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By Anna Merlan
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Imagine a world where the same pill soothed victims and perpetrators alike. Henry David Thoreau advised, "Make the most of your regrets; never smother your sorrow. . . . To regret deeply is to live afresh." Without remorse, there would have been no John Newton, a slave trader who found religion during a harrowing storm at sea and later became an abolitionist; he's best known for penning "Amazing Grace."
For doctors, the drugs would present a tricky dilemma. Most people exposed to traumatic situations don't end up with PTSD, but there are few means of knowing on the spot who might need treatment much further down the line. Researchers say that for the medicines to be effective, patients would need to take them soon after the upsetting event. The temptation for physicians might be to err on the side of caution, at the cost of curbing normal emotional responses. Victims might be eager to avoid lasting pain, wrongdoers the full sting of self-examination.
"The impulse is to help people to not fall apart. You don't want to condemn that," says Kass. "But that you would treat these things with equanimity, the horrible things of the world, so that they don't disturb you . . . you'd cease to be a human being."
The very idea of PTSD has been attacked as a social construction, a vague catchall that provides exculpation for the misdeeds of war. But researchers are trying to prevent the onset of a disease, not change the social circumstances that bring it about. James L. McGaugh, a neurobiologist at U.C. Irvine whose study of stress hormones and memory consolidation in rats is one of the cornerstones of the effort, acknowledges the ambiguities but comes out swinging in defense of his work. "Is it immoral to weaken the memory of horrendous acts a person has committed? Well, I suppose one might make that case. Some of your strongest memories are of embarrassments and of the guilty things you did. It doesn't surprise me at all that people would wake up screaming, thinking of the young children they killed in Vietnam," McGaugh says. "But is treating that worse than saying, 'Don't worry if your leg is shot off, we've got penicillin and surgery to prevent you from dying of infection'? Why is it any worse to give them a drug that prevents them from having PSTD for the rest of their lives? The moral dilemma is sending people to war in the first place."
Nevertheless, fellow fear researcher Dr. Gregory Quirk of the Ponce School of Medicine, in Puerto Rico, is troubled by how his work might be used if it progressed from studies of rats to therapies for humans. He argues that fear isn't created and degraded in the amygdala alone, but is also unlearned in the prefrontal cortex, which in PTSD patients is only weakly active. Quirk thinks a physician could stimulate those areas with magnets while patients view the images they fear, and could thus restore balance to the mind. With that same method, he says, firemen could stave off episodes of life-threatening panic. "Certainly the military might be interested in something like that," he says. "If this would be used to go against fear that's important for survival or morality, I would have a problem with that."
There are reasons to believe our military would covet mastery of Quirk's technique in humans. People at war dehumanize their enemies to make killing more palatable. Now, in the war on terror, our modern cultural taboos against torture are fraying. Put yourself in the room then. The commission of heinous acts, even deliberate torture, can also visit lifelong torment on perpetrators who aren't hardwired very well to be sadistic. The sounds of screaming?a primordial alert that mortal danger is near?trigger those damning hormones even in the torturer.
And couple Quirk's magnetic manipulation of the brain with this: "One of the horrible things I discovered after the Gulf War was that, because of the coeducation of wars, as it were, male soldiers were given extensive desensitization training to make them able to hear women being raped and tortured in the next room without breaking," Kass says. "It's a deformation of the soul of the first order. I cannot speak about it without outrage."
But a trauma-born irrational aversion to necessary war?pacifism in the face of an expanding evil?isn't healthy either. "Such emotions can blind us as well as make us wiser," says Howe. "It's possible that these kinds of drugs would help patients see in a clearer way." On the flip side, could anyone possibly maintain that Ahab was a better captain for not having been chemically mollified after the white whale bit off his leg?
An uncomfortable reality is that war isn't an aberration; it has a very codified place in our culture. We agree through treaties to normalize it. We demand punishment for soldiers who violate those treaties, though more often those from the losing side. But we don't deny them medical treatment. And one needn't have committed a war crime to feel wracked by sorrow. "In my dreams I meet six Vietnamese people I murdered. Whether they had a gun on them is irrelevant," says Romo, who, as a 19-year-old lieutenant, served as a platoon leader in the 196th Light Infantry Brigade in 1967 and 1968. His ticket home was as a body escort for his similarly aged nephew, who served in the same unit. "I returned to the United States on my nephew's dead body," he says.