The Evil Hours (34 page)

This drug—propranolol, a beta-blocker developed to prevent heart attacks in 1964—blocks the action of adrenaline within humans.
As he explained, if you were to administer propranolol to a person a few hours after a traumatic event, you would block the neurological process that would otherwise cause that memory to become traumatic. In the language of neuroscience, you would prevent its “overconsolidation” within the brain and prevent the event from being permanently etched into the amygdala, one of the brain's fear centers. You would prevent the patient from being “thrown into the river.” The experience would be remembered much like any other event was remembered—without the elevated heart rate, without the shortness of breath, and without the amygdala being unduly impacted. A serious car crash would be rendered identical to a trip to the coffee shop, neurologically speaking.

Further, he explained, propranolol was completely safe, could be taken orally, had few side effects, had been in wide use for decades, and was off-patent, which means that, like a number of older drugs (such as penicillin), it wasn't controlled by a particular drug company.

The only catch was the timing. For propranolol to work, you had to administer it to the traumatized person within six hours of the “emotionally significant” event, and the sooner the better ideally. As I would learn later, the other not-small problem, at least for soldiers in a war zone or for refugees living in displaced persons camps and the like, is that for as long as the person is on propranolol, they are going to have to live without the benefit of adrenaline and the normal fight-or-flight response that would allow them to deal with danger.
They would, in other words, be defenseless—tiger meat, from a Darwinian perspective.

An hour later, I left McGaugh's office bewildered. While I'd gleaned a few nuggets of basic neuroscience, some things were far less clear to me than when I'd arrived. As I made my way across the sleek UCI campus, I wondered if I'd had it wrong all this time. All along, I had been thinking of trauma and PTSD as a profound, almost existential condition, a way of being in the world as much as a discrete diagnosis. Could trauma—the nightmares, the daemons, the vanished hopes, the impacted grief, the lost time, the great overturned jigsaw puzzle that used to be a person's life—simply be the product of an ill-timed surge of adrenaline?
An overrelease of epinephrine (the proper name for adrenaline) that resulted in a corresponding overrelease of norepinephrine (a neurotransmitter released during times of stress) in the amygdala? An overrelease that resulted in an overconsolidated memory trace in the fear center of the brain? Was this to be the historical conclusion to the odyssey begun by Lifton and Shatan four decades before?

The idea that our memories, the fund of information that makes us who we are, could be manipulated so easily flew in the face of nearly everything I wanted to believe about post-traumatic stress. It flew in the face of everything I wanted to believe about human nature. The world is so big, so complex, so replete with surprise and disillusionment and sublime loss, and the idea that they could all be banished by a heart pill invented six years before Lifton had even set foot inside the VVAW office was more than I was prepared to accept.

In my own way, I felt a little like John Keats in 1816, pondering the new world being ushered in by Isaac Newton. The natural sciences, he wrote,

 

. . . will clip an Angel's wings,

Conquer all mysteries by rule and line,

Empty the haunted air, and gnomed mine—

Unweave a rainbow.

 

Nevertheless, there remained the not-insignificant problem of timing, of administering the propranolol within the requisite six-hour window after the traumatic event. As a lifelong student of war and disaster, I understood this to be a tall order indeed. The idea that you could expect to pull thousands of troops off the line during a war, or round up tens of thousands of hurricane victims, and administer them a drug that would render them helpless as sheep for ten to twelve days seemed like a classic case of science failing to live in the real world. In the case of infantry and special operations troops, you would in essence be rendering them combat-ineffective, denying them the use of the biological hardware fine-tuned over millions of years of evolution.

But, as I would learn after returning home and Googling around, researchers have been hard at work trying to solve the timing problem ever since McGaugh and Cahill made their initial discoveries. In 2008, Roger Pitman at Harvard, along with some of his colleagues, published a preliminary study in the
Journal of Psychiatric Research
that tackled the timing dilemma head on. While the number of research subjects involved was relatively small, the results were promising.
Pitman took a group of patients diagnosed with PTSD, and after selectively exposing them to emotionally disturbing slide imagery, gave them doses of propranolol. What they found was astonishing: reactivating their memories with the slides coupled with the administration of propranolol reduced their symptoms by nearly 50 percent. (A similar experiment, conducted in 2001 by Pitman with McGaugh's input, administered a ten-day course of propranolol to forty-one emergency room patients within six hours of a traumatic event, and it had a slightly better outcome.) Pitman's results were encouraging enough that the Department of Defense awarded his team seven million dollars to develop a drug therapy to block this sort of traumatic memory reconsolidation in PTSD patients.

In January 2014, Pitman told me he was putting the final touches on a study that used “imaginals” similar to those used in PE therapy to activate patients' symptoms several months
after
a traumatic event and treating them with propranolol, and that they're finding the same pattern of reduced post-traumatic symptoms.
In other words, the timing problem with propranolol may have been solved.

 

In
Eternal Sunshine of the Spotless Mind
, the 2004 film directed by Michel Gondry, a reclusive artist named Joel Barish (played by Jim Carrey) discovers that his exgirlfriend has had her memories of their relationship erased through an innovative procedure developed by a psychiatrist. Devastated and angry, Barish decides to have the same operation done to have his brain expunged of any trace of his ex. When he asks if there is any risk of brain damage, the psychiatrist, Dr. Mierzwiak, responds, “Well, technically speaking, the operation is brain damage, but it's on par with a night of heavy drinking, nothing you'll miss.” In time, Barish comes to regret his decision, and for the bulk of the film, we see the star-crossed lovers chasing one another through Barish's various memories before they are vaporized by Mierzwiak and his technicians.

The film, written by Charlie Kaufman, hit theaters before propranolol's medical potential had been widely reported (a
60 Minutes
story on propranolol aired two years later, in November 2006), but the procedure depicted in the film resembles propranolol in enough respects that we have to credit Kaufman for creating a work of art that life has seen fit to imitate. In Kaufman's story, the effect of this technologically induced amnesia is almost entirely negative, creating a kind of moral chaos. Characters, unconcerned about the consequences of their actions, actions that no one will remember, betray one another as a matter of course. The romance at the center of the film is nearly destroyed by the ability to erase memories on a whim. All sense of an objective, stable reality is lost. As the plot unfolds, we learn that the seemingly benevolent Dr. Mierzwiak has, in fact, used the procedure several times to delete an affair he'd had with his attractive young receptionist, played by Kirsten Dunst. The movie ends with Dunst's character stealing all of Mierzwiak's files and mailing them to his roster of patients in an effort to undo the damage wreaked by this neurological Frankenstein. Society, it seems, is not ready for wholesale memory erasure.

Kaufman's screenplay, heavily influenced by the work of science fiction novelist Philip K. Dick, presages much of the criticism that has followed the advent of propranolol. In October 2003, before the most promising experiments by Pitman had even been published, President Bush's Council on Bioethics released a lengthy monograph titled
Beyond Therapy: Biotechnology and the Pursuit of Happiness
, in which the authors, addressing the potential of propranolol, asked “Would dulling our memory of terrible things make us too comfortable with the world, unmoved by suffering, wrongdoing, or cruelty? Does not the experience of hard truths—of the unchosen, the inexplicable, the tragic—remind us that we can never be fully at home in the world, especially if we are to take seriously the reality of human evil? Further, by blunting our experience and awareness of shameful, fearful, and hateful things, might we not also risk deadening our response to what is admirable, inspiring, and lovable?”

The Council's report, which was regrettably loaded with early War on Terror–style references to “evil” and “evildoers,” still manages to get its basic point across: propranolol is one of the most morally challenging drugs to emerge in a very long time and could radically alter how society deals with trauma and moral terror. As numerous bioethicists have observed, the moral problems it introduces are virtually limitless. As Chuck Klosterman, an author and
Esquire
columnist, argued, “Propranolol might be the most philosophically vexing pharmaceutical since Prozac. It openly questions the significance of reality.”

Klosterman, an avid student of pop culture, goes on to ask, “How big is your life? That is neither a rhetorical nor impossible question. The answer is easy: your life is as big as your memory. Forgotten actions still have an impact on other people, but they don't have an impact on you; this is the entire point of
Memento
. Reality is defined by what we know, and we (obviously) can't know what we can't remember. What this means is that propranolol provides an opportunity to shrink reality. It doesn't make past events wholly disappear from the mind, but it warps their meaning and context. So if people's personalities are simply the aggregation of their realities (and if reality is just an aggregation of memories), it can be argued that propranolol is a drug that makes people's lives artificially smaller.”

Klosterman and other critics assert that by tinkering with the rudiments of human memory, we might unwittingly change human nature itself, rendering terror, atrocity, rape, and every manner of depredation a banal occurrence. As Paul Outka, an English professor at Florida State University, inveighs, “To be denied a ‘normal psychopathology,' to be remade into an entity that can witness any horror and survive without permanent damage, is to be a fundamentally different sort of human.”

Outka makes a good point. While it is too early to say exactly how powerful propranolol will be in diluting the power of traumatic memories, one of the foundational principles of recognizing trauma among humans is that it serves a greater moral purpose. PTSD is, in a manner of speaking, a way of institutionalizing moral outrage. As Robert Lifton and others have argued, to treat trauma on a strictly technical basis, like any other psychic ailment, is to miss the point entirely. To them, trauma transcends the individual. Trauma is symbolic. Trauma is history made manifest in the flesh. Trauma, when heard by society, is a form of testimony.

It is no coincidence that since the Vietnam War and the advent of PTSD, the casualty totals of American wars have fallen dramatically. Among the many things that PTSD has done is given victims of violence a status they lacked before. Society today is far more sensitive to the concerns of the victimized than it was in the first half of the twentieth century, and this is, in no small measure, due to the advocacy work of the Vietnam generation. If through the miracles of modern neuroscience we end up significantly diluting the moral force of trauma, we risk creating a far more violent and cruel society than the one we currently live in.

Nevertheless, not everyone is convinced that propranolol represents a threat to the social order.
Adam Kolber, a law professor at the University of San Diego and the author of a widely read neuroethics blog, has, with respect to propranolol, advocated for what he calls “freedom of memory.” Kolber quotes one survivor, who said, “I have severe [PTSD] and would sell my soul to the devil himself to be rid of my 24/7 hellish flashbacks and night terrors.” His extensive sixty-six-page legal review of the possible impacts of propranolol concludes by saying, “Concerns over memory dampening are insufficient to justify broad restrictions on the therapy. Furthermore, having the choice to dampen memories supports our interests in self-determination and in avoiding mental illness and upset enables us to identify more strongly with memories that we decide to keep. Given the potential that memory dampening has to ease the pain of so many people, and that, at a minimum, memory dampening ought not be entirely prohibited, it follows that we should have some right to dampen our memories.”

Despite the controversy surrounding its use, the therapeutic potential of propranolol and beta-blockers is still largely unknown. The drug, in its current form, can diminish the potency of certain types of memories under certain conditions, but it is by no means a memory wipe–type drug of the sort depicted in science fiction movies like
Men in Black
. As Pitman has argued, “The original memory is indeed still there, deep inside the brain.”
And as I discovered firsthand undergoing imaginal therapy with the VA, post-traumatic stress is frequently caused by a whole series of stressful events, a large swath of time spent under stress, rather than a single, discrete event that can be easily isolated and treated with beta-blockers.

In this way, propranolol raises still more vexing issues with respect to the PTSD diagnosis as a whole because in no clinical trial have post-traumatic stress symptoms been eliminated completely by administering either a beta-blocker or another similar drug. Virtually every experiment published so far shows that disrupting memory consolidation and/or reconsolidation results in the PTSD rate being cut roughly in half. What then are we to make of this other half, the patients who despite being given propranolol or a similar drug go on to develop post-traumatic symptoms? Are they the result of a flawed experimental design? Are they noncompliant patients? Are they misrepresenting their symptoms to the assessors who give them the CAPS? Or is it possible that part of what we call PTSD exists outside of the realm of neuroscience as it is understood today? Is it possible that some aspect of trauma exists in the moral sphere, a sense not merely of being haunted by horror but in some way feeling tainted by it?