Love and enhancement technology

Oxford Handbook of Philosophy of Love Love and Enhancement Technology Brian D. Earp This is the author’s copy of a book chapter published online ahead of print – accepted manuscript version. The chapter may be cited as follows: Earp, B. D. (2019). Love and enhancement technology. In C. Grau & A. Smuts (Eds.), Oxford Handbook of Philosophy of Love. Online ahead of print at http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199395729.001.0001/oxfordhb9780199395729-e-36 Abstract Chemical and other interventions into the biological dimensions of love are currently possible and will likely become more powerful in years to come. This chapter explores some of the conceptual issues surrounding what it would mean to change love with biochemical agents, and presents a handful of case studies of individuals and couples who might desire to use such agents as a way of enhancing their love and relationships. The chapter then discusses a number of ethical and other worries that would likely be raised by the development or use of such biotechnologies and offers some tentative responses. Ultimately, it is argued that loveenhancing biotechnology is not just a conceptual possibility, but may already be practically feasible, and is likely in some cases to be morally desirable. Keywords: love enhancement, ethics, biochemical agent, changing love, relationship Consider a serious, romantic couple. The couple is facing difficulties in their long-term relationship and is considering whether to break up. They value the relationship, and would like it to continue, but their feelings of love and desire for each other have faded over the years. They have tried counseling. It did not work. They went on a couple’s retreat. Their feelings did not reignite. They opened up the relationship to other partners, but decided this was not for them. In fact, they tried everything they could think of, and still no flame. Nevertheless, they sincerely believe, and let us assume with good reason, that the relationship is, all things considered, worth maintaining. They have a house together, and children. They have shared goals and commitments. They get along with each other’s families. There is nothing really wrong with the relationship. It is not violent or abusive. There are no irreconcilable differences to contend with. It is just that the color has gone from what was once a vibrant partnership.1 A couple in this situation faces a choice. They can resign themselves to a loveless future, or they can sacrifice what they have built together over so many years and attempt to start over with other partners. Or (among other options) they can simply get out of the relationship business altogether. Such decisions are not easy, and it may often seem that there is no right answer. But I want to explore whether there may be another way forward. In what follows I ask whether it could it be prudent for a couple in this or a similar situation to use a loveenhancing biotechnology to keep their relationship intact while attempting to restore love and happiness within it. This possibility is starting to receive some attention in the philosophical literature.2 This is a good thing. As my coauthors and I have argued, it is highly likely that some such technology will be available in the not-too-distant future. And in fact, some medications can already affect love, albeit in a haphazard and hard-to-predict way.3 The choice about whether to use such technology or medicine, then, may soon be a live issue for many couples. Assuming, of course, that it is not banned or otherwise rendered inaccessible, which is exactly what some might argue should happen. Indeed, I assume that many people will find the prospect of biochemical interventions into love and relationships at the very least unsettling, if not outright frightening and absolutely to be avoided. One of my aims in this chapter is to make sense of where such reactions might be coming from and to assess the extent to which they are or can be justified. One place they might be coming from is a pair of common intuitions about the nature of love. True love, you might think, is both unchosen and unchanging. In other words, people cannot just make themselves fall in love: it either happens or it does not. And as Shakespeare said, love is not love which “alters when it alteration finds.”4 Putting these ideas together, the thought is that if you are no longer in love with your partner, that is just the way things are and you need to accept it; and perhaps it was never really love to begin with. I think this view is mistaken, both descriptively and normatively. While it is true that you cannot make yourself fall in love, as if by drinking an elixir, you can certainly take informed, deliberate steps to make it more likely to come into existence and persist through time. Even without biotechnology, you can do things like spend more time with your partner, increase the frequency with which you have sex (assuming that is a positive experience for both of you), focus on their best qualities, try to remove barriers to love that are rooted in past traumas, and so on. As for the claim that if you no longer love your partner it must never have been true love in the first place, this strikes me the kind of thing people say as a post hoc rationalization: a psychological trick to get over a horrible break-up, perhaps, but not necessarily an accurate description of reality. Sometimes, that is, we do truly love someone, and then later, truly not. Hence, true love can change and even go out of existence, or so I assert. That is the descriptive issue. The normative issue is that if you adopt an unchosen/unchanging view of love, this may foster a passive or even fatalistic approach to a potentially valuable romantic relationship that directly contributes to its needless dissolution. If you think of love as something you simply fall into when you meet the right person, for example, as many people do think, then it becomes that much easier to fall back out of love when the going gets tough. Or at least, it becomes that much easier to conceive of what is happening in your relationship in such terms, thereby concluding that the loss of love is unpreventable. An alternative approach would be to take responsibility for your love, in part by putting in the requisite time and effort to improve the relationship (assuming it is worth preserving). In other words, there may be value in seeing love as something that is—at least to an extent—up to us.5 Something that requires choice, skill, and determination, not passivity and acquiescence. And while we cannot simply wave a magic wand (nor should we necessarily want to), we can decide whether and how to intervene in the course of love, helping it to last or, where appropriate, expire. This is not a new idea, nor should it be controversial. Those who accept that couples counseling—for instance—can be an appropriate, even praiseworthy, course of action for at least some romantic partners should be comfortable with the idea that love “takes work.”6 The only real innovation here is to propose that interventions into the psychosocial dimensions of love (couples counseling and the like) may one day fruitfully be complemented by interventions into its biological dimensions: hence love-enhancing biotechnology.7 In support of this proposal, for the rest of this chapter, I attempt to do the following things: 1. Explain how some currently existing biotechnologies can be understood as already having significant love-altering capacities, whether in enhancing love or hastening its end. This is to highlight the urgency of this ethical conversation and to render analogous potential future technologies more plausible. 2. Put these love-altering effects into a wider philosophical context by discussing a dualnature theory of love, according to which love is fundamentally both biological and psychosocial in nature (and hence susceptible to being modified along either or both dimensions).8 3. Give examples of situations where it would likely be morally justified and even prudent to intervene in love’s biological dimension directly (ideally in conjunction with more conventional forms of psychosocial intervention). With respect to the third, I stop short of trying to defend any particular, much less allencompassing, ethical stance about when such biological intervention would be permissible, prudent, or otherwise. My goal is not to answer such questions, but to raise them. I do, however, stress their importance and float some ideas for how they might be productively approached from a bird’s-eye view. So what kind of biological interventions am I talking about, and how exactly would they affect the love between romantic partners? I take this question up in the next section. 1. Real-Life Love Potions: A Primer and Proof of Principle It is a cliché to point out that love is associated more with the heart (or the soul) than the brain, and to explain why such a view is naïve. Thus, a great many popular books and even sober, scientific articles now openly discuss what are sometimes described as the biological “underpinnings” of romantic love: that is, the brain chemistry, neural architecture, and genetic foundations of lust, attraction, and longer-term attachment.9 Importantly for our purposes, some scientists now think that the more we understand this biology, the more we will be able to influence or even manipulate those variables directly, through biochemical or other intervention.10 This, in turn, would give us increased control over the higher-level, experiential aspects of love that are affected by those variables. Love is not simply reducible to biology or neurochemistry, as I explain in a later section. But interventions into the biological side of love have not received as much attention as interventions into its psychosocial side, and it is time to start evening out the scales. This is because interventions of the former kind are either here or on the horizon, as I have suggested, and they have the potential to dramatically alter the experience, quality, or even existence of love between individuals, on any number of plausible accounts of what love is. To illustrate, I address just one higher-level feature of love that regularly appears at the center of such accounts, and show how it can be manipulated—fairly directly—through brain-level biochemical means. Consider the view that true love, whatever else it is, is something that requires a genuine, noninstrumental concern for the well-being of the person so beloved.11 If I really love you, that is, I must be devoted to your ultimate flourishing for its own sake. Necessarily, then, I must care deeply about your feelings: not only your transient emotional states, but also your desires and preferences, your wishes and dreams, and your subjective experiences generally, with all the various meanings they carry. Well, then, imagine I took a drug that made it so I did not care about your feelings in some or all of those senses, much less your overall well-being. Or perhaps I do care, but only in some abstract, “cognitive” sense that does not correspond to the appropriate motivations or behavior. For example, suppose I can see that you are very upset about something, but your upset does not strike me as all that important (so long as I am taking this drug). I know it should affect me. It is not that I think you are pretending. I believe you are genuinely hurt and have good reason to be (let us say). But for all that, your anguish does not move me. Does such an awful-sounding drug really exist? Yes, it does. It is called a selective serotonin reuptake inhibitor, or SSRI—the most commonly used drug to treat depression. Such SSRIs do not have this effect on everyone. But according to Adam Opbroek and colleagues,12 a growing pile of case reports suggest that some patients taking SSRIs experience diminished emotional responsiveness to things that should affect them—like their partners’ feelings. To explore this issue, Opbroek asked patients reporting SSRI-induced sexual dysfunction to complete a number of additional questionnaires assessing their emotions. Compared to controls, the patients reported less ability to cry, experience irritation, dream erotically, or express creativity. They were also less able to feel surprise, anger, or sexual pleasure. Less able to worry over things or situations. And, crucially for our purposes, less able to care about the feelings of others. In fact, fully 80 percent of the patients described such clinically significant “blunting” of their emotions. These results are not entirely surprising. Part of the point of SSRIs, at least in their role as a treatment for depression, is precisely to “blunt” emotions: specifically, a person’s chronically maladaptive feelings of sadness. But for some patients, the ability to care about other people’s feelings seems to be blunted as well. What if one of those other people is your romantic partner? Remember that we are assuming that caring about your partner’s feelings is one of the bare-bones necessary ingredients of true love. If your very capacity to do so is sufficiently degraded by an SSRI, then it seems that the drug would be at least largely responsible for altering—that is, diminishing or interfering with—your higher-level love for your partner. Change in biology, change in love; proof of principle. Take another example. Consider the loss of libido that often occurs as a side-effect of SSRIs.13 How might that affect your relationship? For many couples, sexual interaction is a very important part of how they relate to each other. Indeed, on some views, the experience and expression of sexual desire is partly constitutive of romantic relationships—and romantic love. In other words, wanting to be physically intimate with someone (more than fleetingly or only under unusual circumstances), at least in the early stages of a relationship, is often seen the very thing that carves a more or less distinct dividing line between the sort of love you feel for your romantic partner and the sort of love may you feel for your platonic best friend—no matter how strong and sincere your feelings of affection for the latter.14 If that sort of view is right, then a drug that removes your desire for sex (or sexual activity more broadly construed) with your romantic partner is also a drug that changes something essential about the nature of the love between you. At the extreme end, you might think that sexual desire is required for romantic love to exist, in which case the drug would be directly responsible for quelling such love, simply by lowering your libido below some threshold (i.e., with no other changes being necessary).15 But there are also other ways the drug could change, if not necessarily eliminate, your love for your partner, by more or less direct pathways. Consider the hormone oxytocin. This hormone is released in mothers during the birthing process and through breastfeeding, and it is largely responsible for the formation and maintenance of the mother–infant pair-bond—a paradigmatic instance of love and attachment.16 This same hormone is released through intimate touch, sex, and orgasm; and it is similarly responsible for the attachment that forms, insofar as it does, between adult romantic partners. If, therefore, you stop having sex with your partner—due to the effects of an SSRI, let us say—you will also stop releasing oxytocin together in one of its most potent contexts, which in turn could negatively affect the attachment bond between you. Again, insofar as a certain kind or degree of attachment features in one’s account of love (that is, as a necessary ingredient), this change in biology would amount to a change in love. So much for drugs that can interfere with love. What about love-enhancing biotechnology, which is our topic for this chapter? Just run these alterations in reverse. Oxytocin, for example, can now be administered artificially by way of a nasal spray.17 Testosterone—which can be boosted in various ways—has long been known to increase libido.18 And MDMA, which was used in the 1980s as an adjunct to couples counseling, can promote the ability to care about others’ feelings and take their perspective.19 In fact, even SSRIs can bolster love when their effects are on target and the relationship difficulties stem from whatever problem they are treating.20 Again, none of these effects in isolation is necessarily sufficient for creating or augmenting love. But in combination with other variables and given the right particulars, they may well bring about (or even constitute) the missing ingredients, thus making love more likely or helping it to last.21 Needless to say, the precise connection between what is going on in someone’s brain as the result of any particular biochemical intervention and their subjective experiences of love—much less the nature or quality of love between them and their partner or partners—are complex and currently only poorly understood. They likely differ from person to person and couple to couple. Moreover, different doses, timings, contexts, and interactions between neurochemical processes add further variability. But none of this detracts from the main point of this section, which is simply that there is reason to believe that existing biotechnologies are already capable of altering love, both positively and negatively, through a number of different routes. Assuming that our understanding of the functional make-up of the brain— and of the neurochemical means by which it can be influenced—continues to advance in this area, we may soon face the prospect of even more powerful biotechnologies whose effects can be better predicted or made more precise. To understand the implications of this potential development for the modification of love, it will be useful to have a more fleshed-out theory of what love is. I turn to that next. 2. A Dual-Nature Theory of Love In this section I overview arguments suggesting that love has a dual nature, based primarily on the recent articulation and defense of this idea by Carrie Jenkins.22 In a nutshell, the dualnature of theory of love holds that love is neither a purely biological or neurochemical phenomenon, on the one hand, nor a purely psychosocial construction, on the other. Rather, it is constituted by both dimensions. To convey what this means in more concrete terms, I shall quickly summarize the “biological” dimension, since it builds on what we learned in the previous section, and then circle back to the psychosocial side of love. In rough outline, the science goes like this.23 Underlying romantic love is a set of overlapping yet functionally distinct brain systems that evolved to suit the reproductive needs of our ancestors. These go by various names, but a common typology distinguishes between lust, attraction, and attachment. Lust or libido’s role—as assigned by natural selection—is to inspire interest in a range of potential mating partners. The attraction system then narrows our focus down to a smaller number of partners, often one in particular. And the attachment system supports the formation of a long-term pair-bond, which is thought to have been adaptive for child rearing in the ancestral environment. Different brain chemicals regulate these quasi-independent systems, including testosterone, oxytocin, dopamine, and many others, and their characteristic patterns of action and reaction largely govern our interpersonal drives and emotions. According to some theorists, these brain chemicals and the neural pathways along which they travel form the universal building blocks of romantic love, which are then reflected in and shaped by various cultural and historical factors across time and geography. So, although there is considerable variation in both subjective experiences and conceptions of love from person to person, between cultures, and over time, the thought is that the same basic biological “machinery” is under the hood. And by tinkering with this machinery through the application of biotechnologies, my coauthors and I have suggested, it will soon be possible to strongly influence those aspects of love that manifest, as it were, above the hood.24 Car analogies should be used sparingly, but let me run with this one a little further. Obviously, the way a car operates, including how and where it moves through space, is shaped not just by internal mechanical factors—corresponding to the biological or neurochemical dimensions of love—but also by external factors such as the decisions of the driver, the movement of pedestrians, the commands of traffic signals, and even completely arbitrary conventions for coordinating behavior, like which side of the road one is supposed to drive on. So, too, is the course and character of love constrained, and, on Jenkins’s account, even partially constituted, by a complex tapestry of external forces flowing from society in a given historical context and interacting with individual psychology and behavior. Those forces, too, can be modified in various ways. If this account is right, then it should be possible to change love, or make it more or less likely to come about or endure, without any fancy technologies (as I hinted at earlier). Changing behavior or circumstances, for example, like breaking off contact with a lover and starting to see someone else, is an obvious way to try to fade love out and (perhaps) fade a new love in. But wider social norms, expectations, and concepts about love can also change, and this may affect what actually counts as love in a given society as we will see in a moment. So sociocultural and behavioral factors must not be ignored. As Lisa Diamond argues, “Calling attention to the biological substrates of love and desire [does not] imply that biological factors are more important than cultural factors in shaping these experiences. On the contrary, research across many disciplines has shown that human experiences of sexual arousal and romantic love are always mediated by social, cultural, and interpersonal contexts, and ignoring these contexts produces a distorted account of human experience.”25 At the same time, however, “ignoring the biological underpinnings of human behavior produces a similarly distorted account . . . human sexual and affectional experiences are neither ‘mainly cultural’ nor ‘mainly biological’ but must always be understood as products of powerful interactions between biological and social factors.” 26 In short, love has a dual nature. It is both biological and psychosocial. To see this dual nature in action, consider the example from Jenkins of a lesbian couple in nineteenth-century England.27 Biologically, she tells us, they are in love: the brain systems for lust, attraction, and romantic attachment are all firing away; the couple is experiencing the rush of adrenaline, the high of serotonin and dopamine, the pull of oxytocin, and so on. But given their historical context, the norms surrounding love and the available social scripts for them to follow are highly restricted. They cannot get married. They cannot publicly express their affection without putting themselves at risk. They cannot raise children together, and so on. In short, the biological dimension of their love is disabled from manifesting in the social sphere as it would for a heterosexual couple. In fact, their feelings for one another—as passionate and sincere and deeply rooted as they are—might not even be recognized as a true form of love by members of the wider society. This lack of recognition, in turn, could shape how they conceive of their own relationship, interpret their own emotions, behave even when they are alone, and so on, all of which might affect what is happening biochemically between them. Feeling shame, for instance, can interfere with sexual desire or inhibit its expression, which can decrease testosterone levels and curb the release of oxytocin, which can erode attachment, which can affect behavior, and round it goes. Simply put, historically contingent norms and expectations drastically limit their ability to engage in, and have others recognize, the psychosocial aspects of the biological machinery that is normally associated with romantic love.28 3. Intervening in Love’s Two Natures Things have improved for lesbian couples in many countries since the late nineteenth century. The social script for love—to repeat that metaphor—has in several respects dramatically changed. Political debates, philosophical argument, appeals to people’s sense of common decency and shared humanity; plays, books, movies, and television shows presenting alternative visions of gay and lesbian relationships: all of this has combined to make same-sex love a coherent concept with wide recognition. This, in turn, has ramifications for the felt and enacted experiences of love between same-sex partners: less shame and repression, perhaps; greater participation in dominant cultural practices like marriage, and so on. So the psychosocial side of love can evidently change in response to concerted interventions. Moreover, it can do so in a way that many people—including this author—see as morally good. What about the biological side of love? Suddenly, things grind to a halt. There is an immediate sense of danger here, and rightly so. When the social script is held constant, and the biological “actor” cannot seem to pull off the role they have been assigned, societies have often tried to coercively modify the individual performer so that nothing upsets the production of the play. I am thinking here of sexual orientation conversion efforts (SOCEs), many of which have been biologically based.29 I have written at length about SOCEs elsewhere.30 There are also chastity belts, genital mutilations intended curb sexual desire,31 teaching children they will go to hell if they masturbate, punishing people for falling in love with the supposedly wrong person, and other such destructive interventions. History is full of examples of oppressive societies trying to retrain recalcitrant actors, often in vain, in an attempt to force them into ill-suited roles. There are also many examples still today. So perhaps we should conclude that the biological actor is right, at least most of the time, and if there is a mismatch of some sort, it is the social script that should be expected to change. I have defended something like this view before, calling it the “Principle of Default Natural Ethics.”32 All else being equal, I argued, we should adopt social scripts—institutions, norms, and so on—that are maximally consistent with our biological natures: for example, our sexual orientations. The reason for this is that it helps us to avoid certain harmful effects of misguided prohibitions and repression, whether enforced through law or custom, on individual and societal well-being. As Erich Fromm argued in Man for Himself: An Inquiry into the Psychology of Ethics: If man were infinitely malleable then . . . norms and institutions unfavorable to human welfare would have a chance to mold man forever into their patterns without the possibility that intrinsic forces in man’s nature would be mobilized and tend to change these patterns. Man would be only the puppet of social arrangements and not—as he has proved to be in history—an agent whose intrinsic properties react strenuously against the powerful pressure of unfavorable social and cultural patterns. In fact if man were nothing but the reflex of culture patterns no social order could be criticized or judged from the standpoint of man’s welfare since there would be no concept of “man.”33 Sexual repression is a case in point.34 It has been argued that Puritanical sexual attitudes in the United States, coupled with abstinence-only sex education policies, have led to such backfiring ills as higher teen pregnancy rates and increased transmission of sexually transmitted infections among American religious youths.35 Some researchers have drawn a straight line from sexual repression and denial of bodily pleasure to seemingly unrelated acts of violence.36 And the unspeakable scandal of child sex abuse in the Catholic Church has been linked, in part, to norms of celibacy in the priesthood.37 This does not absolve anyone of responsibility for their actions. But it does force us to ask whether widespread standards of sexual repression do more harm than good. It is only when biology-consistent norms about human behavior lead to harm or violate other moral standards, like justice, that laissez faire policies should be reconsidered. Then, the costs and benefits of different forms of social regulation can be tallied up. Consider the example of forced sex, which in humans is a form of rape (some forms of rape do not involve physical force, which is why I am drawing this distinction). Some theorists have characterized such behavior as being ultimately rooted in biology, in the sense that it appears to exist in our primate relatives and may have been a way for low-status ancestral human males to pass on their genes despite not being able to find a willing mate.38 Rape is, in some sense, “natural” according to this view. This view is controversial, not just politically but also scientifically: the evidence raised in support of it has been sharply criticized.39 (Among other problems, it shifts attention away from sociocultural norms and structures that tend to be permissive of male violence in human societies,40 when these are central to understanding the more immediate causes of rape in the contemporary world.) The point I am making is more conceptual. It is that even if rape could be meaningfully explained in terms of biological factors (in addition to social, psychological, and cultural ones), this could never ethically justify rape. Rape is wrong not because it is natural or unnatural, biological or social, or motived by a desire for sex or power. It is wrong because it is a gross violation of another’s sexual autonomy and bodily integrity, and often causes grievous harm.41 Therefore, we should condemn sexual assault in all its forms, punish it as severely as the law (and human decency) allows, and try to prevent it from happening whenever we can. In a similar vein, some scientists believe that pedophilia—that is, primary erotic interest in pubescent or prepubescent children—is at least partially explained by biological factors: stable, internal factors present at birth that are not something a person can choose. Much like a sexual orientation, in fact.42 So, for example, the finding that males with pedophilia are more likely to be left-handed and have low IQs “suggests that pedophilia may [be] causally related to neurodevelopment. It is possible, in other words, that associations exist among pedophilia, left-handedness, and poor cognitive functioning, because neurodevelopmental problems during prenatal life dispose a male to develop all three.” 43 This perspective, too, is controversial. But let us just assume for the sake of argument that such findings turn out to be widely replicated,44 and that pedophilia even comes to be seen as a sexual orientation (albeit one based on age or physical development rather than sex or gender). Would this suggest that we should rewrite the social script condemning sexual contact with children—that is, acting on a pedophilic orientation—so that those with pedophilia can more easily express this part of their biological nature? Far from it. Although we should not necessarily stigmatize those who have, but do not act on, such desires (assuming that the desires themselves are unchosen), we should certainly uphold the strongest possible norms against sexual abuse of children. Moreover, if a person with pedophilia volunteers to have their biology changed—through the ingestion of testosterone-blockers, for instance—in an effort to curb their risky sexual desires, some would argue that they should be commended.45 The naturalistic fallacy is one of the oldest and most famous mistakes in ethics. It involves drawing conclusions about what should be the case, or what should be done, directly from descriptive statements about how things are, such as what our natural or biological dispositions happen to be.46 But something’s being natural or biological does not, by itself, logically, morally, or in any other way entail that it is good or desirable. 47 Cancer is natural but bad. Modern medicine is unnatural but good. Naturalness and moral status can come apart. Now consider a very different example: people with transgender identities. Roughly speaking, a transgender person is someone whose gender identity (such as man, woman, or genderqueer)48 does not align with the gender role that was assigned to them at birth, usually based on their external reproductive characteristics (like whether they have a penis or vulva).49 This experience of misalignment, which often has both biological and social components, can be profoundly distressing, and something has to give. Part of the problem is that the dominant social norms surrounding gender are so binary and restrictive. According to these norms, if you are an adult, you are either a man (who must look, dress, and behave in particular ways) or a woman (who must look, dress, and behave in other ways), or face the consequences. In a perfect world, these norms would be softened and expanded and in general made much more fluid. We should all try to make that happen. But in the meantime, many people, transgender or otherwise, feel that they have to conform to one binary role or another, sometimes just to get by. They may even face violence for failing to do so.50 In order to simply survive in the world, or in some cases, to manifest their gender identity in a way that is most authentic for them (irrespective of social stigma), changing biological features through hormone treatments51 or surgeries is the best option for some transgender individuals.52 And these individuals may justifiably pursue such means even as they work with others to rewrite the constricting social scripts that are currently available for enacting gender.53 What this last example shows is that, even if you think the social script is bad—in this case, because its gender roles are too narrow and restrictive—it does not automatically follow that the biological aspects of the person or phenomenon must at all costs remain untouched. Certainly, no person should be forced to undergo a biological modification, at least in most cases (the moral bioenhancement of violent psychopaths has been proposed as an exception), 54 but some individuals might reasonably decide to modify aspects of their own biology, and be well within their rights to do so, even if the social script has certain flaws. The same general idea, I suggest, applies to love and relationships. As we saw in the previous section, love has both biological and psychosocial aspects, and it can be modified along either or both dimension(s). There may be inherent biological obstacles to the success of especially long-term romantic partnerships in modern societies, due to various tensions that can arise between the building blocks for love (lust, attraction, and attachment) and the way these variables manifest in a given sociohistorical context. In short, the underlying machinery for love did not evolve to promote happy, meaningful relationships in the contemporary world, but rather the survival of offspring in the world of our ancestors.55 To see how this can create difficulties for romantic partnerships of different kinds in the world of today, I turn to some examples. 4. Human Natures Consider a monogamous couple. Let us assume that they are married. In other words, as a part of their wedding vows, they agreed to be sexually exclusive with each other so long as their marriage lasts. Indeed, most couples who get married do make such a promise: it is a largely taken-for-granted feature of the prevailing social script for long-term relationships in Western (and many other) societies. It is also a promise that is often broken, leading to great suffering in many cases. There is an obvious tension here, and if we are concerned about human welfare, something must be done to relieve it. So what should change? The social script that favors monogamy? Or the drive to have sex with more than one person, notwithstanding a long-term partnership? This is a false dichotomy, of course, and that is part of my point, but it gives us a place to start. We can take the social script issue first. Based on our discussion in the previous section, the default position—which can be overridden as necessary—should be to adopt social scripts, including relationship norms, that are in line with those aspects of human biology that do not respond well to cultural suppression (in the sense spelled out by Erich Fromm). According to this perspective, the answer to the question about whether the social script should change depends, in part, on facts about human biology as they bear on sexual exclusivity. Unsurprisingly, there is disagreement among scientists about those facts. Certainly, humans as a species are generally disposed, biologically speaking, to form a long-term pairbond with at least one primary partner, with whom they will often raise offspring together. But very few species in the wider animal kingdom, including our closest primate relatives, are completely sexually monogamous. From an evolutionary perspective, such stringent fidelity tends not to maximize reproductive success, and so is unlikely to survive as a dominant mating strategy. Humans are no exception. Quite a lot of sex occurs in our species outside of the primary pair-bond—I do not need to cite evidence for this, it is so widespread—and this is true even in societies where such behavior is strongly condemned and heavily policed.56 This fact has led some researchers to argue that claims of “natural monogamy” for our species are no more than conservative propaganda: desperate attempts to justify (by commission of the naturalistic fallacy) outdated and oppressive cultural norms. The sex researchers Christopher Ryan and Cacilda Jethá are well known for advancing such a view. “Like bonobos and chimps,” they write, “we are the randy descendants of hypersexual ancestors.” Accordingly: Conventional notions of monogamous, till-death-do-us-part marriage strain under the dead weight of a false narrative that insists we’re something else. [The] campaign to obscure the true nature of our species’ sexuality leaves half our marriages collapsing under an unstoppable tide of swirling sexual frustration, libido-killing boredom, impulsive betrayal, dysfunction, confusion, and shame.57 If Ryan and Jethá are right, the prevailing social script that valorizes monogamy should indeed be revised. But not everyone is on board with this broad-brush picture of human nature (including other leading sex researchers).58 According to Carrie Jenkins, it is almost as though the traditional moralists—the ones who claim that human beings are primarily sexually monogamous by nature and that they should follow the corresponding social norm— have asserted that “blue is the natural eye color for humans, and then Ryan and Jethá, noting that a lot of humans have green eyes, [counter] that green is the natural eye color for humans.” But this is to make the same essentializing mistake the other way around. For many people, as Jenkins observes, “monogamy really doesn’t seem to be a terrible struggle. They say it feels perfectly ‘natural’ and delightful and right.”59 Others feel exactly the opposite—hence the “unstoppable tide of swirling sexual frustration.” Humans are not uniform. So although it can be maddeningly hard to distinguish what is “natural” for our species from deep-seated cultural expectations, even if those expectations could somehow be magically filtered out, we would still find a lot of individual variance down at the level of “pure” biology. To put this another way: just as some people may be “wired up” to be attracted to partners of the same sex or gender (I realize this is a gross oversimplification; also please forgive the electronics metaphor),60 other people may be “wired up” to feel attracted to, and desire a physical and emotional relationship with, more than one person at a time. The exact percentage of humans this description applies to is not clear, and I am not really sure it matters from a moral perspective. If homosexuality is “natural” for some people—meaning something like, most consistent with a person’s innermost, unchosen, most stable, hard-toignore preferences and desires—then polyamory is probably natural for some people, too, just as heterosexuality and/or monogamy are natural for others.61 What this suggests is that the social script for love should allow for a range of different relationship norms, so that people can figure out what is right for them, and be socially supported in their decision. In other words, even if there is a single, underlying human nature that applies to the vast majority of our species, this does not entail that there should be a single set of social norms to which everyone must conform. In fact, recent research suggests that consensually nonmonogamous relationships can be just as functional and conducive to happiness as consensually monogamous relationships, notwithstanding greater stigma toward the former.62 5. Resolving Tensions Let me take stock of where are. Depending on one’s nature (in the sense I sketched in the previous section), the prevailing relationship norms in one’s society, and one’s own considered beliefs and values, various sources of tension can arise among these and related factors. I have suggested that the ideal social script would allow for a range of relationship norms (so long as these as these are not unjust, harmful, and so on) so that people can choose the one that works best for them. In that way, they can minimize the tensions alluded to previously without having to modify various aspects of their biology that may be difficult or risky to change. But even when there is room for such choice, this does not make for an easy decision. Nor does it rule out the potential usefulness of a biological intervention. I consider these last two points in turn. First, to see some of the difficulty involved in deciding what norm(s) to adopt, consider again the example of monogamy. According to Bryan R. Weaver and Fiona Woollard, adopting this norm in a given relationship can be good or valuable when it is motivated by a reasonable belief that doing so will fulfill the emotional and sexual needs of both partners. 63 In other words: when sacrificing other sexual opportunities—for the sake of the relationship—is likely to promote the overall welfare and happiness of both. But they also argue that monogamy can be disvaluable when it is motivated by jealousy, insecurity, or a desire for control. By the same token, rejection of monogamy can be valuable when it demonstrates maturity and a well-grounded belief that the partnership is strong enough flourish even as the partners see other people. And rejection of monogamy can be disvaluable when the motive is selfish, or based in an attempt to avoid working together as partners to address whatever sexual or other needs may be going unfulfilled. Let us suppose that you do reject monogamy. Suppose you have carefully reflected on the sorts of considerations raised by Weaver and Woolard, and based upon a deep reflection about your innermost “nature” (in my sense) you have decided to foreground a commitment to nonpossessiveness, sexual freedom, openness, and generosity about love in your constellation of values. Does this mean that you are now immune from the sorts of tensions we discussed in the previous section? Or that there is no potential role for a biological intervention? By no means. Chances are, in this day and age, that at least one source of tension for you is the existence of negative judgments from (some) members of the surrounding culture who, mistakenly in your view, see polyamory as inherently sinful, selfish, or unsustainable.64 One way to address this tension would be to try to contest those negative judgments: difficult to do on your own, but if enough polyamorists come out of the closet and take a stand for their relationship values, they might make good progress on rewriting the social script. The gay rights movement, again, provides a model. Other sources of tension could be internal, however. Maybe you struggle to control your jealousy, despite firmly believing that this emotion is not a reliable guide to moral judgments or good behavior.65 It may be instructive to dwell on this example. Jealousy has deep evolutionary roots. Most scientists think that it was an adaptive solution to the problem of paternity uncertainty in ancestral males and resource insecurity in ancestral females (the details are interesting, but they go beyond the scope of this chapter).66 In other words, they think that the capacity to feel intensely jealous, especially when faced with a perceived sexual rival, is an ingrained feature of your—and indeed most people’s—biological “actor.” Could a biological antijealousy modification help you meet your relationship goals? Something to supplement the more conventional methods of stamping out (unproductive) jealousy you might already be using? Consider the following real-life case study—of a monogamous couple rather than a polyamorous one, but the principle remains the same: A 54-year-old male manager of an antique shop presented himself [to a psychiatrist] with a 4-week complaint of “depression” . . . He volunteered two causes, a council election with one party’s policies being a threat to his business, and recent marital dysfunction.67 The “marital dysfunction” part is the one I am interested in: Marital difficulties followed his stated wish to make contact with a former girlfriend, with whom there had been no contact for 30 years. His wife agreed pleasantly, however, a week later, asked if she could make contact with her old boyfriend. The patient progressively developed a set of anxiety symptoms including panic attacks, and depersonalization experiences. He began to harass his wife, initially about her motivation for re-establishing contact, and later pursuing all details of her original relationship with the man, questioning and haranguing her for hours. He accepted referral when his wife stated that his behavior threatened their 20-year-long happy marriage and that, if it persisted, she would leave him.68 The man’s psychiatrist dug deeper. Personality review suggested a man with a distinct obsessional personality: always on time for appointments, preoccupied with order and efficiency, extremely well organized, a meticulous checker of minor and major issues, perfectionistic, productivity-focused, scrupulous about morality and ethics, and distinctly conscientious. Symptom review indicated long-standing mild anxiety. A diagnosis of anxiety state with secondary depression was made initially, and he was prescribed alprazolam [Xanax] for a brief interval to reduce his anxiety. At the third consultation, the possibility of OCD [obsessive-compulsive disorder] was considered.69 Indeed, intense jealousy is a lot like OCD: fixation on tiny details, compulsive thinking, intrusive and unwanted thoughts, persisting in repetitive behavior despite clear signs it is not helping anything, and may very well be making things worse. Perhaps the two phenomena have more in common than we realize. The psychiatrist Paul E. Mullen has pointed out that “checking,” an obsessive behavior associated with OCD, also occurs in people who experience jealousy: “an almost universal behavior among the jealous [is] checking that the lover is where they say they are and with whom they say, cross checking, re-checking (with frequent) inquisitorial cross-questioning of the lover.”70 Following this line of thinking, the man’s psychiatrist changed the course of medication to clomipramine, sold under the brand name Anafranil, a common treatment for OCD. After six days of taking the drug, the antique shop manager “stated that he felt less anxious . . . and that his jealousy (subjective feeling and associated behavioral actions) had eased considerably.” A specialized program of “exposure therapy, response prevention and cognitive restructuring,” was then started; four weeks later, the man “reported that the original concerns were no longer relevant.”71 Marriage saved. Part of what is interesting about this case is that jealousy is not usually seen as being a mental disorder that is amenable to being treated with medicine. In fact, this man was not diagnosed with jealousy, as such, but was rather treated, in the words of his psychiatrist, “as if he had an obsessive-compulsive disorder.”72 Emphasis on “as if.” What this goes to show is that it may not be necessary to pathologize, that is, conceptualize as a disease state, so-called ordinary human experiences, in order to recognize that sometimes our romantic biology pulls on our conscious thinking and behavior in ways that we do not want and did not ask for, and that pose a threat to our and our partners’ well-being. Moreover, as we just saw, sometimes biological interventions—especially when combined with appropriate psychosocial approaches—can help to eliminate that threat, whether we want to call it medicine or not. That last example was brought up in a discussion of polyamory, where jealousy of any kind is often seen as conflicting with the partners’ highest values. But suppose you are in a monogamous relationship, like the couple we started with. Maybe you and your partner genuinely believe that monogamy is the right way to go, all things considered: it is the closest fit between your natures, your social and cultural environment, and your mutual goals and values. In this case, instead of trying to tamp down jealousy about your partner’s other partner(s), perhaps it is your own wandering eye that is standing between you and the happiest version of your committed relationship. Could science, one day, help the biological “actor” in you do a better job of following the social script you actively endorse and agreed to follow? Imagine this scenario. You and your partner are deeply in love. You are truly committed to each other, and you make each other happy in just about every way. But there is one thing gnawing at you—one persistent problem that you just cannot seem to shake no matter what you do. Your sex drive is much stronger than that of your partner. You desire sex most of the time, at least once a day, while your partner is more of an every-other-week type, give or take. This asymmetry causes friction, despite your best attempts to dance around it. Your partner starts to feel guilty, even though you have promised it is not their fault. You start to feel resentful and unfulfilled, even though you try to push those feelings away. There is nothing wrong with either of you. You just have different sexual needs— something that applies to many long-term relationships. Maybe you even started out with similar levels of desire, and things shifted for one or both of you over time. There is nothing necessarily pathological about that, either. Now you have a life together. A house, kids, mutual friends. Neither of you wants to give this up. Your partner is “perfect” for you in every other way. You know sex is not everything. You know that good relationships require sacrifice, and you are willing to do whatever it takes. But still you find yourself fantasizing about sex with others, and you fear you will act against your values at some point if something does not change. Now let us further imagine that you and your partner have great communication. You have been honest. You each know how the other feels. You have gone to a relationship counselor together and tried various exercises to sync up your sexual drives. It does not work. You have even talked about opening up your relationship (that is, allowing for sex outside the relationship, with certain rules and restrictions to keep things secure), but, like the couple from the start of this chapter, you both conclude, after much consideration, that it would cause more trouble than it is worth. You seem to be facing a horrible choice. Either end a relationship that means the world to you, ignore or suppress your sexual desires, or cheat on your partner in a moment of weakness.73 What do you do? Let us add one more detail to this story. Suppose you are taking some medication, prescribed by your doctor, for anxiety and mild depression—buproprion, let us say (commonly sold as Wellbutrin). Unlike many antidepressant medications, Buproprion is not an SSRI, but is rather an NDRI (norepinephrine-dopamine reuptake inhibitor), and it has fewer sexual side-effects, like loss of libido.74 According to one study, subjects treated with SSRI-based medications, compared to buproprion, experienced “significantly decreased libido, arousal, duration of orgasm, and intensity of orgasm” below levels experienced before treatment.75 The next time you see your doctor, you decide to ask about switching from an NDRI to an SSRI, knowing full well that this might lower your libido. Assuming that the latter is an equally valid treatment for your anxiety and depression, suppose that your doctor agrees. You switch medications and you find that your desire for sex becomes more subdued. Your fantasies about sex with others become less frequent. The friction in your relationship begins to subside. Once again we have a case where biochemical intervention could be seen as effectively resolving a source of serious tension between biology, norms, and values. 6. Analysis and Concluding Thoughts I designed that case to be intuitively sensible. You are supposed to think it would be justifiable, perhaps even praiseworthy, to switch your medication in order to save your relationship and adhere to your values. If you do think that, then I have cleared a low bar: it can sometimes be appropriate to intervene in love’s biological side to help a couple achieve their relationship goals. You might not agree with that perspective, however. You might think that you should not turn to medication, no matter what the cost to you or your family, to resolve such tensions in your romantic relationship. Now, let me remind you that you were already taking medication in this scenario, and that other strategies had been tried in good faith and were not working. Even so, you might say, that is just something you will have to deal with: you should only change your medication if it is to address a “medical” problem, and desiring more sex than your partner is not a medical problem. True enough—it is not. There is nothing medically wrong with you if you happen to desire a lot of sex (just as there is nothing medically wrong with you if you happen to feel jealous about your wife’s ex-boyfriend—within reason). In many cases, trying to find a partner with a similar sex drive, or one who is open to nonmonogamy, will be the best way for you to secure a happy relationship. Maybe even breaking up with your current partner— getting a divorce, splitting up the kids, moving to another part of town and starting over—is the price to pay for being true to “who you are.” Or maybe you should stay in the relationship, and try to convince your partner to reconsider your promise of monogamy; or else bury that part of “who you are” underground. There is no one right way to proceed. The most justifiable course of action will depend on the details, and different couples will find that different solutions are (all things considered) best for them. It would be strange indeed if everyone had the same needs and values. Accordingly, there will never be a one-size fits-all resolution to the various tensions that can arise in romantic partnerships. But the best decision will be one that takes seriously the available options and weighs them against each other without prejudging the conclusion. As my coauthor on much of this work—Julian Savulescu—has argued, how well our lives go is largely determined by four major factors: natural environment, social environment, psychology, and biology.76 Each of these can typically be modified in a number of different ways. Absent a clear overriding reason not to, we should at least consider the full range of potential modifications, and then choose the modification, or combination of modifications, that is likeliest to be best or most effective at improving our lives. There may be very good reasons to prefer psychosocial interventions over biological interventions in trying to improve various facets of our lives, including our relationships. For instance, such interventions might be safer, more likely to be successful, or more fair or just (based on limited resources, for example). But we should not just dismiss biological interventions from the start.77 Indeed, in some cases it may be the biological interventions that are safer, more likely to be successful, and demanded by justice. Since love is fundamentally both biological and psychosocial, I have argued, we should at least consider intervening along both dimensions if we want love and happiness to coincide in our relationships. Bibliography Aas, Sean, and Candice Delmas. “The Ethics of Sexual Reorientation: What Should Clinicians and Researchers Do?” Journal of Medical Ethics 42, no. 6 (2016): 340–347. https://doi.org/10.1136/medethics-2016-103562. Aas, Sean, and Candice Delmas. “Sexual Reorientation in Ideal and Non-Ideal Theory.” Journal of Political Philosophy 26, no. 4 (2018): 463-485. Arrell, Robbie. “Should We Biochemically Enhance Sexual Fidelity?” Royal Institute of Philosophy Supplements 83 (2018): 389–414. https://doi.org/10.1017/S1358246118000462. Baccarini, Elvio, and Luca Malatesti. “The Moral Bioenhancement of Psychopaths.” Journal of Medical Ethics 43, no. 10 (2017): 697–701. https://doi.org/10.1136/medethics2016-103537. Bamford, Rebecca. “Unrequited: Neurochemical Enhancement of Love.” Cambridge Quarterly of Healthcare Ethics 24, no. 3 (2015): 355–360. https://doi.org/10.1017/S0963180114000668. Diamond, Lisa M. “What Does Sexual Orientation Orient? A Biobehavioral Model Distinguishing Romantic Love and Sexual Desire.” Psychological Review 110, no. 1 (2003): 173–92. https://doi.org/10.1037/0033-295X.110.1.173. Earp, Brian D. “Love and Other Drugs.” Philosophy Now 91 (2012): 14–17. Earp, Brian D. “Can You Be Gay by Choice?” In Philosophers Take on the World, edited by David Edmonds, 95–98. Oxford: Oxford University Press, 2016. Earp, Brian D. “Psychedelic Moral Enhancement.” Royal Institute of Philosophy Supplement 83, no. 1 (2018): 415–439. Earp, Brian D., Thomas Douglas, and Julian Savulescu. “Moral Neuroenhancement.” In Routledge Handbook of Neuroethics, edited by Sid M. Johnson and Karen S. Rommelfanger, 166–184. Abingdon: Routledge, 2017. Earp, Brian D., Bennett Foddy, Olga A. Wudarczyk, and Julian Savulescu. “Love Addiction: Reply to Jenkins and Levy. ” Philosophy, Psychiatry, and Psychology 24, no. 1 (2017): 101–103. Earp, Brian D., and Michael Hauskeller. “Binocularity in Bioethics—and Beyond.” American Journal of Bioethics 16, no. 2 (2016): W3–W6. Earp, Brian D., Anders Sandberg, Guy Kahane, and Julian Savulescu. “When Is Diminishment a Form of Enhancement? Rethinking the Enhancement Debate in Biomedical Ethics.” Frontiers in Systems Neuroscience 8, no. 12 (2014): 1–8. Earp, Brian D., Anders Sandberg, and Julian Savulescu. “Natural Selection, Childrearing, and the Ethics of Marriage (and Divorce): Building a Case for the Neuroenhancement of Human Relationships.” Philosophy and Technology 25, no. 4 (2012): 561–587. https://doi.org/10.1007/s13347-012-0081-8. Earp, Brian D., Anders Sandberg, and Julian Savulescu. “Brave New Love: The Threat of High-Tech ‘Conversion’ Therapy and the Bio-Oppression of Sexual Minorities.” AJOB Neuroscience 5, no. 1 (2014): 4–12. https://doi.org/10.1080/21507740.2013.863242. Earp, Brian D., Anders Sandberg, and Julian Savulescu. “The Medicalization of Love.” Cambridge Quarterly of Healthcare Ethics 24, no. 3 (2015): 323–336. https://doi.org/10.1017/S0963180114000206. Earp, Brian D., Anders Sandberg, and Julian Savulescu. “The Medicalization of Love: Response to Critics.” Cambridge Quarterly of Healthcare Ethics 25, no. 4 (2016): 759– 771. Earp, Brian D., and Julian Savulescu. “Is There Such a Thing as a Love Drug? Reply to McGee.” Philosophy, Psychiatry, and Psychology 23, no. 2 (2016): 93–96. Earp, Brian D., and Julian Savulescu. “Love Drugs: Why Scientists Should Study the Effects of Pharmaceuticals on Human Romantic Relationships.” Technology in Society 52, no. 2 (2018): 10–16. https://doi.org/10.1016/j.techsoc.2017.02.001. Earp, Brian D., Anders Sandberg, Julian Savulescu, and Ross Andersen. “The Case for Using Drugs to Enhance our Relationships (and Our Break Ups).” The Atlantic, January 31, 2013. https://www.theatlantic.com/technology/archive/2013/01/the-case-for-usingdrugs-to-enhance-our-relationships-and-our-break-ups/272615/. Earp, Brian D., and Andrew Vierra. “Sexual Orientation Minority Rights and High-Tech Conversion Therapy.” In The Palgrave Handbook of Philosophy and Public Policy, edited by David Boonin, 535–550. Cham, Switzerland: Springer International Publishing, 2018. https://doi.org/10.1007/978-3-319-93907-0_41. Earp, Brian D., Olga A. Wudarczyk, Bennett Foddy, and Julian Savulescu. “Addicted to Love: What Is Love Addiction and When Should It Be Treated? ” Philosophy, Psychiatry, and Psychology 24, no. 1 (2017): 77–92. Earp, Brian D., Olga A. Wudarczyk, Anders Sandberg, and Julian Savulescu. “If I Could Just Stop Loving You: Anti-Love Biotechnology and the Ethics of a Chemical Breakup.” American Journal of Bioethics 13, no. 11 (November 1, 2013): 3–17. https://doi.org/10.1080/15265161.2013.839752. Fisher, Helen E. Anatomy of Love. New York: Norton, 2016. Fisher, Helen E., Arthur Aron, and Lucy L. Brown. “Romantic Love: A Mammalian Brain System for Mate Choice.” Philosophical Transactions of the Royal Society B: Biological Sciences 361, no. 1476 (2006): 2173–2186. https://doi.org/10.1098/rstb.2006.1938. Fromm, Erich. Man for Himself: An Inquiry into the Psychology of Ethics. London: Routledge, 1947. Fromm, Erich. The Art of Loving. New York: Harper & Row, 1956. Giubilini, Alberto. “Normality, Therapy, and Enhancement: What Should Bioconservatives Say about the Medicalization of Love?” Cambridge Quarterly of Healthcare Ethics 24, no. 3 (2015): 347–354. https://doi.org/10.1017/S0963180114000656. Greer, George R., and Requa Tolbert. “A Method of Conducting Therapeutic Sessions with MDMA.” Journal of Psychoactive Drugs 30, no. 4 (1998): 371–379. https://doi.org/10.1080/02791072.1998.10399713. Hauskeller, Michael. “Clipping the Angel’s Wings: Why the Medicalization of Love May Still Be Worrying.” Cambridge Quarterly of Healthcare Ethics 24, no. 3 (2015): 361– 365. https://doi.org/10.1017/S096318011400067X. Jenkins, Carrie. What Love Is: And What It Could Be. New York: Basic Books, 2017. Klesse, Christian. “Theorizing Multi-Partner Relationships and Sexualities: Recent Work on Non-Monogamy and Polyamory.” Sexualities 21, no. 7 (2018): 1109–1124. https://doi.org/10.1177/1363460717701691. Maslen, Hannah, Brian D. Earp, Roi Cohen Kadosh, and Julian Savulescu. “Brain Stimulation for Treatment and Enhancement in Children: An Ethical Analysis.” Frontiers in Human Neuroscience 8, no. 953 (2014): 1–5. McGee, Andrew. “Is There Such a Thing as a Love Drug?” Philosophy, Psychiatry, and Psychology 23, no. 2 (2016): 79–92. https://doi.org/10.1353/ppp.2016.0006. Minerva, Francesca. “Unrequited Love Hurts: The Medicalization of Broken Hearts Is Therapy, Not Enhancement.” Cambridge Quarterly of Healthcare Ethics 24, no. 4 (2015): 479–485. https://doi.org/10.1017/S0963180115000134. Naar, Hichem. “Real‐World Love Drugs: Reply to Nyholm.” Journal of Applied Philosophy 33, no. 2 (May 1, 2016): 197–201. https://doi.org/10.1111/japp.12141. Nyholm, Sven. “Love Troubles: Human Attachment and Biomedical Enhancements.” Journal of Applied Philosophy 32, no. 2 (2015): 190–202. https://doi.org/10.1111/japp.12085. Nyholm, Sven. “The Medicalization of Love and Narrow and Broad Conceptions of Human Well-Being.” Cambridge Quarterly of Healthcare Ethics 24, no. 3 (2015): 337–346. https://doi.org/10.1017/S0963180114000644. Parens, Erik. “On Good and Bad Forms of Medicalization.” Bioethics 27, no. 1 (2013): 28– 35. https://doi.org/10.1111/j.1467-8519.2011.01885.x. Savulescu, Julian. “New Breeds of Humans: The Moral Obligation to Enhance.” Reproductive BioMedicine Online 10 (2005): 36–39. https://doi.org/10.1016/S14726483(10)62202-X. Savulescu, Julian. “Genetic Interventions and the Ethics of Enhancement of Human Beings.” In Readings in the Philosophy of Technology, edited by David M. Kaplan. New York: Rowman & Littlefield, 2009. Savulescu, Julian, and Brian D. Earp. “Neuroreductionism about Sex and Love.” Think 13, no. 38 (2014): 7–12. Savulescu, Julian, and Anders Sandberg. “Neuroenhancement of Love and Marriage: The Chemicals between Us.” Neuroethics 1, no. 1 (2008): 31–44. https://doi.org/10.1007/s12152-007-9002-4. de Sousa, Ronald. “Love, Jealousy, and Compersion.” In The Oxford Handbook of Philosophy of Love, edited by Christopher Grau and Aaron Smuts. Oxford: Oxford University Press, 2017. http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199395729.001.0001/oxf ordhb-9780199395729-e-30. Spreeuwenberg, Lotte. “Taking the Love Pill: A Reply to Naar and Nyholm.” Journal of Applied Philosophy, in press, online ahead of print. https://doi.org/10.1111/japp.12305. Striepens, Nadine, Keith M. Kendrick, Wolfgang Maier, and René Hurlemann. “Prosocial Effects of Oxytocin and Clinical Evidence for Its Therapeutic Potential.” Frontiers in Neuroendocrinology 32, no. 4 (2011): 426–450. https://doi.org/10.1016/j.yfrne.2011.07.001. Tweedy, Ann E. “Polyamory as a Sexual Orientation.” University of Cincinnati Law Review 79, no. 4 (2010): 1461–1515. Weaver, Bryan R., and Fiona Woollard. “Marriage and the Norm of Monogamy.” The Monist 91, no. 3/4 (2008): 506–522. Wudarczyk, Olga A., Brian D. Earp, Adam Guastella, and Julian Savulescu. “Could Intranasal Oxytocin Be Used to Enhance Relationships? Research Imperatives, Clinical Policy, and Ethical Considerations.” Current Opinion in Psychiatry 26, no. 5 (2013): 474–484. https://doi.org/10.1097/YCO.0b013e3283642e10. Notes 1 Of the more than one million divorces that occur annually in the United States, there is evidence that the majority stem from relationships much like this. In other words, it is not just those marriages characterized by constant fighting, abuse, or other clearly dysfunctional habits that keep the divorce courts packed. Rather, a surprisingly high proportion consists of relatively low-conflict marriages that are reasonably stable, functional, and perhaps even occasionally pleasant, but when it comes right down to it, less than happy. See Pamela Haag, Marriage Confidential: Love in the Post-Romantic Age (New York: HarperCollins, 2011). For a more formal discussion, see Tim B. Heaton and Stan L. Albrecht, “Stable Unhappy Marriages,” Journal of Marriage and Family 53, no. 3 (1991): 747–758, https://doi.org/10.2307/352748. 2 For recent discussions by others (that is, excluding myself and my usual coauthors; our papers are listed in the bibliography), see Andrew McGee, “Is There Such a Thing as a Love Drug?” Philosophy, Psychiatry, and Psychology 23, no. 2 (2016): 79–92, https://doi.org/10.1353/ppp.2016.0006; Sven Nyholm, “Love Troubles: Human Attachment and Biomedical Enhancements,” Journal of Applied Philosophy 32, no. 2 (2015): 190–202, https://doi.org/10.1111/japp.12085; Sven Nyholm, “The Medicalization of Love and Narrow and Broad Conceptions of Human Well-Being,” Cambridge Quarterly of Healthcare Ethics 24, no. 3 (2015): 337–346, https://doi.org/10.1017/S0963180114000644; Hichem Naar, “Real‐World Love Drugs: Reply to Nyholm,” Journal of Applied Philosophy 33, no. 2 (May 1, 2016): 197–201, https://doi.org/10.1111/japp.12141; Francesca Minerva, “Unrequited Love Hurts: The Medicalization of Broken Hearts Is Therapy, Not Enhancement,” Cambridge Quarterly of Healthcare Ethics 24, no. 4 (2015): 479–485, https://doi.org/10.1017/S0963180115000134; Alberto Giubilini, “Normality, Therapy, and Enhancement: What Should Bioconservatives Say about the Medicalization of Love?,” Cambridge Quarterly of Healthcare Ethics 24, no. 3 (2015): 347–354, https://doi.org/10.1017/S0963180114000656; Rebecca Bamford, “Unrequited: Neurochemical Enhancement of Love,” Cambridge Quarterly of Healthcare Ethics 24, no. 3 (2015): 355–360, https://doi.org/10.1017/S0963180114000668; Robbie Arrell, “Should We Biochemically Enhance Sexual Fidelity?,” Royal Institute of Philosophy Supplements 83 (2018): 389–414, https://doi.org/10.1017/S1358246118000462; Michael Hauskeller, “Clipping the Angel’s Wings: Why the Medicalization of Love May Still Be Worrying,” Cambridge Quarterly of Healthcare Ethics 24, no. 3 (2015): 361–365, https://doi.org/10.1017/S096318011400067X; Lotte Spreeuwenberg, “Taking the Love Pill: A Reply to Naar and Nyholm,” Journal of Applied Philosophy, in press, online ahead of print, https://doi.org/10.1111/japp.12305. 3 See Brian D. Earp and Julian Savulescu, “Love Drugs: Why Scientists Should Study the Effects of Pharmaceuticals on Human Romantic Relationships,” Technology in Society 52, no. 2 (2018): 10– 16, https://doi.org/10.1016/j.techsoc.2017.02.001. See also Brian D. Earp et al., “If I Could Just Stop Loving You: Anti-Love Biotechnology and the Ethics of a Chemical Breakup,” American Journal of Bioethics 13, no. 11 (2013): 3–17, https://doi.org/10.1080/15265161.2013.839752. 4 William Shakespeare, Sonnet 116. For a thoughtful discussion of the philosophical implications of such a notion, see Amelie Oksenberg Rorty, “The Historicity of Psychological Attitudes: Love Is Not Love Which Alters Not When It Alteration Finds,” Midwest Studies In Philosophy 10, no. 1 (n.d.): 399–412, https://doi.org/10.1111/j.1475-4975.1987.tb00548.x. 5 For a classic defense of this view, see Erich Fromm, The Art of Loving (New York: Harper & Row, 1956). 6 Erik Parens, “On Good and Bad Forms of Medicalization,” Bioethics 27, no. 1 (2013): 28–35, https://doi.org/10.1111/j.1467–8519.2011.01885.x. 7 In fact, the innovation is only partial. As I have written about elsewhere, the use of biochemical substances to enhance the effects of couples counseling is also, at least in some circles, old news: MDMA was used in the 1980s as an aid to individual and interpersonal psychotherapy before it was banned following a conservative shift in the culture: see Brian D. Earp, “Psychedelic Moral Enhancement,” Royal Institute of Philosophy Supplement 83, no. 1 (2018): 415–439; Brian D. Earp, “Drogen Nehmen—um Wohl Unserer Kinder?” GEO Magazine 10, no. 1 (2015): 62–63. My so-called innovation, then, might better be described as a revival, although I do hope that the philosophical and ethical insights I am trying to raise are original enough to inspire further conversation. 8 Carrie Jenkins, What Love Is: And What It Could Be (New York: Basic Books, 2017). 9 For example, Helen E. Fisher, Arthur Aron, and Lucy L. Brown, “Romantic Love: A Mammalian Brain System for Mate Choice,” Philosophical Transactions of the Royal Society B: Biological Sciences 361, no. 1476 (2006): 2173–2186, https://doi.org/10.1098/rstb.2006.1938. 10 Larry J. Young, “Being Human: Love: Neuroscience Reveals All,” Nature 457 (2009): 148, https://doi.org/10.1038/457148a. 11 Bennett Helm, “Love,” ed. Edward N. Zalta, Stanford Encyclopedia of Philosophy Fall (2017): 1– 52. For further discussion, see Earp, Brian D., Bennett Foddy, Olga A. Wudarczyk, and Julian Savulescu. “Love Addiction: Reply to Jenkins and Levy. ” Philosophy, Psychiatry, and Psychology 24, no. 1 (2017): 101–103. 12 Adam Opbroek et al., “Emotional Blunting Associated with SSRI-Induced Sexual Dysfunction. Do SSRIs Inhibit Emotional Responses?,” International Journal of Neuropsychopharmacology 5, no. 2 (June 1, 2002): 147–151, https://doi.org/10.1017/S1461145702002870. 13 Richard Balon, “SSRI-Associated Sexual Dysfunction,” American Journal of Psychiatry 163, no. 9 (2006): 1504–1509, https://doi.org/10.1176/ajp.2006.163.9.1504. 14 Neil Delaney, “Romantic Loving Commitment: Articulating a Modern Ideal,” American Philosophical Quarterly 33, no. 4 (1996): 339–355. 15 Anecdotally, there are also reports of such drugs “saving” marriages because one partner’s libido was lowered to a point where they did not feel compelled to stray. I discuss this issue later in the chapter. The upshot is that, depending on the aspects of love one finds most important—passion versus commitment, for example—one and the same physiological effect could potentially count as either love diminishing or love enhancing. For discussion, see Helen E. Fisher and J. Anderson Thomson Jr., “Lust, Romance, Attachment: Do the Side Effects of Serotonin-Enhancing Antidepressants Jeopardize Romantic Love, Marriage, and Fertility?,” in Evolutionary Cognitive Neuroscience, ed. Steven Platek et al. (Cambridge, MA: MIT Press, 2007), 245–283. 16 Olga A. Wudarczyk et al., “Could Intranasal Oxytocin Be Used to Enhance Relationships? Research Imperatives, Clinical Policy, and Ethical Considerations,” Current Opinion in Psychiatry 26, no. 5 (2013): 474–484, https://doi.org/10.1097/YCO.0b013e3283642e10; Beverley Fehr and James A. Russell, “The Concept of Love Viewed from a Prototype Perspective,” Journal of Personality and Social Psychology 60, no. 3 (1991): 425–438, https://doi.org/10.1037/00223514.60.3.425. 17 Nadine Striepens et al., “Prosocial Effects of Oxytocin and Clinical Evidence for Its Therapeutic Potential,” Frontiers in Neuroendocrinology 32, no. 4 (2011): 426–450, https://doi.org/10.1016/j.yfrne.2011.07.001. 18 Reid M. Rubsamen and Robert Cole, “Increasing Libido in Humans via Acute Testosterone Administration,” United States US6632419B2, filed March 19, 2001, and issued October 14, 2003, https://patents.google.com/patent/US6632419B2/en. 19 George R. Greer and Requa Tolbert, “A Method of Conducting Therapeutic Sessions with MDMA,” Journal of Psychoactive Drugs 30, no. 4 (1998): 371–379, https://doi.org/10.1080/02791072.1998.10399713. 20 For informal discussion and case studies, see Louisa Kamps, “The Couple Who Medicates Together,” ELLE, April 18, 2012, https://www.elle.com/life-love/sexrelationships/advice/a14208/the-couple-who-medicates-together-654677/. 21 Naar, “Real World Love Drugs.” 22 Jenkins, What Love Is. 23 This paragraph and the next are adapted from Brian D. Earp, Anders Sandberg, and Julian Savulescu, “The Medicalization of Love,” Cambridge Quarterly of Healthcare Ethics 24, no. 3 (2015): 323–336, https://doi.org/10.1017/S0963180114000206. See that paper for primary sources. For an extended discussion, see Helen E. Fisher, Anatomy of Love (New York: Norton, 2016). 24 Consider a set of animal experiments to get the basic idea. In one study, scientists induced a monogamous pair-bond in a species of vole by injecting a dose of oxytocin into their brains. They later did the opposite with an oxytocin blocker. In other words, voles that would have bonded if not for the injection failed to do so and became interested in novel sexual partners. Humans would not submit themselves to such experiments, so there is no direct evidence for such an effect in people. But as a less invasive option, as I mentioned, they can sniff synthetic oxytocin into their brains through their noses, which initial research suggests can increase attachment-related cognitions in some individuals. See Wudarczyk et al., “Could Intranasal Oxytocin Be Used to Enhance Relationships?” 25 <IBT>Lisa M. Diamond, “What Does Sexual Orientation Orient? A Biobehavioral Model Distinguishing Romantic Love and Sexual Desire.,” Psychological Review 110, no. 1 (2003): 173– 192, https://doi.org/10.1037/0033-295X.110.1.173. At page 174, internal references omitted.</IBT> 26 Ibid. 27 Jenkins, What Love Is. 28 Ibid. 29 Brian D. Earp, Anders Sandberg, and Julian Savulescu, “Brave New Love: The Threat of HighTech ‘Conversion’ Therapy and the Bio-Oppression of Sexual Minorities,” AJOB Neuroscience 5, no. 1 (2014): 4–12, https://doi.org/10.1080/21507740.2013.863242; Sean Aas and Candice Delmas, “The Ethics of Sexual Reorientation: What Should Clinicians and Researchers Do?,” Journal of Medical Ethics 42, no. 6 (2016): 340–347, https://doi.org/10.1136/medethics-2016- 103562; Sean Aas and Candice Delmas, “Sexual Reorientation in Ideal and Non-Ideal Theory,” Journal of Political Philosophy, 26, no. 4 (2018): 463-485. 30 Brian D. Earp and Andrew Vierra, “Sexual Orientation Minority Rights and High-Tech Conversion Therapy,” in The Palgrave Handbook of Philosophy and Public Policy, ed. David Boonin (Cham, Switzerland: Springer International, 2018), 535–550, https://doi.org/10.1007/978-3-319-939070_41; Earp, Sandberg, and Savulescu, “Brave New Love.” 31 For in-depth discussions, see Brian D. Earp, “Between Moral Relativism and Moral Hypocrisy: Reframing the Debate on ‘FGM,’” Kennedy Institute of Ethics Journal 26, no. 2 (2016): 105–144, https://doi.org/10.1353/ken.2016.0009; Brian D. Earp, “Female Genital Mutilation and Male Circumcision: Toward an Autonomy-Based Ethical Framework,” Medicolegal and Bioethics 5, no. 1 (2015): 89–104, https://doi.org/10.2147/MB.S63709; Brian D. Earp and Rebecca Steinfeld, “Gender and Genital Cutting: A New Paradigm,” in Gifted Women, Fragile Men, ed. T. G. Barbat, Euromind Monographs 2 (Brussels: ALDE Group-EU Parliament., 2017), http://euromind.global/brian-d-earp-and-rebecca-steinfeld/?lang=en; Brian D. Earp and Rebecca Steinfeld, “Genital Autonomy and Sexual Well-Being,” Current Sexual Health Reports 10 (2018): 7–17, https://doi.org/10.1007/s11930-018-0141-x. 32 Brian D. Earp, Anders Sandberg, and Julian Savulescu, “Natural Selection, Childrearing, and the Ethics of Marriage (and Divorce): Building a Case for the Neuroenhancement of Human Relationships,” Philosophy and Technology 25, no. 4 (2012): 561–587, https://doi.org/10.1007/s13347-012-0081-8. Some material in this section is adapted from this essay. 33 Erich Fromm, Man for Himself: An Inquiry into the Psychology of Ethics (London: Routledge, 1947), p. 31. 34 Christopher Ryan, “Sexual Repression,” Psychology Today, April 20, 2010, https://www.psychologytoday.com/us/blog/sex-dawn/201004/sexual-repression. 35 Kathrin F. Stanger-Hall and David W. Hall, “Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S.,” PLOS ONE 6, no. 10 (2011): e24658, https://doi.org/10.1371/journal.pone.0024658. 36 James W. Prescott, “Body Pleasure and the Origins of Violence,” Bulletin of the Atomic Scientists 31, no. 9 (1975): 10–20, https://doi.org/10.1080/00963402.1975.11458292. 37 Christopher Ryan and Cacilda Jethá, Sex at Dawn (New York: HarperCollins, 2010); Thomas G. Plante, “Catholic Priests Who Sexually Abuse Minors: Why Do We Hear so Much yet Know so Little?,” Pastoral Psychology 44, no. 5 (1996): 305–310, https://doi.org/10.1007/BF02262821; Jason Berry, Lead Us Not into Temptation: Catholic Priests and the Sexual Abuse of Children (New York: Doubleday, 1992). 38 Richard Wrangham and Dale Peterson, Demonic Males: Apes and the Origins of Human Violence (London: Bloomsbury, 1997); Randy Thornhill and Craig T. Palmer, A Natural History of Rape: Biological Bases of Sexual Coercion (Cambridge, MA: MIT Press, 2000). 39 Jerry A. Coyne and Andrew Berry, “Rape as an Adaptation,” Nature 404 (2000): 121–122, https://doi.org/10.1038/35004636; Jonathan Marks, review of Review of Demonic Males: Apes and the Origins of Human Violence, by Richard Wrangham and Dale Peterson, Human Biology 71, no. 1 (1999): 143–146. 40 For a general discussion, see Kate Manne, Down Girl: The Logic of Misogyny (Oxford: Oxford University Press, 2017). 41 David Archard, “The Wrong of Rape,” Philosophical Quarterly 57, no. 228 (2007): 374–393, https://www.jstor.org/stable/4543243; Brian D. Earp, “‘Legitimate Rape,’ Moral Coherence, and Degrees of Sexual Harm,” Think 14, no. 41 (2015): 9–20, https://doi.org/10.1017/S1477175615000172. 42 Michael C. Seto, “Is Pedophilia a Sexual Orientation?,” Archives of Sexual Behavior 41, no. 1 (2012): 231–236, https://doi.org/10.1007/s10508-011-9882-6. 43 Ray Blanchard, James M. Cantor, and Lori K. Robichaud, “Biological Factors in the Development of Sexual Deviance and Aggression in Males,” in The Juvenile Sex Offender, ed. Howard E. Barbaree and William L. Marshall (New York: Guilford Press, 2008), 77–104, p. 80. 44 There are now growing concerns about the replicability of many published findings in the human sciences. For an overview, see Brian D. Earp and David Trafimow, “Replication, Falsification, and the Crisis of Confidence in Social Psychology,” Frontiers in Psychology 6, no. 621 (2015): 1–11, https://doi.org/10.3389/fpsyg.2015.00621. 45 For discussion, see Ole Martin Moen, “The Ethics of Pedophilia,” Etikk i Praksis—Nordic Journal of Applied Ethics 9, no. 1 (2015): 111–124, http://dx.doi.org/10.5324/eip.v9i1.1718. 46 Brian D. Earp, “Science Cannot Determine Human Values,” Think 15, no. 43 (2016): 17–23, https://doi.org/10.1017/S1477175616000026. 47 William K. Frankena, “The Naturalistic Fallacy,” Mind 48, no. 192 (1939): 464–477. 48 See Robin A. Dembroff, “Beyond Binary: Genderqueer as a Critical Gender Kind,” unpublished manuscript. Abstract of the forthcoming paper available at https://robindembroff.weebly.com/inprogress.html. See also Robin A. Dembroff, “Why Be Non-Binary?,” Aeon, October 30, 2018, https://aeon.co/essays/nonbinary-identity-is-a-radical-stance-against-gender-segregation. 49 For an excellent overview, see Talia Mae Bettcher, “Feminist Perspectives on Trans Issues,” in The Stanford Encyclopedia of Philosophy, ed. Edward N. Zalta, Spring 2014 (Metaphysics Research Lab, Stanford University, 2014), https://plato.stanford.edu/archives/spr2014/entries/feminismtrans/. 50 Rebecca L. Stotzer, “Violence against Transgender People: A Review of United States Data,” Aggression and Violent Behavior 14, no. 3 (2009): 170–179, https://doi.org/10.1016/j.avb.2009.01.006; Talia Mae Bettcher, “Evil Deceivers and MakeBelievers: On Transphobic Violence and the Politics of Illusion,” Hypatia 22, no. 3 (2007): 43–65, https://www.jstor.org/stable/4640081. 51 Sari L. Reisner, Asa Radix, and Madeline B. Deutsch, “Integrated and Gender-Affirming Transgender Clinical Care and Research,” Journal of Acquired Immune Deficiency Syndromes (1999) 72, no. Suppl 3 (2016): S235–S242, https://doi.org/10.1097/QAI.0000000000001088. 52 R. Vitelli et al., “Trans Identities and Medical Practice in Italy: Self-Positioning towards Gender Affirmation Surgery,” Sexologies 26, no. 4 (2017): e43–e51, https://doi.org/10.1016/j.sexol.2017.08.001. 53 Larry R. Martinez and Michelle R. Hebl, “Additional Agents of Change in Promoting Lesbian, Gay, Bisexual, and Transgendered Inclusiveness in Organizations,” Industrial and Organizational Psychology 3, no. 1 (2010): 82–85, https://doi.org/10.1111/j.1754-9434.2009.01203.x. 54 Elvio Baccarini and Luca Malatesti, “The Moral Bioenhancement of Psychopaths,” Journal of Medical Ethics 43, no. 10 (2017): 697–701, https://doi.org/10.1136/medethics-2016-103537. 55 Julian Savulescu and Anders Sandberg, “Neuroenhancement of Love and Marriage: The Chemicals between Us,” Neuroethics 1, no. 1 (2008): 31–44, https://doi.org/10.1007/s12152-007-9002-4; Earp, Sandberg, and Savulescu, “Natural Selection, Childrearing, and the Ethics of Marriage (and Divorce).” 56 David P. Barash and Judith E. Lipton, The Myth of Monogamy (New York: Macmillan, 2002). According to the evolutionary psychologist and expert on human mating practices, Geoffrey Miller, “Everybody who studies human mating knows that we tend to do lots of ‘nonmonogamous’ behavior, including adolescent sexual experimentation, short-term casual mating during young adulthood, occasional affairs even given pair bonds, mate-switching to new pair bonds (‘serial monogamy’), and polygyny among high-status males. The only real disagreement among sex researchers is whether most people most of the time are in long-term pair bonds that are highly sexually exclusive, or whether most people most of the time are in (one or more) long-term pair bonds that are relatively open to other relationships” (personal communication, November 2, 2018). 57 Ryan and Jethá, Sex at Dawn, p. 2. 58 According to Miller (see note 56), in fact, only a small minority of sex researchers go as far as Ryan and Jethá in claiming that our ancestors were full-fledged bonobo-like polyamorists. 59 Jenkins, What Love Is, p. 93 of the advanced copy. For a scientific defense of the view that monogamy is largely in line with human nature, see David P. Schmidt, “An Evolutionary Perspective on Mate Choice and Relationship Initiation,” in Handbook of Relationship Initiation, ed. Amy Wenzel, Susan Sprecher, and John Harvey (Abingdon and New York: Routledge Handbooks Online, 2018), https://doi.org/10.4324/9780203809853.ch3. 60 For discussion, see Brian D. Earp, “Can You Be Gay by Choice?,” in Philosophers Take on the World, ed. David Edmonds (Oxford: Oxford University Press, 2016), 95–98. 61 For a fascinating discussion, see Ann E. Tweedy, “Polyamory as a Sexual Orientation,” University of Cincinnati Law Review 79, no. 4 (2010): 1461–1515. 62 Terri D. Conley et al., “Investigation of Consensually Nonmonogamous Relationships: Theories, Methods, and New Directions,” Perspectives on Psychological Science 12, no. 2 (2017): 205–232, https://doi.org/10.1177/1745691616667925. 63 Bryan R. Weaver and Fiona Woollard, “Marriage and the Norm of Monogamy,” The Monist 91, no. 3/4 (2008): 506–522. 64 Amy C. Moors et al., “Stigma toward Individuals Engaged in Consensual Nonmonogamy: Robust and Worthy of Additional Research,” Analyses of Social Issues and Public Policy 13, no. 1 (2013): 52–69, https://doi.org/10.1111/asap.12020. 65 For an argument that lovers should attempt to convert negative feelings of jealousy into a positive feelings of compersion (pleasure taken in the thought of one’s lover enjoying love or sex with someone else), see Ronald de Sousa, “Love, Jealousy, and Compersion,” in The Oxford Handbook of Philosophy of Love, ed. Christopher Grau and Aaron Smuts (Oxford: Oxford University Press, 2017), http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199395729.001.0001/oxfordhb9780199395729-e-30. 66 David M. Buss and Martie Haselton, “The Evolution of Jealousy,” Trends in Cognitive Sciences 9, no. 11 (2005): 506–507, https://doi.org/10.1016/j.tics.2005.09.006. 67 <IBT>Gordon Parker and Elaine Barrett, “Morbid Jealousy as a Variant of Obsessive-Compulsive Disorder,” Australian and New Zealand Journal of Psychiatry 31, no. 1 (February 1, 1997): 133– 138, p. 134,https://doi.org/10.3109/00048679709073811.</IBT> 68 Ibid. 69 Ibid. 70 Paul E. Mullen, “A Phenomenology of Jealousy,” Australian and New Zealand Journal of Psychiatry 24, no. 1 (1990): 17–28, https://doi.org/10.3109/00048679009062882. 71 Parker and Barrett, “Morbid Jealousy,” p. 134. 72 Parker and Barrett, “Morbid Jealousy,” p. 133. 73 I do not mean to suggest that this is an exhaustive list of the choices you and your partner face. But they are, I think, among the most likely or main ones. 74 <IBT>Jack G. Modell et al., “Comparative Sexual Side Effects of Bupropion, Fluoxetine, Paroxetine, and Sertraline,” Clinical Pharmacology and Therapeutics 61, no. 4 (1997): 476–487, https://doi.org/10.1016/S0009-9236(97)90198-3.</IBT> 75 Ibid., p. 476. 76 Julian Savulescu, “Genetic Interventions and the Ethics of Enhancement of Human Beings,” in Readings in the Philosophy of Technology, ed. David M. Kaplan (New York: Rowman & Littlefield, 2009). 77 Julian Savulescu, “New Breeds of Humans: The Moral Obligation to Enhance,” Reproductive BioMedicine Online 10 (2005): 36–39, https://doi.org/10.1016/S1472-6483(10)62202-X.