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The Ethics of Behavior Modifying Drugs: From A Clockwork Orange to Modern Medicine

By Carlota Hermer

The Ethics of Behavior Modifying Drugs: From A Clockwork Orange to Modern Medicine

In Anthony Burgess’s 1962 dystopian novella A Clockwork Orange, Alex, a 15-year-old gang leader and convicted murderer, is administered the Ludovico Technique at the government's recommendation. This technique is a form of aversion therapy that uses drugs to condition Alex to become ill at the thought of violence. In turn, he can shorten his prison sentence to be released into society as a ‘reformed’ civilian. The novella and its movie adaptation both raise complex ethical questions: Is it morally acceptable to forcibly change a person’s behavior, even if it makes them ‘good’?

The ‘aversive stimulus’ drug that Alex used is an example of a behavior-modifying medication: a drug that affects the central nervous system to influence behaviors, thoughts, mental processes, or mood [2]. The dispensing of certain behavior-modifying medications has increased in recent years; for example, a 2024 cross-sectional study by FDA researchers revealed an 81% increase in prescriptions for nonstimulant ADHD medications among individuals aged 20 to 39, from 2018 to 2022 [3].

Such pharmaceuticals include mental health medications like antipsychotics, antidepressants, mood stabilizers, and stimulants. These drugs can be used to lessen the behavioral symptoms associated with psychiatric disorders, such as bipolar disorder, ADHD, and depression [4]. Many individuals opt to take these substances to manage their disorders, as several of them have been shown to be highly successful in reducing behavioral symptoms; for example, a 2024 meta-analysis conducted by several research institutions suggests that Vyvanse, an ADHD medication, is effective in alleviating the symptoms associated with the disorder [5]. However, as presented in A Clockwork Orange, others also take these medications as a result of recommendations or requirements from legal organizations or psychiatric professionals, whether to improve their behavior, stabilize moods, or conform to social expectations. This brings up complex ethical questions regarding the role of behavior-modifying drugs in shaping or controlling behavior. Are these medications a means for personal improvement, or just a means of conformity? Furthermore, is it ethical to recommend or mandate behavior-modifying drugs to people who do not seek them?

Behavior-modifying drugs serve to address two complex forces: society and oneself. Those who aim for self-improvement for their mental illnesses, such as depression, can benefit greatly from seeking help and being prescribed medications. Historically, around a third of depressed individuals seek help to manage their symptoms, likely to improve their quality of life [6]. Thus, the prescribing of antidepressants such as SSRIs can be a beneficial tool for said patients, as research suggests that they can be effective in improving depressive symptoms [7]. Therefore, the use of antidepressants can be empowering and used as a form of self-care.

However, as illustrated by the state convincing Alex to partake in the Ludovico Technique in A Clockwork Orange, the use of these medications is sometimes used to benefit the lives of others, not simply the person who is prescribed them. This is also demonstrated in educational settings. For example, in public schools, while it is prohibited to mandate that a child take medication, teachers are permitted to suggest that a child undergo evaluation if they show signs of struggling in class or display symptoms of disorders like ADHD [8]. To help these students, schools could invest in hiring more special education specialists and extending their practices beyond general education. Instead, some children are simply prescribed behavior-modifying medications, such as Ritalin or Adderall, to help them meet classroom behavioral expectations. This raises crucial ethical questions: are people genuinely giving voluntary consent to these medications, or are they being subtly coerced by our society’s norms? Also, should we be asking individuals to ‘normalize’ their behaviors, or should we work towards a society that more readily accommodates individual differences?

A second key issue regarding the use of behavior- reforming drugs is the potential stripping of one's autonomy. In A Clockwork Orange, Alex is stripped of his autonomy due to the drugs used in the Ludovico Technique, restraining his ability to act on his true desires and impulses. This makes his improvement of behavior considerably insincere, as they are simply a result of his loss of free will. While this example may be based on a fictional story, similar events can occur in real life; for individuals over the age of 18, the court can order an individual to comply with medication administrations, even if they have been involuntarily evaluated [9]. While dispensing of said drugs may be an effort to benefit the well-being of these patients, their autonomy is being lost, and their ‘improvements’ are likely more caused by the drug’s effects than their personal changes.

The Ethics of Behavior Modifying Drugs: From A Clockwork Orange to Modern Medicine

The ethical considerations of behavior-modifying drugs intensify when considering pediatric prescription of these pharmaceuticals. While minors have the option to reject taking any medications, they may lack the capacity to understand the effects of these medications on their developing minds and bodies [10]. Drug administration to growing children can be argued to be a restraint to their developmental freedom; if a child whose emotions are controlled by medications, who is to say that they have been allowed to gain their own, authentic sense of self? This could lead to issues once children mature and decide to stop taking their prescriptions, as they may find that they do not know who they are without the influence of psychopharmaceuticals.

Does this mean that the administration of behavior-altering medications is unethical? Should individuals like Alex be prohibited from accessing self-correcting treatment, despite the harm he is posing to himself and his family without it? As children have undeveloped brains and may not understand the negative implications of drug use, one could argue that it is, in fact, inappropriate. On the other hand, if a medication can greatly improve the quality of a youth’s life, it is arguably equal or more immoral to prevent the child from accessing it. Thus, the ethical principles surrounding the pediatric prescriptions of behavior-altering drugs are ultimately drawn in a fine line.

As the prescription rates for certain psychopharmaceuticals rise, the ethical implications of using said drugs should be carefully considered. A Clockwork Orange serves as a cautionary tale depicting the risks of using said pharmaceuticals to enforce social norms and ‘improve’ individuals, despite their potential loss of free will. While the use of these prescriptions often yields much more dramatic effects than presented in Burgess’s novel, children and adults may feel coerced into taking them or struggling with their side effects. As medicinal research advances, we must aim to make the administration of behavior-altering medication a mode of self-improvement, rather than social engineering.

The Ethics of Behavior Modifying Drugs: From A Clockwork Orange to Modern Medicine

Review Editor: Emma Zhang
Design Editor: Allison Chin

[1] Burgess, A. (1962). A Clockwork Orange. New York: W.W. Nortan & Company.

[2] Mental Health Medications. National Institute of Mental Health. (n.d.). Retrieved November 23, 2024, from https://www.nimh.nih.gov/health/topics/mental-health-medications


[3] Chai, G., Xu, J., Goyal, S., Woods, C., Ho, A., Song, J., & Dal Pan, G. (April 1, 2024). Trends in Incident Prescriptions for Behavioral Health Medications in the US, 2018-2022. JAMA psychiatry, 81(4), 396–405. Retrieved on November 23, 2024 from https://doi.org/10.1001/jamapsychiatry.2023.5045

[4] 700 Behavior Modifying Medications. Department of Economic Security. (January 31, 2014). Retrieved November 10, 2024, from https://des.az.gov/sites/default/files/700%20Behavior%20Modifying%20Medications.pdf

[5] Rutledge-Jukes, H., Jonnalagadda, P., McIntosh, A. P., Krstovski, S., Andriani, N., Smith, I. R., Prendergast, L., & Lynch, J. M. (August 31, 2024). Lisdexamfetamine's Efficacy in Treating Attention Deficit Hyperactivity Disorder (ADHD): A Meta-Analysis and Review. Cureus, 16(8), e68324. Retrieved November 23, 2024, from https://doi.org/10.7759/cureus.68324

[6] Pratt, L., & Brody, J. (December, 2014) Depression in the U.S. Household Population, 2009-2012. National Center for Health Statistics. Retrieved November 10, 2024, from https://www.cdc.gov/nchs/data/databriefs/db172.pdf

[7] Depression: Learn More - How effective are antidepressants?. InformedHealth.org. (April 15, 2024). Retrieved on November 10, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK361016/

[8] Jones, D. (n.d.). Can the school require my child to take ADHD medication?. Understood. Retrieved on November 10, 2024, from https://www.understood.org/en/articles/can-a-school-make-medication-a-requirement-for-my-child-to-attend

[9] Court Order for Mental Health Treathment. Maricopa.gov. (n.d.). Retrieved on November 10, 2024, from https://www.maricopa.gov/DocumentCenter/View/2334/Mental-Health-Process-PDF

[10] Wolf, C., Broutman, E., Stern, D., Fensterman, A. (October 1st, 2010). Behavioral Health News. Retrieved on October 1, 2024, from https://behavioralhealthnews.org/obtaining-judicial-authorization-to-medicate-a-minor/#:~:text=Minors%2C%20like%20adults%2C%20have%20the%20right%20to,medication%20they%20do%20not%20wish%20to%20take.&text=One%20thing%20is%20clear%20though%2C%20if%20a,any%20action%20seeking%20Court%20authorization%20for%20treatment

[11] Beyond Therapy Biotechnnology and the Pursuit of Happiness. The President’s Council on Bioethics.(October, 2003) Retrieved on October 10, 2024, from https://biotech.law.lsu.edu/research/pbc/reports/beyondtherapy/beyond_therapy_final_report_pcbe.pdf

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