Running scared

My Internal Medicine clerkship began today, and I was on long call. When my resident said we'd cap at ten admissions, I felt real fear for the first time since Surgery. At some point today the fear gave way to hunger, and now sleepiness.

Speaking of fear, check out this New York Times magazine piece on desensitizing the formation of traumatic memories. There's a human trial underway of a CNS-acting beta-blocker (propanalol) that, in rats at least, seems to dull the feelings that get encoded along with painful memories. The facts of a trauma are retained without the terrible emotions that can accompany them.

There's potential for preventing flashbacks, dissociative states, avoidance, and all the terrible things that go with PTSD (post-traumatic stress disorder). But the author of the piece, Robin Marantz Henig, asks if our society will be better off this way:

''Would dulling our memory of terrible things make us too comfortable with the world, unmoved by suffering, wrongdoing or cruelty?'' asks the bioethics council in its report. ''Does not the experience of hard truths -- of the unchosen, the inexplicable, the tragic -- remind us that we can never be fully at home in the world, especially if we are to take seriously the reality of human evil?'' The council also asked whether the blunting of our recollections of ''shameful, fearful and hateful things'' might also blunt our memories of the most wondrous parts of our lives. ''Can we become numb to life's sharpest arrows without becoming numb to its greatest joys?''

Still, to scientists who study memory, there is nothing beneficial, for either individuals or for society, about debilitating, unbidden memories of combat, rape or acts of terrorism. ''Going through difficult experiences is what life is all about; it's not all honey and roses,'' said Eric Kandel, a professor of psychiatry and physiology at Columbia University. ''But some experiences are different. When society asks a soldier to go through battle to protect our country, for instance, then society has a responsibility to help that soldier get through the aftermath of having seen the horrors of war.''

Of course, post-battlefield remorse serves as a check on our militaristic tendencies. Vietnam veterans haunted by memories of combat were among the most forceful opponents of the war after their return home. But have we the right to buy a surrogate conscience at the cost of thousands of ruined lives? If we have the responsibility to treat veterans' physical wounds, don't we also have a responsibility to ease their psychic suffering?

...Without witnessing the torment of unremitting post-traumatic stress disorder, it is easy to exaggerate the benefits of holding on to bitter memories. But a person crippled by memories is a diminished person; there is nothing ennobling about it. If we as a society decide it's better to keep people locked in their anguish because of some idealized view of what it means to be human, we might be revealing ourselves to be a society with a twisted notion of what being human really means.

Was Charlie Kaufman thinking about this when he wrote "Eternal Sunshine for the Spotless Mind" ? I really should see that, if I get the chance.