That said, in describing the concerns raised by drugs like antidepressants I didn’t intend to endorse laws restricting these practices. In fact I think the government should pull back (though not withdraw entirely) from interfering with how people alter consciousness. So I don’t think we should “forbid” Tess from alleviating her suffering, even if she becomes less committed to helping others as a result. But the fact that we shouldn’t impose our own choices on Tess doesn’t mean we shouldn’t be concerned about the consequences of these kinds of practices – for individuals and for society at large.

My point about alcohol vs. caffeine and book-reading wasn’t that we should criminalize antidepressant use. I was just responding to your suggestion that since we already modify consciousness in many different ways there’s no basis for distinguishing antidepressant use from other interventions. In fact we routinely distinguish among various ways of altering consciousness based on assessments of their risks – and not merely risks of harms to third parties. Controlled substances are restricted based in large part on the dangers they pose to users, not to others. Again, I’m not advocating imposing similar legal restrictions (and certainly not criminal penalties) on the kinds of practices discussed in my post. I’m merely arguing that it’s reasonable to be more concerned about these practices than the effects of caffeine or book-reading.

The Tess argument, it seems to me, is an argument for good knowledge up front – “you know, if you take this you may find that your anxiety about your responsibilities fades away but so may your sense of responsibility; are you sure you want to do this? – as well as an argument for (relative) reversibility, which might means drugs or implants versus surgery.

Every time someone takes an action to improve their own, individual life they arguably reduce the pressure to change the societal pressures/world realities that had held them down. Can we forbid them to seek to improve their lives, at least assuming good informed consent and barring clear and negative third party consequences?

We have many concerns and several laws about alcohol use because of its fairly reliable potential to impair judgment. I think some of the concerns about interventions like antidepressants are similarly rooted in their potential to impair judgment, though in a very different way – namely, by decoupling one’s emotional responses from her circumstances. If, for example, an antidepressant caused a parent to feel no grief at the loss of her child, I think that would be troubling – and qualitatively different from the kind of effect you’d get from a good book, caffeine, or even alcohol.

Peter Kramer describes the experience of one of his patients, “Tess,” on antidepressants. Part of what made Tess miserable was her outsized sense of responsibility to others: “She still cared for her mother, and she kept one foot in the projects, sitting on the school committee, working with the health clinics, investing personal effort in the lives of individuals who mostly would disappoint her.” On Prozac, according to Kramer, Tess’ heightened sense of responsibility waned. She was happier, but something may have been lost in the process. I don’t think you have to condemn Tess (or Kramer) to feel some trepidation about this – particularly when you multiply “diminished concern for others” across the 11% of Americans age 12 or older who take antidepressants (http://www.cdc.gov/nchs/data/databriefs/db76.htm).

Or consider that “[w]omen are 2½ times more likely to be taking an antidepressant than men,” and that nearly 1 in 4 American women in their 40s and 50s take antidepressants (http://www.health.harvard.edu/blog/astounding-increase-in-antidepressant-use-by-americans-201110203624). Maybe that’s because there’s something really wrong with American women’s brains. But it could also be because of societal circumstances that leave women feeling alienated, anxious, or depressed. If it’s the latter, are we better off with medicated women who feel more content with their lot, or alienated women who want their circumstances to change?

Our emotions connect us to the outside world. Unpleasant emotions – like disgust, indignation, or anger in response to injustice – have value. Disconnecting emotions from circumstances can have costs. Some interventions seem to pose more danger of this than others.

That said, while I sympathize with these concerns I don’t think they serve as good bases for legal restrictions. On the contrary, I think we should be getting government out of the business of regulating consciousness – a contention I plan to explore in my next post.

But, of course, is caffeine part of the Penfield Mood Organ, or alcohol, or re-reading Pride and Prejudice (or The Hobbit) again? I know it must get old to have people respond with “spectrum” arguments – you can’t complain about X because we already do A through J – but I do think there needs to be a good argument for why we should only go to P, or to somewhere between N through R.

Thanks for writing this post. I haven’t read Do Androids Dream of Electric Sheep for about 15 years, though I do think it has the best title of any science fiction book; I need to go back and read it again. Should I watch the movie (for the first time)?