By Sarah Hippolitus
A prospective college student walks into his doctor’s office for his mandatory wellness exam. He gets the required physical exam and his vital signs look good. He is given Hepatitis vaccinations for strains A, B, and C. Additionally he is given a tetanus shot, as required every ten years. He was immunized against measles, mumps, and rubella when he was young so he doesn’t need to re-vaccinate. The student’s immunization records and physical exam results, along with his signed certificate of “Health Examination and Immunity” are faxed over to the school’s wellness center, thereby completing his admission process. He has met the wellness standards for his university (and for most schools).
But aren’t these standards a little low? Have we not seen enough school shootings to raise them? I have.
A different scene: A prospective college students walks into his doctor’s office for his mandatory wellness exam. He is given the necessary vaccines required by the school and administered the standard physical exam testing his vital signs. He gets a PET scan, and it is determined that his monoamine oxidase A (MAO A) levels are quite low – a biological condition shown to be linked with aggressive behavior. In fact, he has been in and out of juvenile detention centers for vandalism and repeated assault. His parents made him go to therapy various times but to no avail. He never felt comfortable talking about his anger management issues and would just sit in the office with his arms crossed and stare at the clock. He is placed on an anti-depressant to increase his compromised serotonin levels, and an L-tryptophan supplement, an amino acid that increases serotonin levels thereby decreasing aggression (exercise also elevates tryptophan levels). Granted, there are many well-adjusted individuals with low levels of MAO A, but scientific studies* demonstrate a strong correlation between impulsive aggressive, criminal behavior and defects in this particular brain enzyme (lower platelet activity) involved in the metabolism of serotonin. He is ordered to have a psychiatric evaluation to determine his progress on the medication once a month for six months, and then once every three months. Follow-up paperwork is required to remain enrolled in school and will be kept in a confidential medical file at the university. The student’s immunization, physical exam results and drug prescription records, along with a signed certificate of “Health Examination and Immunity” are faxed over to the school’s wellness center, and his admission process is complete.
Of course, the first scenario is an everyday event, while the second one is just illegal. Yet where is the moral difference? It can’t be invasiveness – in the real-life scenario, we require someone to get a needle stuck in them depositing chemicals into the bloodstream. The second scenario is arguably less invasive – we are simply requiring someone to take a pill once a day, every day. Yet, society would not approve of requiring the second treatment for this student’s admission into school. Granted, one reason is that psychiatric drugs have more significant potential negative side effects than a vaccine, which usually causes minimal temporary side effects, if any. So, for the sake of argument, let us reasonably suppose medicine has advanced and there are no longer any harmful side effects to psychiatric drugs. My guess is that society would still have a problem with this proposal.
I suggest that society does not take mental illness seriously enough. Look at what we call it – “mental” illness, when it is clearly just as physical as any other illness. The label allows for the misconception that a person can think his way to good mental health. It’s high time we recognize the significant limitations of even the most advanced cognitive therapy. Of course, we want to utilize non-invasive treatments first – therapy, exercise, socialization, nutrition, and certain OTC supplements. I am not advocating medication as a first and only option. I am just pointing out the overlooked fact that sometimes a cognitive condition is serious enough where psychiatric drugs are necessary for behavioral improvement.
Do we assume that people have a special right to what goes on in their brains that they don’t have for any other body part? So, we can inject them with chemicals only if we aren’t treating a brain condition? Is it that we can’t legally do anything to someone’s brain that he doesn’t want done? – that can’t be it because we force kids to go to school until they are 18 (some states it is 16). So the moral difference can’t be forcing something upon another’s brain. It must be chemical force (via drugs), and specifically on someone’s brain.
This is troubling. We live in a society. If Dylan Klebold doesn’t want to take his medication, that refusal should be considered as a social and moral irresponsibility. I don’t think I should have to suffer the consequences of someone’s unhealthy, untreated brain. Again, we know that there is no definite behavioral expectation from something like low MAO levels, but let’s look at what’s going on in a brain like this in more detail. After all, aggression is a complex process mediated by several different areas of the brain.
Let’s say this young man also got a SPECT scan (Single Photo Emission Computerized Tomography, a sophisticated nuclear medicine study that looks directly at cerebral blood flow and indirectly at brain activity – or metabolism). In “Change Your Brain, Change Your Life”, Dr. Daniel Amen, MD, presents a common picture of a person’s brain with moderate to severe aggression issues. In our scenario, the following brain regions are defective as follows:
- “Decreased activity in the pre-frontal cortex (this area of the brain is involved in mediating concentration, impulse control, and critical thinking). Aggressive people often misinterpret situations and react in an impulsive manner.
- Increased activity in the cingulate, which causes people to become “stuck” on certain thoughts or behaviors. Aggressive people often become “stuck” on real or imagined injustices and think about them over and over.
- Increased activity in the basal ganglia, often found in patients who have anxiety or panic disorders. People who are aggressive often report a baseline level of tension or anxiety, and many clinicians have seen a pattern with these patients when they become increasingly more anxious before they act out.
- Increased activity in the limbic system. Studies consistently find that when the amygdala, a structure in the deep temporal lobes considered part of the limbic system, is stimulated, a person becomes more agitated and aggressive” (p. 218). (The limbic system heavily influences mood. Depression is caused in large part by low levels of serotonin, one of the three main neurotransmitters that influence the functioning of this brain region – the other two are dopamine and norepinephrine. Again, low MAO-A levels, aka the aggression neural correlate, result in low serotonin levels.)
We can see that several key brain regions in the left hemisphere are involved with an aggression disorder, and how they can be compromised. Again, should this hypothetical student be placed on prescription drugs to elevate his serotonin levels to offset the aggression as a prerequisite for college admission? Should he be required to undergo follow-up treatment to remain enrolled? Or, are we more comfortable with this student being admitted to a university with this kind of unregulated, defective, and volatile brain chemistry? This is the choice we confront. Let’s face it, if he goes untreated for too long and is provoked in just the right way, he could be set off and cause great harm to others on campus. If you think about it, crime is a consequence of letting someone’s brain chemistry remain his own private affair.
What if the Virginia Tech shooter had been required to undergo a brain scan and/or a psychiatric evaluation before being accepted? What if he had been required to take an anti-depressant? What if he had been required to follow-up regularly with a campus psychiatrist for continued enrollment? It cannot be argued that the tragedy could have been likely avoided this way. The alternative, not letting him go to school seems worse than just requiring him to take the necessary medication to regulate his aggression. The student in our hypothetical scenario earned the grades necessary to get into college, and it would be immoral to deprive him of an education because of his brain chemistry.
We all agree that we are morally obligated as a society to protect others as long as we don’t violate someone else’s rights. I argue we aren’t violating the student’s rights. The functioning capability of the brain is what drives our behavior. If he wants to go to school, he needs to be responsible for his behavior, which requires taking responsibility for his brain health. If this is a rights violation, I want to know why. If that is the case, there are serious ramifications to contend with – are these ramifications worth protecting this purported right? I really don’t think so – the stakes are too high.
There already is rapidly developing technology available for neurologists to devise brain implants to modify damaged areas of the brain. This might be an attractive alternative to psychiatric drugs. I suspect society won’t be keen on requiring brain implants either. Again, intuitions suggest that injecting chemicals into the bloodstream is okay, while insertion of silicon neuron chips onto regions of the brain isn’t. Why trust only intuition? Where is the relevant moral difference? I maintain that the moral qualm people have (I don’t, clearly) against controlling someone’s chemical interactions via psychiatric drugs in his brain is unjustified.
I expect the moral intuition is that requiring someone to heal their brains in this way is a violation of their freedom. We won’t mandate prescription anti-psychotic drugs, or brain implants – yet when a “mentally” defective person kills someone in an act of uncontrollable (yes uncontrollable) impulsive aggression, all we can think of to do is to throw him in jail. That surely is a restriction of freedom – where has our reverence for freedom gone then? You can’t say that jail isn’t invasive or freedom-restricting. And what about the freedom lost by the victim? We can’t ignore the tragic consequences of society’s unwillingness to exert some authority over the chemicals in someone’s brain. Ideally, the student would volunteer to be on medication, as that would be the ethical thing to do, but the assumption in this scenario is he doesn’t want to – maybe he thinks, thanks to society, being on an anti-depressant makes him a weak person. The conundrum is whether society may intervene to protect itself.
I want to close with a very moving passage from prominent psychiatrist, Dr. Daniel Amen (he is also a theist – don’t hold my atheism against me here, readers, this has nothing to do with it!):
I was raised in a strong Catholic family. I was taught to believe that if you lived a clean life and work hard, you will be successful. I believed that there was something the matter with character of people who were drug addicts, murderers, child abusers, and even those who took their own lives. After being involved with about five thousand brain SPECT studies my mind has changed completely. I now believe that it is essential to evaluate the brain when behavior is out of bounds. The brain is an organ that dramatically influences behavior, thoughts, and feelings [I’d say the brain causes behavior full-stop, not just dramatically influences it! – I think his theism is at play, but I could be wrong]. These cases and many like them are yet further examples to me to press on studying the brains of people with abnormal behavior. What we need is more understanding, more knowledge, and less judgment.
Sometimes I want to cry when I think of all the children and teenagers who are in group homes, residential treatment facilities, and juvenile halls, or who have run away from home because their families could not deal with them any longer. I know that many, many of them, have brain problems that have never been properly evaluated. Perhaps they have seen a local counselor or physician who looked at the abnormal behavior and told the parents that the child could behave if only he or she really wanted to. In today’s “enlightened” society, that attitude is a prevalent as ever. No amount of trying would have changed Peter’s behavior” [in this section, he is talking about a young male patient who he successfully treated with psychiatric drugs for serious aggressive tendencies, when all other therapeutic methods failed] (218).
The attitudinal barrier here seems to be a belief in the false concept of free will – if you just try hard enough, you can resist your impulses and behave desirably. Dr. Amen is right – you can’t simply “will” your way to mental health. Our brains need help, and in serious cases, chemical manipulation via psychiatric drugs is often the very best option.
I leave the reader with this final thought: If we can require vaccinations to protect people from being harmed by another’s physical defects, why can’t we require medication for the same purpose? Why can’t we “vaccinate” against crime?
“Crime Times, Vol. 3, No. 2, 1997 Page 7” http://www.autismwebsite.com/crimetimes/97b/w97bp8.htm
“Research Links Brain Chemistry with Aggressive Personality” http://www.physorg.com/news100187677.html