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A break-up in a pill: it’s all about chemistry

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Can drugs re-engineer the ‘chemical process of love’ in the brain to help an individual out of an unhealthy relationship?

In the original Hans Christian Andersen telling of ‘The Little Mermaid’, Ariel is miserable. She’s the youngest of five sisters and can only swim up to the surface – per tradition – on her 15th birthday, to see the things that live above her father’s underwater kingdom. Her sisters tell her all sorts of stories about this magical surface world, but Ariel can’t go. Mermaids, we are also told, cannot cry: “So she had to suffer all the more.” In the 1837 fairy tale, there is no “hot crustacean band” to distract Ariel from this mournful existence.

Ariel waits until her 15th birthday, passing time following the shadows of ships across the seabed. When the day eventually arrives, it so happens that her birthday coincides with that of the handsome prince, who is having a lavish party on his yacht, with multicoloured lanterns, music and fireworks. Ariel falls instantly in love. Then a storm breaks the ship in half and everybody drowns.

Everyone, that is, except the prince, whom Ariel saves and then begins to stalk, day in and day out, from the shallows. Ariel is so infatuated that she strikes a deal with the Sea Witch, swapping her tail for human legs so she can seduce the prince with a beautiful dance (a subclause in the agreement with the Sea Witch states that Ariel agrees to have her tongue cut out, limiting her options for seduction). The plan almost works, but alas, the prince is betrothed to another and Ariel – bound by another piece of magical small print – throws herself off a cliff, explodes into sea foam and dies. The end.

Ariel’s and the prince’s relationship is clearly not a healthy one (even before one of them explodes). While its message is different from the Disney film we remember, the Andersen original still resonates. We have words for what Ariel is experiencing: infatuation, obsession and that all-consuming kind of love that defines many people’s teenage years. Teenagers fall in love, teenagers have their hearts broken and we say it’s all part of growing up – a life lesson before they grow up and find the ‘right’ person to spend their lives with.

Not that adults do much better. While the divorce rate in the UK is actually going down, as of 2018 it’s still 42 per cent. You probably wouldn’t watch a film with a 58 per cent review score average. Those same odds on building a family together with another person and maintaining it for the rest of your lives? People trip over themselves to do that – even the ones who understand that that 42 per cent also ignores marriages that are romantically dead, but where the couple feel compelled to stay together for financial reasons, apathy or the sake of the children.

Brian Earp, research fellow at Oxford University’s Uehiro Centre for Practical Ethics and co-author of ‘Love is the Drug’ with Professor Julian Savulescu (also of Oxford and the Uehiro Centre), argues that if we are going to keep collectively spinning the roulette wheel on marriage, then we need to have a serious conversation about drugs.

Mermaid love

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For years, Earp, Savulescu and other ethicists have argued that if love is a chemical process, we should be considering chemical treatments for relationships that go bad just as we would for serious illness: ‘love drugs’ in partnership with couples counselling, and ‘anti-love drugs’ to prise couples apart where that love has turned abusive. Some 173 people (overwhelmingly women) were killed in the UK in 2018 as a result of domestic violence, according to BBC research published this year. The Office for National Statistics put the number of domestic abuse cases for the year ending March 2018 at 2,006,000 but noted that this is likely to be a highly conservative estimate, as domestic abuse “is often a hidden crime that is not reported to the police”.

Drugs that save lives and treat pain are good things. We fund their research and make them available free on the NHS. And yet, despite more than two million reported cases of domestic abuse last year and 173 deaths, our romanticised idea of love blinds us to any discussion of pharmaceutical treatments. We know the stereotype of the battered spouse who ‘walked into a door’, yet we continue to celebrate love as a supernatural force for good and blame – even stigmatise – people when it begins to spiral downwards. Why?

“It’s partly rooted in the view that love is something that just happens to you, like some kind of magical pixie dust,” Earp says. “The thought is that if the love starts to fade, it must not really have been worthwhile in the first place, or it wasn’t really ‘true love’.

“These are high-school attitudes,” he continues. “Anybody who thinks about how you make a relationship robust over time understands that you have to try and understand a little about how love works.”

Love, like any experience, is something that happens in the brain. Proving that isn’t particularly hard: all we need is a person, some pictures of their loved ones and an MRI scanner. Yet societally, the way we talk about love has got stuck somewhere behind the science. We talk about falling in love the same way as we talk about falling down the stairs: as something involuntary and surprising. Love itself is allowed to do all sorts of disgustingly twee things as if it were its own organism: ‘blossom’, ‘grow’, ‘wither’, ‘die’. But love isn’t a plant. It’s an interplay of chemicals. Which means we should be able to prune it.

“Love is a multidimensional phenomenon: if you make certain interventions into the biological side of love you can affect the experience of it,” Earp says.

“We’re used to thinking about love as the sort of thing you might be able to influence through couples counselling… [And as] people fall in and out of love, love seems to be the kind of thing that can change. [Our] point is just that the more we understand about the biological dimensions of love, we have one more [way] in which some kind of agency is possible.”

Neither Earp nor Savulescu are calling for a paternalistic approach to anti-love drugs. Whatever form they may take, drugs that fray or cut the ties between two people shouldn’t be casually dispensed or mandated by anyone (more than once Earp refers to homophobia in the latter part of the 20th century as an example of a time when even ‘developed’ nations took stances against homosexuality that today would be horrifying). The idea is not to cheapen love or provide a universal on-off switch for whenever a relationship becomes inconvenient. The idea is to save those people who find themselves chemically, irrationally attached to a person who repeatedly and deliberately hurts them. We have a word for this kind of compulsive self-destructive behaviour, but again we rarely use it in the context of love: addiction.

One of the most persuasive arguments for classifying addiction as a disease is that by pathologising it, the medical profession is more readily able to treat it. But who is going to write off love – sonnets and ballads, chocolates and roses – as a disease? No one, clearly. Which means getting an anti-love drug to some hopelessly lovesick person on their way to becoming a tragic statistic is a problem.

“Society [at some point] more or less decided that drugs fall into two categories: medical or recreational,” says Earp. “If it’s medical, there needs to be a diagnosable disease, disorder or illness that the drug is meant to be treating. We’ve fully committed to this medicalised conception of drugs... but some drugs might be able to help improve people’s lives even if we haven’t pathologised them or decided they have some kind of mental illness.

“If you think of these drugs – used in the right way and carefully administered – as akin to a form of life therapy that’s not rooted in some notion of pathology, then you can start to see that this medication/recreation dichotomy is little bit over-​simplified. There might be ways that we can use certain chemicals in certain ways that improve our wellbeing rather than just things that are used in a trivial or recreational way.”

Discussing these sorts of treatments is of little comfort to the people who need them most, and Earp and Savulescu give examples throughout the book of people who have medicated themselves out of bad relationships in unlikely ways.

They describe a married man whose raging jealousy is apparently treated with clomipramine – a medication commonly prescribed for the treatment of obsessive-compulsive disorder. A commonly reported side effect of many antidepressant drugs is an accompanying sense of detachment from friends, family and spouses – a scatter-gun approach to the problem of one bad relationship, but certainly an option for somebody desperate enough.

Another drug that was being trialled by therapists until the 1980s in couples counselling is MDMA (or ecstasy). While you might think that a drug which famously makes people fleetingly open, empathetic and tactile would pull troubled couples back together (at least temporarily), Earp and Savulescu point to examples of MDMA’s ability to promote a kind of ‘self-love’, which is considerably longer lasting. In this way, MDMA can act as an anti-​love drug by reinvigorating an atrophied sense of self-​worth, allowing patients to see themselves as better than the toxic relationships they’re in and capable of moving on.

In his book, ‘In the Realm of Hungry Ghosts’, Dr Gabor Maté argues that all addiction begins with pain. Love is, for most people, the greatest source of joy in their lives. But anyone trapped in an abusive relationship – chemically bound, petrified and being slowly ground away – knows love at its darkest and most painful: the compulsive need to be loved even by the person steadily stripping you down to nothing.

Earp is not offering a cure-all – there is currently no panacea for poisoned love – but is calling for the discussion. If we are going to spare these people pain we need an answer to why we can’t fix a broken heart when 50-year-old science and a steady trickle of modern anecdotes say we can.

There should be an answer for those two million people a year living in this pain; an answer to why a pharmacological solution to love-turned-sour isn’t being discussed, let alone pursued. Societally, our answer needs to be better than ‘love is pixie dust’. 

Chemicals

Alcohol

There is one drug that has managed to elbow a space for itself between ‘medicine’ and ‘narcotic’ – and without it, Western courtship going back decades would look markedly different.

“In the book, we call alcohol the oldest love drug around,” Earp says. “That’s a drug that can obviously be very harmful... but it’s also something which, if used [responsibly], can improve people’s ability to connect in a meaningful way. If you need alcohol to make a meaningful connection, that’s a problem, but everybody knows that it’s possible for alcohol to play a role in facilitating a mindset where perhaps you’re more open to connecting with someone you really do have a reason to build a relationship with.”

That double standard, says Earp, is borne of familiarity. If alcohol were invented today, it would almost certainly be illegal – there are very few drugs that are as dangerous, whatever your criteria for assessment.

“Because we’ve sort of co-evolved with alcohol, we don’t see it as scary,” Earp says. “We more or less know how to use it – although again, we do often misuse it - but we don’t see it as frightening because it’s familiar.

“It’s a drug: it’s a chemical, like anything, that does certain things,” he continues. “And we can allow it to do stuff in concert with our social behaviour and have that in some cases be very positive. And we can also allow it to do stuff in concert with our behaviour that’s very negative. We need to always be thinking – of all drugs – ‘[How do we] harness the potentially positive effects rather than misusing them or abusing them?’”

 

 

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