Our discussions in class have been based around this central issue: “Am I being my authentic self?” This question has come up with the issue of taking Prozac, as some people claim that they are only their authentic selves when they are on medication. It is one thing to take Prozac to blunt the pain of anxiety, to use it to treat depression, and to use it to treat pathology. However, it is another thing entirely when it is used for self-actualization and enhancement purposes. “This is who I am. I feel strong. I feel resilient. I feel confident,” a patient was reported to say.

One aspect of our humanity that is threatened by enhancement is our own agency – our capacity to act freely, make our own choices, through our own efforts, and to consider ourselves worthy of blame or praise for the things we do and the way we are. Instead of being able to take pride of our own efforts, we attribute our successes to the drug. What sort of toll does this begin to take on our self-esteem and sense of self?

Let’s take athletics as an example. As Lance Armstrong demonstrated, it is one thing to win through disciplined training and strength of heart. It is another thing when that heart pumps an unnatural, chemically induced number of red blood cells through the veins in order to achieve superhuman feats of stamina.

What if the same were applied to personality? What if, instead of going through the grueling, soul-searching process of self-esteem building, we instead took Prozac to turn our meekness into self-confidence and assertiveness, to jumpstart our sluggish brains into higher cognition? What happens when we regularly use prescription drugs for “better than normal” purposes? Take, for instance, the hypothetical example of Nancy the neurotic, who has always been high-strung and melancholic regardless of her life circumstances. Her temperament is described as negative and gloomy and she finds her interpersonal and professional life compromised because of her low-grade depression and anxiety. She meditates for this purpose but her moods have gotten so overwhelming that they are interfering with her meditation. Furthermore, she is a Avon saleswoman who believes that Prozac will improve her personality and allow her to become more effective at her job. Does this constitute a cosmetic or clinical use of the drug? According to our diagnostic methods, this is purely cosmetic, but the lines are blurry. Are the definitions of “clinical” and “cosmetic” such a binary or mutually exclusive? Mental health seems like a constant continuum where health will slide easily back into illness and illness will rise back up to health.

A physician who would prescribe Prozac for the purposes of improving Nancy’s personality might be accused of sub-standard care. But what about other conditions that are not medically pressing, such as acne-treatment for prom queens, ketoconazole for dandruff, Botox for aging citizens? Why are these socially acceptable as proper use of medical treatment? What about someone who wants a breast reduction to improve her performance as a distance runner? Her request is not likely to be refused, since most doctors would see the physical and psychological benefits of this “cosmetic” enhancement. And what about the fact that Nancy’s condition interferes with her ability to meditate? This is not a clinical illness, but it is existential suffering – should it be regarded on par with a physical illness and treated with pharmaceuticals? Are cosmoceuticals on their way to becoming FDA-approved?

Ultimately, how does cosmetic psychopharmacology change the goals of medicine? Modern day life favors those who adapt easily, find their bearings quickly, smoothly transition into dynamic, changing environments with minimal effort and stress. Employers like workers who are efficient, think quickly on their feet, and rebound quickly when life throws them curveballs (I might be mixing my sports metaphors there). It has been argued that employers might mandate enhancement drugs for their workers. Other than the health risks involved, what other ethical snafus do you think we’d run into? The jury’s still out.