The Dynamics of the Treatment-enhancement Distinction: ADHD as a Case Study

A central issue in the ethical debate on psychopharmacological enhancers concerns the distinction between therapy and enhancement. Although from a theoretical point of view it is difficult to make a clear-cut distinction between treatment (of disease) on the one hand, and enhancement (of normal functioning) on the other, in medical practice and policy debates the counter-positioning of therapy to enhancement is clearly at work. Especially pharmaceutical companies have an interest in occupying the ‘grey area’ between normal and abnorm al, treatment and enhancement. This article discusses the dynamics of the treatment-enhancement distinction, and argues that practices that could be labelled ‘enhancement’ can also be understood in terms of medicalisation and ‘d isease mongering’. The argument is supported by results from a qualitative empirical study into the experiences and opinions of adults diagnosed with Attention Deficit Hyperactivity Disorder (ADH D). Patients are ambivalent about how to understand ADH D: as a disease, a disorder or a normal variation. Intervention with psychopharmacological means can a lso be understood in d ifferent ways . From an insider perspective it is conceived of as a ‘norm alising’ of functioning, w hereas from an outsider perspective it can be understood as med icalisation of underperformance, or indeed as performance enhancement. This draws attention to new moral issues which are important but under-recognised in the enhancement debate, and which are related to medicalisation.