs concerns
about the wider social consequences of their medication, itıs because
theyıre more interested, quite reasonably, in feeling better and living a
successful life.

What really worries critics like Safire and Fukuyama is that Prozac and
Ritalin may be the neuropharmacological equivalent of bearskins and stone
axes compared to the new drugs that are coming. Probably the most critical
mental function to be enhanced is memory. And this, it turns out, is where
the most promising work is being done. At Princeton, biologist Joe Tsienıs
laboratory famously created smart mice by genetically modifying them to
produce more NMDA brain receptors, which are critical for the formation and
maintenance of memories. Tsienıs mice were much faster learners than their
unmodified counterparts. "By enhancing learning, that is, memory
acquisition, animals seem to be able to solve problems faster," notes Tsien.
He believes his work has identified an important target that will lead other
researchers to develop drugs that enhance memory.

A number of companies are already hard at work developing memory drugs.
Cortex Pharmaceuticals has developed a class of compounds called AMPA
receptor modulators, which enhance the glutamate-based transmission between
brain cells. Preliminary results indicate that the compounds do enhance
memory and cognition in human beings. Memory Pharmaceuticals, co-founded by
Nobel laureate Eric Kandel, is developing a calcium channel receptor
modulator that increases the sensitivity of neurons and allows them to
transmit information more speedily and a nicotine receptor modulator that
plays a role in synaptic plasticity. Both modulators apparently improve
memory. Another company, Targacept, is working on the nicotinic receptors as
well.

All these companies hope to cure the memory deficits that some 30 million
baby boomers will suffer as they age. If these compounds can fix deficient
memories, it is likely that they can enhance normal memories as well. Tsien
points out that a century ago the encroaching senility of Alzheimerıs
disease might have been considered part of the "normal" progression of
aging. "So it depends on how you define normal," he says. "Today we know
that most people have less good memories after age 40, and I donıt believe
thatıs a normal process."

Eight Objections

And so we face the prospect of pills to improve our mood, our memory, our
intelligence, and perhaps more. Why would anyone object to that?

Eight objections to such enhancements recur in neuroethicistsı arguments.
None of them is really convincing.

* Neurological enhancements permanently change the brain. Erik Parens of
the Hastings Center, a bioethics think tank, argues that itıs better to
enhance a childıs performance by changing his environment than by changing
his brain -- that itıs better to, say, reduce his class size than to give
him Ritalin. But this is a false dichotomy. Reducing class size is aimed at
changing the childıs biology too, albeit indirectly. Activities like
teaching are supposed to induce biological changes in a childıs brain,
through a process called learning.



Fukuyama falls into this same error when he suggests that even if there is
some biological basis for their condition, people with ADHD "clearly ...can
do things that would affect their final degree of attentiveness or
hyperactivity. Training, character, determination, and environment more
generally would all play important roles." So can Ritalin, and much more
expeditiously, too. "What is the difference between Ritalin and the Kaplan
SAT review?" asks the Dartmouth neuroscientist Michael Gazzaniga. "Itıs six
of one and a half dozen of the other. If both can boost SAT scores by, say,
120 points, I think itıs immaterial which way itıs done."

* Neurological enhancements are anti-egalitarian. A perennial objection
to new medical technologies is the one Parens calls "unfairness in the
distribution of resources." In other words, the rich and their children will
get access to brain enhancements first, and will thus acquire more
competitive advantages over the poor.



This objection rests on the same false dichotomy as the first. As the
University of Virginiaıs Moreno puts it, "We donıt stop people from giving
their kids tennis lessons." If anything, the new enhancements might increase
social equality. Moreno notes that neuropharmaceuticals are likely to be
more equitably distributed than genetic enhancements, because "after all, a
pill is easier to deliver than DNA."

* Neurological enhancements are self-defeating. Not content to argue that
the distribution of brain enhancements wonıt be egalitarian enough, some
critics turn around and argue that it will be too egalitarian. Parens has
summarized this objection succinctly: "If everyone achieved the same
relative advantage with a given enhancement, then ultimately no oneıs
position would change; the Œenhancementı would have failed if its purpose
was to increase competitive advantage."



This is a flagrant example of the zero-sum approach that afflicts so much
bioethical thought. Letıs assume, for the sake of argument, that everyone in
society will take a beneficial brain-enhancing drug. Their relative
positions may not change, but the overall productivity and wealth of society
would increase considerably, making everyone better off. Surely that is a
social good.

* Neurological enhancements are difficult to re-fuse. Why exactly would
everyone in the country take the same drug? Because, the argument goes,
competitive pressures in our go-go society will be so strong that a person
will be forced to take a memory-enhancing drug just to keep up with everyone
else. Even if the law protects freedom of choice, social pressures will draw
us in.



For one thing, this misunderstands the nature of the technology. Itıs not
simply a matter of popping a pill and suddenly zooming ahead. "I know a lot
of smart people who donıt amount to a row of beans," says Gazzaniga.
"Theyıre just happy underachieving, living life below their potential. So a
pill that pumps up your intellectual processing power wonıt necessarily give
you the drive and ambition to use it."

Beyond that, itıs not as though we donıt all face competitive pressures
anyway -- to get into and graduate from good universities, to constantly
upgrade skills, to buy better computers and more productive software,
whatever. Some people choose to enhance themselves by getting a Ph.D. in
English; others are happy to stop their formal education after high school.
Itıs not clear why a pill should be more irresistible than higher education,
or why one should raise special ethical concerns while the other does not.

* Neurological enhancements undermine good character. For some critics,
the comparison to higher education suggests a different problem. We should
strive for what we get, they suggest; taking a pill to enhance cognitive
functioning is just too easy. As Fukuyama puts it: "The normal, and morally
acceptable, way of overcoming low self-esteem was to struggle with oneself
and with others, to work hard, to endure painful sacrifices, and finally to
rise and be seen as having done so."



"By denying access to brain-enhancing drugs, people like Fukuyama are
advocating an exaggerated stoicism," counters Moreno. "I donıt see the
benefit or advantage of that kind of tough love." Especially since there
will still be many different ways to achieve things and many difficult
challenges in life. Brain-enhancing drugs might ease some of our labors, but
as Moreno notes, "there are still lots of hills to climb, and they are
pretty steep." Cars, computers, and washing machines have tremendously
enhanced our ability to deal with formerly formidable tasks. That doesnıt
mean lifeıs struggles have disappeared -- just that we can now tackle the
next ones.

* Neurological enhancements undermine personal responsibility. Carol
Freedman, a philosopher at Williams College, argues that what is at stake
"is a conception of ourselves as responsible agents, not machines." Fukuyama
extends the point, claiming that "ordinary people" are eager to "medicalize
as much of their behavior as possible and thereby reduce their
responsibility for their own actions." As an example, he suggests that
people who claim to suffer from ADHD "want to absolve themselves of personal
responsibility."



But we are not debating people who might use an ADHD diagnosis as an excuse
to behave irresponsibly. We are speaking of people who use Ritalin to change
their behavior. Wouldnıt it be more irresponsible of them to not take
corrective action?

* Neurological enhancements enforce dubious norms. There are those who
assert that corrective action might be irresponsible after all, depending on
just what it is that youıre trying to correct. People might take
neuropharmaceuticals, some warn, to conform to a harmful social conception
of normality. Many bioethicists -- Georgetown Universityıs Margaret Little,
for example -- argue that we can already see this process in action among
women who resort to expensive and painful cosmetic surgery to conform to a
social ideal of feminine beauty.



Never mind for the moment that beauty norms for both men and women have
never been so diverse. Providing and choosing to avail oneself of that
surgery makes one complicit in norms that are morally wrong, the critics
argue. After all, people should be judged not by their physical appearances
but by the content of their characters.

That may be so, but why should someone suffer from societyıs slights if she
can overcome them with a nip here and a tuck there? The norms may indeed be
suspect, but the suffering is experienced by real people whose lives are
consequently diminished. Little acknowledges this point, but argues that
those who benefit from using a technology to conform have a moral obligation
to fight against the suspect norm. Does this mean people should be given
access to technologies they regard as beneficial only if they agree to sign
on to a bioethical fatwa?

Of course, we should admire people who challenge norms they disagree with
and live as they wish, but why should others be denied relief just because
some bioethical commissars decree that societyıs misdirected values must
change? Change may come, but real people should not be sacrificed to some
restrictive bioethical utopia in the meantime. Similarly, we should no doubt
value depressed people or people with bad memories just as highly as we do
happy geniuses, but until that glad day comes people should be allowed to
take advantage of technologies that improve their lives in the society in
which they actually live.

Furthermore, itıs far from clear that everyone will use these enhancements
in the same ways. There are people who alter their bodies via cosmetic
surgery to bring them closer to the norm, and there are people who alter
their bodies via piercings and tattoos to make them more individually
expressive. It doesnıt take much imagination to think of unusual or
unexpected ways that Americans might use mind-enhancing technologies.
Indeed, the war on drugs is being waged, in part, against a small but
significant minority of people who prefer to alter their consciousness in
socially disapproved ways.

* Neurological enhancements make us inauthentic. Parens and others worry
that the users of brain-altering chemicals are less authentically themselves
when theyıre on the drug. Some of them would reply that the exact opposite
is the case. In Listening to Prozac, Kramer chronicles some dramatic
transformations in the personalities and attitudes of his patients once
theyıre on the drug. The aforementioned Tess tells him it was "as if I had
been in a drugged state all those years and now Iım clearheaded."



Again, the question takes a different shape when one considers the false
dichotomy between biological and "nonbiological" enhancements. Consider a
person who undergoes a religious conversion and emerges from the experience
with a more upbeat and attractive personality. Is he no longer his "real"
self? Must every religious convert be deprogrammed?

Even if there were such a thing as a "real" personality, why should you
stick with it if you donıt like it? If youıre socially withdrawn and a pill
can give you a more vivacious and outgoing manner, why not go with it? After
all, youıre choosing to take responsibility for being the "new" person the
drug helps you to be.

Authenticity and Responsibility

"Is it a drug-induced personality or has the drug cleared away barriers to
the real personality?" asks the University of Pennsylvaniaıs Wolpe. Surely
the person who is choosing to use the drug is in a better position to answer
that question than some bioethical busybody.

This argument over authenticity lies at the heart of the neuroethicistsı
objections. If there is a single line that divides the supporters of
neurological freedom from those who would restrict the new treatments, it is
the debate over whether a natural state of human being exists and, if so,
how appropriate it is to modify it. Wolpe makes the point that in one sense
cognitive enhancement resembles its opposite, Alzheimerıs disease. A person
with Alzheimerıs loses her personality. Similarly, an enhanced individualıs
personality may become unrecognizable to those who knew her before.

Not that this is unusual. Many people experience a version of this process
when they go away from their homes to college or the military. They return
as changed people with new capacities, likes, dislikes, and social styles,
and they often find that their families and friends no longer relate to them
in the old ways. Their brains have been changed by those experiences, and
they are not the same people they were before they went away. Change makes
most people uncomfortable, probably never more so than when it happens to a
loved one. Much of the neuro-Ludditesı case rests on a belief in an
unvarying, static personality, something that simply doesnıt exist.

It isnıt just personality that changes over time. Consciousness itself is
far less static than weıve previously assumed, a fact that raises
contentious questions of free will and determinism. Neuroscientists are
finding more and more of the underlying automatic processes operating in the
brain, allowing us to take a sometimes disturbing look under our own hoods.
"Weıre finding out that by the time weıre conscious of doing something, the
brainıs already done it," explains Gazzaniga. Consciousness, rather than
being the director of our activities, seems instead to be a way for the
brain to explain to itself why it did something.

Haunting the whole debate over neuroscientific re-search and
neuroenhancements is the fear that neuroscience will undercut notions of
responsibility and free will. Very preliminary research has suggested that
many violent criminals do have altered brains. At the Stanford conference,
Science editor Donald Kennedy suggested that once we know more about brains,
our legal system will have to make adjustments in how we punish those who
break the law. A murderer or rapist might one day plead innocence on the
grounds that "my amygdala made me do it." There is precedent for this: The
legal system already mitigates criminal punishment when an offender can
convince a jury heıs so mentally ill that he cannot distinguish right from
wrong.

Of course, there are other ways such discoveries might pan out in the legal
system, with results less damaging to social order but still troubling for
notions of personal autonomy. One possibility is that an offenderıs
punishment might be reduced if he agrees to take a pill that corrects the
brain defect he blames for his crime. We already hold people responsible
when their drug use causes harm to others -- most notably, with laws against
drunk driving. Perhaps in the future we will hold people responsible if they
fail to take drugs that would help prevent them from behaving in harmful
ways. After all, which is more damaging to personal autonomy, a life
confined to a jail cell or roaming free while taking a medication?

The philosopher Patricia Churchland examines these conundrums in her
forthcoming book, Brainwise: Studies in Neurophilosophy. "Much of human
social life depends on the expectation that agents have control over their
actions and are responsible for their choices," she writes. "In daily life
it is commonly assumed that it is sensible to punish and reward behavior so
long as the person was in control and chose knowingly and intentionally."
And thatıs the way it should remain, even as we learn more about how our
brains work and how they sometimes break down.

Churchland points out that neuroscientific research by scientists like the
University of Iowaıs Antonio Damasio strongly shows that emotions are an
essential component of viable practical reasoning about what a person should
do. In other words, neuroscience is bolstering philosopher David Humeıs
insight that "reason is and ought only to be the slave of the passions."
Patients whose affects are depressed or lacking due to brain injury are
incapable of judging or evaluating between courses of action. Emotion is
what prompts and guides our choices.

Churchland further argues that moral agents come to be morally and
practically wise not through pure cogni-tion but by developing moral beliefs
and habits through life experiences. Our moral reflexes are honed through
watching and hearing about which actions are rewarded and which are
punished; we learn to be moral the same way we learn language. Consequently,
Churchland concludes "the default presumption that agents are responsible
for their actions is empirically necessary to an agentıs learning, both
emotionally and cognitively, how to evaluate the consequences of certain
events and the price of taking risks."

Itıs always risky to try to derive an "ought" from an "is," but neuroscience
seems to be implying that liberty -- i.e., letting people make choices and
then suffer or enjoy the consequences -- is essential for inculcating virtue
and maintaining social cooperation. Far from undermining personal
responsibility, neuroscience may end up strengthening it.

For Neurological Liberty

Fukuyama wants to "draw red lines" to distinguish between therapy and
enhancement, "directing research toward the former while putting
restrictions on the latter." He adds that "the original purpose of medicine
is, after all, to heal the sick, not turn healthy people into gods." He
imagines a federal agency that would oversee neurological research,
prohibiting anything that aims at enhancing our capacities beyond some
notion of the human norm.

"For us to flourish as human beings, we have to live according to our
nature, satisfying the deepest longings that we as natural beings have,"
Fukuyama told the Christian review Books & Culture last summer. "For
example, our nature gives us tremendous cognitive capabilities, capability
for reason, capability to learn, to teach ourselves things, to change our
opinions, and so forth. What follows from that? A way of life that permits
such growth is better than a life in which this capacity is shriveled and
stunted in various ways." This is absolutely correct. The trouble is that
Fukuyama has a shriveled, stunted vision of human nature, leading him and
others to stand athwart neuroscientific advances that will make it possible
for more people to take fuller advantage of their reasoning and learning
capabilities.

Like any technology, neurological enhancements can be abused, especially if
theyıre doled out -- or imposed -- by an unchecked authority. But Fukuyama
and other critics have not made a strong case for why individuals, in
consultation with their doctors, should not be allowed to take advantage of
new neuroscientific breakthroughs to enhance the functioning of their
brains. And it is those individuals that the critics will have to convince
if they seriously expect to restrict this research.

Itıs difficult to believe that theyıll manage that. In the 1960s many states
outlawed the birth control pill, on the grounds that it would be too
disruptive to society. Yet Americans, eager to take control of their
reproductive lives, managed to roll back those laws, and no one believes
that the pill could be re-outlawed today.

Moreno thinks the same will be true of the neurological advances to come.
"My hunch," he says, "is that in the United States, medications that enhance
our performance are not going to be prohibited." When you consider the
sometimes despairing tone that Fukuyama and others like him adopt, itıs hard
not to conclude that on that much, at least, they agree.



Ronald Bailey is Reasonıs science correspondent and the editor of Global
Warming and Other Eco-Myths: How the Environmental Movement Uses False
Science to Scare Us to Death (Prima Publishing).

http://www.reason.com/0302/fe.rb.the.shtml