The academic debate surrounding “cognitive enhancement” is now into its third decade. Simply put, the debate concerns attempts, actual and speculative, to amplify and extend “core capacities of the mind through improvement or augmentation of internal or external information processing systems” (Bostrom and Sanberg 2009). Some definitions of cognitive enhancement have sought to constrain the debate by limiting the types of augmenting or extending interventions to contemporary bio- and information technologies. Take for example the definition of cognitive enhancement provided on the website of the Oxford Centre for Neuroethics, one of the central institutional protagonists in the debate: “to extend the abilities of the human mind and to modulate affective and hedonic states through genetic, neuropharmaceutical, computer or direct neural interventions.”Footnote 1 The epistemological coherence of limiting the definition to contemporary technologies, while discounting other now normalized and ubiquitous ones, for example writing implements, as these definitions do, is certainly suspect and has been heavily criticized (e.g. Buchanan 2011a, b). Elsewhere, I have referred to approaches to enhancement that don’t try to limit the concept of enhancement to the use of contemporary bio- or information technologies as “inflationary” (Meacham 2015). An enhancement in the inflationary sense can be defined in the fashion that Buchanan does as “an intervention—a human action of any kind—that improves some capacity (or characteristics) that normal human beings ordinarily have, or more radically that produces a new one” (Buchanan 2011b, p.5). The inflationary approach does not acknowledge an epistemologically or normatively salient difference in kind between novel technologies (e.g. neuropharmaceuticals, genetic engineering, or neural intervention) and existing, normalized, ubiquitous ones (e.g. pen and paper). This approach, if pushed, seems not only to call into question distinctions between different kinds of technological interventions, but also the distinction between “natural” and technologically mediated or augmented cognitive engagements between and organism and its environment. If we follow the inflationary approach to its limits, there seem to be good reasons to consider some, for example, mnemonic processes involving language that we would normally consider natural, i.e. not technologically mediated, to in fact be technological cognitive enhancements. The justification for this would be that there are good reasons to consider numbers and language itself as technology (Frank et al. 2008). The inflationary approach is particularly significant in the context of this special issue as it opens up the discussion of cognitive enhancement into a broader discussion concerning human relations with technology more generally speaking, and also onto questions of what “normal” cognitive relations with the environment might be. This broadening of the debate finds resonances outside of the frame of Anglo-analytic bioethics and moral philosophy, particularly in areas associated with French Epistemology, Phenomenology and more recently developed sub-fields which draw upon these approaches, namely the methods grouped around the designation 4E–Cognition (enactive, embodied, extended, ecological) (see Menary 2010) – hereafter I’ll refer to these as FE-PHEN-4E. The argument that I wish to sketch out here, and which the contributions to this issue support, is that the expansion of the enhancement debate to a broader range of philosophical approaches and methods may help to not only enrich the debate and provide greater philosophical rigor, but also to move it past the current impasse that it arguably finds itself in.
Before proceeding into a discussion of this impasse, it is necessary to point out a further dimension of the debate. We can find this clearly indicated in Hildt’s (2013) definition of enhancement: the attempt to “increase cognitive function such as memory or attention in healthy individuals” (Hildt 2013, 1 – my emphasis). This definition describes interventions aimed at a specific capacity or class of capacities (e.g. memory, attention), but requires that, for it to be counted as an enhancement, the individual to whom the intervention pertains must be “healthy”. This would imply that an individual with an impaired capacity cannot be healthy. The definition relies on a concept of healthy or normal-functioning capacities. While it is often not clear what concept of health or normality is being used – sometimes it is clear, see, Daniels (2000) – the implied conception seems to be something along the Boorsian biostatistical model of health (Boorse 1977). Kingma (2007) provides a succinct summary of Boorse’s position: “According to Boorse’s Bio Statistical Theory (BST), health is normal species functioning, which is the statistically typical contribution of all the organism’s parts and processes to the organism’s overall goals of survival and reproduction. The group with respect to which a contribution is statistically typical is the reference class, specifically an age group or sex or a race of a species.” Kingma also convincingly argues that Boorse is not able to provide solid grounds for why some reference classes (age, sex, etc.) should be selected over others. Boorse also does not provide an argument either why some functions (survival and reproduction) are the only relevant functions for a theory of health and has been much criticized for this reductionist approach.Footnote 2 Nonetheless, the biostatistical model seems implicitly to be the default understanding of normal health within much of the literature on enhancement, but this definition, entails the augmenting of a capacity or performance beyond or above “normal” reference class functioning. This definition is at least arguably potentially useful insofar as it allows a clear demarcation – important to medical ethics – between medical therapy or treatment and enhancement. Bostrom and Sandberg give a very clear account of how it is generally used in the enhancement literature: “An intervention that is aimed at correcting a specific pathology or defect of a cognitive subsystem may be characterized as therapeutic. An enhancement is an intervention that improves a subsystem in some way other than repairing something that is broken or remedying a specific dysfunction” (Bostrom and Sanberg 2009: 312).
By this account, the aim of a therapy is to restore a capacity or an individual, to return the sick or impaired capacity or individual to a normal healthy state as determined by the statistical norm for the relevant reference class. An intervention that alters the capacity or individual in such a way that they now perform beyond a previous individual or population healthy norm is an enhancement. But such definitions often overlook problems with this notion of normal or healthy; problems which are exacerbated by the concept of enhancement itself. This is particularly important when we speak about cognitive enhancement where conceptions of normality are particularly reliant upon contingent social and cultural environmental conditions. This is precisely the standard critique of Boorse’s model. It does not take historical and cultural variations into account concerning what is understood to be normal health. As the French philosopher Georges Canguilhem wrote:
most of the time when speaking of abnormal directions or representations, the psychologist or psychiatrist has in mind as “normal,” a certain form of adaptation to the real or to life, one that has no absolute meaning—except, that is, for those who never had an inkling of the relativity of technical, economic or cultural values, who adhere without reservation to the value of these values, and who in the end, forgetting their own conditioning by their surroundings and by the history of those surroundings [… ] show themselves to any thinking even a bit critical to be victims of an illusion very near to what they denounce as madness. (Canguilhem 2008 – my emphasis)
A contemporary example of this is the rise in prevalence of ADHD (attention deficit hyperactivity disorder) in the United States. Without going into detail, it’s helpful to refer to psychiatrist Richard Friedman who argues: “People with ADHD may not have a disease, so much as a set of behavioral traits that don’t match the expectations of our contemporary culture” (Friedman 2014). Lending more support to the thesis that psychopathologies can be institutionally-socially mediated is the finding that there are correlations between geographical discrepancies in the rise of ADHD diagnosis and the implementation of the No Child Left Behind Act in the United States (Hinshaw and Scheffler 2014).Footnote 3 The fact that the psychostimulant pharmaceuticals used to treat ADHD are also the most commonly discussed (both in the media and the academic literature) form of cognitive enhancement for “healthy” individuals makes the technological-institutional structuring of normality and health all the more relevant in the discussion of enhancement.
The inflationary understanding of enhancement further complicates the notion of health or normality. Enhancement within the treatment-enhancement distinction is an intervention that augments or alters a performance or capacity beyond what is deemed normal or healthy, but presumably in a way that is beneficial for the organism. The difficulty introduced by the inflationary concept comes when, as Canguilhem notes, the normal is technologically constituted. In such cases, normal, healthy functioning is dependent upon enhancement technologies that have become normalized or ubiquitous in their use and integration within a certain population. Literacy again serves as a helpful example in relation to cognitive capacity. The inability to use written language as a mnemonic technology is certainly within contemporary modernized society an impairment or pathology (a deviation negatively impacting the individual’s ability to function within a specific environment); but its status as such is mediated by the past introduction of an enhancement technology – namely writing and the suite of technologies that surround the practice. The normal or healthy against which the notion of enhancement is distinguished is mediated by enhancement-technology. Bostrom and Sanberg (2009) address this issue of normalized or ubiquitous enhancement technologies by making a distinction between “conventional” and unconventional enhancement. They include education, training, and the use of cognitive artifacts in their account of “conventional” enhancements (312). As Heersmink points out in this issue (Heersmink 2017), conventional for Bostrom and Sandberg means culturally accepted and hence morally unproblematic. But to close off discussion of “conventional” forms of enhancement on the grounds that they are “often well established and culturally accepted” is question begging at best; at worst, it reduces the acceptability of ethical norms to cultural embeddedness or majority opinion. Rather than using the distinction to close off debate concerning “conventional” enhancements, Buchanan does the opposite. He uses the lack of an epistemologically or ethically salient distinction between normal, ubiquitous, conventional enhancements and novel, unconventional, radical enhancement technologies to undermine what he calls arguments against enhancement per se: “The harshest criticisms of biomedical enhancements appear to apply to enhancements per se, whether biomedical or not. [ …] if we accept that view, we would not only have to reject cognitive enhancement drugs, but must also regard literacy, institutions, and the agrarian revolution in a highly unfavourable light as well.” (Buchanan 2011a: 26–27). Buchanan’s proposal is to focus on the practical problems raised by specific technologies, but this also defers the conceptual problem that arises from the consideration of the relation between the normal and the enhanced. As Bernard Stiegler has pointed out, Buchanan’s inflationary concept of enhancement is nearly identical to anthropologist Leroi-Gourhan’s idea of hominization as exteriorization: the human is marked by technique; the human struggle for survival is facilitated by the development and utilization of external organs, technologies. Stiegler puts it nicely when he says: “this is the beginning of what is called today the enhancement of the human as the beginning of the human” (Stiegler 2012). Buchanan apparently unknowingly comes very close to Leroi-Gourhan when he writes that not only is “human progress dependent upon enhancement” but that “enhancement has made us what we are – human” (Buchanan 2011b: 24).
We can now parse this understanding of the inextricable link between being a normal human and enhancing oneself through Canguilhem’s account of health and normality. For Canguilhem, normality or health is not a statistical concept, but refers to an organism’s capacity to successfully respond to the demands made upon it by its environment. Canguilhem plays on Darwin’s idea that the most salient aspect of an organism’s environment are other organisms; for humans this means that the environment posing demands against which health or sickness will be assessed as states is also a technological, social and economic one. An organism is normal if it can flourish in a given environment, normalcy and health thus pertain to individual somatic and behavioral patterns that the organism adopts in order to respond to the challenges of its environment. Thus, health or normalcy have no absolute meaning for Canguilhem, but are rather an assessment of the relation between an individual organism and its environment. Canguilhem cites René Leriche to make his point: “under the same anatomical exterior one may be either sick or not […] in itself a lesion does not constitute a clinical disease” (Canguilhem 2008: 130). This entails a relativity of the normal and the pathological from one individual to the next, but within an individual life the experienced difference is absolute. What characterizes pathology in this context is an inability to respond to environmental challenges or shifts in environmental conditions. Canguilhem borrows an expression from the neurologist Kurt Goldstein in stating that the sick individual lives within a “shrunken milieu” which differs qualitatively and experientially from healthy life (132). In his emphasis on the qualitative experience of the individual as the criteria for assessing the distinction between the normal and the pathological, Canguilhem becomes phenomenological in a fashion that we can recognize from Merleau-Ponty’s phenomenological descriptions of pathology – for which he drew heavily on Goldstein’s studies of pathology and neurological injury. At least for humans, it is the experienced relation between one’s self and the environment that is most salient in the distinction between healthy and pathological life. Normal health as contrasting with pathology is not a fixed set of characteristics, but “the capacity to tolerate variations in norms […] An individual is truly healthy when he is capable of several norms, when he is more than normal. The measure of health is to overcome organic crises and to establish a new physiological order, different from the old” (132). Since the human environment is always a technological environment and since the human individual always extends or enhances itself by way of technology, the capacity to adapt to different demands is likewise nearly always bound up with a technical capacity of the individual.
What has fallen away here is not just the distinction between the normal and the pathological or the normal and the enhanced, but also the absolute distinction between all three terms, normal, pathological and enhanced. What has also fallen away is the notion of a fixed environment or set of environmental demands against which the states of normal, pathological and enhanced could be assessed. The technological extension of human life, which allowed it to better adapt to changing environmental demands also lends additional technological precariousness to health. A human being experiences health, in part, by mustering the technical capacities to respond to challenges posed by a technological-institutional environment. Humans must enhance themselves to feel normal. But a continuously changing technological-institutional environment and its correlative demands require that the organism also be continuous in technologically enhancing itself lest it fall into a pathological state by being unable to meet the technological demands of its human-made technological environment. The case of ADHD diagnosis and prevalence in the United States is an example of this. A change in the technological environment facilitates the emergence of the pathology that is named ADHD – a set of behavioral characteristics which might have been advantageous in another environment – a further change in the technological milieu, the introduction of the No Child Left Behind Act is hypothised to have raised the prevalence of the pathology, which is experienced as an incapacity to function well within certain technological environments. A social choice is then made between alteration of the environment and alteration of the affected individuals, primarily school age boys. The requisite further technological alteration to the individual is, in this case, made via psychopharmaceutical inventions which purportedly improve the experience of the individual and its capacity to respond to challenges within the relevant environment. Other individuals who do not manifest the maladaptation to the specific technological environment may also use the same enhancement technology to further improve their capacities within that environment. It is arguable that in both cases the desire to enhance is motivated by an experience of lack or to use Goldstein’s term, a “shrunken milieu” which can itself be described as pathological, even if it is not always medicalised.
An environment in which some individuals are deemed to have pathologies due to inadequate capacities to adapt to technical change may also itself shift, expanding or reducing the experience of pathology that creates the demand for enhancement. If for example, an individual is not able to meet the demands posed by a particular working environment without the use of an enhancement, a pathology is in this sense created. In this sense, due to a form of enhancement technology ‘lock-in’, the possibility arises that while a technology may improve individual performances on the individual level, at the social or environmental level it also creates technologically mediated pathologies that subsequently lead to experiences of limitation or “shrunken environments” not gains in autonomy. This is not a question of a gap opening up between the “normals” and the enhanced, as is often discussed in the literature, but of the creations of new pathologies through the emergence of new technological environments which place new sets of demands upon individual organisms.
In almost any contemporary work environment the use of language and writing technologies is required. Illiteracy can be understood both as a kind of pathology and a lack of a certain technological enhancement in such environments. In most social environments where this is the case, literacy technology is readily available, in the form of public education to nearly the entire population. This particular enhancement technology was a social invention that was designed to allow individuals to meet the demands of new (industrial) working environments that emerged in Europe in the nineteenth century (estimated illiteracy rates for English men dropped from about 40% to less than 5% between 1800 and 1900) (Mitch 2004: 344). One could likewise envision a situation where a particular social or work environment places a demand upon the individual that is best met through the intervention of psychostimulant pharmaceuticals. An inability (or unwillingness) to adopt this enhancement then becomes pathological within that environment. Thus a distinction remerges, not between the normal/healthy and the pathological but between the pathological and the enhanced. What falls away is the concept of the normal. What I think is key to fruitful engagement in the enhancement debate is the understanding that this dynamic is itself technologically-institutionally mediated. The environment that creates the demand for technological enhancement of human capacities is not a natural given, but is itself the result of processes of technological enhancement cum development. It is our engagement in and with these environmental conditions that determines the openness and health or closure and pathology of our relation with it. As Canguilhem writes: “in a sense there is no natural selection in the human species, to the extent that man can create new milieus instead of passively submitting to changes in old ones. And in another sense, selection in man has reached the limit of perfection, to the extent that man is the living being capable of existence, resistance, as well as technical and cultural activity in all milieus” (Canguilhem 2008: 128).
What I have tried to show through this initial discussion of the concepts and challenges facing the enhancement debate is that the concept of enhancement if taken in its inflationary sense, which I think it should be, does not slide neatly into the relations between the normal/healthy and the pathological, it fundamentally alters these relations to the extent that the distinction itself becomes suspect. Moreover, the relation that I have argued emerges in its stead, that of the pathological and the enhanced, is mediated by environmental relations with technological artifacts that mediate and facilitate our human capacities. Most relevant in the current discussion are those technological artifacts classed as cognitive artifacts – artifacts made for the aim of altering human cognitive capacities. Finally, this mediate relation between the always technologically enhanced human being and its technological environment should be analysed phenomenologically, in terms of how it is experienced by individuals, and particularly in terms of the experiences of openness and closedness of the environment and the possibilities that it presents to individuals. These analyses and indeed I think the future fruitfulness of the enhancement debates, which currently are at an impasse, require drawing on aspects of what I called above FE-PHEN-4E.