Forgetting about fear: A neuroethics perspective

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By Laura Cabrera, PhD

The alluring possibility of deleting memories has been the topic of movies such as Men in Black, Total Recall, and Eternal Sunshine of the Spotless Mind, yet in real life the chances of ever achieving such fine-tuned memory erasure is not a realistic bet. But suppose if by taking a pill we could forget about fear and about those things that cause us to be anxious? A New York Times article addressed exactly that possibility with the recent coverage of a drug to “cure” fear—by dampening memory. One factor influencing and shaping memory processes is their emotional intensity. Extensive psychological research and personal experiences confirm that events that occur during heightened states of emotion, such as fear, anger and joy, are generally more memorable than less dramatic occurrences. That research explains why you might remember exactly what you were doing when you found out about 9/11, but not necessarily be able to recall what you had for supper two days ago. Some memories with an intense emotional component might leave individuals susceptible to develop phobias, or possibly even post-traumatic stress disorder (PTSD).

The current standard treatment for many anxiety-related disorders involves exposure therapy. There are two distinct points at which memory is more vulnerable to modification, when we first form those memories and when we recall them. Thus, the idea behind exposure therapy is to repeatedly present the feared object or the frightening memory in a safe environment, so that the person can then acquire a new safe memory, in effect replacing the “bad” memory. However this type of therapy has concerning limitations including that the old fear could awaken with a vengeance; the therapy might be useful for only a limited period of time; and finally for some people the idea of reliving frightening memories is simply intolerable.

Given the limitations of those therapies, and considering that there might be cases where underlying organic brain profiles make people more susceptible to develop phobias and trauma, other interventions, including pharmacological ones, have been widely researched. Propranolol—a Food and Drug Administration (FDA) approved drug to treat hypertension—has been found to have potential for disrupting memory reconsolidation, in particular by influencing the affective value of a given memory. A number of preliminary empirical studies demonstrate propranolol’s efficacy in reducing PTSD symptoms when taken within a few hours of the traumatic event (Brunet et al., 2008; Pitman et al., 2002). Those studies suggest that patients with PTSD symptoms had a reduction in trauma-associated physiological responses after taking propranolol. Friedman (New York Times) mentioned yet another propranolol study (Soeter and colleagues, 2015). Those researchers found that arachnophobes (those experiencing fear of spiders) exposed to the fear trigger, i.e., a spider, to reactivate their fear, were then given propranolol and as a consequence were able to touch the spider within days. Reportedly, the behavioral effects persisted 1 year after the study.

Propranolol is just one of many agents currently being researched with the goal of facilitating the extinction of fear and trauma. Some have called this quest for drugs that would dampen “bad” memories, “therapeutic forgetting.” However, the process is not as easy as simply popping a pill to have the traumatic memories disappear. For example it remains unclear whether broader fear memories or older memories would be similarly sensitive to drug-facilitated memory dampening. There is an additional risk that by reducing the emotional intensity of memories, in a linked fashion, we might also dampen their factual richness, or inadvertently distort positive memories as well.

Discussion around the normative implications of memory modification is an especially hot topic within neuroethics. Some are disturbed by attempts to directly tamper with memory because they view it as threatening to our identities and the authenticity of our experiences. Conversely, others see it as a genuine attempt to relieve suffering. The President’s Council on Bioethics is well known for arguing against memory dampening (Bioethics, 2003), noting that “We might often be tempted to sacrifice the accuracy of our memories for the sake of easing our pain […] severing ourselves from reality and leaving our own identity behind.” But others argue that in cases of severe phobia or anxiety, memory dampening interventions can indeed be useful and in fact might help people to shape their identities in a positive way and in so doing be more authentic to what they take their lives to be.

When considering memory-erasing drug interventions there are related pragmatic considerations such as safety, informed consent, and social pressure. In relation to concerns about social pressure, some have argued that when compared with the potential costs of hours of psychotherapy and chronic treatment with pharmacological agents for anxiety and PTSD, the financial benefits of pill-induced therapeutic forgetting are unmistakable. However, this line of thinking might unreasonably push society further in the direction of a search for easy solutions for problems that might require far more than simply popping a pill.

Fear is a natural and adaptive response. Up to certain limits anxiety and fear are appropriate reflections of the fragility of human life. The disagreement with reducing the emotional intensity of memories associated with traumatic events is not so much about whether that strategy is good or bad, but instead, disagreement lies in the zone of ambiguity, “where reasonable people will reach different conclusions about the same set of facts” (Parens, 2010). Where can one reasonably draw the line between therapeutically forgetting and just “messing around” with memories? Trauma, fear and anxiety are concepts shaped as much by cultural and societal standards as by medical ones. This diversity of influence has contributed to the widening of diagnostic boundaries, which can result in people opting for taking a pill, rather than the more arduous process of reflecting on their fears and the emotional aspects of their memories. Perhaps a memory erasing pill would prevent us from engaging in experiences necessary for moral learning and personal growth. As a society, we should be careful where to set the limits of normal and pathological. Scientific breakthroughs are nearly always double-edged swords. So while the prospect of a pill for therapeutically forgetting brings hope for those suffering with debilitating phobias and trauma, we simultaneously need to keep an open and critical mind on the related expansion of disorders boundaries—and with that expansion the linked potential of exploitation by pharmaceutical companies.

Laura Cabrera, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Translational Science & Molecular Medicine at Michigan State University.

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References

1. Bioethics (2003). Beyond Therapy: Biotechnology and the Pursuit of Happiness. The President’s Council on Bioethics. (Washington DC).
2. Brunet, A., Orr, S. P., Tremblay, J., Robertson, K., Nader, K., & Pitman, R. K. (2008). Effect of post-retrieval propranolol on psychophysiologic responding during subsequent script-driven traumatic imagery in post-traumatic stress disorder. Journal of Psychiatric Research, 42(6), 503–506. doi:10.1016/j.jpsychires.2007.05.006
3. Friedman, R. A. (2016). A Drug to Cure Fear. New York Times. http://nyti.ms/1Pai84M
4. Kolber, A. J. (2006). Therapeutic Forgetting: The Legal and Ethical Implications of Memory Dampening. Vanderbilt Law Review, 59: 1561. San Diego Legal Studies Paper No. 07-37. Available at: http://ssrn.com/abstract=887061
5. Parens, E. (2010). The ethics of memory blunting and the narcissism of small differences. Neuroethics, 3(2), 99–107. doi:10.1007/s12152-010-9070-8
6. Pitman, R. K., Sanders, K. M., Zusman, R. M., Healy, A. R., Cheema, F., Lasko, N. B., et al. (2002). Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biological Psychiatry, 51(2), 189–192. doi:10.1016/S0006-3223(01)01279-3
7. Soeter, M., Kindt, M. (2015). An abrupt transformation of phobic behavior after a post-retrieval amnesic agent. Biological Psychiatry 78(12): 880-886. doi: 10.1016/j.biopsych.2015.04.006