Sick brains, sick minds or sick societies – what, if anything, might be ‘enhanced’?

The assumption that the diagnostic categories of mental illness provided by the DSM in whatever version can be translated into specific brain dysfunctions, manifested at physiological, anatomical, biochemical or genetic level, is deep rooted. It is the basic premise of biological psychiatry. It has built tens of thousands of academic and psychiatric careers, and formed the basis for the treatment of many millions of patients. Over the past half century it has consumed a significant portion of the budgets of NIH, MRC and analogous funding institutions across the developed world and spawned an immensely profitable psychopharmaceutical industry. To challenge its assumptions seems perilous – a return to the anti-psychiatry of the 1960s or to its modern descendents. Certainly a tricky case to argue for a molecularly based neuroscientist like me. Yet nothing speaks louder as to the failure of the paradigm than the recent withdrawal of Big Pharma – Pfizer, GSK and others – from CNS based research. I review some of the epidemiological, biochemical and genetic evidence relating to depression, schizophrenia and ADHD which has so discouraged Big Pharma, and ask what conclusions can be drawn. Yet even as the Pharma companies withdraw, enthusiasts are loudly insisting that the psychopharmacological enhancement – the obverse of therapy - of cognition, happiness and performance is imminent or even currently available, precipitating much debate about the social ethical and legal consequences of such developments. I will address the reasons for skepticism as to what enhancement might achieve and what special ethical problems it might present.