Remembering the Pill

The Pill turned 50 in May. Such a significant anniversary prompted cover stories, histories, celebratory remembrances, and calls for expanded access. None of this attention is surprising: the Pill was and continues to be an enormous source of social change in demographics, sexual activity, social mores, divorce, gender roles, and the economy. What is surprising is how mixed some of these assessments have been.

While one expects criticism of the Pill from some religious and political groups, the commentary found in mainstream, non-religious journalism has been remarkably subdued, with many essays expressing a sense of mixed blessings and paradox, moderating praise with frequent discordant notes of social problems, the rise of illegitimacy, the failure to make women happy, sexual dysfunction, and the Pill's unhappy correlation with HIV/AIDS, among other hesitations.

In fact, so honest are the accounts of the Pill's failure to deliver as promised that one might expect serious reservations about the Pill's future. One Los Angeles Times story on the Pill's dismal results in reducing unwanted pregnancies and abortions paraphrases James Trussell, director of Princeton University's Office of Population Research, who "thinks that the pill's time is passing."

Imagine: the very occasion of celebrating the Pill's legacy to the world also brings a strong sense that the fruits have not been unalloyed, and even that the Pill might have seen its best days behind it.

If it's true, as stated in the LA Times story, that 80% of women will use the Pill at some point during their reproductive years, then the potential decline in the Pill's use would be as socially remarkable as its advent and acceptance. Given the nature of our contemporary sexual self-understanding, however, it's extremely unlikely that accessible birth control will be abandoned.

Dr. Trussell, for instance, does not simply conclude that the Pill's time is over but hopefully expresses that "the future lies instead with fool-proof contraceptives that require almost no thought or action." He argues that "many women would be far better served by newer long-acting contraceptive methods that don't require remembering to take a pill each day."

No thought or action. No memory. These are the new hopes given the rather disappointing results of the Pill. Not self-control or cultural intelligence but newer, easier, more convenient techniques.

Contraception is already so normalized in our society that its use is presumed for both married and unmarried alike; in fact, so normalized is contraception that its use is thought not only responsible but even obligatory. Contraception is thought of as something like shampoo or deodorant, a "necessity" that one picks up at the drug store when occasion arises or supplies are low. If we follow Aristotle in defining choice as deliberative desire – that is, that one chooses after deliberating on the means of action to some desired end – we might even say that many people do not even choose to use contraception but rather use it as an inherited and unexamined cultural norm. While Dr. Trussell is certainly correct that new devices and technologies can be invented or promoted that reduce or eliminate the need to think and to remember to take a pill, we've already reached the point of being thoughtless and forgetful when it comes to birth control.

It's strange (putting it mildly) to think of the morning's hormone dosage as a kind of sacramental recurrence but in some small way the Pill serves as a daily reminder of the hierarchy of one's own values (one could think also of the sacramental-like use of soma in Brave New World).

In The Art of the Commonplace, Wendell Berry states that "birth control is a serious matter, both culturally and biologically," but what is really "horrifying is not that we are relying so exclusively on a technology of birth control that is still experimental, but that we are using it casually, in utter cultural nakedness, unceremoniously, without sufficient understanding, and as a substitute for cultural solutions . . . and to promote these means without cultural insight." In other words, a serious matter requiring careful deliberation and sound judgment has been handled carelessly and thoughtlessly – we have been forgetful.

Berry continues by noting that such thoughtless neglect is made possible, and subsequently exploited, by specialists; in this case the separation of sexuality from fertility has resulted in two groups of specialists, "the sexual clinicians and the pornographers, both of whom subsist on the increasing possibility of sex between people who neither know nor care about each other." Both groups separate sexuality from fertility in the name of freedom and "thrive in a profound cultural rift" where sex is free "from thought, responsibility, and the issue of quality."

Many people reflect about the technique and use of contraception – questions such as cost, efficacy, health, ease of use – I'm sure most users rationally engage contraception at this level. However, one consequence of a technological age is a failure to reflect about purposes and ends and so reduce deliberation merely to the level of choosing means to an already determined end. But how is the end determined? If Berry is correct, as I suspect he is, then the end is determined not by the ordinary person but by the specialists, the "technologists of fertility . . . without community ties or cultural responsibilities." One could think here of Alasdair MacIntyre's description of the manager in emotivist society, for the manager, like the specialist, is quite good at arranging matters so as to attain the desired end but almost entirely incapable of reflecting on the goodness of the ends.

Of course, to act without reflection on the ends or purposes of action is in some way not to act but simply to "behave," i.e., to exhibit behavior while obeying the instructions of the specialist/manager. Actions are intelligible if and only if a choice is done for a reason, for the sake of something else, and that reason must either itself be a self-evident reason for action or ultimately grounded in such a reason if the action is to be intelligible, a human act, and not just a doing or a behavior. To use contraception in the current manner, free from thought, with responsibility handed over to the specialists, is to accomplish Dr. Trussell's wish, for such thoughtlessness is free of real action.

The Pill has, among other "flaws," the troubling necessity of being taken. The user needs to remember. For many, such memory is as automatic and thoughtless as any other routine of the morning toilet: when is the last time you remembered to put on your glasses or insert your contacts, or thought to comb your hair? One simply does such things. The condom or diaphragm must be remembered – so too, but less so, the Pill. What of the new devices – implants and IUDs – that range in their effectiveness from three to twelve years. Imagine not needing to remember contraception for twelve years! A 16-year-old could simply forget about contraception until she was 28! One could sever fertility from sexuality without the need to remember anything for a very long time.

What happens when our clinicians succeed in their enforced forgetting and we can, as a society, essentially cede our need for reflection and live in blissful forgetfulness that once, long ago, fertility required intelligence, thought, action, deliberation, memory, forbearance, patience, forgiveness, and love?

Tracey Rowland explains the consequence of action free of memory. She suggests that contemporary culture is one of "forced forgetting" in distinction to a Christian understanding of "celebrated recurrence." It's strange (putting it mildly) to think of the morning's hormone dosage as a kind of sacramental recurrence but in some small way the Pill serves as a daily reminder of the hierarchy of one's own values (one could think also of the sacramental-like use of soma in Brave New World). Rowland, following Augustine, Bonaventure, and Aquinas, places very high value on the necessity of memory for moral agency, arguing that memory is an "indispensible auxiliary of the virtue of prudence" and "a condition of making ethical judgments." Memory serves as a reservoir for moral experience, of right and wrong actions, and so becomes a storehouse of "sapiential experience," i.e., of wisdom. Experience allows for reflection and provides a directive for future actions; this is perhaps why Aristotle suspected that the young, lacking the requisite experience, were poorly suited for ethical and political leadership.

Already some data supports the notion that the Pill has decreased human happiness, and certainly proponents of the natural law have argued that contraception is incompatible with human flourishing, but what will happen if Dr. Trussell gets his way? Fifty years from now we will be noting that during that half-century interval a woman would have needed to think about, remember, and act regarding contraception only four times. Would anyone have a sufficient memory to engage subsequently in prudential reasoning about the proper ends of fertility and sexuality?

Rowland's arguments suggest that a culture of thoughtless, forgetful, actionless use of contraception would become a culture incapable of moral reflection on the purposes of the body. She remarks that the attempts to revive natural law theory and to critique emotivism and utilitarianism must be "supplemented with an account of the effect of 'mass culture' upon the memory," presumably implying that enforced forgetting can potentially render the arguments of natural law incomprehensible and unheard by an non-deliberative culture of managers, specialists, and followers who've happily paid the fare to cross the river Lethe.

Berry remarks frequently that the culture of specialists is irrational because human knowledge is incapable of knowing the whole story but still the specialist plows ahead as if he does. Inevitably some unintended and unforeseen consequence emerges and a new specialist is called in to fix the problem, which he does in ignorance of yet further unintended consequences of the "solution." And so it goes, with one specialist fixing the problem caused by a previous one while creating work for another specialist in the future.

We know that one specialist of sexuality, the pornographer, causes enormous damage. There is a good reason to believe that the other specialist, the sexual clinician and peddler of birth control, causes damage as well, perhaps even facilitating the success of the pornographer. And this damage occurs now, even before contraception has become almost entirely without thought, memory, or act. Already contraception has escaped the domain of rational reflection and deliberation in anything other than the domain of instrumental reason, but at least it still demands some thought, limited though it might be. What happens when our clinicians succeed in their enforced forgetting and we can, as a society, essentially cede our need for reflection and live in blissful forgetfulness that once, long ago, fertility required intelligence, thought, action, deliberation, memory, forbearance, patience, forgiveness, and love?