PTSD — Rebuttal

I was stunned when I read this article, “Should we erase painful memories?”, in Salon magazine. Which is kinda what propranolol seems to do.

The first speculative steps are now being taken in an attempt to develop techniques of what is being called “therapeutic forgetting.” Military veterans suffering from PTSD are currently serving as subjects in research projects on using propranolol to mitigate the effects of wartime trauma. Some veterans’ advocates criticize the project because they see it as a “metaphor” for how the “administration, Defense Department, and Veterans Affairs officials, not to mention many Americans, are approaching the problem of war trauma during the Iraq experience.”

The argument is that terrible combat experiences are “part of a soldier’s life” and are “embedded in our national psyche, too,” and that these treatments reflect an illegitimate wish to forget the pain suffered by war veterans. Tara McKelvey, who researched veterans’ attitudes to the research project, quoted one veteran as disapproving of the project on the grounds that “problems have to be dealt with.” This comment came from a veteran who spends time “helping other veterans deal with their ghosts, and he gives talks to high school and college students about war.” McKelvey’s informant felt that the definition of who he was “comes from remembering the pain and dealing with it — not from trying to forget it.” The assumption here is that treating the pain of war pharmacologically is equivalent to minimizing, discounting, disrespecting and ultimately setting aside altogether the sacrifices made by veterans, and by society itself. People who objected to the possibility of altering emotional memories with drugs were concerned that this amounted to avoiding one’s true problems instead of “dealing” with them. An artificial record of the individual past would by the same token contribute to a skewed collective memory of the costs of war.

WTF? Yeah, let’s remember all the violence, pain, and discomfort of being in a war. Including your getting your ass blown off!

Then I learned this same argument appeared when anesthesia came in general use.

Yet physical anesthetics have some relevant common ground with the prospective memory technologies, and there is a long history of resistance to the idea of physical anesthesia on grounds similar to some of the arguments being mounted here. Skeptics argued that a loss of sensation would disconnect sufferers from a valuable experience (as in childbirth) and from information they needed to have. Before the advent of anesthesia, techniques that seemed to involve an intentional suspension of sensation could trigger alarm on a scale that now seems almost inconceivable.

My reaction is “What a crock!” But the logic is this:

One of the most tenacious themes of 20th-century memory research was the idea that people tormented by the memories of terrible experiences could benefit from remembering them, and from remembering them better. The assumption — broadly indebted to psychoanalysis — was that psychological records of traumatic events often failed to be fully “integrated” into conscious memories. As long as these records remained “dissociated,” the sufferer was compelled to “relive” them instead of benignly remembering them. The more fully and appropriately one remembered terrible events, the more attenuated would be their emotional power.

Oh, yeah! Remembering getting your arm sawed off or the abuse a parent imparts on you is valuable. BS! I have memories I will NEVER explore. I tried it once and only got near them when terror set in. They will stay locked in the basement of my mind.

No wonder I never accepted all that crap Freud espoused. Digging up painful memories does not always heal; it can destroy.

Then there is the legal issues.

In addition to the work with veterans, there have been pilot studies with civilians in emergency rooms. In 2002, psychiatrist Roger Pitman of Harvard took a group of 31 volunteers from the emergency rooms at Massachusetts General Hospital, all people who had suffered some traumatic event, and for 10 days treated some with a placebo and the rest with propranolol [a beta blocker]. Those who received propranolol later had no stressful physical response to reminders of the original trauma, while almost half of the others did. Should those E.R. patients have been worried about the possible legal implications of taking the drug? Could one claim to be as good a witness once one’s memory had been altered by propranolol? And in a civil suit, could the defense argue that less harm had been done, since the plaintiff had avoided much of the emotional damage that an undrugged victim would have suffered? Attorneys did indeed ask about the implications for witness testimony, damages, and more generally, a devaluation of harm to victims of crime. One legal scholar framed this as a choice between protecting memory “authenticity” (a category he used with some skepticism) and “freedom of memory.” Protecting “authenticity” could not be done without sacrificing our freedom to control our own minds, including our acts of recall.

So that brings it down to retribution or forgiveness, IMO. If someone is doing OK without remembering driving into the side of a bus, that seems a better choice. Or maybe we can keep them in torment until after the trial. Dante would love this!

But the mere possibility seems to have threatened an important convention for representing memory in relation to personal identity. These worries draw their force from a deep-seated attachment to two related beliefs: first, that we are, in some ambiguous but important way, the accretion of our life experiences; and second, that those life experiences are perfectly preserved even if our ability to remember them is far from perfect. When Alzheimer’s disease patients lose significant amounts of memory, dismayed friends often say that their very selves have crumbled or faded away and that in some literal way they are “no longer themselves.”

The thought here is not that people believe their memories are perfect — far from it. Common understandings of memory centrally involve the idea that memories are unreliable, fickle and capricious. But there is another belief about memory that has been articulated by many figures in memory research: that in some fundamental way, secreted within us are perfect records of past experiences, even if we might never access them consciously.

I work with Alz patients and watched my Dad slide into his own world. Yeah, he was different but was he no longer my Dad? I didn’t think so; he just recalled things differently. As my teaching about dealing with Alz patients teaches, you don’t argue with them; their reality is REALITY. Kinda like some politicians!

But the mere possibility seems to have threatened an important convention for representing memory in relation to personal identity. These worries draw their force from a deep-seated attachment to two related beliefs: first, that we are, in some ambiguous but important way, the accretion of our life experiences; and second, that those life experiences are perfectly preserved even if our ability to remember them is far from perfect. When Alzheimer’s disease patients lose significant amounts of memory, dismayed friends often say that their very selves have crumbled or faded away and that in some literal way they are “no longer themselves.”

For instance, in the 1830s, during disputes over whether mesmerism could create an altered state of mind in which an individual was entirely incapable of sensation, the editor of a major London medical journal urged his readers to consider such a thing impossible not merely because it was implausible but because it would be an immense moral affront and a threat to one’s personal integrity. “Consider the implications,” he urged his readers: “the teeth could be pulled from one’s head without one’s knowledge.”

The thought here is not that people believe their memories are perfect — far from it. Common understandings of memory centrally involve the idea that memories are unreliable, fickle and capricious. But there is another belief about memory that has been articulated by many figures in memory research: that in some fundamental way, secreted within us are perfect records of past experiences, even if we might never access them consciously.

From the comments:

David Epstein

The concerns voiced in the article stem from a major misunderstanding of what propranolol does and what “emotional memories” are.

“Emotional memories” aren’t memories in the colloquial sense; they’re Pavlovian associations. They’re the panic felt by a battle survivor when a car backfires nearby; they’re the craving felt by an alcoholic when a champagne cork pops.

Propranolol and other reconsolidation-attenuating drugs do NOT touch narrative memories of particular experiences; they only reduce conditioned emotional responses to particular sensory stimuli. It’s a distinction that makes all the difference in the world.

—–

Aunt Messy

I think the propanolol treatment is not only valid, but may become standard over the next few years. When truly traumatic things happen to us, it’s enough to know that it happened and contend with the physical aspect of healing. Being forced to relive the experience for the rest of your life is the antithesis of mental health.

It took me years to be able to step back and look at my life without falling apart. I wasted a lot of time fighting emotional responses to past events.

Answered by kagogo

Did you think it was a complete waste of time? Don’t you think a lot of that contributed to the depth of your character today?

I honestly don’t know the answer to that. I don’t know who I would be if those past reactions never happened. Maybe I would be better. But maybe I would be more callous and less wise.

And a bluntly frank reply from Aunt Messy (Go, Messy!) with a codicil by Beans and Greens.

It was a complete and utter waste of time. I hurt people. I destroyed at least three potentially lucrative careers for myself, and I tortured myself with guilt for things that I couldn’t control.

It was twenty years of living, down the shit-hole, and for what? So I could get to a place where I can acknowledge the events without feeling the emotions? What the hell was the point, when I could potentially got to that place WITHOUT almost self-destructing in the process.

That process MADE me callous. I had to become callous to (literally) survive. You’re dreaming in Technicolor if you thing there’s value in what I (and millions of others) were forced to endure just to become a functional adult.

BeansAndGreens
Sunday, January 1, 2012 at 10:57 am

I agree, Aunt Messy. There are memories of utter tragedy I’ve witnessed that I do not need to keep. The world is filled with constant reminders of misery and suffering, gross injustice and cruel irony. Empathetic people will never lack for reasons to care, but having a loved one die miserably in one’s arms? I can easily do without such memories.

I couldn’t have said it better. Our future is worth more than hanging onto the pain of memories.

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PTSD — Why?

An article in Mother Jones magazine got me on this subject. The issue was an old one (2008) and had worked its way to the bottom of my bathroom reading pile but the relevancy is still important. One paragraph in particular struck me:

In the spring of 2002, an Army major named Peter Kilner submitted an unusual essay to Military Review, a journal published by the Combined Arms Center in Fort Leavenworth, Kansas. Kilner argued that combat leaders have an obligation to justify the killing their soldiers do. “Soldiers who kill reflexively in combat will likely one day reconsider their actions reflectively,” he wrote. “If they are unable to justify to themselves that they killed another human being, they will likely, and understandably, suffer enormous guilt” that could balloon into post-traumatic stress disorder (ptsd).”

This is a separate matter from Traumatic Brain Injury (TBI) which is a physical “scrambling” of one’s brains from a severe concussion or explosive damage. PTSD can occur to anyone, military or civilian. Even children.

Study lead author Dean G. Kilpatrick, Ph.D. and colleagues from the National Crime Victims Research and Treatment Center at the Medical University of South Carolina were particularly struck by the prevalence of PTSD in the national sample of adolescents. “Nearly four percent of the boys (3.7%) and over six percent of the girls (6.3%) reported PTSD symptoms during the preceding six months, indicating that a high percentage of youth in the United States encounter traumatic events and experience significant emotional responses associated with these events,” according to Dr. Kilpatrick.

Interpersonal violence (i.e., sexual and physical assault, witnessed violence) increased the risk of PTSD . . .

This condition goes back to WWI when it was referred to as “shell shock”. Explanations for this were usually based on conditions: heat, being frightening, in an alien place, etc. But not on what soldiers did. I had two uncles in WWII, one my namesake, and another whose name I can’t recall. Charlie slowly slid into a deep depression while the other would regale anyone who would listen about his experiences in Germany. Charlie had lost a leg. I suspect their experiences were very different.

My own experiences give me some insight into this. I was a combat doorgunner who only fired when fired upon and, due to our “sneaky Pete” work rarely encountered hostiles. Except the shoot-down in the A Shau Valley of Viet Nam. When we lost engine oil pressure, the pilot began a descent to an LZ. Any LZ! It was not a nice neighborhood with what later turned out to be the base for an entire NVA Division hanging around. I saw muzzle flashes in the dusk in a field as we went down and automatically returned fire with my M60. One of the shooters and one of the guys standing around watching went down as I raked them. At the time, and even now, I feel guilty about shooting an unarmed farmer.

Viet Nam Vets and Gulf War Vets have about the same levels of PTSD but I cannot find any studies of their combat experiences. “. . . because the military doesn’t collect statistics on how many have killed in the line of duty, not even among those who are treated for depression or ptsd.” I did find this in an article, “Rates of PTSD and major depression were highest among Army soldiers and Marines, and among service members who were no longer on active duty (people in the reserves and those who had been discharged or retired from the military). Women, Hispanics and enlisted personnel all were more likely to report symptoms of PTSD and major depressions, but the single best predictor of PTSD and depression was exposure to combat trauma while deployed.” The trauma was often seeing a fellow soldier badly injured or die.

Poor concentration and depression are the commonest indicators of combat PTSD. But a new, definitive test has been found: magnetoencephalography (MEG). This measures the current of brain activity and PTSD suffers’ patterns are different. This is an offshoot of Alz and MS studies.

So what can be done for these veterans and other PTSD victims? Traditionally, the military, when it does anything, uses traditional group therapy and counseling. But this has been both expensive and ineffectual. A technique used with Viet Nam vets has shown significant results; Transcendental Meditation (TM). In only 8 weeks of twice daily TM practice, a 50% reduction symptoms were evident.

Another promising effort is a drug, propranolol, prescribed for high blood pressure, anxiety, and heart arrhythmia, works well. It hasn’t been tested on veterans yet but this sounds like a good possibility. The first article gives a clear explanation the mechanism of PTSD in the body.

I know this wasn’t the cheeriest post I have made but this is a subject I have been interested in for sometime. If you read to here, thank you for your attention.