Tuesday, March 22, 2011

Happiness and Mood Enhancement

This week in one of my courses ("Science and Justice") we discussed chapter 5 of the President's Council of Bioethics Report on Beyond Therapy, which is the chapter titled "Happy Souls". We had a very fruitful and interesting discussion concerning the issues that arise with mood enhancements and I wanted to note some of these points here.

To think rationally and clearly about the regulation of new potential technologies (especially biotechnologies), I think it is most helpful to start by considering our attitudes towards existing interventions. This can help us better appreciate the complexity of issues and diverse stakes that might arise with new, currently speculative, interventions.

So let us begin with some reflections on existing mood enhancers. Take for example, caffeine. Caffeine is the most widely consumed stimulant in the world. It is estimated that caffeine is consumed daily by 90% of all adults in the US. Why do so many people consume caffeine? Caffeine can alter our mood- it can make you feel more awake, calm and attentive. Of course it really depends on the dosage of caffeine you consume. Two cups of coffee a day is fine. But if you are drinking more than 4 cups of coffee a day there are some potential adverse consequences. Too much caffeine can cause nervousness, anxiety and sleeplessness. Furthermore, people can suffer withdrawal if they don't get their daily caffeine fix, and this could to headaches, etc.

So the case of caffeine is interesting because it is a stimulant that we not only permit, but most consume daily even though there are some health risks and it is addictive. We can then move on to other drugs that can modulate mood (reducing stress, increasing sociability, etc.), such as alcohol and smoking. These interventions can have very serious health risks (e.g. drinking and driving, lung cancer, etc.). Both are legal, though they are regulated (e.g. drinking and smoking have age requirements, there are regulations about where they can be sold, etc.).

Every day people drink coffee, tea, pop, and alcohol for their mood enhancing benefits. But we can push the example even further, as there are many different types of interventions that enhance mood. Listening to music, for example, can relax you, help motivate you to exercise, or create a romantic setting. Fine food and chocolate can trigger the reward centres of the brain. So can sex, exercise, sleep and gossip. Meditation, yoga and religion can all help reduce stress and anxiety and they alter the biochemistry of one's brain.

When we reflect on the vast array of mood enhancing interventions we could, and do, pursue on a daily basis we ought to realize that there is a strong presumption in favour of things that promote subjective wellbeing. There are of course provisos and caveats to be added. Drinking a glass of wine after work can be good for both mind and body, but drinking a bottle of wine every night would be harmful. So one must get the dosage correct, which can be tricky if the substance is addictive. The same concerns apply for caffeine and even sex and exercise. These interventions can be addictive, and if consumed or pursued too much they can compromise our opportunity to flourish.

But these provisos and conditions are often discarded when people start to think about the development of a new intervention like a happiness pill. Suppose a drug was developed that could make "normal people" (i.e. those not suffering any mental illness, such as depression) more happy. Would this be a good thing? Would you take such a drug?

Of course our first reaction would be a concern about side effects: could this drug be, in the long run, harmful (e.g. by increasing our risk of cancer or mental illness)? Could this drug be addictive? These are very legitimate concerns.

But suppose the empirical evidence suggested that these concerns were not very pressing with this new drug. That is, the evidence suggested that, if taken in the proper stipulated doses- just like caffeine, alcohol, sex and exercise- this drug would be reasonably safe, just as safe as these other drugs and activities. Bear in mind that (unprotected) sex has potentially harmful consequences (the transmission of STDs, unwanted pregnancies, etc.). And even exercise has risks of injury and death: every single day there are people who sprain ankles, pull a muscle, crash their bikes (resulting in very serious injury, even death) while exercising. So none of these "mood enhancing" interventions are 100% safe.

So the first bias we must overcome, when contemplating new mood enhancing technologies, is one that imposes a much higher safety threshold for such technologies. We can overcome this bias by rationally reflecting on the harms of existing mood enhancements.

Here is a useful thought experiment to help us overcome our bias in thinking about both safety and equal access to mood enhancers. Imagine music had never been invented (I know this is a real strength to imagine, but it is just an imaginary thought experiment). Some innovative scientists experimenting with sound created the first musical instrument- a drum. They found that playing the drum had a mood enhancing benefit. It was enjoyable to play the drum, but there was also a calming and "spirit-lifting" effect on those that heard the drum.

So the scientists were very excited about their discovery. However, there were some problems. Firstly, they discovered that, if played too loudly, the drum could cause hearing problems. Indeed, after 10 continuous days of enthusiasticly playing the drum the lead scientist suffered some temporary hearing loss. And there are concerns that permanent hearing damage could occur if the drum was played excessively.

Secondly, the scientists worry about how unfair it might be if only a few people would likely enjoy the benefits of this music. Only 3 drums had been created to date, and as they are expensive (few people have the expertise to design these new instruments) it was unlikely that everyone in society would be able to enjoy equal access to this new mood enhancer.

In light of these health concerns and concerns of unequal access, these pioneering music scientists decide to abandon their research. And so humanity never realizes the joys of music.

Such an outcome would of course be a tragedy. Music is one of life's most enjoyable things. Yes it can be harmful. Yes there is some inequality in the opportunities to enjoy it (some don't have as much time as others to listen to music, some don't have the income to regularly attend concerts, buy new CDs, MP3 players, etc.). But to forfeit the benefits of music because of these concerns would be an unwise decision. The proper course of action would be to (a) safely regulate music consumption (education about the possibility of hearing damage, limits on how loud concerts and MP3 players can go, etc.) and (b) pursue measures which fairly disperse the benefits of the intervention (exposure children to music in school, public radio, etc.). The mood enhancing benefits of music are just too great to forfeit because of concerns about safely and inequality. Might the same be true of a new mood enhancing drug? It's certainly possible. I say let the evidence, rather than our intuitions, decide the matter. Why should we presume that the most effective mood enhancements have already been discovered? Perhaps something as big as music, or even bigger, will be discovered. We should be open to that possibility, just as we should be open to the possibility that love, play, friendship, exercise, a nice dinner, wine and music can enhance our mood.

Now, back to the Beyond Therapy report. The report highlights the dangers inherent in memory dulling drugs (how do we know in advance which memories to dull, the risks of falsifying our understanding of the world, etc.) A key theme emphasized early on in the chapter is the importance of memory for our happiness. At this stage it is appropriate to insert the video below, which is a great lecture on the role of memory in human happiness:

Ok, back to the Report's chapter. A recurring theme is the concern that our pursuit of happiness by "authentic". In many ways this parallels Nozick's objection (p. 42) to Bentham's hedonism. Nozick argued that it is not simply the pleasurable experiences that we desire. We do not want to just "feel" like we are in love, or are reading great poetry, etc., we want to actually do these things. A machine that simulated these experiences would be a false existence that would miss many of the things that actually constitute human welfare.

I do feel the pull of Nozick's example, however I think this kind of objection is problematic when raised as an objection to the development of mood-brightening agents. Why? I can think of two reasons.

Firstly, we do not take this view to current interventions. No one argues that people should deprive themselves of caffeine, love, play or a nice meal so they can "live truly". That is an odd thing to say because part of real life is that there exists possible interventions that can modulate our mood. How do we determine which of these interventions compromise an "authentic" life? I agree Nozick's experience machine is such a case, but I don't think a "happiness" pill necessarily is. And if it is such a case then we ought to say the same about people who are in love, for they are not "living truly"- the person they are in love with really isn't "1 in a million" or a "soul mate". Perhaps the best example is religious belief. Suppose, as is plausible, belief in a personal loving god helps a person cope with the death of a child. They believe that the child's death was part of "god's plan", and that one day they will be reunited with the child in heaven. In such a case this religious belief is a "mood enhancer" for this person. It helps them get out of bed and continue on with life. But it need not be such a dramatic case. What if someone believes in heaven and an afterlife and this improves their mood. When they pray they are more relaxed, less anxious, and feel more happy. Should we take the view that this person is really "living falsely" and that someone ought to sit them down and tell them, for their own good, the truth of the matter (there is no god or afterlife)?

It's an interesting case to consider. If our imagined "happiness" pill simply does to the human brain what religious belief already does in terms of brigthening one's mood, is it a problem to take it? Would one be living any less of an authentic life than the billions of religious people in the world today? [I found it ironic that this chapter of the report was titled "Happy Souls" and yet it placed such a premium on the concern to live truly]

The second problem I have with raising the "living falsely" objection to "mood-brightening agents" is that it assumes the brain we have inherited from our Darwinian legacy, with its particular reward system, is the ideal or the appropriate baseline to invoke when thinking about human happiness. It is not clear to me that this ought to be the case. We constantly try to suppress or curb our brain's natural design. If our brain had its way we would eat all the Halloween chocolate in one sitting. The very concept of "will power" implies that we recognise that our inbuilt instincts and reward systems ought not to be deferred to carte blanche. Our culture (music, art, computer technologies, etc.) modulates our biology. Why select just one potential way of modulating this biology (through mood-enhancing drugs) out for special treatment?

Few things in life are as important as our happiness. So we ought not to dismiss interventions that could increase our wellbeing. Mood-brigthening agents could lead to interventions that dramatically improve the quality of life for humans on this planet.