The Medicalization of Love

Neuroethics Now

Neuroethics Now welcomes articles addressing the ethical application

https://doi.org/10.1017/S0963180114000206 of neuroscience in research and patient care, as well as its impact on . . society.

BRIAN D. EARP , ANDERS SANDBERG , and JULIAN SAVULESCU https://www.cambridge.org/core/terms Abstract: Pharmaceuticals or other emerging technologies could be used to enhance (or diminish) feelings of lust, attraction, and attachment in adult romantic partnerships. Although such interventions could conceivably be used to promote individual (and couple) well-being, their widespread development and/or adoption might lead to the ‘medicalization’ of human love and heartache—for some, a source of a serious concern. In this essay, we argue that the medicalization of love need not necessarily be problematic, on balance, but could plausibly be expected to have either good or bad consequences depending upon how it unfolds. By anticipating some of the speciﬁ c ways in which these technologies could yield unwanted outcomes, bioethicists and others can help to direct the course of love’s medicalization—should it happen to occur—more toward the ‘good’ side than the ‘bad.’

Keywords: medicalization ; love ; love drugs ; neuroenhancement ; marriage ; ethics

. . . Do not all charms ﬂ y

, subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , At the mere touch of cold philosophy? There was an awful rainbow once in heaven: We know her woof, her texture; she is given In the dull catalogue of common things. Philosophy will clip an Angel’s wings, Conquer all mysteries by rule and line,

02 Oct 2021 at 14:56:39 at 2021 Oct 02 Empty the haunted air, and gnomed mine—

Unweave a rainbow, as it erewhile made , on on , The tender-person’d Lamia melt into a shade.

John Keats, Lamia (1820) 170.106.35.93 Introduction accounts, the biological building blocks 1

Scientists have begun to unravel some of love. The neurobiologist Larry . IP address: address: IP . of the neurochemical and other brain- Young, for example, has characterized level factors that underlie human lust, romantic love as “an emergent property attraction, and attachment—on some of a cocktail of ancient neuropeptides

Thanks are due to Marion Godman, Andrew Buskell, Alessa Colaianni, Tomi Kushner, and members of the HPS Philosophy Workshop at the University of Cambridge for helpful feedback on earlier drafts of this

manuscript. Please note that this work was supported in part by a Wellcome Trust grant, #086041/Z/08/Z. https://www.cambridge.org/core Cambridge Quarterly of Healthcare Ethics (2015), 24 , 323–336 . © Cambridge University Press 2015. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

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and neurotransmitters,” leading him to seem to regulate our interpersonal drives speculate that drugs “that manipulate and emotions, including the formation [our] brain systems at whim to enhance of romantic pair-bonds. Although love or diminish our love for one another is not simply reducible to these brain 2

https://doi.org/10.1017/S0963180114000206 may not be far away.” More recent chemicals or pathways—and although . . research suggests that such drugs—at there are many different theories of love, least in a nascent form—may already including how it should be defi ned— be partly available,3 , 4 and future versions what is clear by now is that these under- may be even more potent. 5 Granting, lying phenomena do much to shape (as then, that pharmaceuticals and other well as to respond to) our higher-level emerging technologies could be used romantic experiences, across a wide to “enhance” or “diminish” our love- range of theoretical conceptions. related drives, emotions, and attach- What scientists are now beginning ments, could such manipulations ever to discover is that these brain systems https://www.cambridge.org/core/terms be justifi ed? can be infl uenced, certainly in animal Over a series of recent papers, we models, and at least to some degree in have argued that they could—at least humans as well, by administering or for some individuals and some couples, blocking the relevant chemical com- under certain types of conditions. 6 , 7 , 8 , 9 , 10 pounds. For example, by administer- Although several commentators agreed ing a dose of oxytocin—by injecting it with our reasoning concerning the spe- directly into the brain—scientists can cifi c set of cases we explored11 , 12 , 13 , 14 , 15 — induce a pair-bond in a certain spe- including both enhancing and cies of vole, even if the voles have not diminishing interventions16 —some also yet engaged in any mating behavior.26 cautioned that the wider social conse- They can also reverse this process, quences of developing love-affecting by administering an oxytocin blocker: technologies would have to be consid- voles that would otherwise have formed 17 , 18 , 19 , 20

, subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , ered as well. Some of these poten- a monogamous attachment fail to do tial consequences have been addressed so and express interest in novel sexual elsewhere, 21 but others remain to be partners. 27 Similarly, in humans, syn- analyzed. In the present article, we con- thetic oxytocin can be administered as sider an objection that has not yet a simple nasal spray (and seems to received signiﬁ cant attention, namely strengthen attachment-related represen- 02 Oct 2021 at 14:56:39 at 2021 Oct 02 that the development or the use of such tations as well as romantic bonding , on on , technologies would lead to the ‘medical- cues), 28 while the modulation of other ization’ of human love and heartache. neurochemicals can interfere with rela- Before we turn to this objection, we tionship attachments, for example, by

170.106.35.93 need to describe what kind of technol- diminishing the sex drive.29 The ques- ogy we have in mind for this analysis. tion raised by these kinds of ﬁ ndings More thorough discussions of the neu- is whether we could (or should) attempt

. IP address: address: IP . roscience involved can be found in to harness such information in order earlier papers,22 , 23 , 24 , 25 but the basic to pursue a research program into the principle is as follows. Underlying neuromodulation of human love and human romantic attachment is a collec- relationships. tion of interlocking brain systems that are hypothesized to have evolved to suit The Objection the reproductive needs of our ances- tors. Brain chemicals such as oxytocin, One reason to think that we should not https://www.cambridge.org/core dopamine, testosterone, and many others pursue such a program is that it might

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lead to love’s medicalization. ‘Medical- argument), we note that there exists a ization’ has been defi ned by Joseph E. substantial amount of evidence that Davis as “the process by which medical human love and relationships are already defi nitions and practices are applied to deeply implicated in such uncontrover- https://doi.org/10.1017/S0963180114000206 sially ‘medical’ phenomena as physical . . behaviors, psychological phenomena, and somatic experiences not previously health and longevity. 37 Positive interper- within the conceptual or therapeutic sonal relationships yield a wide array of scope of medicine.” 30 The concern that medical benefi ts including improved such a process might spread to the case coping with major illnesses 38 ; indeed, of love has been raised by the sociolo- the “infl uence of social relationships on gist John Evans: the risk of death [is] comparable with [or even exceeds] well-established risk fac- [Many people have] reached the nor- tors for mortality” such as smoking, mative conclusion that they do not drinking, lack of exercise, and obesity. 39 https://www.cambridge.org/core/terms want to live in a world where increas- By contrast, relationship dysfunction ing swaths of human experience are and loneliness are damaging to health under the logic of medicine. There are, and well-being and can lead to such or should be, experiences that use an outcomes as illness, depression, and older logic, which are under the juris- infl amed immune responses of the type diction of another profession or under that contribute to arthritis and coronary no jurisdiction at all. We can all fear the heart disease. 40 , 41 Hence, as we argued 31 medicalization of love . in a recent paper: “If relationship dysfunction . . . turns out to be at the ‘root’ of Evans portrays love as an outer limit such serious problems as heart disease for the process of medicalization—a or arthritis, then treatment modalities bright red line that simply should not aimed at addressing relationship health be crossed. In other words, although in the fi rst instance would seem to be we might potentially have to tolerate, if 42

, subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , well worth investigating.” not condone, such phenomena as the Of course, relationship ‘treatments’— widespread use of Prozac for the treat- even if warranted—would not need 32 ment of depression (the “medicaliza- to be biochemically based. Most exist- 33 tion of misery” according to some ), or ing therapies are not. 43 Perhaps the 34 even the “invention” of ADHD to worry, then, is not about medicaliza- 02 Oct 2021 at 14:56:39 at 2021 Oct 02 justify the administration of Ritalin in tion per se, but rather about pharma- , on on , obstreperous young boys (see Sami ceuticalization, a related but distinct Timimi’s discussion of the “medicaliza- phenomenon. 44 For, as Parens states: tion of childhood”35 ), critics of medical- “Insofar as relationship difﬁ culties are

170.106.35.93 ization might suggest that we should not a normal human problem, and insofar be prepared to accept the encroach- as marriage counseling is sometimes ment of medicine into matters of the done by people with medical degrees,

. IP address: address: IP . heart. As Eric Parens notes, “At work it seems fair to say that . . . relation- in Evans’s claim is the at-ﬁ rst seem- ship counseling to maintain a marriage ingly obvious assumption that medical- relationship could be [considered] a izing love is bad, full-stop.” 36 No further ‘good’ form of medicalization.” 45 That argument needed. much seems uncontroversial. Our aim in this article—or one of our What about the addition of drugs, aims—is to challenge this basic assump- then? If we are prepared to agree that relation. As a point of departure (although tionship counseling is, or can be, an https://www.cambridge.org/core this will not be the main thrust of our acceptable form of medicalization—and

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that insights gleaned from the ‘scientiﬁ c’ (or perhaps that we should) “all fear the study of factors that promote, or detract medicalization of love.” Peter Conrad from, relationship health and functioning has identiﬁ ed a number of worries about can reasonably be applied in such medicalization that recur throughout the 46 50

https://doi.org/10.1017/S0963180114000206 settings —then it would seem to be literature. These include the following: . . important to determine whether (or to what extent) the additional, adjunctive • Worry 1: The Pathologization of use of a bond-enhancing neurochemical Everything. Medicalization can trans- substance would alter the underlying form ‘ordinary’ human differences moral equation. Such a substance would and experiences into ‘pathologies,’ not work to create love ‘magically,’ of redeﬁ ning what is “normal, expected, course, but it might certainly help it and acceptable in life” through the along by acting on the underlying sub- ever-expanding application of dis- strates of attachment, 47 or by promoting ease categories and labels. 51 https://www.cambridge.org/core/terms more empathic states of mind. 48 Imagine • Worry 2: The Expansion of Medical the following scenario: Social Control. Medicalization can expand the scope of medical sur- John and Lisa are a married couple. veillance and thus medical social They are in a relationship counseling 52 session and are working on their com- control over so-called deviance. It munication. Their counselor, Mary, can also create openings for phar- has shown them research suggesting maceutical companies and other that the neurotransmitter oxytocin— ‘medical entrepreneurs’ to sell us administered via a nasal spray—can drugs we don’t need for diseases decrease levels of stress while simul- we don’t have (or that have been taneously increasing productive simply invented out of whole cloth), communication behaviors in some thereby expanding the power of Big 49 couples. Mary has explained the Pharma to meddle in our lives. 53

, subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , risks and beneﬁ ts of using oxytocin in a well-controlled setting, and John and • Worry 3: The Narrow Focus on Indi- Lisa have undertaken a prescreening viduals Rather Than the Social Context. exercise to ensure that neither of them Medicalization can lead to the “indi- is at serious risk for adverse outcomes. vidualization of social problems,” They both agree that they would like taking resources and attention away 02 Oct 2021 at 14:56:39 at 2021 Oct 02 to improve their communication; they from the wider social and contextual

, on on , are convinced, with good reason, that factors that may be creating the need the addition of oxytocin to their coun- 54 seling regime could be helpful toward for ‘treatment’ in the ﬁ rst place. that end; and they give their (fully This concern has been summarized 170.106.35.93 informed) consent to having Mary by Barbara Wootton: “Always it is administer a dose of oxytocin, at regu- easier to put up a clinic than to pull lar intervals, under her careful and down a slum.”55

. IP address: address: IP . expert guidance. A related worry can be discerned in Is this a scenario to be feared—even at a the work of John Bancroft,56 , 57 Karen larger scale? It is not immediately obvi- Houppert, 58 Leonore Tiefer, 59 Mark ous that it is. It seems, therefore, that Rapley et al., 60 and many others and further work is needed to bring to the can be expressed as follows: surface some of the hidden considerations that might be buttressing this sort • Worry 4: The Narrow Focus on the https://www.cambridge.org/core of perspective—namely, that we can Biological (or Neurochemical) Rather

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Than the Psychological. Medicaliza tion a ‘spiritual’ condition), the medicaliza- can lead to a sort of bio-reductionism, tion of alcohol addiction (formerly ‘devi- favoring molecular-level under- ant drinking’), or the medicalization— standings of phenomena that are and hence treatment—of pain. Parens

https://doi.org/10.1017/S0963180114000206 in reality much more complex. observes that a “blanket condemnation” . . Such reductionism can lead to an of medicalization would fail “to acknowl- undue emphasis on molecular-level edge the respect[s] in which women interventions as well, promoting (and men) use medical technologies to a “view of ourselves as objects gain control over their lives to promote that can be fi xed [rather than] as their own fl ourishing.” 64 In other words: subjects who can be infl uenced by there are “good and bad forms of reasons.”61 medicalization.” Following on from this view, as Matthis A fi nal worry that is sometimes raised Synofzik has forcefully argued, 65 ques- https://www.cambridge.org/core/terms in the context of concerns about tions about the prudent, legitimate use medicalization—and one that follows of psychopharmacological treatments naturally from Worry 4—is that drug- and other forms of medical intervention based treatments (in particular) have cannot be discussed in purely abstract the potential to render inauthentic the terms but rather require a domain- and feelings or behavior of the individuals even case-specifi c analysis. We agree and undergoing the intervention, thereby would like to attempt such an analysis undermining their ‘true’ selves. Hence: for the case of love, beginning with a discussion of the fi rst two worries intro- • Worry 5: The Threat to Authenticity duced above. and the Undermining of the True Self. Medicalization—and pharma- Worries 1 and 2: The Pathologization ceuticalization more specifi cally— of Everything and the Expansion of

, subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , might serve to separate the Medical Social Control individual from un-drug-mediated experiences and hence from how How might these speciﬁ c worries apply they “really are” and how “the to the medicalization of love and roman- world really is.” 62 tic relationships? One way to begin to understand the concern is by recalling 02 Oct 2021 at 14:56:39 at 2021 Oct 02 What these worries seem to indicate is the history of medicalization as applied , on on , that medicalization—and pharmaceuti- to sex and sexual attraction : obviously calization—have the potential to lead love, sex, and relationships are inti- to a number of potentially bad conse- mately intertwined.66 As numerous

170.106.35.93 quences. But they can have good con- critics have noted, the subjugation of sequences as well. The medicalization ‘natural’ sexual variation to the disease of abortion, for instance, which many labels of medicine has led to numerous

. IP address: address: IP . regard as a positive development, was problematic outcomes. Same-sex attrac- responsible for transforming the “end- tion, for example, was regarded as a ing [of] unwanted pregnancy . . . from medical problem by the mainstream a criminal act to a medical one” even profession of mental health as recently though “pregnancy . . . is not a disease.”63 as the 1970s, and misguided attempts There are numerous additional examples at ‘treatment’ and ‘conversion therapy’ of medicalization that one might think are still being carried out in some con- have been on balance beneﬁ cial, such as servative religious communities to this https://www.cambridge.org/core the medicalization of epilepsy (formerly day. 67 Indeed, there are countless other

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examples of ordinary sexual and rela- rampant pathologization of natural tional differences being overtly and differences (whose ‘harmfulness’ may harmfully pathologized throughout the be socially constructed and/or based course of prior centuries. 68 upon ﬂ awed moral thinking)—are not

https://doi.org/10.1017/S0963180114000206 Kristina Gupta has recently warned unavoidable and need not be left . . that restrictive norms about monogamy unchecked. Davis, for example, high- might lead to stigmatization of non- lights the growing leverage of social monogamous relationships, driving movements, grassroots efforts, and some individuals to turn to neurotech- patient advocacy groups that work “to nological interventions to try to conform secure medical recognition for . . . to prevailing expectations. 69 One could condition[s] or [diagnoses]” that are even imagine the invention of various consistent with their own norms and relationship ‘diseases’—perhaps pro- values—as well as de medicalization of moted by pharmaceutical companies in those that are inconsistent with those https://www.cambridge.org/core/terms their hungry pursuit of proﬁ t—ranging values (as illustrated by the case of from ‘commitment phobia’ to ‘adultery homosexuality)—even in the face of proneness syndrome’ to ‘hypoactive love medical resistance. 76 In addition, Gupta disorder.’ One related example from real has outlined several measures that could life is the conspicuous invention of be put in place to diminish the restrictive “hypoactive sexual desire disorder,” 70 normalizing pressures of any future an instance of crude neuroreductionism technologies, including passing certain (see our paper “Neuroreductionism restrictions on the activities of drug com- about Sex and Love” for further panies and making changes to the curri- discussion).71 , 72 cula of medical education programs.77 We agree that these are outcomes to Finally, ethicists, including Synofzik, be feared—or at least regarded with are increasingly arguing for the serious suspicion. But several points permissibility—even prudence—of

, subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , of nuance need to be raised. First, as allowing the administration of psycho- Synofzik has pointed out, the disease- tropic substances on the basis of their oriented focus of medicine seems to ability to improve individuals’ quality be diminishing, rather than increasing, of life—even if there is no particular over time. The older model, which cen- ‘illness’ to diagnose (in the sense of a tered on “objective clinical-pathologic mechanical breakdown of some brain 02 Oct 2021 at 14:56:39 at 2021 Oct 02 indices and favored a paternalistic system, for example). This would fur- , on on , physician-patient relationship” is shift- ther defuse the potential problem of the ing more toward “a new quality of life- pathologization of everything because oriented focus which emphasizes a it would separate treatment (applying

170.106.35.93 patient’s subjective well-being and indi- a medical technology) from pathology vidual life preferences within a coequal (identifying a ‘real’ disease). Such a physician-patient relationship.”73 In paradigm would obviously blur the

. IP address: address: IP . addition, the attempts of pharmaceutical distinction between treatment and companies and the medical-industrial enhancement (or else count the for- complex to conjure diseases out of thin mer as a subclass of the latter), a topic air is being met with increasing public of much debate in the recent litera- skepticism and awareness.74 , 75 ture. For enhancement theorists such This does not mean that opportunities as ourselves—who argue that the goal for abuse do not persist. But it does show in either case should be to improve that the problematic consequences asso- well-being—this would be a welcome https://www.cambridge.org/core ciated with medicalization—including shift. 78 Thus, as we argued recently with

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respect to romantic relationships, “treat- from Jonah Lehrer. 83 It tells of a psychi- ment [paradigms] should hinge on con- atrist who was all too eager to prescribe siderations of harm and well-being, antidepressants to his patients, failing rather than on deﬁ nitions of disease.” 79 to “distinguish between suffering rooted

https://doi.org/10.1017/S0963180114000206 Taking these considerations together, in [their] dysfunctional bodies and . . it seems not only that the old suffering rooted in their minds or social Foucauldian specter of pervasive medi- contexts.”84 The punch line comes when cal surveillance—of oppressive normal- he asks one of his patients how her anti- ization and top-down control—may be depressant medication is working. losing considerable steam, but also that, “It’s working great,” she says. “I feel so with conscious and deliberate effort, much better. But I’m still married to the this trend could be reinforced.80 The same alcoholic son of a bitch. It’s just take-away lesson here is that, as long now he’s tolerable.” as one does not subscribe to a strong Diana Aurenque and Christopher https://www.cambridge.org/core/terms technological determinism, according McDougall have made a similar point to which the mere availability of a given using a slightly different example. technology inevitably produces certain Focusing on a case of domestic abuse in social outcomes (thus making most which the victim’s emotional attach- ethical discussion irrelevant), the solu- ment to her abuser is preventing her tion does not lie in avoiding potentially from leaving the relationship, they argue problematic technologies altogether. that “the fi rst and most obviously justi- Instead, it has to do with attempting fi ed intervention in [this] case is . . . not to anticipate any diffi culties that may to drug [the woman] into unfeeling, but be associated with those technologies to alert the authorities to the violence and then modifying the context (social, and refer her to supportive social and legal, etc.) in which they would most legal services.” 85 Indeed, as Purdy notes, likely be used. administering ‘medicine’ to women in

, subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , oppressive social situations may be no better than putting on a superﬁ cial Worries 3 and 4: The Narrow Focus on Band-Aid and can lead to far worse out- Individuals (and Biology) Rather Than comes overall than would be achieved on Social Context (and Psychology) by changing the conditions in which What about this concern? Conrad has they live. 86 02 Oct 2021 at 14:56:39 at 2021 Oct 02 expressed it well: “Medicalization can These are unquestionably valid obser- , on on , obscure the social forces that inﬂ uence vations. But here too there is room for well-being. For example, by focusing nuance, as Purdy herself points out. completely on the neurobiological fea- “These points imply that women’s

170.106.35.93 tures [of some condition, it may be health will be far better protected by viewed as a genetic or biological prob- political action than by medicalization,” lem], and [thus] treated predominately she writes. However, “does it follow

. IP address: address: IP . with [drugs]—while the social environ- that women’s health . . . should [there- ments that . . . feed [the condition] are fore] be excluded from the medical not altered.” 81 Unfortunately, this “focus realm? Surely not. [For] even in the best on the individual has reinforced the pro- [of] circumstances, a few women would clivity of treating complex societal prob- require all the help that medicine can lems with technological ﬁ xes . . . rather offer, and such help needs to be made than by changing the social structure.” 82 available to them.”87 The key is for societ- The relevance of this concern to rela- ies, including policymakers, to consider https://www.cambridge.org/core tionships can be illustrated by a story medical interventions as complements

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to social change, rather than as replace- Worry 5: The Threat to Authenticity ments for it. As Gupta writes with respect and the Undermining of the True Self to love-altering technologies speciﬁ cally, The ﬁ nal concern is that medicalized individual/structural and biological/

treatments and/or enhancements of https://doi.org/10.1017/S0963180114000206

. . social factors are co-constitutive: ‘love’ might threaten authenticity or self- hood. The President’s Council on Interventions aimed at the individual Bioethics has stated this concern as fol- may be effective and may have rever- berating effects on the broader social lows: “We might succeed in easing . . . issues, and vice versa. I would simply suffering [or ‘improving’ a relation- encourage scholars considering the ship] at the risk of falsifying our per- ethics of biotechnological interven- ception of the world and undermining tions to address problems with an our true identity.”91 With respect to individual and social component to bond-enhancing substances in particu- https://www.cambridge.org/core/terms emphasize the importance of inte- lar, the worry might be that they could grating these individual interventions make someone more approachable, more with social interventions and to con- trusting, or more empathic than she sider how the two might work in tan- ‘really is,’ or even more likely to feel dem to achieve change. Combined love than would otherwise be the case. with efforts to address the social fac- We do not underestimate the impor- tors that contribute to [problematic relationships or forms or states of tance of such concerns. But it is important love] and with measures in place to to think through some of the speciﬁ cs mitigate the normalizing potential of what exactly is being implied. First, of these interventions, [love-altering] it might be pointed out that a person technologies may indeed increase can ‘enhance’ her own romantic chem- human ﬂ ourishing. 88 istry behaviorally—by receiving a massage, engaging in sexual intercourse,

Finally, we should note that—in going on an adventure with her partner, , subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , general—the ‘treatment’ for some con- or attending couple’s therapy. All of these dition need not be determined by its activities release such neurotransmit- primary etiology. To return to the exam- ters as oxytocin and dopamine, albeit ple of depression, as Synofzik points out: endogenously and in a particular “If we alleviate our depressive mood behavioral context. Yet if someone pur-

02 Oct 2021 at 14:56:39 at 2021 Oct 02 by going running, sunbathing or eating sued these activities (sex, massage, etc.)

, on on , a piece of chocolate, we improve a pre- with the explicit aim of improving her dominately psychosocial problem by relationship—by increasing trust, empa- means of a treatment which is not in thy, and interpersonal connection—it

170.106.35.93 a psychosocial, but in a physical and would be difﬁ cult to see how her partly even neurochemical modality. . . . authenticity had been compromised in Thus the modality difference between any obvious way. 92

. IP address: address: IP . etiology and treatment cannot func- That being the case, however, it is tion per se as the normatively deci- not at all clear that the exogenous modiﬁ - sive factor.”89 As we have argued cation of that same brain chemistry— previously, therefore, the modality especially in a similar behavioral context , or the type of intervention does not yet through the use of an oxytocin matter as much from a moral perspec- nasal spray, as in the example of John tive as whether it improves the well- and Lisa—would introduce a special being of the people involved, all things moral problem. Rather, such modiﬁ ca- https://www.cambridge.org/core considered. 90 tion might even promote a person’s

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ability to live her life ‘authentically’ and administration of love drugs would in accordance with her goals and values. in fact pose a threat to authenticity (or As Niklas Juth has written, “In general, whether it would do so for some indi- plans require capacities in order for viduals and couples but not others),

https://doi.org/10.1017/S0963180114000206 them to be put [into] effect and [drug- and, second, it is unclear whether, even . . based treatments may] increase our if it did pose such a threat, this would capacities to do the things we need to entail that it should not be done (under do in order to effectuate our plans.” 93 the right kinds of conditions). Indeed, If the administration of certain ‘love one might wish to consider a more drugs’ turns out to be effective in pro- basic issue, which is to ask what exactly moting states of mind and behavioral the value of authenticity is—and how it dispositions that are conducive to a weighs against other values. Perhaps it healthy relationship, then couples may is authentic for a person to be sad and simply have an additional tool at hand sullen, withdrawn and incommunica- https://www.cambridge.org/core/terms to help them pursue their overriding tive, or cold, unapproachable, and unlov- interpersonal aims. ing. Yet within the hierarchy of values Another concern about authenticity for a particular couple, a happy or well- is that drug-based interventions might functioning relationship may be more introduce psychological or behavioral important than an abstract notion of inconsistencies in the person or couple authenticity. It would seem reasonable being enhanced—possibly interfering to argue that couples should be able to with the sense that it is the ‘same person’ pursue their highest values by whatever (or relationship) through time. This (legal) means they themselves, perhaps does seem like a meaningful worry. in conjunction with the guidance of a However, it is an empirical question trained professional, deem to be most whether such inconsistencies would be appropriate and most effective. 94 introduced, and for many neurochemi-

, subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , cal interventions with which we are Conclusion: Unweaving the already familiar (alcohol, antidepressant Rainbow? medication, etc.), they are not, or do not seem to be, in a reasonably large number Let us summarize our argument thus of cases. If such inconsistencies were far. We have tried to show that the introduced, however, there would still medicalization of love cannot be pro- 02 Oct 2021 at 14:56:39 at 2021 Oct 02 be further questions. To what degree are ductively analyzed in abstract terms, , on on , they introduced? Are they introduced in because medicalization in general can all people who take such drugs, or only be either good or bad, and which one it in some people? Can such differences be is, on balance, depends on a number of

170.106.35.93 predicted? Are the inconsistencies—if speciﬁ c and even idiosyncratic factors. they have been introduced—necessarily These factors, we have suggested, vary bad? And if they are bad, how do they along with the phenomenon (such as

. IP address: address: IP . weigh against the various benefi ts love) in question, the individuals or brought to the relationship or to the groups involved, and the wider social individual’s sense of self along other context. By looking at fi ve particular dimensions? In this context, we should worries—or classes of worry—that per- remember that even our ‘true’ selves— tain to the medicalization of love and and experiences/conceptions of love— relationships, we have argued that cer- can be self-contradictory to some extent. tain bad consequences could reason- Thus there seem to be two main ably be expected to follow, although they https://www.cambridge.org/core issues: fi rst, it is unclear whether the might be softened or even reversed by

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other factors, including by preemptive in the view that love is something that ethical deliberation, as well as by the ‘just happens to us’—when we meet implementation of a number of policy the ‘right’ person, for example—rather measures, such as those that have been than something for which we must take

https://doi.org/10.1017/S0963180114000206 proposed by Gupta. We hope that this

. . personal responsibility, and work on, has been suffi cient at least to cast doubt and try to improve. Many individuals upon the view that “we can all fear the who are delighted to be ‘swept off their medicalization of love” (full stop). feet’ in the early stages of a romantic If it has been suffi cient, then we have relationship are just as devastated, later accomplished our main task; and we on, when such feelings begin to fade, could end the article here. Yet we think seemingly outside of their control. that there may be a deeper worry associ- They might even (mis) attribute their ated with this debate, and that is that the changing feelings to something wrong medicalization of love, or even just the in the partner, or in the relationship, and https://www.cambridge.org/core/terms study of love from a scientifi c perspec- go rushing into a breakup or divorce. But tive, will somehow rob it of its value what if the problem is not in their partner and importance—reducing it to a set of or the relationship, but at least partly mindless chemicals. As Wordsworth in their conception of love? What if to wrote in The Tables Turned , perhaps “Our love is to practice an art, as Fromm meddling intellect / Mis-shapes the argued, that requires conscious effort and beauteous forms of things.” Perhaps we discipline—as well as knowledge, and have to “murder to dissect.”95 One is therefore understanding? What if know- also reminded of Keats, who, according ing how love works, in other words, to a famous biologist’s interpretation, could help us be better at being in love? “believed that Newton had destroyed As the biologist Richard Dawkins all the poetry of the rainbow by reduc- once wrote, in response to Keats’s ing it to the prismatic colours.” 96 lament, “Newton’s unweaving of the

, subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , This view has a certain appeal. Part rainbow led on to spectroscopy, which of the magic of love, it seems, is that it has proved the key to much of what we can be so mysterious and wonderful—it know today about the cosmos. And the can sweep us off our feet, as though by a heart of any poet worthy of the title force outside ourselves. Do we really Romantic could not fail to leap up if he

want to put it under a microscope? All beheld the universe of Einstein, Hubble 02 Oct 2021 at 14:56:39 at 2021 Oct 02

for the sake of ‘health’ or some abstract and Hawking.”98 This observation raises , on on , notion of ‘well-being’? Perhaps we do an interesting possibility concerning the not. But one might also want to ask scientifi c investigation of human rela- whether the value of love resides in tionships. Could there be a similar les- 170.106.35.93 its mysteriousness—in our inability to son for the biochemical unweaving of understand it—or rather more generally romantic love as well? Could it open up in how it acts in our lives. Neither similar poetic vistas? And here is a quote . IP address: address: IP . unpredictability nor ignorance alone from the physicist Richard Feynman, makes something worthwhile, and even whose relevance to this discussion will with a perfect medical understanding of make itself clear: love, we would not be able to predict who we would fall in love with or spe- I have a friend who’s an artist and has cifi cally how the relationship would sometimes taken a view which I don’t play out. agree with very well. He’ll hold up a Moreover, as Erich Fromm has fl ower and say “look how beautiful it https://www.cambridge.org/core argued,97 there may be a hidden danger is,” and I’ll agree. Then he says “I as

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an artist can see how beautiful this is 2. Young LJ . Being human: Love: Neuroscience but you as a scientist take this all reveals all . Nature 2009 ; 457 ( 7226 ): 148 . apart and it becomes a dull thing,” 3. Earp BD , Sandberg A , Savulescu J . Natural and I think that he’s kind of nutty. selection, childrearing, and the ethics of mar-

First of all, the beauty that he sees is riage (and divorce): Building a case for the https://doi.org/10.1017/S0963180114000206

. . neuroenhancement of human relationships . available to other people and to me Philosophy & Technology 2012 ; 25 ( 4 ): 561 –87. too, I believe. Although I may not be 4. Earp BD , Wudarczyk OA , Sandberg A , quite as refi ned aesthetically as he is . . . Savulescu J . If I could just stop loving you: I can appreciate the beauty of a fl ower. Anti-love biotechnology and the ethics of a At the same time, I see much more chemical breakup. The American Journal of about the fl ower than he sees. I could Bioethics 2013 ; 13 ( 11 ): 3 – 17 . imagine the cells in there, the compli- 5. Lynch Z . Neurotechnology and society cated actions inside, which also have (2010–2060) . Annals of the New York Academy of a beauty. I mean it’s not just beauty Sciences 2004 ; 1013 ( 1 ): 229 –33. at this dimension, at one centimeter; 6. Savulescu J , Sandberg A . Neuroenhancement https://www.cambridge.org/core/terms there’s also beauty at smaller dimen- of love and marriage: The chemicals between us . Neuroethics 2008 ; 1 ( 1 ): 31 – 44 . sions, the inner structure, also the 7. Earp BD . Love and other drugs . Philosophy processes. The fact that the colors in Now 2012 ; 91 : 14 – 17 . the fl ower evolved in order to attract 8. Wudarczyk OA , Earp BD , Guastella A , insects to pollinate it is interesting; it Savulescu J . Could intranasal oxytocin be used means that insects can see the color. It to enhance relationships? Research impera- adds a question: does this aesthetic tives, clinical policy, and ethical considerations . sense also exist in the lower forms? Current Opinion in Psychiatry 2013 ; 26 ( 5 ): 474 –84. Why is it aesthetic? All kinds of inter- 9. See note 3, Earp et al. 2012. esting questions which the science 10. See note 4, Earp et al. 2013. knowledge only adds to the excite- 11. Gupta K . Anti-love biotechnologies: Integrating ment, the mystery and the awe of a considerations of the social . The American Journal of Bioethics 2013 ; 13 ( 11 ): 18 – 19 . fl ower. It only adds. I don’t under- 99 12. Enck G . An error theory of biotechnology and stand how it subtracts. the ethics of chemical breakups: It is the rea-

sons, not the pharmaceuticals, that are impor- , subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , What if medicalizing love made it even tant in defending against perilous love . The more beautiful, for some couples, adding American Journal of Bioethics 2013 ; 13 ( 11 ): 32 –4. new questions and types of experiences 13. Marchant GE , Stevens YA . Involuntary expo- for them to explore? Dawkins and sures to love-enhancing or anti-love agents . The American Journal of Bioethics 2013 ; 13 ( 11 ): 26 –7. Feynman certainly give us food for 14. Garasic MD . Anti-love biotechnology: Was it

02 Oct 2021 at 14:56:39 at 2021 Oct 02 thought. Although their perspective may not better to have loved and lost than never

, on on , seem implausible, or even alienating, to to have loved at all? The American Journal of some, to others it may be interesting and Bioethics 2013 ; 13 ( 11 ): 22 –3. exciting. Whatever the case, we can be 15. Boesch B. A Thomistic account of anti-love biotechnology. The American Journal of Bioethics

170.106.35.93 sure that love drugs will not be for 2013 ; 13 ( 11 ): 30 –1. everyone. Their value and their useful- 16. Earp BD , Sandberg A , Kahane G , Savulescu J . ness, and how they alter one’s concep- When is diminishment a form of enhancement? Rethinking the “enhancement debates”

. IP address: address: IP . tions (and/or experiences) of love and relationships, are—and we think ought in biomedical ethics . Frontiers in Systems Neuroscience 2014 ; 8 ( 12 ): 1 – 8 . to be—in the eye of each beholder. 17. See note 11, Gupta 2013. 18. Epright MC , Waller S . When love hurts chil- Notes dren: Controlling the feelings of minors. The American Journal of Bioethics 2013 ; 13 ( 11 ): 28 –9. 1. Fisher HE , Aron A , Brown LL . Romantic love: 19. Wahlert L . Anti-love or anti-“lifestyle”: A mammalian brain system for mate choice. Historical reﬂ ections on reparative therapies Philosophical Transactions of the Royal Society B: for homosexuality . The American Journal of https://www.cambridge.org/core Biological Sciences 2006 ; 361 ( 1476 ): 2173 –86. Bioethics 2013 ; 13 ( 11 ): 36 –8.

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20. McArthur N . The heart outright: A comment 39. Holt-Lunstad J , Smith TB , Layton JB . Social on “If I could just stop loving you.” The relationships and mortality risk: A meta- American Journal of Bioethics 2013 ; 13 ( 11 ): 24 –5. analytic review. PLoS Medicine 2010 ; 7 ( 7 ), 21. Earp BD , Sandberg A , Savulescu J . Brave new e1000316 :20.

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. . apy and the bio-oppression of sexual minori- promotes inﬂ ammation during acute stress. ties . AJOB Neuroscience 2014 ; 5 ( 1 ): 4 – 12 . Psychological Science 2013;(Early Access):1–9. 22. See note 6, Savulescu, Sandberg 2008. 41. Wilson C , Oswald AJ . How does marriage 23. See note 3, Earp et al. 2012. affect physical and psychological health? 24. See note 4, Earp et al. 2013. A survey of the longitudinal evidence . IZA 25. See note 8, Wudarczyk et al. 2013. Discussion Paper 2005 ; 1619 : 1 – 30 . 26. Insel TR , Young LJ . The neurobiology of 42. See note 8, Wudarczyk et al. 2013, at 482. attachment. Nature Reviews Neuroscience 2001 ; 43. Though note that MDMA (Ecstasy) was used 2 ( 2 ): 129 –36. in the 1980s in couples’ counseling, and that 27. See note 26, Insel, Young 2001. scientiﬁ c interest in its therapeutic potential 28. See note 8, Wudarczyk et al. 2013. has recently been rekindled: Sessa B. Is there

https://www.cambridge.org/core/terms 29. See note 4, Earp et al. 2013. a case for MDMA-assisted psychotherapy 30. Davis JE. Medicalization, social control, in the UK? Journal of Psychopharmacology and the relief of suffering. In: Cockerham 2007;21(2):220–4. There is also anecdotal WC, ed. The New Blackwell Companion to Medical evidence (Hutchinson, personal correspon- Sociology . Singapore: Wiley-Blackwell; 2010: dence) that MDMA is currently being used, 211–41. albeit illicitly, by a network of relationship 31. Quoted in Parens E . On good and bad forms of therapists in Canada, although such research medicalization. Bioethics 2013 ; 27 ( 1 ): 28 – 35 , at 33. cannot be published. Oxytocin is also being Note that the paper by Evans has not yet been used currently by some counselors: Boesveld published, so we must rely on Erik Parens’s S. Chemical seduction: How “love drugs” reading of the passage. However, we wish to may one day help couples save failing rela- point out that, as quoted, it is unclear whether tionships. National Post 2013 Mar 30; available the claim that “we can all fear the medicaliza- at http://news.nationalpost.com/2013/03/ tion of love” is one that Evans himself would 30/chemical-seduction-how-love-drugs- endorse, or whether, as a sociologist, he is may-one-day-help-couples-save-failing- intending only to illustrate the sort of com- relationships/ (last accessed 19 May 2014).

plaint that might be raised by critics of medi- 44. Abraham deﬁ nes the term “pharmaceuti- , subject to the Cambridge Core terms of use, available at at available use, of terms Core Cambridge the to subject , calization generally. Thus, our argument calization” as “the process by which social, should be interpreted as being a response to behavioural or bodily conditions are treated the claim (and the sorts of worries that we or deemed to be in need of treatment, with think might be lying behind it), rather than as medical drugs by doctors or patients”: a rebuttal to Evans. Abraham J. Partial progress: Governing 32. Kramer PD. Listening to Prozac. New York: the pharmaceutical industry and the NHS,

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170.106.35.93 Psychiatry Makes “Patients” of Normal Children . 45. See note 31, Parens 2013, at 34. Victoria: Trafford; 2006. 46. Gottman JM. Marital Interaction: Experimental 35. Timimi S. Pathological Child Psychiatry and the Investigations. Vol. 5. New York: Academic

Medicalization of Childhood . East Sussex: Press; 1979. . IP address: address: IP . Brunner-Routledge; 2002. 47. See note 8, Wudarczyk et al. 2013. 36. See note 31, Parens 2013, at 33. 48. Bartz JA, Zaki J, Bolger N, Hollander E, 37. Traupmann J, Hatfi eld E. Love and its effect Ludwig NN, Kolevzon A, et al. Oxytocin on mental and physical health. In: Fogel R, selectively improves empathic accuracy. Hatfi eld E, Kiesler S, Shanas E, eds. Aging: Psychological Science 2010;21(10):1426–8. Stability and Change in the Family . New York: 49. Ditzen B , Schaer M , Gabriel B , Bodenmann G, Academic Press; 1981:253–74. Ehlert U , Heinrichs M . Intranasal oxytocin 38. Pienta AM , Hayward MD , Jenkins KR . Health increases positive communication and reduces consequences of marriage for the retirement cortisol levels during couple confl ict . Biological https://www.cambridge.org/core years . Journal of Family Issues 2000 ; 21 : 559 –86. Psychiatry 2009 ; 65 ( 9 ): 728 –31.

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not lead to a medicalization of everything, at 227. . IP address: address: IP . despite being seen as explanations for much of 92. See note 8, Wudarczyk et al. 2013. human behavior, emotion, and thought. 93. Juth N. Enhancement, autonomy, and authen- 67. See note 21, Earp et al. 2014. ticity. In: Savulescu et al. 2011 (see note 90):36. 68. See note 59, Tiefer 1996. 94. Another angle on the matter comes from 69. Gupta K. Protecting sexual diversity: Rethinking Guy Kahane’s recent essay, “Reasons to Feel, the use of neurotechnological interventions Reasons to Take Pills.” Kahane argues that to alter sexuality. AJOB Neuroscience 2012; biochemical modiﬁ cation of certain feelings 3(3):26. may be morally permissible if it is the case 70. American Psychiatric Association. Diagnostic that one ought to feel differently from how https://www.cambridge.org/core and Statistical Manual of Mental Disorders, Fourth one does in fact feel—due, perhaps, to

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, on on ,

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. IP address: address: IP . https://www.cambridge.org/core

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