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
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
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.
CHAIRMAN KASS: No, no.
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.
CHAIRMAN KASS: Mary Ann.
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
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
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.
CHAIRMAN KASS: Huh?
PROF. SANDEL: Let's hear what Gil
has to say to that.
CHAIRMAN KASS: You should make him answer
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
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
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.
PROF. MEILAENDER: Yes, but that's
got nothing to do with their conscious shaping of their sense
of the narrative of their life.
CHAIRMAN KASS: Bill May.
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
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
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
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
CHAIRMAN KASS: Of?
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
DR. FOSTER: Yes, that's right.
CHAIRMAN KASS: As long as you remember
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
DR. MAY: Right. The consent issues are
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
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
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
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
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
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
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
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
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
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.
CHAIRMAN KASS: Okay.
DR. GAZZANIGA: No, I'm not saying
CHAIRMAN KASS: Okay.
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
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
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
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
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
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
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.
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
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
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
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
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
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,
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.)