Friday, September 30, 2016

The Stain of the Spotless Mind: Policy Recommendations for Memory Erasure

By Peter Leistikow

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

Peter Leistikow is an undergraduate student at Emory University studying Neuroscience and Sociology. When he is not doing research in pharmacology, Peter works as a volunteer Advanced EMT in the student-run Emory Emergency Medical Service.

Over the course of 15 years, psychologist Dan McAdams studied how Americans describe their lives. Specifically, McAdams wanted to know what kind of life narratives were associated with lives high in “generativity;” that is, a concern for and commitment to promoting the well-being of future generations. He ultimately discovered that generative adults had narrative identities that emphasized redemption, such as a second chance or delivery from suffering (McAdams 2006).

The observation that it might be essential to have overcome adversity, reaping all the lessons and baggage it entails, in order to become a compassionate, mature adult is especially important in light of new developments in the field of dampening or even erasing memories. This alarming area of research warrants a further examination by policymakers, and it is the recommendation of this briefing that decisive limitations should be imposed on access to this technology.

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Memories were not always considered malleable; it was not until the 1960s that experiments in rats challenged the ideas that memories could be subjected to further modification, given the right conditions (Singer 2009). Fearful memories are made when emotionally salient events are labeled by the amygdala in the brain as emotionally significant and sent to the hippocampus for consolidation, strengthening synaptic connections into what will become a memory (Lu 2015). However, these connections can be disrupted; current therapies for post-traumatic stress disorder (PTSD) aim to block reconsolidation after reactivating these traumatic fear-based memories or promote extinction learning, a re-conditioning of fearful stimuli (Guistino et al. 2015). These are precisely the pathways targeted by drugs such as propranolol, a repurposed beta blocker that has been given hyperbolic names such as “the magic pill” or “a drug to cure fear” for its ability to alter memory reconsolidation, even allowing people with arachnophobia to touch spiders during exposure therapy (Scutti 2013; Friedman 2016). On the non-pharmacological front, developments in areas such as optogenetics may allow for the precise targeting of light sensitive proteins of the brain’s fear circuitry; devices that electrically stimulate the brain, the veritable alphabet soup of TMS, DBS, and tDCS, may strength exposure based therapy (Milad et al. 2014).

Limitations of this technology exist; in studies of pharmacological interventions such as D-cycloserine (DCS), it was shown that DCS can actually augment traumatic memory reconsolidation if paired with unsuccessful exposure therapy (Hoffmann 2014). Propranolol too may have adverse effects, negatively impacting other forms of memory such as semantic memory (for facts) and procedural memory (for things like how to ride a bike) that are interconnected and located close to sites of fear memories (Aoki 2008). Nevertheless, memory altering technology is here, and advances in technology will only increase its prevalence.

Thus, memory dampening technology requires intense scrutiny, and its use should be curbed such that it is only supplied in a clinical setting for only the most severe cases of PTSD. Central to this assertion are issues of personal identity and authenticity, appropriate moral response and traumatic growth, and justice. Memory dampening technology could cause significant harm to each of these values should it be allowed to reach prevalence in general practice or for cosmetic use.

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The 18th century Scottish philosopher David Hume defined the self as the connections within a discrete “bundle” of sensations and experiences; he believed that any changes in memory would be a change to the very self (Gentile 2010). Contrary to this view, some modern ethicists view memory erasure as a way to return to what is closer to the true self than the individual would have been living life dominated by the traumatic memory (Kolber 2011). Implicit in this assumption is that there is a self that is wholly independent from life circumstances; that character is static, and is not built by repeated actions and thoughts. Erler (2010) states that even core aspects of the “true self” such as personality and disposition can change over time despite being independent of choice; thus, it is inaccurate to appeal the true self as an abstract “essence.” Nevertheless, it is important to maintain authenticity by rejecting frivolous use of memory dampening technology. Erler (2010) states that it is inauthentic to change one’s memories such that “they change themselves in a way that distorts their perception of the world.” He goes on to offer the example of Liz, whose ability to unconditionally forgive the bullies of her adolescence following memory erasure would be contrary to the real harm she suffered that informed her reluctant nature, regardless of the nobility of the sentiment (Erler 2010). Indeed, emotions reveal deeply held concerns that are a product of one’s experiences and inform movement through moral space (Kabasenche 2007).

Memory also figures into broader aspects of appropriate moral response. Removing memory of an event deprives one of the experience of exercising agency in cognitively appraising the event and even possibly addressing larger social ills (Liao & Sandberg 2008). Furthermore, experiencing hardship allows one to become more empathetic to the struggles of others, a moral betterment. For example, Wallace (2011) explains how the experience of a nearly fatal car crash allowed him to not only gain the wisdom to critically evaluate his priorities, but also a deep compassion for others; the trauma is inseparable from the transformative experience it became. However, not all experiences are transformative for the individual. As Kolber (2006) states, some experiences of senseless violence seem to offer no opportunities for growth, and in some cases individuals are so impaired that they can no longer derive growth from hardship; these would be severe cases of PTSD in which it might seem permissible to use memory dampening drugs under rigorous clinical observation. Unfortunately, any criteria defining differentiating “severe” PTSD from “normal” PTSD would be largely arbitrary, and would be subject to cultural and economic pressures from outside the medical field. The use of memory dampening in cases of inconsistently defined cases of extreme PTSD sets the stage for further widespread medicalized treatment of trauma that “pathologizes” normal aspects of the human experience, leaving consumers ripe for exploitation by corporate pharmaceutical interests (Bell 2007).

Lastly, memories must be preserved in order to administer justice in accordance with the laws of society. For example, survivors of sexual assault may be further stigmatized and less likely to report the crime committed against them if standard treatment involves the use of memory erasing drugs that may call their testimony into question (Chandler et al. 2013). Although many sexual assault survivors report a high incidence of severe PTSD, Chandler et al. (2013) also state that memory deficits are associated with PTSD; in extreme cases the ultimate outcome is still one that favors justice, as memory erasure may enable testimony of equal or greater clarity. Ultimately, prohibition of prophylactic memory erasure while allowing erasure in cases of extreme suffering optimizes justice for society and survivors. This tension between societal and individual good is also seen in other cases, such as the maintenance of collective memory for tragedies, in which societal justice is served by limiting the individual’s access to memory erasure (Tenenbaum &Reese 2007). Clearly, policy changes in memory erasure technology will have to accompany a reevaluation of the individual’s duty to society cross culturally.

Thus, it is the recommendation of this briefing that memory erasure should be prohibited. Memory erasure technology has the potential to be a destructive force if allowed to reach prevalence among the general populace; the time is now to impose regulation that will preserve authenticity, personal identity, growth, and justice. Life narratives, always in flux, should embody the whole life experience without the tyranny of selective erasure.

References

Aoki, C.R.A. 2008. Rewriting my autobiography: The legal and ethical implications of memory-dampening agents. Bulletin of Science Technology & Society 28(4): 349-359. doi: 10.1177/0270467608320223

Bell, J.A. 2007. Preventing Post-Traumatic Stress disorder or pathologizing bad memories. American Journal of Bioethics 7(9): 29-30. doi:10.1080/15265160701518540

Chandler J.A., Mogyoros, A., Rubio, T.A., & Racine, E. 2013. Another look at the legal and ethical consequences of pharmacological memory dampening: The case of sexual assault. The Journal of Law, Medicine, and Ethics 41(4):859-71. doi: 10.1111/jlme.12096.

Erler, A. 2011.Does memory modification threaten our authenticity. Neuroethics 4:235–249.
doi:10.1007/s12152-010-9090-4

Friedman, R.A. 2016. A drug to cure fear. The New York Times, January 22. Available at: http://www.nytimes.com/2016/01/24/opinion/sunday/a-drug-to-cure-fear.html?_r=0 (accessed on June 19, 2016).

Gentile, S. 2010. If we erase our memories, do we erase ourselves. Public Broadcasting Service, November 24. Available at: http://www.pbs.org/wnet/need-to-know/the-daily-need/if-we-erase-our-memories-do-we-erase-ourselves/5322/ (accessed June 19, 2016).

Hoffmann, S.G. 2014. D-cycloserine for Treating Anxiety Disorders: Making Good Exposures Better and Bad Exposures Worse. Depression and Anxiety 31(3):175-177. doi:10.1002/da.22257

Giustino, T.F., Fitzgerald, P.J., & Maren, S. 2016. Revisiting propranolol and PTSD: Memory erasure or extinction enhancement. Neurobiology of Learning and Memory 130:26-33. doi:10.1016/j.nlm.2016.01.009

Kabasenche , W.P. 2007. Emotions, memory suppression, and identity. American Journal of Bioethics 7(9): 33-34. doi: 10.1080/15265160701518581

Kolber, A. 2006. Therapeutic forgetting: The legal and ethical implications of memory dampening. Vanderbilt Law Review 59:1561-1627.

Kolber, A. 2011. Give memory-altering drugs a chance. Nature 476: 275-276. doi:10.1038/476275a
Liao, S.M. & Sandberg, A. 2008. The normativity of memory modification. Neuroethics 1:85-99. doi: 10.1007/s12152-008-9009-5

Lu, S. 2015. Erasing bad memories. Monitor on Psychology 46(2):42.

McAdams, D. P. 2006. The redemptive self: Stories Americans live by. New York, NY: Oxford University Press.

Milad, M.R., Rosenbaum, B.L., & Simon, N.M. 2014. Neuroscience of fear extinction: Implications for assessment and treatment of fear-based and anxiety related disorders. Behavior Research and Therapy 62: 17-23. doi:10.1016/j.brat.2014.08.006

Scutti, S. Memory, forgetting and propranolol: Should some experiences never be recalled. Medical Daily, July 8. Available at: http://www.medicaldaily.com/memory-forgetting-and-propranolol-should-some-experiences-never-be-recalled-video-247469 (accessed on June 19, 2016).

Singer, E. 2009. Manipulating Memory. MIT Technology Review, April 21. Available at: https://www.technologyreview.com/s/413109/manipulating-memory/ (accessed on June 19, 2016).

Tenenbaum, E.M. & Reese, B. 2007. Memory-altering drugs: Shifting the paradigm of informed consent. The American Journal of Bioethics 7(9): 40-42. doi:10.1080/15265160701518649

Wallace, L. 2011. Even if we could erase bad memories, should we. The Atlantic, May 10. Available at: http://www.theatlantic.com/health/archive/2011/05/even-if-we-could-erase-bad-memories-should-we/238444/ (accessed on June 19, 2016).

Want to cite this post?

Leistikow, P. (2016). The Stain of the Spotless Mind: Policy Recommendations for Memory Erasure. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/09/the-stain-of-spotless-mind-policy.html

1 comment:

el roam said...

Thanks for that interesting post, just worth to note, that , there are very well established criminal procedures, where an early testimony can be given or be questioned , so, such erasure of memory as presented, can no longer interrupt justice making process. It can be done, even with sophisticated devices (imaging and screening) and enhance even the evidentiary reliability of the evidences in a given crime investigated . So, if full consent would be given (by the victim), and, the memory is causing substantial clinical disorders (flashbacks, delusional thoughts and senses, intrusive nightmares and so forth …. ) Preliminary procedure, can reconcile both: justice, and: curing patients wittingly .

Thanks