Cosmetic psychiatry may raise fears of a brave new world with a "pill for every ill." Yet, Huxley (1958) in his review of the drug-oriented society, Brave New World Revisited, worried not about the use, but the overuse, of psychoactive drugs. It was the need for equipoise that drew his concern. Western philosophy does not allow emotions to be erased; the physical, intellectual and spiritual worlds exist to be "experienced." It is also a post-Enlightenment axiom that the full range of human emotion is the birthright of all. This birthright, however, is not always accepted. Physicians routinely mask the "experiences" of pain, insomnia, nausea and motion sickness. In addition, physical cosmetic pharmaceutical agents such as tretinoin(Drug information on tretinoin) (Retin-A), minoxidil(Drug information on minoxidil) (Rogaine) and α-hydroxy acid are used daily by well patients wishing only to blur the effects of aging by cosmetic physical pharmacology.
It is the use and not the abuse of psychotropic medication that forms the framework of cosmetic psychiatry. Cosmetic use is conceptualized as an adaptive, nonabusive approach to life. This is in contrast to the nonadaptive, abusing retreat of addiction. Cosmetic psychiatry can enhance but not distort memory and perception, increase performance but not create introversion, and establish conditions for an overall sense of enjoyment and fulfillment.
Many nonaddictive, relatively safe medications are available for the well person seeking subjective perfection. In some cases it is the side effect that provides the desired enhancement.
Propranolol(Drug information on propranolol) (Inderal), an antihypertensive, has short-lived anxiolytic effects and can be cosmetically prescribed for people who do not meet criteria for an anxiety disorder but must, nevertheless, occasionally function in emotionally charged situations (Kohnen and Oswald, 1988). Overscheduled students could likewise benefit from the short-lived energy boosts and diminished sleep requirements associated with the early phase of bupropion (Wellbutrin) usage (PDR Drug Guide for Mental Health Professionals, 2002). Moderate weight reduction can be achieved with sertraline(Drug information on sertraline) (Zoloft) in euthymic patients without amphetamine-like effects (PDR Drug Guide for Mental Health Professionals, 2002). End-of-workday ennui can respond to the γ-aminobutyric acid (GABA)-ergic effects of kava kava (Piper methysticum) without the intoxication of an evening nightcap (Singh, 1992). (The U.S. Food and Drug Administration advised consumers of the potential risk of severe liver injury associated with the use of kava-containing dietary supplements in 2002--Ed.)
A feeling of overall well-being, not quite realized in daily pursuit of the mundane, can sometimes be produced with St. John's wort (Hypericum perforatum) without addiction in people without depression (Hoffman and Kuhl, 1979). Bupropion can increase libido, while fluoxetine(Drug information on fluoxetine) (Prozac) can decrease this drive depending on the requirements of the well person's lifestyle. Overstressed workers can "come down" with valerian (Valeriana officinalis), experiencing enhanced mood and diminished anxiety (Kohnen and Oswald, 1988).
Well people can use these substances with or without the guidance of psychiatrists. If this guidance is withheld, the users of these medications may be exposed to the dangers of side effects and misuse. It has been reported that self-prescribing individuals without guidance are less likely to follow directions and report greater toxic effects (Beckman et al., 2000; Chan et al., 1995). Our knowledge of psychopharmacology can be properly employed to achieve the greatest possible benefit. It is our responsibility to use that knowledge when harm is not done and well-being is enhanced (Glazer et al., 2001).
It may be further argued that acceptance of the concept of cosmetic psychiatry can also encourage recreational drug use. This argument, however, ignores the current availability of cosmetic psychotropics. Valerian and kava kava can be purchased in commercially bottled teas or tea bags. These botanicals, as well as St. John's wort, can also be purchased without prescription in capsule form at the neighborhood pharmacy or mall-based health food store. The public is ready for these agents. One need not embrace the libertarian agenda to accept that, in a free society, adults are capable of making informed decisions regarding their emotional status (Bentham, 1996). Psychiatry can respond to the legitimate needs and expectations of the public or be shunted aside. We can appropriately administer these medications to well people or allow such use to proceed without our guidance (Giannini and Giannini, 2000).