Omer Bonne means well; that much is certain. As director of psychiatry at Jerusalem’s Hadassah University Hospital, Bonne has seen patients – young men – come in again and again to treat the problem of their shameful, too-high sex drives. And Bonne has a ready solution: Prozac.
Prozac is one of the antidepressants that Bonne and other rabbis have prescribed to yeshiva students, not because they are depressed but because such drugs have the well-known side effect of lowering libido. Bonne believes, as reported in 2012 by the Israeli newspaper Haaretz, that these sexual desires put conservative Jews ‘in conflict with their values and cause them mental problems, even to the point of depression’. In the face of societal stigma and the frustration of betraying one’s religious values, he thinks it only humane to do what is necessary to soothe these urges and make life easier.
Bonne isn’t the only one using drugs to control sex drive and attraction. Oral naltrexone, a medication that treats addiction by chemically blocking narcotics, has also been used to suppress an addiction to internet pornography..Lupron, a prostate cancer therapy that suppresses sex hormones, is now being used to chemically castrate men with sex addiction. These are initial, clumsy examples of how we may one day use drugs to more directly manipulate our experiences of love and desire. The possibilities are many: a spray that stops us from feeling pain over a breakup; pills that permit someone to fall out of love with, and then leave, an abusive partner; a vaccine to immunise us from desire, leaving more space for creative work and less to cheat on a spouse.
These are some of the scenarios envisioned by Brian Earp, a bioethicist at the University of Oxford. Earp coined the term ‘anti-love biotechnologies’ to describe these love drugs, and, with colleagues, wrote a series of articles that have created the framework for thinking about their promise and peril while ultimately coming down in favor of their use under certain circumstances.
‘“Love hurts”—as the saying goes—and a certain degree of pain and difficulty in intimate relationships is unavoidable,’ Earp writes in 2013, in a paper in the American Journal of Bioethics. ‘Sometimes it may even be beneficial, since, as it is often argued, some types (and amounts) of suffering can lead to personal growth, self-discovery, and a range of other essential components of a life well lived. But at other times, love can be downright dangerous. Either it can trap a person in a cycle of violence …or it can prevent a person from moving on with her life or forming healthier relationships.’
Yet tampering chemically with love – whether easing a painful, unrequited obsession or changing one’s sexual orientation – is seen as taboo because society now places love in an exalted category all of its own. We see whom we love and how we love as among the most important parts of our identity. Love trumps most of our other values, such as ambition or even the desire to be free from suffering. Doctors readily prescribe drugs to heal bodily injuries so we can be in control of our bodies. Activists fight to de-stigmatise medication that helps mental-health problems.
Love alone is untouchable, one of the last frontiers where the ability to manipulate or shun an experience seems to be asking for too much – but why? As Earp points out, love is in many ways a chemical reaction, and when love causes intense suffering or conflicts deeply with other values, people who want a chemical solution should, providing they give informed consent, have one. Access to anti-love drugs could bring some of us closer to one of the core values of Western society: personal autonomy, and a future where we control our lives and become the people we most want to be.
By insisting that no one can opt-out of the love experience, suffering and all, we often ignore the very real damage that love can cause simply because the source of the damage is seen as so necessary. When it comes to deciding whether to treat suffering, we hold the pain caused by love to a standard much higher than the pain from many other conditions, even as anthropologists and doctors argue that the experience of love can function as an addiction, or a mental illness – and even when suicide can result.
Everything that happens with romantic love has a chemical basis, says Helen Fisher, a bio-anthropologist who is one of the world’s leading authorities on love. For instance, researchers know that the neurotransmitter dopamine promotes pair bonding and monogamy. In a series of studies with prairie voles starting from 2003 to the present day, University of Michigan researchers have shown that males injected with a dopamine blocker became less monogamous. Fisher has repeatedly stated that love acts like an addiction because not only do people in love act like those with an addiction, but fMRI studies show that feelings of romantic love activate the same regions of the brain as those activated by substance addictions. She frequently compares the pain of a devastating breakup to the pain of drug withdrawal, but doctors are far more likely to see the latter as rightfully deserving a treatment such as naltrexone.
It has come to pass, writes the cultural theorist Laura Kipnis, that ‘saying no to love… isn’t just heresy; it’s tragedy: for our sort the failure to achieve what is most essentially human.’ To opt out of this one experience is to be monstrous, a loser, someone who must be fixed.
This wasn’t always the case. Stories of star-crossed lovers, whose painful affairs could never survive the norms of their time, go back centuries. Romantic love was subordinate to social status and economic security, and marriage remained a pragmatic arrangement. As people began to ‘expect marriage to satisfy more of their psychological and social needs than ever before’, writes the cultural historian Stephanie Coontz, love became tied to marriage and its importance was then elevated.
Where there is love, there is suffering, and especially in modern times, we’ve glorified suffering because of its power to create art. Dante’s unobtainable Beatrice is said to have been the inspiration for much of his work. A body of scientific evidence now points to the power of post-traumatic growth – the positive transformation sometimes brought about by surviving such hardships as cancer and war; should you make it through the trauma, life’s meaning might be enhanced.
But often, suffering is just suffering, and it can go on endlessly, without providing new sources of meaning or inspiration, or any growth at all. In her book Unrequited: Women and Romantic Obsession, the journalist Lisa Phillips recounts how, after being rejected by a lover, she checked herself into a medical centre because she ‘didn’t know what else to do’. The psychiatry resident gave her a prescription for painkillers, telling her that she was far from the only one to check herself in because of love trouble. In her book, she recounts the stories of woman after woman waiting by the phone, filled with desperation, sometimes accused of stalking, sometimes in pain for years. Many people have friends who can’t seem to move on and the internet is full of pleas from those who don’t understand why unrequited love still hurts. ‘It has been 10 years and the pain, the anger, the hurt and yes the love is still fresh,’ one woman writes. ‘I saw his picture on Facebook and I hurt so bad! I no longer cry, but I still get depressed over it.’
Homer understood in the 8th century BCE what modernity has yet to accept – love can be an addiction, and when it is, we need substantial outside help
Albert Wakin, a psychologist at Sacred Heart University in Connecticut, has lobbied for obsessive love, called limerence, to be included in the Diagnostic and Statistical Manual of Mental Disorders. He suggests that five per cent of the population suffer from limerence, whose symptoms include intense grief, insomnia, low appetite and chest pains. Wakin, who had one patient who suffered from obsessive love for 60 years, says that limerence has many similarities with obsessive-compulsive disorder, a condition that far fewer people would hesitate to treat with medication.
Perhaps the best analogy is depression, a condition that some insist reflects real-life strife we must pass through and understand to move on. There may be some depressed individuals who gain meaning from their depression, but those who want to be free of it should be able to take action – and most mental health professionals agree, since ongoing severe depression is a major cause of suicide. Forcing people to succumb to every whim of love is likewise cruel.
When Odysseus tied himself to the mast so he could hear the sirens without falling overboard, we admired him for his cleverness instead of berating him for his hubris. Homer understood in the 8th century BCE what modernity has yet to accept – love can be an addiction, and when it is, we need substantial outside help.
Treating the torment of obsessive romantic love isn’t the only love therapy in the offing; for people at the opposite end of the spectrum, with low libido, a treatment has emerged, as well. In August last year, the United States Food and Drug Administration approved a libido-boosting drug called Addyi, or flibanserin, that is said to increase women’s desire for sex.
Although it promises only modest benefits – and even those promises have been disputed – its existence raises serious questions for those, like me, who are asexual, or whose sexual orientation is that they do not experience sexual attraction to any gender. An improved flibanserin could be seen as an asexual equivalent of gay conversion therapy, says the Wake Forest University bioethicist Kristina Gupta, though she notes that prejudice against the asexual population has typically not been as strong as that against other members of the LGBT community.
The expansion of the love-drug market from merely treating obsession to managing all forms of difference requires an ethical discussion of much wider range. When it comes to homosexuality, for instance, the fight for acceptance has been long and difficult. The history of gay-conversion therapy, one of the abuses against this group, is horrific, and there is almost no evidence that it has ever been effective or caused anything but hardship and pain. But what if this biotechnology someday existed – if it were safe and effective? Should people have the option to use it to improve or just change their lives, even if that use hurt the community’s civil rights and set society back?
There is a real threat that such biotechnologies could be used to support the status quo, Gupta comments. An anti-love drug could help someone to avoid cheating on her partner, but at the cost of discussing the difficulty of monogamy with that partner, and exploring the possibility of a polyamorous relationship. A conversion drug could make someone’s life easier by making him or her straight or want to have sex, at the cost of forcing conversations about why other ways of being are seen as wrong.
As for my asexual friends, most said they would have taken flibanserin – or something like it – earlier in life, but later embraced their asexuality as a valid way of being, and not a sign that they were broken. It is society that needs to change, I heard over and over, not asexual people, not gay people, not the people who face these stigmas.
There are so many external forces putting pressure on our choices, so ‘we need to look at social inequality and social stigma and [place] less focus on individual decision-making’, Gupta adds.
I strongly agree. But change happens slowly, and the high rates of depression and suicide among those who don’t fit the norm is the evidence we need that this suffering is real.
I would rather she be alive and out of pain than a tragic figurehead who shocked people into action and pushed our society forward
If these potential drugs were unavailable, it could ensure that people were not tempted to ‘drug themselves straight’, but it might not promise them the chance to lead the happiest lives they can. For some, there may come a point where relieving personal pain must take precedence over fighting the good fight, and so Gupta ultimately argues that conversion therapies should be available given careful regulation and education, ‘if someone determines that it would be good to their flourishing and if they felt that it was in their best interests’.
This is a fight being duked out in many arenas. Women who go on harsh diets and get breast implants almost certainly want them because of unattainable beauty ideals, yet an attempt to ban diets or cosmetic surgery would lead to charges of being paternalistic. Conversion drugs should not be treated differently. If someone desires this option and receives other types of support and hears about all the other options, personal autonomy and individual happiness should prevail. The suicide of transgender Leelah Alcorn brought widespread attention to transphobia – but, had she wanted it, I would not have denied her a treatment for her gender dysphoria. Alcorn did not commit suicide because she was trans; she committed suicide because of transphobia, but I would rather she be alive and out of pain than a tragic figurehead who shocked people into action and pushed our society forward.
Making this choice is not necessarily a betrayal of one’s ‘authentic’ self, because the way we view authenticity is rife with contradictions. Oxford University bioethicist Brian Earp, who has written extensively on anti-love biotechnologies, suggests a relative view may be best. ‘Authenticity is seen as a good thing – you know, “be yourself” – but what if the self is a psychopath? I think that in the end, we don’t care as much about authenticity, we care about having a disposition that’s consistent with our most considered values,’ he states. Few of us would consciously select the torment of an unrelenting obsessive love, unreturned, as the best way to pursue a satisfying life for decades on end. Nor would we feel authenticated by love for someone who verbally insulted us and put us down as part of the relationship, yet we may be stuck in those places. Why not tap a love cure to release the more authentic parts of our selves from the parts that are trapped? Should we endure years of psychotherapy that may or may not work, or seek a drug?
Earp proposes four conditions that should be met before resorting to love drugs to ease one’s pain. First, the love must be clearly harmful (such as the love for an abuser); someone must want to take the drug themselves to minimise the risk of outside coercion; the drug must help achieve greater goals; and it must have been proven to be nearly impossible to fix the issue with non-chemical means such as therapy and counselling. I think the last condition – that someone must try other means first and see what they can learn – is one of the most important. There should clearly be age restrictions, too.
When it comes to flibanserin, almost nobody I spoke to supported a full ban. I don’t either. This is a question of education and personal choice. A woman going to the doctor with concerns about low sex drive should learn about the options of therapy, relationship counseling, the possibility of asexuality, the acknowledgement that there is nothing inherently wrong with not wanting sex – and then, if she still wants it, flibanserin. We want people, even if they’re asexual, to have this option if it’s what they truly want, my contacts said. The important thing is that we want them to know that there are other ways of being as well.
Advocates suggesting that we take charge of matters of the heart by choosing whom we want to be with should also support this same agency if we choose to opt out of the fight. Many of the ideals that were once seen as crucial – God, country, a white picket fence and two kids – have fallen, and there is little reason romantic love alone should remain untouchable.
Ultimately, Earp has argued, the individual and voluntary use of these technologies ‘can be justified or even morally required …In some cases, to deny its use would be inhumane…For however wonderful it can feel to be in love, this most central of human emotions can also be, as Shaw wrote, an “insane” and “delusive” passion—and a dangerous one as well.’ When love becomes dangerous, we need path to safety, ‘even if this would require the swallowing of a pill.’
The taboo on treating love and the taboo on treating taboos – all of it needs to go.
