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Should We Try to Live Forever?

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We all want to live longer. Every year, billions of dollars are spent prolonging our lives, and we are still waiting for the pill that cures aging once and for all.

But if we lived forever, wouldn’t we just end up bored and depressed? Think about the goal you’re most invested in right now, whether that is getting a degree, searching for a romantic partner, raising children, or advancing your career. Part of what makes this goal compelling is that it has an end date, a point at which it will have been accomplished. But if our lives continued on forever, then eventually we would have no goals left to accomplish, leaving us apathetic, unmotivated, and potentially downright miserable.

A life worth living, though, is not merely the sum of our projects. Instead, there are certain things we enjoy doing simply for their own sake. These things include spending time with friends and family, reading a good book, listening to music, or going for a run – activities that do not cease to be fulfilling once they are accomplished. If not for our biological limitations, they could potentially go on without end.

Longevity is one of the most recent crazes in Silicon Valley, with leading figures pouring cash into extending their lifespans. Jeff Bezos and Sam Altman have both given millions of dollars to longevity start-ups, and Bryan Johnson, founder of e-commerce company Braintree, spends millions of dollars every year so that he can be functionally 18 years old again.

With all this money being spent on longevity, the science may not be far behind. David Sinclair, a longevity researcher at Harvard Medical School, thinks that current medical advances will allow some of us to live to at least 150. Some of these advances are thought to have the potential to not only slow death, but to reverse aging altogether.

This all raises an obvious question: Should we want to live forever? Most have assumed the answer is an obvious yes. Along with all of the current life-extending research, most major religions – including Christianity, Islam, Hinduism, and Mormonism – include the promised reward of an eternal afterlife. If given the choice, it seems like most of us would prefer to live forever.

Of course, there are circumstances that could make immortality unappealing. If I am chronically ill or depressed, then living forever might look more like a curse than a blessing. But assuming that we are in good mental and physical health, most people think that eternal life sounds like a pretty good deal.

But if we really think about it, would living forever actually be a good thing? Philosopher Bernard Williams thinks the answer is no. He considers the story of Elina Makropulos, the protagonist of the Czech opera The Makropulos Affair. After imbibing a potion that allows her to live for 300 more years, Elina goes on to become a widely renowned vocalist. Nevertheless, when it comes time to take the potion again, Elina is depressed and apathetic, and while she still fears death, she no longer desires to go on living.

Will the same inevitably happen to us? The long-term projects that make our lives meaningful – education, career, and family – could all be accomplished in a never-ending life. But once we get our degrees, climb the corporate ladder, and raise a family, what would we do then?

Even if we did have projects that couldn’t be completed in such a (relatively) short period of time, this probably wouldn’t help. We would either ultimately succeed at those goals and still have an infinite life ahead of us, or we would eventually recognize that some of our goals are impossible to achieve, an equally depressing realization.

But there is more to life than projects with definitive end dates. Consider some of the things you like to do for fun, like eating out with friends, attending local music festivals, or going for bike rides. Contrasted with projects that have some sort of end or telos, such activities are “atelic” in that they do not have any point where they will have been achieved.

Basing our happiness on project-based goals is likely to make us unhappy both right now as well as in an infinite future.  In his book Midlife, MIT philosopher Kieran Setiya points out that if our happiness is determined by telic projects and endeavors, then we will always be either striving for yet another accomplishment or aimless and depressed after we reach our goal.

The moral of this contrast is obvious. We should focus on deriving more of our happiness, not from the goals we accomplish, but the activities that we enjoy doing just for their own sake.

But along with offering us guidance on how to live in the present, the difference between telic and atelic activities explains why living forever could actually be a good thing. Our lives are a mix of both kinds of activities, but by and large, our goal-based projects are undertaken in service of the things that we enjoy doing for their own sake.

When asked what we would do if money were no object, many of us respond with some kind of atelic pursuit or activity. We mourn the loss of the freedom we had when we were young adults, able to simply enjoy our lives without the weight of so many goal-based responsibilities. And maybe that’s what living forever would be like, a return to a simpler, less demanding way of existing in the world.

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On Our Collective Empathy Fatigue

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A Vanderbilt University employee was recently lambasted for callousness after utilizing ChatGPT to write a letter to students in the wake of the Michigan State tragedy. While such an action clearly displays poor professional judgment, I think many of us (if we’re honest) can relate to a kind of emotional numbness in the face of yet another instance of suffering and loss in our society. While it is impossible to know if such feelings are what prompted that particular employee’s actions, it is clear enough that many of us currently face a type of emotional fatigue in the face of numerous, seemingly insurmountable problems.

These negative feelings are further amplified if we zoom out of our national landscape and consider the state of the human race at large. The worst earthquake to strike the Middle East in a century further devastated an already impoverished, war-torn population, and there is a constant humdrum of deep injustices such as modern slavery, food and water insecurity, and regional violence in far away places. Human beings, even the most compassionate amongst us, do not have the emotional or cognitive bandwidth to carry the weight of tragedies that fill the world.

This inability can lead to a particular kind of condition, sometimes referred to as empathy fatigue. The condition is a product of being continually subjected to upsetting news or circumstances, paired with an inability to fix the issues at hand. Symptoms of the condition include feeling lackluster about the future, disconnected from those around us, and numb to our emotions. Given we live in a unique historical moment where news from across the world is nearly instantaneously available to us, we have access to an endless stream of information that can serve as fodder for this condition. There is evidence that frequent news consumption stirs up anxiety and raises cortisol levels, but we’re nevertheless consistently inundated with news updates via our phones, computers, and social media feeds. Even if you’ve never experienced the full force of empathy fatigue, you’ve most likely felt at some point a type of powerlessness when it comes to making a meaningful, global impact.

So what is the remedy for these feelings of apathy and detachment? I propose a certain group of liberal skeptics are well-equipped to answer this question.

The communitarian critique of liberalism, while arguably failing in its more ambitious project of offering an alternative to the liberal political order, succeeds in highlighting certain pitfalls of modern life. The movement, primarily comprised of moral and political philosophers, pushes for an increased focus on human nature, contending that our social and political structures must be responsive to this nature if they are to promote human flourishing. Political liberalism is doomed to failure because it fails to accurately account for the conditions of human flourishing, or so the charge goes. Communitarians particularly emphasize the inadequacy of the “autonomous self” conception of the person, arguing that the existence of such an entity is a damaging fiction at the heart of liberalism. As human beings, we are not able to thrive as autonomous entities, but rather we thrive when embedded in networks of meaningful social relationships that help guide and constrain our actions.

Our social networks tend to serve as primary sources of meaning, purpose, and identity in our lives, and thus we also plausibly bear certain duties of service to these communities in turn. Communitarians borrow from Aristotelian thought by contending that personal flourishing is bound up in communal flourishing. Communal and individual health are woven together in a way often rejected or, at least, downplayed in modern society. This emphasis on holistic flourishing places Communitarians at odds with the current political binary that characterizes the United States. Communitarianism is opposed to the rise of the large-scale bureaucratic state associated with the political left, as well as the downstream impacts of consumer capitalism, which tend to erode the cultural particularities of local communities. The preservation and cultivation of rich local cultures is of great importance to Communitarians, and thus their social and political prescriptions are aimed at this end.

So what are the practical takeaways these Communitarian insights offer us in regards to our collective empathy fatigue?

Importantly, a takeaway is not that we should decrease charitable activity in places outside our local community or stop involving ourselves in social and political efforts that seek to enact large-scale change. Rather, Communitarian thought encourages us to embrace our local communities as a grounding anchor and to reflect on what we might morally owe to these individuals or groups in our immediate vicinity. For the mass majority of us, our family, friends, and local communities constitute our primary domains of influence. Despite this reality, a quick look at the relevant statistics seems to suggest many of us are failing to fully invest in these communities. For example, local elections tend to elicit significantly lower voter turnout rates than presidential elections. Grassroots community organizations are oftentimes doing life-changing, transformational work, but statistics show less than a third of Americans regularly volunteer, and rates of charitable giving have sharply declined in recent years. Additionally, data shows that almost one-quarter of people under the age of thirty do not know any of their neighbors, a large statistical increase from older generations.

Don’t let the outcome of empathy fatigue be complacency and detachment but rather local investment. Insofar as the condition is exacerbated by an excess of information about tragedies we can do nothing or very little to change, an increased focus on our local communities can help alleviate feelings of powerlessness that threaten to render us apathetic. The empirical data seems to back this up, as there are demonstrated personal benefits associated with serving one’s community. Thus, both yourself and your community will be better off if you choose to implement some of the insights of the Communitarian movement in your own backyard.

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“Suicide Kits” for Sale

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This article discusses suicide. Following common journalistic ethics practice, precise details about means or resources for committing suicide may have been deliberately left out or altered.

Method matters. Depending on the study, between 80% and 90% of people who attempt suicide and fail do not go on to attempt suicide again. The public health implication is that by regulating the availability of popular and effective means of suicide – mainly firearms and select chemicals and pharmaceuticals – deaths from suicide can be prevented.

Given this, what should we make of the fact that highly purified sodium nitrite, an increasingly popular option for suicide, has been readily available for purchase on Amazon in the United States? A lawsuit filed on September, 29th accuses Amazon and Loudwolf – a sodium nitrite manufacturer featured on Amazon – of “promoting and aiding” the suicide of two teenagers. A Twitter thread by Carrie Goldberg, a lawyer working on the case, characterized Amazon as a “serial killer.”

The case will likely turn on a number of details alleged by the plaintiffs: that Amazon recommendations packaged together sodium nitrite with other supplies and informational materials in so-called “suicide kits”; that Amazon failed to enforce its own policies; that Loudwolf failed to include FDA-required warning labels on sodium nitrite; that Amazon was previously warned and did nothing about sodium nitrite sold on its platform being used in suicides; that no information was included about methylene blue (the recommended treatment for sodium nitrite poisoning); that there is no compelling reason to allow household purchases of pure sodium nitrite; and, of course, that both deaths were minors.

Abstracting away from the details, however, the case is part of a decades-long pattern of the internet facilitating suicide – from providing community, to disseminating information, to assisting the purchase of supplies.

It began in 1990 with alt.suicide.holiday, a Usenet news group (similar to an internet discussion forum). Users would frankly discuss suicide and share tips and resources. While that group is now defunct, there have been multiple variants. The popularity of sodium nitrite as a means of suicide is attributed to a recent iteration. In many U.S. jurisdictions, advising or encouraging suicide is illegal, so these sites’ relationship with the law is complex – so too is their relationship with the media. Such forums begin as niche communities of the suicidal for the suicidal, and end up as New York Times exposés (most recently in December of 2021). Once aware, grieving families and the broader public often push (successfully) for these sites to be shut down or hidden from internet search results.

In contrast to the prevailing public health or prevention narrative of suicide, the leitmotif of these communities is, in their words, “pro-choice.” The idea is that the right to suicide is simply an extension of our personal autonomy and right to self-determination.

Especially in liberal individual rights-oriented contexts, autonomy is an enormously important ethical principle and people are given broad latitude to make their own decisions as long as they do not negatively impact the rights of others.

In American medicine, for example, patients have an almost unlimited license to refuse treatment. However, humans are not always autonomous actors. Children for instance are not allowed to make their own medical decisions. Being intoxicated is another common exception. In rare cases, people have been known to commit sexual assault or other crimes under the influence of the sleep aid zolpidem (Ambien). The defense is that these were not autonomous actions; that they did not flow from the authentic reasons and desires of the offender.

Can suicide be an autonomous act? Under the prevailing medical account of suicide, in which suicide results from serious mental illness, it almost definitionally cannot. In American law, risk of harm to self or others is grounds for violating patient autonomy and forcibly administering treatment.

That a person is suicidal is treated as evidence that they are not in sound mind and not an autonomous decision maker. Suicidality discounts autonomy.

Those in the online suicide “pro-choice” community challenge this logic and hold that suicide can be a reasonable reaction to a person’s life and circumstances, and people should have access to the knowledge and means to kill themselves relatively painlessly. In this they have at least some philosophical company. Thomas Szasz, a controversial Hungarian-American philosopher and psychotherapist, long asserted that suicide was simply a choice as opposed to an expression of sin or illness.

Szasz is an extreme case and was broadly skeptical of the very designation of mental illness. However, in contrast to a previous Christian sanctity-of-life framing, there is growing acceptance in the Western world that suicide may not always be unreasonable. Instead, it can be an understandable response to circumstances in which someone’s quality of life is below some personal threshold. A good case in point is the right-to-die movement, which advocates for medical-aid-in-dying and physician-assisted suicide. Ten states currently have medical-aid-in-dying in which a terminally ill person with six months or less to live is able to request a lethal medicine they can ingest. Supporters of medical-aid-in-dying stress that the practice is distinct from suicide, partly to escape the stigma associated with suicide, but the conceptual distinctions are slippery.

America is comparatively conservative, but several nations have far more permissive laws when it comes to assisted suicide. Belgium, the Netherlands, and Canada, among other countries, allow for voluntary euthanasia on the basis of extensive and untreatable mental suffering even absent terminal illness or, indeed, any physical illness whatsoever. (The ethics of this have been previously discussed here at the Prindle Post.) The 2018 case of Aurelia Brouwers, who was voluntarily euthanized in the Netherlands after years of failed mental health treatment, brought broader attention to the practice. She was the subject of a short film documentary.

Once it is accepted that unbearable suffering alone is an adequate basis for suicide, then distinctions about how long someone has left to live, or whether that suffering is mental or physical become secondary.

The process of seeking assisted suicide on the basis of mental suffering is supposed to have extensive safeguards, yet critics worry that slip-ups happen. Note, though, that the locus of discussion shifts from the act of suicide to the process of doing it responsibly and ethically.

Surprising to some, among the staunchest critics of the right-to-die movement are segments of the disability rights movement. The concern is that people may be pressured into choosing assisted suicide due to discrimination against people with disabilities or inadequate medical care, i.e. that these decisions are not fully autonomous. Of course, there will always be reasons for suicide, and these reasons may often be due to larger social and economic failings. Poverty is a known contributing factor to suicide. How reasonable this is may depend on where one is standing. In individual cases it is partly the environmental factors – poverty, debt, personal tragedy, discrimination – that can make suicide seem an appropriate response to circumstance. And yet, it may appear ghoulish to have a state-sanctioned process that facilitates suicides partly driven by these factors that the state itself perpetuates (or at least is often in the best position to address.)

Negotiating the appropriate policy prescription remains an impossible task. Mental health professionals, suicide prevention advocates, the American right-to-die movement, disability rights activists, and the online suicide pro-choice community can all share a broader commitment to self-determination and yet disagree vehemently about specific issues: when suicide is an autonomous act, what kind of safeguards need to be in place, what counts as unbearable suffering (or a lack of possibility of improvement), and what action is justified to prevent suicides.

Still, vanishingly few people would consider 16-year-olds killing themselves with online instructions and chemicals purchased on the internet as anything other than a tragedy.

It is statistically likely that had the teens in the lawsuit against Amazon attempted suicide with a less lethal method, they could have been successfully treated and their suicide attempt would have been a thing of the past.

Without speculating on the details of the specific case, it is nonetheless worth acknowledging that Amazon, whatever its failing as a corporation, cannot be the sole cause of this or any suicide. People are seeking information and supplies. And at least some suicides will default to known, highly lethal methods like firearms. It is also true that while the majority of those who attempt suicide and fail do not attempt again, previous suicide attempts are the single biggest risk factor for a later successful suicide. Put cynically, there is a demand. Regulating supply, while important given the relevance of the method, can only do so much. Suicide often exists at the intersection of means, mental health, and personal and environmental circumstance.

One relatively radical way to think about suicide would be as a regulated right – something permitted but tightly controlled. The provision of medical care and mental health care would presumably be part of seeking state-sanctioned suicide. People would need to have good reasons (whatever society decides those reasons are) for seeking materials-for or aid-in suicide, and undergo an appropriate approval process.

As countries like the Netherlands and Canada illustrate, negotiating what this approval process should be like is fraught. The balancing point of different communities with an interest in suicide including the suicidal, their families, mental health professionals, disability rights activists, religious communities, and the state will undoubtedly be a precarious one. Nonetheless, taking seriously the demand for suicide could plausibly help to bring suicidality out of the dark as something that people can talk seriously about and potentially get treated for. Surely a society ought to inquire as to why its citizens wish to take their own lives.

If you or someone you know is struggling with thoughts of suicide, (prevention-focused) resources can be found at SpeakingOfSuicide.com/resources.

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Moral Burnout

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Many workers are moving towards a practice of “quiet quitting,” which, though somewhat misleadingly named, involves setting firm boundaries around work and resolving to meet expectations rather than exceed them. But not everyone enjoys that luxury. Doctors, teachers, and other caregivers may find that it is much harder to avoid going above and beyond when there are patients, students, or family members in need.

What happens when you can’t easily scale back from a state of overwork because of the moral demands of your job? It might lead to a specific kind of burnout: moral burnout. Like other varieties of burnout, moral burnout can leave you feeling mentally and physically exhausted, disillusioned with your work, and weakened by a host of other symptoms. Unlike other varieties of burnout, moral burnout involves losing sight of the basic point or meaning of morality itself.

How could this happen? Many people enter caregiving professions out of a desire to help people and do the right thing — out of a deep commitment to morality itself. When people in these professions find that, despite their best efforts, they cannot meet the needs around them, it can be easy to feel defeated.

Over time, the meaning of those moral commitments can become eroded to where all that is left is a sense of obligation or burden without any joy attached to it. The letter of the moral law has survived, but not its spirit.

Moral philosophers often try to defend morality to the immoralist who only cares about themselves and maybe the people around them. But it seems to me that there might be an equally strong challenge from the other side: the hypermoralist who tries to follow morality’s demands as best they can but who is left cold and exhausted, no longer seeing the point of morality though still feeling bound to its dictates. What might the moral philosopher say in defense to this kind of case? It seems that it depends on diagnosing what exactly has gone wrong.

So, what has gone wrong when “moral burnout” appears? First, it seems that, like in normal cases of burnout, the person is not receiving enough support or care themselves. This might be from a systematic failure, such as doctors being unable to get their patients the care they need due to injustices in the healthcare system. It could be from an interpersonal failure, where friends and family members in that person’s life fail to see their needs or adequately support them. Or perhaps it is from an individual failure, such as the person failing to reach out for or accept help.

The main problem is that there is a significant mismatch between the amount of morally significant labor that the person gives and the amount of support and recognition they receive.

This mismatch alone, however, is not enough to explain why the hypermoralist is left cold by morality. Sure, they may feel exhausted and disillusioned with their job or the people around them, but they might say something like “morality is still worthwhile; it’s just that other people aren’t holding up their end of the deal with me.”

What else is required to become disillusioned with morality itself? Especially for those who were raised to take all the responsibility on themselves, it’s easy to misunderstand morality as having to do only with duties to others and not at all with duties to oneself. In this case, the person can fail to properly value or take care of themselves, and lose sight of an important part of morality – self-respect. It is no surprise that this kind of person would become disillusioned.

Even for those who understand the importance of duties to oneself, it can be easy to fall into a similar trap of self-sacrifice if no one else will take responsibility for a clear and present need.

Another possibility is that, even though the person recognizes and works to fulfill duties of self-respect and self-care, they may find themselves caught up in a kind of rule fetishism, where morality becomes merely a list of moral tasks to complete. Self-care becomes another obligation to fulfill, rather than a chance to rest and recuperate. In this state, morality can seem to be a matter solely of burdens and obligations that must be completed, without the sense of meaning that one would normally get from saying a kind word, helping someone else, or standing up for oneself. Perhaps the hypermoralist has lost sight of the possibility of healthier relationships with others, or is unable to set healthy boundaries within their relationships or accept friendship and help from others.

Like friendship, morality is not transactional – it isn’t simply a set of tasks to complete. Morality is essentially relational.

Though praising and blaming ourselves and others for the actions we perform is a core part of our moral practices, these norms allow us to analyze whether we stand in the right relation with ourselves and with others. It is no surprise, then, that the hypermoralist has lost the meaning of morality if they have substituted its relational core of love for self and love for others with a list of tasks and obligations that lack relational context.

So, what can the hypermoralist do to regain a sense of moral meaning? The answer to that question depends on a host of considerations that will vary based on the individual in question. The basic gist, however, is that it’s vital to seek meaningful and healthy relationships and advocate for support when it’s needed. For example, a doctor in an unjust working environment might protest the indifference and profit-motivation of insurance companies who stand in the way of their patients getting the care they need. Ideally, this would not be another task that the doctor takes up alone but one that allows them to be in solidarity with others in their position — meeting people they can trust and rely upon along the way. Seeking out those meaningful and healthy relationships (moral and otherwise) can be tricky. But I hope for all of us that we can find good friends.

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Should I Stay, or Should I Go: Holidays in the Age of Coronavirus

photograph of "Stay Safe" message among pumpkins and thanksgiving background

Some of the busiest holidays in America — Thanksgiving, Christmas, and New Years — bring floods of people into airports, who are all looking to travel across the country to see family that they might not have seen all year. Normally, the last few months of the year bring plenty of opportunity for those families to meet each other over pounds of food and gift exchanges. The year of 2020, however, is anything but normal. The coronavirus has put a halt to any and all ideas of what was once considered typical. This virus has been ravaging the world for almost a year now, and the country has managed to still celebrate some holidays, such as the Fourth of July, as summer weather allowed for outdoor gatherings where it was easy to social distance, and harder for the virus to spread. Now that winter is coming on, however, these get-togethers will have to be inside the homes of Americans, with far more risk of transmission. As cases climb and hospitals fill, one has to ask what the appropriate course of action is for Americans who want (understandably) to visit family during the holidays, while this pandemic is surging forward with little end in sight.

As scientists have been concerned about since the beginning of this pandemic, the world appears to be entering a second wave of coronavirus cases. After opening up during the summer months, Europe is introducing new restrictions limiting which businesses can open, as well as night curfews for citizens, as they see cases beginning to surge across the continent. Due to far less restrictions than Europe, and the lack of a cohesive federal response to COVID, America never really cleared the first wave of the virus. While the summer months saw a decline in cases, recently the country set a new record of 90,000 cases in a single day, bringing the total cases to nearly 9 million just in the U.S. As cases rise, hospitals are quickly beginning to fill up, which when this virus first hit led to people dying in hallways of hospitals, mass burials, and hospital workers not having proper equipment to protect themselves from the virus. While in the summer it appeared as if the country was past those horrible conditions, the colder months have brought a reminder of the fact that the world is still very much in the midst of this pandemic.

As the temperature grows colder people are coming in contact more often in enclosed spaces, which increases the spread of the virus. But there is also the issue of pandemic fatigue. This virus has taken over every aspect of life, putting extra stress on everyone’s lives. People have had to create new routines and question behaviors that they once thought completely normal, like hugging grandma. People are growing weary of the fact that life is not what it once was, and that there is an ever-present threat that continues to loom over the entire globe. This exhaustion can lead to an increase in cases as people begin to exercise more risky behavior, like dining inside or going to large events, as if we’ve beaten the virus. As we head into the holidays it makes sense that people want to spend time with their loved ones, especially ones that they haven’t seen for months. The winter months already see a combination of seasonal depression with regular depression among people, and COVID certainly led to a decline of mental health among Americans. The rates of both suicides and opioid overdoses have become very concerning for public health experts who warn of an underlying mental health crisis as a result of the stress and anxiety surrounding the coronavirus. People have been isolated from their families and friends for months because of travel restrictions, and now is the time when people most often travel to see their loved ones. It makes perfect sense that people would want to gather for comfort and strength in these very uncertain and stressful times. Many families have lost loved ones — there are over 230,00 deaths in the U.S. currently — and this is the first time that they will have to experience these holidays without those people present. Grief is a powerful emotion, and mixed with pandemic fatigue, this may lead to people willing to take more risks in order to seek comfort in their families.

The winter holidays are most definitely some of the busiest days of the years for travel, either by car, plane, or other transport. This creates a big risk for people who want to visit their families, but need to visit airports to make it home. Just last year over 45 million people traveled on American airlines throughout the globe over this time period. Considering the fact that many countries have restrictions on who can come in, and America is often on the list of those nationalities who are not allowed in, that number will most definitely be lower. Masks are required throughout the airports and during the flight, which would make it seem as if these flights were quite safe. A new study even came out recently which concluded air travel was safer than eating at a restaurant, albeit this study was sponsored by the air industry, which is desperate for flyers due to the loss of revenue from air travel being restricted throughout the entire globe. A recent long distance flight to Ireland, however, questions the validity of this study as 13 passengers tested positive for the coronavirus on the flight, and then passed it on to people in Ireland, for a total of 59 cases all linked to this flight. Throughout the pandemic, the coronavirus has shown how little we actually know about the virus, as even mask wearing was once deemed not important by health officials. But now calls for a national mask mandate have been amplifying, as they have proven to be extremely effective in stopping transmission of the virus. So the question of risk regarding air travel remains up in the air.

This last year has probably been one of the most stressful, if not the most stressful, period of most people’s lives around the world. This virus is something that none of us can ignore because it affects everyone. If it takes the whole world to spread the virus, it seems it is going to take the whole world working together in order to stop it. This end appears to still be quite a ways off, however, and people are still left with a feeling of inevitableness of this eternal feeling of waiting. Understandably, the first instinct for a lot of people might be to reach out to those closest to them. Some might want to continue decades-long traditions that their families have carried on in an attempt to find a sense of normalcy in these strange times. The Centers for Disease Control (CDC) has information on their website to help people make responsible decisions if they decide to have some sort of celebration for the holidays. But, one must remember that these are strange times, and any contact with people outside those you live with carries some level of risks. As with most things during this pandemic, people will have to consider the risks of celebrating the holidays this year with those they hold most dear.

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The Politics of Depression

blurred photograph of crowd on busy street at night

In contrast to the exuberant energy of the 2016 presidential election (for better or for worse), the 2020 election has been characterized by fatigue, anxiety, and even depression. Regardless of which candidate triumphs in the presidential election, many voters on both sides can’t help feeling daunted by the government’s inability to meet the needs of its citizens.

The language of illness has always been a useful lexicon for politics; the metaphor of the “body politic” informed statecraft in Europe for centuries, and enemies of the state have always been described as a disease eating away at that body. But for those members of the body politic struggling with mental illness, the question is how to remain politically active while battling depression, especially when the stakes are so high.

Depression may be the mental illness par excellence for political discourse under capitalism. While capitalism has been linked to schizophrenia (we are expected to be sober workers by day and hedonists by night, as sociologist Daniel Bell points out, which ultimately creates a fractured psyche), Mark Fisher draws comparisons between his experiences with depression and the mindset induced by capitalism. In his 2009 book Capitalist Realism, he writes that “while sadness apprehends itself as a contingent and temporary state of affairs, depression presents itself as necessary and interminable: the glacial surfaces of the depressive’s world extend to every conceivable horizon.” He sees a parallel between the “the seeming ‘realism’ of the depressive, with its radically lowered expectations, and capitalist realism.” As Fisher understands, enacting political change and fighting depression are struggles against a similar opponent.

Depression itself is becoming increasingly political, both in terms of how we conceptualize it and how we attempt to cure it. Danish literary critic Mikkel Krause Frantzen proclaims in an incendiary essay for the LA Review of Books that “any cure to the problem of depression must take a collective, political form; instead of individualizing the problem of mental illness, it is imperative to start problematizing the individualization of mental illness.” He asserts that “Dealing with depression—and other forms of psychopathology—is not only part of, but a condition of possibility for an emancipatory project today. Before we can throw bricks through windows, we need to be able to get out of bed.” This political approach to illness is rooted in a wider politicization of illness. For example, Anne Boyer writes in her recently published memoir about cancer, The Undying, that “Disease is never neutral. Treatment never not ideological. Mortality never without its politics.” Boyer rejects apolitical cancer treatment, noting that “Our genes are tested, our drinking water is not. Our body is scanned, but not our air . . . The news of cancer comes to us on the same sort of screens as the news about elections.” Like cancer, depression is often viewed as purely somatic, not as a condition with a basis in the material reality of the afflicted.

When we acknowledge that material reality, we create the potential to radicalize those with mental illness. However, the fatalistic mindset of depression often discourages political engagement. One study conducted by researchers at Pennsylvania State University, which argues that “that depression is a political phenomenon insofar as it has political sources and consequences,” found that mental illness “consistently and negatively affects voting and political participation.” Furthermore, “depression also has developmental consequences for political behavior. Adolescent depression has the potential to set individuals on a trajectory of political disengagement in adulthood.” The study paints this as a vicious cycle; without adequate mental health care, we become depressed, and then depression inhibits political engagement, which prevents healthcare policies from ever changing. The study concludes that though research into the neurological aspect of depression is extremely important, it is also,

“worthwhile to theorize about depression in terms of the social model, especially because the experience of a mood disorder such as depression is largely rooted in social circumstances. Depression is socially-situated in so far as it is not something that simply ‘happens’ to someone but arises out of the circumstances of life. This is compounded by the fact that traditionally disadvantaged groups disproportionately experience depression.”

So how can the mentally ill break out of that vicious cycle? There is no easy solution to this dilemma. Even recognizing that major changes that need to be enacted in order to create a liveable world isn’t always enough. As Frantzen says, “there is no reason to believe that abolishing private property ownership, or realizing a global and absolute cancellation of private debt, will relieve the suffering of depressed people with a single stroke, as if by magic.” For voters experiencing a sense of hopelessness at the polls, and who fear plunging to an even greater depth of hopelessness on election night, a radical kind of self-care is needed. Many have already pointed out the often vacant politics of “self-care,” which does not always promote social change as much as we’d like it to. But when self-care is able to foster “not competition among the sick, but alliances of care that will make people feel less alone and less morally responsible for their illness,” in Frantzen’s words, it is certainly a step in the right direction.

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Depression, “Special K,” and the FDA

refracted rings of yellow light emanate from red core

Recently approved by the FDA is the newest groundbreaking antidepressant by the name of Esketamine. In the form of a nasal spray, the drug can treat symptoms of depression in a matter of hours. Esketamine is composed of the chemical ketamine and will be produced by the company Johnson & Johnson. This drug could offer relief to those who are suffering from Treatment Resistant Depression (TRD). TRD is when people have tried two or more antidepressants without success. Major depressive disorder effects 300 million people globally and approximately 1 in 3 people that suffer from depression would qualify for the treatment.

There are many positives that come from this new drug. Depression is still widely studied and is difficult to treat because everyone responds differently to antidepressants. Esketamine gives those who were once hopeless a new option for finding a successful treatment. Those who take the drug will no longer suffer from the very serious mood disorder that once hampered their daily lives.

In addition, this research has led to groundbreaking findings relating to the drug ketamine, the major component in esketamine. Ketamine is used as an anesthetic for “children or patients undergoing minor surgeries”and veterinary purposes. However another main use of ketamine was its infamous reputation as a party drug, called “special K.” Taken at high doses, ketamine can cause users to hallucinate and lose sense of time and reality. People “trip” on the drug in the same way they might trip on LSD and other hallucinogenic drugs. The drug became such a problem that in 1999 the federal government classified ketamine as a Schedule III controlled substance to make an effort in stopping its recreational use.

Patients who take esketamine can experience side effects from ketamine. Such side effects are serious and can lead to memory loss, hallucinations, and loss of body control. That’s why ketamine is unique in depression treatment as the drug cannot be brought home. Instead, the antidepressant is administered from a certified treatment center. Patients are required to return to the treatment centers once or twice a week.

One issue to consider with ketamine is its limited accessibility. Because the drug needs to be closely monitored, the only people able to receive the treatment are those with access to authorized treatment centers. In addition, the list price of the drug is currently set at $590 to $885 per treatment session depending on the dosage. For just the first month of treatment, the expected price range is between $4,720 and $6,785. This limits the usage of the drug to only those who can afford to take it.

While the FDA approved the treatment, it was given a “black box warning,” the most serious warning that can be issued. “It will caution users that they could experience sedation, problems with attention, judgement and thinking, and there’s a potential for suicidal and abusive thoughts,” explains the Washington Post. The FDA advisory committee approved the drug in a vote 14-2. The approval process differed from other approved antidepressants. TRD qualifies the drug for “fast track” approval because of the severity of the disorder and the need of the product. Instead of having two positive short-term trials of the drug, keramine only had one positive trial. It then had a second trial that was a withdrawal study.

Kim Witczak is a member of the advisory committee and a consumer representative that voted against the drug. Witczak wrote in a blog that she feared the limited case trials and the serious side effects that come with the drug outweighed the potential benefit the drug can bring. She said, “I cannot vote for something when the perceived benefits do not clearly and demonstrably outweigh the potential for known harms such as sedation, dissociation, and long-term cognitive or memory loss — this is especially so considering the extremely limited positive clinical trial results.” In her rebuttal, she criticized the ineffectiveness of other trials and how there was only one positive short-term trial. There were also participant suicides that occurred during the trials that were “glossed over and presented as unrelated.”

Although Witczak is just one opinion on the FDA advisory board, it is still important to consider her objections. In particular, Witczak notes the conflicts at the heart of FDA drug approval. Should we “fast track” drugs that have an urgent demand? Should we scale down the process to help more people quicker?

The hope is that Esketamine is just the start of treatments that more effectively treat depression. Although it is called groundbreaking today, we could also consider other drugs that were groundbreaking at the time. Prozac was the game changer antidepressant in the 1980s and it was only after this that people discovered the true inadequacy of antidepressants and the dangers associated with them including suicide and withdrawal. With a drug with so many risks like ketamine it is intriguing to think of the impact it will make in the long run.

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Sparking Joy: The Ethics of Medically-Induced Happiness

Photograph of a sunflower in sunshine with blue sky behind

This article has a set of discussion questions tailored for classroom use. Click here to download them. To see a full list of articles with discussion questions and other resources, visit our “Educational Resources” page.

Happiness is often viewed as an ephemeral thing. Finding happiness is an individual and ever-developing process. Biologically speaking, however, all emotions are the simple result of hormones and electrical impulses. In a recent medical breakthrough, a team of scientists has found a way to tap in to these electrical impulses and induce joy directly in the brain. This kind of procedure has long been the stuff of speculation, but now it has become a reality. While the technique shows a good deal of promise in treating disorders such as depression and post-traumatic stress, it also presents an ethical conundrum worth considering.

On initial examination, it is difficult to point out anything particularly wrong with causing “artificial” joy. Ethical hedonism would prioritize happiness over all other values, regardless of the manner in which happiness is arrived at. However, many people would experience a knee-jerk rejection to the procedure. It bears some similarity to drug-induced euphoria, but unlike illicit drugs, this electrical procedure seems to have no harmful side effects, according to the published study. Of course, with a small sample size and a relatively short-term trial, addiction and other harmful aspects of the procedure may be yet undiscovered. If, as this initial study suggests, the procedure is risk-free, should it be ethically accepted? Or is there cause for hesitation beyond what is overtly harmful?

The possibility of instantaneous, over-the-counter happiness has been a frequent subject of science-fiction. Notable examples include Aldous Huxley’s Brave New World, which featured a happiness-inducing drug called “soma”; and Philip K. Dick’s Do Androids Dream of Electric Sheep? (later adapted into the film Blade Runner), which included a mood-altering device called a “mood organ.” Both novels treat these inventions as key elements in a dystopian future. Because the emotions produced by these devices are “false”—the direct result of chemical alteration, rather than a “natural” response to external conditions—the society which revolves around them is empty and void of meaning. What is the validity of this viewpoint? Our bias towards what we perceive as “natural” may be simply a matter of maintaining the status quo–we’re more comfortable with whatever we’re used to. This is similar to the preference for foods containing “natural” over “artificial” flavoring despite nearly identical chemical compositions. While we are instinctively wary of the “artificial” emotions, there may be no substantive difference to the unbiased feeler.

Of course, emotions exist for more than just the experience of feeling. The connection between emotions and the outside world was addressed by Kelly Bijanki, one of the scientists involved in the electrically-induced happiness study, in her interview with Discover Magazine: “Our emotions exist for a very specific purpose, to help us understand our world, and they’ve evolved to help us have a cognitive shortcut for what’s good for us and what’s bad for us.” Just as pain helps us avoid dangerous hazards and our ability to taste bitterness helps us avoid poisonous things, negative emotions help drive us away from harmful situations and towards beneficial ones. However, living in a modern society to which the human body is not biologically adapted, our normally helpful sensory responses like pain and fear can sometimes backfire. Some people experience chronic pain connected to a bodily condition that cannot be immediately resolved; in these cases, the pain itself becomes the problem, rather than a useful signal. As such, we seek medical solutions to the pain itself. Chronic unhappiness, such as in cases of anxiety and depression, could be considered the same way: as a normally useful sensory feedback which has “gone wrong” and itself become a problem requiring medical treatment.

What if the use of electrically-induced happiness extended beyond temporary medical treatments? Why shouldn’t we opt to live our lives in a state of perpetual euphoria, or at least have the option to control our emotions directly? As was previously mentioned, artificial happiness may be indistinguishable from the real thing, at least as far as our bodies are concerned. Human beings already use a wide variety of chemicals and actions to “induce” happiness–that is, to make ourselves happy. If eating chocolate or exercising are “natural” paths to happiness, why would an electrical jolt be “unnatural”? Of course, the question of meaning still bears on the issue. Robert Nozick argues that humans make a qualitative distinction between the experience of doing something and actually doing it. We want our happiness to be tied to real accomplishments; the emotion alone isn’t enough. More concretely, we would probably become desensitized to happiness if it were all we experienced. In the right doses, sadness helps us value happiness more; occasional pain makes our pleasure more precious.

If happiness in the absence of meaning is truly “empty,” our ethical outlook toward happiness should reflect this view. Rather than viewing pleasure or happiness itself as the ultimate good, we might instead see happiness as a component of a well-lived life. Whether something is good would depend not on whether it brings happiness, but whether it fulfills some wider sense of meaning. Of course, exactly what constitutes this wider meaning would continue to be the subject of endless philosophical debate.

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Why Act When It Doesn’t Make a Difference?

This post originally appeared on May 28, 2015.

I’ve got a friend who’s suffering from depression. He’s been holed up in his house for the last two years; living first on sick pay, then savings; venturing out only for fish and canned vegetables. (“They’re healthy.”) I visit him from time to time, which isn’t often enough, and I excuse the infrequency with a lame thought: it doesn’t matter whether I go.

The problem is not that I’m wrong. He doesn’t want visitors, we have the same conversation each time, and he isn’t getting any closer to the man he once was, all bright and bounding. If I’m showing up to make a difference, I’m probably wasting my time.

This defense of inaction is psychologically powerful. We know how the election will play out, so we don’t vote. We know that having tofu won’t save a cow from slaughter, so we have the burger. We know that Old Navy isn’t going to notice whether we shop elsewhere, so we may as well save some money. When we can’t make a difference, why bother?

Sometimes, because we’re wrong. It only seems like we can’t make a difference because so many people contribute to the effect. This tends to be the story in consumer ethics: industries don’t care about what any one person does, but they certainly care about what lots of people do, and “lots of people” don’t do anything if we don’t do something.

In other cases, we really can’t accomplish what we’d like—too few are willing to take up the cause—but we can do something else worthwhile. Consider, for example, participating in Adjunct Walkout Day. My university isn’t going to start paying adjuncts a living wage, so canceling class for their sake feels pointless. By joining in, though, we stand in solidarity with those who aren’t being treated fairly, insisting that wrongdoers be held accountable. That’s a far cry from achieving securing fair wages, but it still isn’t trivial to encourage and criticize, respectively, those who deserve encouragement and criticism.

All that said, my friend’s depression isn’t a collective action problem; it isn’t as though a few more supporters will tip the scales. Protest won’t help either: depression may be a thief, but it can’t be shamed. And we could conclude, on this basis, that my excuse is a good one. But I remain unsatisfied by it. When I drive the twenty-two miles to his door, I’m his friend. When I pick up a book instead, I’m not. And that choice isn’t trivial.

It might sound like I’ve just made this about me. “I can’t make a difference in my friend’s life, but I can make a difference in mine: I can choose what sort of person I’ll become, the ideals that I’ll embody.” And although those things are true, they’re beside the point.

Which is this: sometimes, difference-making doesn’t matter. If I’m going to be a friend, I’m going to sit with him in his depression. Not at the expense of everything else in my life—that’s martyrdom. But at real expense, since that’s what friendship involves. Likewise, if I’m a citizen, I vote; if I’m compassionate, I don’t want anything to do with factory farms. That’s what it is to be a friend, or a citizen, or compassionate. And that’s why we aren’t bad friends or citizens if we fail, or a little less compassionate when we keep eating animals. Rather, we are “friends” and “citizens” and “compassionate.” We have different versions of these relationships and roles and virtues—the paltry, calculating ones where “This is my country” isn’t argument enough for voting, and “That creature suffered needlessly” isn’t argument enough for abstaining. Not so with the versions worth having: they settle how we ought to proceed. (Indeed, that’s much of why they’re worth having.)

Why act when it doesn’t make a difference? In some cases, because it does—though only with some help, or not how we’d hoped. But often enough, this is the wrong sort of question to ask, and the right kind is much simpler:

Are we friends?