Passion, activity, and "the care of the self".

As a way of beginning to think about Prozac, and about other "enhancement technologies" as well, let's consider these sentences from Michel Foucault's The Care of the Self, the third volume of his "History of Sexuality": In keeping with a tradition that goes back a very long way in Greek culture, the care of the self is in close correlation with medical thought and practice. This ancient correlation became increasingly strong, so much so that Plutarch is able to say, at the beginning of Advice about Keeping Well, that philosophy and medicine are concerned with a "single field" (mia chora). They do draw on a shared set of notions, whose central element is the concept of "pathos." It applies to passion as well as to physical illness, to the distress of the body and to the involuntary movement of the soul; and in both cases alike, it refers to a state of passivity, which for the body takes the form of a disorder which upsets the balance of its humors or its qualities and which for the soul takes the form of a movement capable of carrying it away in spite of itself. On the basis of this shared concept, it was possible to construct a grid of analysis that was valid for the ailments of the body and the soul.[1] In this account, ideas about passion and activity are deeply implicated in conceptions of disease and health, both physical and spiritual. The care of the self, which is the defining ambition of philosophy, and the care of the body, which is the defining ambition of medicine, are both characterized as the conquest--however temporary--of "pathos." The philosopher and the physician equally struggle against an "involuntary movement," a disorder that presses itself on one from "outside" (so to speak), upsetting the internally regulated and harmonious balance of forces that is, in the ideal, one's natural activity. Health, whether of the body or of the soul, is pictured here as a certain sort of imperviousness, a capacity to resist depredations on one's internal ordering of oneself; to be well is to exercise a particular sort of well-ordered self-determination. To be easily "moved," and especially to be subject to "involuntary movement," is dangerous; to submit to "pathos" is to open oneself to disturbance and disease. And this way of thinking is not just an historical artifact, now replaced by much more detailed and accurate physiological accounts of disease etiology. We still think in these ancient terms, especially at the level of trope (and what deeper level is there?). In the ordinary forms of our talk with one another, we constantly find ourselves picturing illness as something that besets us against our will, as a disequillibrating force from "outside" our natural ordering, a "foreign" entity against which we struggle to free ourselves. "Don't get too close; I'm fighting a cold," we caution our neighbor. Or we report, "John's depression really has him by the throat these days." Or as children we tell a silly joke to explain why we got sick: "I slept with the window open and in flew Enza." We "suffer" our illnesses, we say, and that doesn't (just) mean that they often cause us pain. It means that we bear them; they come to us as passions to be undergone, as burdens laid on us, willy-nilly, from outside our natural course of orderly and self-determined activity.[2] Even our words "pathology" and "pathogen" enshrine the ancient idea that "pathos" is essentially linked to disease. Enhancement Rightly Earned How might Foucault's analysis help us to think about Tess, the woman transformed by Prozac in one of Peter Kramer's most memorable case histories?[3] Well, when Tess was ill with her depression, she was in the grip of a "passion," an "involuntary movement" of body and soul; that is, she was "moved" off her normal (self-regulating, self-determining) course through life by a "force" from "outside" that slowed her down, sapped her energy and hope, deflected her from her ordinary aims, and diminished her capacity for self-possession. …