The Market for Medicalization: Enhancing Evolution?

shy.jpgMany recent books are questioning the expansive trend toward “medicalizing” emotional responses that were once considered acceptable. I greatly enjoyed Christopher Lane’s Shyness: How a Normal Behavior Became a Sickness, and I’ve just started in on Peter Conrad’s The Medicalization of Society: On the Transformation of Human Conditions Into Treatable Disorders. Metapsychology has given a positive review to Horwitz and Wakefield’s The Loss of Sadness: How Psychiatry Transformed Normal Sorrrow into Depressive Disorder. The authors argue that “instances of what Freud called ‘ordinary human misery’ should not be confused with real mental disorder”–but there are many pressures toward treating them as such.

As the realm of “mental optimization” expands, I predict more employers will request (or demand) employees take certain drugs. For example, someone grieved by a loss might become much more productive if they can nip misery in the bud with the right intervention. Will such pill-taking ever become a bona fide occupational qualification? Are there cases where it might make sense?

I think it is helpful to think about two “ideal types” here. First, imagine some pill that makes pilots particularly acute during their flights, or gives them better vision, with no side effects. Second, imagine a personality “brightener” that a company believes makes its sales force far more fun and personable. Is one intervention less objectionable than the other?

I think the first is far more understandable, because flying has some objective standards (most notably, don’t crash). By contrast, the sales force is engaged in what is essentially a positional competition for more revenue–there’s no way to define “good performance” that is not relative to how well other employees are doing. (For an example, consider Jack Welch’s famous policy of knocking out the bottom 10% of employees each year–or the struggle for a partnership at a law firm.) Moreover, the first intervention is unlikely to affect the personality of the pilots, while the latter may go to the heart of personality.

A few parting thoughts. First, thanks to Patrick at the Medical Humanities Blog for pointing out Christian Perring’s superb article on clarifying the concept of mental illness. I have worried that greater pressure to perform will lead to an endless expansion of this category.

Second, the pressures to take chemical enhancements should lead us to question any sanguine characterization of the ethics of enhancement as a purely personal and individual matter. In his Enhancing Evolution, John Harris argues that “citizens should be free to make their own choices in the light of their own values, whether or not these choices and values are acceptable to the majority.” As Jonathan Franzen suggested in The Corrections, a positional rat race may be driving personality optimization far more concretely than “individual values.” Harris briefly mentions positional competitions in his book before throwing up his hands at solving them. Thankfully theorists like Jonathan Wolff and Avner de-Shalit are taking the issue more seriously. Where Harris sees the “enhancement” of evolution, many others may more justifiably predict its derailment.

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