Most medical students are pretty good at passing exams, but who wouldn't want to be better? Advances in pharmacology have led to the creation of a generation of drugs that claim to enhance cognition. Now you can stay up all night, keep on task, and maybe even boost your IQ. But are such drugs practical, ethical, or harmful? Should Christians take them?

A recent article in the Guardian [1] highlighted the extent of the problem. For around £3 per dose, you can order stimulants like methylphenidate (Ritalin) or modafinil from the internet. About a sixth of American university students do this on a regular basis. They are being joined by long-distance truckers and even top-class athletes. The British Medical Association (BMA) just published a report [2] saying that they expect to see a rise in the numbers of people attempting to enhance their cognition artificially – by synthetic tablets, natural supplements or surgery.

it works

The problem with mind-enhancing drugs is that they work – in the short term. In a study of 200 healthy male undergraduates at Cambridge University [3] a single dose of modafinil enhanced concentration and spatial awareness. The United States military admits to using caffeine and amphetamines for night-time operations, and many of us remember James Bond taking benzedrine in the film Dr No!

However, there is growing evidence that the benefits are not as simple as researchers initially thought. Response times to psychological testing are quicker but less accurate, as less checking is done. The BMA report summarises some of the key academic papers in this field; it also cites qualitative evidence about people becoming addicted as well as developing side effects like irritability and depression.

mind-restoring drugs

Stimulants are legitimately prescribed and effective for conditions like narcolepsy and attention deficit and hyperactivity disorder (ADHD). Where there is a medical need for medication, it is appropriate for doctors to restore the natural balance. Antidepressants raise serotonin levels in the depressed brain; cholinesterase inhibitors raise acetylcholine levels in the dementing brain; and stimulants boost an underactive reticular activating system in ADHD.

These things are the blessing of God and part of his healing. It is no different to someone taking insulin for diabetes, levodopa for Parkinson's disease and beta-blockers for high blood pressure. Just because they affect the brain and not the body doesn't mean they are somehow wrong. Christians have a long and incorrect tradition of thinking the mind and soul are the same thing because they both happen inside the head, but this is a Greek way of thinking (thanks to Plato) and not biblical. But my faith goes far beyond my brain – I value my body as God's creation, my church family as God's community and evangelism as God's command. As Christians, we should not be worried about using mind-restoring drugs that restore the natural balance when the imbalance is caused by an illness, and we should not see illnesses like severe depression or ADHD as sins.

Many mental health problems are spectrum disorders. Severe cases will see a return to normal functioning, but milder cases will also see a slight enhancement in cognition following the use of drugs. If fellow students with mild ADHD get Ritalin, will they be getting an unfair advantage over other hard working colleagues? In America, parents have started to ask for medication for their child because every other child in the class is taking some.

It is hard to give good advice to Christians in this respect. You could suggest that we should only take medication if it is prescribed by a doctor, but this seems rather simplistic and open to abuse. Or you could decide to abstain from any 'treatment' that is not for a life and death condition, but this seems unrealistic. The ethics of spectrum disorders cannot be painted in black and white. It is often impossible to draw a line between medical and personal motives; perhaps more helpful questions are 'why do I want to enhance my cognition?' and 'what is the cost of this enhancement?'

It's not clear cut – we have all tried to improve our performance; whether it's by having a coffee or three to help us concentrate and finish that essay, by revising for exams, training for competitions, or taking vitamins for colds. Is hiring a tutor for your child somehow less natural than taking a tablet? The BMA paper covers some of the ethical dilemmas in more detail and it is well worth a read. In the rest of this article I examine what the Bible says about our motives for enhancement and the consequences of choosing that path.

biblical examples

The most famous story of people seeking knowledge must be Adam and Eve, chasing after the fruit of the tree of the knowledge of good and evil.[4] The fall of humanity was due to an attempt to enhance cognition. Surely, that should be warning enough – but God has given us more examples! The account of the Tower of Babel [5] shows how God is opposed to intelligence sought without reference to him. Later, we see Solomon dissatisfied with wisdom, [6] finding that it brings grief unless accompanied by faith. In the New Testament, earthly knowledge is found wanting when contrasted with godly knowledge, [7] and philosophers are exposed as ignorant despite their great learning.[8]

Throughout Scripture we see how God is against a limitless increase in the power of the mind, especially when it comes at the cost of knowing him. This is not because he is against us bettering ourselves, but because he knows that this knowledge comes at a cost and he seeks to spare us from the pain. At the heart of cognitive enhancement is often an idol – the degree, the job, a career, or influence. These things can be used for good - and most Christian medical students will be pretty altruistic – but they can also be pursued for the wrong reasons, at the expense of our faith.

God is against idols and he will not bless attempts to chase them. The 'why' question is vital here – is it really so important to finish that essay or can I take this opportunity to re-examine my priorities? God may allow me to benefit from stimulants and pass that degree. But I also believe that he will make that choice clear to us, for he will tell us when we are straying from worshipping himself. God longs for us to follow him alone. Ultimately, he wants to redeem humanity and the choice for cheap knowledge that Adam and Eve made. Are you ignoring that voice?

physiological risks

In a desire to keep up with the Joneses, many parents overlook some fundamental questions, such as whether their child even suffers from ADHD and what the long term costs are. Ritalin is not without its risks (neutropenia, appetite suppression and stunted growth), and we simply don't know the effects of long term stimulants on healthy people.

In the BMA report, one of the main arguments against the use of these drugs is 'interconnectedness'. It says that we must look at the potential risks or benefits of cognitive enhancement alongside its effects on other aspects of an individual's personality such as emotional stability, creativity and social connectedness.

It may be true that these medications will sharpen your mind or help you stay awake to finish that essay. But the choice to enhance cognition comes at the expense of many things: the ability to relax and for our brains to rest; the learning we can get from failure and setbacks; the chance to escape from parental academic expectations; the humility that comes from knowing others are better than you; and, perhaps sweetest of all, the joy that comes from being loved even when we are not at the top of the pile.

One of the most frequently used metaphors in the Bible is the description of the church as a body. A body has some parts that work better than others. It is clear from these passages [9] that the aim is not just to 'sort out' the weaker parts but to care for them, value them and learn to love them. By all means, heal those parts that are sick – but there is a natural variation that is more beautiful than uniformity; in our weaknesses, God is revealed.[10]

is it a free lunch?

The BMA paper looks in detail at some of the studies that seem to show cognitive enhancement with stimulant use. Simple measures of cognition may be raised, but other more important dimensions are not. The learning is rote and not deep. It is short term and not long term. It is contextual and poorly generalised to wider situations in life. The free lunch, if one exists, is high in carbohydrates and low in vitamins!

As a psychiatrist, I am aware that there are benefits in the wider process of learning, often through suffering and hard choices. An education fuelled by stimulants may get you letters after your name. But it may come at the expense of contemplation, critical appraisal and personality development. University can be a time for realising limitations, setting priorities and making decisions – to live a holistic life. The ability to work harder and faster will not help medical students avoid the track record of many doctors who fail to achieve a healthy work-life balance.

In this environment, Christian medical students are ideally placed to bear witness to a balanced life, demonstrating such a satisfaction with their talents that is only possible through a relationship with Jesus.[11]