Darian Meacham tackles a difficult question
If this were a straightforward question, you would not be reading about it in a philosophy magazine. But you are, so it makes sense that we try to clarify the terms of the discussion before wading in too far. Unfortunately (or fortunately depending on how you look at it), when philosophers set out to de-obfuscate what look to be relatively forthright questions, things usually get more complicated rather than less: each of the operative terms at stake in the question, ‘should students take smart drugs?’ opens us up onto larger debates about the nature of medicine, health, education, learning, and creativity as well as economic, political and social structures and norms. So, in a sense, a seemingly rather narrow question about a relatively peripheral issue in the education sector morphs into a much larger question about how we think about and value learning; what constitutes psychiatric illness and in what ways should we deal with it; and what sort of productivity should educational institutions like universities, but also secondary and even primary schools value and be oriented towards?
The first question that needs to be addressed is what is a ‘smart drug’? I have in mind two things when I use the term here:
(1) On the one hand, existing psychostimulants normally prescribed for children and adults with a variety of conditions, most prominently ADHD (Attention Deficit Hyperactivity Disorder), but also various others like narcolepsy, sleep-work disorder and schizophrenia. Commonly known by brand and generic names like Adderall, Ritalin, and Modafinil, these drugs are often sold off-label or on the grey market for what could be called non-medical or ‘enhancement’ purposes. The off-label use of psychostimulants for cognitive enhancement purposes is reported to be quite widespread in the USA. So the debate over the use of smart drugs is very much tied up with debates about how the behavioural and cognitive disorders for which these drugs are prescribed are diagnosed and what the causes of such conditions are.
(2) On the other hand, the philosophical-ethical debate around smart drugs need not be restricted to currently existing technologies. Broader issues at stake in the debate allow us to reflect on questions surrounding possible future cognitive enhancement technologies, and even much older ones. In this sense, the question about the use of smart drugs situates itself in a broader discussion about cognitive enhancement and enhancement in general.
So, should students take smart drugs? The addressee(s) of the ‘should’ needs to be rendered more finely. Students are not a homogeneous group. Different students face different challenges in their quest to learn and also achieve the necessary qualifications for economic and material success within contemporary socio-economic conditions. Thus a distinction needs to be made between students who have been diagnosed with a medical need for behaviour altering pharmaceuticals and those who acquire and take such drugs for specifically cognitive enhancing purposes. Then we need to think critically about these diagnoses, and especially why they have risen so dramatically in recent years, fuelling a grey market in these pharmaceuticals. In the USA, ADHD prevalence rates among school age children have risen to around 11% and nearly 20% for high-school boys, a 41% rise in the last decade. Critically examining the sharp rise in these types of diagnoses leads us to the question of what makes taking the same pharmaceutical a medical intervention for some and enhancement for others. This question is especially pertinent when the diagnosis involved in the prescription of the drugs is not a well-defined one, which is the case with ADHD.
Our possible responses to the ‘should’ in the question, whether in the negative or the affirmative, also need to be more carefully delineated. If we answer in the affirmative, does this mean that students should be encouraged to seek pharmaceutical enhancements to various aspects of their learning capacities, similar to the way that healthy eating, getting enough sleep, or improving vocabulary are encouraged?
More radically, given the assumption that better education of young people benefits society as a whole, should public institutions charged with caring for the health and education of the population actively provide such pharmaceuticals – on the NHS for example? Should we see the role of institutions like the NHS as not only responsible for maintaining public health, but also enhancing the capacities of the population, and hence improving possibilities for greater and more widespread flourishing? What would the difference be? And if effective (and safe) smart drugs are actually developed and not provided at low cost to low-income students do we risk seeing a technologically mediated cognitive capacity gap between rich and poor? In fact this already exists: children from low-income households perform worse on cognitive tests than those from middle income and rich homes even prior to beginning formal education.
One theory gaining attention is that this cognitive gap can be put down to differential exposure to language relative to household income. If we consider language as a form of cognitive enhancement technology, as I think we should, than we may already talk about a stark cognitive enhancement gap in contemporary western countries. This may pose further questions about the relation between politics, medicine and enhancement. As an American psychiatrist was recently quoted as saying: ‘We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.’
If we wish to answer the ‘should’ in the negative does this mean that the use of smart drugs should be mildly discouraged like high consumption of legal substances like caffeine or alcohol? Or, should the kind of pharmaceuticals in question be prohibited to those without a medical reason for taking them, as is the case currently with the psychostimulants mentioned above? Safety issues aside, this question of prohibition, except in cases of medical need, brings us back to the murky distinction between treatment and enhancement and what role environmental factors play in establishing and maintaining this distinction. Is a poorly performing student, undiagnosed with a cognitive or behavioural impairment, who takes a psychostimulant to improve her capacity to focus enhancing herself, treating herself, or perhaps just fooling herself? What makes questions like this difficult is that normal cognitive capacity cannot be established purely by examining the individual student. Rather, the scope of normal capacity and functioning for any organism is always a question of the relation between it and its environment, and specifically the various demands placed on it by the environment.
But why limit the question to students? A quick practical answer might be because students are a vulnerable group often feeling enormous pressure to succeed in education. This, coupled with the fact that adolescents and young adults are often seen (rather arbitrarily) as not being fully rational and prone to taking poorly judged risks, means that we should pay special attention to what harms they are exposed to stemming from various social pressures. We could also point out that the recent rise in diagnoses of conditions like ADHD among children and adolescents has created a situation where psychostimulants are readily available to secondary and university students on the grey market. Some studies in the US have claimed that around 10% of students sampled have used some form of psychostimulant for cognitive enhancing purposes (a study at Cambridge University showed similar numbers, but I think firmer evidence is needed in the UK). Add this to the number of students taking psychostimulants for medical reasons and you have a significant proportion of the student population using or experimenting with psychostimulant drugs, often with the express intention of cognitive enhancement.
All these are good reasons to give students and young people special attention in this debate. There is also another more speculative reason: education is a special sphere of society set apart to someextent in terms of what is valued within it and what its goals are. As such, there may be certain aspects of this sphere and what we take to be of value in it that we want to carefully watch over; maybe not always with a mind to maintaining things the way they are, but to taking extra care when it comes to rapid and wide-ranging changes. I will come back to what I think these special aspects are below.
Finally, the sixty-four-thousand-dollar question: do these drugs make you smarter? When it comes to the psychostimulants mentioned above, most of the evidence shows that for healthy individuals the answer is no. So what makes them attractive for healthy individuals? Some researchers insist that there is simply a kind of placebo effect at work. People who take these drugs for the purpose of cognitive enhancement expect to have their performance improved and so they feel as though it is. As they are working on real world tasks and not a battery of lab tests, they are none the wiser about the actual change in performance, or lack thereof.
As usual, the owl of Minerva flies at dusk, and many philosophers may be behind the curve. While there is probably some truth to the placebo explanation it does not tell the whole story. Learning has many aspects and involves many capacities some of them not so easily captured under the rubric of cognitive function. Nearly all real-world learning, especially the formal type of learning that we do at school or university, involves a dimension of effort and motivation. The anecdotal evidence for why students (or anyone) take the currently existing smart drugs usually involves some account of an increase in motivation or the ability to focus for longer periods of time. These terms relate to the expression of effort and lead down the metaphysical rabbit hole of problems surrounding the will.
Since the will is generally taken to be a metaphysical term that evades scientific explanation, a discussion of an augmentation of some sort in the will’s powers is usually avoided in the empirically minded literature on smart drugs. But the relation to murky and multi-faceted concepts like motivation, effort and will is one of the things that makes this issue interesting from the perspective of fundamental philosophical questions and not only applied ethics. The problem is something like this: a change in the chemical composition of the body and specifically the brain that current clinical science does not really understand leads to a change in a metaphysical force (the will) that seems not just to be a part of our conscious lives, but underpins it altogether and that philosophers cannot agree on whether it exists, or what it might be. So the issue surrounding why smart drugs are popular with students despite little or no evidence of quantifiable improvement in cognitive performance not only implicates the hard problem of consciousness (how to situate consciousness, its experiences and attributes, in nature, when contemporary science is unable to do so), but also draws in issues surrounding that most nebulous of metaphysical terms, the will. Or, it’s just a placebo effect!
Current psychostimulants aside, it is virtually inconceivable that given the obvious market for cognitive enhancing pharmaceuticals new drugs, trying to target specific areas of cognitive function in healthy subjects, would not be on the horizon. And while, we must bear in mind that cognition consistently shows itself to be a very complex affair involving affective and bodily components as well as what we might call more strictly speaking cognitive modules, I still do not think it makes sense to try to close the debate on smart drugs by simply claiming that they don’t work. Effective enhancement of cognitive capacity through technological intervention in or on the body, where there is not a clear problem, is likely to be a daunting task; but one that pharmaceutical manufacturers will likely put their back into.
It’s also not necessary to limit the debate over cognitive enhancement to pharmaceuticals. There are already many forms of technology, including, for example, corrective eyeglasses and even language itself that could be considered forms of cognitive enhancement. It’s not inconceivable that artificial neural networks might someday enhance brain capacity, or that corporeally embedded human-machine interfaces (imagine Google glass somehow integrated onto the surface of your eye) could soon be a reality. So when we debate the ethical and philosophical dimensions of smart drugs or more broadly cognitive enhancement, it’s prudent to try to keep possible future developments in mind.
There is not space here to provide an account of the various competing definitions of enhancement that are operative in the debate, so I will simply try to explain the most relevant aspects of how I understand the word and use it here. First, enhancements are capacity-relative. To talk about an enhancement means to talk about the improvement of a specific human capacity relative to environmental demands or cues. The scope for what counts as a capacity is of course open and historically contingent as is what counts as an enhancement. It’s safe to say that humans today have capacities that they did not always have. Often this is due to past enhancements that have become so prevalent that they have come to be considered as normal capacities.
Language is probably the most important example: the advent of conceptual language can, I think, be considered a technological human enhancement (linguistic concepts are a kind of technology), but it has certainly become a normal human capacity. Thus we are in a tricky situation where a user of conceptual language may be considered enhanced in one very broad and general sense which looks at the historical development of a population or species. But when looked at in relation to contemporary conspecifics, it does not make sense to call the capacity for language use an enhancement or the speaking individual enhanced. Eyeglasses are another good, but slightly different, example. Eyeglasses allow for enhanced visual capacity relative to age-related eyesight degeneration; thus they can be considered an enhancement. On the other hand, this enhancement has become so prevalent, at least within certain population groups, that it no longer makes sense to call it an enhancement from our contemporary historical position. The capacity to maintain functional vision late into life is now a normal capacity.
Second, I think (and this is more contentious) that an enhancement also entails changing or augmenting a capacity such that the capacity, as instantiated in an individual, functions beyond what was previously the normal population-specific scope of function for that capacity. Most of the time the population group that we are talking about is the human species, but that need not be the case. We might wish to speak of enhancements relative to narrower or even broader populations groups, say northern Europeans or mammals. Both eyeglasses and conceptual language would have once fallen into this category. I think that it is this qualification that also helps maintain some sense of a distinction between therapy and enhancement.
Finally, enhancement is clearly not a value-neutral term. Enhancement means the augmentation of a capacity linked to human flourishing relative to the historically contingent demands of an environment and scope of normal function for a population group. But the relation between flourishing and capacities is not always straightforward. If, for example, we consider learning and education to be important aspects of flourishing, we must also acknowledge that the capacities linked to flourishing via cognition (and by extension learning) are not always themselves sources of flourishing. Memory is a clear example. Not only does much cognition involve the capacity for generalisation and hence a kind of forgetting of individual circumstances, but for most there are things that we’d rather forget at pain of being made to feel anxiety, guilt, shame, or worse. So a central aspect of learning and education (memory) and hence an important dimension of how most of us understand flourishing, can also be responsible for its opposite. This is something that we must keep in mind when it comes to the augmentation of certain capacities with an eye toward enhancement.
This brings me to how I want to respond to the question of ‘should students take smart drugs?’. The examples that I have mentioned above do not so much augment a capacity as something that underlies the deployment of our capacities, namely effort and motivation. My other example entailed a fictional example of a technological interface grafted onto the body allowing access to great swathes of information without the individual having to somehow store and retrieve that information through memory. A couple of points here: Replication of a message, i.e. perfect information retrieval, is not learning (see Gregory Bateson on this point). Technologies that augment information retrieval or facilitate rote memorisation may ultimately be the opposite of cognitive enhancers. True learning always involves the deployment of received information in a kind of creative deformation. The point of all education and learning is to facilitate this possibility for deviation at increasing levels of complexity and sophistication. A technological intervention of some sort that facilitated this find of process or added to it might indeed deserve the name of a cognitive enhancement.
But there is something else to consider. Above, I indicated that the sphere of education was special, one of the reasons for this is the amount of emphasis placed on mustering, through what I would call an act of will, the intellectual effort or motivation to keep working on a problem or task. We value greatly the effort involved in overcoming intellectual obstacles and are suspicious toward mechanisms for overcoming the same obstacles with too much ease or without effort. In all but the rarest exceptions, genius or brilliance entails an enormous drive and the deployment of fantastic intellectual effort. A drug promising to provide your motivation for you, to allow you to try harder without trying would draw suspicion, I believe, and be susceptible to the criticism that that kind of augmentation may in some way be in conflict with deeply held value structures concerning learning, education, and more broadly speaking flourishing. These attitudes may stem from an ethical milieu still steeped in variations of ‘Protestant work ethic’, but they nonetheless play an important role in how we think today about the value of learning to our overall sense of human flourishing. In such cases, the augmentation, via smart drug or other means, of an aspect of cognitive capacity necessary, but not sufficient for learning, may turn out not to be a cognitive enhancement in itself, and for distinct but related reasons certainly not be an educational or learning enhancement – not a component of flourishing.
Ultimately, I would argue that flourishing (intellectual and otherwise) is in relation to values that are historical. These are by no means infallible or unchanging, but we would do well to consider how various forms of augmentation or alteration of capacities might interact with these values and the conceptions of flourishing that they serve before potentially undermining them. It is this kind of reflection that will allow us to have a sustained discussion about whether a particular alteration is an enhancement or not.
Darian Meacham is senior lecturer in philosophy at UWE, Bristol. He specialises in phenomenology, social and political philosophy and bioethics.