Health | Science | Drugs
‘Oxford ethicists promote MDMA to combat divorce.’ At least, that’s what a blogger at Dose Nation said we were doing when we first started writing about the chemical enhancement of love and relationships. The blogger was referring to an interview we’d done with The Atlantic, where we argued that certain psychoactive substances, including MDMA—the key ingredient in the party drug Ecstasy—might help some couples improve their connection if used in the right way.
The truth is, we were not promoting the use of MDMA outright. We were calling for research into this possibility while exploring its ethical implications for individuals and society. The same aim, bolstered by the latest data and insights from the cutting edge of bioethics, applies to the book in your hands.
This time our call for research is more urgent. MDMA, along with psychedelic drugs like psilocybin (from ‘magic’ mushrooms) and even lysergic acid diethylamide (LSD), are moving quickly into the center of mainstream medicine. Receptive pieces by hard-nosed journalists and science writers are coming out almost daily. In the New York Times alone, there have been articles on the ‘Promise of Ecstasy for PTSD’, the benefits of ‘Magic Mushrooms’ for depression in cancer patients, and the potential of LSD as a treatment for alcoholism and anxiety.
Ten years ago such coverage would have been confined to fringe sources. But now with a stream of smaller studies practically flowing out of labs at Imperial College London, Johns Hopkins and other major institutions, things are starting to change. Phrases like ‘paradigm shift’ are beginning to creep into the titles of research reviews on the science of drug-assisted psychotherapy.
Chemicals can control our romantic lives. Relationships are already being influenced by pills we take for other purposes, such as antidepressants, whether prescribed by doctors or illicitly administered. Psychoactive substances might soon be used to encourage affection and help couples work through relationship difficulties, breakups and feelings of rejection. Armed with anecdotal evidence and case-studies, this book offers insights into cutting-edge research into the chemistry of emotion and explores the ethical case for research into “love drugs” and “anti-love drugs”
Our Atlantic interview came out in 2013. This was two years after the first pilot study on MDMA for post-traumatic stress disorder (PTSD) made its way to publication. PTSD is an often disabling condition that can develop in response to violence, including exposure to killing and bloodshed in warzones. It has been a widespread problem in the military for decades, reaching ‘epidemic-level heights’ with the wars in Iraq and Afghanistan. As the Washington Post reports, between 11 and 20 percent of soldiers in these wars suffer from PTSD, which has ‘ravaged lives and broken up marriages’.
C. J. Hardin is one of the soldiers who has benefited from MDMA-assisted therapy. After three tours in Iraq and Afghanistan, he was numb from the stress and violence. Then his marriage fell apart. Depressed and alone, he retreated to a backwoods cabin in North Carolina. He turned to alcohol to drown his pain. He considered suicide. He tried every available treatment for PTSD, from group therapy to nearly a dozen medications.
‘Nothing worked for me, so I put aside the idea that I could get better,’ he told a reporter. ‘I just pretty much became a hermit in my cabin and never went out.’ But MDMA-assisted therapy, he says, ‘changed my life. It allowed me to see my trauma without fear or hesitation and finally process things and move forward.’
C.J. says he saw ‘a profound difference’ in his symptoms after the very first treatment. After three sessions of therapy, ‘my score on the Clinician-Administered PTSD Scale went from 87 to 7 and I no longer qualified for a diagnosis of PTSD.’
‘We can sometimes see this kind of remarkable improvement in traditional psychotherapy, but it can take years, if it happens at all,’ said Dr. Michael C. Mithoefer, the psychiatrist who conducted the early trials, in an interview. ‘We think it works as a catalyst that speeds the natural healing process.’
What about C.J.’s relationship? By the time he got his life back, it was too late for his marriage. There is no way of knowing how things might have gone if he’d found an effective treatment earlier. Maybe his marriage needed to end. Maybe it could have been saved and gone on to blossom. The only way to answer such questions is to ask them in advance.
Love, drugs, and marriage
‘How LSD Saved One Woman’s Marriage.’ That’s a headline from the New York Times. The reference is to a self-experiment with the drug colloquially known as acid by novelist Ayelet Waldman, as recounted in her memoir, A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage and My Life. Microdosing refers to a practice now popular among Silicon Valley types of taking a tenth or so of a regular dose of a psychedelic substance on a somewhat consistent basis (say, every few days). The effects are supposed to be subperceptual: not enough to cause a full-blown trip but enough to feel ‘sparkly’, as one writer put it. And enough, apparently, to bring a troubled relationship back from the brink.
‘I was suffering,’ Waldman writes. ‘Worse, I was making the people around me suffer. I was in pain, and I was desperate and it suddenly seemed like I had nothing to lose.’ The way Waldman describes herself and her behaviour before her microdosing experiment is not flattering. She would frequently pick fights with her husband for no apparent reason, and then berate herself for having done it. Her frustration would then compel her to lash out again, making her even more despondent—‘my shame spiral screwing a hole right through our relationship’. Once she started microdosing every third day, she says, she found herself becoming a better listener, calmer and more content, less prone to conflict, more productive, less irritable, more flexible, more affectionate, and more mindful. Not surprisingly, all of this was positive for her marriage.
Brian Earp is Associate Director of the Yale-Hastings Program in Ethics and Health Policy at Yale University and The Hastings Center, and a Research Fellow in the Uehiro Centre for Practical Ethics at Oxford University. His work is cross-disciplinary, following training in philosophy, cognitive science, psychology, history and sociology of science and medicine, and ethics
Julian Savulescu is a philosopher researching the ethics of new and emerging technologies, including new methods of reproduction and enhancement of physical and cognitive performance through drugs and genetic manipulation. He is director of the Uehiro Centre for Practical Ethics at Oxford University, and is or has been a co-director on many large research projects, looking at topics from geo-engineering to vaccines
Waldman had a good experience. But there is reason for scepticism when you are dealing with a single account. Not only can microdosing land you in jail (it’s illegal), but there are currently no good scientific data on the benefits and risks of this habit, or even how it differs from a sugar-pill placebo. Anecdotes are not enough. What we need is careful research: the empirical kind associated with lab coats and clinical trials but also ethical and sociological studies to make sense of the moral and cultural dimensions of drug-enhanced modes of living and being.
Drug-assisted breakups may also soon be a possibility. One of us (Brian) received an e-mail from a total stranger, written in an Eastern European language. With the help of Google Translate, Brian got into a back-and-forth with his correspondent, a despondent housewife as it soon became clear. We’ll call her Sofia. Sofia was clearly desperate and seemed to be in a bad situation. She couldn’t live with her husband, she said, because he was oppressive and misogynistic. But she couldn’t leave him either, because despite all that, she loved him—really loved him—and the thought of splitting up made her despair.
Sofia knew she needed to get out of the relationship, but her heart kept saying no. So she reached out to us for a remedy, some kind of ‘cure for love’, as she put it, that would vanquish her feelings of attachment to her spouse. Freed from the bonds of a love gone bad, she might then try to start her life over with someone else. She was requesting what we call in our work an ‘anti-love drug’.
Suppose Sofia took such a drug. Could it really make her fall out of love? Partly, this depends on how the drug would work. But it also depends on a deeper, philosophical question: namely, what it actually means to be in love (much less fall out of it). Some would argue that Sofia couldn’t have been experiencing real love, because she was in an oppressive relationship. This is a normative definition of love: it says that the very concept should be reserved for relationships that are essentially positive, good, or healthy. Since love is a highly valued phenomenon, this perspective goes, we should take a moral stand on what sorts of things get to count as love in the first place.
It’s a compelling argument. We have no problem with people who want to use ‘love’ in this restricted way. But it’s a risky argument as well. Once we start defining for other people what love is, we can slip into a narrow-minded and paternalistic way of thinking that discounts their lived experiences. This is not just an academic concern. Only a few decades ago it was commonly held that love between same-sex partners was a conceptual impossibility, a mistake in thought and language, since real love could only occur between a man and a woman. For a depressing illustration of this attitude, look up the YouTube video ‘Christopher Hitchens vs. Bill Donohue’. Then listen to the incredulous groaning and laughter from the audience when Hitchens makes the claim that homosexuality can be a form of love. That debate took place in 2000 in New York City. Not so long ago, and not in some far-off kingdom.
The point is that normative definitions of love often favour the group in power, and their perspective is not always justified—even if they have good intentions. The tendency to ‘medicalize’ love and say that it only really counts if it’s ‘healthy’ may be an example of this. An alternative approach, which is broadly the one we take in this book, would be to opt for a more neutral or descriptive route, giving wide berth to individuals to feel and conceive of love in their own way. When we are talking about people’s romantic experiences, then, we will mostly avoid couching them in thick theoretical terms or trying to show how they link up to the latest philosophical account of love. That is, we’ll often use the word ‘love’ in an informal way and let you fill in the relevant sense according to the context and your own intuitions. And in a similar vein, when we tell you stories about individuals who claim to be in love, we will let them speak for themselves and try to take them at their word.
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