Tuesday, February 28, 2017

Dangerous Love and Anti-Love Drugs: Neuroethics & Public Health Problems

By Kelsey Drewry

Kelsey Drewry is a student in the Master of Arts in Bioethics program at the Emory University Center for Ethics where she works as a graduate assistant for the Healthcare Ethics Consortium. Her current research focuses on computational linguistic analysis of health narrative data, and the use of illness narrative for informing clinical practice of supportive care for patients with neurodegenerative disorders.

The half-priced heart-shaped boxes of chocolates lining grocery store shelves serve as an undeniable marker of the recent holiday. Replete with conceptions of idyllic romance, Valentine’s Day provides an opportunity to celebrate partnership, commitment, and love. However, for those experiencing heartbreak or unrequited love, Cupid may be a harbinger of suffering rather than giddy affection.

The transition from love to pain is an incredibly common experience, and one that is formative for many. The extent of character building in heartbreak and other negative affection experiences is bounded, though, by certain types of “dangerous love”. According to Brian Earp and colleagues, this classification might include domestic abuse, pedophilia, or even jealousy-induced homicide (Earp et al 2013). The suffering associated with these cases surpasses any beneficial emotional development, leading instead to potential enduring physical and psychological harms. Instances of “dangerous love” might become the targets for “drugs that manipulate brain systems at whim to enhance or diminish our love for one another” (Young 2009, 148), which seem to be a reasonable potential product of current trajectories of neuropharmocological research.

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These “anti-love” drugs are certainly beneficently intended, and may indeed be of great value in some instances. An example of neuroenhancement by diminishment, the ability of an individual to rise above the influences of attraction-causing neurochemicals and adhere instead to reason may give rise to a more morally capable person, at least in a Kantian sense. Additionally, decreasing the instances of sexual abuse and physical harms are aims that cohere with lauded public health endeavors across the globe. It is not unreasonable to consider future anti-love biotechnology as a valuable interventional tool in the effort to diminish the incidence of negative health outcomes associated with “dangerous love” on both the individual and community scale.

To this end, Earp and colleagues cite domestic violence as a promising substrate. The context is sensible, if you accept the view that love causes one to enter a state that is “literally not normal” (Marazziti et al 1999), or akin to drug or behavioral addiction (Burket and Young 2012). Under this framework, love may be understood as a neurochemically induced loss of autonomy (to some degree) that causes abuse victims to justify the sacrifice of second-order desires like leaving on account of first-order romantic bonds (Earp et al 2013). The authors proceed to lay out the framework for a “maximally promising” application of anti-love technology in human relationships under the context of domestic abuse:
  1. “The love in question is clearly harmful and needs to dissolve one way or another.
  2. The person would conceivably want to use the technology—and if she did want it, there would be no problematic violations of consent.
  3. The technology would help the person follow her higher order goals instead of her lower order feelings.
  4. It might not be psychologically possible to overcome the perilous feelings without the help of anti-love biotechnology.” (Earp et al 2013, 11-12)
Looking past some of the potentially problematic implications of language like “clearly harmful” and “higher order goals”, these measures seem to provide a reasonable first attempt at outlining a paternalistic anti-love drug administration schema. But returning to our recognition of domestic violence as a public health issue raises unique ethical refinements to even the “maximally promising” scenario for these drugs.

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Epidemiology literature shows that domestic abuse disproportionately affects vulnerable populations, specifically women, racial and ethnic minorities, and those of lower socioeconomic status (Sokoloff and Dupont 2005). In the specific “maximally promising” case of domestic abuse where the woman knows the relationship is detrimental or harmful and wants to leave, but remains only due to her autonomy-impairing neurochemical love, an anti-love drug may lead to increased harms unless applied in conjunction with other supportive measures. In their considerations, Earp and colleagues neglect the practical circumstantial issues very often associated with domestic abuse—if the victim is for some reason unable to remove themselves from the physical space of the relationship, paternalistically administering anti-love medication is eliminating any psychological capacity to tolerate the circumstance. The vulnerabilities associated with domestic violence may also predispose victims to a lack of social support, community and financial resources (Barnett and LaViolette, 1993; Iyengar and Sabik 2009; National Coalition Against Domestic Violence 2007). Removing the neurochemical basis for making some sort of transient positive meaning from an abusive relationship without providing the means for the victim to physically leave that relationship space seems incredibly irresponsible. It seems very possible that a person no longer experiencing feelings of love (or attachment, affection, lust, etc.) in these circumstances, but unable to physically escape abuse, would be predisposed to increased psychological harms—perhaps even suicidality (Cavanaugh et al 2011; Afifi et al 2009; Golding 1999; Sato-DiLorenzo and Sharps 2007).

Thus, in order for Earp’s framework to be considered ethical on the public scale, which it must if the “maximally promising” context is a preexisting concern of public health, a fifth criterion is necessary:
5. The person can conceivably remove herself from the relationship upon diminishment of love.
The justice or access emphasis of public health ethics would extend this idea further to argue that paternalistic administration of such a drug would necessitate the provision of additional supportive interventions for particularly vulnerable individuals meeting criteria 1-4 but not 5. Such a stipulation converts an act of moral permissibility (paternalistic administration of anti-love biotechnology to individuals meeting 1-4) to a moral obligation to provide community-based support in fulfillment of a positive right of assistance for individuals who do not meet criterion 5.

Now, to avoid becoming entangled in an overly specific refinement of a single speculative framework for a hypothetical drug, let us step back from my concerns with the criteria laid out by Earp and colleagues in “If I Could Just Stop Loving You: Anti-Love Biotechnology and the Ethics of a Chemical Breakup”. Arguing abstractly in such an uncertain space is unlikely to be of any benefit other than mental exercise. However, I think my refinement of Earp’s proposed criteria may be a useful case study in the specificity of neuroethical discourse, especially in the context of enhancement. The shear volume, richness, and novelty of information that exists at this intersection of neuroscience, psychology, medicine, philosophy, and public health provide a medium for incredibly nuanced discussion. Certainly, the implications of developing neurotechnologies demand careful ethical consideration distinct in kind—thus the evolution of neuroethics as a field. But becoming mired in the specific novelty of uniquely neuroethical considerations is a hazard of the discipline. It is essential that, even at its most speculative and futuristic, neuroethical discourse retains consideration of the non-neural physical and social limitations of its work. The eventual application of developing neurotechnologies to issues of public health necessitate recognition of and dialogue with the embodied context of the neuroethical question. Such considerations will both enhance the practicality of recommendations, and ensure that they are completely ethical, not just neuroethical.

References

Afifi T.O., H. MacMillan, B.J. Cox, G.J.G. Asmundson, M.B. Stein, and J. Sareen. 2009. Mental health correlates of intimate partner violence in marital relationships in a nationally representative sample of males and females. Journal Of Interpersonal Violence 24(8):1398–1417.

Barnett O.W. and A.D. LaViolette. 1993. It Could Happen to Anyone: Why Battered Women Stay. 178 pp. Sage Publications Inc. Newbury Park, CA.

Burkett, J. and L.J. Young. 2012. The behavioral, anatomical and pharmacological parallels between social attachment, love and addiction. Psychopharmacology 244(1): 1-26.

Cavanaugh, C.E., J.T Messing, M. Del-Colle, C. O’Sullivan, and J.C. Campbell. 2011. Prevalence and Correlates of Suicidal Behavior among Adult Female Victims of Intimate Partner Violence. Suicide Life Treat Behavior (41)4: 372-383.

Earp, B.D., O.A. Wudarczyk, A. Sandberg, and J. Savulescu, 2013. If I Could Just Stop Loving You: Anti-Love Biotechnology and the Ethics of a Chemical Breakup. The American Journal of Bioethics 13(11): 3-17.

Golding, J.M. 1999. Intimate partner violence as a risk factor for mental disorders: A meta-analysis. J Fam Violence 14(2):99–132.

Iyengar, R. and L. Sabik. 2009. The Dangerous Shortage of Domestic Violence Services. Health Affairs 28(6):w1052-w1065.

Mrazziti, D., H.S. Aksiskal, A. Rossi, and G.B. Cassano. 1999. Alteration of the platelet serotonin transporter in romantic love. Psychological Medicine 29: 741-745.

National Coalition Against Domestic Violence. 2007. Domestic Violence Facts. Retrieved Feb. 21, 2017 from here.

Sato-DiLorenzo A. and P.W. Sharps. 2007. Dangerous intimate partner relationships and women's mental health and health behaviors. Issues in Mental Health Nursing 28(8):837–848.

Skoloff, N.J. and I. Dupont. 2005. Domestic Violence: Examining the Intersections of Race, Class, and Gender—An Introduction. In Domestic Violence: Readings on Race, Class, Gender, and Culture, ed. N Skoloff and C. Pratt, 1-13. New Brunswick: Rutgers University Press.

Young, L.J. 2009. Being Human: Love: Neuroscience reveals all. Nature 457(7226): 148.

Want to cite this post?

Drewry, K. (2017). Dangerous Love and Anti-Love Drugs: Neuroethics & Public Health Problems. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/02/dangerous-love-and-anti-love-drugs.html

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