Pharmacology and Flourishing

I’m hoping achieve some clarity and precision in this debate over the use of chemistry in mental wellness. My clumsy efforts so far have led me to consult an expert, Dr. Leon Kass, former chair of the President’s Council on Bioethics. He does a great job, so I’ll let him talk.

Here are a few selections from an article of his (January 2003). You can read the whole thing here. If you want to take issue with him, be sure to read the whole article first.

“And what about pharmacologically assisted happy souls? Painful and shameful memories are disquieting; guilty consciences disturb sleep; low self-esteem, melancholy and world-weariness besmirch the waking hours. Why not memory blockers for the former, mood brighteners for the latter, and a good euphoriant – without risks of hangovers or cirrhosis – when celebratory occasions fail to be jolly? For let us be clear: if it is imbalances of neurotransmitters – a modern equivalent of the medieval doctrine of the four humours – that are responsible for our state of soul, it would be sheer priggishness to refuse the help of pharmacology for our happiness, when we accept it guiltlessly to correct for an absence of insulin or thyroid hormone. An attempted answer to this challenge comes in several parts.”

“First, there is something wrong with the pursuit of utter psychic tranquility, with the attempt to eliminate shame, guilt, and all painful memories. Traumatic memories, shame, and guilt, are, it is true, psychic pains. In extreme doses, they can be crippling. Yet they are also appropriate responses to horror, disgraceful conduct, and sin. Once again, the point is the fitness of awareness and emotional response. Witnessing a murder should be remembered as horrible; doing a beastly deed should trouble one's soul. Righteous indignation at injustice depends on being able to feel injustice's sting. An untroubled soul in a troubling world is a shrunken human being. More fundamentally, to deprive oneself of one's memory – in its truthfulness also of feeling – in to deprive oneself of one's own life and identity.”

“Second, these feeling states of soul though perhaps accompaniments of human flourishing are not its essence. Ersatz pleasure or feelings of self-esteem are not the real McCoy. They are at most but shadows divorced from the links to the underlying human activities that are the essence of flourishing. Not even the most doctrinaire hedonist wants to have the pleasure that comes from playing baseball without swinging the bat or catching the ball. No music lover would be satisfied with getting from a pill the pleasure of listening to Mozart without ever hearing the music. Most people want both to feel good and to feel good about themselves, but only as a result of being good and doing good.”
. . .
“In a word: one major trouble with biotechnical (especially mental)"improvers" is that they produce changes in us by disrupting the normal character of human being-at-work-in-the-world, what Aristotle called energeia psyches, activity of soul, which, when fine and full constitutes human flourishing. With biotechnical interventions that skip the realm of intelligible meaning, we cannot really own the transformations nor experience them as genuinely ours. And we will be at a loss to attest whether the resulting conditions and activities of our bodies and our minds are, in the fullest sense, our own as human.”