Saturday, April 25, 2009

Times A-Changin'

Maybe, or maybe not. Here's Samuel Johnson on "blogging" in 18th-century England (courtesy of Peter Martin's biography). Sound familiar?

(Writing of the proliferation of independent printers) "If we consider chiefly the state of our own country, [it] may be styled with great propriety The Age of Authors...The province of writing was formerly left to those, who by study, or appearance of study, were supposed to have gained knowledge unattainable by the busy part of mankind; but in these enlightened days, every man is qualified to instruct every other man."

(Writing on the pressure of frequent deadlines) "He that condemns himself to compose on a stated day, will often bring to his task an attention dissipated, a memory embarrassed, an imagination overwhelmed, a mind distracted with anxieties, a body languishing with disease: he will labour on a barren topic, sill it is too late to change it; or in the ardour of invention, diffuse his thoughts into wild exuberance, which the pressing hour of publication cannot suffer judgement to examine or reduce."

I have read before that newly prevalent coffee houses in Johnson's era helped to spur the development of literary culture, caffeine promoting attention and perspicacity more effectively than the psychotropics available in taverns and alehouses. Fast forward to contemporary neuroenhancement, whose prime time status is attested to by Margaret Talbot's review of the phenomenon in The New Yorker.

Talbot interestingly profiles college students who, unmedicated, might lapse into indie slackers, but who seem to fire on all cylinders thanks to Adderall, as well as new agey scientific gurus who swear by Provigil. She covers all the usual objections to widespread and off-label use of such agents: the pressure of technocratic conformity, the emphasis upon focused productivity at the expense of serendipitous creativity, and of course known and unknown adverse physiological effects. But she seems to conclude that the practice is roughly analogous to plastic surgery, that is, regrettable perhaps, but likely not illegal or even necessarily unethical.

The enhancement issue occupied my mind a great deal a couple of years ago and yielded a couple of published papers, but here I would say only that neuroenhancement does differ from plastic surgery inasmuch as the former affects not only one's attributes, but also one's capacity or inclination to reflect upon those attributes. If someone without ADHD is in some hyper-focused state due to Adderall or Ritalin, this state may in itself vitiate his ability to consider whether this is a good thing (just as, similarly albeit more dramatically, an actively inebriated person is not well placed to appreciate the virtues of sobriety). It is as if a plastic surgery procedure were to directly (and not just indirectly) make one even more superficial and other-directed than one already was.

For the psychiatrist, it is also somewhat quaint to hear talk of these agents as being fraught with prodigious impact and potentially hazardous effects, when the issue for many folks with real ADHD is less likely to be side effects than limited efficacy.


Anonymous said...

I can see the attraction. Neuroenhancement is a matter of keeping up with the exponential flood of information; not settling for comprise; partaking of everything at an average, or at best, an above par, but definitely not optimal level. There's just too much. It's a reduction of choice between nothing or a little of everything at a discounted price with passable quality. An obsessional diffusion lacking the intensity and genius of concentrated selectivity - the true obsession that yields immortality, not factory standard generic productivity.

But still, it would be nice to have a neural switch of sorts to selectivity enhance apects of your being for maximum potential fulfillment at every level of your existence, without compromise. Instantaneous modal transitions that flex with the tides of living - a constant flux of enhancements and add-ons; a life of neural advancemnt, never regression.

I wouldlike to theink that the human brain will continually metamorphose until it's unrecognisable from the limited piece of flabby machinery it will retroactively be considered in future/s to come.

It's ok to dream - isn't it?

To be human is to have one foot in reality, one foot in fantasy and another foot in delusion.

Retriever said...

Actually, I find deadlines helpful focussing aids. And a serious caffeine habit.

(excuse length of this, but I do not want to offend a friend who will think I am writing about her kid, as opposed to a composite, if I post this in my own blog )

Anyway, the thing I worry about with this current crop of college aged kids is that most of the kids I know from my kids' peer group that were on stimulant medication for ADHD as kids, are now both drinking alcoholically and/or doing illegal drugs, in addition to continuing on the various stimulant drugs which their parents fear they will be unable to get thru college without. Why?

Ours being a rich community, with mostly loving but also pushy and ambitious parents, they were getting prescriptions 14 years ago at age 5. They mostly come from families with at least some covered up history of mood problems or alcoholism. Either depressed mothers, or hypomanic dads or some variant, famlies that are high functioning but engage in significant denial. Sometimes the parents indulged in illegal drugs as college kids 30 years or so ago, and continue moderately heavy but controlled drinkers. They manage their own moods with social drinking and perhaps some prescribed meds. There are lots of substances lying around that a kid can experiment with, steal, even if the parentst nominally forbid drinking or drug use.

Our community has no public transportation worth a damn so all the kids drive. There is actually little to do around here, so they mostly "party".

Based on the admittedly small sample I know best, the kids have their own mood problems but the families have a huge stake in pretending it is "just" ADHD. So comorbidity is the issue.

In addition, many of the kids who are developing alcoholism or drug habits at an early age are, even if there is no serious addiction in the family, self-medicating to compensate for anxiety and agitation that the stimulant meds can induce in kids with even a soft bipolar family history. I have just seen it again and again.

It's interesting that many people tend to think of the stimulants in a similar way to the SSRIs: as drugs that will almost certainly help, and can't possibly hurt. When, in fact, both classes, after an initial honeymoon period, tend to diminish in helpful effects but increasingly have unpleasant if not dangerous side effects.

I know half a dozen boys whose families are, if anything, more "moody" than ours, who were helped for many years to focus and do well in school and socially by the stimulant meds. But something changes after the mid teens, and I don't see the kids benefitting as much from them. Some of them spontaneously remit (or, possibly sports, puberty, structure, emotional maturity may help) and some get flakier. The latter self medicate, whether or not they stay on the meds, but the ones on the meds self-medicate more. On the other hand, it may just be that the more unfocussed have to be kept on the meds?

What bothers me as a parent of a kid with several overlapping diagnoses is that it is not safe to treat his ADHD (which continues) as the meds would make his other conditions worse.

Many people are willing to put their kids on them or take them themselves because of their appetite suppressing effects. I know a wrestler boy who is glad of this, and girls obviously want this.

As far as neuroenhancement by most healthy college students, I feel like smacking them upside their heads. Given how many of them drink themselves insensible three days a week while their parents are spending 45K a year for their college, I have little patience with whining about needing stimulants. A little less liquor and a little more sleep, some regular exercise, and a few cups of coffee a day are all that any healthy kid needs to do fine academic work.