Each of the brain’s 100 billion neurons has somewhere in the realm of 7,000 connections to other neurons, creating a tangled roadmap of about 700 trillion possible turns. But thinking of the brain as roads makes it sound very fixed—you know, pavement, and rebar, and steel girders and all. But the opposite is true: at work in our brains are never-sleeping teams of Fraggles and Doozers who rip apart the roads, build new ones, and are constantly at work retooling the brain’s intersections. This study of Fraggles and Doozers is the booming field of neuroplasticity: how the basic architecture of the brain changes over time. Scientist, neuro math geek, Science Channel personality and accomplished author Garth Sundem writes for ScriptPhD.com about the phenomenon of brain training and memory.

Certainly the brain is plastic—the gray matter you wake up with is not the stuff you take to sleep at night. But what changes the brain? How do the Fraggles know what to rip apart and how do the Doozers know what to build? Part of the answer lies in a simple idea: neurons that fire together, wire together. This is an integral part of the process we call learning. When you have a thought or perform a task, a car leaves point A in your brain and travels to point B. The first time you do something, the route from point A to B might be circuitous and the car might take wrong turns, but the more the car travels this same route, the more efficient the pathway becomes. Your brain learns to more efficiently pass this information through its neural net.

A simple example of this “firing together is wiring together” is seen in the infant hippocampus. The hippocampus packages memories for storage deeper in the brain: an experience goes in and a bundle comes out. I think of it like the pegboard at the Seattle Science Center: you drop a bouncy ball in the top and it ricochets down through the matrix of pegs until exiting a slot at the bottom. In the hippocampus, it’s a defined path: you drop an experience in slot number 5,678,284 and

it comes out exit number 1,274,986. How does the hippocampus possibly know which entrance leads to which exit? It wires itself by trial and error (oversimplification alert…but you get the point). Infants constantly fire test balls through the matrix and ones that reach a worthwhile endpoint reinforce worthwhile pathways. These neurons fire together, wire together, and eventually the hippocampus becomes efficient. It’s just that easy. (And because it’s so easy, researchers aren’t far away from creating an artificial hippocampus.)

Now let’s think about Sudoku. The first time you discover which missing numbers go in which empty boxes, you do so inefficiently. But over time, you get better at it. You learn tricks. You start to see patterns. You develop a workflow. And practice creates efficiency in your brain as neurons create the connections necessary for the quick processing of Sudoku. This is true of any puzzle: your plastic brain changes its basic architecture to allow you to complete subsequent puzzles more efficiently. Okay, that’s great and all, but studies are finding that the vast majority of brain-training attempts don’t generalize to overall intelligence. In other words, by doing Sudoku, you only get better at Sudoku. This might gain you street cred in certain circles, but it doesn’t necessarily make you smarter. Unfortunately, the same is true of puzzle regiments: you get better at the puzzles, but you don’t necessarily get smarter in a general way.

That said, one type of puzzle offers some hope: the crossword. In fact, researchers at Wake Forest University suggest that crossword puzzles strengthen the brain (even in later years) the same way that lifting weights can increase muscle strength. Still, it remains true that doing the crossword only reinforces the mechanism needed to do the crossword. But the crossword uses a very specific mechanism: it forces you to pull a range of facts from deep within your brain into your working memory. This is a nice thing to get better at. Think about it: there are few tasks that don’t require some sort of recall, be it of facts or experiences. And so training a nimble working memory through crosswords seems a more promising regiment than other single type of brain training exercise.

This is borne out by research. A Columbia University study published in 2008 found that training working memory increased overall fluid intelligence. So the answer to this article’s title question is yes, brain training is very real. (Only, there’s lot of schlock out there.) But hidden in this article lies the new key that many researchers hope will point the way to brain training of the future. Any ONE brain training regiment only makes you better at the one thing being trained. But NEW EXPERIENCES in general, promise a varied and continual rewiring of the brain for a fluid and ever-changing development of intelligence. In other words, if you stay in your comfort zone, the comfort zone decays around you. In order to build intelligence or even to keep what you have, you need to be building new rooms, outside your comfort zone. If you consume a new media source in the morning, experiment with a new route to work, eat a new food for lunch, talk to a new person, or…try a NEW puzzle, you’re forcing your brain to rewire itself to be able to deal with these new experiences—you’re growing new neurons and forcing your old ones to scramble to create new connections.

Here’s what that means for your brain-training regimen: doing a puzzle is little more than busywork; it’s the act of figuring out how to do it that makes you smarter. Sit down and read the directions. If you understand them immediately and know how you should go about solving a puzzle, put it down and look for something else…something new. It’s not just use it or lose it. It’s use it in a novel way or lose it. Try it. Your brain will thank you for it.

Garth Sundem works at the intersection of math, science, and humor with a growing list of bestselling books including the recently released Brain Candy: Science, Puzzles, Paradoxes, Logic and Illogic to Nourish Your Neurons, which he packed with tasty tidbits of fun, new experiences in hopes of making readers just a little bit smarter without boring them

into stupidity. He is a frequent on-screen contributor to The Science Channel and has written for magazines including Wired, Seed, Sand Esquire. You can visit him online or follow his Twitter feed.

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Original Premise
Who among us hasn’t wanted, nay desperately needed, to forget a painful event, relationship, person, or circumstance that can’t seem to escape their memory? Oh to be able to just wipe it from your brain and pretend it never happened! The concept sounds like something straight out of the imaginative mind of screenwriter Charlie Kaufman. In his movie, Eternal Sunshine of the Spotless Mind, ex-lovers Joel and Clementine, played by Jim Carrey and Kate Winslet, erase memories of each other after their relationship sours. To do this, they seek out the bioengineering company Lacuna Inc, whose scruples are more than ambiguous. All’s well that ends well for the lovers, as they reconnect towards the end of the movie, rebuild new memories of one another and fall back in love.

Indeed, plenty of recent movies deal with memory loss, of varying degree, origin and consequence. In Christopher Nolan’s brilliant and esoteric Memento, Leonard Shelby (Guy Pearce), suffering from antiretrograde amnesia rendering him unable to form new memories, is trying to piece together the events of the vicious attack and murder of his wife. A similar condition is suffered by Drew Barrymore’s character in the romantic comedy 50 First Dates and has to “meet” her character’s love interest anew every day. In Paycheck, the film adaptation of Philip K. Dick’s science fiction story, Ben Affleck’s character takes extreme measure to protect his clients’ intellectual property, in the form of wiping his own memory, almost costing him his own life as his last deal embroils him in a standoff with the FBI.

Indeed, a slew of medical and psychological syndromes can cause, or is associated with, memory loss. But the idea of selective memory engineering has been the stuff of science fiction fancy.

Until now.

Current Research
While watching an episode of the television version of This American Life, I was struck by the episode entitled “Pandora’s Box”, which profiled the work of SUNY Downstate Medical researchers Drs. Todd Sacktor and Andre Fenton. Dr. Sacktor had a revolutionary idea about how memory is formed in the brain, and the elementary, yet powerful, way to manipulate it by eradicating the function of one regulatory molecule. And what a Pandora’s box did they open! Take a look at this short clip:

Powerful stuff, no? This research, in effect, suggests that a single molecule, Protein Kinase Mzeta, regulates the brain’s ability to form and retain memories, and consequently lies at the heart of memory erasure potential. In a recent New York Times interview, Dr. Sacktor admitted that his scientist dad directed him to a family of molecules called Protein Kinase C in 1985, from which his lab derived PKMzeta as a brain-specific member of that family. In a 1999 paper in the journal Nature Neuroscience, Drs. Jeff Lichtman and Joshua Sanes narrowed down 117 hypothetical molecules involved in long-term potentiation (LTP), the communication between two neurons when stimulated simultaneously. Following this paper, in a subsequent 2002 Nature Neuroscience paper, Dr. Sacktor’s lab was able to isolate PKMzeta as the absolute “it” memory factor, showing that it congregates semi-permanently en masse around these activated neuronal connections. At that point, he was off to the races. He joined forces with the friendly neighbor downstairs, neuroscientist Dr. Andre Fenton, who just happened to study spatial memory in mice and rats. He had previously shown that mice and rats placed in a circular chamber learn how to move around to avoid getting their feet shocked, a memory they retain, days, weeks, even months later. Sacktor’s lab injected an inhibitor for PKMzeta into the rats’ hippocampus, the part of our brain that regulates memory. The results were stunning. Two pioneering papers (paper 1 and paper 2) in the elite research journal Science showed that these “blockers” both reversed the rats’ neurons from forming long-term potentiation, and that it manifested in them forgetting the spatial information they’d learned in the chamber, an effect that seemed to last for weeks. Drs. Sacktor and Fenton had erased the rats’ memory!

Dr. Fenton and Dr. Sacktor’s reaction to their research in the This American Life piece was notable. Normally, scientists are shielded well behind the safe solitude of the ivory tower: long work hours, constant pressure, achieving the next research milestone. It’s not that scientists don’t ever think about the implications of their work per se, but they rarely have the luxury of time for such contemplation or the fortune of far-reaching results. While he read letters from victims of post-traumatic stress disorder, Dr. Fenton broke down crying, and expressed a desire to just help these people.

Less than two months ago, scientists at the Toronto’s Hospital for Sick Children [sorry I can’t help myself… as opposed to healthy ones? I love Canadians!] have added an important piece to this canon of research. In a Science paper, the scientists identified the exact group of neurons—lateral amygdala (LA) neurons with increased cyclic adenosine monophosphate response element-binding protein (CREB)—responsible for formation of a given memory (the neuronal memory trace). Selective targeting and deletion of these neurons using an injectable, inducible neurotoxin blocked all learned memories.

Eventually, of course, all of this body of science will coalesce into a more coherent picture of how memories are formed, what subsets of neurons in which portions of the brain store them, and what molecules and proteins we can manipulate to control, enhance or erase memory altogether. But that still leaves us to grapple with some very powerful and comprehensive bioethical dilemmas. Assuming that this translates into a medical procedure or pharmaceutical treatment for memory manipulation, who will regulate it? How will rules be established to regulate how far to take this therapy? Is memory erasure the equivalent of altering our personalities, the essence of who we are, a psychological lobotomy? Most importantly, however, is the question of how much we need memories, even painful, negative ones, to build the cornerstones of human morality, empathy, and the absolute meaning of right and wrong.

Sheena Jocelyn, one of the researchers involved in the University of Toronto study, acknowledged the bifurcated ethical implications of the research: “Our experiences, both good and bad, teach us things,” she said. “If we didn’t remember that the last time we touched a hot stove we got burned, we would be more likely to do it again. So in this sense, even memories of bad or frightening experiences are useful. However, there are some cases in which fearful memories become maladaptive, such as with post-traumatic stress disorder or severe phobia. Selectively erasing these intrusive memories may improve the lives of afflicted individuals.” In fact, Anjan Chatterjee, M.D., a neuroethicist at the University of Pennsylvania Ethics Center, penned an incredibly prescient piece two years ago that equated psychological mitigation of painful memories to “cosmetic neurology”. “If, as many religions and philosophies argue, struggle and even pain are important to the development of character,” Dr. Chatterje asks, “Does the use of pharmacological interventions to ameliorate our struggles undermine this essential process?”

To shed some light of this ethical quandary, ScriptPhD.com enlisted the help of Mary Devereaux, PhD, a bioethics expert at The Center for Ethics in Science and Technology in San Diego, CA and Peter Wagner, MD, a professor in the Schools of Medicine and Bioengineering at UCSD.

To continue reading these enlightening interviews, click “Continue Reading”…

Interview #1: Peter Wagner, MD, biomedical/pharmacological ethics of memory erasure

1) When an issue presents an ethical dilemma to the medical community, what is the role of bioethicists and the American Medical Association in any FDA approval process for a treatment or drug?

Both AMA and FDA organizations would be the best source of answers to these questions, not me.
That said, my understanding of the general process for bringing a treatment or drug to market is something like this:

The investigator wishing to gain FDA approval will have had the product go through a series of clinical trials (Phases I, II, III etc) that in a sequential manner establish safety and efficacy and also often side effects and indications and exclusions, all over some period of time. These trials may well have had their experimental protocols in part dictated by the FDA itself. The FDA has expert panels to review the trial data and render their verdict. As far as I am aware, the investigator would have the choice of including an ethicist in the process. I do not know whether the FDA gets involved in ethics issues, even at a high level, but I suspect not. This would be a very slippery slope and deciding what constitutes a trigger for FDA involvement might create more problems than ethical intervention would solve. Thus, genetic testing technology exists, but the ethical issues of being able to obtain specific genetic information does not seem to be part of the FDA piece. Ditto for organ transplant and gene therapy and their risks versus benefits. I also suspect that the AMA would not be involved until and unless, after FDA approval and only when the treatment/drug was now being used, there was reported some major medical dilemma that would prompt them to make a statement.

I would point out that there are many cases of treatments getting FDA approval after research suggesting safety and efficacy, yet which, after more experience in the field, were found to have serious risks not evident at the time of approval. How many years should pass and how many patients should be studied before such longer term risks are declared non-existent? During which time, many patients who would benefit from the new treatment are denied access to it? That is an ethical dilemma intrinsic to treatment development and approval, and it can never go away.

2) When anesthesia and epidurals first became available, there were many people who resisted their use on the similar grounds… not sure of the safety, pain as strengthening character. Couldn’t you argue that once we become familiar enough with the usage of such a technology, we might look back on our reticence in the same light?

I would separate medical from ethical issues here as much as possible: safety is a medical issue, and the inventor, the FDA, and the user (surgeon, prescriber etc) all have major, cut and dried, responsibilities to maximize safety during development and use. Ethics enters the room in deciding when a treatment has been tested enough to be sure bad side effects have “reasonably” been identified, as stated above.

Putting up with pain is different – to me that has to be a choice for each person to make based on balancing their own beliefs, their own informed concerns over safety and side effects and in this example, their pain tolerance. Medical professionals have the absolute responsibility of informing the patient of risks and benefits honestly and accurately, but the patient must be responsible for making the choice. Ethics comes in here when the professional misinforms the patient through ignorance or malfeasance.

3) If memory erasure becomes a medical reality, what kind of evaluations or consultations would a patient have to undergo before being allowed to undergo this procedure? What can possibly prepare a patient to mentally comprehend that their memories will be gone?

Nothing is ever simple, and memory manipulation may seem thornier to grapple with than something less mysterious such as heart surgery. Thus, messing with the mind conjures up images of brainwashing by mad scientists; heart surgery just opens clogged vessels but with well-defined physical risks. Yet my answer to your question is exactly as above – the caregiving health professional has to give the patient a detailed, honest and informed account of the risks and benefits. Then the patient has to be the one to decide. In either case, if I were a prospective patient, I would ask a bunch of questions. They would clearly be different between heart surgery and memory erasure. I would want to know if the memory treatment was permanent, would it wipe out good memories along with the bad, could I still form new memories going forward, would it have neural effects on other brain functions from emotional reaction to taste and smell to motor control to control of heart rate – and so on and so on. But the core principle seems to be no different than for heart surgery: properly informed consent so the patient can weigh the risks and benefits and balance them to reach their own decision. In the case of memory erasure, the unknowns may be so many and profound that for many, I expect the answer would be “no thanks”.

The more complicated we try and make the rules imposed on others, the more it actually becomes an ethical problem for us all.

The FDA has to be responsible for regulating treatment availability by requiring and evaluating the studies of treatment development and its job is to be as certain as possible that the efficacy and side effects have all been identified and risks quantified, such that the risk/benefit ratio is acceptable. While the FDA has to grapple with the ethics of what is the right balance of risks to benefits, it should not be charged with societal ethics or moral issues of treatment choice once a treatment is available.

The physician has to be responsible for informing the patient about treatment options and his/her ethical responsibility is to be complete, honest, accurate and unbiased.

The patient then has the responsibility of accepting or rejecting the treatment, be it for heart surgery or memory erasure.

Interview #2: Mary Devereaux, PhD

The ScriptPhD: Back when [Eternal Sunshine of the Spotless Mind] came out, the research hadn’t caught up. And one thing that kind of caught my attention was that now this has actually been done in the lab. I mean, in rats and in mice, but they served as an excellent template for human research. And so there’s no reason to believe that a researcher would not cross over and say, “Well if we can do this in mice, and if there are these chemicals that we can manipulate, or groups of cells….” What interests me is not necessarily the idea of “Can we do the research?” because I think technology races ahead; that’s not something that we can stop. I’m more interested in stopping and saying to ourselves, “What are the long-term ramifications of this and what are some important questions to ask before we race ahead?” And so my first question is a very general one. What is the relationship between memory and self? Between memory erasure and self? And then I’d go on to ask, in erasing painful memories, do we not irrevocably alter what we define as the major component that constitutes personality, and do we have the right to do that? And the reason that I ask this question is that I think it’s an important one to consider before doing something this drastic. What are your thoughts on this?
Mary Devereaux: Well, you know I tend to respond to these things in terms of ethics, because I’m a bioethicist. So, my first question before we get into the more philosophical things, from an ethical point of view, would be, “How good is the technology? How well does it work?” And I think the answer to that is “We don’t know.” That something works in mice doesn’t mean that it works in people. But in order to establish that it works in people, you would have to attempt it. I mean, I take it you have to run some kind of clinical trial. And that raises questions of safety, doing this kind of thing in human beings. Where, I take it, the aim would be to target, or erase, specific memories. But you might get this wrong.
SPhD: Mmm-hmm. Absolutely.
MD: So I think there are real questions about whether it would work and if it would work, how safe it is and how you’re going to establish that with human subjects. Of course you would need to get people’s informed consent and they’d need to understand the risks just like they would for any other kind of scientific research. In terms of actually targeting specific memories, where the idea is to erase those memories, one of my first questions would be about the coherence of the sort of narrative that’s left. That is, supposing, as in a lot of the discussion, we target memories that have to do with trauma, something like the kinds of things that lead to post-traumatic stress disorder. For example, somebody is attacked in the street, or somebody has a particular war memory. I’m not sure what happens here. If what’s left [is], “I had been walking down the street, somebody asks me for the time, and the next thing I know, I wake up in the hospital and I have all of these bruises and maybe I’ve been shot and so on, but I have no recollection of this.” So when you move to thinking about the impact of memory erasure on the self, there are scientific questions that, until you answer those questions, make it very difficult to answer your more general questions about what this is going to mean of ethics or personhood.
SPhD: Absolutely. But I think the point you raise about erasing a war memory, let’s talk about that in more depth. Because it leads really well into my second question. Let’s look at an instance where you have someone who has survived, let’s say Hurricane Katrina, which was a tremendously stressful event. Or they’ve come back from the Iraq War and they have images in their mind that are literally causing them to not be able to live a normal life. Or you’ve been raped—look at the survivors of the Darfur Crisis and what they’re having to look at on a daily basis. One of the things I’ve been reading about in the literature and the ethical literature, is if you look across religions, if you look across cultures, it is written about pain, and painful memories, as something that is a shared human experience. That it brings people together, it causes them to bond, let’s say over the death of a loved one. Another important thing that I’ve seen brought up is that it acts as a social deterrent. For example, if you have something like the Holocaust, and it’s so painful for people that they just choose to eradicate it from their memories, how does that give you the impetus to prevent something like it from happening again? Or to codify moral imperatives as a society? And so the question that I have for you is there a danger in making it really easy, [assuming that the technology is safe], should you do it? Because although there are these incredibly painful things that we go through as human beings, in a way, there’s this risk of numbing us as a society.
MD: Wellll, I think that seems like it’s jumping ahead in two ways. One thing is that there’s a sort of pattern of argument that is constantly used when talking about human enhancements. In a way, it’s kind of funny to talk about memory erasure as a sort of cognitive enhancement because you’re taking something away, but in another sense, you could clearly use the same technology to improve memory. But in taking away something that’s painful, you’re also improving the quality of someone’s cognitive or emotional life. So that too is an enhancement. My one response is that we always say, “Let’s assume that it’s safe and that it’s effective.” I think that’s a big assumption. And I think we too readily make that assumption. I think we’re a long way from it being safe and effective. So that’s point #1. The second point is that even if I give you your assumption, let’s assume that memory erasure works, we haven’t harmed anyone in demonstrating scientifically that it works, and now we have something that not only works, but it works safely. Well, it seems to me your question is sliding between two levels. One level of question is should we do this in individual cases for very specific memories? So, [a fictitious person named] Sarah Jones at Stanford is brutally attacked some night by a group of rowdy people on campus. And we now have the expertise that we can target and remove that memory. That’s a very different kind of question from a question like your example or the Holocaust or Hurricane Katrina. There you’re not talking about targeting individual memories in particular individuals. You’re talking about much more than a given particular memory. You’re talking about a whole historical event. Which is days, if not years, of activity. But the other thing is that you’re talking about, I mean, to erase the memory of the Holocaust, you would be talking about having to erase everyone—almost everyone living’s — memory in some specific way. And that seems to me …
SPhD: I think what I meant was more like an iterative effect. OK, let’s bring it on a much more simple level, like your example. [Fictitious] Sarah Jones is raped at Stanford. And we can erase that memory for her. It still kind of goes to asking about codifying moral imperatives. Because if it becomes easy enough to just erase her memory—I hate to say this, this is a horrible thing to say, but just bear with me for ethical purposes—then why does her rape seem as painful? In a way it seems—

MD: I get what you’re saying. Why punish these young guys who are all on their way to becoming engineers and senators, and they didn’t beat her up, they just raped her. And she didn’t get pregnant, and she didn’t get any sexually transmitted diseases, and now we can remove the memory. So might this actually change our view of the moral awfulness of what they’ve done?
SPhD: Yeah, and what’s to prevent future people from committing this crime? Because part of the horror of what we go through also prevents us from hurting other people. I do think that there’s a certain level of morality that is intrinsic, if you really take religion out of the question, or how we codify our moral standards. I think that human beings, because of our ability to feel and think and process these events, and to store them as memories if we really want to talk about it like that, I think it acts as a certain impetus to not hurt other people. Well, if you can just take [Sarah] Jones to the hospital, and take away her memory—maybe the Holocaust was [too big] of an example—but on an iterative scale—
MD: I think Hurricane Katrina is a much better example.
SPhD: Hurricane Katrina is an EXCELLENT example. But what I was worrying about on an iterative scale is that when all of these add up, that there’s a numbing effect, that what makes rape [as an example] so horrible now if you can just wipe it out of your mind, or any other terrible event for that matter?
MD: Well one thing is it’s horrible for those people who do it. It affects other people’s safety and so on. And it isn’t usually the case that there are no physical or other kinds of consequences. But the other thing is that putting the question this way suggests that if we open the door to the cases we started with, the rape and the Iraqi soldier, both of whom are having symptoms, say, of PTSD, then it will be available to everyone who has ANY kind of painful memory. And I don’t think that follows. I’m also not sure that I share your intuition that the main thing that keeps us from hurting each other is our memory of ourselves being hurt.
SPhD: But there are consequences. And so if you take, for example, the Iraqi soldier. War is horrible. It’s absolutely awful. And if you erase those memories from them [so easily], in a way it is a bit of a numbing down.
MD: Well that’s true. I mean, if you could simply send people off to war and they come back and not remember the two years at all, or however many years they were serving. On the other hand, then part of the appeal of military life, the kind of experience, the good things you gain from those experiences, it would also, I take it, be gone. In short, I’m not sure that you could eliminate something that—I mean, I’m not sure how, scientifically, they locate these memories and how they target them.
SPhD: That’s why I share your concern.
MD: In mice, you administer a shock, they learn to avoid a particular place on the floor of the cage. And then you eradicate that memory. But in order to eradicate that memory, you have to be able to target it. Now, with the mice, it may not matter if we’re targeting the rest of their memory. I mean, do we know, for example, that in these mice experiments, that the only thing the mice have lost is the memory of how to avoid the shock? I mean, they might have also lost where to find their water and where to find their food, whereas with human beings, we’re going to have to be much more fine-grained. We want to lose the memory of, say, the rape, but we don’t want to lose the memory of who we are or who our friends were when we left the bar.
SPhD: And that is the collateral. It could be that we can just never get the technology perfect. There’s a risk with everything we do medically. And so that’s why I think some of the issues you bring forth are really important. And you know, we’ve been talking about these horrific examples, and you can see why there’s a definite yin and yang to it, in the sense that you can really help people who are suffering, but it really begs you to ask these very fundamental questions of how you erase these memories and what is the collateral.
MD: Well, I think you’re right, because there are different kinds of memory. I mean, there’s memory of an event, like that I had dinner last night with such-and-such. But then, I take it there’s memory of a more general kind of experience. But personally, I do think that the real issues concern how you would establish the effectiveness of removing specific memories, and how you would do this safely. My own guess is that if we were able to do this at all, that it would be used very sparingly. Because the risks would be really significant. I mean, would you want somebody to put a probe into your brain to try to identify the correct memory? Well, maybe if you couldn’t sleep and you couldn’t eat and you couldn’t study, then you would be willing to risk that. But if it’s for something more moderate than that, you know the boyfriend or the girlfriend you don’t want to remember anymore—
SPhD: Well, that actually, you’re leading into my next question really well, which is given the assumption, and I think it’s a very fair assumption, that we’re never going to have 100% effectiveness with anything, and the human mind is so complex, how are you ever going to be able to pinpoint a perfect technology—
MD: Well, but it doesn’t have to be perfect. Most of what we do in medicine isn’t perfect. It just has to be good enough.
SPhD: Exactly. Good enough. Let’s say it’s good enough. How do you determine, then, that a certain memory is painful enough that it warrants erasing all others? If you’re the physician or the psychologist working with the physician, how do you assess that? Where is that line drawn in the sand? And I think that’s another really important question to ask.
MD: But from an ethical point of view, that wouldn’t be up to the physician. I mean the physician or the psychologist, I take it, would say to the patient, “You’re clearly suffering from a severe form of PTSD. You’ve not responded to our standard-of-care strategies. We do have something new that’s available. It has higher risks, but since these other things haven’t worked, you might want to consider it.” And then it would really be up to the patient who would be informed of the risks and benefits, and then you’d have to do informed consent, and all of that kind of thing beforehand, just like with any other surgery.
SPhD: That’s a really tough thing with informed consent. That’s actually something that Dr. Wagner talked about a lot, which is that ultimately, it REALLY comes down to the patient. And to me, it’s like being able to grasp the idea that in a state of suffering, I just feel like how can you ever fully comprehend the idea that all of your memories to date might be erased?
MD: But they wouldn’t be doing THAT. They could never. I mean, if that was the program, nobody would sign on for it. I think the only discussion about memory erasure technology has been targeting specific memories. Because if you were wiping somebody’s memory, I mean what is that show—Dollhouse—where they DO wipe people’s memories and so on, no one would agree. So no, I think this is something that’s [potentially] used to target specifically distressing memories. Of course the other question might be, and it might be interesting as a background for what it is you’re writing or posting, and that is, what is the state of PTSD research and therapy now? Because from what I understand, there are reasonably effective desensitizing or de-briefing strategies that people are developing for PTSD. And so, I don’t need you to put a probe in my brain if there are other ways we can de-intensify my memory and my suffering. And I think there are strategies. I think there are various behavioral kinds of things of bringing up memories in various sorts of ways that are effective. So I think it would be interesting to look at the risks and benefits of memory erasure in comparison to what else the neurosciences are allowing us to understand and do.
SPhD: Absolutely! I agree with you. I heard you earlier use the phrase “cognitive enhancement” which is another really interesting aspect of this. The article by Dr. Anjan Chatterjee was really interesting. He’s over at the University of Pennsylvania Ethics Center. And he really seemed to take a stance of, this is no different than, and I don’t want to misquote him, but based on his article, he really likened it to athletes taking steroids to enhance performance. And out of that article derived this very important question, which is, is it psychotropic evolution that presents this unfair advantage to those people for whom it’s either affordable or accessible?
MD: Well the answer to that is yes, and yes. But in that sense, cognitive enhancement or any of these enhancements are no different from almost everything else we’re doing in medicine. There’s very little in the United States medical system that isn’t equally, if not more, unfair. I mean, I don’t know if you’re familiar with this, but apparently, there’s literature suggesting that if you look at soldiers in the same theater of operations, that those who are officers as opposed to unlisted actually have lower rates of PTSD. And I think there’s some suggestion that they have perhaps more resources for self-understanding or managing stress or what have you. So it’s not just money, there are other things—education, psychological resilence, and how people were brought up and what kind of security they had as children, and what education they have, and so on. So yes I think it’s very unfair, but again, I don’t think that’s saying anything specific about cognitive enhancement because all kinds of—almost all medical care in the United States is unfair in that respect. Unless…well…
SPhD: Well, unless you have access to it, and in our country unless you have insurance, which is another—I mean, it just goes back to the idea of inequity in general in Western society and even within Western society within subsets of it. But I thought that particular question is an interesting one if you look at the metadata, and if you look at this kind of 10, 15, 20, 50 years down the line, which is why I was asking some of those questions long-term consequences of just being able to say, “Poof! Bad memory gone!” There is a sort of evolution of the mind there in terms of personality, in terms of consequence of bad things, in terms of how we relate to each other, of being able to bond with another human being over a tragedy as opposed to saying, “Doctor, doctor, make it go away.”
MD: Well, I mean I think if you’re really going to pursue this, then you need to distinguish between shared experience and empathy. Sometimes we commiserate with another because we in fact have experienced the same things. Somebody tells you that they’ve had a heart attack, and you’ve had one, so you know exactly what that’s like. But the other case is where somebody loses the use of their legs and we have our legs and we have no idea what that’s like but we’re able to empathize anyway through the power of the imagination. And I think a lot of what you’re talking about in terms of moral connection and community and how we bond to each other, I don’t think depends upon direct shared experiences of actual events. I think a lot of it comes from watching things, from literature, from storytelling—
SPhD: And I think 9/11 was such a great example of that. There were people who were thousands of miles away from 9/11 and it still brought communities together.
MD: Exactly. That’s a very good example. And the same thing with Katrina, although maybe less so. I think 9/11 really united the country in a way that the slogan “We’re all New Yorkers” exemplified. That’s exactly the kind of thing I’m talking about.
SPhD: And that’s sort of uplifting to think about. Because in researching this topic, it did get me to thinking of, gosh, there’s a nightmare scenario of living in this numb world of erased memories and, I don’t know, it’s kind of a very futuristic, sort of dark, Sci-Fi way of looking at it. And maybe that’s my cynical nature, but it is good to know I think that there is this delineation, and that in a way we would always be impervious to being [completely] numb. There is something in the human existence that even if you were to erase a memory, you can’t wipe away people’s ability to come together, to have this shared experience. And that is wonderful, I think.

I’d like to give a sincere and heartfelt thanks to Dr. Peter Wagner and Dr. Mary Devereaux for the engaging discussion and now open the floor to you, faithful readers. Feel free to comment or give your own opinion on what we’ve been discussing, or bring forth your own ethical concerns!