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Thursday March 6, 2003

Session 4: Beyond Therapy: Better Memories?

Discussion of two papers:
(1) "Why Remember?" by Gilbert Meilaender, and
(2) Staff Working Paper, "'Better' Memories?
The Promise and Peils of Pharmacological Interventions"

CHAIRMAN KASS:  The last session today is revisiting on the topic of better memories, the promise and the peril of pharmacological intervention.

And we have here a staff background paper which, before taking up the technologies now and perhaps soon to be available to intervene in human memories, talks about what memory is in its heterogeneity, talks a lot about what a better memory might be and how difficult it is to specify that; different ways in which memory fails or fails to please us, grouping them amongst lost memories which might be restored, weak memories which might be enhanced, and then bad memories which one might choose to transform.

And that paper concludes by suggesting that perhaps it is this last category, the blunting of the affective aspects of memories of painful, unpleasant memories that might be the technology most upon us.

And, in fact, in the session that we had with Dr. McGaugh and Dr. Schachter, there was some discussion about that prospect in the follow-up discussion.

And then we have also as background, as I think the point of departure from this discussion, a paper that Gil Meilaender wrote really in response to a request and a conversation that we had after the last meeting, which takes up this last possibility and raises the question as to why should we remember especially those things for which a case might be made that we'd be better off not remembering it.

I don't want to have a discussion aimed primarily about any of the papers precisely, and Gil has asked that this not be a sort of back and forth interrogation of what he said, but the paper really is to be used to prompt a discussion aimed at an increased clarification and understanding of the particular issue.

And, once again, I'm going to try and this time I hope to produce a question that's less easily discussed and more readily engaged.

Let's put it this way.  We have, although the obliteration of all pain would produce a kind of bodily disaster, as Professor Pinker already mentioned, but we do have analgesia and for certain kinds of severe infliction of pain, we even have anesthesia, and the question is why shouldn't one think about analgesia for the memory.

Why should we have to live with painful, guilty, shame- filled, shocking or unpleasant memories if we don't have to and science could offer us a way out of it?

That's a question that Gil offers a kind of argument for, an argument which he can make for himself or we can draw on if we wish, but I think that's the question that the paper is trying to get us to think about, and I would simply like to pose the question flatly and see where we go.


DR. GAZZANIGA:  Have you got any Ritalin?


CHAIRMAN KASS:  Look.  If this —

DR. GAZZANIGA:  A fascinating thought.

Well, both of these papers are really well done, I thought, and they remind me of Yogi Berra who says it's not what you don't know that hurts you.  It's what you  know that just ain't true.  And what is not brought up in these two papers probably is a product of who we selected to have as our experts  when we had our memory experts in.

Dan and Jim are fascinated with the encoding part of the memory story, but that's only half of the story.  The other half of the story is the recall of information, how you retrieve it, and there's a whole rich literature on that.

And basically the point I want to make is that what we know about that is that every time you retrieve the memory and it then becomes relayed down as it were, re-remembered, the memory changes.  So it's the memory that you think you have that you are languishing on and that is governing your current beliefs or mental thoughts or what have you, really has been so buffed by you recalling it through the past that if you actually went back to the original event, you many times wouldn't recognize the two.

But your current memory of it and the actual event, and for those of us who write scientific review papers, we have this problem all the time.  If we fail to go back and look up the source of the paper that we actually are trying to write about in five years, we always get it wrong because the memory, the recall system along with the recoding of the information that's recalled, plays all of these tricks on your mind.

So my point is that blunting of the memory, there's a natural blunting of it that occurs just as we recall past events, and it's just a part of the normal process of thinking about the past experience.  It's not that there's going to be this bullet of a drug or a pharmaceutical that's going to come in and modify this pristine, clear memory of a particular event.

And the only other thought, and I cannot speak for the rest of the afternoon, is in the background paper that touched on memory and aging and memory and loss of memory and so forth and the potential pharmaceutical enhancements that could occur to help our lagging memory system, the one point that's lost is that we all have, all of us in our culture have lost a great skill set in our memory tool box.

It used to be that I think we all in this room go back far enough that we used to remember a verse at length and could repeat it and use it constantly.  I heard a little bit this morning, and I was very impressed.  And we've given that tool box up for the visual culture we live in for all of the pneumonic aids we have all around us.

And as a result, we're not going into the aging process particularly well-equipped to continue the mental exercises, and so the deterioration that is occurring through the normal aging process becomes exaggerated because of looking at — I'm not talking about the people in this room.


DR. GAZZANIGA:  But our culture simply is not applying this tool box of rehearsing information or remembering it as they age, and certainly it is clinically known that the people who are insulated the best against early Alzheimer's and all the rest of it are the people who have kept mentally active and are using their memory skill system with vigor.

And so therefore, the reason that I'm bringing that up is that it's my bet that a behavioral resurgence of that will probably even in the short- run be more productive in enhancing and protecting us against deteriorating memory than the pharmaceuticals that are imagined and that, in fact, now are being planned by one start-up or another.

So those are my observations.


PROF. GLENDON:  Can I just try to make a connection between what Michael said and Gil's paper?

I think Michael reminds us quite rightly that this business of memory is very tricky, but the thing that I want to — one of the many things I loved about Gil's paper is the way he connects memory with the narrative of who we are, with the story of who we are.

And I was trying to think about this problem of accuracy of memory and connection with that narrative, and here the literary piece that we need to put in our collection is Mario Vargas, "The Storyteller," which is about a tribe that is losing its storytellers, this Machiguenga tribe, calls itself "The People Who Walk," and they tell their stories.  They have an official storyteller who tells the story over and over again, but, Michael, every time it's told it's told differently.

And the storyteller sometimes says, "Well, when the great god exhaled us, perhaps he did this."  And so there's this perhaps that lets you know that the storyteller knows about it.

So what's happening is not only remembering, but sort of recreation of the story as it's passed on, and I think the most — even though the subject here is memory, I think that Gil was right on when he said that what connects this memory question to being human is its connection to our stories about what our life means, the search for meaning.

CHAIRMAN KASS:  But I mean, let me make life somewhat difficult.  I mean, taking from Mike Gazzaniga's comment the suggestion that, well — I mean, it was quite wonderful.  For the problem of bad memories, time is the best remedy since it won't bother you so much as you get older.

I wish it were true.  There are still things that make me wince.


CHAIRMAN KASS:  And the other part of it is memorized poetry, never mind pharmacology, a sentiment which we could endorse for multiple reasons.  But it seems to me that if having a narrative is a narrative of one's own life is somehow central to our own humanity and self-understanding, and unless the retellings of it are simply accidental in the way in which the messages and the telephone game get changed inadvertently, it does suggest that one could be an editor of one's own narrative and be increasingly the author of our own life, the way we are at least to some extent.

If I don't say it, Bill May is going to say it.  It's not simply a matter of acquiescence and taking what comes, but it's a matter of trying to shape and by acts of will form the life story prospectively, and so the question is so why shouldn't one as the partial author, not the exclusive author of one's life, do a little editorial work to take out those things the memory of which will besmirch, upset, trouble, cripple, I mean, fracture a life?

Why should the narrative that we tell ourselves be somehow necessarily faithful as much as memory could ever be faithful to what we actually endured?  I mean why not be good editors rather than let accident write the story?

PROF. SANDEL:  Let's see what Gil has to say to that.


PROF. SANDEL:  Let's hear what Gil has to say to that.

CHAIRMAN KASS:  You should make him answer first.

PROF. MEILAENDER:  That's an excellent idea.  I was just going to say why exactly did you want to make this case for living in a world of fantasy.  You know, this is Rousseau —

CHAIRMAN KASS:  I'm just asking.

PROF. MEILAENDER:  This is Rousseau walking across Europe preferring to think of kind of the women he can conjure up in his imagination to real women.

PROF. SANDEL:  No.  To tell a life story isn't to be a beat reporter, Gil.  That's how I understood Leon's point.

PROF. MEILAENDER:  No.  You asked why should one want to live truthfully.

DR. GAZZANIGA:  Well, the point is that the truthfulness isn't very good.  I mean, but —

PROF. MEILAENDER:  But, Leon, I acknowledge that one could strive for it.

CHAIRMAN KASS:  No, no, no, no.

PROF. MEILAENDER:  Granting that none of us will remember perfectly, you can still try or you can decide to kind of fix up and get rid of.  That was what —

PROF. SANDEL:  But now you're suggesting, Gil, that the truest life story, the truest narrative for a person would be a transcript.

PROF. MEILAENDER:  No, I wasn't.  You see, we're into the Q&A again.  This is not the right way to do it, and I'm just going to shut up in a minute.

The paper acknowledges that we do reconfigure inevitably and that, indeed, one can't necessarily say what the meaning of an event is until it's seen in the context of the whole life.  That seems to me to be true, or at any rate I certainly say it in the paper.

But simply taking charge of it in such a way as to kind of eliminate those matters that one finds painful in some way doesn't seem to me to be an attempt to live truthfully, and it doesn't take seriously the fact that  we don't know what the meaning of those events can become in the course of a whole life as it's lived out.

CHAIRMAN KASS:  Did you want to follow up that?

PROF. SANDEL:  Just one follow-up.  If we agree that a life story as a narrative is central to the meaning of a life, and I think that point comes out powerfully in your paper, Gil, and Mary Ann elaborated this idea, then we agree that a certain element of creative fashioning is not only desirable.  It's essential if the life story is to be other than a stenographic transcript.

Now, if that's true, then the next step would be to ask:  well, that means being less moved by some facts about our lives than others, seeing them as less central in the story that we weave, and memory enters here because one of the ways in which we de-emphasize certain features of our lives and emphasize others in weaving the story may have to do with a certain faculty not just of will, not just of saying, "Well, let's array all of the facts here truthfully and then I'll pick out the significant ones," but it has to do with the way we take them in in the first place.

And memory even untouched by drugs is selective, and the principles of selectivity may have something to do with bias and prejudice, but may also have something to do with the distinctive way we take in the world in the first place unless you think we just take it in as brute sense data.

And so that suggests that even without the drugs memory is going to be selective memory, selective in a way that reflects our distinctive take on the world.

And so then the objection to altering memory, whether to blot out traumatic memories or to increase our ability to remember certain things on either direction might be seen as part of what we do anyhow when we take in the world, and it might be odd to think that the way we just happen to take in the world unaltered from either direction is the past.  We're back to the moral weight of the given.

Why should we think that that's necessarily going to lead us to the truest life story?

PROF. MEILAENDER:  I think it's peculiar to use the word "selective" in connection with sort of just what we take in.  We haven't yet gotten to something that deserves the word "selective" at that point.  You know, experience comes in.  It's organized in various ways.  I understand that, but the notion of selecting in any strong sense doesn't fit that.

PROF. SANDEL:  No, but experience doesn't just come in.  That's the point.

PROF. MEILAENDER:  I said it's organized in certain ways, but the language is "selecting," I think, is not very good language there.

PROF. SANDEL:  Well, apprehending, and some people are better at apprehending than others, more insightful.  They're —

PROF. MEILAENDER:  Yes, but that's got nothing to do with their conscious shaping of their sense of the narrative of their life.


DR. MAY:  Interesting to think about imagination in relationship to memory.  I mean if we didn't remember the past at all, imagination would function in relationship to the future, but it has very few controls on fantasy.

If I didn't know very much about the various inertias at work in my life, I might fantasize all things, and so memory has — and your discussion of embodiment I think was very important there, Gil.  Memory in lots of ways serves to tether, tame, and restrain imagination as it relates to the future.

On the other hand, imagination is very important in the functioning of memory because, after all, it's passed and, therefore we have to engage in an act of imaginative retrieval.  So it's very interesting.

The retrospective of imagination serves in various ways to constrain the prospective side of imagination as we muddle our way through the present moment.

Now, you use the word selection.  But also there's re-collection, is a very important feature, and when one thinks of the moral task of old age — I think about it more and more — as it bears on this whole question of coherence, there's a task of re-collecting one's past if you're going to be concerned at all with the question of coherence and think about life as a narrative.

There's a kind of re-collecting that goes on.  That word, I recall in root, "collect," "lectionary," and so forth.  It's a reading.  It isn't simply a record.  It's a reading, and as long as we're alive, there is a rereading that is going on in our relationship to the past.

But as you deal now with what you call the wince events, of which they're very important because I discover I am more afflicted by them when something else is going wrong.  So they become symptoms to me when I'm reliving certain kinds of things that, in fact, there are other orders of disarray and incoherence in my present life that makes me think about some of those wince events.

I mean, Paul McHugh will know a great deal more about this than I do.

But Gil also introduces an interesting issue.  How do you relate to those very painful experiences or wince events, and what kind of editing and selecting now, partial reading, where you remove from the book, remove from the pages certain kinds of events to deal with them, and that's one way of achieving a coherence, but it's dealing not with the whole truth.  We know that.

But Gil, on the basis of his religious background at some point suggests that in this life we never have a vantage point that gives us the whole truth, another way of saying there isn't the — the final coherence is never ours, and I guess it is what has led religious traditions to talk about the problems of reparation and atonement; that there's a lot in our lives, even when we make the best efforts at retrieval and collection and so forth that are ragged, are frayed, jagged, that do not fit in, and so forth, and we're engaged in unfinished business.  And where does the completion come from?

And oddly, humility requires us both to aspire for coherence, but to be cautious in assuming that we ever achieve some final vantage point on that, and, of course, that's why we need one another to engage in that kind of correction in our readings, which are so partial, so agenda- driven, so often, from day to day.

CHAIRMAN KASS:  Does that that sort of large and very moving anthropological account lead you to conclude that we doctors of the soul, that is to say I'm speaking for McHugh, not to come in there and do anesthesia of memory, not even for the most painful of memories, if he could?

DR. FOSTER:  Well, while he's thinking, I mean — I mean you all are — I would myself think that that would be a great loss.  You know, I mean, Jacques Martain wrote about this extensively with something that — I forgot exactly who he was quoting about the memories that come like lightning uninvited in, you know, from the past.

If you can allow just a little homely example of this, when I was about 16 years old or 17 years old, 16 years old, I think, I got a very good job working in an electronic — I was a sort of a jack of all trades there and so forth, and one of the bizarre things, there were two of us working there, and he asked me to come work at his house on Saturday, which was not a day that I worked, and I had a date.  So instead of telling him that I had a date and that I didn't think I could come, I made up a frank, bizarre lie.  I said that I had a brother who was coming home from the Service and that I had to greet him.


DR. FOSTER:  So my friend went out to work with him, and my boss, who was a wonderful boss, said, "Well, Dan couldn't come because his brother's coming from the Service," and whereupon my friend, Fred Kongabel, says, "Well, he doesn't have any brother in the service.


DR. FOSTER:  Right?  Well, so the next day, and to his credit, my boss, who was a wonderful person, confronted me with this and in a reparative way.  I thought he would fire me, but he said, "I was very disappointed that you simply didn't tell me the truth because I would have understood.  I've had dates before."

Well, to this day, that is one of the most painful memories that I've ever — I mean, it doesn't sound like much, you know.  It was just a little white lie because I didn't want to work on Saturday, but it is constantly with me as a reminder.  I sometimes tell this story to the residents and so forth and so on.  It reminds me of the importance of truth.


DR. FOSTER:  Of truth, of telling the truth.

And so whenever there's an opportunity where I feel like there's something that I ought not to tell the truth because I don't want to do something, and so forth and so on, that memory, painful as it is, has served to remind me of the awful pain I felt because I disappointed this man who had given me a job to do that.

So I think editing of painful things — I have a lot of wince — I'm not going to tell you about some of them, you know, but I'm pretty straight, you know.  But still I have a lot of those.

I think it would be — I think I agree that it would be a bad thing.  I think it's one thing to eliminate a memory of a plane crash or like the bus that was blown up in Israel yesterday, and you know, with people's faces drawn up.  That might be, you know, to delete something like that might be one thing, but if you had to delete all of the other things from which you've actually learned and probably gotten wisdom and probably finally become something more close to what you wanted to be all your life, then I think that would be bad because then it might be that I wouldn't have that to remind me of things.

So in one sense one deals with those winces by, you know, the forgiveness of friends or the person that you've had or, as Bill says, maybe if there is some ultimate judgment in the universe by that.

I mentioned this article this morning because I wanted to — of Leon Rosenberg's because I was really wanting to just talk about the issue of whether one should just fight problems or deal with them by drugs.

But even though I wanted it in the archives, I think every one of us ought to read this because it's a confession in which he dealt with and did not delete the memories of his suicide attempt, of his inability to fight, and so forth.  And that is now six years beyond that, and he's, you know, restored, but in some sense his need to not not remember, but to share that helped him to get well, along with electroconvulsive therapy and things of that sort.

So I'm speaking too long, but I would be .- I think I would be bereft in terms of the kind of life I want to live if I deleted all of those things that were painful from which I tried to change my life from it.

DR. MAY:  I take it the purpose was to give me time to think through an answer, Dan.


DR. FOSTER:  That's what I — I was trying to help you, Bill.

DR. MAY:  Thank you for your collegial service.

DR. FOSTER:  Yes, that's right.

CHAIRMAN KASS:  As long as you remember the question.

DR. MAY:  Well, it was could you justify interventions, I think is what you asked me, given this —

CHAIRMAN KASS:  As a healer of souls, yes.

DR. MAY:  Yeah, and traumatic memories can be of an order to do something by way of offering provisional shelter for them, it seems to me.  One would have to be satisfied that we know there are traumatic situations where people are so reliving it that, in fact, much else in their past is wiped out, and so it isn't as though you're simply wiping out the past.  You may be sheltering them from certain events in such a way to allow them to reappreciate full ranges of the past that in their obsession they are not able to relate to, but one would hope that it is a limited and provisional shelter.  One would hope in total coherence to allow them even to face up to that event.

So it would seem to me a kind of limited provisional justification.

CHAIRMAN KASS:  Let me bother you just one small point further on this.  It turns out, and it's mentioned, I think, in Gil's paper and also in the staff paper that at least with the memory blunting agents now under discussion, they would have to be taken within a certain short period of time after the event because this has to do with the consolidation.

DR. MAY:  Right.  The consent issues are there, too.

CHAIRMAN KASS:  No, not so much the consent question as much as the question of do you think one would know on the occasion whether this is the kind of an event deserving of such shelter for the sake of the rest?

DR. MAY:  I don't know.  I certainly —

CHAIRMAN KASS:  Or is there some sense that Gil's remark about the unknowability of the meaning of any of these events might lead you to say, well, we can't edit in advance?

DR. MAY:  Yeah, I certainly think one would need to be cautious because it would be very quickly, immediately justified for managerial purposes that you would shoot them up in order to manage them, and whether it was really serving them or whether it's something that they could more directly face might tend to get institutionally repressed.

CHAIRMAN KASS:  Can we continue on these?

Let's see.  Robby, on this?

PROF. GEORGE:  Yeah, just on this because I thought what Bill said was very good, but, Bill, I wonder if you would accept a friendly amendment or maybe I've just misunderstood.  I think the way you summed it up at the end with what you were arguing for was you said you were offering a limited provisional justification for sometimes blocking.

DR. MAY:  You can imagine certain — yeah.

PROF. GEORGE:  But it sounded to me like what you were offering was something slightly different.  Rather it was a justification for a limited provisional blocking, the distinction here begin, I take it, if I can kind of fill in the background to make sense of that, it would be the idea that the — I hate to put it in such sterile, analytic terms, but if you'll forgive me just for the moment that the truth of the proposition is always a reason for knowing it, but it's certainly not always a conclusive reason for adverting to it, especially in view of the fact that very often propositions that we know and can actually avert to in terms of memory are emotionally just awful.

So that in view of that and without in any way attacking the value of truth itself, the value that makes the truth of a proposition the reason for knowing it, we can have reasons for purposes of health, psychological health, doing something to blunt the pathological implications of our inability not to avert to that horrible memory in this or that case.

Am I on your wave length or have I changed your —

DR. MAY:  Yeah.  No, I think that's right.  Timing is very important.

CHAIRMAN KASS:  Michael and then Paul, Mary Ann.  Michael.

PROF. SANDEL:  Bill, you were addressing half of the question of intervention, the one you had been asked about.  Should the doctor of the soul over here intervene to block someone forming a memory?

What about the opposite side of that question?  Should he intervene with the patient to dredge up for them a memory that they've already blocked?  Is there any reason why he should intervene or not — did the same reasons operate on both sides?

DR. MAY:  Well, and Freud depended heavily on the latter obviously.

PROF. SANDEL:  But are the considerations different or is this symmetrical?

DR. MAY:  Well, and I felt part of the justification, as I recall it, was that in failing to retrieve those memories, one is often fated to engage in repetitive acting out because one hasn't dealt with the buried memories.  Is that right, Paul?

PROF. SANDEL:  Maybe, but it may also be an act of kindness or compassion or humanity for Paul to leave some of those buried memories alone, wouldn't you say?  Or is that always a failure of respect because you're not bringing the person into contact with the truth?

CHAIRMAN KASS:  Well, let me make this slightly more complicated, and forgive me for jumping the queue, but it's a continuation of this thought.

One could make an argument in advance that there are certain things that we would be better off not knowing.  If you know what you're doing, you don't really let people to go down and view the dismembered bodies that have been strewn after an explosion, whatever their voyeuristic curiosity might be.

And if you could make an argument that a certain kind of ignorance might be salutary and preventable, therefore, what do you do if someone accidentally stumbles upon a kind of knowledge which would be terribly disorienting and produce all kinds of painful effects through no fault of their own. 

I mean, you know, Ham walks into the tent and sees the nakedness of his father.  Now, he shouldn't have been in the tent, but we're better off if he hadn't seen it, and if we could somehow blunt the memory of his father's disgrace when we would have prevented him from witnessing it in the first place, why not?

PROF. SANDEL:  Right.  That's the —

CHAIRMAN KASS:  That's the kind of line of — that's in keeping —

PROF. SANDEL:  Exactly.

CHAIRMAN KASS:  — with your thought.

PROF. SANDEL:  Yeah, and that seems to me the bigger issue.

PROF. GEORGE:  Well, you certainly don't want to — sorry to interrupt, Leon — but on this I think that the baseline from which we're operating here was provided by Gil.  We don't want to validate the idea that it's okay to live a lie.  We want to take as our baseline that people should live, that a life well lived is a life lived in line with the truth.

But we're wondering if, consistent with that, it's sometimes appropriate to blunt or block access to certain memory.  So I think we need to distinguish and see if  we can put any analytic rigor into distinguishing that blunting and blocking from falsification.

PROF. SANDEL:  The truth ain't everything.

CHAIRMAN KASS:  I'm sorry?

PROF. SANDEL:  The truth ain't everything.

CHAIRMAN KASS:  That I guess is what's under discussion.

Paul and then —

DR. McHUGH:  Yeah, I want to come back really with where Michael began here and then come to what's being discussed.  The essence of memories are that we do affect them and shape them and lose some of the details, but the interesting thing is that we often keep the gist of the memories, a certain aspect of gist is sustained.

So what is this biological function we have of remembering things in which there is a fall-off of detail even though there is a conception of gist?

And I work, after all, with people and their memories and the like, and I can validate a lot of things that Bill is saying, including, for example, that when they're in a particular state of mind all of these nasty, wincing things come back up to them, and they'll say things to me like, "Well, that's really me."  That was, you know, "I told a lie.  I'm really a liar," or you know, "I went to a peep show and I'm really a sex fiend," and things of that sort.

And that's usually coming out of the illness, depression, the disease depression that picks out particular memories and gives them tremendous salience, and I want to correct the depression, and then when I do that, these memories fade back into wincing experiences of the very sort that Dan is talking about.

But there's something else about having a memory capacity that keeps a gist and loses some of the details because we work with that in psychotherapy all the time.  Again, I have people come in to me with a whole variety of — who will bring a life story to me, you know.  They bring the story, and they say, "Look.  I don't know if you can help me at all with this, but this is the way I look at myself and look at my background."

And some of them, for example, bring in, you know, "I was psychoanalyzed for a long time and spent all of my time wondering about my Oedipal complexes and things of that sort."

And I sometimes say, "Well, why do you come to me after that?  You know you're going to get something else if you come to me."

But the issue is that we now know this about people, all people seeking psychotherapy, and that is that they don't have the same story.  They don't have — they're not all Oedipally conflicted.  They do not all, in fact, have sexual conflicts the way Freud thought.

The thing that they have in common is that they're all in the same state of demoralization.  Somehow the way they are looking at the world, the things that they have experienced, the things that have happened to them have demoralized them and have lost for them the capacity to go forward.

And my job is not to eliminate the memories that they have, but to give them a different salience in their life.  I mean, we've just heard this wonderful story from Dan.  Now, you told me a little homely story.  Suppose he had come to me and said, "You know, Paul, there it is.  You know, I'm still sick about it.  Can you help me?"

And he might come in and say, "Can you give me some Prozac?"

I would say, "No."  I would say I want to look at that story.  The gist of it is correct, but I want to look at it as a young fellow who learned something and who had the character to be shamed by that and from that time on, his character, which is the thing which has led him on into other things, is reflective of his abilities and, therefore, give him hope, make him believe in himself again.

You've got to believe Dan.  You've got to believe that you have wonderful things, and the essence of the memories  that allow things to fall away and yet keep a gist is that I can tell a better story for the patient than the one that he brings in that demoralizes him, and I give them a better way of looking at it.

Now, is it the truth?  Well, since the story he brought in wasn't the truth, then the story I'm giving him isn't what you — that was a wonderful — isn't a secretarial truth, you know?  A day-by-day chronicle, it is.

He's got a view of it, and I have a view of it, and I want to give him my view because I think it helps him believe in himself and believe that he has mastery over the future rather than to be demoralized by it.

And so I think the reason that we have this memory that is not a videotape of the world is just for that reason.  It allows us to eventually get hope and develop it, sometimes by help from a coach like me, but often by ourselves.

You know, Dan has come to terms with that.  I'm not going to tell you any of the wincing stories about mine.  Oh, awful, but we go on.

And so the third point I want to make is about these traumatic events, and I'm very concerned about anything that's going to try to eliminate the memory of the traumatic event.  I'm very happy to help somebody who has had a traumatic event and is not sleeping, is anxious and agitated, is house-bound and things of that sort.  I see plenty of them, and I help them with those symptoms even as I sympathize with them, with for example the loss of a child or something of that sort.

Well, I'll help him or her with the symptoms, but I don't want to take the memory away, not only because I think the memory has value in them, in their life story and their chronicle, but also I think that the memory reminds them of the dangers that they're in and what they need to — you know, these other symptoms give us a chance to avoid things.

And then to finally come back to this idea— Do you want to dredge up memories because you think they may be the pathological ones?  Well, that is what has provoked the so-called memory wars of the '90s in which the theory was if you have these moods, you must have something buried, and it's going to be sexual, and it's going to be this.

And, again, we could install that, but that turned out not to be so much a memory as a belief.  These people were not — they called it, "Well, now I remember," but actually it was a belief, and you can even see different things light up in PET scans on them as they try to pull it up.

And our job is not to instill those kinds of false beliefs in them, particularly a false belief that encourages the view that you're a victim.  I don't want to make anybody feel they're a victim.  We've all been victimized, and little guys have been victimized more than tall guys.

But we don't want —


DR. McHUGH:  But we don't want to live our lives and go forward just remembering or thinking about ourselves as victims and these recovered beliefs and all, finally the memory wars are over, but they were an effort to produce beliefs that were not good stories.  They were stories that ultimately invalidated people.

So I'm coming back, coming around to the other thing.  Would I want to eliminate a painful memory from somebody?  Not really.  I would like to relieve the pain if I could, make it less, but I want people to have the gist of their memories, and then they may need help in shaping them in ways that continue to make them feel they still have mastery over their future.

PROF. GLENDON:  What I have to say actually is related to what Paul said.  I agree with your cautiousness about not wanting to take away a traumatic memory, but I wonder if you would accept a distinction between the kind of trauma that a rescue worker may experience in that nightclub fire in Rhode Island or in the World Trade Center?

And it seems to me between that kind of trauma and the trauma that is directly tied up with one's life story, the loss of a loved one under violent circumstances, it seems to me I'm not altogether persuaded that it wouldn't be appropriate to  help the rescue worker take the pill, you  know, even preventively because they know from photographs and other things in their training.  They know what they're going to see, but do they need to see 90 — well, you know, we know what happened there.

DR. McHUGH:  Well, it's interesting that there are data on that in relationship to a major, major disaster, the disaster known as the Piper Alpha disaster, the fire in a North Sea oil rig in which it turned out that there were rescue workers later that went in and brought the bodies out.

And the thing was that the rescue workers had been examined prior for other reasons.  They had been given psychological assessments, and there were then two groups of rescue workers, ones that were just given no assistance, just thrown into the bodies, the morgues, and the other one in which the psychiatrists in Aberdeen were with them throughout, reminding them of the good that was coming of bringing these bodies out for the families, giving them a continuing story about this horror.

And the interesting thing was this second group of people — we talk about grief counselors going in trying to get people out.  They're no use, but if you can give a story to people during their rescue work and recovery work, they manage it.

They put it into there and they said, "No, this is a stinking, dirty, violent work, but it means something to somebody else," and that helps them, and you can do that without a pill if you can make it clear and help people in that process.

The Piper Alpha disaster story was spelled out by the psychiatrist, and it's an absolutely fascinating subject in relationship to traumatic memories.

DR. GAZZANIGA:  So we can't be simplistic about this, and we've done the typical thing that we all do, which is take this and plant it, I mean this traumatic memory and this drug, and we're going to block the traumatic memory, et cetera, et cetera, et cetera, and that's just not how it works.  That's what I'm trying to tell you.  It's a continual updating of an event that gets changed naturally through time.

And the second point is that 90 percent of the people who have a traumatic experience have no problems later on in life of a psychiatric nature, and that what the event does in many instances is it simply triggers a predisposition for a mental condition that will find them at one time or another probably winding up in Paul's office.

So you can't just take this little simple view of the brain that there's this memory.  You can encode it.  You can block it.  You can do this; you can do that.  There's a lot of overhead, of mental overhead in the psychological structure of the person.

Maybe the people who aren't traumatized by this have already told themselves the story.  There's obviously a reason to go in and get these people out, and so they naturally self-administered this sort of thing.

But finally, just to — yeah?

CHAIRMAN KASS:  On the first point, you're now suggesting not only does memory get modified through the retelling and revisiting, but are you also saying that the suggestions of the sort that we hear and that have, in fact, been reported in a way in the literature, that even that is rather simplistic; that there is no such thing as in the process of memory consolidation altering the affective character of the way that gets remembered?

Just as a factual question.

DR. GAZZANIGA:  There are people who react to — you take 100 people and show the same traumatic event, how they react and what they take away from it varies all over the place.

CHAIRMAN KASS:  Agreed, but is there no way to intervene on the occasion?

DR. GAZZANIGA:  Oh, there are these manipulations as reported, yes.  Yeah, yeah, yeah.


DR. GAZZANIGA:  No, I'm not saying that.


DR. GAZZANIGA:  Let me go to Paul's point on this because this is one I happen to know about.  The danger of the implanted memory that we all — the psychiatrists certainly worry about this as they talk to people, and culturally there's a social psychologist new school, Henri Zukier, who was doing a study on the Holocaust syndrome, and he noticed that he could understand the Holocaust syndrome being a reality, but his suspicions began to grow when the children of the Holocaust event had the Holocaust syndrome.

And then finally the coup de gras was the grandchildren of the Holocaust victim.  He said, "How does this work?  You know, we're now two steps away from it." 

So he said he thought he'd go investigate the Holocaust syndrome, and he said, "I'll go to Europe where obviously it would be intense," and he went to the psychiatric communities of Europe on the Holocaust, and they said, "What are you talking about?  There's no Holocaust syndrome."

And he went and did all of the proper scholarship of this and discovered this was an invention of New York psychiatrists that this existed, and they built the syndrome and people came, and in so much of what we're talking about here, we are building syndromes and people come and they are assigned into these categories, and then we as a culture have to live with it, and that's a big problem.

DR. McHUGH:  And we put them in DSM-IV, by the way, operational criteria.

CHAIRMAN KASS:  Gil and then Bill and then Michael.

PROF. MEILAENDER:  Comments on a couple of things.  On the rescue worker issue, if you think that Mary Ann was building up sympathy for, and I can understand it, but if you think about it, we're going to have these people take the pill preemptively, so to speak.  That blunts the memory.

Part of what's going on is you wouldn't think that someone could go through the whole of his life doing this.  I mean, imagine just a lifetime spent as a rescue worker dealing with the horror of dismembered bodies.  That suggests to me that maybe nobody should do this for his life, for a whole life, you see, because otherwise the notion is that it would be fine to sort of create a group of people who, as it were, could do this for their whole life and not be bothered by it.

That seems to me much more troubling than the notion of, you know, letting some people have these memories and then trying to help them deal with it.

So, I mean, if you think about it from that perspective, it seems to me it raises questions about doing it, and I thought that Paul's example was nice in that it suggested a way of dealing redemptively, to use the category that I use in the paper.  So that's one thing on the rescue worker.

And then the other thing, just the question.  I mean, I assume that there are some things that it would be better not to know probably.  The question is how you are to live if you do know them.  That's the question, how you are to live truthfully as a human being.

And I don't think that my claim in the paper was that one lives truthfully in the face of that just by passively accepting it, saying, "Well, there it is.  I know it sort of," or something like that, but rather that one lives humanly with it perhaps simply by sort of stoic fashion, enduring and bearing up under it; perhaps by gradually finding a way of telling the story that transforms it in such a way that it gives it redemptive significance and either or both of those may need the help of other people in order to accomplish.  It's not just something one does.

So those are sort of humanly fitting ways, it seems to me, that one lives truthfully with such events.  They're not the passive acceptance of it, but neither are they denying that this is now part of who I am and I need to find a way to deal with that as part of who I am.

CHAIRMAN KASS:  And for those people who are not blessed either with faith and redemption or the strengths to be stoics and for whom this is just pain, disorienting pain, and who, by the way, may not have community that can help them deal with this, suffer little children.

PROF. MEILAENDER:  You can always make a problem go away and free ourselves of the responsibility to be the community that helps them by hypothesizing such circumstances, but, I mean, it's just there might be such circumstances, but I wouldn't create a policy.  I wouldn't create my general attitude toward the question on the basis of that because, like I say, that let us off too easily.  It lets us off the hook of trying to find ways to serve their need.

CHAIRMAN KASS:  Bill Hurlbut — on this?

PROF. DRESSER:  Just indirectly.  It seems there are two issues.  One is do we want to concede that there are cases where this would be the best thing for the individual, and I remember — maybe I'm misremembering — but I think Dr. McGaugh talked about the post traumatic stress disorder, the Vietnam vets who were really paralyzed.  I mean they could have no life, and he seemed very moved by those cases.

So I wonder if we want to say that that would be a case where we might think it could be justified.

But then the second question as Gil puts it is it seems if you want to frame the intervention as, well, the only way this is going to work is we have to give this to everyone after the Vietnam War or while they're having these horrible experiences, and we know there's, you know, three percent of them who will be able to function after this because then all of these other people won't be able to process the memories in a way that we think is meaningful.

DR. FOSTER:  But remember that you have to use these drugs either before the event or immediately afterwards.  I mean, you can't come back ten years later.  Then if you have a deletion, you delete all memories instead of the very painful one.

So you'd have to say, as I think he said, that maybe we're going to give beta blockers to people who are going into the dessert here ahead of time.  So the big problem that they talk about, the deletion requires anticipation  or immediate intervention within, you know, a very short time.

CHAIRMAN KASS:  Bill Hurlbut and then Michael.

DR. HURLBUT:  When I read this, when I read Gil's paper, it struck me there was a lot of implicit reference back to Leon's paper from last week or last time we met.  The notion that we need to keep life coherent so that we can participate in the intelligible world.

I want to make a comment, but I want to ask you a question on the way.  Is there such a thing, Paul, as a memory that in a — let's talk about healthy adults for the moment — that cannot become like the grain of sand in the oyster that can't become something richer and deeper?  Are there truly destructive memories?

DR. McHUGH:  Well, you know, I think you can have a memory that you make destructive, and you certainly can have an event that you remember that alters your life script.  I mean, let me just tell you, for example, we now know that the sexual abuse of children by an adult which has been summed up often in the traumatic area, the problem that it produces later in life, and it does produce plenty of problems later in life, has less to do with the trauma or even the memory of that event and everything to do with the change in attitude that that child takes about sex itself.

Okay?  We were just talking about that before.  That child, because of the adults — by the way, it has to be an adult.  It's not some playing doctor and peer interactions — an adult that comes in and breaks into the relatively latency period of childhood, that memory teaches that child some things about sexual life that are destructive.  There should be more partners, and they have more partners; that they have very early consensual sexual experiences.  They develop sexual diseases.  They have early pregnancies and the like, and the bad outcome that we know about has more to do with how the script changes because of this event, not the memory.

But if you looked at it, the memory has produced the script, and so there are four.  It's a bad thing, but what the psychiatrists do now for these children, in my opinion, is not that he goes in and tries to eliminate this awful memory, and it's awful that the person has been so intruded into, but they immediately begin to start laying out, well, let's look at the way we'd really like you to think as a person about this very important part of life that you're going to have to grow to, and the thing that has happened to you has made you vulnerable to a pernicious and potentially very pathological life course.

DR. HURLBUT:  So that's the key then, isn't it?  The script that you, the story that you contain your events of your life in is the story that you want to sustain in its intelligibility and work toward a deeper comprehensive understanding of the world as you go, as you go forward.  That's what the human soul is.

And it seems to me that beneath so many of the questions we've been discussing for the last six months is hidden and we haven't spoken of it very much, but is the question of what is the role of disturbing suffering in this formation of the life story.  Over and over it just seems like biotechnology is offering us the opportunity to avoid that which is uncomfortable or eroding to our self-esteem or bad memories or, you know, no decline in aging.

It's interesting.  Earlier when we were talking about the compression of morbidity and so forth, it stirred a memory, a good memory.  I read that Vincent Van Gogh wrote a letter to his brother Theo saying that he didn't want to die suddenly and comfortably.  He wanted to die of a very wrenching disorder like tuberculosis or whatever it was in his vision, but he said that that way it would be like a booster rocket that would send him off in the trajectory of eternity.

And I'm considering how the guy died.  It's a very poignant thing to have said, but what strikes me is that at least — and what's so powerful about his art is that you feel the suffering — at least I do — feel the suffering in his art, in his life, and I for one don't want to tell myself a story that's a fiction.  I would like to go to the bottom of the story, and I think at least somebody in our society has to face the very worst there is in human existence or we're all in trouble.

And probably all of us, to the degree we're capable of it at least, and whether there's some place for childhood and not having memories or something, but the overall thrust of the thing, it seems to me, ought to be to participate in this intelligible language of being, which includes suffering, and to more and more understand our lives at the depths of the reality of the world.

I was wondering what we're doing on this side of the river, and I was think that maybe, when we were running last night — I ran by the cemetery — and I was thinking, "Is Leon such a thoughtful genius that he put us out here next to this memorial of human's noble sacrifice?"

Because finally in the end, we know that's what makes a meaningful life, is whether you're called to it or not, that finally you go that deep, that you know what the world is, that the world involves suffering, and you don't do what they did in Brave New World, which was, you know, basically "Christianity without tears."  As they said, "Nothing costs enough here."

And the one line that kept coming back to me from Leon's paper was, that finally human flourishing rooted is aspiration born of deficiency.  Well, I think we need to for the fullest lives go to the fullest depths of that deficiency.

CHAIRMAN KASS:  Michael, and then I think unless there's someone in the queue — Michael, Alfonso, and I think we'll call a break.

So thank you.

PROF. SANDEL:  Listening to the discussion, I think I've heard two different kinds of arguments against this memory blocking pill, and I'd like to distinguish them.  One of them seems to base the objection on the idea  of the deliberate forgetting, that to take the pill to forget a trauma is to artificially willfully forget.

And moreover, since we have to take it at the moment, we're not in a good position to decide then whether it's the sort of thing we should forget or suppress.  That's one objection.

A second objection goes deeper and depends on the claim that it's always good to know and face the truth, and this stronger claim seems to me questionable, and it's questionable for reasons, Leon, brought out by your example, a biblical one, but there are lots of truths that we every day try to spare our children or loved ones.

Sometimes when the newspaper has a particularly gruesome photo, I take it and hide it not only from my kids, but even from my wife just to spare them.  Now, I'm depriving them of a certain truth.

Now, I don't know if I would conclude from that that if they did happen to see it before I removed it I would give them a pill to forget it, but is there a difference in principle between the first impulse and the second?

But here's a way of testing whether these two reasons go together or whether it's possible to distinguish, whether it's really the deliberate, willful character of it that's objectionable.  I mean, this is may suggestion or hypothesis.  Here might be a way of testing that.

Suppose we remove the deliberate, willful, artificial aspect of the dulling of memory, and consider a case where not a pill, but nature systematically dulls a traumatic memory.

Now, I don't know how scientifically well founded this is, but there is a folk- lore that the memory, the full memory of the pain of childbirth is dulled, and that if it weren't, there would be fewer children born, and we were told this — I don't know .- when we went to child- bearing classes, you know, where they teach you, and this is purely anecdotal, but my wife completely believes and supports this anecdotally at least, that if women really did remember from one child to the next they would have as many kids.

CHAIRMAN KASS:  Scopolamine, I think is what it is, right?

PROF. SANDEL:  Now, here would be a case, if this piece of common folk- lore is true, where it would be nature, not a pill- dulling traumatic memory.  Would we regard that as regrettable?

CHAIRMAN KASS:  Gil, do you want this?

PROF. MEILAENDER:  I don't know quite where your piece of folklore comes from, but I know that there's a story that the rabbis supposedly told asking why a woman had to bring a certain kind of ritual offering after giving birth.  It probably had to do something with ritual purity and so forth.

But the answer the rabbis gave was that it was to atone for a vow she made but never really intended to keep.  That is to say when she was in the pangs of labor, she vowed never again, but when the child was born, that is to say when she saw what the event meant in the light of the whole or at least a fuller story, saw the fruition that gave real redemptive meaning to the labor,  she realized that she never intended to keep that.

Now, that's not a bad example of what we've been talking about.

PROF. SANDEL:  Well, Gill, neither you nor I may be in the best position to testify on this question.  So I would still put the hypothetical.  If nature dulls traumatic memory in the case of the pain of childbirth, is that something to be regretted?


DR. FOSTER:  Let me just say scientifically —

CHAIRMAN KASS:  We now have an authority.  Mary Ann.

DR. FOSTER:  Just to answer your question.

PROF. GLENDON:  Well, I have to disagree with you, Michael, in characterizing it as a traumatic memory.  I think, first of all, pain, and the medical people know better than I do, but I don't think we remember pain, physical pain of any sort quite the way — I mean, that's a funny thing, that memory of physical pain, and I think it is quickly forgotten.

I mean, you know that there was a painful experience, but it's not like the memory that made us all wince when somebody mentioned, the mere mention of the wince factor all around the table was a shudder because we all have those vivid memories of the wince, which are more vivid, I think, than the pain of childbirth.

DR. FOSTER:  Well, what I was trying to say is that most scientists think that those are the release of endorphins and enkephalins, you know.  We don't have an opiate receptor in the pain so that you can take heroin.  There are many people who come through great trauma that have burns and so forth who have no, as Mary Ann says, who have no or little memory of the pain, and so we do have these endogenous opiate-like molecules that are released.

And I think that what she said is probably exactly right.

PROF. SANDEL:  But do they dull the pain or did they dull the memory of the pain, Dan?

DR. FOSTER:  I can't answer that.  I presume that because of their biologicals, they probably dulled the pain more than the memory of it, I would guess.

CHAIRMAN KASS:  Alfonso, take the last, and we'll call a halt.

DR. GÓMEZ-LOBO:  Yeah, actually this hooks up with some of the stuff that Michael was saying.  Let me start with a question about nature, if nature dulls it.

You know, the more I hear about enhancement around this table and the lot I heard last week in the conference on the Future of Life out in Monterey, the more I tend to think that we, I mean, humanity may not be on the right path.

One thing —


DR. GÓMEZ-LOBO:  — one thing that strikes me as deeply wrong is precisely the malleability about which Professor Pinker was talking.  It's this sense that everything can be changed, like we can walk in there and, you  know, change virtually everything.

Now, it seems to me that or I would like to retain the idea that nature is a very complex, marvelous system of causality with a few glitches.  Surely there is illness, and there are very good reasons to work against it.

But there are other domains where I just don't see the point of going into it.  Now, some of you are going to accuse me of unilateral disarmament, and that may be a correct description.  I tend to unilateral  disarmament myself because I think I should measure thing against my own personality, my own authenticity and  not necessarily against my competitors.

Now, that said, I would delighted with Gil's paper not only because of its depth, but because it  provided, it seems to me, all sorts of arguments to say let's leave this domain untouched.

One of the great reasons, for instance, that I saw — and this is really for me going to be a memorable phrase — "not to remember the face of evil is to miss the evil of which we ourselves are capable."

Now, I'm not a psychiatrist, and I can understand that there can be traumatic memories, but, on the other hand, I think it's very important to remember certain things.

I myself lived on the road to Dachau for almost two years in Munich, and I used to take visitors to the camp.  I suddenly discovered that I was no longer taking anyone there after, you know, about half a year, but it's one of those things that in a way I'm grateful I haven't forgotten.

So I would say efforts — I know this is very difficult, but it seems to me that efforts should be directed to trying to draw lines between therapy and the domain beyond therapy and really think whether we're doing something reasonable in all of these efforts, which by the way don't see to be very fruitful from what I've gathered.

I mean, we haven't made much progress in suppression of memory, if I understood correctly the two papers.  We don't seem to be very close to getting to designer babies, and so I know this is very emotional on my part, but I think that there's something very deep to think about here, and it is what are the human goals that ultimately are going to be worthwhile.  Are we really distancing ourselves from nature and under the illusion that we can do better than nature?

I have serious doubts about that.

CHAIRMAN KASS:  Thank you very much.

One sentence to two sentences.  This will be the last formally scheduled, I think, discussion of this topic.  For some of you that's extremely good news.

I think if I might be indulged an editorial word, it's true that some of these vaunted technologies are at the moment at least less than they're cracked up to be when announced in the newspapers, and that's a useful thing to have learned.

But in all aspects of this beyond therapy project, I think we've seen how these new powers, in fact, do touch upon all kinds of things that are really quite important, and the number of things that we've talked about, whether it's the life cycle or the relation to our bodies or the question of memory and the story of the life, these really are the essential features, it  seems to me, of at least part of a richer bioethic.

And I would like to think that a serious discussion of those things, whether it justifies the expenditure of the taxpayers' money, and certainly it's not going to lead to any immediate public policy questions, but it does seem to me that there's an opportunity to do some kind of education of what might be at stake here, where we are, in fact, from knowing what to do, and even a certain cautionary note about whether we know what we were doing if we were doing it.

That I think is to be the spirit of what we will try to write up and circulate amongst you for discussion, if all goes well, before our next meeting.

Tomorrow morning, beginning at 8:30 we have two presentations on the self-regulation of the assisted reproduction profession/industry.  We have presenters, and this is a return now to the project on regulation and public policy, and it should be really quite, quite interesting.

Let me urge people to try to be on time at 8:30 because we will have a guest to present.

You are free for the evening. You will not have to stand in line to get your dinner bill, you know, paid for  for an hour, and I wish you good evening, and we'll see each other in the morning.

(Whereupon, at 5:31 p.m., the meeting in the above-entitled matter was adjourned, to reconvene at 8:30 a.m., Friday, March 7, 2003.)


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