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III Usage

Using Pharmaceuticals to Change Personality: Self-Transformation, Identity, and Authenticity

David DeGrazia

Francis’ Request

Francis is not ill, even if occasionally troubled, and he is by most accounts doing rather well. Three years ago he landed a good position as a professor of molecular genetics at a well-respected university. In the interim, he has managed to score a few grants, and the publications are coming along at a pace that will very likely earn him tenure. Outside of work, he has several close friends, who marvel at his success in view of his appearance of being lost, distractible, and tangential. In addition to having a good job and some friends, Francis is physically fit, due in no small part to the long walks he regularly takes in the woods near his home, and he enjoys creative writing despite lacking any clear idea of what he might do with the products of this pastime.

Notwithstanding these positive factors in his life, Francis is dissatisfied with the status quo. In most settings—in fact, whenever he is not in the company of good friends, family members, or a few other people with whom he feels at ease—Francis tends to be withdrawn. His introversion makes things socially difficult for him at professional conferences, committee meetings, and sometimes even in one-on-one interactions with colleagues and students; nor does it help that he tends to be a bit dark in his perceptions of people’s behavior and motivations. Although clearly not paranoid in any clinically relevant sense, his friends and family find his social perceptions somewhat cynical, with a tendency to assume the worst rather than giving people the benefit of the doubt. And Francis has become aware of this psychological bias, having noticed that his interpretations are often refuted by follow-up

D. DeGrazia (*)

Department of Bioethics, National Institutes of Health, Bethesda, MD, USA

Department of Philosophy, The George Washington University, Washington, DC, USA e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it ; This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer Science+Business Media B.V. 2017

D. Ho (ed.), Philosophical Issues in Pharmaceutics, Philosophy and Medicine 122, DOI 10.1007/978-94-024-0979-6_11

conversations with people whose intentions he had interpreted darkly or by other sources of corrective information.

Another aspect of his mental life and personality that Francis has begun to question is his enormous “spaciness”: his mind’s relentless tendency to shift from a particular task at hand to free association mode with long, zigzagging mental forays in the theater of his consciousness even as he works, reads, converses, or engages in some other activity that calls for focusing attention. Although, just like his friends, Francis sometimes marvels at how well he has been able to function in professional life, he wants to focus better on tasks at hand. Greater focus would make his work easier and possibly superior in quality. It would also make it easier to keep up with conversations (without coming across as spacey or tangential) and to perform any number of other tasks such as reading boring instruction manuals, learning how to use new software, and organizing his tax return. With this change, he could enjoy his world of free association—so rich and capacious that his erstwhile therapist reframed his “spaciness” as “spaciousness”—on those occasions, such as when hiking or relaxing, when outward focus was not needed.

So Francis wants change. He wants to have a brighter, more optimistic outlook— especially in social settings—and to be more extraverted. He also wants to be able to focus better when a task calls for sustained attention and to have some control over when his mind wanders around the cosmos of his imagination. In effect, Francis wants to change his personality, where “personality” is understood broadly to include not just social presentation but also inner life or psychological “style.” In addition to having this somewhat unusual goal, Francis is clear on the primary means by which he wants to pursue it: pharmaceuticals, specifically a selective serotonin reuptake inhibitor (SSRI) such as Lexapro or Prozac, which has a decent chance of making him sunnier and more socially outgoing, and a stimulant such as Adderall or Focalin, which could help him to maintain focus at will. From his experience with psychotherapy several years ago, Francis knows that many mental health professionals would balk at a patient’s goal of changing his personality through the use of medication. They might recommend instead that he return to therapy and maybe work at home on mental exercises (e.g., meditation) to improve focus. But Francis, who has considerable insight and self-knowledge, doubts that these interventions would have much of the desired effect, and he is attracted to the efficiency with which an SSRI and stimulant might take him to his goal.

Francis approaches the therapist whom he saw years ago, makes his request for an SSRI and a stimulant, and explains the basis of his request including the intention to transform his personality in both its social and “inner life” dimensions. His request presents us with several philosophical and ethical issues. With no pretense of offering a comprehensive discussion of this rich conceptual and moral terrain, the present discussion will zero in on three sets of concerns:

1. Is Francis requesting a medical enhancement, and, if so, does that make the

request morally problematic?

  • 2. Does his plan pose a threat to his identity in a morally problematic way?
  • 3. Are Francis’ intentions inauthentic?
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