Tuesday, August 5, 2014

Enhancement and Social Possibility

By Ross Gordon

In their recent paper on neuroenhancement, Brian Earp and his colleagues draw a distinction between “functional enhancement [and] enhancement of well-being,” arguing that the former, dominant construction cannot deal with the ways in which welfare is often enhanced by functional diminishment. On these grounds, the authors propose a “welfarist” paradigm, which defines enhancement as “any change in the biology or psychology of a person which increases the chances of leading a good life in a given set of circumstances.”

On one level, I think Earp's welfarist approach both clarifies debates about enhancement and usefully broadens the set of interventions that could be understood as “enhancing.” On another level, however, I think his discussion of welfare begs a set of far more crucial questions: namely, what does it mean to talk about a “good life,” what “given set of circumstances” exist, and what is the relationship between individual welfare and broader social structures?

In 2003, a controversial advertisement for cosmetic enhancement aired on Indian television. Depicting “a young, dark-skinned girl's father lamenting... his daughter's salary was not high enough,” the commercial suggests that the daughter “could neither get a better job or get married because of her dark skin.” The advertisement concludes with its recommended solution: Unilever's Fair & Lovely, a globally best-selling skin-whitening cream, will (the commercial suggests) increase the daughter's employability as well as her romantic success.

In this instance of purported non-neurological enhancement, the welfarist question appears as obscene. While it's certainly possible to imagine research into Unilever's claims – does Fair & Lovely really improve Indian women's employment prospects? Do Fair & Lovely consumers with newly lightened skin experience, on average, more romantic success? – what is crucial is not whether Fair & Lovely “really works,” but how such a commercial promotes a racial ideology1 that posits individuals with lighter skin as more beautiful, more credible, and more employable than individuals with darker skin. Suggesting a link between Fair & Lovely and increased individual welfare (e.g. employment) misses the point insofar as it isolates the question of “welfare” from this larger ideological structure.

From Brighter Brains
Enhancement and Welfare in Social Context 

What does this have to do with neurological enhancement? While neurological enhancement and (purported) cosmetic enhancement differ in significant ways, both are characterized by tension between short-term individual welfare and broader social structures and ideologies. In addition to the two questions that Earp considers in his paper – “does it enhance?” and “does it increase welfare?” – at least two more questions might help to address this tension. First, “what social conditions have led us to consider a particular intervention as enhancement?”; and second, “what social structures are enabled by the adoption of a given enhancement?”

These latter questions are deeply implicated in the the most popular forms of contemporary neuroenhancement: caffeine and alcohol consumption. On one hand, a general cultural emphasis on work and productivity incentivizes widespread caffeine usage as a means to increase focus and alleviate fatigue. On the other hand, the currently-existing social structure would not be possible without caffeine: coffee (and other stimulants) constitute a sort of invisible precondition for the everyday labor practices of finance professionals, medical school residents, academics, and oil rig workers. Similarly, alcohol use functions simultaneously as a ritualistic “unwinding” from stressful work environments and life situations, and as an enabling condition for social bonding rituals – office parties, fraternity pledging, military socialization, and so forth – that produce social arrangements which would not otherwise be possible.

From caffeineinformer.com

Conversely, substances which might conceivably be construed as “enhancement” are typically not discussed as such when their effects are inconsistent with dominant social values. Psilocybin mushrooms, peyote, ayahuasca, and ibogaine are variously used throughout world for their spiritual, religious, and community-enhancing properties. Ralph Metzner writes of the ceremonies surrounding such drug use:
“...folk religious ceremonies often involve fairly large groups of 20 to 40 participants, and in the case of the Brazilian hoasca churches several hundred... the primary focus is on group worship and celebration with singing and prayer... An important social function of these religious ceremonies is to strengthen community bonds and give members a sense of participation and belonging.”
Crucially, these ritual “enhancement” practices also invert the contemporary American dynamic; where stimulants produce effects consistent with high-productivity capitalist culture, hallucinogens are often deployed for precisely the opposite purpose:
“As has been noted by some anthropologists, a further societal function of these churches is to provide a protective shield of traditional lore against the encroachments of Christian missionaries and the seductions of Western consumer culture in general.”
Debates about enhancement, then, are not simply about – as Earp suggests – interventions which “increase the chances of leading a good life in a given set of circumstances.” Rather, neurological interventions, pharmacological or otherwise, simultaneously call into question what it means to live a “good life,” and influence this “set of circumstances” itself.

“Enhancement” or “productivity enhancement?”

 It is no coincidence that the productivity-enhancement and stress-reduction enhancements typically associated with coffee and alcohol consumption tend to underpin debates about neuroenhancement in general. In fact, nearly every example of enhancement in Earp's paper speaks to one of these values:
“...we see articles asking whether non-invasive brain stimulation should be used to enhance learning... students taking Ritalin to improve focus... ergogenic drugs to stay awake during late-night surgery... enhancements in executive function and self-control, concentration, or of our ability to cope with stressful situations...”
At the same time, even the (potentially) welfare-enhancing interventions characterized by Earp as diminishment (“diminishment of wartime memories; diminishment of harmful love; diminishment of ill-directed lust”) are categorized as such precisely because of their capacity to attenuate emotive threats to productivity. Such assumptions regarding what constitutes “the good life” are neither neutral nor insulated from more nefarious appropriations. There is a disturbingly straight line between some examples in Earp's paper and the stuff of dystopian fantasy. For instance, it is suggested that:
“...too much empathy might drive a person to prioritize attending to others' feelings over meeting her own basic needs... Williams (1989) has hypothesized that among helping professionals, high emotional empathizers may be disposed to earlier career burnout.”
Taken to its logical conclusion, this statement is as obscene as the injunction to increase one's employability via skin-whitening: there is a real danger that the “enhanced” individual coming into view is a light-skinned, non-empathetic, highly-productive Adderall user. Without an analysis of the social and cultural values that produce such ideologically-charged visions, “post-enhancement” humanity risks literally etching its contingent value system onto the materiality of the human brain.

Democratizing Enhancement 

Earp's discussion of welfarism is motivated, at least in part, by a desire to clarify the basis on which decisions about neuroenhancement can be made. A neuroethics which takes its ethical mandate seriously, however, should refuse this question: the more pertinent question is who makes decisions about which enhancements count as “welfare-enhancing,” and on what grounds these decisions are made. Neurological intervention holds the capacity to fundamentally alter both human self-understanding and human social and political possibility. For this reason, determinations of welfare should not be left to medical or policy experts any more than assessments of Fair & Lovely should be left to dermatologists and biochemists.

This is not to dispute that experts will inevitably reach provisional conclusions regarding which enhancements are acceptable and which are not, and that these conclusions will manifest in both a legal infrastructure and a set of social norms. The ethical response to such expert decisions, however, is not to accede to them, but to contest the authority of the decision-makers themselves while asserting alternative interpretations that stem from particular social positions and cultural analyses. Academics are always faced with a prior question: what kinds of problems should we investigate? To pursue questions about welfare “in a given set of circumstances” serves to both legitimate technocratic enhancement decisions and to obscure the larger social context in which they are made.

A democratized enhancement discourse would not insist on any final verdict regarding particular neuroenhancements, but recognize neural modifications as socially-embedded tools which open up certain social possibilities while constraining others. Drugs' capacity to open up the horizons of human possibility – from the Eleusinian Mysteries to the antidepressant revolution – have always factored crucially into their social use and social control. A democratic neuroethics should defend these open possibilities against attempts to subsume neurological modifications under a single interpretive lens.

[1] I don't mean to reduce racial ideology here to the issue of skin tone alone: clearly, such ideologies are both complex and diverse. Unilever's marketing strategy, however, as well as the commercial success of its product, evidence the way in which whit(er) skin tone is often associated with beauty and credibility.


R, Gordon. (2014). Enhancement and Social Possibility. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/07/enhancement-and-social-possibility.html

1 comment:

b.logg.earp said...

Hello Ross - thanks for your interesting analysis of our article. I certainly agree that taking into consideration the wider social structures that might make something an "individual welfare enhancer" is incredibly important; in fact I made that argument recently in the Journal of Medical Ethics concerning "virginity restoration" surgery in Islam: I asked, "How Can Physicians Promote Individual Patient Welfare Without Becoming Complicit in the Perpetuation of Unjust Social Norms?" -- see here:

https://www.academia.edu/3728769/Hymen_restoration_in_cultures_of_oppression_How_can_physicians_promote_individual_patient_welfare_without_becoming_complicit_in_the_perpetuation_of_unjust_social_norms

In any event - your blog raises a lot of good points. Have you considered submitting a version of it to Frontiers in Systems Neuroscience as a "Comment" on our piece? That way, it would appear in the published literature, and we'd be in a better position to write a formal reply, engaging with your criticisms and ideas. If you'd be interested, please shoot me an email and I can put you in touch with the editor for the special section on neuroenhancement, as I'm sure he'd love to consider publishing a version of your post in the journal.

Best,
Brian
---------
Brian D. Earp
Research Fellow,
University of Oxford