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. The Medicalization of Love 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 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 Empty the haunted air, and gnomed mine— Unweave a rainbow, as it erewhile made , 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: 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. doi:10.1017/S0963180114000206 323 Downloaded from Neuroethics Now 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 explored 11 , 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 interventions 16 —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 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 that the development or the use of such tations as well as romantic bonding , 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: 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 324 Downloaded from Neuroethics Now 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 dys- function . 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 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 justify the administration of Ritalin in tion per se, but rather about pharma- , 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, .