Sacrificing Depth for Speed

Cognition Enhancing Drug Use: Sacrificing Depth for Speed

As a scholar and clinician interested in the social construction of Attention-Deficit/Hyperactivity Disorder as well as other mental illnesses more generally (you can look at my dissertation on this subject here), I was asked to render a brief opinion regarding the use of prescription stimulants like Ritalin and Adderall by otherwise healthy people simply for the purpose of getting better grades, or working faster or more efficiently.

At the surface, it seems fairly benign. After all, we have been giving these drugs to our young school-aged children for decades to help stem disruptive behaviors or address difficulties in focusing attention in the classroom. In fact, the National Institutes of Mental Health (NIMH) recently published research touting the possible efficacy of stimulant medication in children as young as three years of age (Greenhill, et al., 2006).

That all makes it understandably easy for people to wonder how dangerous these drugs could possibly be. And, if they do promise to help healthy, responsible, intelligent people get far more work done, more quickly and with fewer distractions, what’s the harm? How different is this from drinking coffee or an energy drink?

If you find yourself nodding in agreement as you read, you have company in some very reputable places. In a recent issue of Nature, which is widely recognized the world over as one of our more prestigious scholarly publications, clinicians and scholars from Harvard Medical School, Stanford University Law School, the University of Cambridge, the University of Manchester, UC Berkeley, and the University of Pennsylvania collaborated on an article advocating the “responsible use of cognitive enhancing drugs by the healthy” (Greely, et al., 2008).

While exploring the question is almost certainly a worthwhile endeavor, this article, and the idea it seeks to advance, concerns me for a number of reasons, particularly given its rather authoritative status. Acknowledging the brevity of this forum, allow me to elaborate upon three of them, and then offer another way of thinking about this issue.

First, the article frames the subject in terms that scarcely anyone would take issue with. Who wouldn’t support “cognitive enhancement?” After all, isn’t that why people attend a University in the first place? I believe special care should be taken to employ more neutral language to frame a debate like this so as not to unduly bias the conversation, or even marginalize dissenting voices before they can be heard. As a community of teachers and researchers, let us respect the power inherent in our positions as constructors of new knowledge, and take particular care not to unintentionally cloak what may be a wolf in a sheep’s clothing.

This brings me to my second point: The article barely acknowledges the potential health risks of taking the drugs in question, and only touches upon the topic in rather general terms. In my opinion, this only serves to further support the apparently innocuous nature of this proposal.
These are powerful pharmaceuticals that carry a long list of potentially serious risks, particularly in young people with still-developing brains

Allow me to fill in the blanks on this latter point with a few specifics. In spite of their seemingly ubiquitous presence, drugs used to treat ADHD are not at all similar to the caffeine in coffee or energy drinks. These are powerful pharmaceuticals that carry a long list of potentially serious risks, particularly in young people with still-developing brains. Adverse drug reactions in stimulant formulas include impaired growth (Swanson, et al., 2007), insomnia, agitation, hypomania, mania, seizures, physical withdrawal, rebound effects, dependence (Breggin, 1999a, 1999b), and even psychosis (Breggin, 2000). Non-stimulant formulas also present safety problems, and their manufacturers were recently ordered by the United States Food and Drug Administration (FDA) to include a “black box” warning regarding the potential for increased suicidal ideation in adolescents (Carey, 2005). The black box was also subsequently ordered by the FDA for some popular stimulant formulas given an increased risk of sudden death (Pettypiece & Blum, 2006).

Third, the article focuses upon only one family of “enhancements” as if they are all that might be possible or desirable—speed, memory and attention. It makes this idea sound every bit as simple as upgrading to a new computer with a faster microprocessor, more RAM and a bigger hard drive. A growing minority in the scholarly community who have been studying the legitimate therapeutic uses of a variety of other psychoactive substances—like MDMA (Parrott, 2007) for example—would have much to say about this limited definition of enhancement. If the scholarly community at large wishes to open the question of the legitimacy of “cognitive enhancement through drug use” for a comprehensive hearing, why not include these substances and what they may offer as well?

I raise that potentially controversial point as a way of leading into what for me is the heart of the matter. It’s not about advocating for all drugs equally. It’s about questioning what this says about our culture. Should we allow the pharmaceutical industry, corporate-owned media, allopathic medicine, the academy, and the Law decide for us what is worthy of enhancing and the means by which we should seek to do so?

Allow me to explain further. Greely and colleagues (2009) talk briefly about the issue of fairness, which I think is salient here, but mainly as a means of focusing in upon this deeper thread of the conversation. Specifically, they compare the use of cognitive enhancing drugs by some students and not others with the notion of some being allowed to use calculators on a math exam while others are limited to pencils and scratch paper. Further, they wonder how this divide might show up as a function of access given socio-economic status. Whatever the case, the authors imply that allowing the use of cognitive enhancing drugs by some may amount to a form of indirect coercion whereby students feel they have no choice but to take the drugs in order to compete. While those are all worthy points from both sociological and psychological perspectives, this begs an even more fundamental question the authors fail to address: Compete for what, and to what ends?

Paul Tillich (1999) framed a convincing case that our culture increasingly tends to overemphasize what he called “the horizontal dimension” of life. I see this showing up in how we relate to our world as a place filled with objects that are separate from us—including, ironically enough in this case, our own brains. These detached objects exist only to be exploited, acquired, shaped, produced, controlled or manipulated, with ever more efficiency, and for ever increasing personal gain.

The result of unconsciously proliferating such cultural practices is, sadly, a loss of the dimension of “depth” in our discourse and in our lives. Tillich (1999) maintains that losing depth amounts to a disconnection from Spirit at the most universal level: namely, “the ability of man to ask passionately the question of the meaning of our existence.” To my mind, that’s where an education at a place like Santa Clara University strives to set itself apart, and often does. So the question for me becomes, “Do we want to risk losing that?”

I’m not suggesting that we ought to ignore the acquisition of skills and excellence in academic performance in the “horizontal” sense of their meaning in the world. What I am suggesting is that we needn’t emphasize or “enhance” them at the expense of students’ concerns for their own Being, or the state of Human Being more broadly.

In my opinion, that is the hidden price tag attached to “cognitive enhancement” as long as it’s all about speed—both literally and more symbolically.

In closing, the awe inspiring opportunity which lies before each of us is to creatively and authentically engage the tension between the horizontal and the deep, to the best of our God-given abilities. When we do, we will co-create an education experience that develops heart and mind, body and soul, cognitive power and depth of feeling, efficiency and creativity. Best of all, such an education will en-courage us all to embody as a whole community the sacred union of intellect, wisdom, skillful means, and love, as expressed in service to all of Humankind.

Now that is the sort of enhancement I can fully support.

References

Breggin, P. R. (1999a). Psychostimulants in the treatment of children diagnosed with ADHD: Part 1–Acute risks and psychological effects. Ethical Human Sciences and Services, 1(1), 13-33.
Breggin, P. R. (1999b). Psychostimulants in the treatment of children diagnosed with ADHD: Part II–Adverse effects on brain and behavior. Ethical Human Sciences and Services, 1(3), 213-242.
Breggin, P. R. (2000). Confirming the hazards of stimulant drug treatment. Ethical Human Sciences and Services, 2(3), 203-204.
Carey, B. (2005). F.D.A. orders new warning on Attention-Deficit drug. The New York Times.com. Retrieved from http://www.nytimes.com/2005/09/30/health/30drug.html?ex=1157169600&en=a11a780cbe726cd4&ei=5070
Greely, H., Campbell, P., Sahakian, B., Harris, J., Kessler, R. C., Gazzaniga, M., et al. (2008). Towards responsible use of cognitive-enhancing drugs by the healthy. Nature (December 2008), 702-705.
Greenhill, L. L., Kollins, S., Abikoff, H. B., McCracken, J. T., Riddle, M., Swanson, J. M., et al. (2006). Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 45(11), 1284-1293.
Parrott, A. C. (2007). The psychotherapeutic potential of MDMA (3,4-methylenedioxymethamphetamine): an evidence-based review. Psychopharmacology, 191, 181-193.
Pettypiece, S., & Blum, J. (2006). Glaxo, Shire stengthen risk warnings on ADHD drugs. Bloomberg.com. Retrieved from http://www.bloomberg.com/apps/news?pid=20601085&sid=alBMR22v6xpI&refer=europe
Swanson, J. M., Elliott, G., Greenhill, L. L., Wigal, T., Arnold, L. E., Vitiello, B., et al. (2007). Effects of stimulant medication on growth rates across three years in the MTA follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 46(8), 1015-1027.
Tillich, P. (1999). The essential Tillich: an anthology of the writings of Paul Tillich. Chicago: University of Chicago Press.

This post originally appeared in the Technological Citizen at Santa Clara University

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Dr. Sean Patrick Hatt, Integrative Psychology

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