Ethical issues in moral and social enhancement

5.3.6. Social control: are we moulding ourselves to fit society instead of 
adapting the society to fit people’s needs? 
An important related issue is that social factors contributing to problems are 
downplayed in comparison to individual biological and psychological factors. The 
increased pressure to perform and to keep pace with society’s increasing demands 
can be seen as an under-recognized part of the problem in adult ADHD (Schermer, 

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2007). The challenges that individuals encounter are framed as individual rather 
than social problems – it is the person that does not perform well enough rather than 
society in need of change. One of the critiques of the use of ADHD diagnosis is that 
when the over-stretched educational system cannot adapt to children’s needs, 
children who are a problem for the system land in doctor’s offices and often get a 
prescription for stimulants (Graham, 2007). The argument here may be that we are 
putting the cart before the horse, forgetting that it is individuals who matter, not the 
abstracted idea of the society.
The more direct negative consequence is that medicalisation may distract attention 
and direct resources away from changing the social structures and expectations that 
can produce suffering in the first place. Perhaps rather than changing the bodies of 
shy people with drugs, we should change our expectations of how people behave in 
novel situations (Parens, 2011) and create environments that are facilitative of 
people with different skills, behaviours and strengths. The tension between attempts 
to change an individual and to adapt the society is clearly visible in the recent 
history of conceptions of disability and the disability movements. On the one hand, 
people with movement disabilities have greater access to rehabilitation than ever 
before, stem cell scientists are working to create a way of addressing spine injury 
and new prosthesis and wheelchairs have been adapted to a variety of activities. On 
the other hand, patient and ‘users’ groups fought for improvements in how 
accessible the environment is for people with movement problems (public buildings 
and many leisure facilities became wheelchair-accessible for example). Each of 
those stances came with an associated view of disability (social vs. medical) which, 
although not necessarily mutually exclusive, are nevertheless associated with 
different practical approaches.
This argument, I think, carries some weight. However, it still leaves us with the 
issue of how to address the outlined problems. In the context of ADHD, we might 
wonder whether it would be better for those children who struggle in the imperfect 
educational system to continue without the pharmacological aid. Provided that the 
pharmacological solutions are safe and effective enough, it seems to me that 
pending the needed social action, we have a good reason to provide the 

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pharmacological remedies. If we consider the problem of ‘the wrong focus’ in 
isolation from the possible side-effects of the medication, I think that the objection 
is too weak to ground a robust critique of medicalization.
The critic of medicalization could see many of the problems that medicine seeks to 
remedy as stemming from the bad organisation of our societies. For example, the 
rise in obesity in Western countries may be seen to be a result, for example, of an 
increase of physically passive jobs and the increased availability of cheap, calorie-
rich food served in big portions, along with the strong lobbying power of the food 
industry. A gastric band surgery, gastric bypass surgery or an effective anti-obesity 
pill might ameliorate some of the negative effects but does not address the root 
cause of the problem. It could be argued that the prevalence of mental illness, 
including depression, can be seen to be a direct or a down-the-line result of living in 
a modern capitalist system, with its economic ups and downs, uncertainties and 
pressures, the necessary economic relocations which fracture social bonds, and the 
lifestyle of a modern worker which is not conducive to wellbeing (e.g. Link and 
Phelan, 1995). Medicine (and related science) can be seen as a part of the social 
order, reinforcing it by smoothing the roughest edges or at least giving hope that 
something can be done. Medicalization is ultimately seen as a mark of social 
control in a pejorative sense of the phrase – 
de facto
creating effective workers and 
dissolving dissent. To propose symptomatic solutions is to leave the cause intact 
which perpetuates and even reinforces the bad underlying dynamics.
An analogical argument can be made specifically in relation to the moral domain 
and moral education. Many education scholars notice a general move from 
supporting the teaching of subjects that were typically conveyed knowledge, values, 
beliefs and skills necessary for developing moral agency, such as art, literature, 
religious studies towards making schooling and the curriculum serve economic 
purposes. On the other hand, the existence and smooth functioning of the society 
and organisations depends on citizens’ ability to display a number of moral and 
civic virtues and behaviours, including responsibility, respecting the interests of 
other persons, not harming others, tolerance, etc. A critic of medicalization might 
point out that the medical conditions labels used to describe ‘disruptive behaviour’ 

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such as oppositional defiant disorder and conduct disorder, detract from the causes 
and appropriate solutions.
For example, Oppositional Defiant Disorder (ODD) is characterized by the frequent 
occurrence of at least four of the following behaviors: losing temper, arguing with 
adults, actively defying or refusing to comply with the requests or rules of adults, 
deliberately doing things that will annoy other people, blaming others for his or her 
own mistakes or misbehavior, being touchy or easily annoyed by others, being 
angry and resentful, or being spiteful or vindictive. ‘Defiant behaviors’ may include 
persistent stubbornness, resistance to directions, and unwillingness to compromise, 
give in, or negotiate with adults or peers and the deliberate or persistent testing of 
limits, usually by ignoring orders, arguing, and failing to accept blame for 
misdeeds. Instead of encouraging schools to teach impulse control, emotion 
management skills, problem solving, taking one’s stance respectfully, as well as 
reasoning through disagreement and ethical issues (much of which is included in 
the ‘character education’ approach to moral education), children who do not 
conform to the prescribed ways of behaviour enforced by economically strained 
educational system, are given ADHD medication (stimulants), atypical 
antipsychotics, antidepressants or tranquilizers.
Let us assume that the above view is correct – that the organisation of modern 
capitalist societies is the cause of many of the problems that medicine addresses. In 
that case, it appears to me that medicalization can serve both a positive the negative 
role in addressing the problems at the societal level. For example, only recently the 
limitations of SSRI treatment come more into focus (Sansone and Sansone, 2010; 
for a resent large study see: Read et al. 2014; for discussion in the context of MBs 
see: Wiseman, 2014; Hyman, 2014). As those limitations are better known and as 
the research on the health impacts of the factors outlined in the previous paragraph 
by Link and Phelan (1995) becomes more robust, one could envisage a change in 
the focus of medicine itself. 
Some of this trend is already visible in the discussions about effective public health 
measures, as well as the ‘trickling down’ of the effects of those investigations – for 
example, it is not uncommon for doctors ‘to prescribe’ exercise. Medical 

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professionals may promote as well as impair the adaption of effective non-
pharmacological measures which at times may provide a counterweight to the 
strongly represented interests of, for example, pharmacological companies or the 
food industry. Insofar as political solutions go, medical professionals may be a 
supporting or inhibiting force for the needed changes. To a large extent, the 
strength of the argument hinges on empirical claims about the role of medical 
professionals, and this role may differ depending on the country, and issue and is 
not immutable. Where the medical focus leads to misallocation of resources, 
perhaps it is a matter of changing medicine’s focus and workings (e.g. by 
encouraging more referrals to psychotherapists in the case of depression), rather 
than pushing for de-medicalization – although the conclusions will need some 
empirical support and are best considered on a case-by-case basis.