Self-control and attentiveness are cornerstones of moral character, and our capacity for these virtues are about half hard-wired. A child’s capacity for self-control predicts their adult likelihood of a successful life, and of myriad bad habits. I discuss the relationship of attention to moral behavior, the ways we can build a more mindful society, and how we can practice self-control and mindfulness with techniques like fasting, exercise and meditation. But many of us, even if we have above average capacities for self-control and attention, will also benefit from the growing number of technologies that enable self-control, from stimulant medications and treatments for addiction to gene therapies and brain-machine devices.
In this series:
I was diagnosed with attention deficit disorder in the first grade, and my son was diagnosed in kindergarten. When I was diagnosed in 1967 ADD was called hyperactivity-hyperkinetivity disorder, and it was still a pretty new idea. I had been getting into fights, wasn’t learning to read, and fortunately my parents were proactive in seeking out help. My brother also got the diagnosis. Ritalin, which we took into our teens, had a dramatic effect on our behavior. The first question whenever we got in trouble was “Did you take your pill?,” because that decision set the stage for all the decisions we would make for the next four to six hours. Every four to six hours we collaborated in the decision to enhance our capacities for self-control. My mother then went on to become a lobbyist for parents of kids with special needs, and a strong advocate for the ADD diagnosis and treatment.
So when my wife and I had kids I was vigilant for ADD traits and kept pestering the pediatricians about it. In the 2000s ADD was being diagnosed a lot more frequently, but it wasn’t until my son was about to get kicked out of his progressive kindergarten for disruptive behavior, a university lab school with a one-to-one student-teacher ratio, that we got him the diagnosis and treatment. As I remembered, the effect of Ritalin for my son was dramatic and life-changing. He is now a student at the University of Chicago and I doubt he would have made it there without medication. So I have a long, personal and passionate commitment that kids and adults who would have been labeled simply bad or willful in previous eras can be helped by the the new neuroscience of self-control and attention.
In a recent study (i) on more than 800 pairs of twins Scottish researchers looked at whether there was evidence for genetic influences on happiness of the flourishing kind that I discussed in the previous essay. They used questions that tapped the twins’ levels of autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. They found evidence for one genetic factor that had a powerful influence on these dimensions of flourishing, and it was their inherited capacity for self-control.
Self-control is the foundation for living the kind of lives we want to lead, and we know that our capacity for self-control is substantially determined by our biology at birth. In a set of now famous experiments in the 1970s the Stanford psychologist Walter Mischel demonstrated the lasting effects of young children’s capacities for self-control on a wide variety of life outcomes. Four to six year olds were given a choice of a treat – cookie, marshmallow or pretzel – and told that if they could hold off eating the treat for fifteen minutes while the experimenter left the room they would get a second treat. Some could delay gratification and others couldn’t. In subsequent decades the children’s ability to delay gratification was correlated to their SAT scores, parental assessments of their competence, and their body weight. Another group[ii] followed 1000 children in New Zealand from birth to age 32 and found that their capacity for self-control at 3-5 years of age predicted their adult health, incomes, and likelihood of being convicted of crimes.
The differences between our brains that determine self-control have been tied to both structure and neurochemistry. Structurally, the capacity for self-control is tied to the relationship of the control centers in the front of our brains, the prefrontal cortex or PFC, to the reward centers, like the amygdala and nucleus accumbens, in the more primitive parts of our brains. The larger, more active and better connected the prefrontal cortex is the better we are able to use mindfulness and reason to control our impulses. Conversely, the larger and more active the reward centers in the amygdala and nucleus accumbens, the harder it is to resist temptation. These brain structure differences have been linked to ADD[iii], weight gain, impulsive sex[iv], addiction risks[v], and criminal behavior.
Dopamine is the chemical that tells the brain to pay attention, especially the attention network in the front of the brain and the reward predictors in the nucleus accumbens. Genetic variations of dopamine in the brain are linked to ADD, making it harder to pay attention to what needs to get done instead of what the brain finds pleasurable. One of the reasons that stimulant medications work to improve attention is that they boost dopamine, telling the brain to pay attention to the task at hand. Addictions are essentially a hijacking of the dopamine pathways so that the brain only pays attention to the addictive substance or behavior. Variations in dopamine genes have been linked to success in school[vi], addiction and risky behavior, infidelity and one night stands[vii], and health and longevity.
Collectively the brain pathways that determine whether we can overcome reflxive reactions, switch our attention to current tasks and future plans, and in general exercise self-control, are known as “executive function.” ADD, schizophrenia, bipolar disorder, substance abuse, antisocial behavior and obsessive–compulsive disorder all involve disorders in executive function. [viii] Twin studies show that differences in executive function are almost entirely genetic[ix], and are linked to variations in the size and activity of the prefrontal cortex, and to variations in dopamine, serotonin and noradrenaline genes.[x]
These genetic, structural and neurochemical differences at birth are what determine our settings for the personality trait of “conscientiousness.” As we would expect, people low on conscientiousness are more prone to risky and criminal behavior, drug use, and poor job performance.[xi]
It is obvious then that for our own health, wealth and happiness, and for the benefit of society, it is critical that we figure out how to enhance our capacities for self-control. At the level of social policy one of the most important things we can do is recognize that self-control disorders have a strong biological basis that need to be treated instead of punished. The United States incarcerates the highest percent of its population in the world, creating a ruinous burden on public finances and ruining lives. More than half of inmates were convicted of drug offenses. Decriminalizing and medicalizing drug addiction would have a revolutionary impact on public health and the public wallet.
Many of the people behind bars for other reasons could also benefit from self-control enhancement therapies. There is substantial evidence that untreated ADD is one of the contributing risk factors for ending up in the criminal justice system, while childhood treatment with stimulant medications reduces later risks of devloping substance abuse[xii] and criminal behavior. House arrest ankle monitors have already allowed hundreds of thousands of people to be released from prison to resume jobs and social life,[xiii] and the hundreds of thousands of drunk drivers given alcohol-monitoring anklets have benefited from lower risks of recidivism.[xiv]
Poverty and powerlessness also have a strong influence on the development of capacities for self-control and the willingness to delay gratification.[xv][xvi] One of the factors that was different between the kids who could delay gratification in the Mischel marshmallow tests were whether the children were confident that delayed gratification would pay off; those whose life experience was that rewards were uncertain were more likely to take the bird in hand.[xvii] For economists the poor’s unwillingness to delay gratification is actuallyits own form of rationality; the poor simply have different “temporal discounting” rules.[xviii] But poverty and disordered home life[xix] do in fact cause children and adults to develop weaker executive functions[xx] and capacities for self-control.[xxi] Eliminating poverty therefore is another important social policy for improving self-control.
Behavioral research on self-control has been demonstrating ways that we can get a handle on our bad habits. Studies by the Harvard sociologist Nicholas Christakis and political scientist James Fowler[xxii] have found that obesity and alcohol use are contagious in social networks; having friends that eat or drink too much greatly increases your risk of eating or drinking too much. Twelve step programs like Alcoholics Anonymous are effective, in part, because they create social systems to reinforce and support self-control, and encourage the affirmation of an identity as a person capable of self-control, tools that can be used in many other contexts. Subconscious “priming” with positive reminders of values and identity as simple as hearing religious words[xxiii] reinforce self-control.
A problem with the exercise of self-control appears to be that it uses a lot of mental energy, leading to “ego depletion,” a model proposed by the psychologist Roy Baumeister and co-author John Tierney in the 2011 bestseller Willpower. Whether the weakening of willpower is because we are actually exhausting our mental muscle, however, or just because we decide to reward ourselves with pleasure after we have successfully resisted temptations[xxiv], we can find ourself successfully controlling one thing while losing control someplace else; exercising, and then rewarding ourself with a big meal, or stopping drinking but taking up smoking.
One of the technologies we now have to guard against this tendency towards “compensatory sinning” is the use of “digital will-power” and self-quantification with software tools like food diaries and wearable devices like the FitBit. These tools and devices allow us to monitor all our habits, and “gamify” self-control,[xxv] giving ourselves dopamine hits for reaching diet, exercise or sobriety goals instead of from our vices. Or if you respond more to the stick than the carrot, the Pavlok device now in development will punish you for not meeting daily goals by locking you out of your phone or even administer electric shocks.[xxvi] (My personal experience with these self-quantification and self-control tools has been quite dramatic. Using food diaries and a wearable activity tracker I lost forty pounds in eighteen months.)
There is now also an enormous body of research suggesting that mindfulness meditation creates structural changes in the brain that strengthens executive function and self-control.[xxvii] Mindfulness meditation increases the thickness of the prefrontal areas of the brain associated with executive function and self-control.[xxviii] Meditators are better able to set aside their emotions and automatic reactions, and make more rational choices. Unfortunately, meditating enough to get these benefits requires a good deal of self-control in the first place.[xxix]
Most of us, even if we have above average capacities for self-control and attention, will also benefit from the growing number of pharmaceuticals and neurotechnologies that enhance self-control, from stimulant medications and treatments for addiction to gene therapies and brain-machine devices. In addition to the standard stimulant medications of methylphenidate (Ritalin) and Adderall, there are now also the non-stimulant ADD treatments atomoxetine (Strattera) and guanfacine (Intuniv). New drugs for enhancing attention and executive function are being explored including the wakefulness drug modafinil and derivatives of nicotine like sofnicline.
Computer games that strengthen executive functions have been in use in treating schizophrenics for more than a decade, and brain games and neurofeedback have been found to be useful in treating ADD[xxx] and in improving executive function in adults without ADD.[xxxi] A group at the University of Texas has now demonstrated that executive functioning can be boosted by sending electrical current through the skull into the prefrontal cortex.[xxxii]
Progress is being made in curing drug addiction by fixing the addicted brain. After decades of War on Drugs neglect, the use of psychedelics to treat addictions is finally being studied again. Drug addiction is being targeted with vaccines that block the activity of the drug in the brain, and by controlling addiction signaling with focused magnetism and directly implanted electric stimulation. A drug that increases neuroplasticity (N-acetylcysteine) appears to help the brain unlearn addiction,[xxxiii] and a team at the University of Buffalo has been able to tamp down addictions by using a combination of nanoparticles and gene therapy to modify dopamine neurons.[xxxiv]
The days are also numbered for the vice of gluttony. Hundreds of thousands of people have undergone lap-band procedures to shrink the size of the stomach, and for most, their appetite for food. Patients are having electrical “pacemakers” implanted in their stomachs to tell the nervous system the stomach is full. Dozens of drugs are being researched to safely control appetite through the manipulation of the hormones involved in satiety, such as ghrelin and leptin. Sibutramine, a drug which blocks the uptake of norepinephrine and serotonin, is in wide use as an appetite suppressant, and in 2012 the FDA approved the appetite suppressant lorcaserin, which acts on the brain’s cannabinoid receptors.
Achieving more sexual self-control for many is about have more sexual desire, which explains the popularity of erectile dysfunction drugs. But many people also suffer from sexual compulsions, which are strongly influenced by testosterone. The recidivism rate of sex offenders has been successfully reduced via chemical suppression of testosterone, and some clinicians are using testosterone suppression, antidepressants and other psychiatric drugs for “sex addiction” or compulsive hypersexuality. The neurochemical vasopressin has also been found to play an important role in sexual fidelity, facilitating the binding of the memory of sexual pleasure to a specific partner. The bioethicists Savulescu and Sandberg have suggested that the administration of oxytocin, vasopressin and testosterone might be useful as an adjunct to marital therapy in the future, rekindling sexual desire, deepening feelings of trust and mentally bonding partners to one another.
As with all the virtues, too much self-control can also be a vice, at least when it manifests as rigidity rather than high levels of executive functioning. Too much delay of gratification can, for instance, reduce spontaneity and the enjoyment of life. Conscientiousness is correlated with shocking people longer in the famous Milgram obedience experiment,[xxxv] suggesting that high self-control may mean that we are less likely to rebel against unjust rules. High conscientiousness is also correlated with more depression when faced with unemployment,[xxxvi] suggesting that those with self-control are more likely to blame themselves for downturns in fortune. Developing the other virtues - positivity, compassion for self and others, and discriminating intelligence - introduces balance and enhances flourishing.
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