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

Autism and Well-Being

By Richard Ashcroft, MA, PhD



Professor Richard Ashcroft teaches medical law and ethics at both the undergraduate and postgraduate level in the Department of Law at Queen Mary, University of London. Previously, he was Professor of Biomedical Ethics in the School of Medicine and Dentistry, and before that he worked at Imperial College London, Bristol University and Liverpool University. Professor Ashcroft is Co-Director of the Centre for the Study of Incentives in Health, funded by the Wellcome Trust, with partners at Kings College London and the London School of Economics.  He is also working on the role of human rights theory, law and practice in bioethics policy, and on ethical challenges in public health. He has a longstanding interest in biomedical research ethics. 



I am both someone who writes and teaches on bioethics, and father of a son with autism.  He’s a delightful and happy child and he and I have good lives. But like most parents of children with autism I do worry about his future. I worry about social exclusion. I worry about mistreatment by others. I worry about education, employment, housing. I worry about how he’ll manage when I’m gone. I worry about whether he’ll meet someone to love, who will treat him right and value him for who he is. In other words, I worry about him the same way any parent worries about his or her child. His autism just gives me a hook to hang the worries on.



Nonetheless, there is something about autism which challenges our dominant accounts of well-being. There is a common and long-running debate about “stims”, which can crudely be described as repetitive, socially unusual behaviours which autistic people sometimes engage in. Common stims include humming, or spinning, or bouncing on one’s feet or certain kinds of hand gesture. The psychology of stims is related to “sensory issues” which often form part of autism, whereby the autistic person is more or less than usually sensitive to certain kinds of sensory input (light or sound or motion, for instance). Stims can be understood as a sort of self-regulatory behaviour to deal with under- or overstimulation of some sensory mechanism. Stims are just one example of visible autistic difference, in a condition which is sometimes described as an “invisible disability”: a disability where there is no obvious physical impairment which a third party would see with the untutored eye. Most autistic people who stim, if they are able to use verbal communication, say that stims are important to them, either as a coping mechanism, or as something which gives them pleasure – or both. Yet many parents, teachers, and passersby find stims bothersome, irritating, or worse. This is the case even when the stim has no direct impact on them.



As for stims, so for many other common behaviours in autism: for instance echolalic speech, perserveration, meltdowns, dietary intolerances or strong preferences may all be experienced as natural and authentic emotional and behavioural responses by the person with autism, and yet be experienced as problematic by the parent, friend, teacher or bystander. It should be noted that autism is very diverse in its presentation, both in the degree of impairment or disability experienced and the forms it may take or the behavioural traits seen.



One important debate about behavioural traits common in autism concerns whether these are signs and symptoms of disability, and whether in turn this disability is an inherent impairment or a social construct.  But the debate about well-being is just as interesting. Taking stims as our example again, is stimming a sign of well-being? A prejudiced bystander or an exhausted parent might well say no. The person who is stimming might say yes. Who has the authority to settle the question? One subtlety is that stimming may be calming, and being calm is a mark of well-being; but as a response to stress or distress it is a mark of relative lack of well-being. We have to work out whether stimming is a sign of enjoyment or stress.   This question of understanding is of enormous practical importance. Equally, however, we have to ask questions about the standard of evaluation. Should we assume that well-being and flourishing are entirely personal, or that there is some objective standard or list of features which is common to all people, or that there is such a thing as “autistic wellbeing” or “autistic flourishing” which is different in nature and scope from “neurotypical” variants of wellbeing and flourishing? Now, in the short run this is fairly easily settled pragmatically: I can usually tell you with some reliability whether my son is happy or not. More to the point, so can he. And we usually agree; and when we don’t I try to find out why not, and his view is probably more trustworthy than mine. It’s his life, after all. But in the long run, this is not such a helpful guide. No parent ever took for granted that moment-by-moment happiness over the course of a childhood is a recipe for, or predictive of, happiness in independent adulthood. The very idea of education militates against that notion too. So the problem is, if we don’t really know what flourishing or well-being is for autistic people in the here and now, how can we sensibly shape education and parenting, which aim at such flourishing as a long term goal? Is educating or training people with autism to “pass for normal” desirable, even if it is achievable?

Source

Various philosophers have struggled with this problem, most notably Martha Nussbaum in her recent Frontiers of Justice and Eva Feder Kittay in many of her writings. Importantly, much of the best writing has been by philosophers with direct experience in raising a child or caring for a relative with a disability or impairment. But philosophers have still been too slow to take the experience and voice of people with autism seriously enough as giving reliable accounts of their own well-being and flourishing. And even when we do take these experiences seriously, we may be listening to too narrow a range of voices.



Recently (October 2013) I took part in a fascinating workshop on autism and wellbeing organised by a Danish philosopher, Raffaele Rodogno, at the University of Aarhus. In the morning I read a paper on the topic, as did Raffaele himself and Ingrid Robeyns (Erasmus University of Rotterdam) and Eva Billstedt (University of Gøteborg). But in the afternoon we had a roundtable discussion led by autistic young adults from a local self-help group. Two things became clear: first, that this was a very articulate and insightful group of young people who had a lot to say about well-being which certainly humbled me in light of my rather inchoate ramblings earlier in the day. Second, that what they had most to say about was not well-being but its lack. And this was not to do with “the miseries of autism”; far from it. They were proud of their interests and their achievements and this was very apparent. Rather it was to do with the mistreatment, discrimination, intolerance and lack of understanding they met on a daily basis: exclusion from school, ridicule of their differences, intolerance of their sensory needs, low expectations on the part of their teachers about what they might achieve in life.



What do I conclude from these reflections: first, we need to think harder about well-being and its diversity; second we need to listen to people’s own accounts of their well-being and flourishing; and third, we need to pay close attention to the ways in which our societies positively destroy well-being.

Want to cite this post?



Ashcroft, R. (2013). Autism and Well-Being. The Neuroethics Blog. Retrieved on
, from http://www.theneuroethicsblog.com/2014/01/autism-and-well-being.html