Explore: The Journal of Science and Healing
Volume 2, Issue 3 , Pages 185-188, May 2006

Memory Management: A Gathering Ethical Storm

Article Outline

 

“The stupid neither forgive nor forget; the naive forgive and forget; the wise forgive but do not forget.”

—Thomas Szasz1

During medical school, one of my professors periodically told us students, “Fifty percent of what we teach you is correct, and 50% is wrong. Unfortunately, we can’t tell one half from the other. But don’t worry. In five years you won’t remember either half.” His comment seemed a joke at the time, but it turned out to be prophetic. Like most doctors, I’ve forgotten probably 99% of the information I learned in medical school and have replaced it with new knowledge. God help my former patients if I could not have forgotten the old stuff.

Yet we all worry when we forget. When we can’t remember where we put our glasses or car keys, we wonder if this is an early sign that our memory is fading.2

We are quick to blame ourselves for forgetting, but we don’t give ourselves credit for the massive number of things we recall every day. We ought to lighten up. Even people who have prodigious memories are forgetful. Thirty-three-year-old Tatiana Cooley-Marquardt, who won the first three USA Memory Championships in 1998, 1999, and 2000, can recall pages in the phone book, yet keeps her life organized by writing notes to herself. “I live by Post-Its,” she says.3

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Forgive and forget 

One of the most valuable contributions of forgetting lies in its connection to forgiveness, as when we say, “Forgive and forget.” When people cannot do this, there is often hell to pay. Germany could not forget its defeat and humiliation in WW I, which led directly to WW II. Bosnia remembered its defeat at the Battle of Kosovo in the 14th Century, and the ongoing hatred played a role in the recent war in Bosnia. Southerners remember their defeat in the Civil War, and Northerners remember their victory. Both sides reenact battles year after year, and many hold grudges to this day, with many Southerners privately hoping that “the South will rise again.” To this day, neither Christians nor Muslims can forget the mutual slaughter of the Crusades, and “crusade” remains an inflammatory word when used in international discourse. Would the world not have been better off if some forgiving and forgetting had taken place in these instances?

“Forgive and forget” doesn’t mean becoming actually amnesic for the wrongs and slights from others. Forgiving is not the same thing as forgetting. As theologian L. B. Smedes notes, “[F]orgetting, in fact, may be a dangerous way to escape the inner surgery of the heart that we call forgiving.”4 And as theologian Donald W. Shriver, Jr, in his discussion of forgiveness in politics, says, “Forgiveness itself begins not with a forgetting but with a remembering, a refusal to buy the repair of the relation at the cost of not mentioning the cause of the fracture.”5

In medicine, forgiveness research is gathering steam as a result of the discovery that forgiveness has its own physiology and that failure to forgive can have negative effects on health.6, 7 Researchers in this field unanimously assert that forgiveness involves not the total eradication of a painful memory, but repairing one’s relations with others, so that the memory no longer triggers anger, hostility, and aggression.

There are many paths to forgiving and forgetting. All religious and spiritual traditions emphasize forgiveness,8, 9 and various psychotherapies can assist people in cultivating empathy and compassion.

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Trauma’s toll 

Yet it is not so simple. Many individuals are so burdened with horrific memories that their lives are controlled and often ruined by the inability to forget. To date, around 100,000 combat veterans—the figures vary—from the Vietnam War have committed suicide, unable to free themselves from their haunting recollections.10 This indicates the lethality of terrible memories: nearly twice as many vets, according to some estimates, have died by their own hand rather than the hand of the enemy. If there were a pill that could selectively extirpate their memories and nightmares, would it not be compassionate to use it?11 Many vets have tried everything else, including years of counseling, cognitive therapy, tranquilizers, and antidepressants without benefit. And what about other seriously traumatized persons—Holocaust survivors, rape victims, abused children, torture victims, survivors of auto accidents or natural disasters? It is estimated that approximately five million Americans between ages 18 and 54 years suffer from posttraumatic stress disorder (PTSD) at any given time and that nearly 8% of the US population will experience PTSD at some point in their lives, with women twice as likely as men to do so.12

James L. McGaugh, director of UC Irvine’s Center for the Neurobiology of Learning and Memory and author of Memory & Emotion: The Making of Lasting Memories, is a leading researcher in reducing or eliminating the impact of painful memories. “Let me give you an example from the 1978 PSA [Pacific Southwest Airlines] crash in San Diego where they made the horrible mistake of sending out desk people and baggage handlers to clean up body parts after the crash. Later, there was a follow-up report that said a very high percentage of those people were never able to work again. They had been permanently disabled because of the trauma. Now, that’s PTSD to the nth degree [and] that would be a case in which something like [a memory-blunting drug] would be of value.”11

McGaugh’s recommendation to use medication to manage bad memories is not science fiction but is based on recent research. The headline-grabbing experiment that catapulted this field to national attention was a pilot study done by Roger Pitman, a professor of psychiatry at Harvard University. In 2002, he recruited 31 patients from the emergency room at Massachusetts General Hospital who had been involved in a severely traumatic event, usually an auto accident. They were offered the option of taking a drug that might reduce the emotional impact of the experience by dulling the memory of it. Some of the volunteers were given propranolol for 10 days following the trauma, and some were given a placebo. When they were evaluated a month later, none of the propranolol-treated patients had a physical stress reaction on recreations of the traumatic event, whereas six of the 14 placebo-treated patients did.13

Propranolol is not approved by the Food and Drug Administration for this purpose. However, it seems to work by blocking the effect of the stress hormones adrenaline, noradrenaline, and cortisol on the amygdala, the almond-shaped brain structure involved in laying down memory traces. The drug seems to disconnect emotion from memory. A disadvantage, however, is that for greatest effect it must be taken shortly after the traumatic event. Researchers are already exploring other drugs that may be more potent and more selective than propranolol, and many experimenters believe it is only a matter of time until such medications are made widely available.

McGaugh and other memory-management researchers doubt that a pill will ever be able to probe an individual’s mind, zero in on specific memories, and blunt them selectively. Memories seem to come in batches. They don’t exist in isolation but are woven in a web of associations and emotions that is difficult and perhaps impossible to tease apart. Therefore, zapping highly selected memories remains a fantasy, as popularized in the 2004 movie Eternal Sunshine of the Spotless Mind.

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Dissent 

Memory alteration has come under intense fire, chiefly from members of the President’s Council on Bioethics, a group of 17 philosophers, medical experts, lawyers, and theologians formed in 2001. “The pattern of our personality is like a Persian rug,” says Council member William B. Hurlbut, a consulting professor of biology at Stanford University. “It is built one knot at a time, each woven into the others. There’s a continuity to self, a sense that who we are is based upon solid, reliable experience. We build our whole interpretation and understanding of the world based upon that experience or on the accuracy of our memories. If you disrupt those memories, remove continuity, what you have is an erosion of personhood.”11

“All of us can think of traumatic events in our lives that were horrible at the time but made us who we are,” says Council member Rebecca Dresser, a medical ethicist at Washington University in St. Louis. “I’m not sure we’d want to wipe those memories out. We don’t have an omniscient view of what’s best for the world.”14

“Consider the case of a person who has suffered or witnessed atrocities that occasion unbearable memories: for example, those with firsthand experience of the Holocaust,” the Council wrote. “The life of that individual might well be served by dulling such bitter memories, but such a humanitarian intervention, if widely practiced, would seem deeply troubling: Would the community as a whole—would the human race—be served by such a mass numbing of this terrible indispensable memory?”14 Bioethicist Leon Kass, chair of the Council, is also critical of tinkering with memory pharmacologically. “It’s the morning-after pill for just about anything that produces regret, remorse, pain, or guilt,” he says.11

There is reason for concern. Consider the case of Prozac (Eli Lilly, Indianapolis, IN), originally marketed for the relief of severe depression. Over time it underwent therapy creep, its use extending to what has been called cosmetic pharmacology to help people feel “better than well,” described by Peter D. Kramer in his book Listening to Prozac.15 Would memory modifiers also be used to lessen the impact of merely inconvenient experiences?

The Council expressed concern that “the use of memory-blunters at the time of traumatic events could interfere with the normal psychic work and adaptive value of emotionally charged memory.” Beta blockers and other drugs may interfere with “the normal process of recovery,” they said, and compromise our character and personality development. These drugs risk “falsifying our perception and understanding of the world. It risks making shameful acts seem less shameful, or terrible acts less terrible, than they really are.”

Bloggers are already suggesting how memory blockers could be used in clever ways. One blogger imagines borrowing money from someone, then slipping the lender a memory eraser to wipe out the recollection of the loan.16 Another blogger sees a use in dulling the pain of failed relationships. “Being able to erase the memory of an ex from your life, I’d sign up in a heartbeat. Not that I have any bitterness … it’s a lot easier when you don’t have emotional baggage to weigh you down.”17

After the Battle of Fredericksburg in 1862 during the Civil War, Confederacy commander-in-chief Robert E. Lee said, “It is well that war is so terrible—otherwise we should grow too fond of it.”18 The President’s Council constructed scenarios that echo General Lee’s suggestion that we need to remember the horror of painful experiences. If somebody committed an act of violence and then took propranolol, would they then think violence is OK? If victims of rape took the drug to dull their recall, would this make them less able to identify their attackers or testify against them? Should not our society as a whole remember the Holocaust and Nine-Eleven so as to guard against a repeat of these terrible events? As Santayana famously warned, “Those who cannot remember the past are doomed to repeat it.”19

Although the President’s Council acknowledges that the motive of the memory managers is to relieve suffering, it has taken a conservative, cautious approach. “The impulse [of the researchers] is to help people to not fall apart,” says chairman Kass. “You don’t want to condemn that. But that you would treat these things with equanimity, the horrible things of the world, so that they don’t disturb you … you’d cease to be a human being.”11 Kass and his colleagues seem to be saying, “The human psyche is exquisitely calibrated. Don’t mess with the fine tuning.”

Yet how can one criticize using any reasonable means to prevent 100,000 suicides in returning Vietnam vets? It isn’t just their lives that are at stake. Military researchers say that 17% of troops returning from Iraq show signs of PTSD, and dozens of suicides have already occurred in troops serving in Iraq and Afghanistan.20

McGaugh is impatient with the sort of talk emanating from the Council. He suggests that society decided, decades ago, that the use of mind-altering drugs was permissible. “We made that decision with the advent and use of psychoactive drugs,” he says. “Valium is a memory-impairing drug, but I don’t hear people raising memory issues about it.”11

Larry Squire, a neurobiologist at UC San Diego and the Veterans’ Administration Medical Center in La Jolla, agrees. “The [memory-blunting] effects [of β-blockers] is rather weak,” he says. “And no one can imagine possibly tinkering with memory that represents our personal identities, memories of childhood, our connections to people and the past. Those are transformed over time. They’re hard-wired in our brains and can’t be fooled with.”11

The prospect that a memory-blunting pill will be officially approved and marketed soon is nil, say insiders. But research is even more active on another front—producing a pill that enhances memory. Nobel-winning neurobiologist Eric Kandel, the Columbia University researcher who in 1998 founded Memory Pharmaceuticals, says, “If we continue making the kind of progress we are now, we will have drugs for age-related memory loss in five or ten years.”21 And neurobiologist Timothy Tully, a founder of Helicon Therapeutics, also predicts success. “It’s not an ‘if’—it’s a ‘when.’ ”21 If the marketing of memory enhancers is just around the corner, can memory erasers be far behind?

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Nothing new 

Memory management is not new. Attempts to manipulate memory are ancient. All governments, including our own, play fast and loose with the facts of history, shading them for their immediate purposes. Sometimes “facts” that don’t exist are inserted into our social memory, and sometimes valid information is purposely obscured. The result is memory management on a societal scale.

Memory manipulation is sometimes dramatic, as when the Taliban, in March 2001, dynamited two priceless, towering Buddhist statues carved into the Hindu Kush mountains in central Afghanistan, claiming that all statues were false idols and contrary to their Islamic beliefs. Later, in November, the Taliban returned to raze the nearby town of Bamiyan and engage in Bosnian-style ethnic cleansing of the surrounding area. Their goal was not only to eradicate the religion but also to erase all traces of its existence in their country. The incident drew international condemnation, including criticism from Muslim leaders around the world. Efforts are currently underway to recarve the statues—a kind of memory restoration, in contrast to the memory destruction favored by the Taliban.22

Memory tinkering has also reached obscene levels in the Holocaust-denial movement. Although it is considered by many as a part of the lunatic fringe and is now illegal in some European countries, Holocaust denial continues to gain adherents in countries around the world, including a few bona fide, degreed historians.23

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A proposal 

So is artificial memory blunting a good idea or not? I keep coming back to those 100,000 suicides in Vietnam vets. To me, their tragedy dulls the arguments of ethicists who wish to preserve memories in the hypothetical interest of society at large and for the continuity of an individual’s personality and character. Why should the lives of more vets be sacrificed so that our society can preserve its collective memory of horrible events? Why should our returning warriors, who fought in our stead, be expected to bear a burden the rest of their lives, a load that is often too heavy to endure?

I confess a more-than-mild irritation at ethicists who sit comfortably around conference tables and philosophize about the value of war memories when most of them have never set foot in a combat zone. Their motives may be noble, but there is a whiff of hypocrisy and elitism in their deliberations.

Using a pill to erase the pain of a failed romance or an embarrassing faux pas is not the same as using a medication to soften a terrible memory that is pushing someone into suicidal depression. True, several therapies besides drug-induced, therapeutic forgetting have been helpful to war trauma survivors, such as those discussed in psychologist Ed Tick’s wise book War and the Soul.10 Yet when all is said and done, there is a residuum of individuals who do not respond to them. For them, using a memory-dulling drug would seem to be the compassionate course of action. Currently, the debate over memory modification shows no signs of resolution, and, because of the influence of the President’s Council, there is a significant chance this life-saving therapy could be legally discouraged, like embryonic stem cell research.

I have a suggestion about how to unlock this stalemate. Send the ethicists to war. If they survive combat, then compel them to make rounds for a week in an evacuation or rehabilitation hospital. This would insure that they have plenty of face time with maimed, blinded, amputated, mutilated combat casualties. Then require them to then visit the families of the war wounded, so they can taste the effects of war on spouses and children. When they return to their conference tables, they just might be begging for some of those bad ol’ memory-blotting meds.

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References 

  1. Szasz T . Wikiquote . 2006; Available at: http://en.wikiquote.org/wiki/Thomas_Szasz. Accessed January 14
  2. Dossey L . Forgetting . Altern Ther Health Med . 2002;8:12–16 104-107
  3. Levinson A . Memory champ lives by Post-Its . SouthCoast Today . 1999; Available at: http://www.s-t.com/daily/02-99/02-24-99/b04li047.htm. Accessed February 24
  4. Smedes LB . Forgive and Forget: Healing the Hurts We Don’t Deserve . New York, NY: Harper & Row; 1984; 60
  5. Shriver DW . Is there forgiveness in politics? Germany, Vietnam, and America . In:  Enright RD ,  North J editor. Exploring Forgiveness . Madison, WI: University of Wisconsin Press; 1998;p. 131–149
  6. Worthington EL , Witvliet CO , Lerner AJ , Scherer M . Forgiveness in health research and medical practice . Explore: J Sci Healing . 2005;1:169–176
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  9. Rye MS , Pargament KI , Ali MA , et al.   Religious perspectives on forgiveness . In:  McCullough ME ,  Pargament KI ,  Thoresen CE editor. Forgiveness: Theory, Research, and Practice . New York, NY: Guilford Press; 2000;p. 17–40
  10. Tick E . War and the Soul . Wheaton, IL: Quest/Theosophical Publishing House; 2005;
  11. Vince G . Rewriting your past . New Scientist . 2005;188:32–35
  12. LaFee S . Blanks for the memories . San Diego Tribune . 2004; February 11. http://www.signonsandiego.com/news/science/20040211-9999-mz1c11blanks.html. Available at: Accessed January 13, 2006.
  13. Pitman RK . Pilot study of secondary prevention of posttraumatic stress disorder with propranolol . Biol Psychiatry . 2002;51:189–192
  14. Stein R . Is every memory work keeping? . The Washington Post . 2004; October 19. http://www.ajc.com/news/content/health/1004/19memory.html. Available at: Accessed January 14, 2006.
  15. Kramer PD . Listening to Prozac . New York, NY: Penguin; 1993;
  16. Johnny-Dee  . Fides quaerens intellectum . 2006; Available at: http://blog.johndepoe.com/2005/03/memory-erase.html. Accessed January 12
  17. Orantia J. Erasing memory. Available at: http://www.jenneth.info/archives/2005/03/erasing_memory.html. Accessed January 12, 2006.
  18. Lee RL. Wikiquote. Avaiable at: http://en.wikiquote.org/wiki/Robert_E._Lee. Accessed January 14, 2006.
  19. Santayana G. Wikiquote. Available at: http://en.wikiquote.org/wiki/Santayana. Accessed January 14, 2006.
  20. Shapiro J . Guardsman/state trooper commits suicide five weeks after Iraq return. Educate yourself . 2004; Available at: http://educate-yourself.org/cn/jeffreyslosssuicide27may04.shtml. May 27. Accessed January 14, 2006.
  21. Langreth R . Viagra for the brain . Forbes . 2002; December. Available at: http://nootropics.com/smartdrugs/brainviagra.html. Accessed January 12, 2006.
  22. BBC News Online: Bamiyan destroyed by Taleban. Available at http://news.bbc.co.uk/1/hi/world/south_asia/1654085.stm. Accessed March 27, 2006.
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PII: S1550-8307(06)00057-7

doi:10.1016/j.explore.2006.03.001

Explore: The Journal of Science and Healing
Volume 2, Issue 3 , Pages 185-188, May 2006

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