For an eight year old movie, the issues that Limitless raise remain as contemporary as ever: What are the actual indications for stimulant pills? What does it say about those living in modern, western culture that they seem simply unable to function without them in modern workplace culture? If so, does that also mean that the environment is a more powerful determinant of ADHD symptoms than biology is? Hence the all too familiar allure of pharmaceuticals: that a medication will make you think clearer, domore, or achieve more than you could ever dream. Enter Edward Morra (Eddie), a writer who has a book contract, but is struggling to actually produce anything. With him holed up in his grotty Manhattan apartment, or procrastinating in local bars, it is clear that Eddie’s life is going nowhere. Eddie then encounters an old acquaintance who tells him about a new drug “NZT” and how it will drastically change his life. Edward hesitantly takes the pill, rationalizing to himself how much worse can things get? Within couple of minutes, he is thinking more clearly (as shown by the onset of new and vivid color tints, as well as his improved alertness and mood) and utilizing his brain to its maximumpotential. He rapidly transforms from boring to interesting, even charismatic.
The plot goes on to showcase Eddie’s exponential learning curve, with him accessing memories that were once hidden deep in his brain. Not surprisingly, Edward starts to make smart choices, as evidenced by his making the right kind of friends and the right kind of investments. He becomes the man about town, able to converse effortlessly in exotic foreign languages. He is invited to high end parties. Not surprisingly, he achieves his star spot in New York City’s big league, with all that money has to offer him, and even more flowing into his electronic coffers. Eddie appears to be experiencing a protracted amphetamine/cocaine-induced intoxication, yet without any associated anxiety, psychosis or impairment in psychosocial functioning. Even accounting for artistic license, the movie raises several interesting questions: 1) are there drugs that actually enhance memory? 2) should success really be defined as a manic frenzy whereby doing as much as possible per day is the expectation? 3) what role do stimulants play in modern workplace culture? With the decades long, rise in stimulant prescriptions in the United States, their known addictive potential, and their widespread use among young students, psychiatrists worldwide may need to acknowledge a separate public thirst for these medications – something that cannot be just accounted for by the baseline prevalence of ADHD alone. Confounding this issue are ongoing diagnostic difficulties in distinguishing ADHD from comorbid diagnoses, such as Bipolar Disorder and Generalized Anxiety Disorder. We may also need to contend with the additional factor of changing cultural norms. The contemporary definition of success in modern society may have become increasingly skewed toward productivity and accomplishment. Eddie was, at the outset, dull and unproductive. With the help of NZT, he transforms into someone who not only accomplishes his cherished dream, but who now simply does a whole lot more per day. Such a tale would naturally resonate with those who would yearn to thrive in such a culture. My own experience in suburban private practice has corroborated this, having encountered numerous patient anecdotes about the intensity, distractibility and deadline-driven, overwork culture of the corporate workplace, inevitably resulting in the inability to concentrate. While I would typically formulate this as their being overwhelmed by anxiety, it was also clear that these patients had become psychologically dependent upon their ADHD medications in order to guarantee the performance demanded of them in such artificially stressful environments. This experience has also made me question the rapid ascendance of the largely biological paradigm that dominates our approach to ADHD today. As a clinician, it became increasingly clear to me that the environment plays its own pivotal role in the genesis of ADHD symptoms. This concern is shared by experts in the field. There are several studies highlighting the use of prescribed stimulants as performance enhancers by college students in the United States, especially those with competitive admission standards. This is even less surprising when one considers that the United States is not only the leading country in the world for prescription stimulants. It seems then that thethirst for memory enhancing smart drugs fails to be quenched. Studies to date suggest that stimulants’ overall effect on executive performance are small and highly variable, if at all. Some studies have even reported negative correlations. Distinguishing improved motivation from actually enhanced performance and the role of vigilance also remain conceptually confusing challenges. Enhancement of long term declarative memory, complex non-verbal fluency and cognitive control are perhaps the only aspects of cognitive functioning that have yielded any tangible improvements with stimulants. Interestingly, a healthy lifestyle has been found to have the most replicable benefits on cognitive performance and brain function than anything else. Judging by the environments in which stimulants are most abused, it would appear that in order to be adaptive, an almost hypomanic level of functioning is the expected norm rather than the exception. Perhaps this is more culturally determined than realized. In the high pressure, intense world of corporate America, such expectations would also self-select the most ambitious and compulsive personality subtypes to meet such demands. Understandably, such cultural pressures influence prescribing practices. Limitless certainly takes artistic license to entertainingly dizzying heights. Its draw lies in the wish fulfillment that human beings have to transform their lives in an instant. Given its bloody ending, it may end up being more of a cautionary tale than the fantasy that many would love to indulge. Prescribers and utilizers of such drugs beware.