Saturday, March 29, 2008

Autonomy And Lust

In my proto-post on Viagra I promised reflection on the whole Viagra-for-women controversy.

What controversy, you ask? Well, obviously Pfizer and other pharmaceutical companies are dying to make and market a female equivalent to Viagra.

Turns out that's more complicated than they thought, because women's physiology, and women's sexuality, is more complicated than men's.

And some women are arguing that not only is a female desire pill elusive, it's also a step down a wrong and dangerous road: it improperly treats women's lack of desire as medical "problem" or disease, while in fact it is both natural and a proper response to certain life conditions, like age.

Leonore Tiefer, a psychiatry prof at NYU, has become a kind of spokesperson for this view, and has started The New View campaign to educate women and industry about the idea that "female sexual dysfunction" may not be dysfunction at all.

For Viagra's 10th anniversary, US News and World Report interviewed Tiefer; you can read it online here. While I agree that there are certain dangers associated with any drug that alters the way a person feels, it seems to me the push to not create such drugs at all is a dramatic overreaction to these dangers.

The most obvious point here is that some women do experience loss of desire in a way that does seem "dysfunctional" and in a way that makes them unhappy. Women who've had various diseases, women on anti-depressants and other drugs, women who have unusual hormonal distributions may experience loss of sexual desire as a physiological effect in a relatively simple sense. It's hard to see why they should be prevented from treatment they want.

Others have made this point effectively. But I want to defend the more radical point of view that desire-enhancing drugs are appropriate for pretty much any woman who wants them.

Sometimes the worry is that "medicalizing" women's desire is a way of manipulating and controlling women from the outside. In a sense this may be true -- I return to it below. But there is one important sense in which it isn't true.

Sometimes philosophers who work on identity distinguish between those desires we identify with and those desires we feel are imposed upon us "from the outside." For instance, if I think of myself as someone who is kind and gentle, and I have an urge to punch you in the face after I lose at checkers, I may feel the violence as alien to my sense of self, even if it comes literally from inside me.

It's hard to distinguish these conceptually, or to find a good criterion. But one popular attempt to do so tells us that the desires that are "ours" are the ones we want to have: if I want to want to be kind, that desire is my own; since I would much rather not want to punch you, that desire is not. (see, e. g., the work of Harry Frankfurt).

Theorists endorsing this line of thought sometimes say that the ability to have the desires you want to have makes you more free, more autonomous, more yourself. I If I punch you after checkers I am less free, less autonomous, less myself, because I am controlled by a force that is not me: my rage.

On this criterion, anyway, desire-enhancing drugs would make the person who takes them more free, more autonomous, and more herself -- assuming her longing to feel desire is genuine -- since she would then have the desires she wants to have. So such drugs would not at all be manipulative.

It is true that for this to be the case, a woman's preference must be genuine. And perhaps one may say that once there are drugs for female desire, the social pressures to take them, or the pressure from men to take them, would make such preferences social, and not autonomous -- not belonging to the woman herself.

I admit such dangers are real. But for these considerations to trump others, it seems to me we have to assume that they are overwhelming: that women's preferences in this area could seldom be genuine, could seldom be their own, will always be the result of pressure. Women, on this view, must be incapable of choosing for themselves.

It seems to me the dangers of such an assumption are worse than the dangers of medicalizing female desire. So, on this autonomy thing, I'm coming down on the side of the pharmaceutical companies: you want to make female Viagra, and market it to the world, and become rich? Fine. Knock yourselves out.

I will say that if Viagra continues to be covered by insurance and the female drugs are not I will be pissed off on principle!

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