Academic journal article Health Sociology Review

The Sociology of Cognitive Enhancement: Medicalisation and Beyond

Academic journal article Health Sociology Review

The Sociology of Cognitive Enhancement: Medicalisation and Beyond

Article excerpt

The use of chemical substances to alter mental states, whether for the purpose of healing or enhancement, pleasure or instead of happiness, is certainly not a new or recent phenomenon (see, for example, Herzberg, 2009; Rasmussen, 2008). However, over the past few years there has been an upsurge in interest regarding the promises and perils of new neurotechnologies, particularly psychopharmaceuticals that have the potential to be used as so-called 'cognitive enhancers'. It is now increasingly claimed indeed that we are entering an era where cognition enhancing drugs will be readily available, legally or otherwise, for those who wish to take them; 'smart' drugs, that is to say, designed to boost our brain power and make us 'better' humans, if not 'better than' human (Miller & Wilsdon, 2006).

In recent years scientific and bioethical debates surrounding the acceptability of cognitive enhancement have been extensive and have caught the imagination of publics and professionals alike; sparking further debate in various arenas outside of academia from popular media to parliament (Department of Trade and Industry, 2005; Parliamentary Office of Science and Technology [POST], 2007). So-called 'enhancement drugs' have been at the forefront of these debates with many commentators claiming the practice of cognitive enhancement by healthy people is already happening. A therapy/ enhancement dichotomy is often presented whereby drugs that have been developed for the treatment of diseases and disorders1 have applications outside of medicine for the cognitive enhancement of healthy individuals (Coveney, 2011). Images of our future society are constructed in these debates in which human behaviours can be pharmacologically controlled for ultimate performance and efficiency, through the advent of more effective and safer drugs (Coveney, 2010; Martin, Pickersgill, Coveney, & Williams, 2011; Williams, 2010; Williams, Seale, Boden, Lowe, & Steinberg, 2008). Although there are indeed a wide variety of views and reactions to the prospect of cognitive enhancement within the scientific community and amongst ethicists (De Jongh, Bolt, Schermer, & Olivier, 2008; Quednow, 2010), positive assumptions regarding the demand, social need, impact and desirability of cognitive enhancement technologies expressed in ethical debates directly influence the ethical issues that are prioritised (Williams, 2010). The ethical discourse generates several expectations: that there will be an inevitable increase in the pursuit of psychopharmaceutical enhancement; this widespread usage will change the way we live our lives; and that the future will bring new ways of enhancing, controlling and reading the brain (Martin et al., 2011; Quednow, 2010).

Sociological engagements with these debates, particularly within the sociology of health, have been somewhat limited to date. In this review, therefore, we explore the implications of these developments for the sociology of health, with particular reference to questions of medicalisation or biomedicalisation. For example, how useful are the sociological concepts of medicalisation and biomedicalisation in thinking through the problems and prospects of cognitive enhancement drugs and what, if any, are the limitations of these sociological concepts? Are other more specific sociological concepts required here, for instance, in order for us to capture and convey the complexities of these problems and prospects of cognitive enhancement, particularly amongst the healthy?

These are some of the sociological questions we seek to answer in this review. First, however, for analytical purposes we provide a brief recap on recent debates regarding medicalisation, biomedicalisation and associated matters regarding the health and the governance of bodies, as a backdrop to the sociological themes that follow on the problems and prospects of cognitive enhancement.

MEDICALISATION OR BIOMEDICALISATION?

A physical, biological or psychological condition or behaviour is said to be 'medicalised' when it is described within a medical framework, given a medical label (as an illness or disorder) or treated with a medical intervention (pharmacologic or otherwise). …

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