The Guilt-Free Soldier

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New Science Raises the Specter of a World Without RegretThe Guilt-Free Soldierby Erik BaardJanuary 22 - 28, 2003http://www.villagevoice.com/issues/0304/baard.phpsoldier faces a drab cluster of buildings off a broken highway, where theenemy is encamped among civilians. Local farmers and their families areroutinely forced to fill the basements and shacks, acting as human shieldsfor weapons that threaten the lives of other civilians, the soldier'scomrades, and his cause in this messy 21st-century war.There will be no surgical strikes tonight. The artillery this soldier canunleash with a single command to his mobile computer will bring flames andscreaming, deafening blasts and unforgettably acrid air. The ground aroundhim will be littered with the broken bodies of women and children, and he'llhave to walk right through. Every value he learned as a boy tells him toback down, to return to base and find another way of routing the enemy. Or,he reasons, he could complete the task and rush back to start popping pillsthat can, over the course of two weeks, immunize him against a lifetime ofcrushing remorse. He draws one last clean breath and fires.Pills like those won't be available to the troops heading off for possiblewar with Iraq, but the prospect of a soul absolved by meds remains veryreal. Feelings of guilt and regret travel neural pathways in a manner thatmimics the tracings of ingrained fear, so a prophylactic against one couldguard against the other. Several current lines of research, some federallyfunded, show strong promise for this.At the University of California at Irvine, experiments in rats indicate thatthe brain's hormonal reactions to fear can be inhibited, softening theformation of memories and the emotions they evoke. At New York University,researchers are mastering the means of short-circuiting the very wiring ofprimal fear. At Columbia University one Nobel laureate's lab has discoveredthe gene behind a fear-inhibiting protein, uncovering a vision of "fight orflight" at the molecular level. In Puerto Rico, at the Ponce School ofMedicine, scientists are discovering ways to help the brain unlearn fear andinhibitions by stimulating it with magnets. And at Harvard University,survivors of car accidents are already swallowing propranolol pills, in thefirst human trials of that common cardiac drug as a means to nip the effectsof trauma in the bud.The web of your worst nightmares, your hauntings and panics and shame,radiates from a dense knot of neurons called the amygdala. With each newfrightening or humiliating experience, or even the reliving of an old one,this fear center triggers a release of hormones that sear horrifyingimpressions into your brain. That which is unbearable becomes unforgettabletoo. Unless, it seems, you act quickly enough to block traumatic memoriesfrom taking a stranglehold.Some observers say that in the name of human decency there are some thingspeople should have to live with. They object to the idea of medicating awayone's conscience."It's the morning-after pill for just about anything that produces regret,remorse, pain, or guilt," says Dr. Leon Kass, chairman of the President'sCouncil on Bioethics, who emphasizes that he's speaking as an individual andnot on behalf of the council. Barry Romo, a national coordinator for VietnamVeterans Against the War, is even more blunt. "That's the devil pill," hesays. "That's the monster pill, the anti-morality pill. That's the pill thatcan make men and women do anything and think they can get away with it. Evenif it doesn't work, what's scary is that a young soldier could believe itwill."Are we ready for the infamous Nuremberg plea—"I was just followingorders"—to be made easier with pharmaceuticals? Though the research so farhas been limited to animals and the most preliminary of human trials, thequestion is worth debating now."If you have the pill, it certainly increases the temptation for the soldierto lower the standard for taking lethal action, if he thinks he'll be numbedto the personal risk of consequences. We don't want soldiers sayingwilly-nilly, 'Screw it. I can take my pill and even if doing this is notreally warranted, I'll be OK,' " says psychiatrist Edmund G. Howe, directorof the Program on Medical Ethics at the Uniformed Services University of theHealth Sciences. "If soldiers are going to have that lower threshold, wemight have to build in even stronger safeguards than we have right nowagainst, say, blowing away human shields. We'll need a higher standard ofproof [that an action is justified]."The scientists behind this advance into the shadows of memory and fear don'tdream of creating morally anesthetized grunts. They're trying to fend offpost-traumatic stress disorder, or PTSD, so that women who've been raped canleave their houses without feeling like targets. So that survivors ofterrorist attacks can function, raise families, and move forward. And yes,so that those young soldiers aren't left shattered for decades by whatthey've seen and done in service.--Combat and psychoactive chemicals have always been inseparable, whether theagent was alcohol or a space-age pill. A half-century after Japan hopped itssoldiers up on methylamphetamines during World War II, the U.S. has pilotscurrently in the dock for mistakenly bombing Canadian troops while usingspeed to stay awake. When Eric Kandel, the Nobel laureate in medicine whoworks out of Columbia, was asked if his genetic exploration of fear wasfunded by the Pentagon's Defense Advanced Research Projects Agency, hequipped, "No, but you're welcome to call them and tell them about me."Imagine a world where the same pill soothed victims and perpetrators alike.Henry David Thoreau advised, "Make the most of your regrets; never smotheryour sorrow. . . . To regret deeply is to live afresh." Without remorse,there would have been no John Newton, a slave trader who found religionduring a harrowing storm at sea and later became an abolitionist; he's bestknown for penning "Amazing Grace."For doctors, the drugs would present a tricky dilemma. Most people exposedto traumatic situations don't end up with PTSD, but there are few means ofknowing on the spot who might need treatment much further down the line.Researchers say that for the medicines to be effective, patients would needto take them soon after the upsetting event. The temptation for physiciansmight be to err on the side of caution, at the cost of curbing normalemotional 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 condemnthat," 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'dcease to be a human being."The very idea of PTSD has been attacked as a social construction, a vaguecatchall that provides exculpation for the misdeeds of war. But researchersare trying to prevent the onset of a disease, not change the socialcircumstances that bring it about. James L. McGaugh, a neurobiologist atU.C. Irvine whose study of stress hormones and memory consolidation in ratsis one of the cornerstones of the effort, acknowledges the ambiguities butcomes out swinging in defense of his work. "Is it immoral to weaken thememory of horrendous acts a person has committed? Well, I suppose one mightmake that case. Some of your strongest memories are of embarrassments and ofthe guilty things you did. It doesn't surprise me at all that people wouldwake up screaming, thinking of the young children they killed in Vietnam,"McGaugh says. "But is treating that worse than saying, 'Don't worry if yourleg is shot off, we've got penicillin and surgery to prevent you from dyingof infection'? Why is it any worse to give them a drug that prevents themfrom having PSTD for the rest of their lives? The moral dilemma is sendingpeople to war in the first place."Nevertheless, fellow fear researcher Dr. Gregory Quirk of the Ponce Schoolof Medicine, in Puerto Rico, is troubled by how his work might be used if itprogressed from studies of rats to therapies for humans. He argues that fearisn't created and degraded in the amygdala alone, but is also unlearned inthe prefrontal cortex, which in PTSD patients is only weakly active. Quirkthinks a physician could stimulate those areas with magnets while patientsview the images they fear, and could thus restore balance to the mind. Withthat same method, he says, firemen could stave off episodes oflife-threatening panic. "Certainly the military might be interested insomething like that," he says. "If this would be used to go against fearthat's important for survival or morality, I would have a problem withthat."There are reasons to believe our military would covet mastery of Quirk'stechnique in humans. People at war dehumanize their enemies to make killingmore palatable. Now, in the war on terror, our modern cultural taboosagainst torture are fraying. Put yourself in the room then. The commissionof heinous acts, even deliberate torture, can also visit lifelong torment onperpetrators who aren't hardwired very well to be sadistic. The sounds ofscreaming—a primordial alert that mortal danger is near—trigger thosedamning hormones even in the torturer.And couple Quirk's magnetic manipulation of the brain with this: "One of thehorrible things I discovered after the Gulf War was that, because of thecoeducation of wars, as it were, male soldiers were given extensivedesensitization training to make them able to hear women being raped andtortured in the next room without breaking," Kass says. "It's a deformationof 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 faceof an expanding evil—isn't healthy either. "Such emotions can blind us aswell as make us wiser," says Howe. "It's possible that these kinds of drugswould help patients see in a clearer way." On the flip side, could anyonepossibly maintain that Ahab was a better captain for not having beenchemically mollified after the white whale bit off his leg?--An uncomfortable reality is that war isn't an aberration; it has a verycodified place in our culture. We agree through treaties to normalize it. Wedemand punishment for soldiers who violate those treaties, though more oftenthose from the losing side. But we don't deny them medical treatment. Andone needn't have committed a war crime to feel wracked by sorrow. "In mydreams I meet six Vietnamese people I murdered. Whether they had a gun onthem is irrelevant," says Romo, who, as a 19-year-old lieutenant, served asa platoon leader in the 196th Light Infantry Brigade Infantry in 1967 and1968. 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'sdead body," he says.Romo and veterans like him have taken it upon themselves to use theirexperiences to teach peace. But veterans torn apart by PTSD don't have achoice about being Exhibit A in the case against war. "When you see what canhappen to a young person, it passes on in a very real way, not in ahistory-class sense, that reality of what war and blood really is," he says.Who are we to impose this emotionalalbatross on soldiers? As a nation, weelect our leaders. It seems unjust to make veterans a special class tosuffer for our sins in wrongheaded wars, or pay a continuing price forvictory in the "good" ones."That's a heavy burden to put on people to preserve the morality you'retalking about," says Dr. Roger K. Pitman of Harvard University, who'sleading the propranolol study in people fresh from car accidents. "By thatsame logic, if you could make a lightweight bulletproof garment for soldierswe still shouldn't do it. For moral reasons we ought to make them able to beshot, to preserve the cost of war, the deterrent to war. But we work toprevent our soldiers from being shot, and I say there are mental bulletsflying around there, too."There's another context to be considered as well, McGaugh notes, one thatwas made clear by the recent demand from representatives Charles B. Rangelof New York and John Conyers Jr. of Michigan that we reinstate the draft toaddress racial and economic inequities. "Who are our soldiers?" McGaughasks. "They are in the wrong place at the wrong time. Very few of theirdaddies go to Harvard, Yale, or Princeton."But PTSD doesn't result solely from war. When Kass first heard of McGaugh'sresearch, at a presentation in October, he had a far more intimate horror inmind: rape. "At fraternity parties they'll be popping Ecstasy at night andforgetfulness in the morning," he growls.The victim would be an obvious candidate for an anti-trauma drug. Woulddulling her emotional memories of the event help her to endure the lengthy,perhaps humiliating, pursuit of justice through the courts, or would it robher of the righteous anger she'll need to persevere and perhaps the empathyto later help other victims? The rapist is part of the equation too. If hisvictim stabbed him in her own defense, no doubt he would be bodily healed.No physician could refuse to treat him. "If such a person had PTSD stemmingfrom the circumstances of the act, he could be a candidate [for therapy],"Pitman says.How much of our remorse do we have a right to dispense with, and how muchexists in service to others, a check on our worst impulses? "Each experiencewe have changes our brain and in some sense alters who we are," says Dr.Joseph E. LeDoux of NYU, who studies emotional memory. "The more significantthe experience, the more the alteration. We have to decide as a society howfar we want to go in changing the self. Science will surely give us new andpowerful ways of doing this. Individuals may want more change than societywants to permit."********You can help us make a difference. 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