Sex and Drugs (and Ethics)

Sex and Drugs (and Ethics) by Pixabay


Shortly before Love Drugs arrived in the post, I had finished reading two bestselling books by non-philosophers that both unsettled and captivated me: Michael Pollan’s How to Change Your Mind which explores the new “psychedelic revolution” that is taking shape within the scientific community; and Esther Perel’s Mating in Captivity which explores the complex interplay (or fundamental mismatch) of sexuality and domesticity. Both books speak to a certain stagnancy that many of us come to take for granted: in the former case, our minds become set in predictable ruts, our thinking becomes dull, and, as Pollan puts it, “the muscles of attention atrophy.” Similarly, in the latter case we may become resigned to what Perel calls “the inescapable death of eros.”

As someone like Slavoj Žižek loves telling us in his own inimitable way, we have never been freer sexually yet at the same time we have never found sex so dull. Love Drugs thus arrived at the perfect time, offering, as you might expect from two highly respected bioethicists, a compelling and provocative yet balanced and rigorously argued overview of the existing and emerging medical technologies that “act on the brain’s lust, attraction, and attachment systems, whether to strengthen a good relationship or help a bad one to end.” ​ The idea of drugs that intervene in our love lives sounds like a really bad one, the kind of sinister-sounding idea that is likely to generate an instinctive sense of horror or despair in anticipation of yet another aspect of our lives coming under the medical gaze, of new love-related mental disorders being manufactured by drug companies and added to the already comically expanding catalogue of disorders in the Diagnostic and Statistical Manual (DSM), of a virulent form of bio-reductionism that reduces the complexities of love to neuronal firings in a particular part of the brain, and so on. Earp and Savulescu (E&S from now on) would agree with these kinds of worries, and indeed in the conclusion to the book they write: Do we really need more drugs? We actually think the answer is no. What we need are changes to society: political action that puts human welfare ahead of special interests; resources to help people make good choices about forming and maintaining close relationships; less stress, and more time with friends and family. This, then, is not a sequel to the psychiatrist Peter Kramer’s highly influential mid-90s book Listening to Prozac, a wildly overblown defence of “cosmetic psychopharmacology” in which anti-depressant medication was praised as a drug that could make people feel “better than well”; rather, E&S start from the fact that “the horse has bolted”, i.e. love drugs are no longer speculations of science-fiction writers like Aldous Huxley. They are already with us, and we need to carefully consider the ethical implications of where this may take us.

Anti-depressants, and specifically the kind of anti-depressants of which Prozac is a well-known brand – the selective serotonin reuptake inhibitors (SSRIs) – play a central role in E&S’s narrative. Following the early euphoria captured in Kramer’s book, the next 20 years have not been so kind to the SSRIs, with numerous studies emerging questioning their efficacy and exploring their harmful side effects. For E&S, SSRIs are a classic example of a love drug that is already with us, for it is widely acknowledged to have a significant negative impact on libido. That this side effect has not been a major talking point up to now is, E&S argue, a result of a “blind spot in Western medicine: the tendency to ignore the interpersonal effect of drug-based interventions”. How, they ask, “can scientific research norms be overhauled to take relationships into account?”

As an example of an ethical conundrum raised by this common side effect, they consider the case of usage of SSRIs with Orthodox Jewish yeshiva students to undermine behaviours like masturbation or sexual orientations like homosexuality that are in conflict with the community’s values. The ethical conundrum deepens when we consider that the students are actually feeling depressed about the mismatch between their biology and their religious beliefs, and are voluntarily seeking to alleviate this profound distress. The prescription of SSRIs would thus function to alleviate the depression by reducing the libidinal impulses (the normal sought effect thus becomes the side effect!). And yet, as E&S comment, “while prescribing the drug might very well help an individual in the here and now suffer less severely, the norm reinforcement might disadvantage future generations of sexual minorities in the same community.” As is a pervasive feature of their analysis which is rooted in the axiom that “practical ethics is all about context and details”, E&S admit that there is “no easy way out of this bind”. Given that so many of the conversations surrounding love drugs will tend to polarise around progressive vs. conservative, as well as religious vs. secular orientations, these debates can never, as E&S conclude, “be resolved in an academic vacuum.”

One of the most exciting discussions within the book relates to the emergence of (currently illegal) drugs like psilocybin (extracted from “magic” mushrooms) and MDMA (better known as the club drug Ecstasy) within the relationship domain. Both are increasingly gaining recognition as having significant efficacy across a wide range of clinical interventions, e.g. in relation to PTSD and depression. For E&S, their efficacy in non-clinical settings, e.g. couples counselling, is also beginning to be acknowledged. E&S focus especially on MDMA, citing evidence that use of MDMA in therapy benefits couples in terms of their ability to move beyond past pains and grudges, thus “basing their relationships much more on love and trust than on fear and suspicion”.

Picture of MDMA Molecule

While MDMA seems to work to bring couples together by allowing them to open up more deeply to each other, in fact its role is more ambiguous as it may be also useful in allowing couples to realize that they are in fact not suited to each other. E&S quote the psychiatrist Ben Sessa: “MDMA provides an opportunity for self-reflection, which is an enlightening experience, which you can then use to either leave a relationship or bolster a relationship.” Similarly, if, as is hypothesized, psilocybin is a “mind-expanding” drug, one of its functions may be to help couples work out whether they are actually suited to each other, i.e. it helps them to push past all the daily rationalizations and justifications and fears that may keep couples in relationships that are not actually suitable. An example in the Pollan book mentioned earlier brings this home, as one of the participants in an experiment using psilocybin said that the experience had brought home to her that she and her husband were very different people. She said: “Everything was now so clear to me.” As Pollan puts it, she “broke the news to him in the car going home [from the experiment] and has not looked back.”

E&S discuss both love drugs and anti-love drugs. We can see how psilocybin worked in the example above to bring an end to a relationship that was not fulfilling; in this sense, it serves as an anti-love drug. However, this is a very mild case. Imagine, by contrast, how this kind of insight could be especially useful in those widely reported cases where a woman continues to stay with her partner despite the relationship being abusive. As E&S put it, she has “a rational second-order desire to leave [the relationship], but her more visceral feeling of romantic attachment is standing in the way... She is in conflict with herself, and she wants a resolution.” Anti-love drugs thus work by “fast-tracking” a relationship breakup, allowing people to avoid unnecessarily protracted suffering and to move on with their lives.

Again, E&S are acutely sensitive to the kind of ethical dilemmas raised by such a scenario, exploring the contrasting views of “bio-conservatives” and “bio-liberals” in relation to this kind of scenario. This builds upon a long history of philosophical and theological debate over perceived value of suffering. In an interview, the playwright Arthur Miller defends the value of suffering in relation to what he sees as the devaluing of suffering in psychoanalysis:

My argument with so much of psychoanalysis is the preconception that suffering is a mistake, or a sign of weakness, or a sign even of illness, when in fact, possibly the greatest truths we know have come out of people’s suffering; that the problem is not to undo suffering or to wipe it off the face of the earth but to make it inform our lives, instead of trying to cure ourselves of it constantly and avoid it.

It has been widely argued that our relationship to suffering has profoundly changed in the modern West. Deprived of religious and, increasingly, existential or moral narratives within which to ground the experience, suffering has lost any value, any sense of new perspectives or insights to be gained from it. Suffering has become meaningless and its relief regarded as meaningful and good. The psychotherapist James Davies refers to the “rationalization of suffering” as “the process by which human discontent has increasingly become less a matter for spiritual, moral, or philosophical consideration, than for biological, behavioural, political, or psychiatric understanding and intervention”.

In the context of grief, Loretta Kopelman argues that “the good of uncomplicated grief generally outweighs the bad when we consider its meaning in the life of individuals”, and that “grief makes us into different individuals” and is “a necessary concomitant of many things that contribute to a good life, including empathy, family, and a sense of community”. For Kopelman, the evils of “pain, loss of wellbeing, increased morbidity and mortality, and decreased function” are more than cancelled out by the goodness associated with it, such as its adaptive qualities, its meaning in the life of a person, as well as the negative aspects associated with avoidance and anesthetizing of grief.

​E&S outline these same kinds of arguments in relation to the possibility of diminishing certain harmful forms of love or attachment via biochemical means. The bio-conservative will tend to take the position that, “With suffering comes understanding”, while the bio-liberal will tend to counter that position by noting that, “Sometimes suffering is just suffering.” On the side of the bio-conservative we can find a range of defenses of the value of suffering from across human history: The Christian myth is that suffering is part of God’s plan for humanity; Stoics and Buddhists maintain an indifference to suffering as something morally irrelevant; Nietzsche held that suffering ennobles the human spirit and makes possible human advancement; Heidegger held that suffering could pull you out of the everyday and towards greater authenticity. A more contemporary take on the bio-conservative position is captured in an especially uncompromising way by Heidegger’s pupil Hans-Georg Gadamer: “Is there not a terrifying challenge involved in the fact that through psychiatric drugs doctors are able not only to eliminate and deaden various organic disturbances, but also to take away from a person their own deepest distress and confusion?”

To counter these rather lofty visions of the value inherent in suffering, E&S quote the bioethicist Erik Parens who suggests that: “We should be slower to imagine that suffering leads to growth and understanding, and quicker to remember that sometimes it just crushes human souls.” Again, E&S lay out the terrain of the argument extremely clearly before offering what seems like the only reasonable liberal conclusion: “No universal line can be drawn in the sands of human suffering. People do have to decide for themselves.”

There is so much more I would like to highlight and discuss about this nuanced and sophisticated exploration of a rapidly advancing field of study – for example, the extremely thorough analysis of what we actually mean by “love” built around its “dual nature” as both a biological and a socio-cultural phenomenon, the fascinating overview of the extraordinary diversity of ways in which love can take shape and flourish as well as the fragilities that have emerged in the infrastructures sustaining modern relationships, and the subtle explorations of the role of medicalization in our lives – but I was asked to keep the review fairly short. So, I’ll end by noting how refreshing it is to read philosophy that is so engaged with real world matters. At times, E&S almost read like “agony uncles”:

Book Love Drugs by Brian D. Earp & Julian Savulescu

But suppose you’ve gone over all this a million times. You’ve considered every scenario, and you still aren’t sure whether to make that big change, whether it’s taking a relationship-enhancing drug (assuming that becomes legal) or ending your long-term relationship. If that describes your situation, we have some advice. Go for it. Make the change. You will probably be happier for it in the long run. ​ Perhaps I shouldn’t be surprised that bio-ethicists are so deeply enmeshed in the intricacies of our daily lives, but nonetheless there is an energy and passion in the writing here that sets it aside from 99% of the philosophy that I have read in the past year. I applaud Earp and Savulescu for their ambition, and hope that the book generates the kinds of debates that its highly controversial subject matter clearly deserves. ​ Elizabeth Robson is a writer and translator based in Paris. She is a regular contributor to The Philosopher.


From The Philosopher, vol. 108, no. 1 ('The Other Animals'). Read more articles from The Philosopher, purchase this issue or become a subscriber.