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Preventing a Lifetime of Trauma: Is it Ever Acceptable to Alter Memories in Children?

By Tabitha Moses


Image courtesy of Health.mil.

More than two-thirds of children will experience a traumatic event by the age of 16 (van der Kolk, 2005). The effects of this experience can drastically influence a child’s future. Post Traumatic Stress Disorder (PTSD), one outcome of trauma, is characterized by intense and disturbing thoughts about a traumatic event, even after that event has ended. It is associated with a range of debilitating symptoms, including hyperarousal and sleep problems (Kilpatrick et al., 2013). It can be triggered by many types of traumas, such as natural disasters, accidents, combat or other forms of psychological, physical, or sexual trauma. Although almost 90% of Americans will experience a traumatic event, fewer than 10% will develop PTSD (Kilpatrick et al., 2013). Unfortunately, we cannot predict who will develop PTSD.


Pharmacological agents may be able to alter memories in such a way that reduces the risk of developing PTSD or even cures PTSD altogether (Giustino et al., 2016). The theory behind this work is based in the fact that memories form in multiple stages; there is a step that must occur a short-term memory can be stored in long-term memory, this is called consolidation (Thomas et al., 2017). There are certain medications that interfere with aspects of consolidation. Beta-blockers for example, appear to block consolidation of emotional significance of potentially traumatic memories when given soon after the traumatic event (Villain et al., 2016; Thomas et al., 2017). The use of such medications to reduce PTSD through memory alteration in adults has already seen significant ethical debate (Parens, 2010; Hui & Fisher, 2015); however, since trauma in childhood may have a longer lasting impact (when compared to adult trauma exposure), it is important to consider whether this type of therapy could be appropriate in children.

There have been many ethical concerns discussed in the context of adults with memory alteration; these largely fall into a two main categories (Erler, 2011; Kolber, 2014). The first is the risk that editing memory may result in a lack of authenticity. Authenticity has varying definitions depending on the context, but one account is described as the “true self” account which includes “central features of that person’s narrative identity” (Erler, 2011). The concern is that by altering memories, we are altering the central core of identity and thereby undermining true identity. In isolation, the concerns of authenticity hold merit for the use of these agents in both adults and children; furthermore, many studies have demonstrated how malleable memory is, showing that experimenter manipulation can alter memories and even create new false memories (Loftus & Greenspan, 2017). If we consider this incredible malleability of memory and the knowledge that many of our memories may not be based in fact (Rojahn, 2013; Howe & Knott, 2015), then this concern surrounding authenticity may become irrelevant. In other words, if our authenticity is based on our ability to remember accurately then the fact that the majority of us do not have accurate recall about much of our past indicates that we are already living inauthentic lives; therefore, a “memory modifying treatment” would have no major impact.

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The second ethical concern of memory modification to prevent PTSD surrounds the wider societal impact of the trauma and a potential “duty to remember” (Kolber, 2014). Some memories may play an important societal role as they allow a person to serve as a witness in criminal trials or even on a smaller level they allow the person to avoid—and help others to avoid—similar traumatizing situations. To be clear these candidate medications for PTSD will not remove the memory entirely; rather, they will just reduce the emotional impact of said memory. As such, it may still be possible for individuals on memory-modifying medications to serve as witnesses in a legal court. It is worth considering that the criminal justice system relies, in part, on impact of the crime on the victim (Myers & Greene, 2004). Juries look at the impact of the crime in addition to the facts of the case; a person who received this type of treatment after developing PTSD due to a crime is unlikely to present as strongly affected by the crime in the same way as a person with PTSD who did not receive treatment. This could have an impact on prosecution of the individuals responsible and on the way in which the jurors may perceive the legitimacy of the victims statement (Wevodau et al., 2014; Feigenson, 2016).


Some argue that individuals, either as an adult or child, may be able to  use their own painful past to help others who have been through the same experience. This rationale is problematic in that it suggests that it may be worthwhile to allow one person to experience a lower quality of life for the benefit of others. Our current ethical and legal standards do not support the sacrifice of another for the benefit of many. As adults, we may be able to make this type of decision about ourselves, but this should not be a decision made on behalf of another. Autonomy must be maintained wherever possible and making this decision on behalf of a child would remove autonomy. We must also recognize that the provision of memory altering medications would also remove autonomy; however, in the context of medications that affect the emotional valance of the memory without removing the memory itself we are still providing the child with the ability to draw upon aspects of this experience in the future. Nevertheless, it is worth considering the fact that a memory without any emotional valance attached to it is unlikely to remain salient and therefore may be forgotten just as most of us have forgotten what we ate for dinner 7 months ago.

When discussing the rights of children and whether a certain childhood intervention is appropriate the right to an open future is often brought up (Millum, 2014). The ”open future argument” suggests that children possess certain rights that are derived from the rights to autonomy they may have as adults; as such, any decision that could impact their autonomy as an adult may infringe upon their right to an open future. In instances of trauma and PTSD, the child’s future is constricted regardless of the provision of medications to prevent PTSD. A child who experiences a traumatic event is immediately at an increased risk of having learning problems, increased involvement in the juvenile justice system, long-term physical health problems, and almost all behavioral health and substance use disorders (van der Kolk, 2005; De Bellis & Zisk, 2014; van Nierop et al., 2015; Fox et al., 2015; Veer et al., 2015). It is clear that the individual harms of experiencing trauma already result in outcomes that restrict a child’s future. Although this is not the optimal experience, it is through this lens that we must weigh the appropriateness of treating a child with a memory altering medication to prevent development of PTSD and other trauma-related outcomes. It is true that provision of this medication also impacts the child’s future and may constrict it in some way; however, the question is whether this constriction of an open future is greater than that which occurs after trauma. Both trauma alone and trauma in combination with memory alteration result in constricted future and may both result in long-term neural changes, but it is not currently believed that trauma alongside memory modification would result in the increased risk of additional problems that are associated with experiencing trauma. The effects of a trauma can be far-reaching and many of its effects can last long into adulthood both directly (e.g. health problems) and indirectly (e.g. childhood substance use leading to dropping out of high school, which in turn affects employment).

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We already accept that parents are responsible for making the decisions about what is best for their child, and we assume they do so based on what is in their child’s best interest. As such, the provision of this type of pharmacological therapy does not violate the bounds of normal parental rights. Although it is assumed that parents will make the best decision for their child, current debates regarding vaccinations and the rights of the parent to make medical decisions, even when it may endanger the child, illustrate the complexity of this issue. If these memory-modifying medications become a reality, it should never be the case that parents have access to these medications to provide to their child at will; instead, much like many other controlled psychiatric medications, the child would be evaluated by a physician who would recommend this treatment. The parent could not access the medication without a physician’s prescription, which should help ensure that the parent is acting in the child’s best interest.


The effects of childhood trauma often cause lifelong negative impacts, reducing the child’s autonomy by binding them to a certain type of future and removing access to certain possibilities. That is not to say the pharmacological approach does not remove autonomy from the child, rather both options do so, as such we must consider which is the lesser of two evils: the loss of the choice to remember an experience, or the loss of the ability to experience childhood free from the long-term psychological and physical impacts of trauma.

Although the development of these medications sounds like science fiction, it is far closer than we may think. There is clear evidence in animal models that medications can alter memory (Villain et al., 2016; Giustino et al., 2016) and these effects have been replicated in humans (Giustino et al., 2016; Thomas et al., 2017). We may still be years away from this becoming an FDA-approved, commonplace treatment; however, there are already recommendations to use these medications in high risk populations (e.g. veterans) (Donovan, 2010), so we must consider how and when we might use these treatment. If we find a safe way to block the emotional consolidation of traumatic memories in children then it merits consideration that there are instances when this may be the right choice.


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Tabitha Moses is entering her 4th year as an MD/PhD student at Wayne State University School of Medicine. She is working towards her PhD in Translational Neuroscience. Her primary project examines how stress impacts substance use and whether transcranial magnetic stimulation ameliorates these stress effects. She intends to continue her medical training in psychiatry with a focus on addiction medicine. You can find more information about this and her other research projects at www.tabithamoses.com





References

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Moses, T. (2019). Preventing a Lifetime of Trauma: Is it Ever Acceptable to Alter Memories in Children? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2019/07/preventing-lifetime-of-trauma-is-it.html


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