Applying biomedical technologies that are initially developed for treating illness to the improvement of human capacities is called "enhancement." Enhancement that aims to improve human mental capacities using psychotropic drugs is termed neuroenhancement. Neuroenhancement is a hotly discussed topic in ethics. In this discussion, four concerns have been expressed with regard to the unlimited use of neuroenhancement: safety/efficacy, coercion, unfairness, and complicity. Psychiatrists are familiar with the safety/efficacy concern because this has been well considered in the use of usual pharmacological treatments. In contrast, the other three concerns seem to be specific to neuroenhancement. The concern regarding coercion considers whether individuals would unwillingly take this type of medication in response to demand from people surrounding them. As for the concern of unfairness, whether the possibility of unequal distribution of neuroenhancing drugs would result in further fixation of social inequality is considered. Finally, the concern regarding complicity refers to the fact that neuroenhancement might unexpectedly strengthen arbitrary and sometimes unjust social values and norms. Although not all people who attend a psychiatric clinic have a psychiatric illness, the distinction between pathology and normality is often vague. These days, more and more people with mild forms of depression or anxiety and with concerns regarding possible neurodevelopmental disorders overlooked during childhood are visiting psychiatrists. In such cases, it is sometimes impossible to discriminate pathology from normality, and accordingly, treatment from enhancement. In these cases, clinical decision making relies on value judgements, such as "whether this person should be treated within the context of psychiatry," or "whether psychotropic medication is beneficial for this person." Therefore, the issues raised regarding neuroenhancement are also relevant for "pharmacotherapy" in psychiatric practice, as far as borderline cases are concerned. In this paper, a case vignette for which the concern about coercion and complicity is relevant will be illustrated. A "compromise" model of psychiatry will then be proposed. Unlike the biomedical model of psychiatry, this model does not presuppose the discrimination of pathology from normality and instead aims to settle the conflict between the individual and the society. The compromise model allows the use of psychotropic drugs as long as it is useful for the aim. Meanwhile, this model also tries to counterbalance the "side effect" of medicalization by requiring some degree of societal accommodation for the individual.
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