Mind games

Martha Farah Photo credit: Candace diCarlo

Neuroethics is to Prozac what bioethics is to stem cell research. The emerging field, explains Penn Psychology Professor Martha Farah, examines the social and ethical issues of any technology that alters the brain, whether it’s a mood-enhancing drug or an electrode implanted in the frontal lobe.

“There’s a huge array of neuroscience driven technologies that can alter our minds,” says Farah, who also directs Penn’s Center for Cognitive Neuroscience, “as well as, not to sound too sensationalist, ‘read’ our minds in some sense.” Neuroethics studies those techniques and thinks about how they might influence society.

We sat down with Farah recently to talk about brain- and mood-enhancing drugs and their use by healthy people who want to be “better than well.” It’s a phenomenon that’s on the rise and clearly there are neuroethical implications, from simple safety concerns to the knottier riddles of human identity.

Q. What are some of the drugs people are using in off-label ways to enhance their mood or improve their performance?
A. I think the first one that came to the public’s attention was Prozac and now more generally the SSRI antidepressants, the selective serotonin reuptake inhibitors, of which Prozac is an example. The thing about Prozac and its ilk is they’re antidepressants like the older medications, but unlike them, they have pretty tolerable side effects. With the older meds you had to be feeling pretty horrendous to want to put up with the side effects, but with Prozac and the SSRIs the side effect profile is better and as a result people who are less sick are willing to use them to get their benefits.

Q. What benefits are people looking for? Is it just a happy drug?
A. A lot of people assume that what they are is happy pills, and they’re not. What they are is more like “not sad” pills. So if you give Prozac to somebody who’s depressed, assuming that they are a depressed person who responds well to these drugs, they will find that they are no longer sad, they are no longer anxious, but they’re not especially happy. They’re not elated, just the pain and misery is gone from their lives. If you give a normal, healthy person Prozac the effects are much more subtle obviously, because they weren’t experiencing a lot of pain and misery to begin with, but the finding that’s been reported is that the little hassles and irritations and bummers of everyday life are less bothersome.

Q. I know there are also certain drugs out there that people are taking for performance enhancing abilities.
A. Yes, and those are the ones that have really crossed over from the realm of “treatment” of disorder to “enhancement” of normal people. There aren’t a lot of perfectly normal, happy, healthy people taking Prozac. We’re not talking large segments of the population here. On the other hand, large segments of at least certain populations, like the college population in this country, are using prescription stimulant medications to enhance their academic performance, to increase their focus while studying, to lengthen the number of hours they can concentrate productively. These are medications usually prescribed for the treatment of ADHD, but it appears that they not only improve the attention of people with ADHD but improve just about everybody’s attention. And let me tell you, the undergraduates have discovered this … this is a national phenomenon. In the U.S. there are so many of these drugs around because ADHD is so widely diagnosed and treated that the meds are commonplace on American college campuses and end up in the hands of all kinds of students.

Q. Competitive people have always looked for an extra edge. How are these drugs different from caffeine or other stimulants?
A. Well, I think they are and they aren’t different. They are different in the sense that they’re much more potent than, say, caffeine. Specifically, we’re talking about Ritalin and Adderall right now, and they have much stronger effects on your brain and on attention and concentration than caffeine does and they also have the potential for more serious side effects. A small percentage of people using these prescription medications will have heart problems as a result, or end up hooked. So I don’t want to leave you with the impression that I think coffee and Ritalin amount to the same thing. On the other hand there are a lot of similarities. I think our approach to the phenomenon of healthy students using prescription stimulants can be informed by thinking about the role of more familiar performance enhancers and stimulant substances like caffeine.

Q. It seems that from the beginning of time people have sought ways to tweak their mental abilities, whether it’s through caffeine or alcohol, St. Johns Wort or whatever funny mushrooms they happened to find.
A. Right. I think taking a historical perspective is very useful, because in fact we have been tweaking our brain chemistry since time immemorial and this is just the continuation of that trend. If you look at the history of the use of psychoactive substances you see a process of civilizations purifying them, making them stronger, more effective, more selective. So we started out with pre-Columbian farmers chewing coca leaves to get a little bit of cocaine out of the leaf and into their saliva, and that helped them bring in the harvest when they had to work long hours. Centuries later people found chemical ways to extract the cocaine from the coca leaf and that made a much more potent, pure substance, which was accordingly more dangerous and more likely to create addicts, and later still people started synthesizing new drugs with similar actions in the brain like amphetamines.

Let me also mention that as a society we are big drug takers. It’s becoming more and more a normal thing to be popping pills for cholesterol, heartburn, erectile dysfunction and so on, and I think that has also set us up to find it quite normal and quite reasonable to take pills to enhance studying, for example.

Q. We’ve said that people have always found ways to alter their brain chemistry and now it seems we’ve been able to do it really, really well. Is there an inherent danger?
A. First of all I have to say that for all the talk of rational drug design and modern pharmaceuticals, and for all the glossy magazine ads you see, psychiatric drug discovery is still pretty trial and error, so we have a long way to go before we can identify a mental trait or an aspect of mood and say we want a molecule that will strengthen this trait or increase this aspect of mood or attenuate that aspect of mood.

We are nowhere near there. Whether that’s good news or bad news depends on whether you’re wishing for better treatments for all the people in this world with mental illness or whether you’re worried about a brave new world scenario where everybody’s going around in some kind of chemically engineered state. But basically I don’t think we’re doing as well as you suggested with your question.

Q. Do you foresee other types of mind-altering, mind-boosting types of medications coming out?
A. Well I can tell you what I’ve heard different companies are working on. There are some pretty interesting new cognitive enhancers in the pipeline, drugs that will improve memory ability, which is of particularly great interest to aging baby boomers. Psychologists have found that a normal, healthy person begins to suffer some decline in memory ability in their 30s. You may not notice it in your 30s but by the time you’re in the 40s and 50s most people are wishing that they had the memories they had when they were younger. So a drug that would enhance memory and in effect restore middle-age memory to its younger, better state will sell a lot.

Q. If we’re significantly changing our mood with drugs of any sort, are we still who we think we are?
A. That is really a very philosophical question and I’m not sure I can answer it, but let me say this: We all have a very strong intuition that we exist as the same person over time, so the me sitting here with you now is the same me that got up this morning and is the same me who came to Penn 14 years ago. And yet, obviously, that me 14 years ago was very different in many ways.

There’s a lot that I had yet to experience that now I have incorporated as part of my life experience. So we have this really strong gut feeling that there is a single, immutable self that goes with us through life and yet it’s really hard to say what that self comes down to exactly because people learn new things, people forget old things, people’s personalities change as a result not just of taking Prozac but of experiences, religious conversions, whatever.

So I suspect that this sense of an enduring, constant self is actually an illusion. All kinds of non-pharmaceutical things change us in various ways, and pharmaceutical things change us too, which brings us to the paradox of a drug like Prozac. Some of Peter Kramer’s [author of “Listening to Prozac”] patients said to him that since they’d been on Prozac they felt like themselves for the first time. They said, “That’s who I really was all along and I couldn’t get to it before I took the drug.” And other people said they really felt their old, depressed self was their true self but they’d rather be the drug-enhanced self. So who am I? Am I the same person on the drugs as off them? Those kinds of puzzles and paradoxes I think are just one more reminder that we don’t have a fixed immutable self despite our intuitions.

Interviewed by Greg Lester

To listen to a podcast of this interview, go to www.upenn.edu/pennnews/rss.php. To learn more about neuroethics and Farah’s work, go to http://neuroethics.upenn.edu/.

Originally published on December 7, 2006.

Originally published on January 18, 2007