Psychopharmacological enhancement: a conceptual framework

Although psychotropics have been used for medicinal, recreational, and spiritual purposes since the dawn of humanity, the science of psychopharmacology is a relatively new one. In recent decades, however, there have been significant advances in understanding brain-mind structures and mechanisms, and a range of novel psychotropics have come to market. The availability of these agents raises the possibility that they will be used for enhancement purposes; that "smart pills" will be used to promote learning and clarify thinking, "happy pills" to increase mood and improve temperament, and "pep pills" to increase energy and maximize motivation.The debate on so-called cosmetic psychopharmacology pits pharmacological Calvinism (which emphasizes the negative aspects of having a pill for every ill) against psychotropic utopianism (which underscore the positive aspects of enhancements). This debate immediately raises key questions in philosophy of medicine and psychiatry - in particular, what is a medical disorder, and what is a psychiatric disorder? These questions in turn raise fundament issues in philosophy of language, science, and ethics. In this paper, a naturalistic conceptual framework is proposed for addressing these issues and cosmetic psychopharmacology. This framework begins by contrasting classical and critical concepts of categories, and then puts forward an integrative position that is based on cognitive-affective research.Before outlining this approach, however, let us consider 3 patient vignettes:？ Adam (aged 20) has severe social anxiety disorder with comorbid depression. As a child he had selective mutism, and had to repeat a year of schooling. Major depression began in adolescence. Social anxiety has meant that he was unable to go to college, or seek work. He has been in several psychotherapies, without clear effect. Treatment with an antidepressant has not yet been attempted.？ Beth (aged 24) has felt uncomfortable in social situations since adolescence. S